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Chien KS, Ong F, Kim K, Li Z, Kanagal‐Shamanna R, DiNardo CD, Takahashi K, Montalban‐Bravo G, Hammond D, Sasaki K, Pierce SA, Kantarjian HM, Garcia‐Manero G. Cancer patients with clonal hematopoiesis die from primary malignancy or comorbidities despite higher rates of transformation to myeloid neoplasms. Cancer Med 2024; 13:e7093. [PMID: 38497538 PMCID: PMC10945882 DOI: 10.1002/cam4.7093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 01/25/2024] [Accepted: 02/28/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND The occurrence of somatic mutations in patients with no evidence of hematological disorders is called clonal hematopoiesis (CH). CH, whose subtypes include CH of indeterminate potential and clonal cytopenia of undetermined significance, has been associated with both hematologic cancers and systemic comorbidities. However, CH's effect on patients, especially those with concomitant malignancies, is not fully understood. METHODS We performed a retrospective evaluation of all patients with CH at a tertiary cancer center. Patient characteristics, mutational data, and outcomes were collected and analyzed. RESULTS Of 78 individuals included, 59 (76%) had a history of cancer and 60 (77%) had moderate to severe comorbidity burdens. DNMT3A, TET2, TP53, and ASXL1 were the most common mutations. For the entire cohort, the 2-year overall survival rate was 79% (95% CI: 70, 90), while the median survival was not reached. Of 20 observed deaths, most were related to primary malignancies (n = 7, 35%), comorbidities (n = 4, 20%), or myeloid neoplasms (n = 4, 20%). Twelve patients (15%) experienced transformation to a myeloid neoplasm. According to the clonal hematopoiesis risk score, the 3-year transformation rate was 0% in low-risk, 15% in intermediate-risk (p = 0.098), and 28% in high-risk (p = 0.05) patients. By multivariate analysis, transformation was associated with variant allele frequency ≥0.2 and hemoglobin <10 g/dL. CONCLUSIONS In a population including mostly cancer patients, CH was associated with comorbidities and myeloid transformation in patients with higher mutational burdens and anemia. Nevertheless, such patients were less likely to die of their myeloid neoplasm than of primary malignancy or comorbidities.
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Affiliation(s)
- Kelly S. Chien
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Faustine Ong
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Kunhwa Kim
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Ziyi Li
- Department of BiostatisticsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Rashmi Kanagal‐Shamanna
- Department of HematopathologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Courtney D. DiNardo
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Koichi Takahashi
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | | | - Danielle Hammond
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Koji Sasaki
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Sherry A. Pierce
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Hagop M. Kantarjian
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
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2
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Kim K, Konopleva M, DiNardo CD, Borthakur G, Loghavi S, Tang G, Daver N, Pemmaraju N, Jabbour E, Rausch CR, Yilmaz M, Sasaki K, Short NJ, Jain N, Brandt M, Pierce S, Garcia‐Manero G, Ravandi F, Kantarjian H, Kadia TM. Urgent cytoreduction for newly diagnosed acute myeloid leukemia patients allows acquisition of pretreatment genomic data and enrollment on investigational clinical trials. Am J Hematol 2022; 97:885-894. [PMID: 35413152 DOI: 10.1002/ajh.26572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/15/2022] [Accepted: 04/11/2022] [Indexed: 11/11/2022]
Abstract
Newly diagnosed acute myeloid leukemia is often deemed a medical emergency, requiring urgent treatment. This is in contradiction with the need for accurate cytogenetic and molecular data, which is not immediately available, to select optimal therapy. We hypothesized that cytoreduction with hydroxyurea or cytarabine would enable urgent disease control and provide a bridge to clinical trial enrollment. We analyzed three prospective frontline clinical trials that allowed the use of cytoreduction before treatment initiation. Among 274 patients with a median age of 62 (range, 18-89), there was no significant difference in short- and long-term outcome and safety among patients who did (CytoRed) or did not receive (NoCytoRed) cytoreduction. The overall response rate in CytoRed group was 91%, compared with 86% in NoCytoRed group (p = .264). The 30- and 60-day mortality rates were 2% and 7% in CytoRed group, compared with 2% (p = .978) and 6% (p = .652) in NoCytoRed group, respectively. There was no significant difference in overall survival (OS) between in CytoRed group compared with NoCytoRed group (Hazard ratio 0.97, 95% CI 0.70-1.37, p = .879). Results were unchanged after stratification by age (< or ≥65 years) or after multivariate analyses for OS. Our data suggests that urgent cytoreduction using hydroxyurea or cytarabine is a feasible and safe approach to facilitate acquisition of complete diagnostic information prior to treatment initiation on a clinical trial.
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Affiliation(s)
- Kunhwa Kim
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Marina Konopleva
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Courtney D. DiNardo
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Gautam Borthakur
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Sanam Loghavi
- Department of Hematopathology The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Guilin Tang
- Department of Hematopathology The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Naval Daver
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Naveen Pemmaraju
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Elias Jabbour
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Caitlin R. Rausch
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Musa Yilmaz
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Koji Sasaki
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Nicholas J. Short
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Nitin Jain
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Mark Brandt
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Sherry Pierce
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | | | - Farhad Ravandi
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Hagop Kantarjian
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Tapan M. Kadia
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
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3
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DiNardo CD, Lachowiez CA, Takahashi K, Loghavi S, Kadia T, Daver N, Xiao L, Adeoti M, Short NJ, Sasaki K, Wang SA, Borthakur G, Issa G, Maiti A, Alvarado Y, Pemmaraju N, Bravo GM, Masarova L, Yilmaz M, Jain N, Andreeff M, Garcia‐Manero G, Kornblau S, Ravandi F, Jabbour E, Konopleva MY, Kantarjian HM. Venetoclax combined with FLAG-IDA induction and consolidation in newly diagnosed acute myeloid leukemia. Am J Hematol 2022; 97:1035-1043. [PMID: 35583199 DOI: 10.1002/ajh.26601] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 12/17/2022]
Abstract
Multi-agent induction chemotherapy (IC) improves response rates in younger patients with acute myeloid leukemia (AML); however, relapse remains the principal cause of treatment failure. Improved induction regimens are needed. A prospective single-center phase Ib/II study evaluating fludarabine, cytarabine, G-CSF, and idarubicin combined with venetoclax (FLAG-IDA + VEN) in patients with newly diagnosed (ND) or relapsed/refractory AML. The primary efficacy endpoint was assessment of overall activity (overall response rate [ORR]: complete remission [CR] + CR with partial hematologic recovery [CRh] + CR with incomplete hematologic recovery [CRi] + morphologic leukemia free state + partial response). Secondary objectives included additional assessments of efficacy, overall survival (OS), and event-free survival (EFS). Results of the expanded ND cohort with additional follow-up are reported. Forty-five patients (median age: 44 years [range 20-65]) enrolled. ORR was 98% (N = 44/45; 95% credible interval 89.9%-99.7%). Eighty-nine percent (N = 40/45) of patients attained a composite CR (CRc + CRh + CRi) including 93% (N = 37/40) who were measurable residual disease (MRD) negative. Twenty-seven (60%) patients transitioned to allogeneic stem cell transplant (alloHSCT). Common non-hematologic adverse events included febrile neutropenia (44%; N = 20), pneumonia (22%, N = 10), bacteremia (18%, N = 8), and skin/soft tissue infections (44%, N = 20). After a median follow-up of 20 months, median EFS and OS were not reached. Estimated 24-month EFS and OS were 64% and 76%, respectively. FLAG-IDA + VEN is an active regimen in ND-AML capable of producing high MRD-negative remission rates and enabling transition to alloHSCT when appropriate in most patients. Toxicities were as expected with IC and were manageable. Estimated 24-month survival appears favorable compared to historical IC benchmarks.
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Affiliation(s)
- Courtney D. DiNardo
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Curtis A. Lachowiez
- Division of Cancer Medicine The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Koichi Takahashi
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Sanam Loghavi
- Department of Hematopathology The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Tapan Kadia
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Naval Daver
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Lianchun Xiao
- Department of Biostatistics The University of Texas MD Anderson Cancer Center Houston Texas United States
| | - Maria Adeoti
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Nicholas J. Short
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Koji Sasaki
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Sa A. Wang
- Department of Hematopathology The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Gautam Borthakur
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Ghayas Issa
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Abhishek Maiti
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Yesid Alvarado
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Naveen Pemmaraju
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | | | - Lucia Masarova
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Musa Yilmaz
- Division of Cancer Medicine The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Nitin Jain
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Michael Andreeff
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | | | - Steven Kornblau
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Farhad Ravandi
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Elias Jabbour
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Marina Y. Konopleva
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Hagop M. Kantarjian
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
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Senapati J, Shoukier M, Garcia‐Manero G, Wang X, Patel K, Kadia T, Ravandi F, Pemmaraju N, Ohanian M, Daver N, DiNardo C, Alvarado Y, Aldrich J, Borthakur G. Activity of decitabine as maintenance therapy in core binding factor acute myeloid leukemia. Am J Hematol 2022; 97:574-582. [PMID: 35150150 PMCID: PMC9303262 DOI: 10.1002/ajh.26496] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 12/11/2022]
Abstract
Background Posttherapy measurable residual disease (MRD) positivity in core binding factor acute myeloid leukemia (CBF‐AML) is associated with shorter relapse‐free survival (RFS). Elimination of MRD measured via quantitative reverse transcription polymerase chain reaction (qRTPCR) for disease specific transcripts can potentially lead to better outcomes in CBF‐AML. Methods We prospectively monitored the MRD using qRTPCR and flow cytometry on bone marrow samples in patients with newly diagnosed CBF‐AML who received decitabine (DAC) maintenance therapy after fludarabine/cytarabine/G‐CSF (FLAG)‐based induction/consolidation regimen. Negative qRTPCR (CMR) was defined as fusion transcript <0.01%. Results Thirty‐one patients with CBF‐AML including 14 with t(8;21) and 17 with inv(16) received parenteral DAC as maintenance therapy. Fifteen patients (48.3%) had completed FLAG‐based induction/consolidation but with positive MRD (0.35%, range = 0.01%–0.91%) (Group 1). Sixteen patients (51.7%) could not complete recommended consolidations with FLAG‐based regimen (due to older age or complications) and were switched to DAC maintenance (Group 2). In Group 2, eight patients (50%) had undetectable MRD (Group 2A) (all had qRTPCR ≤ 0.01%) and the other eight patients (50%) had residual fusion product by qRTPCR (0.1%, range = 0.02%–0.36%) (Group 2B) prior to starting DAC. Amongst the 23 patients who had a PCR ≥ 0.01% before maintenance therapy (Groups 1 and 2B), 12 patients (52%) attained a CMR as their best response (responders). The median pre‐DAC qRTPCR amongst responders were 0.03% compared to 0.14% in nonresponders (p = .002). The median estimated molecular RFS amongst responders were 93.9 months. At a median follow‐up of 59.3 months (13.2–106 months) from DAC initiation, 16 patients (51.6%) had to be initiated on a second line of therapy (40%, 25%, and 100% patients, respectively, in Groups1, 2A, and 2B). The median estimated time to new treatment between responders was 112.4 versus 5.8 months in nonresponders (hazard ratio = 0.16, 95% confidence interval = 0.04–0.54); however, there were no difference in overall survival between these groups (p = .37). Conclusion DAC is an effective maintenance therapy for CBF‐AML patients with persistent fusion transcript at a low level after FLAG‐based regimen. Attainment of CMR with DAC maintenance can lead to long‐term remission in patients who have persistent MRD positive after FLAG‐based regimen or are unable to receive the full course of consolidation therapy.
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Affiliation(s)
- Jayastu Senapati
- Department of Leukemia the University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Mahran Shoukier
- Department of Leukemia the University of Texas MD Anderson Cancer Center Houston Texas USA
| | | | - Xuemei Wang
- Department of Biostatistics The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Keyur Patel
- Department of Hematopathology The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Tapan Kadia
- Department of Leukemia the University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Farhad Ravandi
- Department of Leukemia the University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Naveen Pemmaraju
- Department of Leukemia the University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Maro Ohanian
- Department of Leukemia the University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Naval Daver
- Department of Leukemia the University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Courtney DiNardo
- Department of Leukemia the University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Yesid Alvarado
- Department of Leukemia the University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Jeffrey Aldrich
- Department of Internal Medicine The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Gautam Borthakur
- Department of Leukemia the University of Texas MD Anderson Cancer Center Houston Texas USA
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5
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Sasaki K, Kadia T, Begna K, DiNardo CD, Borthakur G, Short NJ, Jain N, Daver N, Jabbour E, Garcia‐Manero G, Bravo GM, Masarova L, Pierce S, Konopleva M, Ravandi F, Tefferi A, Kantarjian H. Prediction of early (4-week) mortality in acute myeloid leukemia with intensive chemotherapy. Am J Hematol 2022; 97:68-78. [PMID: 34716921 DOI: 10.1002/ajh.26395] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/26/2021] [Accepted: 10/28/2021] [Indexed: 12/19/2022]
Abstract
The progress with intensive chemotherapy and supportive care measures has improved survival in patients with newly diagnosed acute myeloid leukemia (AML). Given the recent development of effective low intensity therapies, an optimal decision on the therapy intensity may improve survival through the avoidance of early mortality. We reviewed the outcome of 3728 patients with newly diagnosed AML who received intensive chemotherapy between August 1980 and May 2020. Intensive chemotherapy was defined as a cumulative cytarabine dose ≥ 700 mg/m2 during induction therapy. We divided the whole cohort into a training and validation group at a 3:1 ratio. The population was divided into a training (2790 patients) and a validation cohort (938 patients). The median age was 55 years (range, 15-99). Among them, 442 patients (12%) had core-binding factor AML. Binary logistic regression identified older age, worse performance status, hyperbilirubinemia, elevated creatinine, hyperuricemia, cytogenetic abnormalities other than CBF and -Y, and pneumonia as adverse prognostic factors for an early 4-week mortality. This risk classification for early mortality was verified in the validation cohort of patients. In the validation cohort of more recently treated patients from 2000 to 2017, the 4-week mortality rates with intensive chemotherapy were 2%, 14%, and 50% in the low-, high-, and very high-risk group, respectively. The mortality rates with low intensity therapies were 3%, 9%, and 20%, respectively. The risk classification guides treatment intensity by the assessment of age, frailty, organ dysfunction, cytogenetic abnormality, and infection to avoid early mortality.
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Affiliation(s)
- Koji Sasaki
- Department of Leukemia MD Anderson Cancer Center Houston Texas USA
| | - Tapan Kadia
- Department of Leukemia MD Anderson Cancer Center Houston Texas USA
| | - Kebede Begna
- Department of Medicine, Division of Hematology Mayo Clinic Rochester Minnesota USA
| | | | - Gautam Borthakur
- Department of Leukemia MD Anderson Cancer Center Houston Texas USA
| | | | - Nitin Jain
- Department of Leukemia MD Anderson Cancer Center Houston Texas USA
| | - Naval Daver
- Department of Leukemia MD Anderson Cancer Center Houston Texas USA
| | - Elias Jabbour
- Department of Leukemia MD Anderson Cancer Center Houston Texas USA
| | | | | | - Lucia Masarova
- Department of Leukemia MD Anderson Cancer Center Houston Texas USA
| | - Sherry Pierce
- Department of Leukemia MD Anderson Cancer Center Houston Texas USA
| | - Marina Konopleva
- Department of Leukemia MD Anderson Cancer Center Houston Texas USA
| | - Farhad Ravandi
- Department of Leukemia MD Anderson Cancer Center Houston Texas USA
| | - Ayalew Tefferi
- Department of Medicine, Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Hagop Kantarjian
- Department of Leukemia MD Anderson Cancer Center Houston Texas USA
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6
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Garcia‐Manero G, Pierce S, Ravandi F, Kantarjian H. Dr. Elihu H. Estey (1946-2021). Am J Hematol 2021. [PMID: 34800347 DOI: 10.1002/ajh.26415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Sherry Pierce
- Department of Leukemia University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Farhad Ravandi
- Department of Leukemia University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Hagop Kantarjian
- Department of Leukemia University of Texas MD Anderson Cancer Center Houston Texas USA
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7
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Kadia TM, Ravandi F, Borthakur G, Konopleva M, DiNardo CD, Daver N, Pemmaraju N, Kanagal‐Shamanna R, Wang X, Huang X, Pierce S, Rausch C, Burger J, Ferrajoli A, Jain N, Popat U, Estrov Z, Verstovsek S, Jabbour E, Garcia‐Manero G, Kantarjian H. Long-term results of low-intensity chemotherapy with clofarabine or cladribine combined with low-dose cytarabine alternating with decitabine in older patients with newly diagnosed acute myeloid leukemia. Am J Hematol 2021; 96:914-924. [PMID: 33901324 DOI: 10.1002/ajh.26206] [Citation(s) in RCA: 12] [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: 04/03/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 02/06/2023]
Abstract
The treatment of older patients with newly diagnosed acute myeloid leukemia (AML) using intensive chemotherapy is associated with treatment intolerance and poor survival. We evaluated two new lower-intensity regimens with clofarabine (n = 119) or cladribine (n = 129) combined with low-dose cytarabine (LDAC) alternating with decitabine. We reviewed response rates by subgroup and long term outcomes of 248 patients with newly diagnosed non core-binding-factor AML treated on two clinical trials investigating double nucleoside-analogue therapy (DNT) alternating with HMA from October, 2008 to April, 2018. Of 248 patients with a median age of 69 years (range, 49-85 years), 102 patients (41%) were ≥ 70 years, and 108 (44%) had adverse karyotype. Overall, 164 patients (66%) responded: 147 (59%) complete remission (CR) and 17 (7%) CR with incomplete count recovery (CRi). With a median follow up of 60 months, median relapse-free and overall survival (OS) were 10.8 and 12.5 months, respectively. The 2-year OS was 29%. Among patients with normal karyotype, the CR/CRi rate was 79% and the median OS 19.9 months. High response rates and OS were observed in patients with mutations in NPM1, FLT3, IDH2, and RUNX1. The 4- and 8-week mortality rates were 2% and 11%, respectively. The backbone of clofarabine or cladribine and LDAC alternating with decitabine was effective and safe for the treatment of older patients with newly diagnosed AML. Incorporating targeted therapies could extend the efficacy of this approach and provide more curative therapeutic options in this AML population.
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Affiliation(s)
- Tapan M. Kadia
- Department of Leukemia University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Farhad Ravandi
- Department of Leukemia University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Gautam Borthakur
- Department of Leukemia University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Marina Konopleva
- Department of Leukemia University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Courtney D. DiNardo
- Department of Leukemia University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Naval Daver
- Department of Leukemia University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Naveen Pemmaraju
- Department of Leukemia University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Rashmi Kanagal‐Shamanna
- Department of Hematopathology University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Xuemei Wang
- Department of Biostatistics University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Xuelin Huang
- Department of Biostatistics University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Sherry Pierce
- Department of Leukemia University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Caitlin Rausch
- Department of Pharmacy University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Jan Burger
- Department of Leukemia University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Alessandra Ferrajoli
- Department of Leukemia University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Nitin Jain
- Department of Leukemia University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Uday Popat
- Department of Stem Cell Transplant University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Zeev Estrov
- Department of Leukemia University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Srdan Verstovsek
- Department of Leukemia University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Elias Jabbour
- Department of Leukemia University of Texas MD Anderson Cancer Center Houston Texas USA
| | | | - Hagop Kantarjian
- Department of Leukemia University of Texas MD Anderson Cancer Center Houston Texas USA
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8
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Montalban‐Bravo G, Kanagal‐Shamanna R, Darbaniyan F, Siddiqui MT, Sasaki K, Wei Y, Yang H, Chien KS, Naqvi K, Jabbour E, Kadia TM, Daver N, DiNardo C, Ravandi F, Pemmaraju N, Bose P, Verstovsek S, Pierce S, Bueso‐Ramos C, Patel K, Do K, Kantarjian H, Garcia‐Manero G. Clinical, genomic, and transcriptomic differences between myelodysplastic syndrome/myeloproliferative neoplasm with ring sideroblasts and thrombocytosis (MDS/MPN-RS-T) and myelodysplastic syndrome with ring sideroblasts (MDS-RS). Am J Hematol 2021; 96:E246-E249. [PMID: 33811786 DOI: 10.1002/ajh.26182] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 12/11/2022]
Affiliation(s)
| | - Rashmi Kanagal‐Shamanna
- Department of Hematopathology The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Faezeh Darbaniyan
- Department of Biostatistics The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Maria Tariq Siddiqui
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Koji Sasaki
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Yue Wei
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Hui Yang
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Kelly S. Chien
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Kiran Naqvi
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Elias Jabbour
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Tapan M. Kadia
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Naval Daver
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Courtney DiNardo
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Farhad Ravandi
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Naveen Pemmaraju
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Prithviraj Bose
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Srdan Verstovsek
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Sherry Pierce
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Carlos Bueso‐Ramos
- Department of Hematopathology The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Keyur Patel
- Department of Hematopathology The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Kim‐Anh Do
- Department of Biostatistics The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Hagop Kantarjian
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
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9
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Morita K, Jain N, Kantarjian H, Takahashi K, Fang H, Konopleva M, El Hussein S, Wang F, Short NJ, Maiti A, Sasaki K, Garcia‐Manero G, Konoplev S, Ravandi F, Khoury JD, Jabbour E. Outcome of T-cell acute lymphoblastic leukemia/lymphoma: Focus on near-ETP phenotype and differential impact of nelarabine. Am J Hematol 2021; 96:589-598. [PMID: 33639000 DOI: 10.1002/ajh.26144] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 02/24/2021] [Accepted: 02/24/2021] [Indexed: 02/02/2023]
Abstract
Early T-cell precursor acute lymphoblastic leukemia/lymphoma (ETP-ALL/LBL) is characterized by a distinct immunophenotype (CD1a-negative, CD8-negative, CD5-negative or weak-positive <75%, myeloid/stem-cell markers positive) and poor clinical outcomes. Near-ETP ALL is transcriptionally similar to ETP-ALL but CD5 expression level is not low enough to meet the criteria of ETP immunophenotype. Outcomes of near-ETP ALL are not well characterized. We reviewed 171 patients with newly-diagnosed T-ALL/LBL. Patients were categorized into three groups; ETP (N = 27), near-ETP (N = 24), and non-ETP ALL/LBL (N = 120). ETP-ALL/LBL was associated with a significantly worse survival compared with non-ETP ALL/LBL: 5-year overall survival (OS) rates 32% versus 63% (p < .001). Outcome was similar between near-ETP and non-ETP ALL/LBL: 5-year OS rates 56% versus 63% (p = .543). Landmark analysis showed that allogeneic stem cell transplant (allo-SCT) in first remission was beneficial in ETP-ALL/LBL (5-year event-free survival rates 36% versus 18%, p = .030) but not in near-ETP or non-ETP ALL/LBL. Multivariate analysis selected the following as significant independent prognostic factors for OS: age ≥ 60 years (HR 3.11; p = .003); elevated WBC ≥100 × 109 /L (HR 2.60; p = .005); and ETP immunophenotype (HR 2.29; p = .010). A survival advantage with adding nelarabine to hyper-CVAD was observed in non-ETP ALL (5-year OS rates 83% versus 38% with hyper-CVAD plus neralabine versus hyper-CVAD, p = .003). In conclusion, outcome of ETP-ALL/LBL was poor and improved with allo-SCT; outcome of near-ETP ALL/LBL was similar to non-ETP ALL/LBL; the addition of nelarabine to hyper-CVAD improved the survival in non-ETP ALL only.
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Affiliation(s)
- Kiyomi Morita
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Nitin Jain
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Hagop Kantarjian
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Koichi Takahashi
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
- Department of Genomic Medicine The University of Texas MD Anderson Cancer Center Houston Texas
| | - Hong Fang
- Department of Hematopatholgy The University of Texas MD Anderson Cancer Center Houston Texas
| | - Marina Konopleva
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Siba El Hussein
- Department of Hematopatholgy The University of Texas MD Anderson Cancer Center Houston Texas
| | - Feng Wang
- Department of Genomic Medicine The University of Texas MD Anderson Cancer Center Houston Texas
| | - Nicholas J. Short
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Abhishek Maiti
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Koji Sasaki
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | | | - Sergej Konoplev
- Department of Hematopatholgy The University of Texas MD Anderson Cancer Center Houston Texas
| | - Farhad Ravandi
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Joseph D. Khoury
- Department of Hematopatholgy The University of Texas MD Anderson Cancer Center Houston Texas
| | - Elias Jabbour
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
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10
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Garcia‐Manero G, Diez‐Campelo M, Vellenga E, Jacoby MA, Merchan B, Breems D, Cortelezzi A, Doronin V, Gomez V, Beckers M, Della Porta MG, Varsos H, Xiu L, DeAngelis N, Nnane I, Rose E, Eygen K. Daratumumab in transfusion-dependent patients with low or intermediate-1 risk myelodysplastic syndromes. Am J Hematol 2021; 96:E111-E114. [PMID: 33448430 DOI: 10.1002/ajh.26095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/10/2021] [Accepted: 01/11/2021] [Indexed: 11/12/2022]
Affiliation(s)
| | | | - Edo Vellenga
- Department of Hematology, University Medical Center Groningen University of Groningen Groningen The Netherlands
| | | | | | | | - Agostino Cortelezzi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico and University of Milano Milan Italy
| | | | - Valle Gomez
- Hospital Universitario de La Princesa Madrid Spain
| | | | | | - Helen Varsos
- Janssen Research & Development, LLC Raritan New Jersey USA
| | - Liang Xiu
- Janssen Research & Development, LLC Raritan New Jersey USA
| | - Nikki DeAngelis
- Janssen Research & Development, LLC Spring House Pennsylvania USA
| | - Ivo Nnane
- Janssen Research & Development, LLC Spring House Pennsylvania USA
| | - Esther Rose
- Janssen Research & Development, LLC Raritan New Jersey USA
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11
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Maiti A, Qiao W, Sasaki K, Ravandi F, Kadia TM, Jabbour EJ, Daver NG, Borthakur G, Garcia‐Manero G, Pierce SA, Montalbano KS, Pemmaraju N, Naqvi K, Ohanian M, Short NJ, Alvarado Y, Takahashi K, Yilmaz M, Jain N, Kornblau SM, Andreeff M, Bose P, Ferrajoli A, Issa GC, Masarova L, Thompson PA, Rausch CR, Ning J, Kantarjian HM, DiNardo CD, Konopleva MY. Venetoclax with decitabine vs intensive chemotherapy in acute myeloid leukemia: A propensity score matched analysis stratified by risk of treatment-related mortality. Am J Hematol 2021; 96:282-291. [PMID: 33264443 DOI: 10.1002/ajh.26061] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/23/2020] [Accepted: 11/29/2020] [Indexed: 12/11/2022]
Abstract
Hypomethylating agents (HMA) with venetoclax is a new standard for older/unfit patients with acute myeloid leukemia (AML). However, it is unknown how HMA with venetoclax compare to intensive chemotherapy (IC) in patients who are "fit" or "unfit" for IC. We compared outcomes of older patients with newly diagnosed AML receiving 10-day decitabine with venetoclax (DEC10-VEN) vs IC. DEC10-VEN consisted of daily venetoclax with decitabine 20 mg/m2 for 10 days for induction and decitabine for 5 days as consolidation. The IC cohort received regimens containing cytarabine ≥1 g/m2 /d. A validated treatment-related mortality score (TRMS) was used to classify patients at high-risk or low-risk for TRM with IC. Propensity scores were used to match patients to minimize bias. Median age of the DEC10-VEN cohort (n = 85) was 72 years (range 63-89) and 28% patients were at high-risk of TRM with IC. The comparator IC group (n = 85) matched closely in terms of baseline characteristics. DEC10-VEN was associated with significantly higher CR/CRi compared to IC (81% vs 52%, P < .001), and lower rate of relapse (34% vs 56%, P = .01), 30-day mortality (1% vs 24%, P < .01), and longer overall survival (OS; 12.4 vs 4.5 months, HR = 0.48, 95%CI 0.29-0.79, P < .01). In patients at both at high-risk and low-risk of TRM, DEC10-VEN showed significantly higher CR/CRi, lower 30-day mortality, and longer OS compared to IC. Patients at both high-risk and low-risk of TRM had comparable outcomes with DEC10-VEN. In conclusion, DEC10-VEN offers better outcomes compared to intensive chemotherapy in older patients with newly diagnosed AML, particularly in those at high-risk of TRM.
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Affiliation(s)
- Abhishek Maiti
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
- Division of Cancer Medicine The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Wei Qiao
- Department of Biostatistics The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Koji Sasaki
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Farhad Ravandi
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Tapan M. Kadia
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Elias J. Jabbour
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Naval G. Daver
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Gautam Borthakur
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | | | - Sherry A. Pierce
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Kathryn S. Montalbano
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Naveen Pemmaraju
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Kiran Naqvi
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Maro Ohanian
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Nicholas J. Short
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Yesid Alvarado
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Koichi Takahashi
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Musa Yilmaz
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Nitin Jain
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Steven M. Kornblau
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Michael Andreeff
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Prithviraj Bose
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Alessandra Ferrajoli
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Ghayas C. Issa
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Lucia Masarova
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Philip A. Thompson
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Caitlin R. Rausch
- Division of Pharmacy The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Jing Ning
- Division of Pharmacy The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Hagop M. Kantarjian
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Courtney D. DiNardo
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Marina Y. Konopleva
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
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12
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Montalban‐Bravo G, Kanagal‐Shamanna R, Guerra V, Ramos‐Perez J, Hammond D, Shilpa P, Naqvi K, Sasaki K, Jabbour E, DiNardo C, Takahashi K, Konopleva M, Pemmaraju N, Kadia T, Ravandi F, Daver N, Borthakur G, Estrov Z, Khoury JD, Loghavi S, Pierce S, Bueso‐Ramos C, Patel K, Kantarjian H, Garcia‐Manero G. Clinical outcomes and influence of mutation clonal dominance in oligomonocytic and classical chronic myelomonocytic leukemia. Am J Hematol 2021; 96:E50-E53. [PMID: 33156969 DOI: 10.1002/ajh.26044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 11/06/2022]
Affiliation(s)
| | - Rashmi Kanagal‐Shamanna
- Department of Hematopathology The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Veronica Guerra
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Jorge Ramos‐Perez
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Danielle Hammond
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Paul Shilpa
- Department of Pharmacy The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Kiran Naqvi
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Koji Sasaki
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Elias Jabbour
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Courtney DiNardo
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Koichi Takahashi
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Marina Konopleva
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Naveen Pemmaraju
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Tapan Kadia
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Farhad Ravandi
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Naval Daver
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Gautam Borthakur
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Zeev Estrov
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Joseph D. Khoury
- Department of Hematopathology The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Sanam Loghavi
- Department of Hematopathology The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Sherry Pierce
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Carlos Bueso‐Ramos
- Department of Hematopathology The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Keyur Patel
- Department of Hematopathology The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Hagop Kantarjian
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
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13
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Sasaki K, Jabbour EJ, Ravandi F, Konopleva M, Borthakur G, Wierda WG, Daver N, Takahashi K, Naqvi K, DiNardo C, Montalban‐Bravo G, Kanagal‐Shamanna R, Issa G, Jain P, Skinner J, Rios MB, Pierce S, Soltysiak KA, Sato J, Garcia‐Manero G, Cortes JE. The LEukemia Artificial Intelligence Program (LEAP) in chronic myeloid leukemia in chronic phase: A model to improve patient outcomes. Am J Hematol 2021; 96:241-250. [PMID: 33180322 DOI: 10.1002/ajh.26047] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/05/2020] [Accepted: 11/09/2020] [Indexed: 12/19/2022]
Abstract
Extreme gradient boosting methods outperform conventional machine-learning models. Here, we have developed the LEukemia Artificial intelligence Program (LEAP) with the extreme gradient boosting decision tree method for the optimal treatment recommendation of tyrosine kinase inhibitors (TKIs) in patients with chronic myeloid leukemia in chronic phase (CML-CP). A cohort of CML-CP patients was randomly divided into training/validation (N = 504) and test cohorts (N = 126). The training/validation cohort was used for 3-fold cross validation to develop the LEAP CML-CP model using 101 variables at diagnosis. The test cohort was then applied to the LEAP CML-CP model and an optimum TKI treatment was suggested for each patient. The area under the curve in the test cohort was 0.81899.Backward multivariate analysis identified age at diagnosis, the degree of comorbidities, and TKI recommended therapy by the LEAP CML-CP model as independent prognostic factors for overall survival. The bootstrapping method internally validated the association of the LEAP CML-CP recommendation with overall survival as an independent prognostic for overall survival. Selecting treatment according to the LEAP CML-CP personalized recommendations, in this model, is associated with better survival probability compared to treatment with a LEAP CML-CP non-recommended therapy. This approach may pave a way of new era of personalized treatment recommendations for patients with cancer.
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Affiliation(s)
- Koji Sasaki
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
- Department of Hematology, Graduate School of Medical and Dental Sciences Tokyo Medical and Dental University Tokyo Japan
| | - Elias J. Jabbour
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Farhad Ravandi
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Marina Konopleva
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Gautam Borthakur
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - William G. Wierda
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Naval Daver
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Koichi Takahashi
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Kiran Naqvi
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Courtney DiNardo
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | | | - Rashmi Kanagal‐Shamanna
- Department of Hematopathology The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Ghayas Issa
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Preetesh Jain
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Jeffrey Skinner
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Mary B. Rios
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Sherry Pierce
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Kelly A. Soltysiak
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Junya Sato
- Faculty of Medicine The University of Osaka Osaka Japan
| | | | - Jorge E. Cortes
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
- Georgia Cancer Center Augusta Georgia USA
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14
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Sasaki K, Montalban‐Bravo G, Kanagal‐Shamanna R, Jabbour E, Ravandi F, Kadia T, Daver N, Pemmaraju N, Konopleva M, Borthakur G, Takahashi K, Patel K, Soltysiak KA, Chien KS, Sakurai K, Pierce S, Kantarjian HM, Garcia‐Manero G. Natural history of newly diagnosed myelodysplastic syndrome with isolated inv(3)/t(3;3). Am J Hematol 2020; 95:E326-E329. [PMID: 32886803 DOI: 10.1002/ajh.25991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 08/28/2020] [Accepted: 08/29/2020] [Indexed: 11/12/2022]
Affiliation(s)
- Koji Sasaki
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | | | - Rashmi Kanagal‐Shamanna
- Departmemt of Hematopathology The University of Texas MD Anderson Cancer Center Houston Texas
| | - Elias Jabbour
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Farhad Ravandi
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Tapan Kadia
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Naval Daver
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Naveen Pemmaraju
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Marina Konopleva
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Gautam Borthakur
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Koichi Takahashi
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Keyur Patel
- Departmemt of Hematopathology The University of Texas MD Anderson Cancer Center Houston Texas
| | - Kelly A. Soltysiak
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Kelly S. Chien
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Kenichi Sakurai
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Sherry Pierce
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Hagop M. Kantarjian
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
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15
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Lee S, Wang F, Trujillo‐Ocampo A, Ruiz‐Vasquez W, Cho H, Takahashi K, Molldrem JJ, Futreal A, Garcia‐Manero G, Im JS. Fidelity of peripheral blood for monitoring genomics and tumor immune‐microenvironment in myelodysplastic syndromes. eJHaem 2020; 1:552-557. [PMID: 35844984 PMCID: PMC9175915 DOI: 10.1002/jha2.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 09/21/2020] [Accepted: 09/23/2020] [Indexed: 11/29/2022]
Abstract
The aim of this study is to investigate whether the peripheral blood (PB) can serve as a surrogate immune‐microenvironment to bone marrow for genetic and immune monitoring in myelodysplastic syndrome (MDS). We compared the composition of T cell subsets and somatic mutation burden in 36 pairs of PB and matching bone marrow aspirate (BMA) using multi‐parameter flow cytometry and NGS‐based targeted sequencing analysis, respectively. Our immune‐subset and NGS‐based mutation analysis of BMA showed significant concordance with those of PB in MDS. Therefore, PB can provide easily accessible tumor immune‐microenvironment for monitoring in the immune and genetic landscapes for MDS patients.
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Affiliation(s)
- Sung‐Eun Lee
- Department of Stem Cell Transplantation and Cellular Therapy, Division of Cancer Medicine The University of Texas M.D. Anderson Cancer Center Houston Texas USA
- Department of Hematology, Seoul St. Mary's Hospital, College of Medicine The Catholic University of Korea Seoul South Korea
| | - Feng Wang
- Department of Genomic Medicine, Division of Cancer Medicine The University of Texas M.D. Anderson Cancer Center Houston Texas USA
| | - Abel Trujillo‐Ocampo
- Department of Stem Cell Transplantation and Cellular Therapy, Division of Cancer Medicine The University of Texas M.D. Anderson Cancer Center Houston Texas USA
| | - Wilfredo Ruiz‐Vasquez
- Department of Stem Cell Transplantation and Cellular Therapy, Division of Cancer Medicine The University of Texas M.D. Anderson Cancer Center Houston Texas USA
| | - Hyun‐Woo Cho
- Department of Stem Cell Transplantation and Cellular Therapy, Division of Cancer Medicine The University of Texas M.D. Anderson Cancer Center Houston Texas USA
| | - Koichi Takahashi
- Department of Genomic Medicine, Division of Cancer Medicine The University of Texas M.D. Anderson Cancer Center Houston Texas USA
- Department of Leukemia, Division of Cancer Medicine The University of Texas M.D. Anderson Cancer Center Houston Texas USA
| | - Jeffrey J. Molldrem
- Department of Stem Cell Transplantation and Cellular Therapy, Division of Cancer Medicine The University of Texas M.D. Anderson Cancer Center Houston Texas USA
- Department of Hematopoietic Biology and Malignancy, Division of Cancer Medicine The University of Texas M.D. Anderson Cancer Center Houston Texas USA
| | - Andrew Futreal
- Department of Genomic Medicine, Division of Cancer Medicine The University of Texas M.D. Anderson Cancer Center Houston Texas USA
| | - Guillermo Garcia‐Manero
- Department of Leukemia, Division of Cancer Medicine The University of Texas M.D. Anderson Cancer Center Houston Texas USA
| | - Jin S. Im
- Department of Stem Cell Transplantation and Cellular Therapy, Division of Cancer Medicine The University of Texas M.D. Anderson Cancer Center Houston Texas USA
- Department of Hematopoietic Biology and Malignancy, Division of Cancer Medicine The University of Texas M.D. Anderson Cancer Center Houston Texas USA
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16
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Lachowiez C, Bannon S, Loghavi S, Wang F, Kanagal‐Shamanna R, Mehta R, Daver N, Borthakur G, Pemmaraju N, Ravandi F, Patel KP, Garcia‐Manero G, Takahashi K, Kantarjian H, Bhalla K, DiNardo CD. Clonal evolution and treatment outcomes in hematopoietic neoplasms arising in patients with germline RUNX1 mutations. Am J Hematol 2020; 95:E313-E315. [PMID: 32804409 DOI: 10.1002/ajh.25965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Curtis Lachowiez
- Division of Cancer Medicine University of Texas M.D. Anderson Cancer Center Houston Texas USA
| | - Sarah Bannon
- Clinical Cancer Genetics Program University of Texas M.D. Anderson Cancer Center Houston Texas USA
| | - Sanam Loghavi
- Department of Hematopathology University of Texas M.D. Anderson Cancer Center Houston Texas USA
| | - Feng Wang
- Department of Genomic Medicine University of Texas M.D. Anderson Cancer Center Houston Texas USA
| | - Rashmi Kanagal‐Shamanna
- Department of Hematopathology University of Texas M.D. Anderson Cancer Center Houston Texas USA
| | - Rohtesh Mehta
- Department of Stem Cell Transplantation and Cellular Therapy University of Texas M.D. Anderson Cancer Center Houston Texas USA
| | - Naval Daver
- Department of Leukemia University of Texas M.D. Anderson Cancer Center Houston Texas USA
| | - Gautam Borthakur
- Department of Leukemia University of Texas M.D. Anderson Cancer Center Houston Texas USA
| | - Naveen Pemmaraju
- Department of Leukemia University of Texas M.D. Anderson Cancer Center Houston Texas USA
| | - Farhad Ravandi
- Department of Leukemia University of Texas M.D. Anderson Cancer Center Houston Texas USA
| | - Keyur P. Patel
- Department of Hematopathology University of Texas M.D. Anderson Cancer Center Houston Texas USA
| | | | - Koichi Takahashi
- Department of Leukemia University of Texas M.D. Anderson Cancer Center Houston Texas USA
| | - Hagop Kantarjian
- Department of Leukemia University of Texas M.D. Anderson Cancer Center Houston Texas USA
| | - Kapil Bhalla
- Department of Leukemia University of Texas M.D. Anderson Cancer Center Houston Texas USA
| | - Courtney D. DiNardo
- Department of Leukemia University of Texas M.D. Anderson Cancer Center Houston Texas USA
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17
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Garcia‐Manero G, Chien KS, Montalban‐Bravo G. Myelodysplastic syndromes: 2021 update on diagnosis, risk stratification and management. Am J Hematol 2020; 95:1399-1420. [PMID: 32744763 DOI: 10.1002/ajh.25950] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 07/30/2020] [Accepted: 07/30/2020] [Indexed: 12/12/2022]
Abstract
DISEASE OVERVIEW The myelodysplastic syndromes (MDS) are a very heterogeneous group of myeloid disorders characterized by peripheral blood cytopenias and increased risk of transformation to acute myelogenous leukemia (AML). Myelodysplastic syndromes occur more frequently in older males and in individuals with prior exposure to cytotoxic therapy. DIAGNOSIS Diagnosis of MDS is based on morphological evidence of dysplasia upon visual examination of a bone marrow aspirate and biopsy. Information obtained from additional studies such as karyotype, flow cytometry and molecular genetics is usually complementary and may help refine diagnosis. RISK-STRATIFICATION Prognosis of patients with MDS can be calculated using a number of scoring systems. In general, all these scoring systems include analysis of peripheral cytopenias, percentage of blasts in the bone marrow and cytogenetic characteristics. The most commonly accepted system is the Revised International Prognostic Scoring System (IPSS-R). Somatic mutations can help define prognosis and therapy. RISK-ADAPTED THERAPY Therapy is selected based on risk, transfusion needs, percent of bone marrow blasts, cytogenetic and mutational profiles, comorbidities, potential for allogeneic stem cell transplantation (alloSCT) and prior exposure to hypomethylating agents (HMA). Goals of therapy are different in lower-risk patients than in higher-risk individuals and in those with HMA failure. In lower-risk MDS, the goal is to decrease transfusion needs and transformation to higher risk disease or AML, as well as to improve survival. In higher-risk disease, the goal is to prolong survival. In 2020, we witnessed an explosion of new agents and investigational approaches. Current available therapies include growth factor support, lenalidomide, HMAs, intensive chemotherapy and alloSCT. Novel therapeutics approved in 2020 are luspatercept and the oral HMA ASTX727. At the present time, there are no approved interventions for patients with progressive or refractory disease particularly after HMA-based therapy. Options include participation in a clinical trial, cytarabine-based therapy or alloSCT.
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Affiliation(s)
- Guillermo Garcia‐Manero
- Section of MDS, Department of Leukemia University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Kelly S. Chien
- Section of MDS, Department of Leukemia University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Guillermo Montalban‐Bravo
- Section of MDS, Department of Leukemia University of Texas MD Anderson Cancer Center Houston Texas USA
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18
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Sasaki K, Kantarjian H, Wierda W, Ravandi‐Kashani F, Jorgensen J, Wang SA, Khoury J, Daver N, Burger J, Di Nardo CD, Jain N, Short NJ, Estrov MD Z, Konopleva MD, PhD M, Ohanian DO M, Garcia‐Manero G, Kadia T, Alvarado‐Valero Y, Yilmaz M, Pierce S, Garris R, Ingram A, Cortes J, OʼBrien S, Jabbour E. Phase 2 study of hyper-CMAD with liposomal vincristine for patients with newly diagnosed acute lymphoblastic leukemia. Am J Hematol 2020; 95:734-739. [PMID: 32170867 DOI: 10.1002/ajh.25784] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/04/2020] [Accepted: 03/10/2020] [Indexed: 11/10/2022]
Abstract
Liposomal vincristine is designed to reduce neurotoxicity and increase dose intensity delivery, and has been approved as salvage therapy in relapsed/refractory acute lymphoblastic leukemia (ALL). Our aim was to evaluate the response rate, toxicities, and outcome of adults with newly diagnosed ALL who received liposomal vincristine, rather than regular vincristine in combination with intensive chemotherapy (Hyper-CMAD). In a single-center, phase 2 study, patients ≥18 years with newly-diagnosed B-cell ALL were eligible to receive hyper-CMAD alternating with high-dose methotrexate and cytarabine. Rituximab was administered in CD20 positive ALL. Tyrosine kinase inhibitors (imatinib or dasatinib) were added in Philadelphia chromosome-positive (Ph-positive) ALL. Thirty-one patients were enrolled, median follow-up of 59 months (0.3-70). Thirteen patients (42%) had CD20 positive ALL, and 21 (68%) had Ph-positive ALL. Thirty (97%) achieved complete remission (CR). All 26 patients with abnormal karyotype achieved complete cytogenetic response (CCyR), and 27/30 (90%) achieved negative minimal residual disease status by multicolor flow cytometry. Of 20 evaluable Ph-positive ALL patients, major molecular response (MMR) was achieved in 19 patients (95%); complete molecular response (CMR) in 14 (70%). Grade 3/4 peripheral neuropathy was observed in five (16%) with all grade peripheral neuropathy in 21 (68%). With a median follow-up of 59 months, 21 (68%) patients are alive. The 5-year CR duration and survival rates were 73% and 61%, respectively. Ten (32%) patients died: one, sepsis on C1D10; four, unknown; one, post-transplant complications; four, relapse. Hyper-CMAD with liposomal vincristine is safe and demonstrated high response and survival rates in newly diagnosed ALL.
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Affiliation(s)
- Koji Sasaki
- Department of LeukemiaUniversity of Texas, MD Anderson Cancer Center Houston Texas USA
| | - Hagop Kantarjian
- Department of LeukemiaUniversity of Texas, MD Anderson Cancer Center Houston Texas USA
| | - William Wierda
- Department of LeukemiaUniversity of Texas, MD Anderson Cancer Center Houston Texas USA
| | | | - Jeffrey Jorgensen
- Department of LeukemiaUniversity of Texas, MD Anderson Cancer Center Houston Texas USA
| | - Sa A. Wang
- Department of LeukemiaUniversity of Texas, MD Anderson Cancer Center Houston Texas USA
| | - Joseph Khoury
- Department of LeukemiaUniversity of Texas, MD Anderson Cancer Center Houston Texas USA
| | - Naval Daver
- Department of LeukemiaUniversity of Texas, MD Anderson Cancer Center Houston Texas USA
| | - Jan Burger
- Department of LeukemiaUniversity of Texas, MD Anderson Cancer Center Houston Texas USA
| | - Courtney D. Di Nardo
- Department of LeukemiaUniversity of Texas, MD Anderson Cancer Center Houston Texas USA
| | - Nitin Jain
- Department of LeukemiaUniversity of Texas, MD Anderson Cancer Center Houston Texas USA
| | - Nicholas J. Short
- Department of LeukemiaUniversity of Texas, MD Anderson Cancer Center Houston Texas USA
| | - Zeev Estrov MD
- Department of LeukemiaUniversity of Texas, MD Anderson Cancer Center Houston Texas USA
| | | | - Maro Ohanian DO
- Department of LeukemiaUniversity of Texas, MD Anderson Cancer Center Houston Texas USA
| | | | - Tapan Kadia
- Department of LeukemiaUniversity of Texas, MD Anderson Cancer Center Houston Texas USA
| | - Yesid Alvarado‐Valero
- Department of LeukemiaUniversity of Texas, MD Anderson Cancer Center Houston Texas USA
| | - Musa Yilmaz
- Department of LeukemiaUniversity of Texas, MD Anderson Cancer Center Houston Texas USA
| | - Sherry Pierce
- Department of LeukemiaUniversity of Texas, MD Anderson Cancer Center Houston Texas USA
| | - Rebecca Garris
- Department of LeukemiaUniversity of Texas, MD Anderson Cancer Center Houston Texas USA
| | - April Ingram
- Department of LeukemiaUniversity of Texas, MD Anderson Cancer Center Houston Texas USA
| | | | - Susan OʼBrien
- Chao Family Comprehensive Cancer CenterUniversity of California Irvine Orange California USA
| | - Elias Jabbour
- Department of LeukemiaUniversity of Texas, MD Anderson Cancer Center Houston Texas USA
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19
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Pollyea DA, George TI, Abedi M, Bejar R, Cogle CR, Foucar K, Garcia‐Manero G, Grinblatt DL, Komrokji RS, Maciejewski JP, Revicki DA, Roboz GJ, Savona MR, Scott BL, Sekeres MA, Thompson MA, Kurtin SE, Louis CU, Nifenecker M, Flick ED, Swern AS, Kiselev P, Steensma DP, Erba HP. Diagnostic and molecular testing patterns in patients with newly diagnosed acute myeloid leukemia in the Connect ® MDS/AML Disease Registry. EJHaem 2020; 1:58-68. [PMID: 35847712 PMCID: PMC9176048 DOI: 10.1002/jha2.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/01/2020] [Indexed: 12/19/2022]
Abstract
Diagnostic and molecular genetic testing are key in advancing the treatment of acute myeloid leukemia (AML), yet little is known about testing patterns outside of clinical trials, especially in older patients. We analyzed diagnostic and molecular testing patterns over time in 565 patients aged ≥ 55 years with newly diagnosed AML enrolled in the Connect® MDS/AML Disease Registry (NCT01688011) in the United States. Diagnostic data were recorded at enrolment and compared with published guidelines. The percentage of bone marrow blasts was reported for 82.1% of patients, and cellularity was the most commonly reported bone marrow morphological feature. Flow cytometry, karyotyping, molecular testing, and fluorescence in situ hybridization were performed in 98.8%, 95.4%, 75.9%, and 75.7% of patients, respectively. Molecular testing was done more frequently at academic than community/government sites (84.3% vs 70.2%; P < .001). Enrolment to the Registry after 2016 was significantly associated with molecular testing at academic sites (odds ratio [OR] 2.59; P = .023) and at community/government sites (OR 4.85; P < .001) in logistic regression analyses. Better understanding of practice patterns may identify unmet needs and inform institutional protocols regarding the diagnosis of patients with AML.
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Affiliation(s)
- Daniel A. Pollyea
- Department of MedicineDivision of HematologyUniversity of ColoradoAuroraColoradoUSA
| | - Tracy I. George
- University of Utah and ARUP LaboratoriesSalt Lake CityUtahUSA
| | - Mehrdad Abedi
- University of CaliforniaDavisSacramentoCaliforniaUSA
| | - Rafael Bejar
- Moores Cancer CenterUniversity of California San Diego HealthLa JollaCaliforniaUSA
| | | | - Kathryn Foucar
- University of New Mexico Health Sciences CenterAlbuquerqueNew MexicoUSA
| | | | | | | | | | | | - Gail J. Roboz
- Weill Cornell College of MedicineNew YorkNew YorkUSA
| | - Michael R. Savona
- Vanderbilt‐Ingram Cancer CenterVanderbilt University School of MedicineNashvilleTennesseeUSA
| | - Bart L. Scott
- Fred Hutchinson Cancer Research CenterSeattleWashingtonUSA
| | | | - Michael A. Thompson
- Advocate Aurora HealthAdvocate Aurora Research InstituteMilwaukeeWisconsinUSA
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20
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Abou Dalle I, Kantarjian H, Bannon SA, Kanagal‐Shamanna R, Routbort M, Patel KP, Hu S, Bhalla K, Garcia‐Manero G, DiNardo CD. Successful lenalidomide treatment in high risk myelodysplastic syndrome with germline DDX41 mutation. Am J Hematol 2020; 95:227-229. [PMID: 31400013 DOI: 10.1002/ajh.25610] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Iman Abou Dalle
- Department of LeukemiaThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Hagop Kantarjian
- Department of LeukemiaThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Sarah A. Bannon
- Department of Clinical Cancer GeneticsThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Rashmi Kanagal‐Shamanna
- Department of HematopathologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Mark Routbort
- Department of HematopathologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Keyur P. Patel
- Department of HematopathologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Shimin Hu
- Department of HematopathologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Kapil Bhalla
- Department of LeukemiaThe University of Texas MD Anderson Cancer Center Houston Texas
| | | | - Courtney D. DiNardo
- Department of LeukemiaThe University of Texas MD Anderson Cancer Center Houston Texas
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21
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Abou Dalle I, Kantarjian HM, Short NJ, Konopleva M, Jain N, Garcia‐Manero G, Garris R, Qiao W, Cortes JE, O'Brien S, Kebriaei P, Kadia T, Jabbour E, Ravandi F. Philadelphia chromosome-positive acute lymphoblastic leukemia at first relapse in the era of tyrosine kinase inhibitors. Am J Hematol 2019; 94:1388-1395. [PMID: 31595534 DOI: 10.1002/ajh.25648] [Citation(s) in RCA: 20] [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: 06/20/2019] [Revised: 09/02/2019] [Accepted: 09/26/2019] [Indexed: 01/17/2023]
Abstract
Despite the advances in the management of Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL) with the introduction of tyrosine kinase inhibitors (TKIs), relapses remain challenging. We reviewed clinical data from adult patients with Ph + ALL who received frontline hyperCVAD chemotherapy with a TKI to determine their outcomes after first relapse. Patients with first morphological relapse after prior complete remission were evaluated for predictors of response and survival. For 57 of 233 (25%) patients, there was morphological relapse after a median of 15.9 months from first remission [range: 5.3-94]. The choice of salvage treatments was at the discretion of the treating physician. So, 43 (75%) patients received a TKI in combination with their salvage treatment. Second remission was achieved in 41 of 49 (84%) evaluable patients. Median relapse free survival (RFS) was 10.5 months [range, 0.2-81]. The 1-year and 2-year overall survival (OS) were 41% and 20% respectively. On multivariate analysis, only elevated LDH (units/L), the use of first-generation or no TKI at the time of first relapse and the achievement of a major molecular response (MMR) had a significant effect on OS (HR: 2.82, 95% CI:1.11-7.16, P = .029; HR = 2.39, 95% CI: 1.07,5.39, P = .034; HR = 0.39, 95% CI: 0.16-0.94, P = .03, respectively). Whereas, only achievement of MMR was significantly prognostic for RFS with a HR of 0.48 (95% CI: 0.23-0.98, P = .04). The OS and RFS were comparable between recipients and non-recipients of allogeneic hematopoietic stem cell transplantation (alloHSCT) at second remission, due to a higher non-relapse mortality (53%) seen in patients who underwent alloHSCT.
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Affiliation(s)
- Iman Abou Dalle
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Hagop M. Kantarjian
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Nicholas J. Short
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Marina Konopleva
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Nitin Jain
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | | | - Rebecca Garris
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Wei Qiao
- Department of Biostatistics The University of Texas MD Anderson Cancer Center Houston Texas
| | - Jorge E. Cortes
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Susan O'Brien
- Division of Hematology‐Oncology University of California, Irvine Orange California
| | - Partow Kebriaei
- Department of Stem Cell Transplantation and Cellular Therapy The University of Texas MD Anderson Cancer Center Houston Texas
| | - Tapan Kadia
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Elias Jabbour
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Farhad Ravandi
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
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22
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Yalniz F, Abou Dalle I, Kantarjian H, Borthakur G, Kadia T, Patel K, Loghavi S, Garcia‐Manero G, Sasaki K, Daver N, DiNardo C, Pemmaraju N, Short NJ, Yilmaz M, Bose P, Naqvi K, Pierce S, Nogueras González GM, Konopleva M, Andreeff M, Cortes J, Ravandi F. Prognostic significance of baseline FLT3-ITD mutant allele level in acute myeloid leukemia treated with intensive chemotherapy with/without sorafenib. Am J Hematol 2019; 94:984-991. [PMID: 31237017 DOI: 10.1002/ajh.25553] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/01/2019] [Accepted: 06/06/2019] [Indexed: 11/11/2022]
Abstract
Internal tandem duplication (ITD) of the fms-related tyrosine kinase-3 gene (FLT3) confer a poor prognosis in adult AML. Studies have reported that a higher mutant allelic burden is associated with a worse prognosis. Adult patients with FLT3-ITD mutated AML treated at our institution were identified. Patients were assigned into 2 groups; patients who received idarubicin and cytarabine (IA, group one) containing induction, and who received sorafenib in addition to IA containing regimens at induction (group two). The optimal FLT3-ITD mutant allele cut-off was defined as the cut-off to divide the whole cohort with the highest statistical significance. A total of 183 patients including 104 (57%) in group one and 79 (43%) in group two were identified. The complete remission (CR)/CR with incomplete hematologic recovery (CRi) for group one and group two were 85% and 99%, respectively (P = .004). The median relapse free survival (RFS) for group one and two were 12 and 45 months, respectively (P = .02). The median overall survival (mOS) was 17 months in group one, and has not been reached in group two (P = .008). The optimal FLT3-ITD mutant allele cut-off for OS was 6.9% in group one, there was no optimal cut-off in group two. On multivariate analysis, poor performance status (PS) (P = .003), sorafenib (P = .01), and presenting white blood cells (WBC) (P < .001) were independent predictors of OS. Higher FLT3-ITD allele burden is associated with a worse outcome in patients treated with IA-based chemotherapy. Addition of sorafenib to chemotherapy not only nullifies the negative prognostic impact of higher allele burden, but also improves outcome of FLT3-ITD mutated AML patients regardless of the allele burden.
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Affiliation(s)
- Fevzi Yalniz
- Department of LeukemiaThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Iman Abou Dalle
- Department of LeukemiaThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Hagop Kantarjian
- Department of LeukemiaThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Gautam Borthakur
- Department of LeukemiaThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Tapan Kadia
- Department of LeukemiaThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Keyur Patel
- Department of PathologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Sanam Loghavi
- Department of PathologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | | | - Koji Sasaki
- Department of LeukemiaThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Naval Daver
- Department of LeukemiaThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Courtney DiNardo
- Department of LeukemiaThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Naveen Pemmaraju
- Department of LeukemiaThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Nicholas J. Short
- Department of LeukemiaThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Musa Yilmaz
- Department of LeukemiaThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Prithviraj Bose
- Department of LeukemiaThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Kiran Naqvi
- Department of LeukemiaThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Sherry Pierce
- Department of LeukemiaThe University of Texas MD Anderson Cancer Center Houston Texas
| | | | - Marina Konopleva
- Department of LeukemiaThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Michael Andreeff
- Department of LeukemiaThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Jorge Cortes
- Department of LeukemiaThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Farhad Ravandi
- Department of LeukemiaThe University of Texas MD Anderson Cancer Center Houston Texas
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23
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Strati P, Garcia‐Manero G, Zhao C, Kadia T, Borthakur G, Konopleva M, Daver N, DiNardo CD, Short NJ, Yilmaz M, Naqvi K, Alvarado Y, Pierce SA, Cortes J, Bueso‐Ramos C, Kantarjian H, Ravandi F. Intensive chemotherapy is more effective than hypomethylating agents for the treatment of younger patients with myelodysplastic syndrome and elevated bone marrow blasts. Am J Hematol 2019; 94:E188-E190. [PMID: 30977182 DOI: 10.1002/ajh.25490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/05/2019] [Accepted: 04/08/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Paolo Strati
- Department of LeukemiaThe University of Texas MD Anderson Cancer Center Houston Texas
| | | | - Chong Zhao
- Department of Hemato‐PathologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Tapan Kadia
- Department of LeukemiaThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Gautam Borthakur
- Department of LeukemiaThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Marina Konopleva
- Department of LeukemiaThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Naval Daver
- Department of LeukemiaThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Courtney D. DiNardo
- Department of LeukemiaThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Nicholas J. Short
- Department of LeukemiaThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Musa Yilmaz
- Department of LeukemiaThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Kiran Naqvi
- Department of LeukemiaThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Yesid Alvarado
- Department of LeukemiaThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Sherry A. Pierce
- Department of LeukemiaThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Jorge Cortes
- Department of LeukemiaThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Carlos Bueso‐Ramos
- Department of Hemato‐PathologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Hagop Kantarjian
- Department of LeukemiaThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Farhad Ravandi
- Department of LeukemiaThe University of Texas MD Anderson Cancer Center Houston Texas
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24
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Quesada AE, Routbort MJ, DiNardo CD, Bueso‐Ramos CE, Kanagal‐Shamanna R, Khoury JD, Thakral B, Zuo Z, Yin CC, Loghavi S, Ok CY, Wang SA, Tang Z, Bannon SA, Benton CB, Garcia‐Manero G, Kantarjian H, Luthra R, Medeiros LJ, Patel KP. DDX41 mutations in myeloid neoplasms are associated with male gender, TP53 mutations and high-risk disease. Am J Hematol 2019; 94:757-766. [PMID: 30963592 DOI: 10.1002/ajh.25486] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 02/01/2023]
Abstract
Myeloid neoplasms with germline DDX41 mutations have been incorporated into the 2017 WHO classification. Limited studies describing the clinicopathologic features and mutation profile are available. We searched for myeloid neoplasms with a DDX41 gene mutation tested by an 81-gene next-generation sequencing panel over a 7-month period. We identified 34 patients with myeloid neoplasms with DDX41 abnormalities; 26 (76%) men and 8 women (24%) [median age, 70 years], 20 acute myeloid leukemia (AML), 10 myelodysplastic syndrome (MDS), 1 chronic myelomonocytic leukemia (CMML) and 3 myeloproliferative neoplasms (MPN). Fifty-nine DDX41 variants were detected: 27 (46%) appeared somatic and 32 (54%) were presumably germline mutations. The majority of presumed germline mutations were upstream of the Helicase 2 domain (93%) and involved loss of the start codon (30%). The majority of somatic mutations were within the Helicase 2 domain (78%), with the missense mutation p.R525H being most common (67%). There was a significant difference in the location of germline or somatic mutations (P < .0001). Concomitant mutations were detected involving 19 genes, but only TP53 (n = 11, 32%), ASXL1 (n = 8, 24%), and JAK2 (n = 4, 12%) were recurrent. Twenty (59%) patients showed diploid cytogenetics. Twenty-three (68%) patients presented with AML or MDS-EB-2, suggesting an association with high-grade myeloid neoplasm. Patients with myeloid neoplasms carrying DDX41 mutations show male predominance (3:1), higher age at presentation, association with TP53 mutations, and association with high-grade myeloid neoplasms in our cohort at a referral cancer center setting. These findings support the recognition of myeloid neoplasms with DDX41 mutation as unique, need for germline confirmation, and further assessment of family members.
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Affiliation(s)
- Andrés E. Quesada
- Department of HematopathologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Mark J. Routbort
- Department of HematopathologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Courtney D. DiNardo
- Department of LeukemiaThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Carlos E. Bueso‐Ramos
- Department of HematopathologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Rashmi Kanagal‐Shamanna
- Department of HematopathologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Joseph D. Khoury
- Department of HematopathologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Beenu Thakral
- Department of HematopathologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Zhuang Zuo
- Department of HematopathologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - C. Cameron Yin
- Department of HematopathologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Sanam Loghavi
- Department of HematopathologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Chi Y. Ok
- Department of HematopathologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Sa A. Wang
- Department of HematopathologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Zhenya Tang
- Department of HematopathologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Sarah A. Bannon
- Department of Clinical Cancer GeneticsThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Christopher B. Benton
- Department of LeukemiaThe University of Texas MD Anderson Cancer Center Houston Texas
| | | | - Hagop Kantarjian
- Department of LeukemiaThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Rajyalakshmi Luthra
- Department of HematopathologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - L. Jeffrey Medeiros
- Department of HematopathologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Keyur P. Patel
- Department of HematopathologyThe University of Texas MD Anderson Cancer Center Houston Texas
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25
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Benton CB, Boddu PC, DiNardo CD, Bose P, Wang F, Assi R, Pemmaraju N, KC D, Pierce S, Patel K, Konopleva M, Ravandi F, Garcia‐Manero G, Kadia TM, Cortes J, Kantarjian HM, Andreeff M, Verstovsek S. Janus kinase 2 variants associated with the transformation of myeloproliferative neoplasms into acute myeloid leukemia. Cancer 2019; 125:1855-1866. [DOI: 10.1002/cncr.31986] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 12/20/2018] [Indexed: 01/12/2023]
Affiliation(s)
- Christopher B. Benton
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Prajwal C. Boddu
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Courtney D. DiNardo
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Prithviraj Bose
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Feng Wang
- Department of Genomic Medicine The University of Texas MD Anderson Cancer Center Houston Texas
| | - Rita Assi
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Naveen Pemmaraju
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Devendra KC
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Sherry Pierce
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Keyur Patel
- Department of Hematopathology The University of Texas MD Anderson Cancer Center Houston Texas
| | - Marina Konopleva
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Farhad Ravandi
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | | | - Tapan M. Kadia
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Jorge Cortes
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Hagop M. Kantarjian
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Michael Andreeff
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Srdan Verstovsek
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
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26
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Pemmaraju N, Kantarjian H, Jorgensen JL, Jabbour E, Jain N, Thomas D, O'Brien S, Wang X, Huang X, Wang SA, Konopleva M, Konoplev S, Kadia T, Garris R, Pierce S, Garcia‐Manero G, Cortes J, Ravandi F. Significance of recurrence of minimal residual disease detected by multi-parameter flow cytometry in patients with acute lymphoblastic leukemia in morphological remission. Am J Hematol 2017; 92:279-285. [PMID: 28052371 DOI: 10.1002/ajh.24629] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 12/17/2016] [Accepted: 12/21/2016] [Indexed: 12/16/2022]
Abstract
We sought to determine the significance of minimal residual disease (MRD) relapse in patients with ALL after achieving MRD negative status following induction and consolidation therapy. Between January 2003 and September 2014, 647 newly diagnosed patients were treated [HyperCVAD-based (n = 531); Augmented BFM (n = 116)]. Six hundred and one (93%) achieved complete remission (CR), and 546 (91%) became MRD negative. Fifty-five patients [HyperCVAD-based (n = 49); Augmented BFM (n = 6)] developed recurrence of MRD while still in morphological CR and are the subjects of this study. MRD was assessed by 6-color (4-color prior to 2009) multi-parameter flow cytometry (MFC) at CR and multiple time points thereafter. Their median age was 44 years (range, 18-72 years), median WBC at initial presentation was 7.3 K/µL-1 (range, 0.6-303.8 K/µL-1 ) and median bone marrow blast percentage 88% (range, 26-98%). The median time to MRD relapse was 14 months (range 3-58 months). Forty-four (80%) patients subsequently developed morphological relapse after median of 3 months (range, <1-33 months) from detection of MRD recurrence. Treatments received after MRD positivity and prior to morphological relapse: 16 continued maintenance chemotherapy; 15 received late intensification; 9 allogeneic stem cell transplant, 9 changed chemotherapy, 6 no further therapy. Only six remain alive and in CR1 and nine are alive after morphological relapse. MRD relapse detected by MFC at any time after achieving CR is associated with a high risk for morphological relapse. SCT can result in long-term remission in some patients. Prospective studies of long-term MRD assessments, together with less toxic treatment strategies to eradicate MRD, are warranted.
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Affiliation(s)
- Naveen Pemmaraju
- Department of LeukemiaUniversity of Texas, MD Anderson Cancer CenterHouston Texas
| | - Hagop Kantarjian
- Department of LeukemiaUniversity of Texas, MD Anderson Cancer CenterHouston Texas
| | - Jeffrey L. Jorgensen
- Department of PathologyUniversity of Texas, MD Anderson Cancer CenterHouston Texas
| | - Elias Jabbour
- Department of LeukemiaUniversity of Texas, MD Anderson Cancer CenterHouston Texas
| | - Nitin Jain
- Department of LeukemiaUniversity of Texas, MD Anderson Cancer CenterHouston Texas
| | - Deborah Thomas
- Department of LeukemiaUniversity of Texas, MD Anderson Cancer CenterHouston Texas
| | - Susan O'Brien
- Division of Hematology/Oncology, University of California, Chao Family Comprehensive Cancer Center, Irvine California
| | - Xuemei Wang
- Department of BiostatisticsUniversity of Texas, MD Anderson Cancer Center Texas
| | - Xuelin Huang
- Department of BiostatisticsUniversity of Texas, MD Anderson Cancer Center Texas
| | - Sa A. Wang
- Department of PathologyUniversity of Texas, MD Anderson Cancer CenterHouston Texas
| | - Marina Konopleva
- Department of LeukemiaUniversity of Texas, MD Anderson Cancer CenterHouston Texas
| | - Sergej Konoplev
- Department of PathologyUniversity of Texas, MD Anderson Cancer CenterHouston Texas
| | - Tapan Kadia
- Department of LeukemiaUniversity of Texas, MD Anderson Cancer CenterHouston Texas
| | - Rebecca Garris
- Department of LeukemiaUniversity of Texas, MD Anderson Cancer CenterHouston Texas
| | - Sherry Pierce
- Department of LeukemiaUniversity of Texas, MD Anderson Cancer CenterHouston Texas
| | | | - Jorge Cortes
- Department of LeukemiaUniversity of Texas, MD Anderson Cancer CenterHouston Texas
| | - Farhad Ravandi
- Department of LeukemiaUniversity of Texas, MD Anderson Cancer CenterHouston Texas
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27
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Short NJ, Kantarjian HM, Sasaki K, Ravandi F, Ko H, Cameron Yin C, Garcia‐Manero G, Cortes JE, Garris R, O'Brien SM, Patel K, Khouri M, Thomas D, Jain N, Kadia TM, Daver NG, Benton CB, Issa GC, Konopleva M, Jabbour E. Poor outcomes associated with +der(22)t(9;22) and -9/9p in patients with Philadelphia chromosome-positive acute lymphoblastic leukemia receiving chemotherapy plus a tyrosine kinase inhibitor. Am J Hematol 2017; 92:238-243. [PMID: 28006851 DOI: 10.1002/ajh.24625] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 12/14/2016] [Indexed: 01/07/2023]
Abstract
In patients with Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL) treated with chemotherapy plus a tyrosine kinase inhibitor (TKI), the prognostic impact of additional chromosomal abnormalities (ACAs) is not well-established. We evaluated the prognostic impact of individual ACAs in 152 patients with Ph+ ALL receiving first-line intensive chemotherapy plus either imatinib (n = 36), dasatinib (n = 74), or ponatinib (n = 42). ACAs were identified in 118 patients (78%). Compared to outcomes of patients without ACAs, ACAs were not associated with differences in either relapse-free survival (RFS; P = 0.42) or overall survival (OS; P = 0.51). When individual ACAs were evaluated, +der(22)t(9;22) and/or -9/9p in the absence of high hyperdiploidy (HeH) was present in 16% of patients and constituted a poor-risk ACA group. Patients with one or more poor-risk ACAs in the absence of HeH had significantly shorter RFS (5-year RFS rate 33% versus 59%, P = 0.01) and OS (5-year OS rate 24% versus 63%, P = 0.003). Poor-risk ACAs were prognostic in patients who received imatinib and dasatinib but not in those who received ponatinib. By multivariate analysis, this poor-risk ACA group was independently associated with worse RFS (HR 2.03 [95% CI 1.08-3.30], P = 0.03) and OS (HR 2.02 [95% CI 1.10-3.71], P = 0.02). Patients with Ph+ ALL who have +der(22)t(9;22) and/or -9/9p in the absence of HeH have relatively poor outcomes when treated with chemotherapy plus a TKI.
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Affiliation(s)
- Nicholas J. Short
- Division of Cancer MedicineThe University of Texas MD Anderson Cancer CenterHouston Texas USA
| | - Hagop M. Kantarjian
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHouston Texas USA
| | - Koji Sasaki
- Division of Cancer MedicineThe University of Texas MD Anderson Cancer CenterHouston Texas USA
| | - Farhad Ravandi
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHouston Texas USA
| | - Heidi Ko
- Department of Internal MedicineThe University of Texas Health Science CenterHouston Texas USA
| | - C. Cameron Yin
- Department of HematopathologyThe University of Texas MD Anderson Cancer CenterHouston Texas USA
| | | | - Jorge E. Cortes
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHouston Texas USA
| | - Rebecca Garris
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHouston Texas USA
| | - Susan M. O'Brien
- Chao Family Comprehensive Cancer Center, University of California IrvineOrange California USA
| | - Keyur Patel
- Department of HematopathologyThe University of Texas MD Anderson Cancer CenterHouston Texas USA
| | - Maria Khouri
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHouston Texas USA
| | - Deborah Thomas
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHouston Texas USA
| | - Nitin Jain
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHouston Texas USA
| | - Tapan M. Kadia
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHouston Texas USA
| | - Naval G. Daver
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHouston Texas USA
| | - Christopher B. Benton
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHouston Texas USA
| | - Ghayas C. Issa
- Division of Cancer MedicineThe University of Texas MD Anderson Cancer CenterHouston Texas USA
| | - Marina Konopleva
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHouston Texas USA
| | - Elias Jabbour
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHouston Texas USA
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28
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Short NJ, Benton CB, Chen H, Qiu P, Gu L, Pierce S, Brandt M, Maiti A, Min TL, Naqvi K, Quintas‐Cardama A, Konopleva M, Kadia T, Cortes J, Garcia‐Manero G, Ravandi F, Jabbour E, Kantarjian H, Andreeff M. Peripheral blood blast clearance is an independent prognostic factor for survival and response to acute myeloid leukemia induction chemotherapy. Am J Hematol 2016; 91:1221-1226. [PMID: 27474808 DOI: 10.1002/ajh.24500] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 07/19/2016] [Accepted: 07/28/2016] [Indexed: 01/17/2023]
Abstract
In patients with acute myeloid leukemia (AML), rapid reduction of circulating blasts with induction chemotherapy may serve as an in vivo marker of chemosensitivity. We performed a retrospective analysis of 363 patients with untreated AML who received induction chemotherapy in order to determine the relationship between day of blast disappearance (DOBD) and complete remission (CR) rates, event-free survival (EFS), and overall survival (OS). DOBD ≤ 5 vs. >5 was identified as the most discriminating cutoff for OS. DOBD > 5 was observed in 35 patients (9.6%). The CR rate for patients with DOBD ≤ 5 vs. >5 was 74.0 and 28.6%, median EFS was 9.4 and 1.8 months, and median OS was 17.1 and 5.8 months, respectively (P < 0.001 for all). DOBD > 5 was independently associated with a lower CR rate and shorter EFS and OS (P < 0.001 for all). DOBD > 5 retained prognostic significance for EFS and OS when patients were stratified by cytogenetic risk group, de novo vs. secondary or therapy-related AML, European LeukemiaNet-based risk groups, and whether CR was achieved. We propose DOBD > 5 as a simple and early marker of disease resistance that identifies patients with poor prognosis who otherwise may not be identified with existing risk stratification systems. Am. J. Hematol. 91:1221-1226, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Nicholas J. Short
- Division of Cancer MedicineThe University of Texas MD Anderson Cancer CenterHouston Texas
| | - Christopher B. Benton
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHouston Texas
| | - Hsiang‐Chun Chen
- Department of BiostatisticsThe University of Texas MD Anderson Cancer CenterHouston Texas
| | - Peng Qiu
- Department of Biomedical EngineeringGeorgia Institute of TechnologyAtlanta Georgia
| | - Lisa Gu
- Baylor College of MedicineHouston Texas
| | - Sherry Pierce
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHouston Texas
| | - Mark Brandt
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHouston Texas
| | - Abhishek Maiti
- Department of Internal MedicineThe University of Texas Health Science CenterHouston Texas
| | | | - Kiran Naqvi
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHouston Texas
| | | | - Marina Konopleva
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHouston Texas
| | - Tapan Kadia
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHouston Texas
| | - Jorge Cortes
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHouston Texas
| | | | - Farhad Ravandi
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHouston Texas
| | - Elias Jabbour
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHouston Texas
| | - Hagop Kantarjian
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHouston Texas
| | - Michael Andreeff
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHouston Texas
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29
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Falchi L, Kantarjian HM, Wang X, Verma D, Quintás‐Cardama A, O'Brien S, Jabbour EJ, Ravandi‐Kashani F, Borthakur G, Garcia‐Manero G, Verstovsek S, Burger JA, Luthra R, Cortes JE. Significance of deeper molecular responses in patients with chronic myeloid leukemia in early chronic phase treated with tyrosine kinase inhibitors. Am J Hematol 2013; 88:1024-9. [PMID: 23913852 DOI: 10.1002/ajh.23560] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 07/24/2013] [Accepted: 07/25/2013] [Indexed: 01/30/2023]
Abstract
Most patients with chronic myeloid leukemia (CML) in chronic phase (CP) treated with tyrosine kinase inhibitors (TKI) achieve complete cytogenetic response (CCyR). An increasing number of patients also achieve deep molecular responses (MR). We determined the frequency and significance of deep MR after TKI therapy for CML in CP. MR included: major molecular response (MMR), MR4, MR4.5, and undetectable transcripts (UND), i.e., BCR-ABL/ABL of ≤0.1, ≤0.01, ≤0.0032%, and undetectable transcripts, respectively. Four hundred eighty-three patients received imatinib 400 mg/day (IM400, 71, July 2000 to April 2001), imatinib 800 mg/day (IM800, 204, June 2001 to July 2005), nilotinib (106, July 2005 to date), or dasatinib (102, November 2005 to date). UND rates at 36 months were 18.1, 30.6, 29.2, and 28.6%, respectively. Patients achieving UND have superior transformation-free survival (TFS) and overall survival (OS) versus those obtaining ≤MMR, but not other MR levels. At the 18- and 24-month landmark analysis, patients achieving UND have no advantage in TFS and OS compared to those achieving a lesser degree of MR. Among patients achieving MR4.5, those who maintain it for ≥2 years (susMR4·5) have no additional benefit in TFS or OS. Most patients with early CP CML receiving TKI achieve MMR. BCR-ABL transcripts become undetectable in a significant fraction of them. Deeper MR at 18 or 24 months are not associated with a benefit in TFS or OS. Furthermore, achieving susMR4·5 does not appear to further reduce the risk of transformation or death.
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Affiliation(s)
- Lorenzo Falchi
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHouston Texas
| | - Hagop M. Kantarjian
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHouston Texas
| | - Xuemei Wang
- Department of BiostatisticsThe University of Texas MD Anderson Cancer CenterHouston Texas
| | - Dushyant Verma
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHouston Texas
| | | | - Susan O'Brien
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHouston Texas
| | - Elias J. Jabbour
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHouston Texas
| | | | - Gautam Borthakur
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHouston Texas
| | | | - Srdan Verstovsek
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHouston Texas
| | - Jan A. Burger
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHouston Texas
| | - Raja Luthra
- Department of HematopathologyThe University of Texas MD Anderson Cancer CenterHouston Texas
| | - Jorge E. Cortes
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHouston Texas
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