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Bessede A, Marabelle A, Guégan JP, Danlos FX, Cousin S, Peyraud F, Chaput N, Spalato M, Roubaud G, Cabart M, Khettab M, Chaibi A, Rey C, Nafia I, Mahon FX, Soria JC, Italiano A. Impact of acetaminophen on the efficacy of immunotherapy in cancer patients. Ann Oncol 2022; 33:909-915. [PMID: 35654248 DOI: 10.1016/j.annonc.2022.05.010] [Citation(s) in RCA: 4] [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: 03/31/2022] [Revised: 05/09/2022] [Accepted: 05/24/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Acetaminophen (APAP) use has been associated with blunted vaccine immune responses. This study aimed to assess APAP impact on immunotherapy efficacy in patients with cancer. PATIENTS AND METHODS Exposure to APAP was assessed by plasma analysis and was correlated with clinical outcome in three independent cohorts of patients with advanced cancer who were treated with immune checkpoint blockers (ICB). APAP immunomodulatory effects were evaluated on a pre-clinical tumor model and on human peripheral blood mononuclear cells (PBMCs) from healthy donors. RESULTS Detectable plasma APAP levels at treatment onset was associated with a significantly worse clinical outcome in ICB-treated cancer patients, independently of other prognostic factors. APAP significantly reduced ICB efficacy in the pre-clinical MC38 model, as well as the production of PD1 blockade-related interferon-γ secretion by human PBMCs. Moreover, reduction of ICB efficacy in vivo was associated with significantly increased tumor infiltration by regulatory T cells (Tregs). Administration of APAP over 24 h induced a significant expansion of peripheral Tregs in healthy individuals. In addition, interleukin-10, a crucial mediator of Treg-induced immune suppression, was significantly upregulated upon treatment with ICB in cancer patients taking APAP. CONCLUSION This study provides strong pre-clinical and clinical evidence of the role of APAP as a potential suppressor of antitumor immunity. Hence, APAP should be used with caution in patients treated with ICB.
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Affiliation(s)
- A Bessede
- Explicyte, 229 cours de l'Argonne, Bordeaux, France
| | - A Marabelle
- Département d'Innovation Précoce et d'Essais Thérapeutiques (DITEP), INSERM U1015 & CIC1428, Université Paris Saclay, Gustave Roussy, Villejuif, France
| | - J P Guégan
- Explicyte, 229 cours de l'Argonne, Bordeaux, France
| | - F X Danlos
- Département d'Innovation Précoce et d'Essais Thérapeutiques (DITEP), INSERM U1015 & CIC1428, Université Paris Saclay, Gustave Roussy, Villejuif, France
| | - S Cousin
- Department of Medicine, Institut Bergonié, Bordeaux, France
| | - F Peyraud
- Department of Medicine, Institut Bergonié, Bordeaux, France
| | - N Chaput
- Laboratory of Immunomonitoring in Oncology, Gustave Roussy Cancer Campus, CNRS-UMS 3655 and INSERM-US23, Villejuif, France; Faculty of Pharmacy, University Paris-Saclay, Chatenay-Malabry, France; Laboratory of Genetic Instability and Oncogenesis, UMR CNRS 8200, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - M Spalato
- Department of Medicine, Institut Bergonié, Bordeaux, France
| | - G Roubaud
- Department of Medicine, Institut Bergonié, Bordeaux, France
| | - M Cabart
- Department of Medicine, Institut Bergonié, Bordeaux, France
| | - M Khettab
- Faculty of Medicine, University of Bordeaux, Bordeaux, France
| | - A Chaibi
- Department of Medicine, Institut Bergonié, Bordeaux, France
| | - C Rey
- Department of Medicine, Institut Bergonié, Bordeaux, France
| | - I Nafia
- Explicyte, 229 cours de l'Argonne, Bordeaux, France
| | - F X Mahon
- Department of Medicine, Institut Bergonié, Bordeaux, France; Faculty of Medicine, University of Bordeaux, Bordeaux, France
| | - J C Soria
- Department of Medicine, Gustave Roussy, Villejuif, France
| | - A Italiano
- Département d'Innovation Précoce et d'Essais Thérapeutiques (DITEP), INSERM U1015 & CIC1428, Université Paris Saclay, Gustave Roussy, Villejuif, France; Department of Medicine, Institut Bergonié, Bordeaux, France; Faculty of Medicine, University of Bordeaux, Bordeaux, France.
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2
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Blay JY, Boucher S, Le Vu B, Cropet C, Chabaud S, Perol D, Barranger E, Campone M, Conroy T, Coutant C, De Crevoisier R, Debreuve-Theresette A, Delord JP, Fumoleau P, Gentil J, Gomez F, Guerin O, Jaffré A, Lartigau E, Lemoine C, Mahe MA, Mahon FX, Mathieu-Daude H, Merrouche Y, Penault-Llorca F, Pivot X, Soria JC, Thomas G, Vera P, Vermeulin T, Viens P, Ychou M, Beaupere S. Delayed care for patients with newly diagnosed cancer due to COVID-19 and estimated impact on cancer mortality in France. ESMO Open 2021; 6:100134. [PMID: 33984676 PMCID: PMC8134718 DOI: 10.1016/j.esmoop.2021.100134] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/01/2021] [Accepted: 04/02/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The impact of the first coronavirus disease 2019 (COVID-19) wave on cancer patient management was measured within the nationwide network of the Unicancer comprehensive cancer centers in France. PATIENTS AND METHODS The number of patients diagnosed and treated within 17 of the 18 Unicancer centers was collected in 2020 and compared with that during the same periods between 2016 and 2019. Unicancer centers treat close to 20% of cancer patients in France yearly. The reduction in the number of patients attending the Unicancer centers was analyzed per regions and cancer types. The impact of delayed care on cancer-related deaths was calculated based on different hypotheses. RESULTS A 6.8% decrease in patients managed within Unicancer in the first 7 months of 2020 versus 2019 was observed. This reduction reached 21% during April and May, and was not compensated in June and July, nor later until November 2020. This reduction was observed only for newly diagnosed patients, while the clinical activity for previously diagnosed patients increased by 4% similar to previous years. The reduction was more pronounced in women, in breast and prostate cancers, and for patients without metastasis. Using an estimated hazard ratio of 1.06 per month of delay in diagnosis and treatment of new patients, we calculated that the delays observed in the 5-month period from March to July 2020 may result in an excess mortality due to cancer of 1000-6000 patients in coming years. CONCLUSIONS In this study, the delays in cancer patient management were observed only for newly diagnosed patients, more frequently in women, for breast cancer, prostate cancer, and nonmetastatic cancers. These delays may result is an excess risk of cancer-related deaths in the coming years.
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Affiliation(s)
- J Y Blay
- Centre Leon Berard, Lyon, France.
| | | | | | - C Cropet
- Centre Leon Berard, Lyon, France
| | | | - D Perol
- Centre Leon Berard, Lyon, France
| | | | - M Campone
- Institut de Cancerologie de l'Ouest, Nantes et Angers, France
| | - T Conroy
- Institut de Cancerologie de Lorraine, Nancy, France
| | - C Coutant
- Centre George Francoise Leclerc, Dijon, France
| | | | | | - J P Delord
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | | | - J Gentil
- Centre George Francoise Leclerc, Dijon, France
| | - F Gomez
- Centre Leon Berard, Lyon, France
| | - O Guerin
- Institut de Cancerologie de l'Ouest, Nantes et Angers, France
| | | | | | - C Lemoine
- Institut Paoli-Calmettes, Marseille, France
| | - M A Mahe
- Centre François Baclesse, Caen, France
| | | | - H Mathieu-Daude
- Institut de Cancerologie de Montpellier, Montpellier, France
| | | | | | - X Pivot
- Centre Paul Strauss/ICANS, Strasbourg, France
| | | | - G Thomas
- Centre François Baclesse, Caen, France
| | - P Vera
- Centre Henri Becquerel, Rouen, France
| | | | - P Viens
- Institut Paoli-Calmettes, Marseille, France
| | - M Ychou
- Institut de Cancerologie de Montpellier, Montpellier, France
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Hochhaus A, Baccarani M, Silver RT, Schiffer C, Apperley JF, Cervantes F, Clark RE, Cortes JE, Deininger MW, Guilhot F, Hjorth-Hansen H, Hughes TP, Janssen JJWM, Kantarjian HM, Kim DW, Larson RA, Lipton JH, Mahon FX, Mayer J, Nicolini F, Niederwieser D, Pane F, Radich JP, Rea D, Richter J, Rosti G, Rousselot P, Saglio G, Saußele S, Soverini S, Steegmann JL, Turkina A, Zaritskey A, Hehlmann R. European LeukemiaNet 2020 recommendations for treating chronic myeloid leukemia. Leukemia 2020; 34:966-984. [PMID: 32127639 PMCID: PMC7214240 DOI: 10.1038/s41375-020-0776-2] [Citation(s) in RCA: 706] [Impact Index Per Article: 176.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 02/07/2023]
Abstract
The therapeutic landscape of chronic myeloid leukemia (CML) has profoundly changed over the past 7 years. Most patients with chronic phase (CP) now have a normal life expectancy. Another goal is achieving a stable deep molecular response (DMR) and discontinuing medication for treatment-free remission (TFR). The European LeukemiaNet convened an expert panel to critically evaluate and update the evidence to achieve these goals since its previous recommendations. First-line treatment is a tyrosine kinase inhibitor (TKI; imatinib brand or generic, dasatinib, nilotinib, and bosutinib are available first-line). Generic imatinib is the cost-effective initial treatment in CP. Various contraindications and side-effects of all TKIs should be considered. Patient risk status at diagnosis should be assessed with the new EUTOS long-term survival (ELTS)-score. Monitoring of response should be done by quantitative polymerase chain reaction whenever possible. A change of treatment is recommended when intolerance cannot be ameliorated or when molecular milestones are not reached. Greater than 10% BCR-ABL1 at 3 months indicates treatment failure when confirmed. Allogeneic transplantation continues to be a therapeutic option particularly for advanced phase CML. TKI treatment should be withheld during pregnancy. Treatment discontinuation may be considered in patients with durable DMR with the goal of achieving TFR.
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MESH Headings
- Aniline Compounds/therapeutic use
- Antineoplastic Agents/therapeutic use
- Clinical Decision-Making
- Consensus Development Conferences as Topic
- Dasatinib/therapeutic use
- Disease Management
- Fusion Proteins, bcr-abl/antagonists & inhibitors
- Fusion Proteins, bcr-abl/genetics
- Fusion Proteins, bcr-abl/metabolism
- Gene Expression
- Humans
- Imatinib Mesylate/therapeutic use
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/mortality
- Life Expectancy/trends
- Monitoring, Physiologic
- Nitriles/therapeutic use
- Protein Kinase Inhibitors/therapeutic use
- Pyrimidines/therapeutic use
- Quality of Life
- Quinolines/therapeutic use
- Survival Analysis
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Affiliation(s)
- A Hochhaus
- Klinik für Innere Medizin II, Universitätsklinikum, Jena, Germany.
| | - M Baccarani
- Department of Hematology/Oncology, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - R T Silver
- Weill Cornell Medical College, New York, NY, USA
| | - C Schiffer
- Karmanos Cancer Center, Detroit, MI, USA
| | - J F Apperley
- Hammersmith Hospital, Imperial College, London, UK
| | | | - R E Clark
- Department of Molecular & Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - J E Cortes
- Georgia Cancer Center, Augusta University, Augusta, GA, USA
| | - M W Deininger
- Huntsman Cancer Center Salt Lake City, Salt Lake City, UT, USA
| | - F Guilhot
- Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - H Hjorth-Hansen
- Norwegian University of Science and Technology, Trondheim, Norway
| | - T P Hughes
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - J J W M Janssen
- Amsterdam University Medical Center, VUMC, Amsterdam, The Netherlands
| | | | - D W Kim
- St. Mary´s Hematology Hospital, The Catholic University, Seoul, Korea
| | | | | | - F X Mahon
- Institut Bergonie, Université de Bordeaux, Bordeaux, France
| | - J Mayer
- Department of Internal Medicine, Masaryk University Hospital, Brno, Czech Republic
| | | | | | - F Pane
- Department Clinical Medicine and Surgery, University Federico Secondo, Naples, Italy
| | - J P Radich
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - D Rea
- Hôpital St. Louis, Paris, France
| | | | - G Rosti
- Department of Hematology/Oncology, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - P Rousselot
- Centre Hospitalier de Versailles, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France
| | - G Saglio
- University of Turin, Turin, Italy
| | - S Saußele
- III. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - S Soverini
- Department of Hematology/Oncology, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy
| | | | - A Turkina
- National Research Center for Hematology, Moscow, Russian Federation
| | - A Zaritskey
- Almazov National Research Centre, St. Petersburg, Russian Federation
| | - R Hehlmann
- III. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany.
- ELN Foundation, Weinheim, Germany.
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4
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Hochhaus A, Saussele S, Rosti G, Mahon FX, Janssen JJWM, Hjorth-Hansen H, Richter J, Buske C. Chronic myeloid leukaemia: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2018; 29:iv261. [PMID: 30285223 DOI: 10.1093/annonc/mdy159] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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5
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Hughes TP, Leber B, Cervantes F, Spector N, Pasquini R, Clementino NCD, Schwarer AP, Dorlhiac-Llacer PE, Mahon FX, Rea D, Guerci-Bresler A, Kamel-Reid S, Bendit I, Acharya S, Glynos T, Dalal D, Branford S, Lipton JH. Sustained deep molecular responses in patients switched to nilotinib due to persistent BCR-ABL1 on imatinib: final ENESTcmr randomized trial results. Leukemia 2017; 31:2529-2531. [PMID: 28862704 PMCID: PMC5668492 DOI: 10.1038/leu.2017.247] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- T P Hughes
- Division of Haematology, SA Pathology and South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - B Leber
- Clinical Pathology, McMaster University, Hamilton, Ontario, Canada
| | - F Cervantes
- Department of Hematology, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - N Spector
- Departamento de Clínica Médica/FM, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - R Pasquini
- Division of Hematology and Medical Oncology, Federal University of Paraná, Curitiba, Brazil
| | | | - A P Schwarer
- Department of Hematology, Alfred Hospital, Melbourne, Victoria, Australia
| | | | - F-X Mahon
- Laboratoire Hématopoïèse Leucémique et Cible Thérapeutique, Inserm U1035, Université Victor Ségalen, Bordeaux, France
| | - D Rea
- Unité de Thérapie Cellulaire et Clinique Transfusionnelle, Service des Maladies du Sang et EA3518, Hôpital Saint-Louis, Paris, France
| | - A Guerci-Bresler
- Department of Hematology, Brabois Hospital, Vandoeuvre-lès-Nancy, Vandoeuvre, France
| | - S Kamel-Reid
- Clinical Laboratory Genetics, Genome Diagnostics, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - I Bendit
- Hematology Unit, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - S Acharya
- Novartis Healthcare Pvt Ltd, Hyderabad, India
| | - T Glynos
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - D Dalal
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - S Branford
- Leukaemia Unit, Centre for Cancer Biology, SA Pathology, University of South Australia and University of Adelaide, Adelaide, South Australia, Australia
| | - J H Lipton
- Blood and Marrow Transplant Service, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
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6
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Hochhaus A, Saussele S, Rosti G, Mahon FX, Janssen JJWM, Hjorth-Hansen H, Richter J, Buske C. Chronic myeloid leukaemia: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2017; 28:iv41-iv51. [PMID: 28881915 DOI: 10.1093/annonc/mdx219] [Citation(s) in RCA: 209] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- A Hochhaus
- Klinik für Innere Medizin II, Hämatologie/Onkologie, Universitätsklinikum Jena, Jena
| | - S Saussele
- III. Medizinische Klinik, Universitätsmedizin Mannheim, Fakultät für Klinische Medizin Mannheim der Universität Heidelberg, Mannheim, Germany
| | - G Rosti
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Haematology and Medical Oncology Lorenzo ed Ariosto Seràgnoli, Bologna University School of Medicine, Bologna, Italy
| | | | - J J W M Janssen
- Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - H Hjorth-Hansen
- Department of Hematology, St Olavs Hospital and Department of Cancer Research and Molecular Medicine, NTNU, Trondheim, Norway
| | - J Richter
- Department of Hematology, Oncology and Radiation Physics, Skane University Hospital, Lund, Sweden
| | - C Buske
- CCC Ulm, Institut für Experimentelle Tumorforschung, Universitätsklinikum Ulm, Ulm, Germany
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7
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Valent P, Sotlar K, Blatt K, Hartmann K, Reiter A, Sadovnik I, Sperr WR, Bettelheim P, Akin C, Bauer K, George TI, Hadzijusufovic E, Wolf D, Gotlib J, Mahon FX, Metcalfe DD, Horny HP, Arock M. Proposed diagnostic criteria and classification of basophilic leukemias and related disorders. Leukemia 2017; 31:788-797. [PMID: 28090091 DOI: 10.1038/leu.2017.15] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 12/14/2016] [Accepted: 12/19/2016] [Indexed: 01/09/2023]
Abstract
Basophils form a distinct cell lineage within the hematopoietic cell family. In various myeloid neoplasms, including chronic myeloid leukemia, basophilia is frequently seen. Acute and chronic basophilic leukemias, albeit rare, have also been described. However, no generally accepted criteria and classification of basophilic leukemias have been presented to date. To address this unmet need, a series of Working Conferences and other meetings were organized between March 2015 and March 2016. The current article provides a summary of consensus statements from these meetings, together with proposed criteria to delineate acute basophilic leukemia (ABL) from chronic basophilic leukemia (CBL) and primary forms of the disease where no preceding myeloid malignancy is detected, from the more common 'secondary' variants. Moreover, the term hyperbasophilia (HB) is proposed for cases with a persistent peripheral basophil count ⩾1000 per μl of blood. This condition, HB, is highly indicative of the presence of an underlying myeloid neoplasm. Therefore, HB is an important checkpoint in the diagnostic algorithm and requires a detailed hematologic investigation. In these patients, an underlying myeloid malignancy is often found and is then labeled with the appendix -baso, whereas primary cases of ABL or CBL are very rare. The criteria and classification proposed in this article should facilitate the diagnosis and management of patients with unexplained basophilia and basophil neoplasms in routine practice, and in clinical studies.
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Affiliation(s)
- P Valent
- Department of Internal Medicine I, Division of Hematology and Hemostaseology and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria
| | - K Sotlar
- Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - K Blatt
- Department of Internal Medicine I, Division of Hematology and Hemostaseology and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria
| | - K Hartmann
- Department of Dermatology, University of Luebeck, Luebeck, Germany
| | - A Reiter
- Department of Hematology and Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - I Sadovnik
- Department of Internal Medicine I, Division of Hematology and Hemostaseology and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria
| | - W R Sperr
- Department of Internal Medicine I, Division of Hematology and Hemostaseology and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria
| | - P Bettelheim
- Division of Laboratory Medicine, Elisabethinen Hospital Linz, Linz, Austria
| | - C Akin
- Division of Rheumatology, Immunology and Allergy, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - K Bauer
- Department of Internal Medicine I, Division of Hematology and Hemostaseology and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria
| | - T I George
- Department of Pathology, University of New Mexico, Albuquerque, NM, USA
| | - E Hadzijusufovic
- Department of Internal Medicine I, Division of Hematology and Hemostaseology and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria
| | - D Wolf
- Medical Clinic III for Oncology, Haematology and Rheumatology, University Hospital Bonn, Bonn, Germany
| | - J Gotlib
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - F-X Mahon
- Laboratoire d'Hématologie, CHU de Bordeaux, France
| | - D D Metcalfe
- Laboratory of Allergic Diseases, NIAID, NIH, Bethesda, MD, USA
| | - H-P Horny
- Institute of Pathology, Ludwig-Maximilians University, Munich, Germany
| | - M Arock
- LBPA CNRS UMR8113, Ecole Normale Supérieure de Cachan, Cachan, France
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8
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Saußele S, Richter J, Hochhaus A, Mahon FX. The concept of treatment-free remission in chronic myeloid leukemia. Leukemia 2016; 30:1638-47. [PMID: 27133824 PMCID: PMC4980559 DOI: 10.1038/leu.2016.115] [Citation(s) in RCA: 193] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 03/22/2016] [Accepted: 03/30/2016] [Indexed: 02/08/2023]
Abstract
The advent of tyrosine kinase inhibitors (TKI) into the management of patients with chronic myeloid leukemia (CML) has profoundly improved prognosis. Survival of responders is approaching that of the general population but lifelong treatment is still recommended. In several trials, TKI treatment has been stopped successfully in approximately half of the patients with deep molecular response. This has prompted the development of a new concept in the evaluation of CML patients known as 'treatment-free remission'. The future in CML treatment will be to define criteria for the safe and most promising discontinuation of TKI on one hand, and, on the other, to increase the number of patients available for such an attempt. Until safe criteria have been defined, discontinuation of therapy is still experimental and should be restricted to clinical trials or registries. This review will provide an overview of current knowledge as well as an outlook on future challenges.
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Affiliation(s)
- S Saußele
- III. Medizinische Klinik, Universitätsmedizin, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - J Richter
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - A Hochhaus
- Klinik für Innere Medizin II, Hämatologie/Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - F-X Mahon
- Bergonié Cancer Institute, INSERM Unit 916, University of Bordeaux, Bordeaux, France
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9
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le Coutre PD, Hughes TP, Mahon FX, Kim DW, Steegmann JL, Shah NP, Gooden K, Wallis N, Cortes JE. Low incidence of peripheral arterial disease in patients receiving dasatinib in clinical trials. Leukemia 2016; 30:1593-6. [PMID: 26686247 PMCID: PMC4935977 DOI: 10.1038/leu.2015.352] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- P D le Coutre
- Charité, Campus Virchow Klinikum, Medizinische Klinik m.S. Hämatologie und Onkologie, Universitätsmedizin Berlin, Berlin, Germany
| | - T P Hughes
- Cancer Theme, South Australian Health and Medical Research Institute (SAHMRI), Department of Haematology, SA Pathology, University of Adelaide, Adelaide, South Australia, Australia
| | - F-X Mahon
- Centre Hospitalier Universitaire de Bordeaux, Laboratoire d'Hématologie et Service des Maladies du Sang, Bordeaux et Institut Bergonié, Bordeaux, France
| | - D-W Kim
- Division of Hematology, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - J L Steegmann
- Department of Hematology and IIS-IP, Hospital Universitario de la Princesa, Madrid, Spain
| | - N P Shah
- Department of Medicine, Division of Hematology/Oncology, University of California at San Francisco School of Medicine, San Francisco, CA, USA
| | - K Gooden
- Bristol-Myers Squibb, Princeton, NJ, USA
| | - N Wallis
- Bristol-Myers Squibb, Princeton, NJ, USA
| | - J E Cortes
- Division of Cancer Medicine, Department of Leukemia, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
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10
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Charaf L, Mahon FX, Lamrissi-Garcia I, Moranvillier I, Beliveau F, Cardinaud B, Dabernat S, de Verneuil H, Moreau-Gaudry F, Bedel A. Effect of tyrosine kinase inhibitors on stemness in normal and chronic myeloid leukemia cells. Leukemia 2016; 31:65-74. [PMID: 27220663 DOI: 10.1038/leu.2016.154] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 05/13/2016] [Accepted: 05/16/2016] [Indexed: 12/11/2022]
Abstract
Although tyrosine kinase inhibitors (TKIs) efficiently cure chronic myeloid leukemia (CML), they can fail to eradicate CML stem cells (CML-SCs). The mechanisms responsible for CML-SC survival need to be understood for designing therapies. Several previous studies suggest that TKIs could modulate CML-SC quiescence. Unfortunately, CML-SCs are insufficiently available. Induced pluripotent stem cells (iPSCs) offer a promising alternative. In this work, we used iPSCs derived from CML patients (Ph+). Ph+ iPSC clones expressed lower levels of stemness markers than normal iPSCs. BCR-ABL1 was found to be involved in stemness regulation and ERK1/2 to have a key role in the signaling pathway. TKIs unexpectedly promoted stemness marker expression in Ph+ iPSC clones. Imatinib also retained quiescence and induced stemness gene expression in CML-SCs. Our results suggest that TKIs might have a role in residual disease and confirm the need for a targeted therapy different from TKIs that could overcome the stemness-promoting effect caused by TKIs. Interestingly, a similar pro-stemness effect was observed in normal iPSCs and hematopoietic SCs. These findings could help to explain CML resistance mechanisms and the teratogenic side-effects of TKIs in embryonic cells.
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Affiliation(s)
- L Charaf
- Inserm U1035, Biothérapies des Maladies Génétiques et Cancers, Bordeaux, France.,Université de Bordeaux, FR TransBiomed, Bordeaux, France.,Laboratoire d'Excellence GR-Ex, Bordeaux, France
| | - F-X Mahon
- Inserm U1035, Biothérapies des Maladies Génétiques et Cancers, Bordeaux, France.,Université de Bordeaux, FR TransBiomed, Bordeaux, France.,Pôle de Biologie et Pathologie CHU Bordeaux, Bordeaux, France.,Institut Bergonie, SIRIC BRIO, Bordeaux, France
| | - I Lamrissi-Garcia
- Inserm U1035, Biothérapies des Maladies Génétiques et Cancers, Bordeaux, France.,Université de Bordeaux, FR TransBiomed, Bordeaux, France.,Laboratoire d'Excellence GR-Ex, Bordeaux, France
| | - I Moranvillier
- Inserm U1035, Biothérapies des Maladies Génétiques et Cancers, Bordeaux, France.,Université de Bordeaux, FR TransBiomed, Bordeaux, France.,Laboratoire d'Excellence GR-Ex, Bordeaux, France
| | - F Beliveau
- Inserm U1035, Biothérapies des Maladies Génétiques et Cancers, Bordeaux, France.,Laboratoire d'Excellence GR-Ex, Bordeaux, France
| | - B Cardinaud
- Inserm U1035, Biothérapies des Maladies Génétiques et Cancers, Bordeaux, France.,Université de Bordeaux, FR TransBiomed, Bordeaux, France.,Institut Polytechnique de Bordeaux, Talence, France
| | - S Dabernat
- Inserm U1035, Biothérapies des Maladies Génétiques et Cancers, Bordeaux, France.,Université de Bordeaux, FR TransBiomed, Bordeaux, France.,Laboratoire d'Excellence GR-Ex, Bordeaux, France.,Pôle de Biologie et Pathologie CHU Bordeaux, Bordeaux, France
| | - H de Verneuil
- Inserm U1035, Biothérapies des Maladies Génétiques et Cancers, Bordeaux, France.,Université de Bordeaux, FR TransBiomed, Bordeaux, France.,Laboratoire d'Excellence GR-Ex, Bordeaux, France.,Pôle de Biologie et Pathologie CHU Bordeaux, Bordeaux, France
| | - F Moreau-Gaudry
- Inserm U1035, Biothérapies des Maladies Génétiques et Cancers, Bordeaux, France.,Université de Bordeaux, FR TransBiomed, Bordeaux, France.,Laboratoire d'Excellence GR-Ex, Bordeaux, France.,Pôle de Biologie et Pathologie CHU Bordeaux, Bordeaux, France
| | - A Bedel
- Inserm U1035, Biothérapies des Maladies Génétiques et Cancers, Bordeaux, France.,Université de Bordeaux, FR TransBiomed, Bordeaux, France.,Laboratoire d'Excellence GR-Ex, Bordeaux, France.,Pôle de Biologie et Pathologie CHU Bordeaux, Bordeaux, France
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11
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Cross NCP, White HE, Ernst T, Welden L, Dietz C, Saglio G, Mahon FX, Wong CC, Zheng D, Wong S, Wang SS, Akiki S, Albano F, Andrikovics H, Anwar J, Balatzenko G, Bendit I, Beveridge J, Boeckx N, Cerveira N, Cheng SM, Colomer D, Czurda S, Daraio F, Dulucq S, Eggen L, El Housni H, Gerrard G, Gniot M, Izzo B, Jacquin D, Janssen JJWM, Jeromin S, Jurcek T, Kim DW, Machova-Polakova K, Martinez-Lopez J, McBean M, Mesanovic S, Mitterbauer-Hohendanner G, Mobtaker H, Mozziconacci MJ, Pajič T, Pallisgaard N, Panagiotidis P, Press RD, Qin YZ, Radich J, Sacha T, Touloumenidou T, Waits P, Wilkinson E, Zadro R, Müller MC, Hochhaus A, Branford S. Development and evaluation of a secondary reference panel for BCR-ABL1 quantification on the International Scale. Leukemia 2016; 30:1844-52. [PMID: 27109508 PMCID: PMC5240017 DOI: 10.1038/leu.2016.90] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [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: 03/22/2016] [Accepted: 04/11/2016] [Indexed: 12/24/2022]
Abstract
Molecular monitoring of chronic myeloid leukemia patients using robust BCR-ABL1 tests standardized to the International Scale (IS) is key to proper disease management, especially when treatment cessation is considered. Most laboratories currently use a time-consuming sample exchange process with reference laboratories for IS calibration. A World Health Organization (WHO) BCR-ABL1 reference panel was developed (MR1–MR4), but access to the material is limited. In this study, we describe the development of the first cell-based secondary reference panel that is traceable to and faithfully replicates the WHO panel, with an additional MR4.5 level. The secondary panel was calibrated to IS using digital PCR with ABL1, BCR and GUSB as reference genes and evaluated by 44 laboratories worldwide. Interestingly, we found that >40% of BCR-ABL1 assays showed signs of inadequate optimization such as poor linearity and suboptimal PCR efficiency. Nonetheless, when optimized sample inputs were used, >60% demonstrated satisfactory IS accuracy, precision and/or MR4.5 sensitivity, and 58% obtained IS conversion factors from the secondary reference concordant with their current values. Correlation analysis indicated no significant alterations in %BCR-ABL1 results caused by different assay configurations. More assays achieved good precision and/or sensitivity than IS accuracy, indicating the need for better IS calibration mechanisms.
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Affiliation(s)
- N C P Cross
- Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury, UK.,Faculty of Medicine, University of Southampton, Southampton, UK
| | - H E White
- Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury, UK.,Faculty of Medicine, University of Southampton, Southampton, UK
| | - T Ernst
- Department of Hematology/Oncology, Universitätsklinikum Jena, Jena, Germany
| | - L Welden
- Department of Genetics and Molecular Pathology, Centre for Cancer Biology, SA Pathology, Adelaide, SA, Australia
| | - C Dietz
- III. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - G Saglio
- Department of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Orbassano, Italy
| | - F-X Mahon
- Bergonie Institute Cancer Center Bordeaux, INSERM U1218, University of Bordeaux, Bordeaux, France
| | - C C Wong
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - D Zheng
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - S Wong
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - S-S Wang
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - S Akiki
- West Midlands Regional Genetics Laboratory, Birmingham, UK
| | - F Albano
- Department of Hematology, University of Bari, Bari, Italy
| | - H Andrikovics
- Laboratory of Molecular Diagnostics, Hungarian National Blood Transfusion Service, Budapest, Hungary.,Department of Pathophysiology, Semmelweis University, Budapest, Hungary
| | - J Anwar
- King's College Hospital London, London, UK
| | - G Balatzenko
- National Specialized Hospital for Active Treatment of Hematological Diseases, Sofia, Bulgaria
| | - I Bendit
- Laboratorio de Biologia Tumoral, Disciplina de Hematologia do HC-FMUSP, São Paulo, Brazil
| | - J Beveridge
- PathWest Laboratory Medicine WA, Department of Haematology, Fiona Stanley Hospital, Perth, WA, Australia
| | - N Boeckx
- Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, KUL, Leuven, Belgium
| | - N Cerveira
- Department of Genetics, Portuguese Oncology Institute, Porto, Portugal
| | - S-M Cheng
- Department of Hematology and Oncology, Quest Diagnostics Nichols Institute, San Juan Capistrano, CA, USA
| | - D Colomer
- Hematopathology Unit, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - S Czurda
- Division of Molecular Microbiology, Children's Cancer Research Institute, Vienna, Austria
| | - F Daraio
- Department of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Orbassano, Italy
| | - S Dulucq
- Laboratoire Hematologie, Centre Hospitalier Universitaire de Bordeaux, Universite Bordeaux, Bordeaux, France
| | - L Eggen
- Laboratory of Molecular Pathology, Oslo University Hospital, Oslo, Norway
| | - H El Housni
- Clinique de Genetique Oncologique-Service de genetique, Hopital Erasme, Brussels, Belgium
| | - G Gerrard
- Imperial Molecular Pathology, Hammersmith Hospital, London, UK
| | - M Gniot
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland
| | - B Izzo
- Department of Clinical Medicine and Surgery, University 'Federico II' of Naples, Naples, Italy.,CEINGE - Biotecnologie Avanzate, Naples, Italy
| | | | - J J W M Janssen
- Department of Hematology and Molecular Diagnostics, VU University Medical Center, Amsterdam, The Netherlands
| | - S Jeromin
- MLL Munich Leukemia Laboratory, Munich, Germany
| | - T Jurcek
- Center of Molecular Biology and Gene Therapy, Department of Internal Medicine-Hematology and Oncology, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - D-W Kim
- Seoul St Mary's Hospital, Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea
| | - K Machova-Polakova
- Department of Molecular Genetics, Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - J Martinez-Lopez
- Department of Hematology, Hospital Universitario 12 de Octubre, Universidad Complutense, CNIO, Madrid, Spain
| | - M McBean
- Division of Cancer Medicine, Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia
| | - S Mesanovic
- Pathology Department, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - G Mitterbauer-Hohendanner
- Department of Laboratory Medicine, Division of Medical and Chemical Laboratory Diagnostics, Medical University of Vienna, Vienna, Austria
| | | | - M-J Mozziconacci
- Departement de Biopathologie, Institut Paoli-Calmettes, Marseille, France
| | - T Pajič
- Specialized Haematology Laboratory, Department of Haematology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - N Pallisgaard
- Department of Surgical Pathology, Zealand University Hospital, Roskilde, Denmark
| | - P Panagiotidis
- Hematology Unit, First Department of Internal Medicine, Laiko Hospital, University of Athens, Athens, Greece
| | - R D Press
- Department of Pathology and Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | - Y-Z Qin
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - J Radich
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - T Sacha
- Chair and Department of Hematology, Jagiellonian University, Kraków, Poland
| | - T Touloumenidou
- Laboratory of Molecular Biology, Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - P Waits
- Bristol Genetics Laboratory, Bristol, UK
| | | | - R Zadro
- Faculty of Pharmacy and Biochemistry and University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
| | - M C Müller
- III. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - A Hochhaus
- Department of Hematology/Oncology, Universitätsklinikum Jena, Jena, Germany
| | - S Branford
- Department of Genetics and Molecular Pathology, Centre for Cancer Biology, SA Pathology, Adelaide, SA, Australia.,School of Pharmacy and Medical Science, University of South Australia, Adelaide, SA, Australia.,School of Medicine, University of Adelaide, SA, Adelaide, Australia.,School of Molecular and Biomedical Science, University of Adelaide, Adelaide, SA, Australia
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12
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Bouchet S, Dulucq S, Pasquet JM, Lagarde V, Molimard M, Mahon FX. From in vitro to in vivo: intracellular determination of imatinib and nilotinib may be related with clinical outcome. Leukemia 2013; 27:1757-9. [PMID: 23392357 DOI: 10.1038/leu.2013.13] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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13
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Prey S, Ezzedine K, Doussau A, Grandoulier AS, Barcat D, Chatelus E, Diot E, Durant C, Hachulla E, de Korwin-Krokowski JD, Kostrzewa E, Quemeneur T, Paul C, Schaeverbeke T, Seneschal J, Solanilla A, Sparsa A, Bouchet S, Lepreux S, Mahon FX, Chene G, Taïeb A. Imatinib mesylate in scleroderma-associated diffuse skin fibrosis: a phase II multicentre randomized double-blinded controlled trial. Br J Dermatol 2012; 167:1138-44. [PMID: 23039171 DOI: 10.1111/j.1365-2133.2012.11186.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Imatinib mesylate is a potent inhibitor of platelet-derived growth factor and transforming growth factor-β signalling pathways which may play a role in systemic sclerosis (SSc)-associated skin changes. OBJECTIVES We aimed primarily at assessing the efficacy of imatinib mesylate in scleroderma skin fibrosis. METHODS We performed a phase II double-blinded trial on patients with scleroderma with either morphoea involving > 20% of body surface area or SSc with extensive skin involvement: modified Rodnan Skin Score (mRSS) ≥ 20/51. Each patient was randomized to receive either imatinib mesylate 400 mg or placebo daily for a total of 6 months, and then was followed up 6 months after therapy discontinuation. Skin fibrosis was assessed by mRSS and measurement of the dermal thickness using skin biopsies performed at inclusion and at 6 months of treatment. In addition, quality of life (Dermatology Life Quality Index and modified Health Assessment Questionnaire for Scleroderma) was recorded at each visit, and pulmonary function before and after intervention. RESULTS Twenty-eight patients were included in the study with a mean age of 48·9 years (range 30-71): 25 had a diagnosis of a SSc and three of diffuse cutaneous scleroderma. Demographic data, frequency of organ involvement of SSc and mRSS were comparable between groups. At 6 months, the proportion of variation of mRSS from inclusion was not statistically significantly different between the two groups (median +0·10 in imatinib group vs. -0·16 in placebo group, P = 0·098). Similarly, changes in dermal thickness, quality of life and diffusion capacity for carbon monoxide were not significantly different between groups. CONCLUSIONS This study failed to demonstrate the efficacy of imatinib 400 mg daily to improve skin fibrosis of diffuse scleroderma after 6 months of treatment based on validated outcome measurements.
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Affiliation(s)
- S Prey
- Department of Dermatology, Hôpital Saint André, CHU de Bordeaux, 1 rue Jean Burguet, 33075 Bordeaux, France.
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14
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Drullion C, Trégoat C, Lagarde V, Tan S, Gioia R, Priault M, Djavaheri-Mergny M, Brisson A, Auberger P, Mahon FX, Pasquet JM. Apoptosis and autophagy have opposite roles on imatinib-induced K562 leukemia cell senescence. Cell Death Dis 2012; 3:e373. [PMID: 22898871 PMCID: PMC3434662 DOI: 10.1038/cddis.2012.111] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 06/18/2012] [Accepted: 06/18/2012] [Indexed: 12/31/2022]
Abstract
Imatinib, the anti-Abl tyrosine kinase inhibitor used as first-line therapy in chronic myeloid leukemia (CML), eliminates CML cells mainly by apoptosis and induces autophagy. Analysis of imatinib-treated K562 cells reveals a cell population with cell cycle arrest, p27 increase and senescence-associated beta galactosidase (SA-β-Gal) staining. Preventing apoptosis by caspase inhibition decreases annexin V-positive cells, caspase-3 cleavage and increases the SA-β-Gal-positive cell population. In addition, a concomitant increase of the cell cycle inhibitors p21 and p27 is detected emphasizing the senescent phenotype. Inhibition of apoptosis by targeting Bim expression or overexpression of Bcl2 potentiates senescence. The inhibition of autophagy by silencing the expression of the proteins ATG7 or Beclin-1 prevents the increase of SA-β-Gal staining in response to imatinib plus Z-Vad. In contrast, in apoptotic-deficient cells (Bim expression or overexpression of Bcl2), the inhibition of autophagy did not significantly modify the SA-β-Gal-positive cell population. Surprisingly, targeting autophagy by inhibiting ATG5 is accompanied by a strong SA-β-Gal staining, suggesting a specific inhibitory role on senescence. These results demonstrate that in addition to apoptosis and autophagy, imatinib induced senescence in K562 CML cells. Moreover, apoptosis is limiting the senescent response to imatinib, whereas autophagy seems to have an opposite role.
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Affiliation(s)
- C Drullion
- Laboratoire hématopoı¨èse leucémique et cibles thérapeutiques, INSERM U1035, Université Bordeaux Ségalen, 146 rue Léo Saignat Bat TP 4 étage, 33076 Bordeaux, cedex, France
| | - C Trégoat
- Laboratoire hématopoı¨èse leucémique et cibles thérapeutiques, INSERM U1035, Université Bordeaux Ségalen, 146 rue Léo Saignat Bat TP 4 étage, 33076 Bordeaux, cedex, France
| | - V Lagarde
- Laboratoire hématopoı¨èse leucémique et cibles thérapeutiques, INSERM U1035, Université Bordeaux Ségalen, 146 rue Léo Saignat Bat TP 4 étage, 33076 Bordeaux, cedex, France
| | - S Tan
- UMR-5248-CBMN, Université de Bordeaux, Bâtiment B8–Avenue des Facultés, 33405 Talence, France
| | - R Gioia
- Laboratoire hématopoı¨èse leucémique et cibles thérapeutiques, INSERM U1035, Université Bordeaux Ségalen, 146 rue Léo Saignat Bat TP 4 étage, 33076 Bordeaux, cedex, France
| | - M Priault
- UMR CNRS 5095, I.B.G.C, 1 rue Camille Saint Saens, Université de Bordeaux, 33077 Bordeaux, France
| | | | - A Brisson
- UMR-5248-CBMN, Université de Bordeaux, Bâtiment B8–Avenue des Facultés, 33405 Talence, France
| | - P Auberger
- INSERM U1065, Team 2, C3M, 151 route de ginestière, 06204 Nice, France
| | - F-X Mahon
- Laboratoire hématopoı¨èse leucémique et cibles thérapeutiques, INSERM U1035, Université Bordeaux Ségalen, 146 rue Léo Saignat Bat TP 4 étage, 33076 Bordeaux, cedex, France
| | - J-M Pasquet
- Laboratoire hématopoı¨èse leucémique et cibles thérapeutiques, INSERM U1035, Université Bordeaux Ségalen, 146 rue Léo Saignat Bat TP 4 étage, 33076 Bordeaux, cedex, France
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15
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Giles FJ, Kantarjian HM, le Coutre PD, Baccarani M, Mahon FX, Blakesley RE, Gallagher NJ, Gillis K, Goldberg SL, Larson RA, Hochhaus A, Ottmann OG. Nilotinib is effective in imatinib-resistant or -intolerant patients with chronic myeloid leukemia in blastic phase. Leukemia 2011; 26:959-62. [DOI: 10.1038/leu.2011.355] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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16
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Joha S, Nugues AL, Hétuin D, Berthon C, Dezitter X, Dauphin V, Mahon FX, Roche-Lestienne C, Preudhomme C, Quesnel B, Idziorek T. GILZ inhibits the mTORC2/AKT pathway in BCR-ABL(+) cells. Oncogene 2011; 31:1419-30. [PMID: 21804606 PMCID: PMC3312406 DOI: 10.1038/onc.2011.328] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [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] [Indexed: 01/13/2023]
Abstract
The malignant phenotype of chronic myeloid leukemia (CML) is due to the abnormal tyrosine kinase activity of the BCR-ABL oncoprotein, which signals several downstream cell survival pathways, including phosphoinositide 3-kinase/AKT, signal transducer and activator of transcription 5 and extracellular signal-regulated kinase 1/2. In patients with CML, tyrosine kinase inhibitors (TKIs) are used to suppress the BCR-ABL tyrosine kinase, resulting in impressive response rates. However, resistance can occur, especially in acute-phase CML, through various mechanisms. Here, we show that the glucocorticoid-induced leucine zipper protein (GILZ) modulates imatinib and dasatinib resistance and suppresses tumor growth by inactivating the mammalian target of rapamycin complex-2 (mTORC2)/AKT signaling pathway. In mouse and human models, GILZ binds to mTORC2, but not to mTORC1, inhibiting phosphorylation of AKT (at Ser473) and activating FoxO3a-mediated transcription of the pro-apoptotic protein Bim; these results demonstrate that GILZ is a key inhibitor of the mTORC2 pathway. Furthermore, CD34+ stem cells isolated from relapsing CML patients underwent apoptosis and showed inhibition of mTORC2 after incubation with glucocorticoids and imatinib. Our findings provide new mechanistic insights into the role of mTORC2 in BCR-ABL+ cells and indicate that regulation by GILZ may influence TKI sensitivity.
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Affiliation(s)
- S Joha
- Institut de Recherche sur le Cancer de Lille, Université Lille-Nord de France, Lille, France
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17
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Cortes JE, Egorin MJ, Guilhot F, Molimard M, Mahon FX. Pharmacokinetic/pharmacodynamic correlation and blood-level testing in imatinib therapy for chronic myeloid leukemia. Leukemia 2009; 23:1537-44. [PMID: 19404318 DOI: 10.1038/leu.2009.88] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Imatinib is the current standard of care in the treatment of chronic myeloid leukemia (CML), inducing durable responses and prolonged progression-free survival. However, plasma exposure to the drug from a given dosing regimen can vary widely among patients. Reasons for this may include incomplete adherence, intrinsic variations in the metabolism of imatinib, and drug-drug interactions. Data from two recent studies have shown a correlation between imatinib trough plasma concentration and clinical response, leading to suggestions that maintaining imatinib blood concentrations above approximately 1000 ng/ml might be associated with improved outcomes. In patients who do not respond as well as expected to initial imatinib treatment, measurement of trough plasma concentration could assist with decisions about whether to increase the dose. Blood-level testing may also be helpful in other clinical scenarios: for example, when poor adherence is suspected, adverse reactions are unusually severe, or there is a possible drug-drug interaction. Further work is required to confirm prospectively the link between imatinib plasma concentrations and response, and to define effective trough concentrations in different patient populations. However, based on the current data, imatinib blood-level testing seems to be a useful aid when making clinical decisions in CML.
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Affiliation(s)
- J E Cortes
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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18
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Belloc F, Airiau K, Jeanneteau M, Garcia M, Guérin E, Lippert E, Moreau-Gaudry F, Mahon FX. The stem cell factor–c-KIT pathway must be inhibited to enable apoptosis induced by BCR–ABL inhibitors in chronic myelogenous leukemia cells. Leukemia 2009; 23:679-85. [DOI: 10.1038/leu.2008.364] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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19
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Taïeb A, Constans J, Mahon FX. Une nouvelle piste thérapeutique pour les sclérodermies graves: le mésylate d’imatinib. Rev Med Interne 2008; 29:173-5. [PMID: 17597261 DOI: 10.1016/j.revmed.2007.05.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2007] [Accepted: 05/21/2007] [Indexed: 12/26/2022]
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20
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Soria A, Cario-André M, Lepreux S, Rezvani HR, Pasquet JM, Pain C, Schaeverbeke T, Mahon FX, Taïeb A. The effect of imatinib (Glivec) on scleroderma and normal dermal fibroblasts: a preclinical study. Dermatology 2008; 216:109-17. [PMID: 18216472 DOI: 10.1159/000111507] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Accepted: 07/05/2007] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Scleroderma skin overexpresses the platelet-derived growth factor receptor beta-subunit (PDGFR-beta) in dermal vessels and PDGFR-beta messenger RNA in cultured fibroblasts. Moreover, increased levels of PDGF and stimulatory autoantibodies to PDGFR have been identified in the serum of scleroderma patients. OBJECTIVE Imatinib being an inhibitor of tyrosine kinase receptors such as PDGFR, its effect on scleroderma fibroblasts was evaluated in vitro as a preclinical therapeutic step. METHODS The effect of imatinib on fibroblasts grown from normal or involved/uninvolved scleroderma skin was studied by Western blot and the methyltetrazolium test. The pattern of distribution of PDGFR-beta in scleroderma versus normal skin was studied by immunohistochemistry. RESULTS In vitro, imatinib inhibited the proliferation of normal dermal and scleroderma fibroblasts at least partly via the inhibition of the phosphorylation of PDGFR. PDGFR-beta was expressed in the epidermis and adnexae in 5 lesional scleroderma biopsies and not in controls. CONCLUSION This study suggests that imatinib can serve as therapy to limit dermal fibroblast proliferation in scleroderma.
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Affiliation(s)
- A Soria
- INSERM U876, University Victor Segalen Bordeaux 2, Bordeaux, France
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21
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Saldanha J, Silvy M, Beaufils N, Arlinghaus R, Barbany G, Branford S, Cayuela JM, Cazzaniga G, Gonzalez M, Grimwade D, Kairisto V, Miyamura K, Lawler M, Lion T, Macintyre E, Mahon FX, Muller MC, Ostergaard M, Pfeifer H, Saglio G, Sawyers C, Spinelli O, van der Velden VHJ, Wang JQ, Zoi K, Patel V, Phillips P, Matejtschuk P, Gabert J. Characterization of a reference material for BCR-ABL (M-BCR) mRNA quantitation by real-time amplification assays: towards new standards for gene expression measurements. Leukemia 2007; 21:1481-7. [PMID: 17476280 DOI: 10.1038/sj.leu.2404716] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [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: 11/08/2022]
Abstract
Monitoring of BCR-ABL transcripts has become established practice in the management of chronic myeloid leukemia. However, nucleic acid amplification techniques are prone to variations which limit the reliability of real-time quantitative PCR (RQ-PCR) for clinical decision making, highlighting the need for standardization of assays and reporting of minimal residual disease (MRD) data. We evaluated a lyophilized preparation of a leukemic cell line (K562) as a potential quality control reagent. This was found to be relatively stable, yielding comparable respective levels of ABL, GUS and BCR-ABL transcripts as determined by RQ-PCR before and after accelerated degradation experiments as well as following 5 years storage at -20 degrees C. Vials of freeze-dried cells were sent at ambient temperature to 22 laboratories on four continents, with RQ-PCR analyses detecting BCR-ABL transcripts at levels comparable to those observed in primary patient samples. Our results suggest that freeze-dried cells can be used as quality control reagents with a range of analytical instrumentations and could enable the development of urgently needed international standards simulating clinically relevant levels of MRD.
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Affiliation(s)
- J Saldanha
- 1National Institute of Biological Standards and Controls, South Mimms, UK
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22
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Braun C, Duffau P, Mahon FX, Rosier E, Leguay T, Etienne G, Michaud M. [Acute pancreatitis due to hypercalcemia revealing adult T-cell leukemia]. Rev Med Interne 2006; 28:116-9. [PMID: 17157965 DOI: 10.1016/j.revmed.2006.11.005] [Citation(s) in RCA: 3] [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] [Received: 06/01/2006] [Accepted: 11/07/2006] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Hypercalcemia frequently occurs in the course of Adult T-cell leukemia/lymphoma (ATLL). We report the first case of acute pancreatitis revealing ATLL. EXEGESIS A 41-year-old woman, without medical history, presented with acute pancreatitis. Physical examination found recent loss of weight, hepatosplenomegaly and generalised lymphoadenopathy. Biochemical tests showed severe hypercalcemia and the peripheral white blood cell count revealed an atypical lymphocytosis. ATLL was diagnosed by immunophenotypic and morphological analysis of circulating lymphocytes, bone marrow and lymphatic node biopsy. Level of serum parathyroid hormone-related protein was not increased. We discuss the mechanism of hypercalcemia in this context. CONCLUSION In spite of the high prevalence of hypercalcemia in ATLL, acute pancreatitis revealing this pathology is an exceptional condition.
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Affiliation(s)
- C Braun
- Service de médecine interne et maladies infectieuses, hôpital Haut-Lévêque, avenue de Magellan, 33604 Pessac cedex, France.
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23
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Pocaly M, Lagarde V, Etienne G, Ribeil JA, Claverol S, Bonneu M, Moreau-Gaudry F, Guyonnet-Duperat V, Hermine O, Melo JV, Dupouy M, Turcq B, Mahon FX, Pasquet JM. Overexpression of the heat-shock protein 70 is associated to imatinib resistance in chronic myeloid leukemia. Leukemia 2006; 21:93-101. [PMID: 17109025 DOI: 10.1038/sj.leu.2404463] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [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: 01/24/2023]
Abstract
Imatinib is an effective therapy for chronic myeloid leukemia (CML), a myeloproliferative disorder characterized by the expression of the recombinant oncoprotein Bcr-Abl. In this investigation, we studied an imatinib-resistant cell line (K562-r) generated from the K562 cell line in which none of the previously described mechanisms of resistance had been detected. A threefold increase in the expression of the heat-shock protein 70 (Hsp70) was detected in these cells. This increase was not associated to heat-shock transcription factor-1 (HSF-1) overexpression or activation. RNA silencing of Hsp70 decreased dramatically its expression (90%), and was accompanied by a 34% reduction in cell viability. Overexpression of Hsp70 in the imatinib-sensitive K562 line induced resistance to imatinib as detected by a large reduction in cell death in the presence of 1 muM of imatinib. Hsp70 level was also increased in blast cells of CML patients resistant to imatinib, whereas the level remained low in responding patients. Taken together, the results demonstrate that overexpression of Hsp70 can lead to both in vitro and in vivo resistance to imatinib in CML cells. Moreover, the overexpression of Hsp70 detected in imatinib-resistant CML patients supports this mechanism and identifies potentially a marker and a therapeutic target of CML evolution.
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MESH Headings
- Biomarkers, Tumor
- Cell Line, Tumor
- Drug Resistance, Neoplasm/genetics
- Fusion Proteins, bcr-abl/genetics
- Gene Expression Regulation, Neoplastic
- HSP70 Heat-Shock Proteins/biosynthesis
- HSP70 Heat-Shock Proteins/genetics
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/metabolism
- Up-Regulation
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Affiliation(s)
- M Pocaly
- E0217 INSERM, Université Victor SEGALEN Bordeaux 2, Hématopoïèse Leucémique et Cibles Thérapeutiques, Bordeaux cedex, France
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24
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Nicolini FE, Corm S, Lê QH, Sorel N, Hayette S, Bories D, Leguay T, Roy L, Giraudier S, Tulliez M, Facon T, Mahon FX, Cayuela JM, Rousselot P, Michallet M, Preudhomme C, Guilhot F, Roche-Lestienne C. Mutation status and clinical outcome of 89 imatinib mesylate-resistant chronic myelogenous leukemia patients: a retrospective analysis from the French intergroup of CML (Fi(phi)-LMC GROUP). Leukemia 2006; 20:1061-6. [PMID: 16642048 DOI: 10.1038/sj.leu.2404236] [Citation(s) in RCA: 168] [Impact Index Per Article: 9.3] [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: 11/09/2022]
Abstract
The emergence of ABL point mutations is the most frequent cause for imatinib resistance in chronic myelogenous leukemia (CML) patients and can occur during any phase of the disease; however, their clinical impact remains controversial. In this study, we retrospectively analyzed the predictive impact of 94 BCR-ABL kinase domain mutations (18 T315I, 26 P-loop, 50 in other sites) found in 89 imatinib-resistant CML patients. At imatinib onset, 64% of patients (57/89) were in chronic phase (CP), 24% (21/89) in accelerated phase (AP) and 12% (11/89) in blastic phase (BP). T315I and P-loop mutations were preferentially discovered in accelerated phase of BP CML, and other types of mutations in CP (P=0.003). With a median follow-up of 39.2 months (6.3-67.2), since imatinib initiation, overall survival (OS) was significantly worse for P-loop (28.3 months) and for T315I (12.6 months), and not reached for other mutations (P=0.0004). For CP only, multivariate analysis demonstrated a worse OS for P-loop mutations (P=0.014), and a worse progression-free survival (PFS) for T315I mutations (P=0.014). Therefore, P-loop and T315I mutations selectively impair the outcome of imatinib-resistant CML patients, in contrast to other mutations, which may benefit from dose escalation of imatinib, able to improve or stabilize disease response.
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MESH Headings
- Adolescent
- Adult
- Aged
- Benzamides
- DNA Mutational Analysis
- Dose-Response Relationship, Drug
- Drug Resistance, Neoplasm/genetics
- Female
- France
- Fusion Proteins, bcr-abl/genetics
- Humans
- Imatinib Mesylate
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Male
- Middle Aged
- Piperazines/therapeutic use
- Point Mutation
- Predictive Value of Tests
- Pyrimidines/therapeutic use
- Retrospective Studies
- Survival Rate
- Treatment Outcome
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Affiliation(s)
- F E Nicolini
- Hematology Department, E. Herriot Hospital, Lyon, France
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25
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26
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Leguay T, Desplat V, Marit G, Mahon FX. D276G mutation is associated with a poor prognosis in imatinib mesylate-resistant chronic myeloid leukemia patients. Leukemia 2005; 19:2332-3; author reply 2333-4. [PMID: 16281074 DOI: 10.1038/sj.leu.2403993] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
MESH Headings
- Benzamides
- Drug Resistance, Neoplasm/genetics
- Fatal Outcome
- Humans
- Imatinib Mesylate
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Mutation, Missense
- Piperazines/pharmacology
- Piperazines/therapeutic use
- Prognosis
- Pyrimidines/pharmacology
- Pyrimidines/therapeutic use
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27
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Leguay T, Desplat V, Lagarde V, Marit G, Reiffers J, Mahon FX. An amino-acid switch in the BCR-ABL kinase domain modifies sensitivity to imatinib mesylate. Leukemia 2005; 19:1671-3. [PMID: 15973458 DOI: 10.1038/sj.leu.2403831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
MESH Headings
- Amino Acid Substitution
- Apoptosis/drug effects
- Benzamides
- Cell Line, Tumor
- Cell Proliferation/drug effects
- Drug Resistance, Neoplasm/genetics
- Female
- Fusion Proteins, bcr-abl
- Humans
- Imatinib Mesylate
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Middle Aged
- Mutagenesis, Site-Directed
- Piperazines/administration & dosage
- Piperazines/pharmacology
- Piperazines/therapeutic use
- Point Mutation
- Protein-Tyrosine Kinases/antagonists & inhibitors
- Protein-Tyrosine Kinases/genetics
- Protein-Tyrosine Kinases/metabolism
- Pyrimidines/administration & dosage
- Pyrimidines/pharmacology
- Pyrimidines/therapeutic use
- Reverse Transcriptase Polymerase Chain Reaction
- Sensitivity and Specificity
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28
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Tipping AJ, Baluch S, Barnes DJ, Veach DR, Clarkson BM, Bornmann WG, Mahon FX, Goldman JM, Melo JV. Efficacy of dual-specific Bcr-Abl and Src-family kinase inhibitors in cells sensitive and resistant to imatinib mesylate. Leukemia 2004; 18:1352-6. [PMID: 15201856 DOI: 10.1038/sj.leu.2403416] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Monotherapy of chronic myeloid leukemia (CML) with imatinib mesylate has been cast into shadow by the evolution of clinical resistance during therapy. Resistance to imatinib can arise by multiple mechanisms including amplification or mutation of Bcr-Abl, and continuity of imatinib therapy is probably a poor option for either of these patient groups. Recently, however, a structurally distinct new class of drugs, the pyrido[2,3-d]pyrimidines, has been described, and these compounds are predicted to make different molecular contacts in the Abl kinase domain. These drugs potently target both the Bcr-Abl and Src-family kinase activities, both of which are thought to be relevant to survival of the leukemic cell. We asked whether these drugs could selectively induce cell death in murine cell line models of CML cells sensitive and resistant to imatinib by different mechanisms. We show that whereas the pyrido[2,3-d] pyrimidines are indeed highly potent in suppressing proliferation of Bcr-Abl-overexpressing imatinib-resistant cells, they are almost completely ineffective against cells expressing the T315I mutant. This implies that despite structural differences from imatinib, these drugs are unlikely to be useful in patients expressing this mutant Bcr-Abl protein, but may be effective in cases where selection of cells overexpressing the oncoprotein leads to refractoriness to imatinib.
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MESH Headings
- Animals
- Benzamides
- Cell Division/drug effects
- Cell Line, Tumor
- Dose-Response Relationship, Drug
- Drug Delivery Systems
- Drug Resistance, Neoplasm
- Enzyme Inhibitors/pharmacology
- Enzyme Inhibitors/therapeutic use
- Fusion Proteins, bcr-abl/analysis
- Fusion Proteins, bcr-abl/antagonists & inhibitors
- Humans
- Imatinib Mesylate
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Mice
- Piperazines/pharmacology
- Protein-Tyrosine Kinases/antagonists & inhibitors
- Pyrimidines/pharmacology
- Pyrimidines/therapeutic use
- Treatment Outcome
- src-Family Kinases/antagonists & inhibitors
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Affiliation(s)
- A J Tipping
- Department of Haematology, Imperial College London, Hammersmith Hospital, London, UK
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29
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30
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Hasford J, Pfirrmann M, Hehlmann R, Baccarani M, Guilhot F, Mahon FX, Kluin-Nelemans HC, Ohnishi K, Thaler J, Steegmann JL. Prognosis and prognostic factors for patients with chronic myeloid leukemia: nontransplant therapy. Semin Hematol 2003; 40:4-12. [PMID: 12563607 DOI: 10.1053/shem.2003.50006] [Citation(s) in RCA: 5] [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: 11/11/2022]
Abstract
Reliable knowledge about an individual's prognosis is needed to select the appropriate treatment for patients with chronic myeloid leukemia (CML). The New CML score using age, spleen size, blast cell count, eosinophil count, basophil count, and platelet count shows good discrimination for survival (96, 65, or 42 months, P </=.0001) and has been thoroughly validated. Careful analyses indicate that the New CML score is considerably more precise in identifying high-risk patients than the Sokal score. Achievement of complete hematologic response (CHR) up to 9 months shows a distinct impact on survival, which, however, depends on the baseline prognosis. Ten-year survival probabilities for low- and intermediate-risk patients with a CHR were 0.51 (95% confidence interval [CI], 0.42 to 0.60) and 0.23 (95% CI, 0.15 to 0.31) and without a CHR were 0.26 (95% CI, 0.16 to 0.37) and 0.12 (95% CI, 0.04 to 0.20). In high-risk patients CHR had no impact on prognosis. Therapeutic options were widened by the approval of imatinib for the treatment of CML. However, it will still take 2 or more years to know whether the high rates of CHR and cytogenetic complete remission (CCR) achieved with imatinib translate into a clinically relevant survival advantage for all patients.
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Affiliation(s)
- J Hasford
- Forschungsgruppe CML, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Universität München, München, Germany
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31
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Tipping AJ, Mahon FX, Zafirides G, Lagarde V, Goldman JM, Melo JV. Drug responses of imatinib mesylate-resistant cells: synergism of imatinib with other chemotherapeutic drugs. Leukemia 2002; 16:2349-57. [PMID: 12454739 DOI: 10.1038/sj.leu.2402775] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.1] [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: 07/12/2002] [Accepted: 08/27/2002] [Indexed: 11/09/2022]
Abstract
Imatinib mesylate (STI571, Glivec, Gleevec) is a powerful inhibitor of the tyrosine kinase activity of Bcr-Abl, the oncoprotein responsible for chronic myeloid leukemia (CML). The drug shows great efficacy in chronic phase, but is less effective in maintaining hematologic remissions in blast crisis patients. Our group has previously described several cell lines made resistant to imatinib. We now examine the question of cross-resistance to other chemotherapeutic drugs used in CML. Four paired imatinib-sensitive/resistant CML cell lines were assessed by caspase-3 and MTS assays for their proliferative response to cytosine arabinoside (Ara-C), daunorubicin (DNR), homoharringtonine (HHT) and hydroxyurea (HU), either alone or in combination with imatinib. Primary blasts from advanced-stage CML patients refractory to imatinib therapy were studied by semi-solid media clonogenic assays. We found that these drugs are generally capable of major inhibition of proliferation of the CML cell lines, although differential responses to DNR and HHT were noted between some sensitive and resistant cell line pairs, implying that resistance to imatinib may confer a growth advantage under such conditions. The four drugs were also effective in preventing the formation of progenitor cell colonies from CML patients both before treatment with imatinib, and after relapse on the drug. Isobolographic analysis implied that these drugs will generally combine well with imatinib, and in some cases will be synergistic. We conclude that Ara-C, DNR or HHT, either alone or in combination with imatinib, are likely to be the best therapeutic alternatives in the management of patients who become resistant to imatinib monotherapy.
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Affiliation(s)
- A J Tipping
- Dept of Haematology, Imperial College of Science, Technology and Medicine, Hammersmith Hospital, London, UK
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32
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Tabrizi R, Mahon FX, Cony Makhoul P, Lagarde V, Lacombe F, Berthaud P, Melo JV, Reiffers J, Belloc F. Resistance to daunorubicin-induced apoptosis is not completely reversed in CML blast cells by STI571. Leukemia 2002; 16:1154-9. [PMID: 12040447 DOI: 10.1038/sj.leu.2402498] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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: 07/25/2001] [Accepted: 02/01/2002] [Indexed: 11/09/2022]
Abstract
The leukemogenic property of BCR-ABL in chronic myeloid leukemia (CML) is critically dependent on its protein tyrosine kinase activity. STI571 inhibits the BCR-ABL kinase activity, the growth and the viability of BCR-ABL expressing cells. In this study, we report the apoptotic effect of STI571 in combination with daunorubicin (DNR) on peripheral blood mononuclear cells from 11 CML patients and four BCR-ABL-positive cell lines: AR230, LAMA84, K562 and KCL22. Primary blast cells were identified by flow cytometry on the basis of their low CD45 expression. Nucleus fragmentation, exposure of phosphatidylserines and decrease in mitochondrial membrane potential were measured using acridine orange, FITC-annexin V and DiOC6(3), respectively, to evaluate apoptosis. On cell lines, the effect of DNR was negligible, whereas STI571 induced 10 to 35% of apoptosis in 18 h. STI571 sensitized AR230, LAMA84 and K562 cells to DNR when apoptosis was measured at the mitochondrial and membrane but not the nuclear levels. On CML blast cells, phosphatidyl serine exposure was significantly induced by both DNR and STI571 and was higher when these drugs were used in combination (P < 0.0003). However, the effects of this drug combination were only additive and no sensitization of blast cells to DNR by STI571 was observed. Interestingly, sensitization was evidenced in CML but not normal lymphocytes. These results suggest that other mechanisms additional to Bcr-Abl tyrosine kinase activity could be responsible for DNR resistance, and further investigations are needed to understand its origin.
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MESH Headings
- Antineoplastic Agents/pharmacology
- Apoptosis
- Benzamides
- Cell Nucleus/ultrastructure
- DNA Fragmentation
- Daunorubicin/pharmacology
- Drug Resistance, Neoplasm
- Enzyme Inhibitors/pharmacology
- Fusion Proteins, bcr-abl/antagonists & inhibitors
- Humans
- Imatinib Mesylate
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/enzymology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Membrane Potentials/drug effects
- Mitochondria/drug effects
- Mitochondria/physiology
- Phosphatidylserines/analysis
- Piperazines/pharmacology
- Pyrimidines/pharmacology
- Tumor Cells, Cultured
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Affiliation(s)
- R Tabrizi
- Laboratoire d'Hématologie, Hôpital Haut Lévêque, Pessac, France
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33
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Mahon FX, Delbrel X, Cony-Makhoul P, Fabères C, Boiron JM, Barthe C, Bilhou-Nabéra C, Pigneux A, Marit G, Reiffers J. Follow-up of complete cytogenetic remission in patients with chronic myeloid leukemia after cessation of interferon alfa. J Clin Oncol 2002; 20:214-20. [PMID: 11773172 DOI: 10.1200/jco.2002.20.1.214] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.0] [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: 11/20/2022] Open
Abstract
PURPOSE A small proportion of patients with chronic myeloid leukemia (CML) achieve a complete cytogenetic response (CCR), defined as the disappearance of Philadelphia (Ph) chromosome-positive metaphases, after treatment with interferon alfa (IFN). In this population of patients, the question of whether treatment should then be withdrawn is not yet resolved. PATIENTS AND METHODS In the present study, we followed 15 patients who stopped IFN after achieving CCR. In nine patients IFN was stopped in view of adverse reactions (n = 8) or patient's choice (n = 1). For the remaining six patients, the treatment was stopped because no BCR/ABL rearrangement could be detected by reverse transcriptase polymerase chain reaction (RT-PCR) in four successive analyses using peripheral-blood samples. RESULTS Loss of CCR and survival were not statistically different (P =.48; P =.7) for the 15 patients who stopped IFN compared with 41 other CCR patients who continued IFN therapy in our institution. The median follow-up after discontinuation of IFN treatment was 36 months (range, 6 to 108 months). Seven patients (47%) (females, or CCR > 24 months and RT-PCR negative before IFN cessation; P <.0001) did not relapse. Eight other patients (53%) relapsed (lost CCR) within 3 to 33 months of treatment discontinuation. One of them relapsed in major cytogenetic remission (MCR) and was still in MCR 87 months after stopping therapy without any treatment. CONCLUSION It is possible to stop IFN treatment at least in some patients with CML who achieve a prolonged period of CCR. This study also illustrates the hypothesis that persistence of low numbers of Ph-positive cells does not necessarily imply hematologic relapse.
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Affiliation(s)
- F X Mahon
- Service des Maladies du Sang, Centre Hospitalier Universitaire de Bordeaux, Bordeaux 2, France
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34
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Abstract
STI571 induces sustained hematologic remission in patients with chronic myeloid leukemia (CML) in chronic phase. However, in advanced phases, especially blast crisis, the leukemia usually becomes resistant within months. It has been investigated whether resistance to STI571 is stable and immutable or whether it can be reversed in selected CML cell lines. Withdrawal of STI571 for varying lengths of time from cultures of 3 resistant lines (K562-r, KCL22-r, and Baf/BCR-ABL-r1) did not restore sensitivity to the inhibitor. In contrast, LAMA84-resistant cells experienced a sharp reduction in survival and proliferation during the first week of STI571 withdrawal but recovered thereafter. Moreover, when left off the inhibitor for 2 months or longer, this cell line reacquired sensitivity to STI571. It is hypothesized, therefore, that patients who have become resistant to the drug may respond again if STI571 therapy is temporarily interrupted.
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MESH Headings
- Animals
- Benzamides
- Caspase 3
- Caspases/metabolism
- Cell Division/drug effects
- Cell Survival/drug effects
- Drug Resistance, Neoplasm/genetics
- Fusion Proteins, bcr-abl/genetics
- Fusion Proteins, bcr-abl/metabolism
- Gene Expression
- Imatinib Mesylate
- In Situ Hybridization, Fluorescence
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Mice
- Phosphorylation
- Piperazines
- Pyrimidines/administration & dosage
- Pyrimidines/pharmacology
- Pyrimidines/therapeutic use
- Tumor Cells, Cultured
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Affiliation(s)
- A J Tipping
- Department of Haematology, Imperial College School of Medicine, Hammersmith Hospital, London, United Kingdom
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35
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Bonifazi F, de Vivo A, Rosti G, Guilhot F, Guilhot J, Trabacchi E, Hehlmann R, Hochhaus A, Shepherd PC, Steegmann JL, Kluin-Nelemans HC, Thaler J, Simonsson B, Louwagie A, Reiffers J, Mahon FX, Montefusco E, Alimena G, Hasford J, Richards S, Saglio G, Testoni N, Martinelli G, Tura S, Baccarani M. Chronic myeloid leukemia and interferon-alpha: a study of complete cytogenetic responders. Blood 2001; 98:3074-81. [PMID: 11698293 DOI: 10.1182/blood.v98.10.3074] [Citation(s) in RCA: 254] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Achieving a complete cytogenetic response (CCgR) is a major target in the treatment of chronic myeloid leukemia (CML) with interferon-alpha (IFN-alpha), but CCgRs are rare. The mean CCgR rate is 13%, in a range of 5% to 33%. A collaborative study of 9 European Union countries has led to the collection of data on 317 patients who were first seen between 1983 and 1997 and achieved CCgRs with IFN-alpha alone or in combination with hydroxyurea. The median time to first CCgR was 19 months (95% CI, 17-21; range, 3-84 months). At last contact, 212 patients were still alive and in continuous CCgR; 105 patients had lost CCgR, but 53% of them were still alive and in chronic phase. IFN-alpha treatment was discontinued permanently in 23 cases for response loss, in 36 cases for chronic toxicity (15 are still in unmaintained continuous CCgR), and in 8 cases because it was believed that treatment was no longer necessary (7 of these 8 patients are still in unmaintained continuous CCgR). The 10-year survival rate from first CCgR is 72% (95% CI, 62%-82%) and is related to the risk profile. High-risk patients lost CCgR more frequently and more rapidly and none survived more than 10 years. Low-risk patients survived much longer (10-year survival probability 89% for Sokal low risk and 81% for Euro low risk). These data point out that a substantial long-term survival in CCgRs is restricted mainly to low-risk and possibly intermediate-risk patients and occurs significantly less often in high-risk patients.
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MESH Headings
- Adult
- Aged
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/therapeutic use
- Biomarkers, Tumor/blood
- Bone Marrow Transplantation
- Cause of Death
- Combined Modality Therapy
- Europe/epidemiology
- Female
- Follow-Up Studies
- Fusion Proteins, bcr-abl/blood
- Humans
- Immunologic Factors/administration & dosage
- Immunologic Factors/therapeutic use
- Interferon alpha-2
- Interferon-alpha/administration & dosage
- Interferon-alpha/therapeutic use
- 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
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Life Tables
- Male
- Middle Aged
- Recombinant Proteins
- Remission Induction
- Retrospective Studies
- Risk Factors
- Survival Analysis
- Treatment Outcome
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36
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Deininger MW, Vieira SA, Parada Y, Banerji L, Lam EW, Peters G, Mahon FX, Köhler T, Goldman JM, Melo JV. Direct relation between BCR-ABL tyrosine kinase activity and cyclin D2 expression in lymphoblasts. Cancer Res 2001; 61:8005-13. [PMID: 11691826] [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]
Abstract
Leukemia cells bearing the Philadelphia (Ph) chromosome express a Bcr-Abl fusion protein with deregulated protein tyrosine kinase (PTK) activity, which plays a central role in the malignant transformation. Many different signal transduction pathways are activated by Bcr-Abl, but little is known about their downstream targets in specific cell lineages. We show here that Ph-positive cell lines as well as primary cells derived from chronic myeloid leukemia (CML) in lymphoid blast crisis or from acute lymphoblastic leukemia (ALL) consistently express high levels of cyclin D2, whereas expression of this protein is low or absent in comparable Ph-negative lines and Ph-positive myeloid lines. Inhibition of Bcr-Abl with STI571 resulted in down-regulation of cyclin D2 and reduction of the number of cells in S phase, although complete G1 arrest was not induced. The expression of cyclin D2 in Ph-positive lymphoblasts was mediated via the phosphatidyl-inositol-3 kinase pathway. Analogous results were seen in murine BaF/3 cells transfected with a BCR-ABL expression vector. In contrast to the human cell lines, murine Baf/BCR-ABL cells exposed to STI571 inhibitor were all arrested in G1. This arrest could be abrogated by exogenous expression of cyclin D2 from a transfected cDNA construct. We conclude that a direct connection exists between Bcr-Abl PTK activity and cell cycle progression in which cyclin D2 plays a critical role. However, cell cycle progression in human Ph-positive lymphoid cells is not entirely dependent on Bcr-Abl PTK, and additional genetic lesions must be present.
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MESH Headings
- Benzamides
- Blast Crisis
- Cyclin D2
- Cyclins/biosynthesis
- Cyclins/genetics
- Down-Regulation
- Fusion Proteins, bcr-abl/antagonists & inhibitors
- Fusion Proteins, bcr-abl/genetics
- Fusion Proteins, bcr-abl/metabolism
- G1 Phase/drug effects
- Humans
- Imatinib Mesylate
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/enzymology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/metabolism
- Lymphocytes/enzymology
- Lymphocytes/metabolism
- Phosphatidylinositol 3-Kinases/physiology
- Piperazines
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/enzymology
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/genetics
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/metabolism
- Protein-Tyrosine Kinases/antagonists & inhibitors
- Protein-Tyrosine Kinases/genetics
- Protein-Tyrosine Kinases/metabolism
- Pyrimidines/pharmacology
- S Phase/drug effects
- Signal Transduction
- Transfection
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Affiliation(s)
- M W Deininger
- Department of Haematology, Faculty of Medicine, Imperial College of Science, Technology and Medicine, Hammersmith Hospital, London W12 0NN, United Kingdom
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Abstract
INTRODUCTION Chronic myeloid leukemia is a myeloproliferative disorder clinically characterised by a triphasic course: after a chronic phase over a median time of 4 years, patients developed an accelerated phase, then a blastic phase, resulting in the patient's death with 3 to 6 months. PURPOSE During the last past years, progress have been made in the understanding of the molecular mechanism responsible of leukemic growth. This has also provided support for a therapeutic improvement with the appearance of treatment such as tyrosine kinase inhibitors which specifically target the oncoprotein inside the leukemic cells. CONCLUSION These treatments, such as STI571 or Glivec, are at present in clinical trials, and could be the medicines for the future. Thus, chronic myeloid leukemia is also a model for the development of the new therapeutic drugs.
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Affiliation(s)
- F X Mahon
- Laboratoire de greffe de moelle, université Victor-Segalen, UMR CNRS 5540, 146, rue Léo-Saignat, 33076 Bordeaux, France.
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38
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Etienne G, Mahon FX. [Leukemogenesis and new therapy development: the example of chronic myelogenous leukemia]. Bull Cancer 2001; 88:651-8. [PMID: 11495816] [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: 02/21/2023]
Abstract
During the past ten years, the improvements of our understanding of cellular signal transduction pathways provide new targets for drug therapies. Chronic myeloid leukemia (CML), a malignant hematopoietic stem cell disorder, is characterised by an acquired genetic abnormality: the Philadelphia chromosome (Ph) and its molecular counterpart, the oncogene BCR-ABL. The latter, which is translated in an active BCR-ABL protein, exhibited a deregulated tyrosine kinase activity inducing malignant transformation. Produced from the 2-phenylaminopyrimidine class, a novel synthetic inhibitor, identified as CGP57148 (STI571), inhibits tyrosine kinase activity of c-ABL, BCR-ABL, PDGF-R and c-kit at micromolar concentrations. It suppresses the proliferation of the majority of BCR-ABL positive cell lines. The phases I-II clinical trials in CML have demonstrated promising results, especially in the chronic phase of the disease. STI571 is an original therapeutic approach which may be used as a model for the development of other drugs in cancer.
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MESH Headings
- Animals
- Antineoplastic Agents/therapeutic use
- Apoptosis/physiology
- Benzamides
- Bone Marrow Transplantation
- Cancer Vaccines/therapeutic use
- Cell Adhesion/physiology
- Drug Resistance, Neoplasm
- Enzyme Inhibitors/therapeutic use
- Forecasting
- Fusion Proteins, bcr-abl
- Humans
- Imatinib Mesylate
- Interferon-alpha/therapeutic use
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Oligonucleotides, Antisense/therapeutic use
- Oncogene Proteins, Fusion/genetics
- Oncogene Proteins, Fusion/physiology
- Philadelphia Chromosome
- Piperazines/therapeutic use
- Protein-Tyrosine Kinases/antagonists & inhibitors
- Pyrimidines/therapeutic use
- Signal Transduction/physiology
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Affiliation(s)
- G Etienne
- Laboratoire de greffe de moelle, Université Victor-Ségalen UMR CNRS 5540, 146, rue Léo-Saignat, 33076 Bordeaux, France
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39
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Barthe C, Mahon FX, Gharbi MJ, Fabères C, Bilhou-Nabéra C, Hochhaus A, Reiffers J, Marit G. Expression of interferon-α (IFN-α) receptor 2c at diagnosis is associated with cytogenetic response in IFN-α–treated chronic myeloid leukemia. Blood 2001; 97:3568-73. [PMID: 11369652 DOI: 10.1182/blood.v97.11.3568] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [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
For the management of chronic myeloid leukemia (CML), prediction or early determination of the response to interferon-alpha (IFN-α) treatment is important for identifying nonresponder patients to whom alternative therapy may be proposed. In this study, the levels of expression of both BCR-ABL and subunit 2c of IFN-α receptor (IFN-αR2c) genes were analyzed at diagnosis in 74 patients with chronic phase CML treated with an IFN-α monotherapy. By using blood samples, real-time quantitative polymerase chain reaction was performed to quantify BCR-ABL, IFN-αR2c, and G6PDH mRNA as external control. The results were compared with hematologic and cytogenetic responses to IFN-α. A wide variation in the BCR-ABL/G6PDH ratio was observed at diagnosis (median, 6.68%; range, 0.18%-41.31%), but no significant association with response to IFN-α was observed. In contrast, the variation of IFN-αR2c/G6PDH ratio at diagnosis was significantly associated with the achievement of major cytogenetic response (MCR; 34% or lower Ph+metaphases). Median values of IFN-αR2c/G6PDH ratio for patients achieving MCR and for those who did not achieve it were 110.75% (range, 9.47%-612.30%) and 64.42% (range, 5.96%-425.40%), respectively (P = .037). In addition, this novel molecular factor, combined with the achievement of complete hematologic response at 3 months, makes it possible to predict MCR achievement with high probability by Kaplan-Meier analysis (91% ± 17% at 24 months; P = .0001).
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MESH Headings
- Adult
- Aged
- Cytogenetic Analysis
- Female
- Fusion Proteins, bcr-abl/genetics
- Gene Expression
- Glucosephosphate Dehydrogenase/genetics
- Humans
- Interferon-alpha/therapeutic use
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/blood
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Male
- Middle Aged
- Polymerase Chain Reaction
- RNA, Messenger/analysis
- RNA, Messenger/blood
- Receptors, Interferon/genetics
- Sensitivity and Specificity
- Tumor Cells, Cultured
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Affiliation(s)
- C Barthe
- Laboratoire Universitaire d'Hématologie, Université Victor Segalen Bordeaux, 146, Rue Léo Saignat, 33076 Bordeaux cedex, France
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40
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Sainty D, Liso V, Cantù-Rajnoldi A, Head D, Mozziconacci MJ, Arnoulet C, Benattar L, Fenu S, Mancini M, Duchayne E, Mahon FX, Gutierrez N, Birg F, Biondi A, Grimwade D, Lafage-Pochitaloff M, Hagemeijer A, Flandrin G. A new morphologic classification system for acute promyelocytic leukemia distinguishes cases with underlying PLZF/RARA gene rearrangements. Blood 2000; 96:1287-96. [PMID: 10942370] [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: 02/17/2023] Open
Abstract
Acute promyelocytic leukemia (APL) is typified by the t(15;17) translocation, which leads to the formation of the PML/RARA fusion gene and predicts a beneficial response to retinoids. However, approximately 10% of all APL cases lack the classic t(15;17). This group includes (1) cases with cryptic PML/RARA gene rearrangements and t(5;17) that leads to the NPM/RARA fusion gene, which are retinoid-responsive, and (2) cases with t(11;17)(q23;q21) that are associated with the PLZF/RARA fusion gene, which are retinoid-resistant. A key issue is how to rapidly distinguish subtypes of APL that demand distinct treatment approaches. To address this issue, a European workshop was held in Monza, Italy, during June 1997, and a morphologic, immunophenotypic, cytogenetic, and molecular review was undertaken in 60 cases of APL lacking t(15;17). This process led to the development of a novel morphologic classification system that takes into account the major nuclear and cytoplasmic features of APL. There were no major differences observed in morphology or immunophenotype between cases with the classic t(15;17) and those with the cryptic PML/RARA gene rearrangements. Auer rods were absent in the t(5;17) case expressing NPM/RARA. Interestingly, this classification system distinguished 9 cases with t(11;17)(q23;q21) and, in addition, successfully identified 2 cases lacking t(11;17), which were subsequently shown to have underlying PLZF/RARA fusions. The PLZF/RARA cases were characterized by a predominance of blasts with regular nuclei, an increased number of Pelger-like cells, and by expression of CD56 in 4 of 6 cases tested. Use of this classification system, combined with an analysis for CD56 expression, should allow early recognition of APL cases requiring tailored molecular investigations. (Blood. 2000;96:1287-1296)
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Affiliation(s)
- D Sainty
- Department of Biology, Institut Paoli-Calmettes, Marseille, France.
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41
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Mahon FX, Deininger MW, Schultheis B, Chabrol J, Reiffers J, Goldman JM, Melo JV. Selection and characterization of BCR-ABL positive cell lines with differential sensitivity to the tyrosine kinase inhibitor STI571: diverse mechanisms of resistance. Blood 2000; 96:1070-9. [PMID: 10910924] [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: 02/17/2023] Open
Abstract
Targeting the tyrosine kinase activity of Bcr-Abl with STI571 is an attractive therapeutic strategy in chronic myelogenous leukemia (CML). A few CML cell lines and primary progenitors are, however, resistant to this compound. We investigated the mechanism of this resistance in clones of the murine BaF/3 cells transfected with BCR-ABL and in 4 human cell lines from which sensitive (s) and resistant (r) clones were generated by various methods. Although the resistant cells were able to survive in the presence of STI571, their proliferation was approximately 30% lower than that of their sensitive counterparts in the absence of the compound. The concentration of STI571 needed for a 50% reduction in viable cells after a 3-day exposure was on average 10 times higher in the resistant (2-3 micromol/L) than in the sensitive (0.2-0.25 micromol/L) clones. The mechanism of resistance to STI571 varied among the cell lines. Thus, in Baf/BCR-ABL-r, LAMA84-r, and AR230-r, there was up-regulation of the Bcr-Abl protein associated with amplification of the BCR-ABL gene. In K562-r, there was no Bcr-Abl overexpression, but the IC(50) for the inhibition of Bcr-Abl autophosphorylation was increased in the resistant clones. Sequencing of the Abl kinase domain revealed no mutations. The multidrug resistance P-glycoprotein (Pgp) was overexpressed in LAMA84-r, indicating that at least 2 mechanisms of resistance operate in this cell line. KCL22-r showed neither Bcr-Abl up-regulation nor a higher threshold for tyrosine kinase inhibition by STI571. We conclude that BCR-ABL-positive cells can evade the inhibitory effect of STI571 by different mechanisms, such as Bcr-Abl overexpression, reduced intake mediated by Pgp, and, possibly, acquisition of compensatory mutations in genes other than BCR-ABL.
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Affiliation(s)
- F X Mahon
- Department of Haematology, Imperial College School of Science, Technology and Medicine, Hammersmith Hospital, London, UK
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42
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Salesse S, Lagarde V, Ged C, de Verneuil H, Reiffers J, Mahon FX. Retroviral coexpression of IFN-alpha and IFN-gamma genes and inhibitory effects in chronic myeloid leukemia cells. J Interferon Cytokine Res 2000; 20:577-87. [PMID: 10888114 DOI: 10.1089/10799900050044778] [Citation(s) in RCA: 2] [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] [Indexed: 11/12/2022] Open
Abstract
Interferon (IFN) is an effective treatment for chronic myeloid leukemia (CML) in chronic phases, and a number of in vitro antileukemic effects of IFN on CML cells have been reported. The transfer of cytokine genes into tumor cells is reportedly a valuable approach to improve the antitumor activity of cytokines in various models. We first investigated the possibility of transducing CML cells with the retroviral vectors LIalpha2SN and LIgammaSN, encoding the IFN-alpha2 and IFN-gamma genes, respectively, and with the bicistronic vector LIalpha2IrIgammaSN coexpressing the IFN-alpha2 and IFN-gamma genes. We then analyzed the effects of IFN-alpha2 and IFN-gamma produced alone or simultaneously on the proliferation of CML cells. We optimized the transduction efficiency by using the CML-derived K562 cell line. We then introduced IFN genes into CML CD34+ cells. Secretion of IFN-alpha and IFN-gamma was demonstrated in K562 and CML CD34+ cells transduced with the different vectors. The MHC class I antigens were overexpressed in both K562 and CML CD34+ transduced cells. Inhibition of the proliferation of LIalpha2IrIgammaSN-transduced CML cells was greater than with the LIalpha2SN and the LIgammaSN-transduced CML cells. We demonstrate an additive effect of IFN-alpha and IFN-gamma on the inhibition of K562 and CML CD34+ cell proliferation.
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MESH Headings
- Antigens, CD34/metabolism
- Base Sequence
- Cell Division/drug effects
- DNA Primers/genetics
- Gene Expression
- Genetic Therapy
- Genetic Vectors
- Humans
- Interferon Type I/biosynthesis
- Interferon Type I/genetics
- Interferon Type I/pharmacology
- Interferon-gamma/biosynthesis
- Interferon-gamma/genetics
- Interferon-gamma/pharmacology
- K562 Cells
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/immunology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Recombinant Proteins
- Retroviridae/genetics
- Transduction, Genetic
- Tumor Stem Cell Assay
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Affiliation(s)
- S Salesse
- Laboratoire de Greffe de Moelle, UMR CNRS 5540, Fédération de Recherche 60 Biologie des Greffes, Université Victor Segalen Bordeaux, France
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43
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Solanilla A, El Andaloussi A, Grosset C, Duchez P, Mossalayi MD, Mahon FX, Reiffers J, Marit G, Ripoche J. Differential effect of interferon alpha on chronic myelogenous leukaemia and normal haematopoietic progenitors in a stromal cell co-culture context: role of the flt3 ligand. Br J Haematol 2000; 109:382-7. [PMID: 10848829 DOI: 10.1046/j.1365-2141.2000.01917.x] [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] [Indexed: 11/20/2022]
Abstract
Interferon alpha (IFN-alpha) is used to treat chronic myelogenous leukaemia (CML) patients. However, its target(s) remain(s) unknown. One possibility is that there is a differing sensitivity of the leukaemic from the normal colony-forming cell (CFC) compartments to IFN-alpha. Co-cultures of progenitors with stromal cells provide a valuable tool to dissect direct and indirect activities of IFN-alpha. In this study, we have used endothelial cells (EC) as a source of stromal cells. In co-cultures of normal progenitors with EC, IFN-alpha increased the generation of clonogenic cells, mainly via an increased production of flt3 ligand (FL) by EC. In contrast, in co-cultures of CML progenitors with EC, IFN-alpha inhibited the generation of clonogenic cells, mainly by direct inhibition on the progenitors, the up-regulation of FL production by stromal cells being unable to compensate for the direct inhibitory effects of IFN-alpha. These data provide evidence for a differential effect of IFN-alpha on the growth of CML and normal CFC cells in a stromal context and suggest that an alteration in the response of CML progenitor cells to FL is important in the explanation of this differential effect.
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Affiliation(s)
- A Solanilla
- FR 60, Biologie des Greffes, Université de Bordeaux 2, France.
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44
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Pigneux A, Mahon FX, Jazwiec B, Pigeonnier V, Ripoche J, Reiffers J. Effect of antisense oligonucleotides on CD34+ cells from chronic myeloid leukemia. Leuk Lymphoma 2000; 36:569-78. [PMID: 10784402 DOI: 10.3109/10428190009148405] [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] [Indexed: 01/08/2023]
Abstract
Chronic myeloid leukemia (CML) is a hematopoietic stem cell disorder characterized by a specific hybrid gene BCR-ABL (formed as a result of t(9;22)). This leads to two possible mRNA usually present in leukemic cells, either B2A2 or B3A2. Targeting these mRNA by antisense oligonucleotides (AS) might offer the opportunity to decrease leukemic growth. We have tested the ability of AS to inhibit the in vitro proliferation of CD34 positive (CD34+) blood cells from 16 patients with newly diagnosed CML. CD34+ cells were isolated by an immunomagnetic technique and incubated for 16 to 18 hours with an 18 mer AS (0.25 mM). Sense oligonucleotides served as controls. The effects of AS were evaluated by clonogenic test (production of CFU-GM). Moreover, colonies were picked out and studied by RT-PCR to analyse the presence of BCR-ABL transcript. For nine patients with B3A2 transcript, the median inhibition of CFU-GM formation at day 14 was 64.0 +/- 11.2% (68.0 +/- 11.4% at day 21) and for the seven patients with a B2A2 transcript: 59.0 +/- 11.4% (72.5 +/- 12.0% at day 21). AS showed no effect on CD34+ cells from three normal volunteer donor cells. However, for every patient studied, colonies picked out remained BCR-ABL positive with the RT-PCR technique.
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MESH Headings
- Antigens, CD34
- Cell Division/genetics
- Fusion Proteins, bcr-abl/genetics
- Gene Targeting
- Hematopoietic Stem Cells/pathology
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Oligonucleotides, Antisense/genetics
- Oligonucleotides, Antisense/therapeutic use
- RNA, Messenger/antagonists & inhibitors
- RNA, Messenger/genetics
- Reverse Transcriptase Polymerase Chain Reaction
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Affiliation(s)
- A Pigneux
- Laboratoire de Greffe de Moelle, UMR CNRS 5540, Université de Bordeaux II, France
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45
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Solanilla A, Grosset C, Lemercier C, Dupouy M, Mahon FX, Schweitzer K, Reiffers J, Weksler B, Ripoche J. Expression of Flt3-ligand by the endothelial cell. Leukemia 2000; 14:153-62. [PMID: 10637491 DOI: 10.1038/sj.leu.2401635] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.1] [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: 11/08/2022]
Abstract
Flt3-ligand (FL) is a cytokine that is of paramount importance in the proliferation of primitive hematopoietic progenitors. In this study, we show that endothelial cells (EC) produce large amounts of soluble FL and express a membrane-bound form of the molecule. Bone marrow microvascular EC also produce FL, suggesting that EC are an important source of FL in the bone marrow. High concentrations of FL in EC supernatants contrast with its undetectable levels in long-term bone marrow cultures. A single mRNA for FL is detected, suggesting that soluble FL derives from the membrane-bound species by proteolytic release. FL mRNA is stable with a half-life of about 3 h. II-1alpha increases FL mRNA levels and membrane and soluble FL expression. Glucocorticoids, known inhibitors for many hematopoietic growth factors do not down-regulate the expression of FL. On the contrary, GC increase the expression of both species of FL. The neutralization of FL in cocultures EC/ hematopoietic progenitors results in an acceleration of the maturation of the progenitors. IFN-alpha, MIP-1 alpha and TGF-beta stimulate production of membrane-bound and soluble FL. This stimulation is essential to explain their modulatory effect on the generation of clonogenic cells in cocultures EC/hematopoietic progenitors. Leukemia (2000) 14, 153-162.
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Affiliation(s)
- A Solanilla
- Laboratoire de Greffe de Moelle, Université Victor Ségalen, Bordeaux, France
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46
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Marit G, Cao Y, Froussard P, Ripoche J, Dupouy M, Elandaloussi A, Lacombe F, Mahon FX, Keller H, Pla M, Reiffers J, Theze J. Increased liposome-mediated gene transfer into haematopoietic cells grown in adhesion to stromal or fibroblast cell line monolayers. Eur J Haematol 2000; 64:22-31. [PMID: 10680702 DOI: 10.1034/j.1600-0609.2000.80230.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [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: 11/23/2022]
Abstract
We investigated transfection rates of CD34+ haematopoietic progenitor cells (HPC) or haematopoietic cell lines (TF-1, KG1a and K562) using the LacZ gene as a reporter and cationic liposomes. The transfection efficiency of CD34+ haematopoietic progenitor cells (HPC) or TF-1, KG1a and K562 grown in suspension is very low (average percentage of 0.013 for HPC and 0.03 for cell lines). Adhesion of HPC or cell lines to plates by immunological or physical methods significantly enhances transfection efficiency; however, the percentage of transfected cells still remained low. We found that adhesion of TF-1, KG1a and K562 HC to MS-5 stroma cells or NIH-3T3 fibroblast cells increased transfection efficiency. Under these conditions transfection is achieved in 11.2-25% (mean 18.30%) for the cell lines and 13.6% (range 8.2-24.2%) for CD34+ HPC. These results indicate that liposome-mediated transfection of HC is significantly increased when cells are grown in adherence to stroma or fibroblast monolayers.
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Affiliation(s)
- G Marit
- Laboratoire de Greffe de Moelle, UMR CNRS 5540, Université Victor Segalen Bordeaux 2, France.
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Pigneux A, Faberes C, Boiron JM, Mahon FX, Cony-Makhoul P, Agape P, Lounici A, Bernard P, Bilhou-Nabera C, Bouzgarrou R, Marit G, Reiffers J. Autologous stem cell transplantation in chronic myeloid leukemia: a single center experience. Bone Marrow Transplant 1999; 24:265-70. [PMID: 10455364 DOI: 10.1038/sj.bmt.1701871] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [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: 11/09/2022]
Abstract
Between 1980 and 1996, we transplanted 72 patients with CML using blood stem cells collected at diagnosis before treatment and without any mobilization. The median age of patients at diagnosis was 47.5 years (range 20.5-59.5). The median numbers of nucleated cells and CFU-GM transplanted were 10 x 10(8)/kg and 97 x 10(4)/kg, respectively. The median duration to reach more than 0.5 x 10(9)/l neutrophils and 50 x 10(9)/l platelets was 12 (range 5-19) and 11 days (range 0-79), respectively. Twenty patients (group I) were transplanted in chronic phase either for resistance to IFN (14 patients) (group IA) or because the Sokal index was more than 1.2 (six patients) (group IB). All those patients had preparative regimen with busulfan (4 mg/kg/day x 4) and melphalan (140 mg/m2). They were treated with recombinant alpha-interferon (IFN) after transplant. The cumulative incidence of major cytogenetic response (MCR) at 12 months was 25 +/- 21% (95% CI), the 5-year survival was 75 +/- 42% (95% CI). These results (observed in patients with bad prognosis factors) are similar to those usually observed in CML patients treated by IFN, whatever the Sokal risk. Thus autologous transplantation is able to reproduce for poor prognosis patients the results observed in standard risk patients treated with IFN. This suggests that it could prolong survival. Fifty-two other patients (group II) were transplanted for CML in transformation (accelerated phase = 32; blast crisis = 20) after a preparative regimen containing either total body irradiation (TBI) or busulfan. The median survival was short (10.4 months) and only 21 patients survived more than 1 year. The survival was longer for patients transplanted in accelerated phase (vs blast crisis), those who were due to receive a double transplant (vs single) (34 patients), those who were treated with IFN after transplant (vs hydroxyurea) and for the patients who obtained a complete hematologic response.
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Affiliation(s)
- A Pigneux
- Service d'Hématologie, Hôpital du Haut Lévêque, CHU Bordeaux, Pessac, France
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Pigneux A, Mahon FX, Reiffers J. Autologous peripheral blood stem cell transplantation for chronic myelocytic leukaemia, using unmanipulated grafts. Best Pract Res Clin Haematol 1999; 12:193-8. [PMID: 11000992 DOI: 10.1053/beha.1999.0016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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: 11/11/2022]
Abstract
In chronic myeloid leukaemia (CML) allogeneic stem cell transplantation can be proposed to a minority of patients who are both less than 50 years of age and have an HLA-identical donor. Recombinant alpha-interferon induces cytogenetic responses (and prolongation of survival) in only 25-40% of patients. Thus, alternative treatments need to be proposed. When performed in chronic phase with unmodified stem cells, autologous stem cell transplantation is followed by cytogenetic responses in about 40% of cases, and some data suggest that these responder patients could have a prolongation of survival. This now needs to be demonstrated prospectively. If so, further studies could be performed in order to define the best source of stem cells (purged or unpurged) to be used.
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Affiliation(s)
- A Pigneux
- Service d'Hématologie, Hôpital du Haut Lévêque, Bordeaux, France
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Labouyrie E, Dubus P, Groppi A, Mahon FX, Ferrer J, Parrens M, Reiffers J, de Mascarel A, Merlio JP. Expression of neurotrophins and their receptors in human bone marrow. Am J Pathol 1999; 154:405-15. [PMID: 10027399 PMCID: PMC1849993 DOI: 10.1016/s0002-9440(10)65287-x] [Citation(s) in RCA: 136] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The expression of neurotrophins and their receptors, the low-affinity nerve growth factor receptor (p75LNGFR) and the Trk receptors (TrkA, TrkB, and TrkC), was investigated in human bone marrow from 16 weeks fetal age to adulthood. Using reverse transcription-polymerase chain reaction, all transcripts encoding for catalytic and truncated human TrkB or TrkC receptors were detected together with trkAI transcripts, whereas trkAII transcripts were found only in control nerve tissues. Transcripts for the homologue of the rat truncated TrkC(ic113) receptor were identified for the first time in human tissue. Stromal adventitial reticular cells were found immunoreactive for all neutrophin receptors. In contrast, hematopoietic cell types were not immunoreactive for p75LNGFR but showed immunoreactivity for one or several Trk receptors. TrkA immunoreactivity was found in immature erythroblasts. Catalytic TrkB immunoreactivity was observed in eosinophilic metamyelocytes and polymorphonuclear cells. Truncated TrkB immunoreactivity was found in erythroblasts and megacaryocytes. Immunoreactivity for both catalytic and truncated TrkC receptor was observed in promyelocytes, myelocytes, some polymorphonuclear cells and megacaryocytes. Neutrophin transcript levels appeared higher at fetal than at adult stages, no variation in Trk family transcript levels was observed. The local expression of neurotrophin genes suggests a wide range of paracrine and/or autocrine mode of action through their corresponding receptors within the bone marrow.
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Affiliation(s)
- E Labouyrie
- Laboratoire d'Histologie-Embryologie, Université Victor Segalen, Bordeaux, France.
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Mahon FX, Fabères C, Pueyo S, Cony-Makhoul P, Salmi R, Boiron JM, Marit G, Bilhou-Nabera C, Carrère A, Montastruc M, Pigneux A, Bernard P, Reiffers J. Response at three months is a good predictive factor for newly diagnosed chronic myeloid leukemia patients treated by recombinant interferon-alpha. Blood 1998; 92:4059-65. [PMID: 9834210] [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: 02/09/2023] Open
Abstract
In a single institution, we have used recombinant interferon- (IFN-) to treat 116 newly diagnosed Philadelphia-positive (Ph+) chronic myeloid leukemia (CML) patients and analyzed the predictive factors for response and survival. The patients whose median age was 50.3 years (range, 9 to 70) were administered IFN- (5 million units/m2/d) subcutaneously. The IFN- dose was subsequently adjusted to maintain the white blood cell and platelet counts between 1.5 and 5 x 10(9)/L, 50 and 100 x 10(9)/L, respectively. At diagnosis, the Sokal score was used to classify the patients into three groups: low (n = 57), intermediate (n = 42), and high risk (n = 16). A complete hematological response (CHR) was achieved in 93 cases (80.2%). Of the 116 patients, 113 were available for cytogenetic evaluation. Fifty patients (43%) achieved a major cytogenetic response (MCR) (=65% marrow Ph- cells), 37 of them having a complete cytogenetic response (CCR). The estimated 5-year survival of the 116 patients was 68% +/- 11% (95% confidence interval [CI]) with a median follow-up of 42 months (range, 3 to 114) and 85% +/- 11% (95% CI) with a median follow-up of 30.9 (range, 3 to 111) when patients were censored at the time of transplantation. Event-free survival at 5 years (adding death and transplant as event) was 46% +/- 11% (95% CI). Using proportional hazards regression to study time-dependent variables, we confirmed that the most significant factor associated with survival was the cytogenetic response (MCR or CCR) (P <.0001). This factor was independent compared with the Sokal score and baseline variables used to calculate the Sokal score. Moreover, using either univariate or multivariate analysis, the achievement of CHR within 3 months was strongly correlated with MCR (P <.0001). Minimum cytogenetic response (mCR, ie, at least 5% of Ph- metaphases) at 3 months was also a significant predictive factor for MCR (P <.0001). These results show that IFN- can induce a high rate of hematological and cytogenetic response when administered in doses leading to myelosuppression. Factors such as the achievement of CHR and mCR within 3 months could be useful to identify early those patients who will not respond to IFN- and who need alternative treatments such as stem cell transplantation.
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MESH Headings
- Administration, Cutaneous
- Adolescent
- Adult
- Aged
- Child
- Female
- Humans
- Interferon Type I/administration & dosage
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/mortality
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/physiopathology
- Male
- Middle Aged
- Predictive Value of Tests
- Prognosis
- Recombinant Proteins
- Survival Analysis
- Time Factors
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Affiliation(s)
- F X Mahon
- Service des Maladies du Sang, Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Levêque, Pessac, France
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