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Simoes C, Villar S, Ariceta B, Garcés JJ, Burgos L, Alignani D, Sarvide S, Martínez-Cuadrón D, Bergua JM, Vives S, Algarra L, Tormo M, Martinez P, Serrano J, Herrera P, Ramos F, Salamero O, Lavilla E, Gil C, Lopez-Lorenzo JL, Vidriales MB, Chillon C, Labrador J, Falantes JF, Sayas MJ, Ayala R, Martinez-Lopez J, Pierola AA, Calasanz MJ, Prosper F, San-Miguel JF, Sanz MÁ, Paiva B, Montesinos P. Transcriptional and genomic characterization of measurable residual disease in acute myeloid leukaemia. Br J Haematol 2023. [PMID: 37057357 DOI: 10.1111/bjh.18815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 04/15/2023]
Affiliation(s)
- Catia Simoes
- Centro de Investigación Médica Aplicada (CIMA), CCUN, IDISNA, CIBER-ONC number CB16/12/00369 and CB16/12/00489, Clínica Universidad de Navarra, Pamplona, Spain
| | - Sara Villar
- Centro de Investigación Médica Aplicada (CIMA), CCUN, IDISNA, CIBER-ONC number CB16/12/00369 and CB16/12/00489, Clínica Universidad de Navarra, Pamplona, Spain
| | - Beñat Ariceta
- Centro de Investigación Médica Aplicada (CIMA), CCUN, IDISNA, CIBER-ONC number CB16/12/00369 and CB16/12/00489, Clínica Universidad de Navarra, Pamplona, Spain
| | - Juan-José Garcés
- Centro de Investigación Médica Aplicada (CIMA), CCUN, IDISNA, CIBER-ONC number CB16/12/00369 and CB16/12/00489, Clínica Universidad de Navarra, Pamplona, Spain
| | - Leire Burgos
- Centro de Investigación Médica Aplicada (CIMA), CCUN, IDISNA, CIBER-ONC number CB16/12/00369 and CB16/12/00489, Clínica Universidad de Navarra, Pamplona, Spain
| | - Diego Alignani
- Centro de Investigación Médica Aplicada (CIMA), CCUN, IDISNA, CIBER-ONC number CB16/12/00369 and CB16/12/00489, Clínica Universidad de Navarra, Pamplona, Spain
| | - Sarai Sarvide
- Centro de Investigación Médica Aplicada (CIMA), CCUN, IDISNA, CIBER-ONC number CB16/12/00369 and CB16/12/00489, Clínica Universidad de Navarra, Pamplona, Spain
| | - David Martínez-Cuadrón
- CIBER-ONC number CB16/12/00284, Hospital Universitario y Politécnico La Fe, Valencia, Valencia, Spain
| | | | | | | | - Mar Tormo
- Hospital Clínico Universitario de Valencia, Valencia
| | - Pilar Martinez
- Hospital Universitario 12 de Octubre, I+12, CNIO, Complutense University, CIBERONC, Madrid, Spain
| | | | | | | | - Olga Salamero
- Hospital Universitario Vall d'Hebrón, Barcelona, Spain
| | | | - Cristina Gil
- Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Maria-Belen Vidriales
- Hospital Universitario de Salamanca, IBSAL, CIBER-ONC number CB16/12/00233 y Centro de Investigación, Salamanca, Spain
| | - Carmen Chillon
- Hospital Universitario de Salamanca, IBSAL, CIBER-ONC number CB16/12/00233 y Centro de Investigación, Salamanca, Spain
| | - Jorge Labrador
- Hospital Universitario de Burgos, Universidad Isabel I, Burgos, Spain
| | | | | | - Rosa Ayala
- Hospital Universitario 12 de Octubre, I+12, CNIO, Complutense University, CIBERONC, Madrid, Spain
| | - Joaquin Martinez-Lopez
- Hospital Universitario 12 de Octubre, I+12, CNIO, Complutense University, CIBERONC, Madrid, Spain
| | - Ana Alfonso Pierola
- Centro de Investigación Médica Aplicada (CIMA), CCUN, IDISNA, CIBER-ONC number CB16/12/00369 and CB16/12/00489, Clínica Universidad de Navarra, Pamplona, Spain
| | - Maria-Jose Calasanz
- Centro de Investigación Médica Aplicada (CIMA), CCUN, IDISNA, CIBER-ONC number CB16/12/00369 and CB16/12/00489, Clínica Universidad de Navarra, Pamplona, Spain
- CIMA LAB Diagnostics, Universidad de Navarra, Pamplona, Spain
| | - Felipe Prosper
- Centro de Investigación Médica Aplicada (CIMA), CCUN, IDISNA, CIBER-ONC number CB16/12/00369 and CB16/12/00489, Clínica Universidad de Navarra, Pamplona, Spain
| | - Jesús F San-Miguel
- Centro de Investigación Médica Aplicada (CIMA), CCUN, IDISNA, CIBER-ONC number CB16/12/00369 and CB16/12/00489, Clínica Universidad de Navarra, Pamplona, Spain
| | - Miguel Á Sanz
- CIBER-ONC number CB16/12/00284, Hospital Universitario y Politécnico La Fe, Valencia, Valencia, Spain
| | - Bruno Paiva
- Centro de Investigación Médica Aplicada (CIMA), CCUN, IDISNA, CIBER-ONC number CB16/12/00369 and CB16/12/00489, Clínica Universidad de Navarra, Pamplona, Spain
| | - Pau Montesinos
- CIBER-ONC number CB16/12/00284, Hospital Universitario y Politécnico La Fe, Valencia, Valencia, Spain
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Labrador J, Martínez-Cuadrón D, de la Fuente A, Rodríguez-Veiga R, Serrano J, Tormo M, Rodriguez-Arboli E, Ramos F, Bernal T, López-Pavía M, Trigo F, Martínez-Sánchez MP, Rodríguez-Gutiérrez JI, Rodríguez-Medina C, Gil C, Belmonte DG, Vives S, Foncillas MÁ, Pérez-Encinas M, Novo A, Recio I, Rodríguez-Macías G, Bergua JM, Noriega V, Lavilla E, Roldán-Pérez A, Sanz MA, Montesinos P. Azacitidine vs. Decitabine in Unfit Newly Diagnosed Acute Myeloid Leukemia Patients: Results from the PETHEMA Registry. Cancers (Basel) 2022; 14:cancers14092342. [PMID: 35565471 PMCID: PMC9105404 DOI: 10.3390/cancers14092342] [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: 04/09/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 12/04/2022] Open
Abstract
The hypomethylating agents, decitabine (DEC) and azacitidine (AZA), allowed more elderly acute myeloid leukemia (AML) patients to be treated. However, there are little direct comparative data on AZA and DEC. This multicenter retrospective study compared the outcomes of AZA and DEC in terms of response and overall survival (OS). Potential predictors associated with response and OS were also evaluated. A total of 626 AML patients were included (487 treated with AZA and 139 with DEC). Response rates were similar in both groups: CR was 18% with AZA vs. 23% with DEC (p = 0.20), CR/CRi was 20.5% vs. 25% (p = 0.27) and ORR was 32% vs. 39.5% (p = 0.12), respectively. Patients with leukocytes < 10 × 109/L, bone marrow blasts < 50% and ECOG ≥ 2 had higher ORR with DEC than with AZA. OS was similar in both groups: 10.4 months (95% CI: 9.2−11.7) vs. 8.8 months (95% CI: 6.7−11.0, p = 0.455), for AZA and DEC, respectively. Age (≥80 years), leukocytes (≥ 10 × 109/L), platelet count (<20 × 109/L) and eGFR (≥45 mL/min/1.73 m2) were associated with higher OS with AZA compared to DEC. In conclusion, we found no differences in response and OS rates in AML patients treated with AZA or DEC.
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Affiliation(s)
- Jorge Labrador
- Hematology Department, Research Unit, Complejo Asistencial Universitario de Burgos, 09006 Burgos, Spain
- Correspondence: (J.L.); (P.M.)
| | - David Martínez-Cuadrón
- Hematology Department, Hospital Universitari i Politécnic La Fe, 46026 Valencia, Spain; (D.M.-C.); (R.R.-V.); (M.A.S.)
| | - Adolfo de la Fuente
- Hematology Department, MD Anderson Cancer Center Madrid, 28033 Madrid, Spain;
| | - Rebeca Rodríguez-Veiga
- Hematology Department, Hospital Universitari i Politécnic La Fe, 46026 Valencia, Spain; (D.M.-C.); (R.R.-V.); (M.A.S.)
| | - Josefina Serrano
- Hematology Department, Hospital Universitario Reina Sofía, IMIBIC, 14004 Córdoba, Spain;
| | - Mar Tormo
- Hematology Department, Hospital Clínico Universitario de Valencia, Instituto de Investigación Sanitaria—INCLIVA, 46010 Valencia, Spain;
| | - Eduardo Rodriguez-Arboli
- Hematology Department, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC), 41013 Sevilla, Spain;
| | - Fernando Ramos
- Hematology Department, Hospital Universitario de León, 24071 León, Spain;
| | - Teresa Bernal
- Hematology Department, Hospital Universitario Central Asturias, ISPA, IUOPA, 33011 Oviedo, Spain;
| | - María López-Pavía
- Hematology Department, Hospital General de Valencia, 46026 Valencia, Spain;
| | - Fernanda Trigo
- Hematology Department, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal;
| | | | | | - Carlos Rodríguez-Medina
- Hematology Department, Hospital Universitario de Gran Canaria Doctor Negrín, 35010 Las Palmas de Gran Canaria, Spain;
| | - Cristina Gil
- Hematology Department, Hospital General Universitario de Alicante, 03010 Alicante, Spain;
| | | | - Susana Vives
- Hematology Department, Hospital Germans Trias i Pujol-ICO, Josep Carreras Research Institute, Universitat Autònoma de Barcelona, 08916 Badalona, Spain;
| | | | - Manuel Pérez-Encinas
- Hematology Department, Hospital Clínico Universitario de Santiago de Compostela, 15706 Santiago de Compostela, Spain;
| | - Andrés Novo
- Hematology Department, Hospital Universitario Son Espases, 07120 Palma de Mallorca, Spain;
| | - Isabel Recio
- Hematology Department, Complejo Asistencial de Ávila, 05071 Avila, Spain;
| | | | - Juan Miguel Bergua
- Hematology Department, Hospital San Pedro de Alcántara, 10003 Caceres, Spain;
| | - Víctor Noriega
- Hematology Department, Hospital Universitario de A Coruña, 15006 La Coruna, Spain;
| | - Esperanza Lavilla
- Hematology Department, Hospital Universitario Lucus Augusti, 27003 Lugo, Spain;
| | - Alicia Roldán-Pérez
- Hematology Department, Hospital Universitario Infanta Sofía, 28702 San Sebastián de los Reyes, Spain;
| | - Miguel A. Sanz
- Hematology Department, Hospital Universitari i Politécnic La Fe, 46026 Valencia, Spain; (D.M.-C.); (R.R.-V.); (M.A.S.)
| | - Pau Montesinos
- Hematology Department, Hospital Universitari i Politécnic La Fe, 46026 Valencia, Spain; (D.M.-C.); (R.R.-V.); (M.A.S.)
- Correspondence: (J.L.); (P.M.)
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Ayala R, Rapado I, Onecha E, Martínez-Cuadrón D, Carreño-Tarragona G, Bergua JM, Vives S, Algarra JL, Tormo M, Martinez P, Serrano J, Herrera P, Ramos F, Salamero O, Lavilla E, Gil C, López Lorenzo JL, Vidriales MB, Labrador J, Falantes JF, Sayas MJ, Paiva B, Barragán E, Prosper F, Sanz MÁ, Martínez-López J, Montesinos P. The Mutational Landscape of Acute Myeloid Leukaemia Predicts Responses and Outcomes in Elderly Patients from the PETHEMA-FLUGAZA Phase 3 Clinical Trial. Cancers (Basel) 2021; 13:cancers13102458. [PMID: 34070172 PMCID: PMC8158477 DOI: 10.3390/cancers13102458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/14/2021] [Revised: 05/06/2021] [Accepted: 05/12/2021] [Indexed: 12/30/2022] Open
Abstract
We sought to predict treatment responses and outcomes in older patients with newly diagnosed acute myeloid leukemia (AML) from our FLUGAZA phase III clinical trial (PETHEMA group) based on mutational status, comparing azacytidine (AZA) with fludarabine plus low-dose cytarabine (FLUGA). Mutational profiling using a custom 43-gene next-generation sequencing panel revealed differences in profiles between older and younger patients, and several prognostic markers that were useful in young patients were ineffective in older patients. We examined the associations between variables and overall responses at the end of the third cycle. Patients with mutated DNMT3A or EZH2 were shown to benefit from azacytidine in the treatment-adjusted subgroup analysis. An analysis of the associations with tumor burden using variant allele frequency (VAF) quantification showed that a higher overall response was associated with an increase in TET2 VAF (odds ratio (OR), 1.014; p = 0.030) and lower TP53 VAF (OR, 0.981; p = 0.003). In the treatment-adjusted multivariate survival analyses, only the NRAS (hazard ratio (HR), 1.9, p = 0.005) and TP53 (HR, 2.6, p = 9.8 × 10-7) variants were associated with shorter overall survival (OS), whereas only mutated BCOR (HR, 3.6, p = 0.0003) was associated with a shorter relapse-free survival (RFS). Subgroup analyses of OS according to biological and genomic characteristics showed that patients with low-intermediate cytogenetic risk (HR, 1.51, p = 0.045) and mutated NRAS (HR, 3.66, p = 0.047) benefited from azacytidine therapy. In the subgroup analyses, patients with mutated TP53 (HR, 4.71, p = 0.009) showed a better RFS in the azacytidine arm. In conclusion, differential mutational profiling might anticipate the outcomes of first-line treatment choices (AZA or FLUGA) in older patients with AML. The study is registered at ClinicalTrials.gov as NCT02319135.
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Affiliation(s)
- Rosa Ayala
- Hematology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Imas12, 28041 Madrid, Spain; (I.R.); (E.O.); (G.C.-T.)
- Hematological Malignancies Clinical Research Unit, CNIO, 28029 Madrid, Spain
- Departament of Medicine, Complutense University, 28040 Madrid, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto Carlos III, 28029 Madrid, Spain; (B.P.); (E.B.); (F.P.); (M.Á.S.); (P.M.)
- Correspondence: (R.A.); (J.M.-L.)
| | - Inmaculada Rapado
- Hematology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Imas12, 28041 Madrid, Spain; (I.R.); (E.O.); (G.C.-T.)
- Hematological Malignancies Clinical Research Unit, CNIO, 28029 Madrid, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto Carlos III, 28029 Madrid, Spain; (B.P.); (E.B.); (F.P.); (M.Á.S.); (P.M.)
| | - Esther Onecha
- Hematology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Imas12, 28041 Madrid, Spain; (I.R.); (E.O.); (G.C.-T.)
- Hematological Malignancies Clinical Research Unit, CNIO, 28029 Madrid, Spain
| | - David Martínez-Cuadrón
- Hematology Department, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain;
| | - Gonzalo Carreño-Tarragona
- Hematology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Imas12, 28041 Madrid, Spain; (I.R.); (E.O.); (G.C.-T.)
- Hematological Malignancies Clinical Research Unit, CNIO, 28029 Madrid, Spain
| | - Juan Miguel Bergua
- Hematology Department, Hospital San Pedro Acantara, 10003 Cáceres, Spain;
| | - Susana Vives
- Department of Hematology, ICO Badalona-Hospital Germans Trias i Pujol. Josep Carreras Leukemia Research Institute. Universitat Autònoma de Barcelona, 08916 Badalona, Spain;
| | | | - Mar Tormo
- Hematology Department, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain;
| | - Pilar Martinez
- Hematology Department, Hospital 12 de Octubre, 28041 Madrid, Spain;
| | - Josefina Serrano
- Hematology Department, Hospital Universitario Reina Sofía, 14004 Cordoba, Spain;
| | - Pilar Herrera
- Hematology Department, Hospital Ramon y Cajal, 28034 Madrid, Spain;
| | - Fernando Ramos
- Hematology Department, Hospital Universitario de León, 24008 León, Spain;
| | - Olga Salamero
- Hematology Department, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain;
| | - Esperanza Lavilla
- Hematology Department, Hospital Universitario Xeral de Lugo, 27003 Lugo, Spain;
| | - Cristina Gil
- Hematology Department, Hospital General de Alicante, 03010 Alicante, Spain;
| | | | - María Belén Vidriales
- Hematology Department, Hospital Universitario de Salamanca, IBSAL, 37007 Salamanca, Spain;
| | - Jorge Labrador
- Hematology Department, Hospital Universitario de Burgos, 09001 Burgos, Spain;
| | - José Francisco Falantes
- Hematology Department, Hospital Universitario Vírgen del Rocío, Instituto de BioMedicina de Sevilla, 41013 Sevilla, Spain;
| | - María José Sayas
- Hematology Department, Hospital Doctor Peset, 46017 Valencia, Spain;
| | - Bruno Paiva
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto Carlos III, 28029 Madrid, Spain; (B.P.); (E.B.); (F.P.); (M.Á.S.); (P.M.)
- Hematology Department, Clínica Universitaria de Navarra, 31008 Navarra, Spain
| | - Eva Barragán
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto Carlos III, 28029 Madrid, Spain; (B.P.); (E.B.); (F.P.); (M.Á.S.); (P.M.)
- Hematology Department, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain;
| | - Felipe Prosper
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto Carlos III, 28029 Madrid, Spain; (B.P.); (E.B.); (F.P.); (M.Á.S.); (P.M.)
- Hematology Department, Clínica Universitaria de Navarra, 31008 Navarra, Spain
| | - Miguel Ángel Sanz
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto Carlos III, 28029 Madrid, Spain; (B.P.); (E.B.); (F.P.); (M.Á.S.); (P.M.)
- Hematology Department, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain;
| | - Joaquín Martínez-López
- Hematology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Imas12, 28041 Madrid, Spain; (I.R.); (E.O.); (G.C.-T.)
- Hematological Malignancies Clinical Research Unit, CNIO, 28029 Madrid, Spain
- Departament of Medicine, Complutense University, 28040 Madrid, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto Carlos III, 28029 Madrid, Spain; (B.P.); (E.B.); (F.P.); (M.Á.S.); (P.M.)
- Correspondence: (R.A.); (J.M.-L.)
| | - Pau Montesinos
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto Carlos III, 28029 Madrid, Spain; (B.P.); (E.B.); (F.P.); (M.Á.S.); (P.M.)
- Hematology Department, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain;
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González Vicent M, Díaz de Heredia C, González de Pablo J, Molina B, Regueiro A, Pérez Martinez A, Palomo P, López Corral L, García E, Fernández JM, Pérez A, Jiménez MJ, Guerreiro M, Vallejo C, Gallardo AI, López O, Benito A, Marsal J, Duarte M, Bento L, Badell I, Pedraza A, Jiménez Ubieto A, González P, Gómez Centurión I, Costilla L, Beléndez C, Esquirol A, Espigado I, Lavilla E, Díaz MÁ. Defibrotide in hematopoietic stem cell transplantation: A multicenter survey study of the Spanish Hematopoietic Stem Cell Transplantation Group (GETH). Eur J Haematol 2021; 106:842-850. [PMID: 33713387 DOI: 10.1111/ejh.13618] [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: 11/17/2020] [Revised: 03/03/2021] [Accepted: 03/03/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Defibrotide is approved in European Union for the treatment of severe sinusoidal obstruction syndrome (SOS) after HSCT. However, it has also been used for SOS prophylaxis, moderate SOS and in other complications such as transplant-associated thrombotic microangiopathy (TAM). The objective of this study was to evaluate current uses, effectiveness and safety of defibrotide in patients with HSCT. METHODS This multicenter, retrospective study included patients treated with defibrotide for any indication at 28 HSCT centers of the Grupo Español de Trasplante Hematopoyetico (GETH) including the pediatric subgroup Grupo Español de Trasplante de Medula en Niños (GETMON). RESULTS Three hundred and eighty eight patients treated with defibrotide between January 2011 and December 2018 were included. 253 patients were children, and 135 patients were adults. In total, 332 transplants were allogeneic, and the remainder were autologous. Main indications for defibrotide use were severe/very severe SOS in 173 patients, SOS prophylaxis in 135 patients, moderate SOS in 41 patients, TAM in six patients and suspected SOS in 33 patients. Overall survival (OS) at day +100 in the SOS prophylaxis group was 89% (95% CI, 87%-91%). In the group of patients with moderate and severe/very severe SOS, the OS at day +100 was 80% (95% CI, 74%-86%) and 62% (95% CI, 59%-65%), respectively (P = .0015). With a longer follow-up, median of 2 years (4 months-7 years), OS was 63% (95% CI, 59%-67%) in the SOS prophylaxis patients. OS for patients with moderate and severe/very severe SOS groups was 53% (95% CI, 47%-61%) and 26% (95% CI, 22%-30%), respectively (P = .006). 191 patients died, and SOS was the main cause of death in 23 patients (12%). CONCLUSIONS Defibrotide has an acceptable safety profile with an improved response in severe/very severe SOS compared with historical controls, mainly in pediatric patients. Use of defibrotide for prophylaxis may improve prognosis of patients at high risk of complications due to endothelial damage such as those who receive a second transplant. SOS has an important impact on the HSCT long-term survival, as can be concluded from our study.
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Affiliation(s)
| | | | | | | | | | | | - Pilar Palomo
- BMT Unit, Hospital Central de Asturias, Oviedo, Spain
| | | | | | | | | | | | | | - Carlos Vallejo
- BMT Unit, Hospital Universitario de Donosti, San Sebastián, Spain
| | | | - Oriana López
- BMT Unit, Hospital Morales Meseguer, Murcia, Spain
| | - Ana Benito
- BMT Unit, Hospital Regional de Málaga, Málaga, Spain
| | - Julia Marsal
- BMT Unit, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Mónica Duarte
- BMT Unit, Hospital Marqués de Valdecilla, Santander, Spain
| | - Leyre Bento
- BMT Unit, Hospital Son Espases, Mallorca, Spain
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5
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Rodriguez-Otero P, Sirvent M, González-Rodríguez AP, Lavilla E, de Coca AG, Arguiñano JM, Martí JM, Cabañas V, Motlló C, de Cabo E, Encinas C, Murillo I, Hernández-Rivas JÁ, Pérez-Persona E, Casado F, Sampol A, García R, Blanchard MJ, Anguita M, Lafuente AP, Iñigo B, López A, Ribas P, Arnao M, Maldonado R, Bladé J, Mateos MV, Lahuerta JJ, San Miguel JF. Pomalidomide, Cyclophosphamide, and Dexamethasone for the Treatment of Relapsed/Refractory Multiple Myeloma: Real-World Analysis of the Pethema-GEM Experience. Clin Lymphoma Myeloma Leuk 2021; 21:413-420. [PMID: 33741302 DOI: 10.1016/j.clml.2021.02.004] [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] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/02/2021] [Accepted: 02/10/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Treatment of relapsed/refractory multiple myeloma (RRMM) is highly challenging, especially for patients with disease refractory to initial therapy, and in particular for disease developing refractoriness to lenalidomide. Indeed, with currently approved treatments, median progression-free survival (PFS) in the lenalidomide-refractory setting is less than 10 months, reflecting the difficulty in treating this patient population. Pomalidomide is a second-generation immunomodulatory drug that has shown activity in lenalidomide-refractory disease in the setting of different combinations. PATIENTS AND METHODS A real-world study was conducted by the Spanish Myeloma group in a cohort of patients with RRMM treated with pomalidomide, cyclophosphamide, and dexamethasone (PomCiDex). One hundred patients were treated with a median of 3 prior lines of therapy. RESULTS Overall response rate was 39%, with a clinical benefit rate of 93%. Median PFS was 7.6 months; median overall survival (OS) was 12.6 months. Median PFS and OS survival were consistent across the different subgroups analyzed. Prolonged PFS and OS were found in patients with responsive disease. CONCLUSION Our results compared favorably with those obtained with different pomalidomide-based combinations in a similar patient population. PomCiDex remains a manageable, cost-effective, and all-oral triplet combination for RRMM patients.
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Affiliation(s)
| | - Maialen Sirvent
- Department of Hematology, Hospital Donostia, San Sebastian, Spain
| | | | | | - Alfonso García de Coca
- Department of Hematology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Josep M Martí
- Department of Hematology, Hospital Universitari Mutua Terrassa, Terrassa, Spain
| | - Valentin Cabañas
- Department of Hematology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Cristina Motlló
- Department of Hematology, Hospital de Sant Joan de Déu, Fundació Althaia, Manresa, Spain
| | - Erik de Cabo
- Department of Hematology, Hospital de El Bierzo, León, Spain
| | - Cristina Encinas
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ilda Murillo
- Department of Hematology, Hospital General San Jorge, Huesca, Spain
| | | | | | - Felipe Casado
- Department of Hematology, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Antonia Sampol
- Department of Hematology, Hospital Universitario Son Espases, Mallorca, Spain
| | - Ricarda García
- Department of Hematology, Complejo Hospitalario de Especialidades Virgen de la Victoria, Málaga, Spain
| | | | | | | | - Belén Iñigo
- Department of Hematology, Hospital Clinico San Carlos, Madrid, Spain
| | - Aurelio López
- Department of Hematology, Hospital Arnau de Vilanova, Lleida, Spain
| | - Paz Ribas
- Department of Hematology, Hospital Universitario Dr Peset Aleixandre, Valencia, Spain
| | - Mario Arnao
- Department of Hematology, Hospital Universitario La Fe, Valencia, Spain
| | | | - Joan Bladé
- Department of Hematology, Hospital Clinic de Barcelona, IDIBAPS, Barcelona, Spain
| | | | - Juan José Lahuerta
- Department of Hematology, Hospital Universitario 12 de octubre, Madrid, Spain
| | - Jesús F San Miguel
- Department of Hematology, Clínica Universidad de Navarra, Pamplona, Spain
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6
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Vives S, Martínez-Cuadrón D, Bergua Burgues J, Algarra L, Tormo M, Martínez-Sánchez MP, Serrano J, Herrera P, Ramos F, Salamero O, Lavilla E, López-Lorenzo JL, Gil C, Vidriales B, Falantes JF, Serrano A, Labrador J, Sayas MJ, Foncillas MÁ, Amador Barciela ML, Olave MT, Colorado M, Gascón A, Fernández MÁ, Simiele A, Pérez-Encinas MM, Rodríguez-Veiga R, García O, Martínez-López J, Barragán E, Paiva B, Sanz MÁ, Montesinos P. A phase 3 trial of azacitidine versus a semi-intensive fludarabine and cytarabine schedule in older patients with untreated acute myeloid leukemia. Cancer 2021; 127:2003-2014. [PMID: 33626197 DOI: 10.1002/cncr.33403] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 10/22/2020] [Accepted: 11/10/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Options to treat elderly patients (≥65 years old) newly diagnosed with acute myeloid leukemia (AML) include intensive and attenuated chemotherapy, hypomethylating agents with or without venetoclax, and supportive care. This multicenter, randomized, open-label, phase 3 trial was designed to assess the efficacy and safety of a fludarabine, cytarabine, and filgrastim (FLUGA) regimen in comparison with azacitidine (AZA). METHODS Patients (n = 283) were randomized 1:1 to FLUGA (n = 141) or AZA (n = 142). Response was evaluated after cycles 1, 3, 6, and 9. Measurable residual disease (MRD) was assessed after cycle 9. When MRD was ≥0.01%, patients continued with the treatment until relapse or progressive disease. Patients with MRD < 0.01% suspended treatment to enter the follow-up phase. RESULTS The complete remission (CR) rate after 3 cycles was significantly better in the FLUGA arm (18% vs 9%; P = .04), but the CR/CR with incomplete recovery rate at 9 months was similar (33% vs 29%; P = .41). There were no significant differences between arms in early mortality at 30 or 60 days. Hematologic toxicities were more frequent with FLUGA, especially during induction. The 1-year overall survival (OS) rate and the median OS were superior with AZA versus FLUGA: 47% versus 27% and 9.8 months (95% confidence interval [CI], 5.6-14 months) versus 4.1 months (95% CI, 2.7-5.5 months; P = .005), respectively. The median event-free survival was 4.9 months (95% CI, 2.8-7 months) with AZA and 3 months (95% CI, 2.5-3.5 months) with FLUGA (P = .001). CONCLUSIONS FLUGA achieved more remissions after 3 cycles, but the 1-year OS rate was superior with AZA. However, long-term outcomes were disappointing in both arms (3-year OS rate, 10% vs 5%). This study supports the use of an AZA backbone for future combinations in elderly patients with AML.
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Affiliation(s)
- Susana Vives
- Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain.,José Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - David Martínez-Cuadrón
- Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Spanish Biomedical Research Centre in Cancer, Carlos III Institute, Madrid, Spain
| | | | | | - Mar Tormo
- Hospital Clínic de Valencia (INCLIVA), Valencia, Spain
| | | | | | | | | | | | | | | | - Cristina Gil
- Hospital General Universitario de Alicante, Alicante, Spain
| | - Belén Vidriales
- Hospital Universitario de Salamanca, IBSAL, Salamanca, Spain
| | - Jose F Falantes
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, Seville, Spain
| | | | | | | | | | | | | | | | - Adriana Gascón
- Hospital General Universitari de Castelló, Castelló, Spain
| | | | | | | | - Rebeca Rodríguez-Veiga
- Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Spanish Biomedical Research Centre in Cancer, Carlos III Institute, Madrid, Spain
| | - Olga García
- Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain.,José Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Eva Barragán
- Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Spanish Biomedical Research Centre in Cancer, Carlos III Institute, Madrid, Spain
| | - Bruno Paiva
- Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Miguel Á Sanz
- Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Spanish Biomedical Research Centre in Cancer, Carlos III Institute, Madrid, Spain
| | - Pau Montesinos
- Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Spanish Biomedical Research Centre in Cancer, Carlos III Institute, Madrid, Spain
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7
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Ribera JM, García O, Chapchap EC, Gil C, González-Campos J, Barba P, Amigo ML, Moreno MJ, Lavilla E, Alonso N, Bergua JM, Tormo M, Ribera J, Sierra M, Martínez-Carballeira D, Mercadal S, Hernández-Rivas JM, Vall-Llovera F, Genescà E, Cladera A, Novo A, Abella E, García-Cadenas I, Monteserín C, Bermúdez A, Piernas S, Montesinos P, López JL, García-Guiñón A, Serrano A, Martínez MP, Olivares M, López A, Serrano J. Treatment of Frail Older Adults and Elderly Patients With Philadelphia Chromosome-negative Acute Lymphoblastic Leukemia: Results of a Prospective Trial With Minimal Chemotherapy. Clin Lymphoma Myeloma Leuk 2020; 20:e513-e522. [PMID: 32336676 DOI: 10.1016/j.clml.2020.03.011] [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] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/18/2020] [Accepted: 03/23/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND The treatment of acute lymphoblastic leukemia (ALL) in older adults and elderly patients is a challenge, and modern protocols include targeted therapy and immunotherapy in combination with attenuated or minimal chemotherapy. However, frail patients are excluded from these trials, and reports on the outcome of this subgroup of patients are scarce. Our objective was to analyze the outcome of unfit older adults and elderly patients with Philadelphia chromosome-negative ALL included in a prospective trial (ALL-07FRAIL). PATIENTS AND METHODS Older adults and elderly patients with Charlson Comorbidity Index (CCI) ≥ 4 were included. Induction therapy consisted of vincristine and dexamethasone, and maintenance therapy with mercaptopurine and methotrexate for 2 years. RESULTS Seventy-two patients with a median age of 67 years (range, 57-89 years) and a median CCI of 5 (range, 4-12) were included. The rates of early withdrawal, early death, resistance, and complete response (CR) were 5%, 10%, 31%, and 54%, respectively. Six patients with CR abandoned the study, 5 died in CR, and 23 relapsed (cumulative relapse incidence 75%). The medians of disease-free and overall survival (OS) were 6.9 months (95% confidence interval [CI], 0.3-13.5 months) and 7.6 months (95% CI, 6.3-8.9 months), respectively. The most frequent toxic events were hematologic (neutropenia 77% and thrombocytopenia 54%, of grade III-IV in all cases). Eastern Cooperative Oncology Group score but not the CCI had significant impact on OS. CONCLUSION Complete remission with very attenuated chemotherapy can be attained in one-half of older or elderly infirm patients with ALL. These results suggest that some of these patients could benefit from the concomitant or subsequent use of immunotherapy and/or targeted therapy.
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Affiliation(s)
- Josep-Maria Ribera
- Hematology Department, ICO-Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute (IJC), Universitat Autònoma de Barcelona, Badalona, Spain.
| | - Olga García
- Hematology Department, ICO-Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute (IJC), Universitat Autònoma de Barcelona, Badalona, Spain
| | | | - Cristina Gil
- Hematology Department, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Pere Barba
- Hematology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - María-Luz Amigo
- Hematology Department, Hospital General Universitario Morales Meseguer, Murcia, Spain
| | | | | | - Natalia Alonso
- Hematology Department, Complejo Hospitalario Universitario, Santiago de Compostela, Spain
| | | | - Mar Tormo
- Hematology Department, Hospital Clínico, Valencia, Spain
| | - Jordi Ribera
- Hematology Department, ICO-Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute (IJC), Universitat Autònoma de Barcelona, Badalona, Spain
| | - Magdalena Sierra
- Hematology Department, Hospital Virgen de la Concha, Zamora, Spain
| | | | - Santiago Mercadal
- Hematology Department, Institut Català d'Oncologia-Hospital Duran i Reynals, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | | | - Eulàlia Genescà
- Hematology Department, ICO-Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute (IJC), Universitat Autònoma de Barcelona, Badalona, Spain
| | - Antònia Cladera
- Hematology Department, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain
| | - Andrés Novo
- Hematology Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Eugènia Abella
- Hematology Department, Hospital del Mar, Barcelona, Spain
| | | | - Carmen Monteserín
- Hematology Department, Hospital Universitario de Getafe, Getafe, Spain
| | - Arancha Bermúdez
- Hematology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Sonia Piernas
- Hematology Department, Consorci Corporació Sanitària Parc Taulí, Sabadell, Spain
| | - Pau Montesinos
- Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Jose-Luis López
- Hematology Department, Fundación Jiménez Díaz, Madrid, Spain
| | | | - Alfons Serrano
- Hematology Department, Hospital Madrid Norte Sanchinarro, Madrid, Spain
| | | | | | - Aurelio López
- Hematology Department, Hospital Arnau de Vilanova, Valencia, Spain
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8
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Boque C, Antonio M, Hormigo A, Córdoba R, Lavilla E, Barrenetxea C, Cobo M, Fiallo D, Gonzalez Gascon Y Marin I, Jentoff A. EPIDEMIOLOGICAL STUDY ON THE GERIATRIC ASSESSMENT IN PATIENTS WITH HEMATOLOGICAL CANCER: AN UPDATE OF THE REGISTRY OF THE SPANISH GROUP ON HEMATOGERIATRICS. J Geriatr Oncol 2019. [DOI: 10.1016/s1879-4068(19)31170-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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9
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Ribera J, García O, Moreno M, Barba P, García‐Cadenas I, Mercadal S, Montesinos P, Barrios M, González‐Campos J, Martínez‐Carballeira D, Gil C, Ribera J, Vives S, Novo A, Cervera M, Serrano J, Lavilla E, Abella E, Tormo M, Amigo M, Artola M, Genescà E, Bravo P, García‐Belmonte D, García‐Guiñón A, Hernández‐Rivas J, Feliu E. Incidence and outcome after first molecular versus overt recurrence in patients with Philadelphia chromosome–positive acute lymphoblastic leukemia included in the ALL Ph08 trial from the Spanish PETHEMA Group. Cancer 2019; 125:2810-2817. [DOI: 10.1002/cncr.32156] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/08/2019] [Accepted: 03/18/2019] [Indexed: 01/13/2023]
Affiliation(s)
- Josep‐Maria Ribera
- Department of Clinical Hematology ICO Badalona‐Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Autonomous University of Barcelona Badalona Spain
| | - Olga García
- Department of Clinical Hematology ICO Badalona‐Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Autonomous University of Barcelona Badalona Spain
| | - María‐José Moreno
- Department of Hematology Hospital of the Virgen de la Victoria Malaga Spain
| | - Pere Barba
- Department of Hematology Vall d’Hebron University Hospital, Autonomous University of Barcelona Barcelona Spain
| | | | - Santiago Mercadal
- Department of Hematology ICO‐Hospital Duran i Reynals, L’Hospitalet de Llobregat Catalonia Spain
| | - Pau Montesinos
- Department of Hematology Le Fe University and Polytechnic Hospital Valencia Spain
| | - Manuel Barrios
- Department of Hematology Carlos Haya Hospital Malaga Spain
| | | | | | - Cristina Gil
- Department of Hematology General University Hospital of Alicante Alicante Spain
| | - Jordi Ribera
- Department of Clinical Hematology ICO Badalona‐Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Autonomous University of Barcelona Badalona Spain
| | - Susana Vives
- Department of Clinical Hematology ICO Badalona‐Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Autonomous University of Barcelona Badalona Spain
| | - Andrés Novo
- Department of Hematology Son Espases Hospital Palma de Mallorca Spain
| | - Marta Cervera
- Department of Hematology ICO‐Hospital Joan XXIII Tarragona Spain
| | | | | | - Eugenia Abella
- Department of Hematology del Mar Hospital Barcelona Spain
| | - Mar Tormo
- Department of Hematology Clinical Hospital Valencia Spain
| | - María‐Luz Amigo
- Department of Hematology Morales Meseguer University General Hospital Murcia Spain
| | | | - Eulalia Genescà
- Department of Clinical Hematology ICO Badalona‐Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Autonomous University of Barcelona Badalona Spain
| | - Pilar Bravo
- Department of Hematology Fuenlabrada University Hospital Madrid Spain
| | | | | | | | - Evarist Feliu
- Department of Clinical Hematology ICO Badalona‐Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Autonomous University of Barcelona Badalona Spain
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10
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Martínez-Cuadrón D, Gil C, Serrano J, Rodríguez G, Pérez-Oteyza J, García-Boyero R, Jiménez-Bravo S, Vives S, Vidriales MB, Lavilla E, Pérez-Simón JA, Tormo M, Colorado M, Bergua J, López JA, Herrera P, Hernández-Campo P, Gorrochategui J, Primo D, Rojas JL, Villoria J, Moscardó F, Troconiz I, Linares Gómez M, Martínez-López J, Ballesteros J, Sanz M, Montesinos P. A precision medicine test predicts clinical response after idarubicin and cytarabine induction therapy in AML patients. Leuk Res 2018; 76:1-10. [PMID: 30468991 DOI: 10.1016/j.leukres.2018.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 06/06/2018] [Revised: 10/29/2018] [Accepted: 11/12/2018] [Indexed: 01/20/2023]
Abstract
Complete remission (CR) after induction therapy is the first treatment goal in acute myeloid leukemia (AML) patients and has prognostic impact. Our purpose is to determine the correlation between the observed CR/CRi rate after idarubicin (IDA) and cytarabine (CYT) 3 + 7 induction and the leukemic chemosensitivity measured by an ex vivo test of drug activity. Bone marrow samples from adult patients with newly diagnosed AML were included in this study. Whole bone marrow samples were incubated for 48 h in well plates containing IDA, CYT, or their combination. Pharmacological response parameters were estimated using population pharmacodynamic models. Patients attaining a CR/CRi with up to two induction cycles of 3 + 7 were classified as responders and the remaining as resistant. A total of 123 patients fulfilled the inclusion criteria and were evaluable for correlation analyses. The strongest clinical predictors were the area under the curve of the concentration response curves of CYT and IDA. The overall accuracy achieved using MaxSpSe criteria to define positivity was 81%, predicting better responder (93%) than non-responder patients (60%). The ex vivo test provides better yet similar information than cytogenetics, but can be provided before treatment representing a valuable in-time addition. After validation in an external cohort, this novel ex vivo test could be useful to select AML patients for 3 + 7 regimen vs. alternative schedules.
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Affiliation(s)
- David Martínez-Cuadrón
- Hospital Universitari i Politècnic La Fe, Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Cristina Gil
- Hospital General Universitario de Alicante, Alicante, Spain
| | | | | | | | | | | | - Susana Vives
- ICO-Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | | | | | | | - Mar Tormo
- Hospital Clínico Universitario, Valencia, Spain
| | | | - Juan Bergua
- Hospital San Pedro de Alcántara, Cáceres, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | - Miguel Sanz
- Hospital Universitari i Politècnic La Fe, Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Pau Montesinos
- Hospital Universitari i Politècnic La Fe, Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain.
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11
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Villegas A, Núñez R, Gaya A, Cuevas-Ruiz MV, Bosch JM, Carral A, Arrizabalaga B, Gómez-Roncero MI, Mora A, Bravo P, Lavilla E, Monteserín C, Hernández B, Martínez-Barranco P, Jarque I, Urquía MA, García-Donas G, Brunet S, González FA, Urbano Á. Presence of acute and chronic renal failure in patients with paroxysmal nocturnal hemoglobinuria: results of a retrospective analysis from the Spanish PNH Registry. Ann Hematol 2017; 96:1727-1733. [PMID: 28748287 DOI: 10.1007/s00277-017-3059-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 03/12/2016] [Accepted: 07/03/2017] [Indexed: 01/16/2023]
Abstract
Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, life-threatening blood disease. With the advent of eculizumab treatment, renal function has substantially improved, although no data from real-world clinical practice are available. An observational, retrospective, multicenter study was conducted in Spain on clinical data obtained from outpatient visits of patients with PNH (Spanish PNH Registry) who had experienced acute (ARF) or chronic (CRF) renal failure. Of the 128 patients registered (April 2014), 60 were diagnosed with classic PNH. Twenty-seven (45.0%) patients with a mean age of 48.5 (±16.2) years had renal failure, ARF or CRF, and were included in this study. Near half of the patients (n = 13; 48.1%) presented with ARF alone, 33.3% (n = 9) had CRF with episodes of ARF, while 18.5% (n = 5) were diagnosed with CRF alone. For patients with diagnosis of PNH and renal failure (n = 27), the median time to the first ARF episode was 6.5 (CI 95%; 2.2, 14.9) years, whereas the median to the diagnosis of CRF was 14.5 (CI 95%; 3.8, 19.2) years after the diagnosis of PNH. Patients with ARF (n = 22) were treated with eculizumab and did not experience new episodes of ARF, except for one patient with sepsis. Of the patients with CRF, two received treatment without experiencing further episodes of ARF. Sixteen patients who completed treatment (11 with ARF and 5 with ARF + CRF) recovered from the episode of ARF or from CRF. Of the remaining patients treated with eculizumab, one patient improved from stages III to II, three patients stabilized without showing disease progression, and one patient progressed from stages III to IV. Treatment with eculizumab in PNH patients has beneficial effects on renal function, preventing ARF and progression to CRF.
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MESH Headings
- Acute Kidney Injury/drug therapy
- Acute Kidney Injury/epidemiology
- Acute Kidney Injury/etiology
- Acute Kidney Injury/physiopathology
- Adolescent
- Adult
- Aged
- Antibodies, Monoclonal, Humanized/administration & dosage
- Female
- Hemoglobinuria, Paroxysmal/complications
- Hemoglobinuria, Paroxysmal/drug therapy
- Hemoglobinuria, Paroxysmal/epidemiology
- Hemoglobinuria, Paroxysmal/physiopathology
- Humans
- Male
- Middle Aged
- Registries
- Renal Insufficiency, Chronic/drug therapy
- Renal Insufficiency, Chronic/epidemiology
- Renal Insufficiency, Chronic/etiology
- Renal Insufficiency, Chronic/physiopathology
- Retrospective Studies
- Spain/epidemiology
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Affiliation(s)
- Ana Villegas
- Hematology Service, Hospital Clínico San Carlos, Plaza de Cristo Rey s/n, 28040, Madrid, Spain.
- Hematology Service, Universidad Complutense Madrid, Madrid, Spain.
| | - Ramiro Núñez
- Hematology Service, Hospital Virgen del Rocío, Seville, Spain
| | - Anna Gaya
- Hematology Service, Hospital Clínic Barcelona, Barcelona, Spain
| | | | - José Miguel Bosch
- Hematology Service, Hospital Universitario Materno-Insular, Las Palmas de Gran Canaria, Spain
| | - Anna Carral
- Hematology Service, Hospital de Sagunto, Valencia, Spain
| | | | | | - Asunción Mora
- Hematology Service, Hospital Infanta Sofía, Madrid, Spain
| | - Pilar Bravo
- Hematology Service, Hospital de Fuenlabrada, Madrid, Spain
| | | | | | - Belén Hernández
- Hematology Service, Hospital General de Ciudad Real, Ciudad Real, Spain
| | | | | | | | | | - Salut Brunet
- Hematology Service, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Álvaro Urbano
- Hematology Service, Hospital Clínic Barcelona, Barcelona, Spain
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12
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Motlló C, Ribera JM, Morgades M, Granada I, Montesinos P, Mercadal S, González-Campos J, Moreno MJ, Barba P, Cervera M, Barrios M, Novo A, Bernal T, Hernández-Rivas JM, Abella E, Amigo ML, Tormo M, Martino R, Lavilla E, Bergua J, Serrano A, García-Belmonte D, Guàrdia R, Grau J, Feliu E. Frequency and prognostic significance of additional cytogenetic abnormalities to the Philadelphia chromosome in young and older adults with acute lymphoblastic leukemia. Leuk Lymphoma 2017; 59:146-154. [DOI: 10.1080/10428194.2017.1326596] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Cristina Motlló
- Department of Hematology, ICO-Hospital Universitari Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Josep-Maria Ribera
- Department of Hematology, ICO-Hospital Universitari Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mireia Morgades
- Department of Hematology, ICO-Hospital Universitari Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Isabel Granada
- Department of Hematology, ICO-Hospital Universitari Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pau Montesinos
- Department of Hematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Santiago Mercadal
- ICO-Hospital Duran i Reynals, L’Hospitalet de Llobregat, Barcelona, Spain
| | | | | | | | | | | | - Andrés Novo
- Hospital Son Espases, Palma de Mallorca, Palma, Spain
| | | | | | | | | | | | | | | | - Juan Bergua
- Hospital San Pedro de Alcántara, Cáceres, Spain
| | | | | | - Ramon Guàrdia
- Department of Hematology, ICO – Hospital Josep Trueta, Girona, Spain
| | - Javier Grau
- Department of Hematology, ICO-Hospital Universitari Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Evarist Feliu
- Department of Hematology, ICO-Hospital Universitari Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
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13
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Bennett TA, Montesinos P, Moscardo F, Martinez-Cuadron D, Martinez J, Sierra J, García R, de Oteyza JP, Fernandez P, Serrano J, Fernandez A, Herrera P, Gonzalez A, Bethancourt C, Rodriguez-Macias G, Alonso A, Vera JA, Navas B, Lavilla E, Lopez JA, Jimenez S, Simiele A, Vidriales B, Gonzalez BJ, Burgaleta C, Hernandez Rivas JA, Mascuñano RC, Bautista G, Perez Simon JA, Fuente ADL, Rayón C, Troconiz IF, Janda A, Bosanquet AG, Hernandez-Campo P, Primo D, Lopez R, Liebana B, Rojas JL, Gorrochategui J, Sanz MA, Ballesteros J. Pharmacological Profiles of Acute Myeloid Leukemia Treatments in Patient Samples by Automated Flow Cytometry: A Bridge to Individualized Medicine. Clinical Lymphoma Myeloma and Leukemia 2014; 14:305-18. [DOI: 10.1016/j.clml.2013.11.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 10/29/2013] [Accepted: 11/05/2013] [Indexed: 01/26/2023]
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14
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Ribera JM, García O, Fernández-Abellán P, Lavilla E, Bernal MT, González-Campos J, Brunet S, Monteserín MC, Montesinos P, Sarrá J, Calbacho M, Alvarez-Larrán A, Tormo M, Oriol A. Lack of negative impact of Philadelphia chromosome in older patients with acute lymphoblastic leukaemia in the thyrosine kinase inhibitor era: comparison of two prospective parallel protocols. Br J Haematol 2012; 159:485-8. [PMID: 22966847 DOI: 10.1111/bjh.12043] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Suárez L, Vidriales MB, Moreno MJ, López A, García-Laraña J, Pérez-López C, Tormo M, Lavilla E, López-Berges MC, de Santiago M, San Miguel JF, Orfao A. Differences in anti-apoptotic and multidrug resistance phenotypes in elderly and young acute myeloid leukemia patients are related to the maturation of blast cells. Haematologica 2005; 90:54-9. [PMID: 15642669] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Elderly patients with acute myeloid leukemia (AML) have a less favorable outcome, which has been related, among other factors, to multidrug resistance (MDR) phenotypes. DESIGN AND METHODS Freshly obtained erythrocyte-lysed bone marrow samples from 150 elderly patients (> 65 years) with de novo AML and 30 younger AML patients were analyzed using a 4-color immunofluorescence technique for quantitative expression of proteins associated with apoptosis (bcl-2, bax, APO2.7) and MDR (P-gp, MRP, LRP) in 3 blast cell subpopulations, defined according to their maturation stage. RESULTS Although a homogeneous CD34+ blast cell population was more frequent in the elderly patients, (25% vs 7%, p=0.02), no statistically significant differences were detected between the two age groups in the expression of either apoptosis- or MDR-associated proteins, except for slightly higher quantities of LRP protein in the more immature CD34+ blast cell subset in the elderly AML cases (p=0.04). Interestingly, when different blast cell populations were compared, immature (CD34+) blast cells were characterized by higher levels of bcl-2 in both age groups and lower levels of APO2.7 in the elderly group. In addition, higher P-gp levels were found in CD34+ blast cells than in CD34-- ones in elderly AML patients. Reactivity for LRP was low in both elderly and younger patients. INTERPRETATION AND CONCLUSIONS In summary, our results suggest that the higher resistance to chemotherapy observed in elderly AML patients could be related to a higher incidence of cases with a CD34+ homogeneous blast cell population, since these blast cells frequently display a more pronounced anti-apoptotic and MDR1 phenotype.
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Affiliation(s)
- Lilia Suárez
- Department of Hematology, Hospital Universitario, Salamanca, Spain
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16
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Suárez L, Vidriales MB, García-Laraña J, Sanz G, Moreno MJ, López A, Barrena S, Martínez R, Tormo M, Palomera L, Lavilla E, López-Berges MC, de Santiago M, de Equiza MEP, Miguel JFS, Orfao A. CD34+ Cells from Acute Myeloid Leukemia, Myelodysplastic Syndromes, and Normal Bone Marrow Display Different Apoptosis and Drug Resistance–Associated Phenotypes. Clin Cancer Res 2004; 10:7599-606. [PMID: 15569991 DOI: 10.1158/1078-0432.ccr-04-0598] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [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: 11/16/2022]
Abstract
Myelodysplastic syndromes and acute myeloid leukemia (AML) are heterogeneous disorders in which conflicting results in apoptosis and multidrug resistance (MDR) have been reported. We have evaluated by multiparameter flow cytometry the expression of apoptosis- (APO2.7, bcl-2, and bax) and MDR-related proteins [P-glycoprotein (P-gp), multidrug resistance protein (MRP), and lung resistance protein (LRP)] specifically on bone marrow (BM) CD34+ cells, and their major CD32-/dim and CD32+ subsets, in de novo AML (n=90), high-risk myelodysplastic syndrome (n=9), and low-risk myelodysplastic syndrome (n=21) patients at diagnosis, and compared with normal BM CD34+ cells (n=6). CD34+ myeloid cells from AML and high-risk myelodysplastic syndrome patients displayed higher expression of bcl-2 (P <0.0001) and lower reactivity for APO2.7 (P=0.002) compared with low-risk myelodysplastic syndrome and normal controls. Similar results applied to the two predefined CD34+ myeloid cell subsets. No significant differences were found in the expression of P-gp, MRP, and LRP between low-risk myelodysplastic syndrome patients and normal BM, but decreased expression of MRP (P <0.03) in AML and high-risk myelodysplastic syndromes and P-gp (P=0.008) in high-risk myelodysplastic syndromes were detected. Hierarchical clustering analysis showed that low-risk myelodysplastic syndrome patients were clustered next to normal BM samples, whereas high-risk myelodysplastic syndromes were clustered together and mixed with the de novo AML patients. In summary, increased resistance to chemotherapy of CD34+ cells from both AML and high-risk myelodysplastic syndromes would be explained more appropriately in terms of an increased antiapoptotic phenotype rather than a MDR phenotype. In low-risk myelodysplastic syndromes abnormally high apoptotic rates would be restricted to the CD34- cell compartments.
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Affiliation(s)
- Lilia Suárez
- Department of Hematology, Hospital Universitario, Centro de Investigación del Cáncer, University of Salamanca, Salamanca, Spain
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17
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Peñarrubia MJ, Odriozola J, González C, Massagué I, Miguel A, González San Miguel JD, Pérez Encinas M, Lavilla E, Giraldo MP, Casado LF, Ferrer S, Steegmann JL. A randomized study of intermediate as compared with high doses of interferon-alpha for chronic myeloid leukemia: no differences in cytogenetic responses. Ann Hematol 2003; 82:750-8. [PMID: 14517691 DOI: 10.1007/s00277-003-0724-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2003] [Accepted: 05/24/2003] [Indexed: 11/30/2022]
Abstract
Interferon-alpha (IFN-alpha) is a therapy of unquestionable efficacy in chronic myeloid leukemia (CML) patients. The best dose of IFN-alpha in the treatment of CML still remains controversial. Our primary objective was to compare cytogenetic responses in patients treated with intermediate versus high doses of IFN-alpha. A multicenter randomized controlled trial was conducted involving 109 patients with untreated CML in chronic phase from 26 Spanish hospitals. Patients were assigned to receive either an intermediate (2.5 MU/m(2) per day) or high (5 MU/m(2) per day) target dose of IFN-alpha. Hydroxyurea was allowed in both groups. In total, 108 patients were analyzed, 53 in the intermediate- and 55 in the high-dose group. Median follow-up was 47.5 months. The dose of IFN-alpha actually given was lower in the intermediate-dose group (3.83 MU/day) than in the high-dose group (6.6 MU/day) ( p<0.001). The rate of complete cytogenetic response was 24.5% in the intermediate- and 12.7% in the high-dose group (NS). A partial cytogenetic response was obtained in 7.5% and 10.9%, respectively. Cox analysis did not reveal any influence of the randomization arm on cytogenetic response rate. Ten patients in each group discontinued IFN-alpha because of toxicity. Albeit not our primary objective, no differences were found in terms of survival or transformation rate between both groups. Median survival was 73 months; 64% of patients remained free of transformation at 5 years. In terms of cytogenetic response, intermediate doses of IFN-alpha are as effective as high doses in the treatment of CML.
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MESH Headings
- Adult
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/economics
- Cytogenetic Analysis
- Disease Progression
- Dose-Response Relationship, Drug
- Female
- Follow-Up Studies
- Humans
- Interferon-alpha/administration & dosage
- Interferon-alpha/adverse effects
- Interferon-alpha/economics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/blood
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/mortality
- Leukocyte Count
- Male
- Middle Aged
- Survival Analysis
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Affiliation(s)
- M J Peñarrubia
- S. Hematología, Hospital del Río Hortega, Valladolid, Spain
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18
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Suárez L, Vidriales B, García-Laraña J, López A, Martínez R, Martín-Reina V, Tormo M, González-San Miguel JD, Lavilla E, García-Boyero R, Orfao A, San Miguel JF. Multiparametric analysis of apoptotic and multi-drug resistance phenotypes according to the blast cell maturation stage in elderly patients with acute myeloid leukemia. Haematologica 2001; 86:1287-95. [PMID: 11726321] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Acute myeloid leukemia (AML) is a heterogeneous group of malignant diseases, often characterized by coexistence of more than one subpopulation of blast cells. Multiparametric flow cytometry immunophenotyping has proven to be a reliable and sensitive approach for the discrimination of myeloid blast cells from residual normal cells present in bone marrow samples from AML patients and, at the same time, allows the identification of different maturation compartments among myeloid blasts. Therefore, it provides a unique tool for assessing apoptotic and multidrug resistance (MDR)-associated phenotypes in individual subsets of leukemic cells. DESIGN AND METHODS The aim of the present study was to explore the simultaneous expression of proteins related to both apoptosis (APO2.7, bcl-2, bax) and multidrug resistance (MDR1, MRP, LRP) in the different blast cell subpopulations detected at diagnosis in a group of 72 elderly patients with AML. In addition, we included 5 bone marrow samples from healthy adult donors in the analysis. RESULTS Immature blast cells (CD34+: subset I) showed a significantly higher level of bcl-2 expression (p <0.0001) together with a lower reactivity for APO 2.7 (p=0.02) as compared to the other more mature CD34- cell subsets. The expression of Bax parallelled that of APO 2.7, although the difference between immature CD34+ blast cells and the mature blast cell subsets did not reach statistical significance (p=0.18). These results translated into a significantly (p<0.0001) higher bcl-2/bax ratio for the CD34+ blast cells as compared to that of the two CD34- blast cell subpopulations. Regarding the expression of the multidrug resistance-associated proteins Pgp and MRP, CD34+ blast cells displayed a greater expression of both proteins as compared to the more mature CD34- AML blast cells, but differences according to maturation stage of AML blast cells did not reach statistical significance. In contrast, LRP expression was significantly lower in the more immature CD34+ blast cell subset than in the more mature ones (p=0.01). INTERPRETATIONS AND CONCLUSIONS As far as normal bone marrow is concerned our results suggest that all blast cell subpopulations are more protected from apoptosis than their normal counterparts. We conclude that in elderly patients with AML the more immature blast cells are more resistant to apoptotic processes, which could explain why, when AML relapses, the blast cells frequently display a more immature phenotype than that observed at diagnosis. Contradictory results in multidrug resistance profile support the hypothesis that failure to respond to chemotherapeutic drugs in AML is a multifactorial phenomenon.
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Affiliation(s)
- L Suárez
- Department of Hematology, University Hospital of Salamanca, Paseo de San Vicente 58-182, 37007 Salamanca, Spain
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19
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Steegmann JL, Odriozola J, Rodriguez-Salvanés F, Giraldo P, García-Laraña J, Ferro MT, Benítez E, Pérez-Pons C, Giralt M, Escribano L, Lavilla E, Miguel A, Areal C, Pérez-Encinas M, Abad A, Maldonado J, Massagué I, Fernández-Rañada JM. Stage, percentage of basophils at diagnosis, hematologic response within six months, cytogenetic response in the first year: the main prognostic variables affecting outcome in patients with chronic myeloid leukemia in chronic phase treated with interferon-alpha. Results of the CML89 trial of the Spanish Collaborative Group on interferon-alpha2a and CML. Haematologica 1999; 84:978-87. [PMID: 10553157] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Interferon-a (IFN) is increasingly being used as the drug of choice in chronic myeloid leukemia patients. The main objectives of the study were to study the influence of the classic prognostic variables and response to IFN, and to assess the influence of this response on the course of the disease and survival. DESIGN AND METHODS Single arm, prospective, multicenter study, without a control group. Only Ph1-positive CML patients were included. The treatment scheme was biphasic: the patients first received standard chemotherapy and thereafter IFN-a2a was used as monotherapy, with a target dose of 9 MU/d/s.c. RESULTS Twenty-one centers in Spain enrolled 132 patients (72 men, 60 women). The median dose of IFN given was 5.8 MU/d, and the median treatment duration was 431 days (range: 18-2,597). Seventy-two percent of patients obtained a hematologic response in the first six months of IFN treatment. Genetic response was obtained in 47% of the patients, and the response was major or complete in 27% and 19%, respectively. The median time to obtain this response was 7, 9, and 18 months for minimal, partial and complete genetic response, respectively. Multivariant analysis showed that only a higher percentage of basophils at diagnosis was associated with a worse hematologic response at six months (p=0.001) (OR: 1.23) and with a worse cytogenetic response in the first year of IFN therapy (p=0.018) (OR: 1.4). Over an observation period of 8 years, 35.6% of the patients died, and 85 (64.4%) remained alive. With a median follow-up of 42 months (3.7-98), the 6-year projected probabilities of survival and transformation-free survival were 0.61+/-0.07 vs. 0.54+/-0.07, respectively. Patients with Kantarjian's stage 3 disease or in a high-risk Sokal group had lower probabilities of survival, but these systems did not adequately discriminate in our series. Obtaining a complete hematologic response in the first six months of IFN therapy was favorable in terms of overall survival (p=0.05; HR=0.33). Cox's analysis demonstrated that obtaining a cytogenetic response in the first year was independently associated with better overall survival (p=0.04; HR=0.19) and better transformation-free survival (p=0.0035; HR=0.11). INTERPRETATION AND CONCLUSIONS Nearly half of the patients obtained some degree of Philadelphia suppression, which was major in 27%, and complete in 19%. A higher percentage of basophils at diagnosis was the only variable associated with a lower probability of cytogenetic response. Obtaining a cytogenetic response during the first year of IFN treatment was a favorable and independent variable in terms of survival and transformation-free survival. Obtaining a major cytogenetic response during this period decreased the risk of transformation twenty times. Our results suggest that the effect of IFN on survival is independent of the classic prognostic variables.
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Affiliation(s)
- J L Steegmann
- Servicio de Hematología, Hospital de la Princesa, Diego de León 62, 28006 Madrid, Spain.
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20
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Steegmann JL, Granados E, Rodríguez-Salvanés F, Casado LF, Giraldo P, Lavilla E, Gómez-Casares MT, Fernández-Contreras E, Odriozola J. [Interferon alpha in the treatment of chronic myeloid leukemia. Promises, realities, and perspectives]. Sangre (Barc) 1998; 43:137-46. [PMID: 9656775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- J L Steegmann
- Servicio Hematología, Hospital de la Princesa, Madrid
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21
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Arranz R, García-Alfonso P, Sobrino P, Zamora P, Carrión R, García-Laraña J, Pérez G, López J, Lavilla E, Lozano M, Rayón C, Colomer R, Barón MG, Flores E, Pérez-Manga G, Fernández-Rañada JM. Role of interferon alfa-2b in the induction and maintenance treatment of low-grade non-Hodgkin's lymphoma: results from a prospective, multicenter trial with double randomization. J Clin Oncol 1998; 16:1538-46. [PMID: 9580385 DOI: 10.1200/jco.1998.16.4.1538] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [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: 11/20/2022] Open
Abstract
PURPOSE To evaluate the effectiveness of adding interferon (IFN) alfa-2b to chemotherapy in the induction treatment of low-grade non-Hodgkin's lymphoma (NHL), and to assess the role of maintenance IFN. PATIENTS AND METHODS A multicenter, two-phase controlled trial with double randomization was conducted in 155 patients with low-grade NHL. In the first randomization, 78 patients received cyclophosphamide, vincristine, and prednisone (CVP) and IFN, 3 MU/m2 three times a week for 3 months, and 77 patients received CVP alone. Responding patients were randomized to receive IFN for 1 year versus observation. RESULTS Of 144 assessable patients, 73 received CVP + IFN and 71 received CVP. Responses were similar: CVP + IFN 79% versus CVP 76% (P = .62). The number of patients who did not complete the treatment was higher in the CVP + IFN group than in the CVP group (18% v 4%; P = .009), although the received dose-intensity of chemotherapy was comparable. Duration of response and progression-free survival (PFS) were significantly higher in the CVP + IFN group than in the CVP group (P = .0004). However, we observed no differences in overall survival (OS) (P = .30), with a median follow-up for the surviving patients of 3 years. Grade 3/4 granulocytopenia was the most frequent toxicity and was similar in both groups (33% v32%). Eighty-three (74%) of the 112 responding patients were randomized to maintenance IFN or observation. The duration of response was similar between 42 patients that received IFN compared with 41 control patients (P = .83), independently of treatment previously administered. CONCLUSION Adding IFN alfa-2b to induction CVP in low-grade NHL did not induce a higher response rate, but it significantly increased the duration of the responses. We found significant differences in PFS that favored the patients who received CVP + IFN, but not in OS. To date, no additional benefit has been seen from the administration of IFN for maintenance.
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Affiliation(s)
- R Arranz
- Haematology and Clinical Epidemiology Services, Hospital Universitario de la Princesa, Madrid, Spain.
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García-Porrúa C, González-Gay MA, Fernández-Lamelo F, Paz-Carreira JM, Lavilla E, González-López MA. Simultaneous development of SLE-like syndrome and autoimmune thyroiditis following alpha-interferon treatment. Clin Exp Rheumatol 1998; 16:107-8. [PMID: 9543579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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23
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Peñarrubia MJ, Steegmann JL, Lavilla E, Casado F, Requena MJ, Picó M, Arranz R, Fernández-Rañada JM. Hypertriglyceridemia may be severe in CML patients treated with interferon-alpha. Am J Hematol 1995; 49:240-1. [PMID: 7604817 DOI: 10.1002/ajh.2830490311] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [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: 01/26/2023]
Abstract
We analyzed serum triglyceride (TG) levels in 22 chronic myeloid leukemia (CML) patients treated with interferon-alpha (IFN-alpha). Hypertriglyceridemia was present in one-half of patients at diagnosis, and IFN-alpha treatment was associated with a further increase in 90% of the total group of patients. This increase was maximal during the first months of therapy. Four patients (18%) reached levels higher than 1,000 mg/dl. This is the first report describing this secondary effect in CML patients treated with IFN-alpha.
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Affiliation(s)
- M J Peñarrubia
- Hematology Department, Hospital de la Princesa, Madrid, Spain
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Pérez Sánchez M, López J, López JL, Haya S, Lavilla E, Cárdenas MC, Rey L, Gómez N, Fernández-Rañada JM. [3 families with a congenital factor X deficiency, one of them with an associated factor XII deficiency]. Sangre (Barc) 1993; 38:57-61. [PMID: 8470037] [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] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Factor X deficiency constitutes one of the most uncommon congenital bleeding disorders. Here we report three families with Factor X deficiency, one of them with an associated deficit of Factor XII. Family I presented Red variant deficiency (low functional and antigenic activity, the latter in higher levels than the former). In Family II functional activity was low but antigenic one was normal (Prower defect). Besides, an heterozygous deficiency of factor XII was diagnosed. Although genetic analysis supports the hypothesis of combined deficiency, the study was possible in only two generations of the propositus, so a multiple familial deficiency could not be discarded. Finally, Family III suffered from a "classic" or Mr. Stuart deficiency (low levels in functional and immunological assays). Besides, crossed immunoelectrophoresis showed a grossly pathological pattern.
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Arranz R, Lavilla E, García Alfonao P, Carrión R, Zamora P, Esphosa E, García Laraña J, López J, Pérez G, Lozano M, Coma A, Flores E, González Barón y M, Fernández Pmflada J, La Princess H, Gregorio Marafión H, La Paz H, Ramón y Cajal H, Severo Ochoa H. Treatment of low-grade non-Hodgkin's lymphomas (NHL) with CVP ± interferon alfa-2B (IFN). A multicenter randomized prospective trial preliminary results. Eur J Cancer 1993. [DOI: 10.1016/0959-8049(93)91605-k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Fernandez-Rañada JM, Lavilla E, Odriozola J, Garcia-Laraña J, Lozano M, Parody R, Giraldo MP, Carbonell F, Ferro MT, Steegmann JL. Interferon alpha 2A in the treatment of chronic myelogenous leukemia in chronic phase. Results of the Spanish Group. Leuk Lymphoma 1993; 11 Suppl 1:175-9. [PMID: 8251892 DOI: 10.3109/10428199309047882] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [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: 01/29/2023]
Abstract
Fifty-one patients with CML in chronic phase, less than two years after diagnosis, were included in one multicentric study aiming to assess the therapeutic value of interferon alpha 2a (IFN alpha 2a) in this setting. The therapeutic scheme was biphasic: The patients were first treated with hydroxyurea, and afterwards only received IFN alpha 2a, at a planned dose of 5MU/m2/day, s.c. Thirty-eight patients (81%) achieved an hematologic response, which was complete in 57% of the total group. The median time to response was of 42 days. In the last evaluation, a complete hematologic response was sustained in 21 patients (47%). Philadelphia suppression was obtained in 44% of the patients who achieved hematologic responses; major cytogenetic responses were obtained in 16% of the patients. The patients who obtained genetic responses were significantly younger and had a shorter interval from diagnosis to IFN than the patients who did not respond. At the moment of evaluation, 90% of the patients are alive, but the median follow-up of the series (217 days, range 21-1150) is too short to analyze any impact of IFN over survival. Six patients (12%) discontinued IFN because of toxicity, three of them because of severe flu-like syndrome. Leukopenia and thrombocytopenia were frequent, but rarely severe. Hypertriglyceridemia has been a very frequent finding.
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