1
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Appelbaum JS, Wei AH, Mandrekar SJ, Tiong IS, Chua CC, Teh TC, Fong CY, Ting SB, Weber D, Benner A, Hill H, Saadati M, Yin J, Stone RM, Garcia-Manero G, Erba HP, Uy GL, Marcucci G, Larson RA, Thomas A, Freeman SD, Almuina NM, Döhner K, Thomas I, Russel NH, Döhner H, Othus M, Estey EH, Walter RB. Clinical evaluation of complete remission (CR) with partial hematologic recovery (CRh) in acute myeloid leukemia: a report of 7235 patients from seven cohorts. Leukemia 2024; 38:389-392. [PMID: 38263433 PMCID: PMC10996038 DOI: 10.1038/s41375-024-02143-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 01/25/2024]
Affiliation(s)
- Jacob S Appelbaum
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Division of Hematology and Oncology, University of Washington, Seattle, WA, USA
- Seattle Children's Therapeutics, Seattle Children's Hospital, Seattle, WA, USA
| | - Andrew H Wei
- Department of Clinical Haematology, Peter MacCallum Cancer Centre, and Royal Melbourne Hospital, Melbourne, VIC, Australia
- Division of Blood Cells and Blood Cancer, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - Sumithra J Mandrekar
- Department of Quantitative Health Sciences, Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA
| | - Ing S Tiong
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- The Malignant Haematology, Transplantation and Cellular Therapies Service, Alfred Hospital, Melbourne, VIC, Australia
- Australasia Leukaemia and Lymphoma Group (ALLG), Richmond, VIC, Australia
| | - Chong Chyn Chua
- The Malignant Haematology, Transplantation and Cellular Therapies Service, Alfred Hospital, Melbourne, VIC, Australia
- Australasia Leukaemia and Lymphoma Group (ALLG), Richmond, VIC, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Department of Haematology, Northern Hospital, Melbourne, VIC, Australia
| | - Tse-Chieh Teh
- The Malignant Haematology, Transplantation and Cellular Therapies Service, Alfred Hospital, Melbourne, VIC, Australia
- Department of Haematology, Eastern Health, Box Hill, VIC, Australia
| | | | - Stephen B Ting
- Eastern Health, Box Hill Hospital and Monash University, Melbourne, VIC, Australia
| | - Daniela Weber
- Department of Internal Medicine III, Ulm University Hospital, Ulm, Germany
| | - Axel Benner
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - Hannah Hill
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Maral Saadati
- Freelance Statistician, Saadati Solutions, Ladenburg, Germany
| | - Jun Yin
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA
| | - Richard M Stone
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | - Geoffrey L Uy
- Washington University School of Medicine, St. Louis, MO, USA
| | - Guido Marcucci
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | | | - Abin Thomas
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Sylvie D Freeman
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | | | - Konstanze Döhner
- Department of Internal Medicine III, Ulm University Hospital, Ulm, Germany
| | - Ian Thomas
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Nigel H Russel
- School of Medicine, Nottingham University, Nottingham, UK
| | - Hartmut Döhner
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Megan Othus
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, USA.
| | | | - Roland B Walter
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Medicine, Division of Hematology and Oncology, University of Washington, Seattle, WA, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
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2
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Othman J, Tiong IS, O'Nions J, Dennis M, Mokretar K, Ivey A, Austin M, Latif AL, Amer M, Chan WY, Crawley C, Crolla F, Cross J, Dang R, Elliot J, Fong CY, Galli S, Gallipoli P, Hogan F, Kalkur P, Khan A, Krishnamurthy P, Laurie J, Loo S, Marshall S, Mehta P, Murthy V, Nagumantry S, Pillai S, Potter N, Sellar R, Taylor T, Zhao R, Russell NH, Wei AH, Dillon R. Molecular MRD is strongly prognostic in patients with NPM1-mutated AML receiving venetoclax-based nonintensive therapy. Blood 2024; 143:336-341. [PMID: 37647641 DOI: 10.1182/blood.2023021579] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/27/2023] [Accepted: 08/13/2023] [Indexed: 09/01/2023] Open
Abstract
ABSTRACT Assessment of measurable residual disease (MRD) by quantitative reverse transcription polymerase chain reaction is strongly prognostic in patients with NPM1-mutated acute myeloid leukemia (AML) treated with intensive chemotherapy; however, there are no data regarding its utility in venetoclax-based nonintensive therapy, despite high efficacy in this genotype. We analyzed the prognostic impact of NPM1 MRD in an international real-world cohort of 76 previously untreated patients with NPM1-mutated AML who achieved complete remission (CR)/CR with incomplete hematological recovery following treatment with venetoclax and hypomethylating agents (HMAs) or low-dose cytarabine (LDAC). A total of 44 patients (58%) achieved bone marrow (BM) MRD negativity, and a further 14 (18%) achieved a reduction of ≥4 log10 from baseline as their best response, with no difference between HMAs and LDAC. The cumulative rates of BM MRD negativity by the end of cycles 2, 4, and 6 were 25%, 47%, and 50%, respectively. Patients achieving BM MRD negativity by the end of cycle 4 had 2-year overall of 84% compared with 46% if MRD was positive. On multivariable analyses, MRD negativity was the strongest prognostic factor. A total of 22 patients electively stopped therapy in BM MRD-negative remission after a median of 8 cycles, with 2-year treatment-free remission of 88%. In patients with NPM1-mutated AML attaining remission with venetoclax combination therapies, NPM1 MRD provides valuable prognostic information.
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Affiliation(s)
- Jad Othman
- Department of Medical and Molecular Genetics, King's College London, London, United Kingdom
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Ing S Tiong
- Peter MacCallum Cancer Centre, Royal Melbourne Hospital and Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Alfred Hospital and Monash University, Melbourne, Australia
- Austin Health and Olivia Newton John Cancer Research Institute, Melbourne, Australia
| | - Jenny O'Nions
- Department of Haematology, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Mike Dennis
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | - Adam Ivey
- Alfred Hospital and Monash University, Melbourne, Australia
| | - Michael Austin
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Anne-Louise Latif
- Department of Haematology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Mariam Amer
- Haematology, University Hospital Southampton, Southampton, United Kingdom
| | - Wei Yee Chan
- Department of Haematology, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Charles Crawley
- Department of Haematology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | | | - Joe Cross
- Haematology Department, University Hospital Bristol, Bristol, United Kingdom
| | - Ray Dang
- James Cook University Hospital, Middlesbrough, United Kingdom
| | | | - Chun Y Fong
- Austin Health and Olivia Newton John Cancer Research Institute, Melbourne, Australia
| | - Sofia Galli
- Frimley Park Hospital, London, United Kingdom
| | - Paolo Gallipoli
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | | | | | - Anjum Khan
- Department of Haematology, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | | | | | - Sun Loo
- Peter MacCallum Cancer Centre, Royal Melbourne Hospital and Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Scott Marshall
- City Hospitals Sunderland NHS Trust, Sunderland, United Kingdom
| | - Priyanka Mehta
- Haematology Department, University Hospital Bristol, Bristol, United Kingdom
| | - Vidhya Murthy
- Centre for Clinical Haematology, University Hospitals Birmingham, Birmingham, United Kingdom
| | | | - Srinivas Pillai
- Royal Stoke University Hospital, University Hospital of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom
| | - Nicola Potter
- Department of Medical and Molecular Genetics, King's College London, London, United Kingdom
| | - Rob Sellar
- Department of Haematology, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Tom Taylor
- Nottingham University Hospital, Nottingham, United Kingdom
| | - Rui Zhao
- Torbay Hospital, Torquay, United Kingdom
| | - Nigel H Russell
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Andrew H Wei
- Peter MacCallum Cancer Centre, Royal Melbourne Hospital and Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Richard Dillon
- Department of Medical and Molecular Genetics, King's College London, London, United Kingdom
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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3
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Tiong IS, Stevenson WS, Wall M, Yap YZ, Seymour JF, Kenealy M, Blombery P. Favorable outcomes of DDX41-mutated myelodysplastic syndrome and low blast count acute myeloid leukemia treated with azacitidine ± lenalidomide. EJHaem 2023; 4:1212-1215. [PMID: 38024610 PMCID: PMC10660393 DOI: 10.1002/jha2.767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/02/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Ing S. Tiong
- Peter MacCallum Cancer CentreMelbourneVictoriaAustralia
- The Alfred HospitalMelbourneVictoriaAustralia
- Monash UniversityMelbourneVictoriaAustralia
| | - William S. Stevenson
- Royal North Shore HospitalSt LeonardsNew South WalesAustralia
- Northern Clinical School, University of SydneySydneyNew South WalesAustralia
| | - Meaghan Wall
- Monash UniversityMelbourneVictoriaAustralia
- Victorian Clinical Genetics Services, Murdoch Children's Research InstituteMelbourneVictoriaAustralia
| | | | - John F. Seymour
- Peter MacCallum Cancer CentreMelbourneVictoriaAustralia
- Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVictoriaAustralia
- Royal Melbourne HospitalMelbourneVictoriaAustralia
| | - Melita Kenealy
- Monash UniversityMelbourneVictoriaAustralia
- Cabrini HealthMelbourneVictoriaAustralia
| | - Piers Blombery
- Peter MacCallum Cancer CentreMelbourneVictoriaAustralia
- Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVictoriaAustralia
- Royal Melbourne HospitalMelbourneVictoriaAustralia
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4
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Hiwase D, Hahn C, Tran ENH, Chhetri R, Baranwal A, Al-Kali A, Sharplin K, Ladon D, Hollins R, Greipp P, Kutyna M, Alkhateeb H, Badar T, Wang P, Ross DM, Singhal D, Shanmuganathan N, Bardy P, Beligaswatte A, Yeung D, Litzow MR, Mangaonkar A, Giri P, Lee C, Yong A, Horvath N, Singhal N, Gowda R, Hogan W, Gangat N, Patnaik M, Begna K, Tiong IS, Wei A, Kumar S, Brown A, Scott H, Thomas D, Kok CH, Tefferi A, Shah MV. TP53 mutation in therapy-related myeloid neoplasm defines a distinct molecular subtype. Blood 2023; 141:1087-1091. [PMID: 36574363 DOI: 10.1182/blood.2022018236] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/22/2022] [Accepted: 12/08/2022] [Indexed: 12/28/2022] Open
Affiliation(s)
- Devendra Hiwase
- Department of Haematology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
- Precision Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, SA, Australia
| | - Christopher Hahn
- Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, SA, Australia
- Genetic and Molecular Pathology, SA Pathology, Adelaide, SA, Australia
| | - Elizabeth Ngoc Hoa Tran
- Precision Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Rakchha Chhetri
- Department of Haematology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
- Precision Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | | | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Kirsty Sharplin
- Department of Haematology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Dariusz Ladon
- Genetic and Molecular Pathology, SA Pathology, Adelaide, SA, Australia
| | - Rachel Hollins
- Genetic and Molecular Pathology, SA Pathology, Adelaide, SA, Australia
| | - Patricia Greipp
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Monika Kutyna
- Department of Haematology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
- Precision Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | | | - Talha Badar
- Department of Hematology/Oncology, Mayo Clinic, Jacksonville, FL
| | - Paul Wang
- ACRF Cancer Genomic Facility, SA Pathology, Adelaide, SA, Australia
| | - David M Ross
- Department of Haematology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
- Precision Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, SA, Australia
| | - Deepak Singhal
- Department of Haematology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
- Precision Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Naranie Shanmuganathan
- Department of Haematology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
- Precision Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Peter Bardy
- Department of Haematology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Ashanka Beligaswatte
- Department of Haematology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - David Yeung
- Department of Haematology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
- Precision Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | | | | | - Pratyush Giri
- Department of Haematology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Cindy Lee
- Department of Haematology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Angie Yong
- Department of Haematology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Noemi Horvath
- Department of Haematology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Nimit Singhal
- Department of Haematology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Raghu Gowda
- Department of Haematology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | | | | | | | - Kebede Begna
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Ing S Tiong
- Department of Haematology, The Alfred Hospital and Monash University, Melbourne, VIC, Australia
| | - Andrew Wei
- Department of Haematology, The Alfred Hospital and Monash University, Melbourne, VIC, Australia
| | - Sharad Kumar
- Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, SA, Australia
| | - Anna Brown
- Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, SA, Australia
- Genetic and Molecular Pathology, SA Pathology, Adelaide, SA, Australia
| | - Hamish Scott
- Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, SA, Australia
- Genetic and Molecular Pathology, SA Pathology, Adelaide, SA, Australia
| | - Daniel Thomas
- Department of Haematology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
- Precision Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Chung H Kok
- Precision Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
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5
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Tiong IS, Loo S. Targeting Measurable Residual Disease (MRD) in Acute Myeloid Leukemia (AML): Moving beyond Prognostication. Int J Mol Sci 2023; 24:4790. [PMID: 36902217 PMCID: PMC10003715 DOI: 10.3390/ijms24054790] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 03/06/2023] Open
Abstract
Measurable residual disease (MRD) assessment in acute myeloid leukemia (AML) has an established role in disease prognostication, particularly in guiding decisions for hematopoietic cell transplantation in first remission. Serial MRD assessment is now routinely recommended in the evaluation of treatment response and monitoring in AML by the European LeukemiaNet. The key question remains, however, if MRD in AML is clinically actionable or "does MRD merely portend fate"? With a series of new drug approvals since 2017, we now have more targeted and less toxic therapeutic options for the potential application of MRD-directed therapy. Recent approval of NPM1 MRD as a regulatory endpoint is also foreseen to drastically transform the clinical trial landscape such as biomarker-driven adaptive design. In this article, we will review (1) the emerging molecular MRD markers (such as non-DTA mutations, IDH1/2, and FLT3-ITD); (2) the impact of novel therapeutics on MRD endpoints; and (3) how MRD might be used as a predictive biomarker to guide therapy in AML beyond its prognostic role, which is the focus of two large collaborative trials: AMLM26 INTERCEPT (ACTRN12621000439842) and MyeloMATCH (NCT05564390).
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Affiliation(s)
- Ing S. Tiong
- Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
- The Alfred Hospital, Melbourne, VIC 3004, Australia
- Australian Centre for Blood Diseases, Monash University, Melbourne, VIC 3004, Australia
| | - Sun Loo
- Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
- Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia
- The Northern Hospital, Epping, VIC 3076, Australia
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6
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Ryland GL, Umeda M, Holmfeldt L, Lehmann S, Herlin MK, Ma J, Khanlari M, Rubnitz JE, Ries RE, Kosasih HJ, Ekert PG, Goh HN, Tiong IS, Grimmond SM, Haferlach C, Day RB, Ley TJ, Meshinchi S, Ma X, Blombery P, Klco JM. Description of a novel subtype of acute myeloid leukemia defined by recurrent CBFB insertions. Blood 2023; 141:800-805. [PMID: 36179268 PMCID: PMC10273080 DOI: 10.1182/blood.2022017874] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/29/2022] [Accepted: 09/16/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Georgina L. Ryland
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Centre for Cancer Research, University of Melbourne, Parkville, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
| | - Masayuki Umeda
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
| | - Linda Holmfeldt
- Department of Immunology, Genetics, and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
- The Beijer Laboratory, Uppsala, Sweden
| | - Sören Lehmann
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Morten Krogh Herlin
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Jing Ma
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
| | - Mahsa Khanlari
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
| | - Jeffrey E. Rubnitz
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Rhonda E. Ries
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Paul G. Ekert
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
- Murdoch Children's Research Institute, Parkville, VIC, Australia
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW, Australia
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Parkville, VIC, Australia
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW, Australia
| | - Hwee Ngee Goh
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Ing S. Tiong
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Sean M. Grimmond
- Centre for Cancer Research, University of Melbourne, Parkville, VIC, Australia
| | | | - Ryan B. Day
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Timothy J. Ley
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Soheil Meshinchi
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Xiaotu Ma
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN
| | - Piers Blombery
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
- Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Jeffery M. Klco
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
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7
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Moujalled DM, Brown FC, Chua CC, Dengler MA, Pomilio G, Anstee NS, Litalien V, Thompson E, Morley T, MacRaild S, Tiong IS, Morris R, Dun K, Zordan A, Shah J, Banquet S, Halilovic E, Morris E, Herold MJ, Lessene G, Adams JM, Huang DCS, Roberts AW, Blombery P, Wei AH. Acquired mutations in BAX confer resistance to BH3-mimetic therapy in acute myeloid leukemia. Blood 2023; 141:634-644. [PMID: 36219880 PMCID: PMC10651776 DOI: 10.1182/blood.2022016090] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 08/18/2022] [Accepted: 09/19/2022] [Indexed: 11/20/2022] Open
Abstract
Randomized trials in acute myeloid leukemia (AML) have demonstrated improved survival by the BCL-2 inhibitor venetoclax combined with azacitidine in older patients, and clinical trials are actively exploring the role of venetoclax in combination with intensive chemotherapy in fitter patients with AML. As most patients still develop recurrent disease, improved understanding of relapse mechanisms is needed. We find that 17% of patients relapsing after venetoclax-based therapy for AML have acquired inactivating missense or frameshift/nonsense mutations in the apoptosis effector gene BAX. In contrast, such variants were rare after genotoxic chemotherapy. BAX variants arose within either leukemic or preleukemic compartments, with multiple mutations observed in some patients. In vitro, AML cells with mutated BAX were competitively selected during prolonged exposure to BCL-2 antagonists. In model systems, AML cells rendered deficient for BAX, but not its close relative BAK, displayed resistance to BCL-2 targeting, whereas sensitivity to conventional chemotherapy was variable. Acquired mutations in BAX during venetoclax-based therapy represent a novel mechanism of resistance to BH3-mimetics and a potential barrier to the long-term efficacy of drugs targeting BCL-2 in AML.
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Affiliation(s)
- Donia M. Moujalled
- Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
- Department of Clinical Haematology, The Alfred, Melbourne, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Fiona C. Brown
- Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
- Department of Clinical Haematology, The Alfred, Melbourne, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Chong Chyn Chua
- Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
- Department of Clinical Haematology, The Alfred, Melbourne, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Michael A. Dengler
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Department of Pharmacology and Therapeutics, The University of Melbourne, Melbourne, Australia
| | - Giovanna Pomilio
- Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
- Department of Clinical Haematology, The Alfred, Melbourne, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Natasha S. Anstee
- Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
- Department of Clinical Haematology, The Alfred, Melbourne, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Veronique Litalien
- Department of Clinical Haematology, The Alfred, Melbourne, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | | | - Thomas Morley
- Department of Clinical Haematology, The Alfred, Melbourne, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Sarah MacRaild
- Department of Clinical Haematology, The Alfred, Melbourne, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Ing S. Tiong
- Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
- Department of Clinical Haematology, The Alfred, Melbourne, Australia
- Department of Pathology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - Rhiannon Morris
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Karen Dun
- Victorian Cancer and Cytogenetics Service, St. Vincent’s Hospital, Melbourne, Fitzroy, Australia
| | - Adrian Zordan
- Victorian Cancer and Cytogenetics Service, St. Vincent’s Hospital, Melbourne, Fitzroy, Australia
| | - Jaynish Shah
- Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
| | - Sebastien Banquet
- Oncology Research and Development Unit, Institut de Recherches International Servier, Paris, France
| | - Ensar Halilovic
- Novartis Institutes for BioMedical Research, Novartis, Cambridge, MA
| | - Erick Morris
- Novartis Institutes for BioMedical Research, Novartis, Cambridge, MA
| | - Marco J. Herold
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Biology, The University of Melbourne, Melbourne, Australia
| | - Guillaume Lessene
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Biology, The University of Melbourne, Melbourne, Australia
| | - Jerry M. Adams
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Biology, The University of Melbourne, Melbourne, Australia
| | - David C. S. Huang
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Biology, The University of Melbourne, Melbourne, Australia
| | - Andrew W. Roberts
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- The University of Melbourne, Melbourne, Australia
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | | | - Andrew H. Wei
- Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
- Department of Clinical Haematology, The Alfred, Melbourne, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- The University of Melbourne, Melbourne, Australia
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
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8
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Nguyen PC, Donati V, Vassili C, Grigg AP, Tiong IS. Real-world Tolerability of Venetoclax-based Therapy with Azole Antifungal Therapy as Maintenance for Acute Myeloid Leukemia in Remission. Leuk Res 2022; 116:106837. [DOI: 10.1016/j.leukres.2022.106837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/21/2022] [Accepted: 03/24/2022] [Indexed: 11/26/2022]
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9
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Tiong IS, Dillon R, Ivey A, Kuzich JA, Thiagarajah N, Sharplin KM, Kok CH, Tedjaseputra A, Rowland JP, Grove CS, Abro E, Shortt J, Hiwase DK, Bajel A, Potter NE, Smith ML, Hemmaway CJ, Thomas A, Gilkes AF, Russell NH, Wei AH. Clinical impact of NPM1-mutant molecular persistence after chemotherapy for acute myeloid leukemia. Blood Adv 2021; 5:5107-5111. [PMID: 34555849 PMCID: PMC9153038 DOI: 10.1182/bloodadvances.2021005455] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/15/2021] [Indexed: 01/07/2023] Open
Abstract
Monitoring of NPM1 mutant (NPM1mut) measurable residual disease (MRD) in acute myeloid leukemia (AML) has an established role in patients who are treated with intensive chemotherapy. The European LeukemiaNet has defined molecular persistence at low copy number (MP-LCN) as an MRD transcript level <1% to 2% with a <1-log change between any 2 positive samples collected after the end of treatment (EOT). Because the clinical impact of MP-LCN is unknown, we sought to characterize outcomes in patients with persistent NPM1mut MRD after EOT and identify factors associated with disease progression. Consecutive patients with newly diagnosed NPM1mut AML who received ≥2 cycles of intensive chemotherapy were included if bone marrow was NPM1mut MRD positive at the EOT, and they were not transplanted in first complete remission. One hundred patients were followed for a median of 23.5 months; 42% remained free of progression at 1 year, either spontaneously achieving complete molecular remission (CRMRD-; 30%) or retaining a low-level NPM1mut transcript (12% for ≥12 months and 9% at last follow-up). Forty percent met the criteria for MP-LCN. Preemptive salvage therapy significantly prolonged relapse-free survival. Risk factors associated with disease progression were concurrent FLT3-internal tandem duplication at diagnosis and suboptimal MRD response (NPM1mut reduction <4.4-log) at EOT.
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Affiliation(s)
- Ing S. Tiong
- Department of Haematology, The Alfred Hospital and Monash University, Melbourne, VIC, Australia
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Richard Dillon
- Department of Medical and Molecular Genetics, King’s College, London, United Kingdom
- Guy’s Hospital, London, United Kingdom
| | - Adam Ivey
- Department of Haematology, The Alfred Hospital and Monash University, Melbourne, VIC, Australia
- Australian Centre for Blood Diseases, Monash University, Melbourne, VIC, Australia
| | - James A. Kuzich
- Austin Health and Olivia Newton John Cancer Research Institute, Melbourne, VIC, Australia
| | - Nisha Thiagarajah
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | - Chung Hoow Kok
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | | | | | - Carolyn S. Grove
- Department of Haematology, Sir Charles Gairdner Hospital and PathWest, Perth, WA, Australia
| | - Emad Abro
- Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Jake Shortt
- Monash Health, Melbourne, VIC, Australia
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | | | - Ashish Bajel
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Nicola E. Potter
- Department of Medical and Molecular Genetics, King’s College, London, United Kingdom
| | - Matthew L. Smith
- Department of Haematology, St. Bartholomew’s Hospital, London, United Kingdom
| | - Claire J. Hemmaway
- Department of Haematology, Auckland City Hospital, Auckland, New Zealand; and
| | | | - Amanda F. Gilkes
- Department of Haematology, Cardiff University, Cardiff, United Kingdom
| | | | - Andrew H. Wei
- Department of Haematology, The Alfred Hospital and Monash University, Melbourne, VIC, Australia
- Australian Centre for Blood Diseases, Monash University, Melbourne, VIC, Australia
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10
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Nguyen PC, Manos K, Fong CY, Schwarer AP, Tiong IS, Wei AH, Kliman D, Curtis DJ. Outcomes of non-myeloablative allogeneic stem cell transplant in older patients with acute myeloid leukaemia in first remission. Intern Med J 2021; 51:1954-1958. [PMID: 34796631 DOI: 10.1111/imj.15564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 07/12/2021] [Accepted: 09/12/2021] [Indexed: 11/27/2022]
Abstract
The benefits of non-myeloablative stem cell transplant in older patients with acute myeloid leukaemia are unclear. We compare the long-term outcomes of this regimen in those aged 55-65 years in first remission with a chemotherapy only cohort that achieved durable morphologic remission. Five-year overall survival was similar (32% vs 33%, P = 0.90), as was relapse-free survival (23% vs 20%, P = 0.37). There was a trend for decreased relapse that was balanced against increased non-relapse mortality with transplantation.
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Affiliation(s)
- Phillip C Nguyen
- Department of Clinical Haematology, Alfred Health, Melbourne, Victoria, Australia
| | - Kate Manos
- Department of Clinical Haematology, Austin Health and Olivia Newton John Cancer Research Institute, Melbourne, Victoria, Australia
| | - Chun Y Fong
- Department of Clinical Haematology, Austin Health and Olivia Newton John Cancer Research Institute, Melbourne, Victoria, Australia
| | - Anthony P Schwarer
- Department of Clinical Haematology, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Ing S Tiong
- Department of Clinical Haematology, Alfred Health, Melbourne, Victoria, Australia.,Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia
| | - Andrew H Wei
- Department of Clinical Haematology, Alfred Health, Melbourne, Victoria, Australia.,Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia
| | - David Kliman
- Department of Clinical Haematology, Alfred Health, Melbourne, Victoria, Australia
| | - David J Curtis
- Department of Clinical Haematology, Alfred Health, Melbourne, Victoria, Australia.,Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia
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11
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Bosc C, Saland E, Bousard A, Gadaud N, Sabatier M, Cognet G, Farge T, Boet E, Gotanègre M, Aroua N, Mouchel PL, Polley N, Larrue C, Kaphan E, Picard M, Sahal A, Jarrou L, Tosolini M, Rambow F, Cabon F, Nicot N, Poillet-Perez L, Wang Y, Su X, Fovez Q, Kluza J, Argüello RJ, Mazzotti C, Avet-Loiseau H, Vergez F, Tamburini J, Fournié JJ, Tiong IS, Wei AH, Kaoma T, Marine JC, Récher C, Stuani L, Joffre C, Sarry JE. Mitochondrial inhibitors circumvent adaptive resistance to venetoclax and cytarabine combination therapy in acute myeloid leukemia. Nat Cancer 2021; 2:1204-1223. [PMID: 35122057 DOI: 10.1038/s43018-021-00264-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/31/2021] [Indexed: 04/23/2023]
Abstract
Therapy resistance represents a major clinical challenge in acute myeloid leukemia (AML). Here we define a 'MitoScore' signature, which identifies high mitochondrial oxidative phosphorylation in vivo and in patients with AML. Primary AML cells with cytarabine (AraC) resistance and a high MitoScore relied on mitochondrial Bcl2 and were highly sensitive to venetoclax (VEN) + AraC (but not to VEN + azacytidine). Single-cell transcriptomics of VEN + AraC-residual cell populations revealed adaptive resistance associated with changes in oxidative phosphorylation, electron transport chain complex and the TP53 pathway. Accordingly, treatment of VEN + AraC-resistant AML cells with electron transport chain complex inhibitors, pyruvate dehydrogenase inhibitors or mitochondrial ClpP protease agonists substantially delayed relapse following VEN + AraC. These findings highlight the central role of mitochondrial adaptation during AML therapy and provide a scientific rationale for alternating VEN + azacytidine with VEN + AraC in patients with a high MitoScore and to target mitochondrial metabolism to enhance the sensitivity of AML cells to currently approved therapies.
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Affiliation(s)
- Claudie Bosc
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France
- LabEx Toucan, Toulouse, France
- Equipe Labellisée Ligue Nationale Contre le Cancer 2018, Toulouse, France
| | - Estelle Saland
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France
- LabEx Toucan, Toulouse, France
- Equipe Labellisée Ligue Nationale Contre le Cancer 2018, Toulouse, France
| | - Aurélie Bousard
- Department of Oncology, Laboratory for Molecular Cancer Biology, VIB Center for Cancer Biology, Leuven, Belgium
| | - Noémie Gadaud
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France
- LabEx Toucan, Toulouse, France
- Equipe Labellisée Ligue Nationale Contre le Cancer 2018, Toulouse, France
- University of Toulouse, Toulouse, France
- Service d'Hématologie, Institut Universitaire du Cancer de Toulouse-Oncopole, CHU de Toulouse, Toulouse, France
| | - Marie Sabatier
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France
- LabEx Toucan, Toulouse, France
- Equipe Labellisée Ligue Nationale Contre le Cancer 2018, Toulouse, France
| | - Guillaume Cognet
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France
- LabEx Toucan, Toulouse, France
- Equipe Labellisée Ligue Nationale Contre le Cancer 2018, Toulouse, France
| | - Thomas Farge
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France
- LabEx Toucan, Toulouse, France
- Equipe Labellisée Ligue Nationale Contre le Cancer 2018, Toulouse, France
| | - Emeline Boet
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France
- LabEx Toucan, Toulouse, France
- Equipe Labellisée Ligue Nationale Contre le Cancer 2018, Toulouse, France
| | - Mathilde Gotanègre
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France
- LabEx Toucan, Toulouse, France
- Equipe Labellisée Ligue Nationale Contre le Cancer 2018, Toulouse, France
| | - Nesrine Aroua
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France
- LabEx Toucan, Toulouse, France
- Equipe Labellisée Ligue Nationale Contre le Cancer 2018, Toulouse, France
| | - Pierre-Luc Mouchel
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France
- LabEx Toucan, Toulouse, France
- Equipe Labellisée Ligue Nationale Contre le Cancer 2018, Toulouse, France
- University of Toulouse, Toulouse, France
- Service d'Hématologie, Institut Universitaire du Cancer de Toulouse-Oncopole, CHU de Toulouse, Toulouse, France
| | - Nathaniel Polley
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France
- LabEx Toucan, Toulouse, France
- Equipe Labellisée Ligue Nationale Contre le Cancer 2018, Toulouse, France
| | - Clément Larrue
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France
- LabEx Toucan, Toulouse, France
- Equipe Labellisée Ligue Nationale Contre le Cancer 2018, Toulouse, France
| | - Eléonore Kaphan
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France
- LabEx Toucan, Toulouse, France
- Equipe Labellisée Ligue Nationale Contre le Cancer 2018, Toulouse, France
| | - Muriel Picard
- Réanimation Polyvalente IUCT-oncopole, CHU de Toulouse, Toulouse, France
| | - Ambrine Sahal
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France
- LabEx Toucan, Toulouse, France
- Equipe Labellisée Ligue Nationale Contre le Cancer 2018, Toulouse, France
| | - Latifa Jarrou
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France
- LabEx Toucan, Toulouse, France
- Equipe Labellisée Ligue Nationale Contre le Cancer 2018, Toulouse, France
| | - Marie Tosolini
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France
| | - Florian Rambow
- Department of Oncology, Laboratory for Molecular Cancer Biology, VIB Center for Cancer Biology, Leuven, Belgium
| | - Florence Cabon
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France
- LabEx Toucan, Toulouse, France
- Equipe Labellisée Ligue Nationale Contre le Cancer 2018, Toulouse, France
| | - Nathalie Nicot
- LuxGen, Quantitative Biology Unit, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Laura Poillet-Perez
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France
- LabEx Toucan, Toulouse, France
- Equipe Labellisée Ligue Nationale Contre le Cancer 2018, Toulouse, France
| | - Yujue Wang
- Metabolomics Shared Resource, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Xiaoyang Su
- Metabolomics Shared Resource, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Quentin Fovez
- Cancer Heterogeneity Plasticity and Resistance to Therapies (CANTHER), University of Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277, Lille, France
| | - Jérôme Kluza
- Cancer Heterogeneity Plasticity and Resistance to Therapies (CANTHER), University of Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277, Lille, France
| | - Rafael José Argüello
- Aix Marseille University, CNRS, INSERM, CIML, Centre d'Immunologie de Marseille-Luminy, Marseille, France
| | - Céline Mazzotti
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Hervé Avet-Loiseau
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - François Vergez
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France
- LabEx Toucan, Toulouse, France
- Equipe Labellisée Ligue Nationale Contre le Cancer 2018, Toulouse, France
- University of Toulouse, Toulouse, France
- Service d'Hématologie, Institut Universitaire du Cancer de Toulouse-Oncopole, CHU de Toulouse, Toulouse, France
| | | | - Jean-Jacques Fournié
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France
- LabEx Toucan, Toulouse, France
| | - Ing S Tiong
- Department of Clinical Haematology, The Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Andrew H Wei
- Department of Clinical Haematology, The Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Tony Kaoma
- Computational Biomedicine Research Group, Quantitative Biology Unit, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Jean-Christophe Marine
- Department of Oncology, Laboratory for Molecular Cancer Biology, VIB Center for Cancer Biology, Leuven, Belgium
| | - Christian Récher
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France
- LabEx Toucan, Toulouse, France
- Equipe Labellisée Ligue Nationale Contre le Cancer 2018, Toulouse, France
- University of Toulouse, Toulouse, France
- Service d'Hématologie, Institut Universitaire du Cancer de Toulouse-Oncopole, CHU de Toulouse, Toulouse, France
| | - Lucille Stuani
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France
- LabEx Toucan, Toulouse, France
- Equipe Labellisée Ligue Nationale Contre le Cancer 2018, Toulouse, France
| | - Carine Joffre
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France
- LabEx Toucan, Toulouse, France
- Equipe Labellisée Ligue Nationale Contre le Cancer 2018, Toulouse, France
| | - Jean-Emmanuel Sarry
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France.
- LabEx Toucan, Toulouse, France.
- Equipe Labellisée Ligue Nationale Contre le Cancer 2018, Toulouse, France.
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12
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Tiong IS, Dillon R, Ivey A, Teh T, Nguyen P, Cummings N, Taussig DC, Latif A, Potter NE, Runglall M, Russell NH, Raj K, Schwarer AP, Fong CY, Grigg AP, Wei AH. Venetoclax induces rapid elimination of NPM1 mutant measurable residual disease in combination with low-intensity chemotherapy in acute myeloid leukaemia. Br J Haematol 2021; 192:1026-1030. [PMID: 32458446 PMCID: PMC8048658 DOI: 10.1111/bjh.16722] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/28/2020] [Accepted: 04/14/2020] [Indexed: 12/18/2022]
Abstract
Based on promising results in older adults with acute myeloid leukaemia (AML), we treated patients with NPM1mut measurable residual disease (MRD) using off-label venetoclax in combination with low-dose cytarabine or azacitidine. Twelve consecutive patients were retrospectively identified, including five with molecular persistence and seven with molecular relapse/progression. All patients with molecular persistence achieved durable molecular complete remission (CRMRD- ) without transplantation. Six of seven patients with molecular relapse/progression achieved CRMRD- after 1-2 cycles of venetoclax. This paper highlights the promising efficacy of venetoclax-based therapy to reduce the relapse risk in patients with persistent or rising NPM1mut MRD.
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Affiliation(s)
- Ing S. Tiong
- Alfred Hospital and Monash UniversityMelbourneVic.Australia
- Department of Clinical HaematologyAustin Health and Olivia Newton John Cancer Research InstituteMelbourneVic.Australia
| | - Richard Dillon
- Department of Medical and Molecular GeneticsKing's CollegeLondonUK
- Guy's and St Thomas’ HospitalsLondonUK
| | - Adam Ivey
- Alfred Hospital and Monash UniversityMelbourneVic.Australia
| | - Tse‐Chieh Teh
- Alfred Hospital and Monash UniversityMelbourneVic.Australia
| | - Phillip Nguyen
- Alfred Hospital and Monash UniversityMelbourneVic.Australia
| | | | | | | | - Nicola E. Potter
- Department of Medical and Molecular GeneticsKing's CollegeLondonUK
| | - Manohursingh Runglall
- NIHR Comprehensive Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust in partnership with King's College London and King's College HospitalLondonUK
| | | | | | | | - Chun Yew Fong
- Department of Clinical HaematologyAustin Health and Olivia Newton John Cancer Research InstituteMelbourneVic.Australia
| | - Andrew P. Grigg
- Department of Clinical HaematologyAustin Health and Olivia Newton John Cancer Research InstituteMelbourneVic.Australia
| | - Andrew H. Wei
- Alfred Hospital and Monash UniversityMelbourneVic.Australia
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13
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Chua CC, Grigg A, Singh J, Droogleever MP, Zhang L, Lim A, Fong CY, Ting SB, Schwarer A, Tiong IS, Wei AH. Treatment practice and outcomes in FLT3-mutant acute myeloid leukemia in the pre-midostaurin era: a real-world experience from Australian tertiary hospitals. Leuk Lymphoma 2019; 61:848-854. [PMID: 31752581 DOI: 10.1080/10428194.2019.1691192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Recent regulatory approval of midostaurin, a FLT3 targeting small molecular inhibitor, will likely lead to increased use of midostaurin in combination with intensive chemotherapy for patients with FLT3-mutant AML. Translation of clinical trial results into everyday practice has its challenges. This study compared the relevance of the trial population and practices studied in the midostaurin registration study (RATIFY) with real-world practice in terms of patient factors, chemotherapy, mutation-specific frequencies and clinical outcomes among patients with FLT3-mutant AML in the pre-midostaurin era (2010-2015) in Australia. We observed substantial diversity of chemotherapy regimens used in the community and limitations of the generalizability of eligibility criteria used in RATIFY (such as age and hyperleukocytosis). This study provides real-world historical data that may be used for comparison with future trial cohorts incorporating FLT3 inhibitors into the management of FLT3-mutant AML and highlights the inherent difficulties in translating clinical trial data into routine practice.
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Affiliation(s)
- Chong C Chua
- Department of Haematology, The Alfred Hospital and Monash University, Melbourne, Australia
| | - Andrew Grigg
- Department of Clinical Haematology, Austin Health, Heidelberg, Australia
| | - Jasmine Singh
- Department of Haematology, The Alfred Hospital and Monash University, Melbourne, Australia
| | - Mark P Droogleever
- Department of Haematology, The Alfred Hospital and Monash University, Melbourne, Australia.,Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Lan Zhang
- Department of Haematology, The Alfred Hospital and Monash University, Melbourne, Australia
| | - Andrew Lim
- Department of Clinical Haematology, Austin Health, Heidelberg, Australia
| | - Chun Y Fong
- Department of Clinical Haematology, Austin Health, Heidelberg, Australia
| | - Stephen B Ting
- Department of Haematology, Eastern Health and Monash University, Box Hill, Australia
| | - Anthony Schwarer
- Department of Haematology, Eastern Health and Monash University, Box Hill, Australia
| | - Ing S Tiong
- Department of Haematology, The Alfred Hospital and Monash University, Melbourne, Australia
| | - Andrew H Wei
- Department of Haematology, The Alfred Hospital and Monash University, Melbourne, Australia
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14
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Angenendt L, Röllig C, Montesinos P, Martínez-Cuadrón D, Barragan E, García R, Botella C, Martínez P, Ravandi F, Kadia T, Kantarjian HM, Cortes J, Juliusson G, Lazarevic V, Höglund M, Lehmann S, Recher C, Pigneux A, Bertoli S, Dumas PY, Dombret H, Preudhomme C, Micol JB, Terré C, Ráčil Z, Novák J, Žák P, Wei AH, Tiong IS, Wall M, Estey E, Shaw C, Exeler R, Wagenführ L, Stölzel F, Thiede C, Stelljes M, Lenz G, Mikesch JH, Serve H, Ehninger G, Berdel WE, Kramer M, Krug U, Schliemann C. Chromosomal Abnormalities and Prognosis in NPM1-Mutated Acute Myeloid Leukemia: A Pooled Analysis of Individual Patient Data From Nine International Cohorts. J Clin Oncol 2019; 37:2632-2642. [PMID: 31430225 PMCID: PMC8462529 DOI: 10.1200/jco.19.00416] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Nucleophosmin 1 (NPM1) mutations are associated with a favorable prognosis in acute myeloid leukemia (AML) when an internal tandem duplication (ITD) in the fms-related tyrosine kinase 3 gene (FLT3) is absent (FLT3-ITDneg) or present with a low allelic ratio (FLT3-ITDlow). The 2017 European LeukemiaNet guidelines assume this is true regardless of accompanying cytogenetic abnormalities. We investigated the validity of this assumption. METHODS We analyzed associations between karyotype and outcome in intensively treated patients with NPM1mut/FLT3-ITDneg/low AML who were prospectively enrolled in registry databases from nine international study groups or treatment centers. RESULTS Among 2,426 patients with NPM1mut/FLT3-ITDneg/low AML, 2,000 (82.4%) had a normal and 426 (17.6%) had an abnormal karyotype, including 329 patients (13.6%) with intermediate and 83 patients (3.4%) with adverse-risk chromosomal abnormalities. In patients with NPM1mut/FLT3-ITDneg/low AML, adverse cytogenetics were associated with lower complete remission rates (87.7%, 86.0%, and 66.3% for normal, aberrant intermediate, and adverse karyotype, respectively; P < .001), inferior 5-year overall (52.4%, 44.8%, 19.5%, respectively; P < .001) and event-free survival (40.6%, 36.0%, 18.1%, respectively; P < .001), and a higher 5-year cumulative incidence of relapse (43.6%, 44.2%, 51.9%, respectively; P = .0012). These associations remained in multivariable mixed-effects regression analyses adjusted for known clinicopathologic risk factors (P < .001 for all end points). In patients with adverse-risk chromosomal aberrations, we found no significant influence of the NPM1 mutational status on outcome. CONCLUSION Karyotype abnormalities are significantly associated with outcome in NPM1mut/FLT3-ITDneg/low AML. When adverse-risk cytogenetics are present, patients with NPM1mut share the same unfavorable prognosis as patients with NPM1 wild type and should be classified and treated accordingly. Thus, cytogenetic risk predominates over molecular risk in NPM1mut/FLT3-ITDneg/low AML.
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Affiliation(s)
- Linus Angenendt
- University Hospital Münster, Münster, Germany,Linus Angenendt, MD, Department of Medicine A, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany; e-mail:
| | - Christoph Röllig
- University Hospital of the Technical University Dresden, Dresden, Germany
| | - Pau Montesinos
- Hospital Universitari i Politècnic La Fe, Valencia; Centro de Investigación Biomédica en Red de Cáncer, Madrid, Spain
| | - David Martínez-Cuadrón
- Hospital Universitari i Politècnic La Fe, Valencia; Centro de Investigación Biomédica en Red de Cáncer, Madrid, Spain
| | - Eva Barragan
- Hospital Universitari i Politècnic La Fe, Valencia; Centro de Investigación Biomédica en Red de Cáncer, Madrid, Spain
| | | | | | | | - Farhad Ravandi
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tapan Kadia
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Jorge Cortes
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Martin Höglund
- Uppsala University, Uppsala University Hospital, Uppsala, Sweden
| | - Sören Lehmann
- Uppsala University, Uppsala University Hospital, Uppsala, Sweden
| | | | - Arnaud Pigneux
- Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévèque, Bordeaux, France
| | - Sarah Bertoli
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Pierre-Yves Dumas
- Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévèque, Bordeaux, France
| | | | - Claude Preudhomme
- Institut National de la Santé et de la Recherche Médicale Lille, Lille, France
| | | | | | - Zdeněk Ráčil
- Masaryk University, University Hospital Brno, Brno, Czech Republic
| | - Jan Novák
- University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Pavel Žák
- University Hospital Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Andrew H. Wei
- The Alfred Hospital, Monash University, Melbourne, Australia
| | - Ing S. Tiong
- The Alfred Hospital, Monash University, Melbourne, Australia
| | | | - Elihu Estey
- University of Washington, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Carole Shaw
- University of Washington, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Lisa Wagenführ
- University Hospital of the Technical University Dresden, Dresden, Germany
| | - Friedrich Stölzel
- University Hospital of the Technical University Dresden, Dresden, Germany
| | - Christian Thiede
- University Hospital of the Technical University Dresden, Dresden, Germany
| | | | - Georg Lenz
- University Hospital Münster, Münster, Germany
| | | | - Hubert Serve
- University Hospital Frankfurt, Frankfurt, Germany
| | - Gerhard Ehninger
- University Hospital of the Technical University Dresden, Dresden, Germany
| | | | - Michael Kramer
- University Hospital of the Technical University Dresden, Dresden, Germany
| | - Utz Krug
- Klinikum Leverkusen, Leverkusen, Germany
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15
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Goncalves I, Burbury K, Michael M, Iravani A, Ravi Kumar AS, Akhurst T, Tiong IS, Blombery P, Hofman MS, Westerman D, Hicks RJ, Kong G. Characteristics and outcomes of therapy-related myeloid neoplasms after peptide receptor radionuclide/chemoradionuclide therapy (PRRT/PRCRT) for metastatic neuroendocrine neoplasia: a single-institution series. Eur J Nucl Med Mol Imaging 2019; 46:1902-1910. [PMID: 31187162 DOI: 10.1007/s00259-019-04389-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/31/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Peptide receptor radionuclide/chemoradionuclide therapy (PRRT/PRCRT) is an effective therapy for metastatic neuroendocrine neoplasia (NEN), but therapy-related myeloid neoplasms (t-MN) remain of concern. The study reviewed the clinicopathological features and outcomes of patients who developed t-MN. METHODS Retrospective analysis of all patients diagnosed with t-MN by 2016 WHO classification, from a cohort of 521 patients who received PRRT/PRCRT over a 12-year period. Molecular next-generation sequencing using an in-house 26-gene panel was performed. RESULTS Twenty-five of 521 (4.8%) patients were diagnosed with t-MN, including six acute myeloid leukaemia (AML) and 19 myelodysplastic syndrome (MDS). The median time from first cycle PRRT/PRCRT to diagnosis of t-MN was 26 months (range 4-91). Twenty-two of 25 (88%) patients had grade 1-2 pancreatic or small bowel NEN with moderate metastatic liver burden. Six patients (24%) had prior chemotherapy. Median number of PRRT cycles = 5 (22/25 (88%) with concomitant radiosensitising chemotherapy). All 25 patients achieved disease stabilisation (68%) or partial response (32%) on RECIST 1.1 at 3 months post-PRRT. At t-MN diagnosis, all patients presented with thrombocytopenia (median nadir 33 × 109/L, range 3-75) and 17 (68%) remained NEN progression-free. Marrow genetic analysis revealed unfavourable karyotype in 16/25 (66%) patients with tumour protein 53 (TP53) mutation in nine (36%). Azacitidine therapy was utilised in ten eligible patients, while four received induction chemotherapy for AML. The median overall survival from first PRRT was 62 months (19-94), but from t-MN diagnosis was only 13 months (1-56), with death due primarily to haematological disease progression. CONCLUSIONS The diagnosis of t-MN after PRRT/PRCRT is an infrequent but serious complication with poor overall survival. Most patients present with thrombocytopenia; unfavourable genetic mutations have a poor response to t-MN treatment. Prospective data are needed to explore potential pre-existing genetic factors and predictive biomarkers to minimise the risk of t-MN.
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Affiliation(s)
- Isaac Goncalves
- Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, 3000, Australia.
| | - Kate Burbury
- Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, 3000, Australia
| | - Michael Michael
- Nuclear Medicine Department, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia.,Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Amir Iravani
- Nuclear Medicine Department, Peter MacCallum Cancer Centre, Melbourne, Australia.,Neuroendocrine Tumour Service, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Aravind S Ravi Kumar
- Nuclear Medicine Department, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia.,Neuroendocrine Tumour Service, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Tim Akhurst
- Nuclear Medicine Department, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia.,Neuroendocrine Tumour Service, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Ing S Tiong
- Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, 3000, Australia
| | - Piers Blombery
- Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, 3000, Australia
| | - Michael S Hofman
- Nuclear Medicine Department, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia.,Neuroendocrine Tumour Service, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - David Westerman
- Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, 3000, Australia
| | - Rodney J Hicks
- Nuclear Medicine Department, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia.,Neuroendocrine Tumour Service, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Grace Kong
- Nuclear Medicine Department, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia.,Neuroendocrine Tumour Service, Peter MacCallum Cancer Centre, Melbourne, Australia
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16
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Tiong IS, Wei AH. New drugs creating new challenges in acute myeloid leukemia. Genes Chromosomes Cancer 2019; 58:903-914. [PMID: 30861214 DOI: 10.1002/gcc.22750] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 02/20/2019] [Accepted: 03/01/2019] [Indexed: 12/31/2022] Open
Abstract
The therapeutic landscape is rapidly changing, with eight new drugs approved by the Food and Drug Administration within the last 2 years, including midostaurin and gilteritinib for FLT3 mutant newly diagnosed and relapsed/refractory (R/R) acute myeloid leukemia (AML), respectively; CPX-351 (liposomal cytarabine and daunorubicin) for therapy-related AML and AML with myelodysplasia-related changes; gemtuzumab ozogamicin (anti-CD33 monoclonal antibody conjugated with calicheamicin) for newly diagnosed and R/R CD33-positive AML; enasidenib and ivosidenib for IDH2 and IDH1 mutant R/R AML, respectively. Novel therapies have also emerged for newly diagnosed AML in adults who are age 75 years or older, or who have comorbidities that preclude the use of intensive induction chemotherapy. These include venetoclax (BCL-2 inhibitor) in combination with hypomethylating agents (azacitidine or decitabine) or low-dose cytarabine (LDAC), and glasdegib (sonic hedgehog pathway inhibitor) in combination with LDAC. This flurry of new drug approvals has markedly altered the treatment landscape in AML and provided new opportunities, as well as new challenges for treating clinicians. This review will focus on how these drugs might shape clinical practice and the hurdles likely to be faced by new therapies seeking entry into this dynamic and rapidly changing therapeutic landscape.
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Affiliation(s)
- Ing S Tiong
- Department of Haematology, The Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Andrew H Wei
- Department of Haematology, The Alfred Hospital and Monash University, Melbourne, Victoria, Australia
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17
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Tiong IS, Reynolds J, Bradstock KF, Seymour JF, Wei AH. Dissecting causes for improved survival among patients with acute myeloid leukemia in two different eras receiving identical regimens in sequential randomized studies. Blood Cancer J 2018; 8:84. [PMID: 30190488 PMCID: PMC6127140 DOI: 10.1038/s41408-018-0121-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/21/2018] [Accepted: 08/01/2018] [Indexed: 01/28/2023] Open
Affiliation(s)
- Ing S Tiong
- Department of Clinical Haematology, Alfred Hospital and Monash University, Melbourne, Australia
| | - John Reynolds
- Biostatistics Platform, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Kenneth F Bradstock
- Department of Haematology, Westmead Hospital and University of Sydney, Sydney, Australia
| | - John F Seymour
- Integrated Department of Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - Andrew H Wei
- Department of Clinical Haematology, Alfred Hospital and Monash University, Melbourne, Australia.
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18
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Tiong IS, Rodgers SE, Lee CHS, McRae SJ. Baseline and treatment-related changes in thrombin generation in patients with multiple myeloma. Leuk Lymphoma 2016; 58:941-949. [PMID: 27931131 DOI: 10.1080/10428194.2016.1219900] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The prothrombotic risk in multiple myeloma (MM) could be potentially assessed by thrombin generation (TG) assays. TG was performed using Calibrated Automated Thrombography with 5 and 1 pM tissue factor. We compared baseline TG among 24 MM patients, 19 MGUS, and 50 healthy controls, and assessed change in TG in MM patients during the initial treatment period at 1, 2, and 3 months. MM subjects demonstrated increased FVIII and VWF:Ag levels pretreatment, and a prothrombotic TG phenotype with increased velocity index, reduced lag time and time-to-peak, and increased resistance to thrombomodulin inhibition. There were no significant changes in TG with treatment for the majority of parameters, however, MM subjects exhibited persistent elevation of velocity index throughout treatment. Two subjects developed thrombosis during the study period despite thromboprophylaxis. This study provides information on the optimal conditions for examining TG as a predictor of thrombotic risk in MM patients.
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Affiliation(s)
- Ing S Tiong
- a Haematology Division , SA Pathology , Adelaide , SA , Australia.,b School of Medicine, University of Adelaide , Adelaide , SA , Australia
| | - Susan E Rodgers
- a Haematology Division , SA Pathology , Adelaide , SA , Australia.,c School of Pharmacy and Medical Sciences, University of South Australia , Adelaide , SA , Australia
| | - Cindy H S Lee
- a Haematology Division , SA Pathology , Adelaide , SA , Australia.,b School of Medicine, University of Adelaide , Adelaide , SA , Australia.,d Haematology Department , The Queen Elizabeth Hospital , Adelaide , SA , Australia
| | - Simon J McRae
- a Haematology Division , SA Pathology , Adelaide , SA , Australia.,c School of Pharmacy and Medical Sciences, University of South Australia , Adelaide , SA , Australia.,d Haematology Department , The Queen Elizabeth Hospital , Adelaide , SA , Australia
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19
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Tiong IS, Casolari DA, Nguyen T, Van Velzen MJM, Ambler K, D'Andrea RJ, Ross DM. Masked polycythaemia vera is genetically intermediate between JAK2V617F mutated essential thrombocythaemia and overt polycythaemia vera. Blood Cancer J 2016; 6:e459. [PMID: 27540717 PMCID: PMC5022181 DOI: 10.1038/bcj.2016.70] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- I S Tiong
- Haematology Directorate, SA Pathology/Royal Adelaide Hospital, Adelaide, South Australia Australia.,School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - D A Casolari
- Haematology Directorate, SA Pathology/Royal Adelaide Hospital, Adelaide, South Australia Australia.,Centre for Cancer Biology, University of South Australia/SA Pathology, Adelaide, South Australia, Australia
| | - T Nguyen
- Haematology Directorate, SA Pathology/Royal Adelaide Hospital, Adelaide, South Australia Australia.,Centre for Cancer Biology, University of South Australia/SA Pathology, Adelaide, South Australia, Australia
| | - M J M Van Velzen
- Haematology Directorate, SA Pathology/Royal Adelaide Hospital, Adelaide, South Australia Australia.,Centre for Cancer Biology, University of South Australia/SA Pathology, Adelaide, South Australia, Australia.,School of Medical Sciences, VU University Medical Center, Amsterdam, The Netherlands
| | - K Ambler
- Genetics and Molecular Pathology Directorate, SA Pathology, Adelaide, South Australia, Australia
| | - R J D'Andrea
- Haematology Directorate, SA Pathology/Royal Adelaide Hospital, Adelaide, South Australia Australia.,Centre for Cancer Biology, University of South Australia/SA Pathology, Adelaide, South Australia, Australia
| | - D M Ross
- Haematology Directorate, SA Pathology/Royal Adelaide Hospital, Adelaide, South Australia Australia.,School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
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20
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Tiong IS, Williams MJ, Perez DJ. Nonbacterial Thrombotic Endocarditis with ST-elevation Myocardial Infarction Treated with Percutaneous Coronary Aspiration Thrombectomy. Heart Lung Circ 2013; 22:386-9. [DOI: 10.1016/j.hlc.2012.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 10/23/2012] [Accepted: 10/24/2012] [Indexed: 11/28/2022]
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