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Paiva B, Vidriales MB, Sempere A, Tarín F, Colado E, Benavente C, Cedena MT, Sánchez J, Caballero-Velazquez T, Cordón L, Garces JJ, Simoes C, Martínez-Cuadrón D, Bernal T, Botella C, Grille S, Serrano J, Rodríguez-Medina C, Algarra L, Alonso-Domínguez JM, Amigo ML, Barrios M, García-Boyero R, Colorado M, Pérez-Oteyza J, Pérez-Encinas M, Costilla-Barriga L, Sayas MJ, Pérez O, González-Díaz M, Pérez-Simón JA, Martínez-López J, Sossa C, Orfao A, San Miguel JF, Sanz MÁ, Montesinos P. Impact of measurable residual disease by decentralized flow cytometry: a PETHEMA real-world study in 1076 patients with acute myeloid leukemia. Leukemia 2021; 35:2358-2370. [PMID: 33526859 DOI: 10.1038/s41375-021-01126-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/09/2020] [Accepted: 01/07/2021] [Indexed: 01/29/2023]
Abstract
The role of decentralized assessment of measurable residual disease (MRD) for risk stratification in acute myeloid leukemia (AML) remains largely unknown, and so it does which methodological aspects are critical to empower the evaluation of MRD with prognostic significance, particularly if using multiparameter flow cytometry (MFC). We analyzed 1076 AML patients in first remission after induction chemotherapy, in whom MRD was evaluated by MFC in local laboratories of 60 Hospitals participating in the PETHEMA registry. We also conducted a survey on technical aspects of MRD testing to determine the impact of methodological heterogeneity in the prognostic value of MFC. Our results confirmed the recommended cutoff of 0.1% to discriminate patients with significantly different cumulative-incidence of relapse (-CIR- HR:0.71, P < 0.001) and overall survival (HR: 0.73, P = 0.001), but uncovered the limited prognostic value of MFC based MRD in multivariate and recursive partitioning models including other clinical, genetic and treatment related factors. Virtually all aspects related with methodological, interpretation, and reporting of MFC based MRD testing impacted in its ability to discriminate patients with different CIR. Thus, this study demonstrated that "real-world" assessment of MRD using MFC is prognostic in patients at first remission, and urges greater standardization for improved risk-stratification toward clinical decisions in AML.
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Affiliation(s)
- Bruno Paiva
- Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada (CIMA), IDISNA, CIBER-ONC number CB16/12/00369, Pamplona, Spain
| | - María-Belen Vidriales
- Department of Hematology, University Hospital of Salamanca (HUS/IBSAL), CIBERONC (CB16/12/002333) and Center for Cancer Research-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Amparo Sempere
- Hospital Universitario y Politécnico La Fe, CIBER-ONC number CB16/12/00284, Valencia, Spain
| | - Fabián Tarín
- Hospital General Universitario de Alicante, Alicante, Spain
| | - Enrique Colado
- Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria y Universitario Oncológico del Principado de Asturias (ISPA / IUOPA), Oviedo, Spain
| | | | | | | | - Teresa Caballero-Velazquez
- Hopsital Universitario Virgen del Rocío, Instituto de Biomedicina (IBIS / CSIC / CIBERONC), Universidad de Sevilla, Sevilla, Spain
| | - Lourdes Cordón
- Hospital Universitario y Politécnico La Fe, CIBER-ONC number CB16/12/00284, Valencia, Spain
| | - Juan-Jose Garces
- Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada (CIMA), IDISNA, CIBER-ONC number CB16/12/00369, Pamplona, Spain
| | - Catia Simoes
- Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada (CIMA), IDISNA, CIBER-ONC number CB16/12/00369, Pamplona, Spain
| | - David Martínez-Cuadrón
- Hospital Universitario y Politécnico La Fe, CIBER-ONC number CB16/12/00284, Valencia, Spain
| | - Teresa Bernal
- Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria y Universitario Oncológico del Principado de Asturias (ISPA / IUOPA), Oviedo, Spain
| | - Carmen Botella
- Hospital General Universitario de Alicante, Alicante, Spain
| | - Sofia Grille
- Hospital de Clinicas. Montevideo, Uruguay, Spain
| | | | | | | | | | | | - Manuel Barrios
- Hospital Regional Universitario de Málaga, Malaga, Spain
| | | | | | | | | | | | | | - Olga Pérez
- Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Marcos González-Díaz
- Department of Hematology, University Hospital of Salamanca (HUS/IBSAL), CIBERONC (CB16/12/002333) and Center for Cancer Research-IBMCC (USAL-CSIC), Salamanca, Spain
| | - José A Pérez-Simón
- Hopsital Universitario Virgen del Rocío, Instituto de Biomedicina (IBIS / CSIC / CIBERONC), Universidad de Sevilla, Sevilla, Spain
| | | | | | - Alberto Orfao
- Cancer Research Center (IBMCC-CSIC/USAL-IBSAL); Cytometry Service (NUCLEUS) and Department of Medicine, University of Salamanca, Salamanca, Spain.,(USAL) Centro de Investigación Biomédica en Red de Cáncer, Instituto Carlos III, Salamanca, Spain.,CIBER-ONC number CB16/12/00400, Salamanca, Spain
| | - Jesús F San Miguel
- Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada (CIMA), IDISNA, CIBER-ONC number CB16/12/00369, Pamplona, Spain
| | - Miguel-Ángel Sanz
- Hospital Universitario y Politécnico La Fe, CIBER-ONC number CB16/12/00284, Valencia, Spain
| | - Pau Montesinos
- Hospital Universitario y Politécnico La Fe, CIBER-ONC number CB16/12/00284, Valencia, Spain.
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Megías-Vericat JE, Martínez-Cuadrón D, Herrero MJ, Rodríguez-Veiga R, Solana-Altabella A, Boluda B, Ballesta-López O, Cano I, Acuña-Cruz E, Cervera J, Poveda JL, Sanz M, Aliño SF, Montesinos P. Impact of combinations of single-nucleotide polymorphisms of anthracycline transporter genes upon the efficacy and toxicity of induction chemotherapy in acute myeloid leukemia. Leuk Lymphoma 2020; 62:659-668. [PMID: 33135528 DOI: 10.1080/10428194.2020.1839650] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Anthracycline uptake could be affected by influx and efflux transporters in acute myeloid leukemia (AML). Combinations of single-nucleotide polymorphisms (SNPs) of wild-type genotype of influx transporters (SLC22A16, SLCO1B1) and homozygous variant genotypes of ABC polymorphisms (ABCB1, ABCC1, ABCC2, ABCG2) were evaluated in 225 adult de novo AML patients. No differences in complete remission were reported, but higher induction death was observed with combinations of SLCO1B1 rs4149056 and ABCB1 (triple variant haplotype, rs1128503), previously associated with ABCB1 and SLCO1B1 SNPs. Several combinations of SLCO1B1 and SLC22A16 with ABCB1 SNPs were associated with higher toxicities, including nephrotoxicity and hepatotoxicity, neutropenia, previously related to ABCB1, and a novel correlation with mucositis. Combination of SLC22A16 rs714368 and ABCG2 rs2231142 was related to cardiac toxicity, reproducing previous correlations with ABCG2. This study shows the impact of transporter polymorphisms in AML chemotherapy safety. Further prospective studies with larger populations are needed to validate these associations.
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Affiliation(s)
- Juan Eduardo Megías-Vericat
- Grupo de Farmacogenética, Instituto Investigación Sanitaria La Fe and Área del Medicamento, Hospital Universitari i Politècnic, Valencia, Spain.,Servicio de Farmacia, Área del Medicamento. Hospital Universitari i Politècnic, Valencia, Spain
| | - David Martínez-Cuadrón
- Servicio de Hematología y Hemoterapia. Hospital Universitari i Politècnic, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - María José Herrero
- Grupo de Farmacogenética, Instituto Investigación Sanitaria La Fe and Área del Medicamento, Hospital Universitari i Politècnic, Valencia, Spain.,Departamento Farmacología, Facultad de Medicina, Universidad de Valencia, Valencia, Spain
| | - Rebeca Rodríguez-Veiga
- Servicio de Hematología y Hemoterapia. Hospital Universitari i Politècnic, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | | | - Blanca Boluda
- Servicio de Hematología y Hemoterapia. Hospital Universitari i Politècnic, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Octavio Ballesta-López
- Servicio de Farmacia, Área del Medicamento. Hospital Universitari i Politècnic, Valencia, Spain
| | - Isabel Cano
- Servicio de Hematología y Hemoterapia. Hospital Universitari i Politècnic, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Evelyn Acuña-Cruz
- Servicio de Hematología y Hemoterapia. Hospital Universitari i Politècnic, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - José Cervera
- Servicio de Hematología y Hemoterapia. Hospital Universitari i Politècnic, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - José Luis Poveda
- Servicio de Farmacia, Área del Medicamento. Hospital Universitari i Politècnic, Valencia, Spain
| | - MiguelÁngel Sanz
- Servicio de Hematología y Hemoterapia. Hospital Universitari i Politècnic, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Salvador F Aliño
- Grupo de Farmacogenética, Instituto Investigación Sanitaria La Fe and Área del Medicamento, Hospital Universitari i Politècnic, Valencia, Spain.,Departamento Farmacología, Facultad de Medicina, Universidad de Valencia, Valencia, Spain.,Unidad de Farmacología Clínica, Área del Medicamento. Hospital Universitari I Politècnic, Valencia, Spain
| | - Pau Montesinos
- Servicio de Hematología y Hemoterapia. Hospital Universitari i Politècnic, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
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3
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Santiago M, Freiría C, Villalba A, Gómez I, Carpio N, Sanz G, Sanz MÁ, Solves P. Immunohaematological events related to changes in haematic and seric ABO group in patients undergoing haematopoietic stem cell transplantation with major ABO mismatch. Transfus Med 2018; 29:136-137. [PMID: 29732616 DOI: 10.1111/tme.12538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 04/15/2018] [Indexed: 11/30/2022]
Affiliation(s)
- M Santiago
- Transfusion Service Haematology Unit, Hospital Universitari I Politècnic La Fe, Valencia, Spain
| | - C Freiría
- Transfusion Service Haematology Unit, Hospital Universitari I Politècnic La Fe, Valencia, Spain
| | - A Villalba
- Transfusion Service Haematology Unit, Hospital Universitari I Politècnic La Fe, Valencia, Spain
| | - I Gómez
- Transfusion Service Haematology Unit, Hospital Universitari I Politècnic La Fe, Valencia, Spain
| | - N Carpio
- Transfusion Service Haematology Unit, Hospital Universitari I Politècnic La Fe, Valencia, Spain
| | - G Sanz
- Transfusion Service Haematology Unit, Hospital Universitari I Politècnic La Fe, Valencia, Spain
| | - M Á Sanz
- Transfusion Service Haematology Unit, Hospital Universitari I Politècnic La Fe, Valencia, Spain
| | - P Solves
- Transfusion Service Haematology Unit, Hospital Universitari I Politècnic La Fe, Valencia, Spain
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Megías-Vericat JE, Montesinos P, Herrero MJ, Moscardó F, Bosó V, Rojas L, Martínez-Cuadrón D, Rodríguez-Veiga R, Sendra L, Cervera J, Poveda JL, Sanz MÁ, Aliño SF. Impact of NADPH oxidase functional polymorphisms in acute myeloid leukemia induction chemotherapy. Pharmacogenomics J 2018; 18:301-307. [PMID: 28485375 DOI: 10.1038/tpj.2017.19] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 11/22/2016] [Accepted: 01/09/2017] [Indexed: 02/04/2023]
Abstract
Efficacy and toxicity of anthracycline treatment in acute myeloid leukemia (AML) is mediated by reactive oxygen species (ROS). NADPH oxidase is the major endogenous source of ROS and a key mediator of oxidative cardiac damage. The impact of NADPH oxidase polymorphisms (CYBA:rs4673, NCF4:rs1883112, RAC2:rs13058338) was evaluated in 225 adult de novo AML patients. Variant alleles of NCF4 and RAC2 were related to higher complete remission (P=0.035, P=0.016), and CYBA homozygous variant showed lower overall survival with recessive model (P=0.045). Anthracycline-induced cardiotoxicity was associated to NCF4 homozygous variant (P=0.012) and CYBA heterozygous genotype (P=0.027). Novel associations were found between variant allele of CYBA and lower lung and gastrointestinal toxicities, and a protective effect in nephrotoxicity and RAC2 homozygous variant. Moreover, RAC2 homozygous variant was related to delayed thrombocytopenia recovery. This study supports the interest of NADPH oxidase polymorphisms regarding efficacy and toxicity of AML induction therapy, in a coherent integrated manner.
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Affiliation(s)
- J E Megías-Vericat
- Unidad de Farmacogenética, Instituto Investigación Sanitaria La Fe and Área del Medicamento, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Servicio de Farmacia, Área del Medicamento, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - P Montesinos
- Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - M J Herrero
- Unidad de Farmacogenética, Instituto Investigación Sanitaria La Fe and Área del Medicamento, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Facultad de Medicina, Departamento Farmacología, Universidad de Valencia, Valencia, Spain
| | - F Moscardó
- Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - V Bosó
- Unidad de Farmacogenética, Instituto Investigación Sanitaria La Fe and Área del Medicamento, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Servicio de Farmacia, Área del Medicamento, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - L Rojas
- Unidad de Farmacogenética, Instituto Investigación Sanitaria La Fe and Área del Medicamento, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Faculty of Medicine, Department of Internal Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - D Martínez-Cuadrón
- Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - R Rodríguez-Veiga
- Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - L Sendra
- Unidad de Farmacogenética, Instituto Investigación Sanitaria La Fe and Área del Medicamento, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Facultad de Medicina, Departamento Farmacología, Universidad de Valencia, Valencia, Spain
| | - J Cervera
- Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - J L Poveda
- Servicio de Farmacia, Área del Medicamento, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - M Á Sanz
- Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - S F Aliño
- Unidad de Farmacogenética, Instituto Investigación Sanitaria La Fe and Área del Medicamento, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Facultad de Medicina, Departamento Farmacología, Universidad de Valencia, Valencia, Spain
- Unidad de Farmacología Clínica, Área del Medicamento, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Solves P, Carpio N, Carretero C, Lorenzo JI, Sanz J, Gómez I, López-Chuliá F, Arilla MJ, Regadera AI, Montesinos P, Sanz GF, Sanz MÁ. ABO incompatibility does not influence transfusion requirements in patients undergoing single-unit umbilical cord blood transplantation. Bone Marrow Transplant 2016; 52:394-399. [DOI: 10.1038/bmt.2016.264] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/15/2016] [Accepted: 07/14/2016] [Indexed: 11/09/2022]
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Ocio EM, Herrera P, Olave MT, Castro N, Pérez-Simón JA, Brunet S, Oriol A, Mateo M, Sanz MÁ, López J, Montesinos P, Chillón MC, Prieto-Conde MI, Díez-Campelo M, González M, Vidriales MB, Mateos MV, San Miguel JF. Panobinostat as part of induction and maintenance for elderly patients with newly diagnosed acute myeloid leukemia: phase Ib/II panobidara study. Haematologica 2015; 100:1294-300. [PMID: 26160880 DOI: 10.3324/haematol.2015.129577] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 06/25/2015] [Indexed: 01/08/2023] Open
Abstract
This phase Ib/II trial combined the pan-deacetylase inhibitor panobinostat with chemotherapy followed by panobinostat maintenance in elderly patients with newly diagnosed acute myeloid leukemia. Patients with prior history of myelodysplastic syndrome were excluded and 38 evaluable patients were included in the study (median age: 71 years; range: 65-83). Study patients received an induction with idarubicin (8 mg/m(2) iv days 1-3) plus cytarabine (100 mg/m(2) iv days 1-7) plus panobinostat po at escalating doses (days 8, 10, 12, 15, 17 and 19) that could be repeated in non-responding patients. Patients achieving complete remission received a consolidation cycle with the same schema, followed by panobinostat maintenance (40 mg po 3 days/week) every other week until progression. Thirty-one patients were treated at the maximum tolerated dose of panobinostat in the combination (10 mg) with good tolerability. Complete remission rate was 64% with a time to relapse of 17.0 months (12.8-21.1). Median overall survival for the whole series was 17 months (5.5-28.4). Moreover, in 4 of 5 patients with persistent minimal residual disease before maintenance, panobinostat monotherapy reduced its levels, with complete negativization in two of them. Maintenance phase was well tolerated. The most frequent adverse events were thrombocytopenia (25% grades 3/4), and gastrointestinal toxicity, asthenia and anorexia (mainly grades 1/2). Five patients required dose reduction during this phase, but only one discontinued therapy due to toxicity. These results suggest that panobinostat is one of the first novel agents with activity in elderly acute myeloid leukemia patients, and suggest further investigation is warranted, particularly in the context of maintenance therapy. This trial is registered at clinicaltrials.gov identifier: 00840346.
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Affiliation(s)
- Enrique M Ocio
- Complejo Asistencial Universitario de Salamanca (IBSAL), Centro Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca
| | | | | | | | - José A Pérez-Simón
- Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS), Seville
| | | | | | | | | | | | | | - María-Carmen Chillón
- Complejo Asistencial Universitario de Salamanca (IBSAL), Centro Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca
| | - María-Isabel Prieto-Conde
- Complejo Asistencial Universitario de Salamanca (IBSAL), Centro Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca
| | - María Díez-Campelo
- Complejo Asistencial Universitario de Salamanca (IBSAL), Centro Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca
| | - Marcos González
- Complejo Asistencial Universitario de Salamanca (IBSAL), Centro Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca
| | - María-Belén Vidriales
- Complejo Asistencial Universitario de Salamanca (IBSAL), Centro Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca
| | - María-Victoria Mateos
- Complejo Asistencial Universitario de Salamanca (IBSAL), Centro Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca
| | - Jesús F San Miguel
- Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas (CIMA), IDISNA, Pamplona, Spain
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7
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Megías-Vericat JE, Rojas L, Herrero MJ, Bosó V, Montesinos P, Moscardó F, Poveda JL, Sanz MÁ, Aliño SF. Influence of ABCB1 polymorphisms upon the effectiveness of standard treatment for acute myeloid leukemia: A systematic review and meta-analysis of observational studies. Pharmacogenomics J 2015; 15:109-18. [DOI: 10.1038/tpj.2014.80] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 10/15/2014] [Accepted: 11/07/2014] [Indexed: 11/09/2022]
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