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Mora E, Montoro J, Balaguer A, Rovira M, Cabrero M, Heras I, Ribera JM, Antelo G, Martin AA, Lopez Godino O, Torrent A, Villalba M, Chorao P, Sanz MA, Sanz J. Total body irradiation versus thiotepa/busulfan-based conditioning regimens for myeloablative allogeneic stem cell transplantation in adults with acute lymphoblastic leukemia. Bone Marrow Transplant 2024:10.1038/s41409-024-02298-z. [PMID: 38755458 DOI: 10.1038/s41409-024-02298-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 05/18/2024]
Abstract
Total body irradiation (TBI)-based conditioning regimens are generally recommended for allogeneic HSCT (allo-HSCT) in patients with acute lymphoblastic leukemia (ALL). Recent evidence suggests that modern chemotherapy-based regimens may be as effective. This multicenter retrospective study compared the clinical outcomes of myeloablative allo-HSCT with thiotepa, busulfan, and cyclophosphamide/fludarabine (TTB) to TBI-based conditioning. Between 2002 to 2018, 63 and 114 patients received TTB- and TBI-based conditioning regimens, respectively. The 5-year cumulative incidence of relapse was lower in the TBI cohort compared to the TTB cohort (30% [95% CI, 22-38] versus 47% [95% CI, 36-59]; P = 0.03). Multivariate analysis identified T-ALL, Ph-negative B-ALL, and measurable residual disease associated with a higher relapse risk. The 5-year cumulative incidence of non-relapsed mortality (NRM) was significantly lower with TTB (12% [95% CI, 5-20]) compared to TBI (25% [95% CI, 18-33]) (P = 0.001). Multivariate analysis found TBI conditioning, older age, and advanced stages of ALL at transplantation associated with a higher NRM. No statistical difference was seen in overall survival (49% [95% CI, 40-58] and 46% [95% CI, 35-60]) in the TBI and TTB groups, respectively; P = 0.9). The study suggests that TTB-based conditioning may be a promising option for ALL patients undergoing allo-HSCT, as it resulted in similar OS and lower NRM than TBI-based conditioning.
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Affiliation(s)
- Elvira Mora
- Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
- Instituto de Investigación Sanitaria La Fe, Valencia, Spain.
| | - Juan Montoro
- Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Aitana Balaguer
- Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red de Cáncer, Instituto Carlos III, Madrid, Spain
| | - Montserrat Rovira
- BMT Unit. Hematology Department, ICMHO, Hospital Clínic, Institut Josep Carreras contra la leucemia, Barcelona, Spain
| | - Monica Cabrero
- Hematology Department, Hospital Universitario de Salamanca, Salamanca, Spain
- Instituto de Investigación Biomedica de Salamanca-IBSAL, Salamanca, Spain
| | - Inmaculada Heras
- Hematology Department, Hospital General Universitario Morales Meseguer, Murcia, Spain
| | - Josep-Maria Ribera
- Hematology Department. Institut Català d'Oncologia - Hospital Germans Trias i Pujol, Josep Carreras Research Institute, Badalona, Spain
- Department of Medicine, Universidad Autónoma de Barcelona, Badalona, Spain
| | - Gabriela Antelo
- Radiation Oncology Department, ICMHO, Hospital Clínic, Barcelona, Spain
| | - Ana Africa Martin
- Hematology Department, Hospital Universitario de Salamanca, Salamanca, Spain
- Instituto de Investigación Biomedica de Salamanca-IBSAL, Salamanca, Spain
| | - Oriana Lopez Godino
- Hematology Department, Hospital General Universitario Morales Meseguer, Murcia, Spain
| | - Anna Torrent
- Hematology Department. Institut Català d'Oncologia - Hospital Germans Trias i Pujol, Josep Carreras Research Institute, Badalona, Spain
| | - Marta Villalba
- Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Pedro Chorao
- Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Miguel A Sanz
- Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria La Fe, Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
| | - Jaime Sanz
- Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red de Cáncer, Instituto Carlos III, Madrid, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
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Prieto-García L, Alcoceba M, Pérez-López E, López-Corral L, Delgado M, Sánchez-Guijo F, Martín A, Navarro-Bailón A, Baile M, López-Parra M, Tamayo P, Gutiérrez N, Vázquez L, Cabrero M, Martín A, Caballero D. CAR T-CELLS ARE ARRIVING. IS ALLOGENEIC TRANSPLANT AN OBSOLETE APPROACH FOR DE NOVO/TRANSFORMED DLBCL IN THE CAR T-CELLS ERA? LONG-TERM FOLLOW-UP OF A SINGLE CENTRE UNIT. Hematol Oncol 2019. [DOI: 10.1002/hon.191_2631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- L. Prieto-García
- Department of Hematology; University Hospital of Salamanca; Salamanca Spain
| | - M. Alcoceba
- Department of Hematology; University Hospital of Salamanca; Salamanca Spain
| | - E. Pérez-López
- Department of Hematology; University Hospital of Salamanca; Salamanca Spain
| | - L. López-Corral
- Department of Hematology; University Hospital of Salamanca; Salamanca Spain
| | - M. Delgado
- Department of Hematology; University Hospital of Salamanca; Salamanca Spain
| | - F. Sánchez-Guijo
- Department of Hematology; University Hospital of Salamanca; Salamanca Spain
| | - A. Martín
- Department of Hematology; University Hospital of Salamanca; Salamanca Spain
| | - A. Navarro-Bailón
- Department of Hematology; University Hospital of Salamanca; Salamanca Spain
| | - M. Baile
- Department of Hematology; University Hospital of Salamanca; Salamanca Spain
| | - M. López-Parra
- Department of Hematology; University Hospital of Salamanca; Salamanca Spain
| | - P. Tamayo
- Department of Nuclear Medicine; University Hospital of Salamanca; Salamanca Spain
| | - N.C. Gutiérrez
- Department of Hematology; University Hospital of Salamanca; Salamanca Spain
| | - L. Vázquez
- Department of Hematology; University Hospital of Salamanca; Salamanca Spain
| | - M. Cabrero
- Department of Hematology; University Hospital of Salamanca; Salamanca Spain
| | - A. Martín
- Department of Hematology; University Hospital of Salamanca; Salamanca Spain
| | - D. Caballero
- Department of Hematology; University Hospital of Salamanca; Salamanca Spain
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Rivera D, Bastida JM, Lopez-Corral L, Sanchez-Guijo F, Cabrero M, Martin A, Perez E, Lopez-Parra M, Avendaño A, Veiga A, Baile M, Arratibel N, Carrillo J, Vazquez L, Caballero MD, Gonzalez-Porras JR. Usefulness of eltrombopag for treating thrombocytopenia after allogeneic stem cell transplantation. Bone Marrow Transplant 2018; 54:757-761. [DOI: 10.1038/s41409-018-0368-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 09/04/2018] [Accepted: 10/01/2018] [Indexed: 11/09/2022]
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Chamseddine AN, Cabrero M, Wei Y, Ganan-Gomez I, Colla S, Takahashi K, Yang H, Bohannan ZS, Garcia-Manero G. PDE4 Differential Expression Is a Potential Prognostic Factor and Therapeutic Target in Patients With Myelodysplastic Syndrome and Chronic Myelomonocytic Leukemia. Clin Lymphoma Myeloma Leuk 2017; 16 Suppl:S67-73. [PMID: 27521329 DOI: 10.1016/j.clml.2016.02.026] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 02/09/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND (OR PURPOSE) Inflammation has an essential role in the pathogenesis of myelodysplastic syndromes (MDS). Its expression is controlled by phosphodiesterase 4 (PDE4). Thus, PDE4 inhibitors might be useful therapeutic targets for MDS. PATIENTS (OR MATERIALS) AND METHODS We evaluated the expression of each isoform of PDE4 (A, B, C, and D) using transcriptomic profiling and examined the potential impact on the outcome of patients with MDS in terms of survival and response to hypomethylating agents. Total RNA was extracted from CD34(+) bone marrow hematopoietic cells from healthy individuals (n = 10) and patients with MDS (n = 24) or chronic myelomonocytic leukemia (n = 19). RESULTS The study cohort had a median follow-up period of 21.2 months (range, 0.2-68 months) and a median overall survival of 17.6 months (95% confidence interval, 9.6-25.6). The main finding of the present study was that PDE4 mean expression was generally higher in patients with MDS than in healthy individuals. Also, upregulated PDE4 expression seemed to have a possible negative effect on survival (P > .05). Moreover, lower, compared with higher, mean PDE4A and PDE4C expression is indicative of a response to a hypomethylating agent (0.09 and 0.03 vs. 0.54 and 0.49, respectively; P > .05). CONCLUSION These results should be confirmed in a larger patient cohort. PDE4 expression could be an effective potential prognostic factor and therapeutic target for patients with MDS and chronic myelomonocytic leukemia. The role of PDE4 inhibitors should be explored in vitro against MDS cell lines and in preclinical mouse models of MDS.
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Affiliation(s)
- Ali N Chamseddine
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Monica Cabrero
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yue Wei
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Irene Ganan-Gomez
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Simona Colla
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Koichi Takahashi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hui Yang
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Zachary S Bohannan
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
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Tamayo P, Martín A, Díaz L, Cabrero M, García R, García-Talavera P, Caballero D. 18 F-FDG PET/CT in the clinical management of patients with lymphoma. Rev Esp Med Nucl Imagen Mol 2017. [DOI: 10.1016/j.remnie.2017.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Martin-Garcia A, Macias De Plasencia G, Barreiro-Perez M, Diaz-Pelaez E, Lugo Goday C, Caballero Barrigon D, Perez-Perozo J, Adansa-Klain J, Gallego-Delgado M, Cabrero M, Del Canizo Fernandez-Roldan C, Cruz-Hernandez J, Sanchez P. P5259The increased challenge of elderly people diagnosed with cancer, do we know their real basal cardiovascular reserve? Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A. Martin-Garcia
- Hospital Universitario de Salamanca-IBSAL-CIBERCV, Cardiology Department., Salamanca, Spain
| | - G. Macias De Plasencia
- Hospital Universitario de Salamanca-IBSAL-CIBERCV, Cardiology Department., Salamanca, Spain
| | - M. Barreiro-Perez
- Hospital Universitario de Salamanca-IBSAL-CIBERCV, Cardiology Department., Salamanca, Spain
| | - E. Diaz-Pelaez
- Hospital Universitario de Salamanca-IBSAL-CIBERCV, Cardiology Department., Salamanca, Spain
| | - C. Lugo Goday
- Hospital Universitario de Salamanca-IBSAL-CIBERCV, Cardiology Department., Salamanca, Spain
| | | | - J. Perez-Perozo
- Hospital Universitario de Salamanca-IBSAL-CIBERCV, Cardiology Department., Salamanca, Spain
| | - J.C. Adansa-Klain
- Hospital Clínico Universitario, Oncology Department, Salamanca, Spain
| | - M. Gallego-Delgado
- Hospital Universitario de Salamanca-IBSAL-CIBERCV, Cardiology Department., Salamanca, Spain
| | - M. Cabrero
- Hospital Clínico Universitario, Hematology Department, Salamanca, Spain
| | | | | | - P.L. Sanchez
- Hospital Universitario de Salamanca-IBSAL-CIBERCV, Cardiology Department., Salamanca, Spain
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Cabrero M, Lopez-Corral L, de la Cruz F, Jarque I, Valcarcel D, Perez-Lopez E, Martin A, Sanchez-Guijo F, Grande C, Martin-Calvo M, Martin A, Caballero D. Results of a prospective phase II trial with ofatumumab as part of reduced intensity conditioning regimen in high-risk non-Hodgkin B lymphoma patients: A GELTAMO trial. Hematol Oncol 2017. [DOI: 10.1002/hon.2439_96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- M. Cabrero
- Hematology; Salamanca University Hospital; Salamanca Spain
| | | | - F. de la Cruz
- Hematology; Virgen del Rocio University Hospital; Sevilla Spain
| | - I. Jarque
- Hematology; La Fe University Hospital; Valencia Spain
| | - D. Valcarcel
- Hematology; Hospital Vall d'Hebron; Barcelona Spain
| | - E. Perez-Lopez
- Hematology; Salamanca University Hospital; Salamanca Spain
| | - A. Martin
- Hematology; Salamanca University Hospital; Salamanca Spain
| | | | - C. Grande
- Hematology; 12 de Octubre University Hospital; Madrid Spain
| | | | - A. Martin
- Hematology; Salamanca University Hospital; Salamanca Spain
| | - D. Caballero
- Hematology; Salamanca University Hospital; Salamanca Spain
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8
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Tamayo P, Martín A, Díaz L, Cabrero M, García R, García-Talavera P, Caballero D. 18F-FDG PET/CT in the clinical management of patients with lymphoma. Rev Esp Med Nucl Imagen Mol 2017; 36:312-321. [PMID: 28483374 DOI: 10.1016/j.remn.2017.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 03/07/2017] [Accepted: 03/13/2017] [Indexed: 01/01/2023]
Abstract
The aim of this work was to review the current recommendations for staging and response assessment of patients with Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) in routine clinical practice after chemotherapy and/or stem cell transplantation. A five-point scale (5-PS) from the First International Workshop on PET in Lymphoma in Deauville, France, in 2009, was recommended as the standard tool to score imaging to assess treatment response in patients with lymphoma using 18F-Fluorodeoxyglucose (FDG) PET/CT. Following the recommendations of the 11th and 12th International Conferences on Malignant Lymphoma held in Lugano (Switzerland), in 2011 and 2013, respectively, a consensus (the so-called Lugano Classification) was reached regarding the use of PET/CT for staging and response assessment in FDG-avid lymphomas. As a result, 18F-FDG PET/CT was formally incorporated into standard staging for FDG-avid lymphomas. A bone marrow biopsy is no longer indicated for the routine staging of HL and most diffuse large B-cell lymphomas. PET/CT will be used to assess response in FDG-avid histologies using the 5-point scale. The recent introduction of biological agents with immune mechanisms requires flexibility in interpretations of the Lugano criteria due to tumour flare or a pseudo-progression effect produced by these agents. Provisional criteria have been proposed (Lymphoma Response to Immunomodulatory Therapy Criteria) with the introduction of the term 'Indeterminate Response' in order to identify this phenomenon until confirmed as flare/pseudoprogression or true progression. All these recommendations will improve evaluations of patients with lymphoma, and allow comparison of results from clinical practice and trials.
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Affiliation(s)
- P Tamayo
- Servicio de Medicina Nuclear, Hospital Universitario de Salamanca, Salamanca, España; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España.
| | - A Martín
- Servicio de Hematología, Hospital Universitario de Salamanca, Salamanca, España; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
| | - L Díaz
- Servicio de Medicina Nuclear, Hospital Universitario de Salamanca, Salamanca, España
| | - M Cabrero
- Servicio de Hematología, Hospital Universitario de Salamanca, Salamanca, España; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
| | - R García
- Servicio de Hematología, Hospital Universitario de Salamanca, Salamanca, España; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
| | - P García-Talavera
- Servicio de Medicina Nuclear, Hospital Universitario de Salamanca, Salamanca, España
| | - D Caballero
- Servicio de Hematología, Hospital Universitario de Salamanca, Salamanca, España; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
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9
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Jabbour E, Strati P, Cabrero M, O'Brien S, Ravandi F, Bueso-Ramos C, Wei Q, Hu J, Abi Aad S, Short NJ, Dinardo C, Daver N, Kadia T, Wierda W, Wei Y, Colla S, Borthakur G, Cortes J, Estrov Z, Kantarjian H, Garcia-Manero G. Impact of achievement of complete cytogenetic response on outcome in patients with myelodysplastic syndromes treated with hypomethylating agents. Am J Hematol 2017; 92:351-358. [PMID: 28076892 DOI: 10.1002/ajh.24650] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 01/05/2017] [Accepted: 01/07/2017] [Indexed: 11/10/2022]
Abstract
Two hundred and sixteen consecutive patients with MDS and abnormal karyotype treated with hypomethylating agents between 4/04 and 10/12 were reviewed. Median follow-up was 17 months. Using IWG criteria, best responses were complete response (CR) in 79 patients (37%), partial response (PR) in 4 (2%), and hematologic improvement (HI) in 10 (5%). Cytogenetic response (CyR) was achieved in 78 patients (36%): complete (CCyR) in 62 (29%) and partial in 16 (7%). CyR was achieved in 48 of 79 patients (61%) with CR, 1 of 14 (7%) with PR/HI, and in 29 of the 123 (24%) with no morphologic response. Median overall survival (OS) and leukemia-free survival (LFS) for patients with and without CCyR were 21 and 13 months (P = .007), and 16 and 9 months (P = .001), respectively. By multivariate analysis, the achievement of CCyR was predictive for better OS (HR = 2.1; P < .001). In conclusion, CyR occurs at a rate of 36% (complete in 29%) in patients with MDS treated with HMA and is not always associated with morphological response. The achievement of CCyR is associated with survival improvement and constitutes a major predictive factor for outcome particularly in patients without morphologic response. Therefore, the achievement of CCyR should be considered a milestone in the management of patients with MDS.
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Affiliation(s)
- Elias Jabbour
- Department of Leukemia; University of Texas M.D. Anderson Cancer Center; Houston Texas 77030 USA
| | - Paolo Strati
- Department of Leukemia; University of Texas M.D. Anderson Cancer Center; Houston Texas 77030 USA
| | - Monica Cabrero
- Department of Leukemia; University of Texas M.D. Anderson Cancer Center; Houston Texas 77030 USA
| | - Susan O'Brien
- Department of Leukemia; University of Texas M.D. Anderson Cancer Center; Houston Texas 77030 USA
| | - Farhad Ravandi
- Department of Leukemia; University of Texas M.D. Anderson Cancer Center; Houston Texas 77030 USA
| | - Carlos Bueso-Ramos
- Department of Hematopathology; University of Texas M.D. Anderson Cancer Center; Houston Texas 77030 USA
| | - Qiao Wei
- Department of Biostatistics; University of Texas M.D. Anderson Cancer Center; Houston Texas 77030 USA
| | - Jianhua Hu
- Department of Biostatistics; University of Texas M.D. Anderson Cancer Center; Houston Texas 77030 USA
| | - Simon Abi Aad
- Department of Leukemia; University of Texas M.D. Anderson Cancer Center; Houston Texas 77030 USA
| | - Nicholas J. Short
- Department of Leukemia; University of Texas M.D. Anderson Cancer Center; Houston Texas 77030 USA
| | - Courtney Dinardo
- Department of Leukemia; University of Texas M.D. Anderson Cancer Center; Houston Texas 77030 USA
| | - Naval Daver
- Department of Leukemia; University of Texas M.D. Anderson Cancer Center; Houston Texas 77030 USA
| | - Tapan Kadia
- Department of Leukemia; University of Texas M.D. Anderson Cancer Center; Houston Texas 77030 USA
| | - William Wierda
- Department of Leukemia; University of Texas M.D. Anderson Cancer Center; Houston Texas 77030 USA
| | - Yue Wei
- Department of Leukemia; University of Texas M.D. Anderson Cancer Center; Houston Texas 77030 USA
| | - Simona Colla
- Department of Leukemia; University of Texas M.D. Anderson Cancer Center; Houston Texas 77030 USA
| | - Gautam Borthakur
- Department of Leukemia; University of Texas M.D. Anderson Cancer Center; Houston Texas 77030 USA
| | - Jorge Cortes
- Department of Leukemia; University of Texas M.D. Anderson Cancer Center; Houston Texas 77030 USA
| | - Zeev Estrov
- Department of Leukemia; University of Texas M.D. Anderson Cancer Center; Houston Texas 77030 USA
| | - Hagop Kantarjian
- Department of Leukemia; University of Texas M.D. Anderson Cancer Center; Houston Texas 77030 USA
| | - Guillermo Garcia-Manero
- Department of Leukemia; University of Texas M.D. Anderson Cancer Center; Houston Texas 77030 USA
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Cabrero M, Martin A, Briones J, Gayoso J, Jarque I, López J, Grande C, Heras I, Arranz R, Bernal T, Perez-Lopez E, López-Godino O, Conde E, Caballero D. Phase II Study of Yttrium-90-Ibritumomab Tiuxetan as Part of Reduced-Intensity Conditioning (with Melphalan, Fludarabine ± Thiotepa) for Allogeneic Transplantation in Relapsed or Refractory Aggressive B Cell Lymphoma: A GELTAMO Trial. Biol Blood Marrow Transplant 2017; 23:53-59. [DOI: 10.1016/j.bbmt.2016.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 10/05/2016] [Indexed: 10/20/2022]
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11
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Kekre N, Marquez-Malaver FJ, Cabrero M, Piñana J, Esquirol A, Soiffer RJ, Caballero D, Terol MJ, Martino R, Antin JH, Lopez-Corral L, Solano C, Armand P, Pérez-Simon JA. Fludarabine/Busulfan versus Fludarabine/Melphalan Conditioning in Patients Undergoing Reduced-Intensity Conditioning Hematopoietic Stem Cell Transplantation for Lymphoma. Biol Blood Marrow Transplant 2016; 22:1808-1815. [PMID: 27470290 DOI: 10.1016/j.bbmt.2016.07.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 07/15/2016] [Indexed: 02/06/2023]
Abstract
There is at present little data to guide the choice of conditioning for patients with lymphoma undergoing reduced-intensity conditioning (RIC) allogeneic stem cell transplantation (SCT). In this study, we compared the outcomes of patients undergoing RIC SCT who received fludarabine and melphalan (FluMel), the standard RIC regimen used by the Spanish Group of Transplantation, and fludarabine and busulfan (FluBu), the standard RIC regimen used by the Dana-Farber Cancer Institute/Brigham and Women's Hospital. We analyzed 136 patients undergoing RIC SCT for lymphoma with either FluBu (n = 61) or FluMel (n = 75) conditioning between 2007 and 2014. Median follow-up was 36 months. The cumulative incidence of grades II to IV acute graft-versus-host disease (GVHD) was 13% with FluBu and 36% with FluMel (P = .002). The cumulative incidence of nonrelapse mortality (NRM) at 1 year was 3.3% with FluBu and 31% with FluMel (P < .0001). The cumulative incidence of relapse at 1 year was 29% with FluBu and 10% with FluMel (P = .08). The 3-year disease-free survival rate was 47% with FluBu and 36% with FluMel (P = .24), and the 3-year overall survival rate was 62% with FluBu and 48% with FluMel (P = .01). In multivariable analysis, FluMel was associated with a higher risk of acute grades II to IV GVHD (HR, 7.45; 95% CI, 2.30 to 24.17; P = .001) and higher risk of NRM (HR, 4.87; 95% CI, 1.36 to 17.44; P = .015). The type of conditioning was not significantly associated with relapse or disease-free survival in multivariable models. However, conditioning regimen was the only factor significantly associated with overall survival: FluMel conditioning was associated with a hazard ratio for death of 2.78 (95% CI, 1.23 to 6.27; P = .014) compared with FluBu. In conclusion, the use of FluBu as conditioning for patients undergoing SCT for lymphoma was associated with a lower risk of acute GVHD and NRM and improved overall survival when compared with FluMel in our retrospective study. These results confirm the differences between these RIC regimens in terms of toxicity and efficacy and support the need for comparative prospective studies.
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Affiliation(s)
- Natasha Kekre
- Division of Hematology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Francisco J Marquez-Malaver
- Department of Hematology, Instituto de Biomedicina de Sevilla (IBIS)/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Monica Cabrero
- Hematology Department, University Hospital, Instituto Biosanitario de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - Jl Piñana
- Department of Hematology/Oncology, Hospital Clinico Universitario, Valencia, Valencia, Spain
| | - Albert Esquirol
- Department of Clinical Hematology, Hospital de la Santa Creu i Sant Pau, Jose Carreras Leukemia Research Institute, Barcelona, Spain
| | - Robert J Soiffer
- Division of Hematologic Malignancies, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Dolores Caballero
- Hematology Department, University Hospital, Instituto Biosanitario de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - M J Terol
- Department of Hematology/Oncology, Hospital Clinico Universitario, Valencia, Valencia, Spain
| | - Rodrigo Martino
- Department of Clinical Hematology, Hospital de la Santa Creu i Sant Pau, Jose Carreras Leukemia Research Institute, Barcelona, Spain
| | - Joseph H Antin
- Division of Hematologic Malignancies, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - L Lopez-Corral
- Hematology Department, University Hospital, Instituto Biosanitario de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - Carlos Solano
- Department of Hematology/Oncology, Hospital Clinico Universitario, Valencia, Valencia, Spain
| | - Philippe Armand
- Division of Hematologic Malignancies, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Jose A Pérez-Simon
- Department of Hematology, Instituto de Biomedicina de Sevilla (IBIS)/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain.
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12
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De La Serna J, Sanz J, Bermúdez A, Cabrero M, Serrano D, Vallejo C, Gómez V, Moraleda JM, Perez SG, Caballero MD, Conde E, Lahuerta JJ, Sanz G. Toxicity and efficacy of busulfan and fludarabine myeloablative conditioning for HLA-identical sibling allogeneic hematopoietic cell transplantation in AML and MDS. Bone Marrow Transplant 2016; 51:961-6. [PMID: 26950372 DOI: 10.1038/bmt.2016.42] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 11/17/2015] [Accepted: 11/19/2015] [Indexed: 12/26/2022]
Abstract
The safety and efficacy of a 4-day myeloablative conditioning (MAC) regimen consisting of Bu 3.2 mg/kg and fludarabine 40 mg/m(2)/day for HLA-identical sibling allogeneic hematopoietic cell transplantation (HCT) in myeloid malignancies was investigated in 133 patients (median age, 47 years; range 19-74 years) with de novo AML (60%), secondary AML (20%) or myelodysplastic syndrome (20%). All patients engrafted. Hepatic veno-occlusive disease occurred in five patients (4%), and severe toxicities, mostly mucositis, occurred in twenty-three (17%) patients. The non-relapse mortality (NRM) at 100 days was 1.5%. The incidences of acute GVHD grade 2-4 and grade 3-4 were 32 and 13%, respectively. At a median follow-up of 38 months, the cumulative incidence of chronic GVHD was 67%. The relapse incidence was 30% (27 and 31%, respectively, in patients with early- and late-stage disease), and the overall NRM was 15%. The actuarial 4-year disease-free survival (DFS) and overall survival (OS) were 54 and 62%, respectively. Patients aged <50 years had better outcomes compared with older patients (DFS 64 vs 42%, P=0.006; OS 73 vs 47%, P<0.001, respectively).
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Affiliation(s)
- J De La Serna
- Hematology Department, Servicio de Hematología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J Sanz
- Hematology Department, Hospital Universitario La Fe, Valencia, Spain
| | - A Bermúdez
- Hematology Department, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - M Cabrero
- Hematology Department, Hospital Universitario Clínico de Salamanca, Salamanca, Spain
| | - D Serrano
- Hematology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - C Vallejo
- Hematology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - V Gómez
- Hematology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - J M Moraleda
- Hematology Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - S G Perez
- Hematology Department, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - M D Caballero
- Hematology Department, Hospital Universitario Clínico de Salamanca, Salamanca, Spain
| | - E Conde
- Hematology Department, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - J J Lahuerta
- Hematology Department, Servicio de Hematología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - G Sanz
- Hematology Department, Hospital Universitario La Fe, Valencia, Spain
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13
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Cabrero M, Wei Y, Yang H, Ganan-Gomez I, Bohannan Z, Colla S, Marchesini M, Bravo GM, Takahashi K, Bueso-Ramos C, Garcia-Manero G. Down-regulation of EZH2 expression in myelodysplastic syndromes. Leuk Res 2016; 44:1-7. [PMID: 26970171 DOI: 10.1016/j.leukres.2016.02.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 02/22/2016] [Accepted: 02/23/2016] [Indexed: 01/16/2023]
Abstract
EZH2 genetic mutations are common in myelodysplastic syndrome (MDS), which implies that this gene has a pathophysiological role in the disease. To further characterize molecular alterations of EZH2, and their potential prognostic impact in MDS, we assessed EZH2 RNA expression in primary bone marrow CD34+ cells from 78 patients. We found that 47% of patients have reduced EZH2 expression compared to normal controls. Further analyses revealed that EZH2 is significantly underexpressed in patients bearing chromosome 7 or 7q deletions (7-alt) when compared to controls, diploid patients, and patients with other cytogenetic alterations (p<0.05). In survival analysis, we found a non-significant trend toward overall survival (OS) being better among patients with EZH2 underexpression (median OS 55 vs. 36 months; p=0.71). Importantly, this trend became significant when the analysis was restricted to the subset of cases without alterations in chromosome 7 (62 vs. 36 months; p=0.033). Furthermore, our previous work has identified a spectrum of innate immune genes in MDS CD34+ cells that are deregulated via abnormal promoter histone methylation. Because EZH2 is a key regulator of histone methylation, we assessed the relationship between deregulation of these genes and EZH2 underexpression. We observed that the mRNA levels of 11 immune genes were higher in the EZH2 underexpression group and that immune gene expression was significantly higher in patients with concomitant EZH2 underexpression and KDM6B (also known as JMJD3, an H3K27 demethylase) overexpression. Taken together, these data indicate that EZH2 underexpression may have unique impact on the molecular pathogenesis and prognosis in MDS and be an important marker for patients without chromosome 7 alteration.
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Affiliation(s)
- Monica Cabrero
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States.
| | - Yue Wei
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Hui Yang
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Irene Ganan-Gomez
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Zach Bohannan
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Simona Colla
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Matteo Marchesini
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Guillermo Montalban Bravo
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Koichi Takahashi
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Carlos Bueso-Ramos
- Departments of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Guillermo Garcia-Manero
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
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14
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Badar T, Patel KP, Thompson PA, DiNardo C, Takahashi K, Cabrero M, Borthakur G, Cortes J, Konopleva M, Kadia T, Bohannan Z, Pierce S, Jabbour EJ, Ravandi F, Daver N, Luthra R, Kantarjian H, Garcia-Manero G. Detectable FLT3-ITD or RAS mutation at the time of transformation from MDS to AML predicts for very poor outcomes. Leuk Res 2015; 39:1367-74. [PMID: 26547258 DOI: 10.1016/j.leukres.2015.10.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [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: 07/22/2015] [Revised: 09/21/2015] [Accepted: 10/13/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND The molecular events that drive the transformation from myelodysplastic syndromes (MDS) to acute myeloid leukemia (AML) have yet to be fully characterized. We hypothesized that detection of these mutations at the time of transformation from MDS to AML may lead to poorer outcomes. METHODS We analyzed 102 MDS patients who were admitted to our institution between 2004 and 2013, had wild-type (wt) FLT3-ITD and RAS at diagnosis, progressed to AML, and had serial mutation testing at both the MDS and AML stages. RESULTS We detected FLT3-ITD and/or RAS mutations in twenty-seven (26%) patients at the time of transformation to AML. Twenty-two patients (81%) had RAS mutations and five (19%) had FLT3-ITD mutations. The median survival after leukemia transformation in patients who had detectable RAS and/or FLT3-ITD mutations was 2.4 months compared to 7.5 months in patients who retained wt RAS and FLT3-ITD (hazard ratio [HR]: 3.08, 95% confidence interval [CI]: 1.9-5.0, p<0.0001). In multivariate analysis, FLT3-ITD and RAS mutations had independent prognostic significance for poor outcome.
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Affiliation(s)
- Talha Badar
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Keyur P Patel
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Philip A Thompson
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Courtney DiNardo
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Koichi Takahashi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Monica Cabrero
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gautam Borthakur
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jorge Cortes
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marina Konopleva
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tapan Kadia
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Zach Bohannan
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sherry Pierce
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elias J Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Farhad Ravandi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Naval Daver
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Raja Luthra
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hagop Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Guillermo Garcia-Manero
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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15
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Bastida J, Cabrero M, Lopez-Godino O, Lopez-Parra M, Sanchez-Guijo F, Lopez-Corral L, Vazquez L, Caballero D, Del Cañizo C. Influence of donor age in allogeneic stem cell transplant outcome in acute myeloid leukemia and myelodisplastic syndrome. Leuk Res 2015; 39:828-34. [DOI: 10.1016/j.leukres.2015.05.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 05/04/2015] [Accepted: 05/06/2015] [Indexed: 01/22/2023]
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16
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Cabrero M, Yu Y, Verma A, Yang H, Colla S, Jia Y, Zheng H, Bohannan Z, Ganan-Gomez I, Futreal A, Takahashi K, Chin L, Kantarjian H, Pellagatti A, Bowman T, Boultwood J, Garcia-Manero G, Wei Y. Downregulation of Protection of Telomeres 1 expression in myelodysplastic syndromes with 7q deletion. Br J Haematol 2015; 173:161-5. [PMID: 26105212 DOI: 10.1111/bjh.13574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Monica Cabrero
- Departments of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yiting Yu
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Amit Verma
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Hui Yang
- Departments of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Simona Colla
- Departments of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yu Jia
- Departments of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hong Zheng
- Departments of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Zach Bohannan
- Departments of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Irene Ganan-Gomez
- Departments of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Andrew Futreal
- Departments of Genomic Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Koichi Takahashi
- Departments of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lynda Chin
- Departments of Genomic Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hagop Kantarjian
- Departments of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Andrea Pellagatti
- Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | | | - Jacqueline Boultwood
- Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | | | - Yue Wei
- Departments of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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17
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Cabrero M, Jabbour E, Ravandi F, Bohannan Z, Pierce S, Kantarjian HM, Garcia-Manero G. Discontinuation of hypomethylating agent therapy in patients with myelodysplastic syndromes or acute myelogenous leukemia in complete remission or partial response: retrospective analysis of survival after long-term follow-up. Leuk Res 2015; 39:520-4. [PMID: 25828745 DOI: 10.1016/j.leukres.2015.03.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 02/26/2015] [Accepted: 03/05/2015] [Indexed: 02/06/2023]
Abstract
Hypomethylating agents (HMA), such as 5-azacitidine or decitabine, are currently used to treat patients with myelodysplastic syndromes (MDS) or acute myeloid leukemia (AML) until treatment failure. However, the outcomes for patients who discontinue therapy after achieving partial response (PR) or complete remission (CR) but before treatment failure have not been reported. We present a series of 16 patients with higher-risk MDS (n=5; 31%) or AML (n=11; 69%) who achieved PR (n=1) or CR (n=15) and stopped HMA therapy while in response in the context of clinical trials. They received a median of 12 courses (range 1-24) and achieved response after a median of 1 course of therapy (1-4). Loss of response after discontinuation of therapy was rapid, with a median progression-free survival of 4 months (95% CI: 2-6). Median overall survival (OS) from the time of therapy discontinuation was 15 months (95% CI: 6-24). Patients who received 12 cycles of therapy or more had significantly better OS (median: 20 months [95% CI: 12-27]) than those who received fewer than 12 cycles (median: 4 months [95% CI: 1-8]) (p=0.043). Poor-risk cytogenetics were also associated with lower 1-year OS (33% versus 69%; p=0.046). According to these results and considering the poor prognosis after HMA failure, HMA interruption should be avoided once a sustained response has been achieved.
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Affiliation(s)
- Monica Cabrero
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Elias Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Farhad Ravandi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Zach Bohannan
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sherry Pierce
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Hagop M Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Guillermo Garcia-Manero
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
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18
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Cabral R, Caballero JC, Alonso S, Dávila J, Cabrero M, Caballero D, Vázquez L, Sánchez-Guijo F, López L, Cañizo MC, Mateos MV, González M. Late differentiation syndrome in acute promyelocytic leukemia: a challenging diagnosis. Hematol Rep 2014; 6:5654. [PMID: 25568763 PMCID: PMC4274482 DOI: 10.4081/hr.2014.5654] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 10/22/2014] [Indexed: 11/23/2022] Open
Abstract
Detailed knowledge about differentiation syndrome (DS) has remained limited. There are 2 large studies conducted by the Spanish workgroup PETHEMA (Programa Español de Tratamientos en Hematología; Spanish Program on Hematology Treatments) and the European group trial (LPA 96-99 and APL 93) in which the incidence, characteristics, prognostic factors and outcome of patients developing DS are evaluated. Both have described the median time of DS development between 10 and 12 days. The severity of the DS has been evaluated in the study conducted by PETHEMA, and severe DS usually occurs at the beginning of the treatment (median of 6 days), as compared with moderate DS (median of 15 days). We report here in two cases of late severe DS, with late diagnosis due to both time and form of presentation. We discuss the physiopathology, clinical presentation, prophylaxis and treatment of DS.
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Affiliation(s)
- Renata Cabral
- Hematology Service, Hospital Santo António , Porto, Portugal
| | | | - Sara Alonso
- Hematology Service, Hospital Universitário , Salamanca, Spain
| | - Julio Dávila
- Hematology Service, Hospital Universitário , Salamanca, Spain
| | - Monica Cabrero
- Hematology Service, Hospital Universitário , Salamanca, Spain
| | | | - Lourdes Vázquez
- Hematology Service, Hospital Universitário , Salamanca, Spain
| | | | - Lucia López
- Hematology Service, Hospital Universitário , Salamanca, Spain
| | - Maria C Cañizo
- Hematology Service, Hospital Universitário , Salamanca, Spain
| | - Maria V Mateos
- Hematology Service, Hospital Universitário , Salamanca, Spain
| | - Marcos González
- Hematology Service, Hospital Universitário , Salamanca, Spain
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19
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Labrador J, Pérez-López E, Martín A, Cabrero M, Puig N, Díez-Campelo M. Diagnostic utility of bone marrow examination for the assessment of patients with fever of unknown origin: a 10-year single-centre experience. Intern Med J 2014; 44:610-2. [DOI: 10.1111/imj.12443] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 03/16/2014] [Indexed: 01/15/2023]
Affiliation(s)
- J. Labrador
- Department of Hematology; University Hospital of Salamanca; IBSAL; Salamanca Spain
| | - E. Pérez-López
- Department of Hematology; University Hospital of Salamanca; IBSAL; Salamanca Spain
| | - A. Martín
- Department of Hematology; University Hospital of Salamanca; IBSAL; Salamanca Spain
| | - M. Cabrero
- Department of Hematology; University Hospital of Salamanca; IBSAL; Salamanca Spain
| | - N. Puig
- Department of Hematology; University Hospital of Salamanca; IBSAL; Salamanca Spain
| | - M. Díez-Campelo
- Department of Hematology; University Hospital of Salamanca; IBSAL; Salamanca Spain
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20
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Martin TG, Alenda R, Cabrero M. Carcass characteristics of Rubia Gallega and Asturiana cattle at 10 to 18 months of age. J Anim Breed Genet 2011. [DOI: 10.1111/j.1439-0388.1992.tb00418.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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