1
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De la Torre EP, Serrano J, Martínez-Cuadrón D, Torres L, Sargas C, Ayala R, Bilbao-Sieyro C, Chillón MC, Larráyoz MJ, Soria E, Aparicio-Pérez C, Bergua JM, Bernal T, Gil C, Tormo M, Algarra L, Alonso-Domínguez JM, Rodriguez-Arbolí E, Martínez-Sanchez P, Oliva A, Colorado-Araujo AM, Rodríguez-Medina C, Vives S, Hermosín L, Martínez-López J, García-Sanz R, Pérez-Simón JA, Calasanz MJ, Gómez-Casares MT, Barragán E, Sánchez-García J J, Montesinos P. Validation of mutated CEBPA bZIP as a distinct prognosis entity in acute myeloid leukemia: a study by the Spanish PETHEMA registry. Haematologica 2024. [PMID: 38634126 DOI: 10.3324/haematol.2023.284601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Indexed: 04/19/2024] Open
Abstract
Not available.
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Affiliation(s)
- Esther Prados De la Torre
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), UGC Hematología Hospital Universitario Reina Sofía, Universidad de Córdoba (UCO), 14004 Córdoba
| | - Josefina Serrano
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), UGC Hematología Hospital Universitario Reina Sofía, Universidad de Córdoba (UCO), 14004 Córdoba
| | - David Martínez-Cuadrón
- Servicio de Hematología, Grupo Acreditado de Investigación en Hematología, Hospital Universitario y Politécnico La Fe, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain; Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia
| | - Laura Torres
- Servicio de Hematología, Grupo Acreditado de Investigación en Hematología, Hospital Universitario y Politécnico La Fe, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain; Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia
| | - Claudia Sargas
- Grupo Acreditado de Investigación en Hematología, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia
| | - Rosa Ayala
- Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center (CNIO), Department of Medicine, Complutense University, 28041 Madrid
| | - Cristina Bilbao-Sieyro
- Hospital Universitario de Gran Canaria Dr. Negrín, 35010, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria
| | - María Carmen Chillón
- Servicio de Hematología, Hospital Universitario de Salamanca (HUS/IBSAL), CIBERONC, Centro de Investigación del Cáncer-IBMCC (USAL-CSIC), 37007 Salamanca
| | - María José Larráyoz
- Hematological Diseases Laboratory, CIMA LAB Diagnostics, University of Navarra, IdiSNA (Navarra Institute for Health Research), 31008 Pamplona
| | - Elena Soria
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (IBIS/CSIC), Universidad de Sevilla, 41013 Sevilla
| | - Clara Aparicio-Pérez
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), UGC Hematología Hospital Universitario Reina Sofía, Universidad de Córdoba (UCO), 14004 Córdoba
| | - Juan M Bergua
- Hospital Universitario San Pedro de Alcántara, 10003 Cáceres
| | - Teresa Bernal
- Hospital Universitario Central de Asturias, Instituto Universitario (IUOPA), Instituto de Investigación del Principado de Asturias (ISPA), 33011 Oviedo
| | - Cristina Gil
- Hospital General Universitario de Alicante, 03010 Alicante
| | - Mar Tormo
- Hospital Clínico Universitario. Universidad de Valencia. Instituto de investigación INCLIVA, 46010 Valencia
| | | | | | - Eduardo Rodriguez-Arbolí
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (IBIS/CSIC), Universidad de Sevilla, 41013 Sevilla
| | - Pilar Martínez-Sanchez
- Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center (CNIO), Department of Medicine, Complutense University, 28041 Madrid
| | - Ana Oliva
- Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife
| | | | - Carlos Rodríguez-Medina
- Hospital Universitario de Gran Canaria Dr. Negrín, 35010, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria
| | - Susana Vives
- Hospital Universitario Germans Trias i Pujol - ICO Badalona
| | | | - Joaquín Martínez-López
- Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center (CNIO), Department of Medicine, Complutense University, 28041 Madrid
| | - Ramón García-Sanz
- Servicio de Hematología, Hospital Universitario de Salamanca (HUS/IBSAL), CIBERONC, Centro de Investigación del Cáncer-IBMCC (USAL-CSIC), 37007 Salamanca
| | - José A Pérez-Simón
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (IBIS/CSIC), Universidad de Sevilla, 41013 Sevilla
| | - María José Calasanz
- Hematological Diseases Laboratory, CIMA LAB Diagnostics, University of Navarra, IdiSNA (Navarra Institute for Health Research), 31008 Pamplona
| | - María Teresa Gómez-Casares
- Hospital Universitario de Gran Canaria Dr. Negrín, 35010, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria
| | - Eva Barragán
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain; Servicio Análisis Clínicos, Grupo Acreditado de Investigación en Hematología, Hospital Universitario y Politécnico La Fe, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia
| | - Joaquín Sánchez-García J
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), UGC Hematología Hospital Universitario Reina Sofía, Universidad de Córdoba (UCO), 14004 Córdoba
| | - Pau Montesinos
- Servicio de Hematología, Grupo Acreditado de Investigación en Hematología, Hospital Universitario y Politécnico La Fe, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain; Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia
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2
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Sánchez R, Dorado S, Ruíz-Heredia Y, Martín-Muñoz A, Rosa-Rosa JM, Ribera J, García O, Jimenez-Ubieto A, Carreño-Tarragona G, Linares M, Rufián L, Juárez A, Carrillo J, Espino MJ, Cáceres M, Expósito S, Cuevas B, Vanegas R, Casado LF, Torrent A, Zamora L, Mercadal S, Coll R, Cervera M, Morgades M, Hernández-Rivas JÁ, Bravo P, Serí C, Anguita E, Barragán E, Sargas C, Ferrer-Marín F, Sánchez-Calero J, Sevilla J, Ruíz E, Villalón L, Del Mar Herráez M, Riaza R, Magro E, Steegman JL, Wang C, de Toledo P, García-Gutiérrez V, Ayala R, Ribera JM, Barrio S, Martínez-López J. Author Correction: Detection of kinase domain mutations in BCR::ABL1 leukemia by ultra-deep sequencing of genomic DNA. Sci Rep 2024; 14:7400. [PMID: 38548834 PMCID: PMC10978874 DOI: 10.1038/s41598-024-57570-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2024] Open
Affiliation(s)
- Ricardo Sánchez
- Hematology Department, Hospital UniversitarioHospital Universitario 12 Octubre, Madrid, Spain.
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain.
- Hematological Malignancies Clinical Research Unit, CNIO, Madrid, Spain.
- Altum Sequencing Co., Madrid, Spain.
| | - Sara Dorado
- Altum Sequencing Co., Madrid, Spain
- Computer Science and Engineering Department, Carlos III University, Madrid, Spain
| | | | | | - Juan Manuel Rosa-Rosa
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
- Hematological Malignancies Clinical Research Unit, CNIO, Madrid, Spain
| | - Jordi Ribera
- Hematology Department, ICO-Hospital Germans Trias i Pujol. Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Olga García
- Hematology Department, ICO-Hospital Germans Trias i Pujol. Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Ana Jimenez-Ubieto
- Hematology Department, Hospital UniversitarioHospital Universitario 12 Octubre, Madrid, Spain
- Hematological Malignancies Clinical Research Unit, CNIO, Madrid, Spain
| | - Gonzalo Carreño-Tarragona
- Hematology Department, Hospital UniversitarioHospital Universitario 12 Octubre, Madrid, Spain
- Hematological Malignancies Clinical Research Unit, CNIO, Madrid, Spain
| | - María Linares
- Hematological Malignancies Clinical Research Unit, CNIO, Madrid, Spain
- Department of Biochemistry and Molecular Biology, Pharmacy School, Universidad Complutense de Madrid, Madrid, Spain
| | - Laura Rufián
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
- Altum Sequencing Co., Madrid, Spain
| | - Alexandra Juárez
- Hematology Department, Hospital UniversitarioHospital Universitario 12 Octubre, Madrid, Spain
- Altum Sequencing Co., Madrid, Spain
| | | | - María José Espino
- Hematology Department, Hospital UniversitarioHospital Universitario 12 Octubre, Madrid, Spain
| | - Mercedes Cáceres
- Hematology Department, Hospital UniversitarioHospital Universitario 12 Octubre, Madrid, Spain
| | - Sara Expósito
- Laboratory of Neurophysiology and Synaptic Plasticity, Instituto Cajal, CSIC, Madrid, Spain
| | | | - Raúl Vanegas
- Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | - Anna Torrent
- Hematology Department, ICO-Hospital Germans Trias i Pujol. Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Lurdes Zamora
- Hematology Department, ICO-Hospital Germans Trias i Pujol. Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Santiago Mercadal
- Hematology Department, ICO-Hospital Duran i Reynals (Bellvitge), Barcelona, Spain
| | - Rosa Coll
- Hematology Department, ICO-Hospital Dr. Josep Trueta, Girona, Spain
| | - Marta Cervera
- Hematology Department, ICO-Hospital Universitari Joan XXIII, Tarragona, Spain
| | - Mireia Morgades
- Hematology Department, ICO-Hospital Germans Trias i Pujol. Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | | | - Pilar Bravo
- Hospital Universitario de Fuenlabrada, Fuenlabrada (Madrid), Spain
| | - Cristina Serí
- Hospital Central de la Defensa Gómez Ulla, Madrid, Spain
| | - Eduardo Anguita
- Hospital Clínico San Carlos, Department of Medicine, UCM, Madrid, Spain
| | - Eva Barragán
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Claudia Sargas
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | | | | | - Elena Ruíz
- Hospital del Tajo, Aranjuez (Madrid), Spain
| | - Lucía Villalón
- Hospital Universitario Fundación Alcorcón, Alcorcón (Madrid), Spain
| | | | - Rosalía Riaza
- Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
| | - Elena Magro
- Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | | | - Chongwu Wang
- Hosea Precision Medical Technology Co., Ltd., Weihai, Shangdong, China
| | - Paula de Toledo
- Computer Science and Engineering Department, Carlos III University, Madrid, Spain
| | | | - Rosa Ayala
- Hematology Department, Hospital UniversitarioHospital Universitario 12 Octubre, Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
- Hematological Malignancies Clinical Research Unit, CNIO, Madrid, Spain
- Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, Spain
| | - Josep-Maria Ribera
- Hematology Department, ICO-Hospital Germans Trias i Pujol. Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Santiago Barrio
- Hematology Department, Hospital UniversitarioHospital Universitario 12 Octubre, Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
- Hematological Malignancies Clinical Research Unit, CNIO, Madrid, Spain
- Altum Sequencing Co., Madrid, Spain
| | - Joaquín Martínez-López
- Hematology Department, Hospital UniversitarioHospital Universitario 12 Octubre, Madrid, Spain.
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain.
- Hematological Malignancies Clinical Research Unit, CNIO, Madrid, Spain.
- Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, Spain.
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3
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Sargas C, Ayala R, Larráyoz MJ, Chillón MC, Rodriguez-Arboli E, Bilbao C, Prados de la Torre E, Martínez-Cuadrón D, Rodríguez-Veiga R, Boluda B, Gil C, Bernal T, Bergua J, Algarra L, Tormo M, Martínez-Sánchez P, Soria E, Serrano J, Alonso-Dominguez JM, García R, Amigo ML, Herrera-Puente P, Sayas MJ, Lavilla-Rubira E, Martínez-López J, Calasanz MJ, García-Sanz R, Pérez-Simón JA, Gómez Casares MT, Sánchez-García J, Barragán E, Montesinos P. Comparison of the 2022 and 2017 European LeukemiaNet risk classifications in a real-life cohort of the PETHEMA group. Blood Cancer J 2023; 13:77. [PMID: 37173322 PMCID: PMC10182047 DOI: 10.1038/s41408-023-00835-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/24/2023] [Accepted: 04/11/2023] [Indexed: 05/15/2023] Open
Abstract
Next-Generation Sequencing is needed for the accurate genetic risk stratification of acute myeloid leukemia according to European LeukemiaNet (ELN) guidelines. We validated and compared the 2022 ELN risk classification in a real-life cohort of 546 intensively and 379 non-intensively treated patients. Among fit patients, those aged ≥65 years old showed worse OS than younger regardless risk classification. Compared with the 2017 classification, 14.5% of fit patients changed the risk with the 2022 classification, increasing the high-risk group from 44.3% to 51.8%. 3.7% and 0.9% FLT3-ITD mutated patients were removed from the favorable and adverse 2017 categories respectively to 2022 intermediate risk group. We suggest that midostaurin therapy could be a predictor for 3 years OS (85.2% with vs. 54.8% without midostaurin, P = 0.04). Forty-seven (8.6%) patients from the 2017 intermediate group were assigned to the 2022 adverse-risk group as they harbored myelodysplasia (MDS)-related mutations. Patients with one MDS-related mutation did not reach median OS, while patients with ≥2 mutations had 13.6 months median OS (P = 0.002). Patients with TP53 ± complex karyotype or inv(3) had a dismal prognosis (7.1 months median OS). We validate the prognostic utility of the 2022 ELN classification in a real-life setting providing supportive evidences to improve risk stratification guidelines.
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Affiliation(s)
- Claudia Sargas
- Grupo Acreditado de Investigación en Hematología, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | - Rosa Ayala
- Hospital Universitario 12 de Octubre, CNIO, Complutense University, Madrid, Spain
| | | | - María C Chillón
- Servicio de Hematología, Hospital Universitario de Salamanca (HUS/IBSAL), CIBERONC, Centro de Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Eduardo Rodriguez-Arboli
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (IBIS/CSIC), Universidad de Sevilla, Sevilla, Spain
| | - Cristina Bilbao
- Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | | | - David Martínez-Cuadrón
- Servicio de Hematología, Grupo Acreditado de Investigación en Hematología, Hospital Universitario y Politécnico La Fe, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | - Rebeca Rodríguez-Veiga
- Servicio de Hematología, Grupo Acreditado de Investigación en Hematología, Hospital Universitario y Politécnico La Fe, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | - Blanca Boluda
- Servicio de Hematología, Grupo Acreditado de Investigación en Hematología, Hospital Universitario y Politécnico La Fe, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | - Cristina Gil
- Hospital General Universitario de Alicante, Alicante, Spain
| | - Teresa Bernal
- Hospital Universitario Central de Asturias, Instituto Universitario (IUOPA), Instituto de investigación del Principado de Asturias (ISPA), Oviedo, Spain
| | - Juan Bergua
- Hospital Universitario San Pedro de Alcántara, Cáceres, Spain
| | | | - Mar Tormo
- Hospital Clínico Universitario-INCLIVA, Valencia, Spain
| | | | - Elena Soria
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (IBIS/CSIC), Universidad de Sevilla, Sevilla, Spain
| | - Josefina Serrano
- IMIBIC, Hematology, Hospital Universitario Reina Sofía, UCO, Córdoba, Spain
| | | | | | | | | | | | | | | | | | - Ramón García-Sanz
- Servicio de Hematología, Hospital Universitario de Salamanca (HUS/IBSAL), CIBERONC, Centro de Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca, Spain
| | - José A Pérez-Simón
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (IBIS/CSIC), Universidad de Sevilla, Sevilla, Spain
| | - María T Gómez Casares
- Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | | | - Eva Barragán
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
- Servicio Análisis Clínicos, Grupo Acreditado de Investigación en Hematología, Hospital Universitario y Politécnico La Fe, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | - Pau Montesinos
- Servicio de Hematología, Grupo Acreditado de Investigación en Hematología, Hospital Universitario y Politécnico La Fe, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain.
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain.
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Boluda B, Solana-Altabella A, Cano I, Martínez-Cuadrón D, Acuña-Cruz E, Torres-Miñana L, Rodríguez-Veiga R, Navarro-Vicente I, Martínez-Campuzano D, García-Ruiz R, Lloret P, Asensi P, Osa-Sáez A, Aguero J, Rodríguez-Serrano M, Buendía-Fuentes F, Megías-Vericat JE, Martín-Herreros B, Barragán E, Sargas C, Salas M, Wooddell M, Dharmani C, Sanz MA, De la Rubia J, Montesinos P. Incidence and Risk Factors for Development of Cardiac Toxicity in Adult Patients with Newly Diagnosed Acute Myeloid Leukemia. Cancers (Basel) 2023; 15:2267. [PMID: 37190195 PMCID: PMC10136564 DOI: 10.3390/cancers15082267] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/03/2023] [Accepted: 04/06/2023] [Indexed: 05/17/2023] Open
Abstract
The incidence of cardiac morbimortality in acute myeloid leukemia (AML) is not well known. We aim to estimate the cumulative incidence (CI) of cardiac events in AML patients and to identify risk factors for their occurrence. Among 571 newly diagnosed AML patients, 26 (4.6%) developed fatal cardiac events, and among 525 treated patients, 19 (3.6%) experienced fatal cardiac events (CI: 2% at 6 months; 6.7% at 9 years). Prior heart disease was associated with the development of fatal cardiac events (hazard ratio (HR) = 6.9). The CI of non-fatal cardiac events was 43.7% at 6 months and 56.9% at 9 years. Age ≥ 65 (HR = 2.2), relevant cardiac antecedents (HR = 1.4), and non-intensive chemotherapy (HR = 1.8) were associated with non-fatal cardiac events. The 9-year CI of grade 1-2 QTcF prolongation was 11.2%, grade 3 was 2.7%, and no patient had grade 4-5 events. The 9-year CI of grade 1-2 cardiac failure was 1.3%, grade 3-4 was 15%, and grade 5 was 2.1%; of grade 1-2, arrhythmia was 1.9%, grade 3-4 was 9.1%, and grade 5 was 1%. Among 285 intensive therapy patients, median overall survival decreased in those experiencing grade 3-4 cardiac events (p < 0.001). We observed a high incidence of cardiac toxicity associated with significant mortality in AML.
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Affiliation(s)
- Blanca Boluda
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (I.N.-V.)
- Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain
| | - Antonio Solana-Altabella
- Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain
- Pharmacy Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Isabel Cano
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (I.N.-V.)
- Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain
| | - David Martínez-Cuadrón
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (I.N.-V.)
- Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain
- CIBERONC, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Evelyn Acuña-Cruz
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (I.N.-V.)
- Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain
| | - Laura Torres-Miñana
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (I.N.-V.)
- Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain
| | - Rebeca Rodríguez-Veiga
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (I.N.-V.)
- Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain
| | - Irene Navarro-Vicente
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (I.N.-V.)
- Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain
| | - David Martínez-Campuzano
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (I.N.-V.)
| | - Raquel García-Ruiz
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (I.N.-V.)
| | - Pilar Lloret
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (I.N.-V.)
| | - Pedro Asensi
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (I.N.-V.)
| | - Ana Osa-Sáez
- Cardiology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Jaume Aguero
- Cardiology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | | | | | | | - Beatriz Martín-Herreros
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (I.N.-V.)
- Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain
| | - Eva Barragán
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (I.N.-V.)
- Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain
- CIBERONC, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Claudia Sargas
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (I.N.-V.)
- Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain
| | - Maribel Salas
- Daiichi Sankyo, Inc., Basking Ridge, NJ 07920, USA
- Center for Real-World Effectiveness and Safety of Therapeutics (CREST), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | | | | | - Miguel A. Sanz
- Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain
- CIBERONC, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Javier De la Rubia
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (I.N.-V.)
- Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain
- CIBERONC, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Internal Medicine, School of Medicine and Dentistry, Catholic University of Valencia, 46001 Valencia, Spain
| | - Pau Montesinos
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (I.N.-V.)
- Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain
- CIBERONC, Instituto de Salud Carlos III, 28029 Madrid, Spain
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Sargas C, Ayala R, Larráyoz MJ, Chillón MC, Carrillo-Cruz E, Bilbao-Sieyro C, Prados de la Torre E, Martínez-Cuadrón D, Rodríguez-Veiga R, Boluda B, Gil C, Bernal T, Bergua JM, Algarra L, Tormo M, Martínez-Sánchez P, Soria E, Serrano J, Alonso-Domínguez JM, García-Boyero R, Amigo ML, Herrera-Puente P, Sayas MJ, Lavilla-Rubira E, Martínez-López J, Calasanz MJ, García-Sanz R, Pérez-Simón JA, Gómez-Casares MT, Sánchez-García J, Barragán E, Montesinos P. Molecular Landscape and Validation of New Genomic Classification in 2668 Adult AML Patients: Real Life Data from the PETHEMA Registry. Cancers (Basel) 2023; 15:cancers15020438. [PMID: 36672386 PMCID: PMC9856266 DOI: 10.3390/cancers15020438] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/30/2022] [Accepted: 01/07/2023] [Indexed: 01/12/2023] Open
Abstract
Next-Generation Sequencing (NGS) implementation to perform accurate diagnosis in acute myeloid leukemia (AML) represents a major challenge for molecular laboratories in terms of specialization, standardization, costs and logistical support. In this context, the PETHEMA cooperative group has established the first nationwide diagnostic network of seven reference laboratories to provide standardized NGS studies for AML patients. Cross-validation (CV) rounds are regularly performed to ensure the quality of NGS studies and to keep updated clinically relevant genes recommended for NGS study. The molecular characterization of 2856 samples (1631 derived from the NGS-AML project; NCT03311815) with standardized NGS of consensus genes (ABL1, ASXL1, BRAF, CALR, CBL, CEBPA, CSF3R, DNMT3A, ETV6, EZH2, FLT3, GATA2, HRAS, IDH1, IDH2, JAK2, KIT, KRAS, MPL, NPM1, NRAS, PTPN11, RUNX1, SETBP1, SF3B1, SRSF2, TET2, TP53, U2AF1 and WT1) showed 97% of patients having at least one mutation. The mutational profile was highly variable according to moment of disease, age and sex, and several co-occurring and exclusion relations were detected. Molecular testing based on NGS allowed accurate diagnosis and reliable prognosis stratification of 954 AML patients according to new genomic classification proposed by Tazi et al. Novel molecular subgroups, such as mutated WT1 and mutations in at least two myelodysplasia-related genes, have been associated with an adverse prognosis in our cohort. In this way, the PETHEMA cooperative group efficiently provides an extensive molecular characterization for AML diagnosis and risk stratification, ensuring technical quality and equity in access to NGS studies.
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Affiliation(s)
- Claudia Sargas
- Grupo Acreditado de Investigación en Hematología, Instituto de Investigación Sanitaria La Fe (IIS La Fe), 46026 Valencia, Spain
| | - Rosa Ayala
- Hospital Universitario 12 de Octubre, National Cancer Research Center, Complutense University, 28041 Madrid, Spain
| | - María José Larráyoz
- CIMA LAB Diagnostics, Departamento de Bioquímica y Genética, Universidad de Navarra, 31008 Pamplona, Spain
| | - María Carmen Chillón
- Servicio de Hematología, Hospital Universitario de Salamanca (HUS/IBSAL), CIBERONC, Centro de Investigación del Cáncer–IBMCC (USAL–CSIC), 37007 Salamanca, Spain
| | - Estrella Carrillo-Cruz
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (IBIS/CSIC/CIBERONC), Universidad de Sevilla, 41013 Sevilla, Spain
| | - Cristina Bilbao-Sieyro
- Hospital Universitario de Gran Canaria Dr. Negrín, 35010 Las Palmas de Gran Canaria, Spain
| | - Esther Prados de la Torre
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba (UCO), 14004 Córdoba, Spain
| | - David Martínez-Cuadrón
- Servicio de Hematología, Grupo Acreditado de Investigación en Hematología, Hospital Universitario y Politécnico La Fe, Instituto de Investigación Sanitaria La Fe (IIS La Fe), 46026 Valencia, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto de Investigación Sanitaria La Fe (IIS La Fe), 46026 Valencia, Spain
| | - Rebeca Rodríguez-Veiga
- Servicio de Hematología, Grupo Acreditado de Investigación en Hematología, Hospital Universitario y Politécnico La Fe, Instituto de Investigación Sanitaria La Fe (IIS La Fe), 46026 Valencia, Spain
| | - Blanca Boluda
- Servicio de Hematología, Grupo Acreditado de Investigación en Hematología, Hospital Universitario y Politécnico La Fe, Instituto de Investigación Sanitaria La Fe (IIS La Fe), 46026 Valencia, Spain
| | - Cristina Gil
- Hospital General Universitario de Alicante, 03010 Alicante, Spain
| | - Teresa Bernal
- Hospital Universitario Central de Asturias, Instituto Universitario (IUOPA), Instituto de Investigación del Principado de Asturias (ISPA), 33011 Oviedo, Spain
| | | | - Lorenzo Algarra
- Hospital Universitario General de Albacete, 02006 Albacete, Spain
| | - Mar Tormo
- Hospital Clínico Universitario–INCLIVA, 46010 Valencia, Spain
| | - Pilar Martínez-Sánchez
- Hospital Universitario 12 de Octubre, National Cancer Research Center, Complutense University, 28041 Madrid, Spain
| | - Elena Soria
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (IBIS/CSIC/CIBERONC), Universidad de Sevilla, 41013 Sevilla, Spain
| | - Josefina Serrano
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba (UCO), 14004 Córdoba, Spain
| | | | | | - María Luz Amigo
- Hospital Universitario Morales Messeguer, 30008 Murcia, Spain
| | | | | | | | - Joaquín Martínez-López
- Hospital Universitario 12 de Octubre, National Cancer Research Center, Complutense University, 28041 Madrid, Spain
| | - María José Calasanz
- CIMA LAB Diagnostics, Departamento de Bioquímica y Genética, Universidad de Navarra, 31008 Pamplona, Spain
| | - Ramón García-Sanz
- Servicio de Hematología, Hospital Universitario de Salamanca (HUS/IBSAL), CIBERONC, Centro de Investigación del Cáncer–IBMCC (USAL–CSIC), 37007 Salamanca, Spain
| | - José Antonio Pérez-Simón
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (IBIS/CSIC/CIBERONC), Universidad de Sevilla, 41013 Sevilla, Spain
| | | | - Joaquín Sánchez-García
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba (UCO), 14004 Córdoba, Spain
| | - Eva Barragán
- Hospital General Universitario de Alicante, 03010 Alicante, Spain
- Servicio Análisis Clínicos, Grupo Acreditado de Investigación en Hematología, Hospital Universitario y Politécnico La Fe, Instituto de Investigación Sanitaria La Fe (IIS La Fe), 46026 Valencia, Spain
- Correspondence: ; Tel.: +34-961-244589
| | - Pau Montesinos
- Servicio de Hematología, Grupo Acreditado de Investigación en Hematología, Hospital Universitario y Politécnico La Fe, Instituto de Investigación Sanitaria La Fe (IIS La Fe), 46026 Valencia, Spain
- Hospital General Universitario de Alicante, 03010 Alicante, Spain
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6
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Ayala R, Carreño-Tarragona G, Barragán E, Boluda B, Larráyoz MJ, Chillón MC, Carrillo-Cruz E, Bilbao C, Sánchez-García J, Bernal T, Martinez-Cuadron D, Gil C, Serrano J, Rodriguez-Medina C, Bergua J, Pérez-Simón JA, Calbacho M, Alonso-Domínguez JM, Labrador J, Tormo M, Amigo ML, Herrera-Puente P, Rapado I, Sargas C, Vazquez I, Calasanz MJ, Gomez-Casares T, García-Sanz R, Sanz MA, Martínez-López J, Montesinos P. Impact of FLT3-ITD Mutation Status and Its Ratio in a Cohort of 2901 Patients Undergoing Upfront Intensive Chemotherapy: A PETHEMA Registry Study. Cancers (Basel) 2022; 14:cancers14235799. [PMID: 36497281 PMCID: PMC9737662 DOI: 10.3390/cancers14235799] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/04/2022] [Accepted: 11/21/2022] [Indexed: 11/26/2022] Open
Abstract
FLT3−ITD results in a poor prognosis in terms of overall survival (OS) and relapse-free survival (RFS) in acute myeloid leukemia (AML). However, the prognostic usefulness of the allelic ratio (AR) to select post-remission therapy remains controversial. Our study focuses on the prognostic impact of FLT3−ITD and its ratio in a series of 2901 adult patients treated intensively in the pre-FLT3 inhibitor era and reported in the PETHEMA registry. A total of 579 of these patients (20%) harbored FLT3−ITD mutations. In multivariate analyses, patients with an FLT3−ITD allele ratio (AR) of >0.5 showed a lower complete remission (CR rate) and OS (HR 1.47, p = 0.009), while AR > 0.8 was associated with poorer RFS (HR 2.1; p < 0.001). Among NPM1/FLT3−ITD-mutated patients, median OS gradually decreased according to FLT3−ITD status and ratio (34.3 months FLT3−ITD-negative, 25.3 months up to 0.25, 14.5 months up to 0.5, and 10 months ≥ 0.5, p < 0.001). Post-remission allogeneic transplant (allo-HSCT) resulted in better OS and RFS as compared to auto-HSCT in NPM1/FLT3−ITD-mutated AML regardless of pre-established AR cutoff (≤0.5 vs. >0.5). Using the maximally selected log-rank statistics, we established an optimal cutoff of FLT3−ITD AR of 0.44 for OS, and 0.8 for RFS. We analyzed the OS and RFS according to FLT3−ITD status in all patients, and we found that the group of FLT3−ITD-positive patients with AR < 0.44 had similar 5-year OS after allo-HSCT or auto-HSCT (52% and 41%, respectively, p = 0.86), but worse RFS after auto-HSCT (p = 0.01). Among patients with FLT3−ITD AR > 0.44, allo-HSCT was superior to auto-HSCT in terms of OS and RFS. This study provides more evidence for a better characterization of patients with AML harboring FLT3−ITD mutations.
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Affiliation(s)
- Rosa Ayala
- Hematology Department, Hospital Universitario 12 de Octubre, i+12, CNIO, CIBERONC, Complutense University, 28041 Madrid, Spain
| | - Gonzalo Carreño-Tarragona
- Hematology Department, Hospital Universitario 12 de Octubre, i+12, CNIO, CIBERONC, Complutense University, 28041 Madrid, Spain
| | - Eva Barragán
- Molecular Biology Unit, Hospital Universitari i Politécnic-IIS La Fe, 46026 Valencia, Spain
| | - Blanca Boluda
- Hematology Department, Hospital Universitari i Politécnic-IIS La Fe, CIBERONC, 46026 Valencia, Spain
| | | | - María Carmen Chillón
- Hospital Universitario de Salamanca (HUS/IBSAL), CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), 37007 Salamanca, Spain
| | - Estrella Carrillo-Cruz
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (IBIS/CSIC/CIBERONC), Universidad de Sevilla, 41120 Sevilla, Spain
| | - Cristina Bilbao
- Hospital Universitario de Gran Canaria Dr. Negrín, 35002 Las Palmas de Gran Canaria, Spain
| | | | - Teresa Bernal
- Hospital Universitario Central de Asturias, Instituto de Investigación del Principado de Asturias (ISPA), 33011 Oviedo, Spain
| | - David Martinez-Cuadron
- Hematology Department, Hospital Universitari i Politécnic-IIS La Fe, CIBERONC, 46026 Valencia, Spain
| | - Cristina Gil
- Hospital General Universitario de Alicante, 03010 Alicante, Spain
| | - Josefina Serrano
- IMIBIC, Hematology, Hospital Universitario Reina Sofía, UCO, 14004 Córdoba, Spain
| | | | - Juan Bergua
- Hospital Universitario San Pedro de Alcántara, 10001 Cáceres, Spain
| | - José A. Pérez-Simón
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (IBIS/CSIC/CIBERONC), Universidad de Sevilla, 41120 Sevilla, Spain
| | - María Calbacho
- Hematology Department, Hospital Universitario 12 de Octubre, i+12, CNIO, CIBERONC, Complutense University, 28041 Madrid, Spain
| | | | - Jorge Labrador
- Research Unit, Hematology Department, Hospital Universitario de Burgos, Universidad Isabel I, 09006 Burgos, Spain
| | - Mar Tormo
- Hematology Department, Hospital Clínico Universitario-INCLIVA, 46026 Valencia, Spain
| | - Maria Luz Amigo
- Hospital Universitario Morales Messeguer, 30008 Murcia, Spain
| | | | - Inmaculada Rapado
- Hematology Department, Hospital Universitario 12 de Octubre, i+12, CNIO, CIBERONC, Complutense University, 28041 Madrid, Spain
| | - Claudia Sargas
- Molecular Biology Unit, Hospital Universitari i Politécnic-IIS La Fe, 46026 Valencia, Spain
| | - Iria Vazquez
- CIMA LAB Diagnostics, Universidad de Navarra, 31008 Pamplona, Spain
| | | | - Teresa Gomez-Casares
- Hospital Universitario de Gran Canaria Dr. Negrín, 35002 Las Palmas de Gran Canaria, Spain
| | - Ramón García-Sanz
- Hospital Universitario de Salamanca (HUS/IBSAL), CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), 37007 Salamanca, Spain
| | - Miguel A. Sanz
- Hematology Department, Hospital Universitari i Politécnic-IIS La Fe, CIBERONC, 46026 Valencia, Spain
| | - Joaquín Martínez-López
- Hematology Department, Hospital Universitario 12 de Octubre, i+12, CNIO, CIBERONC, Complutense University, 28041 Madrid, Spain
- Correspondence: (J.M.-L.); (P.M.); Tel.: +34-917-792-788 (J.M.-L.); +34-961-244-925 (P.M.); Fax: +34-961-246-201 (P.M.)
| | - Pau Montesinos
- Hematology Department, Hospital Universitari i Politécnic-IIS La Fe, CIBERONC, 46026 Valencia, Spain
- Correspondence: (J.M.-L.); (P.M.); Tel.: +34-917-792-788 (J.M.-L.); +34-961-244-925 (P.M.); Fax: +34-961-246-201 (P.M.)
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7
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Llop M, Sargas C, Barragán E. The role of next-generation sequencing in acute myeloid leukemia. Curr Opin Oncol 2022; 34:723-728. [PMID: 36102349 DOI: 10.1097/cco.0000000000000899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The development of high-throughput techniques like next-generation sequencing (NGS) has unraveled the genetic profile of cancer. In this review, we discuss the role of NGS on the diagnostic, risk stratification, and follow-up of patients with acute myeloid leukemia (AML). RECENT FINDINGS NGS has become an essential tool in clinical practice for AML management. Therefore, efforts are being made to improve its applications, automation, and turnaround time. Other high-throughput techniques, such as whole genome sequencing or RNA-sequencing, can be also used to this end. However, not all institutions may be able to implement these approaches. NGS is being investigated for measurable residual disease (MRD) assessment, especially with the development of error-correction NGS. New data analysis approaches like machine learning are being investigated in order to integrate genomic and clinical data and develop comprehensive classifications and risk scores. SUMMARY NGS has proven to be a useful approach for the analysis of genomic alterations in patients with AML, which aids patient management. Current research is being directed at reducing turnaround time and simplifying processes so that these techniques can be universally integrated into clinical practice.
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Affiliation(s)
- Marta Llop
- Molecular Biology Unit, Service of Clinical Analysis. Hospital Universitari i Politècnic La Fe
- CIBERONC CB16/12/00284
| | - Claudia Sargas
- Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Eva Barragán
- Molecular Biology Unit, Service of Clinical Analysis. Hospital Universitari i Politècnic La Fe
- CIBERONC CB16/12/00284
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8
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Sánchez R, Dorado S, Ruíz-Heredia Y, Martín-Muñoz A, Rosa-Rosa JM, Ribera J, García O, Jimenez-Ubieto A, Carreño-Tarragona G, Linares M, Rufián L, Juárez A, Carrillo J, Espino MJ, Cáceres M, Expósito S, Cuevas B, Vanegas R, Casado LF, Torrent A, Zamora L, Mercadal S, Coll R, Cervera M, Morgades M, Hernández-Rivas JÁ, Bravo P, Serí C, Anguita E, Barragán E, Sargas C, Ferrer-Marín F, Sánchez-Calero J, Sevilla J, Ruíz E, Villalón L, Del Mar Herráez M, Riaza R, Magro E, Steegman JL, Wang C, de Toledo P, García-Gutiérrez V, Ayala R, Ribera JM, Barrio S, Martínez-López J. Detection of kinase domain mutations in BCR::ABL1 leukemia by ultra-deep sequencing of genomic DNA. Sci Rep 2022; 12:13057. [PMID: 35906470 PMCID: PMC9338264 DOI: 10.1038/s41598-022-17271-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 07/22/2022] [Indexed: 11/09/2022] Open
Abstract
The screening of the BCR::ABL1 kinase domain (KD) mutation has become a routine analysis in case of warning/failure for chronic myeloid leukemia (CML) and B-cell precursor acute lymphoblastic leukemia (ALL) Philadelphia (Ph)-positive patients. In this study, we present a novel DNA-based next-generation sequencing (NGS) methodology for KD ABL1 mutation detection and monitoring with a 1.0E-4 sensitivity. This approach was validated with a well-stablished RNA-based nested NGS method. The correlation of both techniques for the quantification of ABL1 mutations was high (Pearson r = 0.858, p < 0.001), offering DNA-DeepNGS a sensitivity of 92% and specificity of 82%. The clinical impact was studied in a cohort of 129 patients (n = 67 for CML and n = 62 for B-ALL patients). A total of 162 samples (n = 86 CML and n = 76 B-ALL) were studied. Of them, 27 out of 86 harbored mutations (6 in warning and 21 in failure) for CML, and 13 out of 76 (2 diagnostic and 11 relapse samples) did in B-ALL patients. In addition, in four cases were detected mutation despite BCR::ABL1 < 1%. In conclusion, we were able to detect KD ABL1 mutations with a 1.0E-4 sensitivity by NGS using DNA as starting material even in patients with low levels of disease.
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Affiliation(s)
- Ricardo Sánchez
- Hematology Department, Hospital UniversitarioHospital Universitario 12 Octubre, Madrid, Spain.
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain.
- Hematological Malignancies Clinical Research Unit, CNIO, Madrid, Spain.
- Altum Sequencing Co., Madrid, Spain.
| | - Sara Dorado
- Altum Sequencing Co., Madrid, Spain
- Computer Science and Engineering Department, Carlos III University, Madrid, Spain
| | | | | | - Juan Manuel Rosa-Rosa
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
- Hematological Malignancies Clinical Research Unit, CNIO, Madrid, Spain
| | - Jordi Ribera
- Hematology Department, ICO-Hospital Germans Trias i Pujol. Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Olga García
- Hematology Department, ICO-Hospital Germans Trias i Pujol. Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Ana Jimenez-Ubieto
- Hematology Department, Hospital UniversitarioHospital Universitario 12 Octubre, Madrid, Spain
- Hematological Malignancies Clinical Research Unit, CNIO, Madrid, Spain
| | - Gonzalo Carreño-Tarragona
- Hematology Department, Hospital UniversitarioHospital Universitario 12 Octubre, Madrid, Spain
- Hematological Malignancies Clinical Research Unit, CNIO, Madrid, Spain
| | - María Linares
- Hematological Malignancies Clinical Research Unit, CNIO, Madrid, Spain
- Department of Biochemistry and Molecular Biology, Pharmacy School, Universidad Complutense de Madrid, Madrid, Spain
| | - Laura Rufián
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
- Altum Sequencing Co., Madrid, Spain
| | - Alexandra Juárez
- Hematology Department, Hospital UniversitarioHospital Universitario 12 Octubre, Madrid, Spain
- Altum Sequencing Co., Madrid, Spain
| | | | - María José Espino
- Hematology Department, Hospital UniversitarioHospital Universitario 12 Octubre, Madrid, Spain
| | - Mercedes Cáceres
- Hematology Department, Hospital UniversitarioHospital Universitario 12 Octubre, Madrid, Spain
| | - Sara Expósito
- Laboratory of Neurophysiology and Synaptic Plasticity, Instituto Cajal, CSIC, Madrid, Spain
| | | | - Raúl Vanegas
- Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | - Anna Torrent
- Hematology Department, ICO-Hospital Germans Trias i Pujol. Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Lurdes Zamora
- Hematology Department, ICO-Hospital Germans Trias i Pujol. Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Santiago Mercadal
- Hematology Department, ICO-Hospital Duran i Reynals (Bellvitge), Barcelona, Spain
| | - Rosa Coll
- Hematology Department, ICO-Hospital Dr. Josep Trueta, Girona, Spain
| | - Marta Cervera
- Hematology Department, ICO-Hospital Universitari Joan XXIII, Tarragona, Spain
| | - Mireia Morgades
- Hematology Department, ICO-Hospital Germans Trias i Pujol. Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | | | - Pilar Bravo
- Hospital Universitario de Fuenlabrada, Fuenlabrada (Madrid), Spain
| | - Cristina Serí
- Hospital Central de la Defensa Gómez Ulla, Madrid, Spain
| | - Eduardo Anguita
- Hospital Clínico San Carlos, Department of Medicine, UCM, Madrid, Spain
| | - Eva Barragán
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Claudia Sargas
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | | | | | - Elena Ruíz
- Hospital del Tajo, Aranjuez (Madrid), Spain
| | - Lucía Villalón
- Hospital Universitario Fundación Alcorcón, Alcorcón (Madrid), Spain
| | | | - Rosalía Riaza
- Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
| | - Elena Magro
- Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | | | - Chongwu Wang
- Hosea Precision Medical Technology Co., Ltd., Weihai, Shangdong, China
| | - Paula de Toledo
- Computer Science and Engineering Department, Carlos III University, Madrid, Spain
| | | | - Rosa Ayala
- Hematology Department, Hospital UniversitarioHospital Universitario 12 Octubre, Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
- Hematological Malignancies Clinical Research Unit, CNIO, Madrid, Spain
- Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, Spain
| | - Josep-Maria Ribera
- Hematology Department, ICO-Hospital Germans Trias i Pujol. Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Santiago Barrio
- Hematology Department, Hospital UniversitarioHospital Universitario 12 Octubre, Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
- Hematological Malignancies Clinical Research Unit, CNIO, Madrid, Spain
- Altum Sequencing Co., Madrid, Spain
| | - Joaquín Martínez-López
- Hematology Department, Hospital UniversitarioHospital Universitario 12 Octubre, Madrid, Spain.
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain.
- Hematological Malignancies Clinical Research Unit, CNIO, Madrid, Spain.
- Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, Spain.
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Solana-Altabella A, Megías-Vericat JE, Ballesta-López O, Boluda B, Cano I, Acuña-Cruz E, Rodríguez-Veiga R, Torres-Miñana L, Sargas C, Sanz MÁ, Borrell-García C, López-Briz E, Poveda-Andrés JL, De la Rubia J, Montesinos P, Martínez-Cuadrón D. Healthcare Resource Utilization among Patients between 60-75 Years with Secondary Acute Myeloid Leukemia Receiving Intensive Chemotherapy Induction: A Spanish Retrospective Observational Study. Cancers (Basel) 2022; 14:cancers14081921. [PMID: 35454828 PMCID: PMC9032151 DOI: 10.3390/cancers14081921] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary Studies addressing the economic costs and burden of secondary acute myeloid leukemia (sAML) are scarce in the literature. We analyzed this topic in a real-life population of sAML patients between 60–75 years receiving intensive chemotherapy induction. In elderly patients with sAML and intensive regimens, it entails an increase in costs and a longer hospital stay. In these specific patients, almost a third of the time is spent hospitalized after the diagnosis of sAML. There are no studies with this type of population and diagnosis, which gives added value to the results obtained. Pharmacoeconomic studies in patients with AML are being carried out due to the need to evaluate the cost-effectiveness of new oral drugs, therapeutic schemes with higher costs than previous treatments. Abstract Background: Information regarding the impact on healthcare systems of secondary acute myeloid leukemia (sAML) is scarce. Methods: A retrospective review of medical charts identified patients aged 60–75 years with sAML between 2010 and 2019. Patient information was collected from diagnosis to death or last follow-up. Outpatient resource use, reimbursement, frequency and duration of hospitalization, and transfusion burden were assessed. Forty-six patients with a median age of 64 years were included. Anthracycline plus cytarabine regimens were the most common induction treatment (39 patients, 85%). The ratio of the total days hospitalized between the total follow-up was 29%, with a sum of 204 hospitalizations (average four/patient; average duration 21 days). The total average reimbursement was EUR 90,008 per patient, with the majority (EUR 77,827) related to hospital admissions (EUR 17,403/hospitalization). Most hospitalizations (163, mean 22 days) occurred in the period before the first allogeneic hematopoietic stem cell transplant (alloHSCT), costing EUR 59,698 per patient and EUR 15,857 per hospitalization. The period after alloHSCT (in only 10 patients) had 41 hospitalizations (mean 21 days), and a mean reimbursement cost of EUR 99,542 per patient and EUR 24,278 per hospitalization. In conclusion, there is a high consumption of economic and healthcare resources in elderly patients with sAML receiving active treatments in Spain.
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Affiliation(s)
- Antonio Solana-Altabella
- Pharmacy Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (A.S.-A.); (J.E.M.-V.); (O.B.-L.); (C.B.-G.); (E.L.-B.); (J.L.P.-A.)
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
| | - Juan Eduardo Megías-Vericat
- Pharmacy Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (A.S.-A.); (J.E.M.-V.); (O.B.-L.); (C.B.-G.); (E.L.-B.); (J.L.P.-A.)
| | - Octavio Ballesta-López
- Pharmacy Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (A.S.-A.); (J.E.M.-V.); (O.B.-L.); (C.B.-G.); (E.L.-B.); (J.L.P.-A.)
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
| | - Blanca Boluda
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Isabel Cano
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Evelyn Acuña-Cruz
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Rebeca Rodríguez-Veiga
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Laura Torres-Miñana
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Claudia Sargas
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Miguel Á. Sanz
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Carmela Borrell-García
- Pharmacy Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (A.S.-A.); (J.E.M.-V.); (O.B.-L.); (C.B.-G.); (E.L.-B.); (J.L.P.-A.)
| | - Eduardo López-Briz
- Pharmacy Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (A.S.-A.); (J.E.M.-V.); (O.B.-L.); (C.B.-G.); (E.L.-B.); (J.L.P.-A.)
| | - José Luis Poveda-Andrés
- Pharmacy Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (A.S.-A.); (J.E.M.-V.); (O.B.-L.); (C.B.-G.); (E.L.-B.); (J.L.P.-A.)
| | - Javier De la Rubia
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
- School of Medicine and Dentistry, Catholic University of Valencia, 46010 Valencia, Spain
| | - Pau Montesinos
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - David Martínez-Cuadrón
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
- Correspondence: ; Tel.: +34-96-1244000 (ext. 4119661)
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10
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Castaño-Bonilla T, Alonso-Dominguez JM, Barragán E, Rodríguez-Veiga R, Sargas C, Gil C, Chillón C, Vidriales MB, García R, Martínez-López J, Ayala R, Larrayoz MJ, Anguita E, Cuello R, Cantalapiedra A, Carrillo E, Soria-Saldise E, Labrador J, Recio I, Algarra L, Rodríguez-Medina C, Bilbao-Syeiro C, López-López JA, Serrano J, De Cabo E, Sayas MJ, Olave MT, Sánchez-García J, Mateos M, Blas C, López-Lorenzo JL, Lainez-Gonzalez D, Serrano J, Martínez-Cuadrón D, Sanz MA, Montesinos P. Prognostic significance of FLT3-ITD length in AML patients treated with intensive regimens. Sci Rep 2021; 11:20745. [PMID: 34671057 PMCID: PMC8528825 DOI: 10.1038/s41598-021-00050-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/24/2021] [Indexed: 12/17/2022] Open
Abstract
FLT3-ITD mutations are detected in approximately 25% of newly diagnosed adult acute myeloid leukemia (AML) patients and confer an adverse prognosis. The FLT3-ITD allelic ratio has clear prognostic value. Nevertheless, there are numerous manuscripts with contradictory results regarding the prognostic relevance of the length and insertion site (IS) of the FLT3-ITD fragment. We aimed to assess the prognostic impact of these variables on the complete remission (CR) rates, overall survival (OS) and relapse-free survival (RFS) of AML patients with FLT3-ITDmutations. We studied the FLT3-ITD length of 362 adult AML patients included in the PETHEMA AML registry. We tried to validate the thresholds of ITD length previously published (i.e., 39 bp and 70 bp) in intensively treated AML patients (n = 161). We also analyzed the mutational profile of 118 FLT3-ITD AML patients with an NGS panel of 39 genes and correlated mutational status with the length and IS of ITD. The AUC of the ROC curve of the ITD length for OS prediction was 0.504, and no differences were found when applying any of the thresholds for OS, RFS or CR rate. Only four out of 106 patients had ITD IS in the TKD1 domain. Our results, alongside previous publications, confirm that FLT3-ITD length lacks prognostic value and clinical applicability.
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Affiliation(s)
- Tamara Castaño-Bonilla
- Hematology Department, Hospital Universitario Fundación Jiménez Díaz, Avenida Reyes Católicos, 2, 28040, Madrid, Spain.,Instituto de Investigación Sanitaria (IIS-FJD), Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Juan M Alonso-Dominguez
- Hematology Department, Hospital Universitario Fundación Jiménez Díaz, Avenida Reyes Católicos, 2, 28040, Madrid, Spain. .,Instituto de Investigación Sanitaria (IIS-FJD), Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
| | - Eva Barragán
- Hematology Department, Hospital Universitario La Fe de Valencia, Valencia, Spain
| | | | - Claudia Sargas
- Hematology Department, Hospital Universitario La Fe de Valencia, Valencia, Spain
| | - Cristina Gil
- Hematology Department, Hospital General de Alicante, Alicante, Spain
| | - Carmen Chillón
- Hematology Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | - María B Vidriales
- Hematology Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Raimundo García
- Hematology Department, Hospital General de Castellón, Castellón, Spain
| | - Joaquín Martínez-López
- Hematology Department, Hospital Universitario Doce de Octubre, Complutense University, CNIO, Madrid, Spain
| | - Rosa Ayala
- Hematology Department, Hospital Universitario Doce de Octubre, Complutense University, CNIO, Madrid, Spain
| | - María J Larrayoz
- Molecular Biology Department, Cimalab Diagnosis, Clínica Universitaria de Navarra, Navarra, Spain
| | - Eduardo Anguita
- Hematology Department, Hospital Universitario Clínico San Carlos, Medicine Department, UCM, Madrid, Spain
| | - Rebeca Cuello
- Hematology Department, Hospital Universitario de Valladolid, Valladolid, Spain
| | | | - Estrella Carrillo
- Hematology Department, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CISC/CIBERON), Sevilla, Spain
| | - Elena Soria-Saldise
- Hematology Department, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CISC/CIBERON), Sevilla, Spain
| | - Jorge Labrador
- Hematology Department, Hospital Universitario de Burgos, Burgos, Spain
| | - Isabel Recio
- Hematology Department, Hospital Ntra. Sra. de Sonsoles de Ávila-Complejo Asistencial Ávila, Ávila, Spain
| | - Lorenzo Algarra
- Hematology Department, Hospital General de Albacete, Albacete, Spain
| | - Carlos Rodríguez-Medina
- Hematology Department, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Cristina Bilbao-Syeiro
- Hematology Department, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | | | - Josefina Serrano
- UGC de Hematologia, Hospital U. Reina Sofia, IMIBIC, UCO, Cordoba, Córdoba, Spain
| | - Erik De Cabo
- Hematology Department, Hospital Comarcal del Bierzo, León, Spain
| | - María J Sayas
- Hematology Department, Hospital Universitario Doctor Peset, Valencia, Spain
| | - María T Olave
- Hematology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - Mamen Mateos
- Hematology Department, Complejo Hospitalario de Navarra, Navarra, Spain
| | - Carlos Blas
- Hematology Department, Hospital Universitario Fundación Jiménez Díaz, Avenida Reyes Católicos, 2, 28040, Madrid, Spain.,Instituto de Investigación Sanitaria (IIS-FJD), Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Jose L López-Lorenzo
- Hematology Department, Hospital Universitario Fundación Jiménez Díaz, Avenida Reyes Católicos, 2, 28040, Madrid, Spain.,Instituto de Investigación Sanitaria (IIS-FJD), Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Daniel Lainez-Gonzalez
- Instituto de Investigación Sanitaria (IIS-FJD), Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Juana Serrano
- Instituto de Investigación Sanitaria (IIS-FJD), Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | - Miguel A Sanz
- Hematology Department, Hospital Universitario La Fe de Valencia, Valencia, Spain
| | - Pau Montesinos
- Hematology Department, Hospital Universitario La Fe de Valencia, Valencia, Spain
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11
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Boluda B, Martínez-Cuadrón D, Algarra L, Cano I, Sayas MJ, Acuña-Cruz E, Blanco A, Marco-Ayala J, DeLapuerta R, Díaz-González Á, Tormo M, Rodríguez-Veiga R, García R, Piñana JL, López-Pavía M, Barragán E, Amigo ML, Sargas C, López A, Solana-Altabella A, Gil C, Megías-Vericat JE, Sanz MA, Montesinos P. Evolving patterns of care and outcomes in relapsed/refractory FLT3 mutated acute myeloid leukemia adult patients. Leuk Lymphoma 2021; 62:2727-2736. [PMID: 34121593 DOI: 10.1080/10428194.2021.1938031] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We have analyzed treatment patterns and outcomes of relapsed/refractory(R/R) FLT3mut AML adult patients registered in our institutional data base between 1998 and 2018. Overall, 147 patients were evaluable: 34 from 1998 to 2009, 113 from 2010 to 2018. Salvage treatments were intensive chemotherapy (n = 25, 74%), and supportive care (n = 9, 26%) in the 1998-2009 period, and intensive chemotherapy (n = 63, 56%), hypomethylating agent (n = 7, 6%), low-dose cytarabine-based (n = 8, 7%), clinical trial (n = 16, 14%) and supportive care (n = 19, 17%) in the 2010-2018 period. Complete remission (CR) or with incomplete recovery (CRi) rate was 44%, 49% among patients treated intensively (vs 30% with non-intensive p = 0.005). Median overall survival since first R/R was 5.8 months, and 16.3 months in subjects receiving an allo-HSCT in CR/CRi after first salvage (vs 3.8 in the remaining patients p < 0.0001). Clinical outcomes of R/R FLT3mut AML remain unsatisfactory. Inclusion in clinical trials and expanding options could lead to improved outcomes.
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Affiliation(s)
- Blanca Boluda
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - David Martínez-Cuadrón
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Lorenzo Algarra
- Hematology Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Isabel Cano
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - María J Sayas
- Hematology Department, Hospital Doctor Peset, Valencia, Spain
| | - Evelyn Acuña-Cruz
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Albert Blanco
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Javier Marco-Ayala
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Rosalía DeLapuerta
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Álvaro Díaz-González
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Mar Tormo
- Hematology Department, Hospital Clínico Universitario, Valencia, Spain
| | - Rebeca Rodríguez-Veiga
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Raimundo García
- Hematology Department, Hospital General Castellón, Castellón, Spain
| | - José L Piñana
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - María López-Pavía
- Hematology Department, Hospital General Universitario, Valencia, Spain
| | - Eva Barragán
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - María L Amigo
- Hematology Department, Hospital Morales Meseguer, Murcia, Spain
| | - Claudia Sargas
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Aurelio López
- Hematology Department, Hospital Arnau de Vilanova, Valencia, Spain
| | - Antonio Solana-Altabella
- Instituto de Investigación Sanitaria La Fe, Valencia, Spain.,Pharmacy Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Cristina Gil
- Hematology Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - Juan Eduardo Megías-Vericat
- Instituto de Investigación Sanitaria La Fe, Valencia, Spain.,Pharmacy Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Miguel A Sanz
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Pau Montesinos
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Instituto de Investigación Sanitaria La Fe, Valencia, Spain
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12
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Martínez Sánchez MP, Megías-Vericat JE, Rodríguez-Veiga R, Vives S, Bergua JM, Torrent A, Suárez-Varela S, Boluda B, Martínez-López J, Cano-Ferri I, Acuña-Cruz E, Torres-Miñana L, Martín-Herreros B, Serrano A, Sempere A, Barragán E, Sargas C, Sanz M, Martínez-Cuadrón D, Montesinos P. A phase I trial of selinexor plus FLAG-Ida for the treatment of refractory/relapsed adult acute myeloid leukemia patients. Ann Hematol 2021; 100:1497-1508. [PMID: 33914097 DOI: 10.1007/s00277-021-04542-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 04/19/2021] [Indexed: 11/25/2022]
Abstract
Prognosis for relapsed or refractory (R/R) acute myeloid leukemia (AML) despite salvage therapy is dismal. This phase I dose-escalation trial assessed the safety and preliminary clinical activity of selinexor, an oral exportin-1 (XPO1) inhibitor, in combination with FLAG-Ida in younger R/R AML patients. The aim was to find the recommended phase 2 dose (RP2D) and maximum tolerated dose (MTD). Fourteen patients were included, and selinexor dosage was 60 mg (3 patients), 80 mg (3 patients), and 100 mg (7 patients) weekly. No dose-limiting toxicities were reported. Grade ≥3 non-hematologic adverse events (AEs) occurred in 78.6% of patients. Two patients were non MTD evaluable due to early death, and overall, 3 out of 14 patients (21.4%) had fatal AEs. Five out of 12 (42%) response and MTD evaluable patients achieved a complete remission (CR; n=4) or CR with incomplete hematologic recovery (CRi, n=1), and 4 patients (33%) subsequently underwent allogeneic transplantation. The median overall survival (OS) and event-free survival (EFS) were 6.0 (range 0.9-19.3) and 1.1 months (range 0.7-19.3), respectively. Using selinexor 100 mg/weekly, CR/CRi rate of 66.7%, OS 13.6 months (range, 1.6-19.3), and EFS 10.6 months (range, 0.9-19.3). At last follow-up, 3 patients were alive. Selinexor 100 mg/weekly with FLAG-Ida combination in R/R AML showed acceptable tolerability and efficacy, establishing the RP2D of this regimen in future clinical trials. ClinicalTrials.gov Identifier: NCT03661515.
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Affiliation(s)
- María P Martínez Sánchez
- Servicio de Hematología y Hemoterapia, Hospital Universitario 12 de Octubre, UCM, CNIO, CIBERONC, Madrid, Spain
| | | | - Rebeca Rodríguez-Veiga
- Servicio de Hematología y Hemoterapia, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Susana Vives
- Servicio de Hematología y Hemoterapia, ICO-Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Juan Miguel Bergua
- Servicio de Hematología y Hemoterapia, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - Anna Torrent
- Servicio de Hematología y Hemoterapia, ICO-Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Sara Suárez-Varela
- Servicio de Hematología y Hemoterapia, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - Blanca Boluda
- Servicio de Hematología y Hemoterapia, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Joaquín Martínez-López
- Servicio de Hematología y Hemoterapia, Hospital Universitario 12 de Octubre, UCM, CNIO, CIBERONC, Madrid, Spain
| | - Isabel Cano-Ferri
- Servicio de Hematología y Hemoterapia, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Evelyn Acuña-Cruz
- Servicio de Hematología y Hemoterapia, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Laura Torres-Miñana
- Servicio de Hematología y Hemoterapia, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Beatriz Martín-Herreros
- Grupo de investigación en Hematología, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain
| | - Alfons Serrano
- Servicio de Hematología y Hemoterapia, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Amparo Sempere
- Servicio de Hematología y Hemoterapia, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Eva Barragán
- Servicio de Hematología y Hemoterapia, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Claudia Sargas
- Servicio de Hematología y Hemoterapia, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Miguel Sanz
- Servicio de Hematología y Hemoterapia, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - David Martínez-Cuadrón
- Servicio de Hematología y Hemoterapia, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Pau Montesinos
- Servicio de Hematología y Hemoterapia, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
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13
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Solana-Altabella A, Boluda B, Rodríguez-Veiga R, Cano I, Acuña-Cruz E, Blanco A, Marco-Ayala J, de la Puerta R, Díaz-González Á, Piñana JL, Sanz J, Sempere A, Cervera J, Barragán E, Sargas C, Ballesta-López O, Megías-Vericat JE, Martínez-Cuadrón D, Sanz MÁ, Montesinos P. Healthcare resource utilization in adult patients with relapsed/refractory FLT3 mutated acute myeloid leukemia: A retrospective chart review from Spain. Eur J Haematol 2021; 106:724-733. [PMID: 33609315 DOI: 10.1111/ejh.13604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 02/13/2021] [Accepted: 02/18/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Information regarding impact on healthcare systems of relapsed or refractory (R/R) FLT3 mutated (FLT3mut) acute myeloid leukemia (AML) is scarce. OBJECTIVE To assess the time and reimbursement associated with hospitalizations of patients with R/R FLT3mut AML in a tertiary Spanish hospital. METHODS Retrospective review of medical charts identified patients aged ≥ 18 years with R/R FLT3mut AML between 1998 and 2018. Data were collected from the date of first diagnosis of R/R FLT3mut AML (index) until death or loss to follow-up. The primary end point was duration and frequency of hospitalization, use of outpatient resources and transfusion burden. Reimbursement associated with hospitalizations (including associated chemotherapy) was also assessed. RESULTS Thirty-eight patients were eligible for inclusion. Their median age was 52 years, and 30 (79%) received intensive salvage chemotherapy; FLAG-IDA-based regimens were the most frequent (24 patients, 63%). Overall, there were 150 hospitalizations (mean 3.9/patient; mean duration 21 days). Patients spent a mean of 24% of the study period in hospital. Total mean reimbursement was €108 293 per patient; the majority (€89 834) attributable to inpatient stays (€22 576 /hospitalization). During chemotherapy period (prior to first alloHSCT), there were 73 hospitalizations (mean duration 22 days); mean reimbursement was €19 776 per hospitalization and €49 819 per patient. AlloHSCT (n = 16) involved 77 hospitalizations (mean duration 21 days), mean reimbursement €25 231/hospitalization and €131 515 per patient. CONCLUSION Data from this study suggest that there is a substantial healthcare resource utilization and cost burden on R/R FLT3mut AML patients in Spain receiving active treatments.
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Affiliation(s)
- Antonio Solana-Altabella
- Pharmacy Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain
| | - Blanca Boluda
- Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain.,Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Rebeca Rodríguez-Veiga
- Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain.,Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Isabel Cano
- Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain.,Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Evelyn Acuña-Cruz
- Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain.,Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Albert Blanco
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Javier Marco-Ayala
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Rosalía de la Puerta
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Álvaro Díaz-González
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - José L Piñana
- Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain.,Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Jaime Sanz
- Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain.,Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Amparo Sempere
- Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain.,Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - José Cervera
- Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain.,Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Eva Barragán
- Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain.,Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Claudia Sargas
- Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain.,Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Octavio Ballesta-López
- Pharmacy Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain
| | - Juan Eduardo Megías-Vericat
- Pharmacy Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain
| | - David Martínez-Cuadrón
- Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain.,Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Miguel Á Sanz
- Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain.,Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Pau Montesinos
- Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain.,Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
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14
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Sargas C, Ayala R, Chillón MC, Larráyoz MJ, Carrillo-Cruz E, Bilbao C, Yébenes-Ramírez M, Llop M, Rapado I, García-Sanz R, Vázquez I, Soria E, Florido-Ortega Y, Janusz K, Botella C, Serrano J, Martínez-Cuadrón D, Bergua J, Amigo ML, Martínez-Sánchez P, Tormo M, Bernal T, Herrera-Puente P, García R, Algarra L, Sayas MJ, Costilla-Barriga L, Pérez-Santolalla E, Marchante I, Lavilla-Rubira E, Noriega V, Alonso-Domínguez JM, Sanz MÁ, Sánchez-Garcia J, Gómez-Casares MT, Pérez-Simón JA, Calasanz MJ, González-Díaz M, Martínez-López J, Barragán E, Montesinos P. Networking for advanced molecular diagnosis in acute myeloid leukemia patients is possible: the PETHEMA NGS-AML project. Haematologica 2020; 106:3079-3089. [PMID: 33179471 PMCID: PMC8634186 DOI: 10.3324/haematol.2020.263806] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Indexed: 11/29/2022] Open
Abstract
Next-generation sequencing (NGS) has recently been introduced to efficiently and simultaneously detect genetic variations in acute myeloid leukemia (AML). However, its implementation in the clinical routine raises new challenges focused on the diversity of assays and variant reporting criteria. In order to overcome this challenge, the PETHEMA group established a nationwide network of reference laboratories aimed to deliver molecular results in the clinics. We report the technical cross-validation results for NGS panel genes during the standardization process and the clinical validation in 823 samples of 751 patients with newly diagnosed or refractory/relapse AML. Two cross-validation rounds were performed in seven nationwide reference laboratories in order to reach a consensus regarding quality metrics criteria and variant reporting. In the pre-standardization cross-validation round, an overall concordance of 60.98% was obtained with a great variability in selected genes and conditions across laboratories. After consensus of relevant genes and optimization of quality parameters the overall concordance rose to 85.57% in the second cross-validation round. We show that a diagnostic network with harmonized NGS analysis and reporting in seven experienced laboratories is feasible in the context of a scientific group. This cooperative nationwide strategy provides advanced molecular diagnostic for AML patients of the PETHEMA group (clinicaltrials gov. Identifier: NCT03311815).
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Affiliation(s)
- Claudia Sargas
- Molecular Biology Unit, Hospital Universitari i Politécnic-IIS La Fe, Valencia
| | - Rosa Ayala
- Hematology Department, Hospital Universitario 12 de Octubre, CNIO, Complutense University, Madrid
| | - María Carmen Chillón
- Hospital Universitario de Salamanca (HUS/IBSAL), CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), Salamanca
| | | | - Estrella Carrillo-Cruz
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (IBIS / CSIC / CIBERONC), Universidad de Sevilla, Sevilla
| | - Cristina Bilbao
- Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria
| | | | - Marta Llop
- Molecular Biology Unit, Hospital Universitari i Politécnic-IIS La Fe, Valencia
| | - Inmaculada Rapado
- Hematology Department, Hospital Universitario 12 de Octubre, CNIO, Complutense University, Madrid
| | - Ramón García-Sanz
- Hospital Universitario de Salamanca (HUS/IBSAL), CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), Salamanca
| | - Iria Vázquez
- CIMA LAB Diagnostics-Universidad de Navarra, Pamplona
| | - Elena Soria
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (IBIS / CSIC / CIBERONC), Universidad de Sevilla, Sevilla
| | | | - Kamila Janusz
- IMIBIC, Hematology, Hospital Universitario Reina Sofía, UCO, Córdoba
| | | | - Josefina Serrano
- IMIBIC, Hematology, Hospital Universitario Reina Sofía, UCO, Córdoba
| | - David Martínez-Cuadrón
- Hematology Department, Hospital Universitari i Politécnic-IIS La Fe, Valencia, Spain; CIBERONC Instituto de Salud Carlos III, Madrid
| | - Juan Bergua
- Hospital Universitario San Pedro de Alcántara, Cáceres
| | | | - Pilar Martínez-Sánchez
- Hematology Department, Hospital Universitario 12 de Octubre, CNIO, Complutense University, Madrid
| | - Mar Tormo
- Hematology Department, Hospital Clínico Universitario-INCLIVA, Valencia
| | | | | | | | | | | | | | | | | | | | | | | | - Miguel Á Sanz
- Hematology Department, Hospital Universitari i Politécnic-IIS La Fe, Valencia, Spain; CIBERONC Instituto de Salud Carlos III, Madrid
| | | | | | - José A Pérez-Simón
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (IBIS / CSIC / CIBERONC), Universidad de Sevilla, Sevilla
| | | | - Marcos González-Díaz
- Hospital Universitario de Salamanca (HUS/IBSAL), CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), Salamanca
| | - Joaquín Martínez-López
- Hematology Department, Hospital Universitario 12 de Octubre, CNIO, Complutense University, Madrid
| | - Eva Barragán
- Molecular Biology Unit, Hospital Universitari i Politécnic-IIS La Fe, Valencia, Spain; CIBERONC Instituto de Salud Carlos III, Madrid.
| | - Pau Montesinos
- Hematology Department, Hospital Universitari i Politécnic-IIS La Fe, Valencia, Spain; CIBERONC Instituto de Salud Carlos III, Madrid
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15
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Ibáñez M, Such E, Onecha E, Gómez-Seguí I, Liquori A, Sellés J, Hervás-Marín D, Barragán E, Ayala R, LLop M, López-Pavía M, Rapado I, Neef A, Sanjuan-Pla A, Sargas C, Gonzalez-Romero E, Boluda-Navarro M, Andreu R, Senent L, Montesinos P, Martínez-López J, Angel Sanz M, Sanz G, Cervera J. Analysis of SNP Array Abnormalities in Patients with DE NOVO Acute Myeloid Leukemia with Normal Karyotype. Sci Rep 2020; 10:5904. [PMID: 32246042 PMCID: PMC7125150 DOI: 10.1038/s41598-020-61589-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 02/28/2020] [Indexed: 02/02/2023] Open
Abstract
Nearly 50% of patients with de novo acute myeloid leukemia (AML) harbor an apparently normal karyotype (NK) by conventional cytogenetic techniques showing a very heterogeneous prognosis. This could be related to the presence of cryptic cytogenetic abnormalities (CCA) not detectable by conventional methods. The study of copy number alterations (CNA) and loss of heterozygozity (LOH) in hematological malignancies is possible using a high resolution SNP-array. Recently, in clinical practice the karyotype study has been complemented with the identification of point mutations in an increasing number of genes. We analyzed 252 de novo NK-AML patients from Hospital La Fe (n = 44) and from previously reported cohorts (n = 208) to identify CCA by SNP-array, and to integrate the analysis of CCA with molecular alterations detected by Next-Generation-sequencing. CCA were detected in 58% of patients. In addition, 49% of them harbored CNA or LOH and point mutations, simultaneously. Patients were grouped in 3 sets by their abnormalities: patients carrying several CCA simultaneously, patients with mutations in FLT3, NPM1 and/or DNMT3A and patients with an amalgam of mutations. We found a negative correlation between the number of CCA and the outcome of the patients. This study outlines that CCA are present in up to 50% of NK-AML patients and have a negative impact on the outcome. CCA may contribute to the heterogeneous prognosis.
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Affiliation(s)
- Mariam Ibáñez
- Hematology Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red de Cáncer, Madrid, Spain
- Departamento de Ciencias Biomédicas. Facultad de Ciencias de la Salud. Universidad CEU Cardenal Herrera, Valencia, Spain
| | - Esperanza Such
- Hematology Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red de Cáncer, Madrid, Spain
- Departamento de Ciencias Biomédicas. Facultad de Ciencias de la Salud. Universidad CEU Cardenal Herrera, Valencia, Spain
| | | | - Inés Gómez-Seguí
- Hematology Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red de Cáncer, Madrid, Spain
| | - Alessandro Liquori
- Centro de Investigación Biomédica en Red de Cáncer, Madrid, Spain
- Grupo de Investigación en Hematología, IIS La Fe, Valencia, Spain
| | - Jorge Sellés
- Array's Unit. Instituto Investigación Sanitaria Fundación La Fe, Valencia, Spain
| | - David Hervás-Marín
- Biostadistic Unit. Instituto Investigación Sanitaria Fundación La Fe, Valencia, Spain
| | - Eva Barragán
- Centro de Investigación Biomédica en Red de Cáncer, Madrid, Spain
- Laboratory of Molecular Biology, Department of Clinical Chemistry, University Hospital La Fe, Valencia, Spain
| | | | - Marta LLop
- Centro de Investigación Biomédica en Red de Cáncer, Madrid, Spain
- Laboratory of Molecular Biology, Department of Clinical Chemistry, University Hospital La Fe, Valencia, Spain
| | | | | | - Alex Neef
- Grupo de Investigación en Hematología, IIS La Fe, Valencia, Spain
| | | | - Claudia Sargas
- Grupo de Investigación en Hematología, IIS La Fe, Valencia, Spain
- Laboratory of Molecular Biology, Department of Clinical Chemistry, University Hospital La Fe, Valencia, Spain
| | - Elisa Gonzalez-Romero
- Centro de Investigación Biomédica en Red de Cáncer, Madrid, Spain
- Grupo de Investigación en Hematología, IIS La Fe, Valencia, Spain
| | | | - Rafa Andreu
- Hematology Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Leonor Senent
- Hematology Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red de Cáncer, Madrid, Spain
| | - Pau Montesinos
- Hematology Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red de Cáncer, Madrid, Spain
| | | | - Miguel Angel Sanz
- Hematology Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red de Cáncer, Madrid, Spain
- Department of Medicine. University of Valencia, Valencia, Spain
| | - Guillermo Sanz
- Hematology Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red de Cáncer, Madrid, Spain
| | - José Cervera
- Hematology Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
- Centro de Investigación Biomédica en Red de Cáncer, Madrid, Spain.
- Genetics Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
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16
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Liquori A, Ibañez M, Sargas C, Sanz MÁ, Barragán E, Cervera J. Acute Promyelocytic Leukemia: A Constellation of Molecular Events around a Single PML-RARA Fusion Gene. Cancers (Basel) 2020; 12:cancers12030624. [PMID: 32182684 PMCID: PMC7139833 DOI: 10.3390/cancers12030624] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [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: 01/30/2020] [Revised: 02/27/2020] [Accepted: 03/05/2020] [Indexed: 12/11/2022] Open
Abstract
Although acute promyelocytic leukemia (APL) is one of the most characterized forms of acute myeloid leukemia (AML), the molecular mechanisms involved in the development and progression of this disease are still a matter of study. APL is defined by the PML-RARA rearrangement as a consequence of the translocation t(15;17)(q24;q21). However, this abnormality alone is not able to trigger the whole leukemic phenotype and secondary cooperating events might contribute to APL pathogenesis. Additional somatic mutations are known to occur recurrently in several genes, such as FLT3, WT1, NRAS and KRAS, whereas mutations in other common AML genes are rarely detected, resulting in a different molecular profile compared to other AML subtypes. How this mutational spectrum, including point mutations in the PML-RARA fusion gene, could contribute to the 10%–15% of relapsed or resistant APL patients is still unknown. Moreover, due to the uncertain impact of additional mutations on prognosis, the identification of the APL-specific genetic lesion is still the only method recommended in the routine evaluation/screening at diagnosis and for minimal residual disease (MRD) assessment. However, the gene expression profile of genes, such as ID1, BAALC, ERG, and KMT2E, once combined with the molecular events, might improve future prognostic models, allowing us to predict clinical outcomes and to categorize APL patients in different risk subsets, as recently reported. In this review, we will focus on the molecular characterization of APL patients at diagnosis, relapse and resistance, in both children and adults. We will also describe different standardized molecular approaches to study MRD, including those recently developed. Finally, we will discuss how novel molecular findings can improve the management of this disease.
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Affiliation(s)
- Alessandro Liquori
- Accredited Research Group in Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (A.L.); (C.S.)
| | - Mariam Ibañez
- Department of Hematology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain; (M.I.); (M.Á.S.); (E.B.)
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28029 Madrid, Spain
| | - Claudia Sargas
- Accredited Research Group in Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (A.L.); (C.S.)
| | - Miguel Ángel Sanz
- Department of Hematology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain; (M.I.); (M.Á.S.); (E.B.)
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28029 Madrid, Spain
| | - Eva Barragán
- Department of Hematology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain; (M.I.); (M.Á.S.); (E.B.)
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28029 Madrid, Spain
| | - José Cervera
- Department of Hematology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain; (M.I.); (M.Á.S.); (E.B.)
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28029 Madrid, Spain
- Correspondence:
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17
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Onecha E, Ruiz-Heredia Y, Martínez-Cuadrón D, Barragán E, Martinez-Sanchez P, Linares M, Rapado I, Perez-Oteyza J, Magro E, Herrera P, Rojas JL, Gorrochategui J, Villoria J, Boluda B, Sargas C, Ballesteros J, Montesinos P, Martínez-López J, Ayala R. Improving the prediction of acute myeloid leukaemia outcomes by complementing mutational profiling with ex vivo chemosensitivity. Br J Haematol 2020; 189:672-683. [PMID: 32068246 DOI: 10.1111/bjh.16432] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/31/2019] [Accepted: 11/01/2019] [Indexed: 02/06/2023]
Abstract
Refractoriness to induction therapy and relapse after complete remission are the leading causes of death in patients with acute myeloid leukaemia (AML). This study focussed on the prediction of response to standard induction therapy and outcome of patients with AML using a combined strategy of mutational profiling by next-generation sequencing (NGS, n = 190) and ex vivo PharmaFlow testing (n = 74) for the 10 most widely used drugs for AML induction therapy, in a cohort of adult patients uniformly treated according to Spanish PETHEMA guidelines. We identified an adverse mutational profile (EZH2, KMT2A, U2AF1 and/or TP53 mutations) that carries a greater risk of death [hazard ratio (HR): 3·29, P < 0·0001]. A high correlation was found between the ex vivo PharmaFlow results and clinical induction response (69%). Clinical correlation analysis showed that the pattern of multiresistance revealed by ex vivo PharmaFlow identified patients with a high risk of death (HR: 2·58). Patients with mutation status also ran a high risk (HR 4·19), and the risk was increased further in patients with both adverse profiles (HR 4·82). We have developed a new score based on NGS and ex vivo drug testing for AML patients that improves upon current prognostic risk stratification and allows clinicians to tailor treatments to minimise drug resistance.
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Affiliation(s)
- Esther Onecha
- Hematology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.,Hematological Malignancies Clinical Research Unit, CNIO, Madrid, Spain
| | - Yanira Ruiz-Heredia
- Hematological Malignancies Clinical Research Unit, CNIO, Madrid, Spain.,Vivia Biotech, Tres Cantos, Madrid, Spain
| | - David Martínez-Cuadrón
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Madrid, Spain
| | - Eva Barragán
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Madrid, Spain
| | - Pilar Martinez-Sanchez
- Hematology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.,Hematological Malignancies Clinical Research Unit, CNIO, Madrid, Spain.,Complutense University, Madrid, Spain
| | - María Linares
- Hematology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.,Hematological Malignancies Clinical Research Unit, CNIO, Madrid, Spain.,Complutense University, Madrid, Spain
| | - Inmaculada Rapado
- Hematology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.,Hematological Malignancies Clinical Research Unit, CNIO, Madrid, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Jaime Perez-Oteyza
- Hematology Department, Hospital Universitario Sanchinarro, Madrid, Spain
| | - Elena Magro
- Hematology Department, Hospital Universitario Principe de Asturias, Madrid, Spain
| | - Pilar Herrera
- Hematology Department, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | | | | | | | - Blanca Boluda
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Madrid, Spain
| | - Claudia Sargas
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Madrid, Spain
| | | | - Pau Montesinos
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Madrid, Spain
| | - Joaquín Martínez-López
- Hematology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.,Hematological Malignancies Clinical Research Unit, CNIO, Madrid, Spain.,Complutense University, Madrid, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Rosa Ayala
- Hematology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.,Hematological Malignancies Clinical Research Unit, CNIO, Madrid, Spain.,Complutense University, Madrid, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
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18
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Alonso CM, Llop M, Sargas C, Pedrola L, Panadero J, Hervás D, Cervera J, Such E, Ibáñez M, Ayala R, Martínez-López J, Onecha E, de Juan I, Palanca S, Martínez-Cuadrón D, Rodríguez-Veiga R, Boluda B, Montesinos P, Sanz G, Sanz MA, Barragán E. Clinical Utility of a Next-Generation Sequencing Panel for Acute Myeloid Leukemia Diagnostics. J Mol Diagn 2019; 21:228-240. [DOI: 10.1016/j.jmoldx.2018.09.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 09/06/2018] [Accepted: 09/20/2018] [Indexed: 10/27/2022] Open
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