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García-Aznar JM, Alonso Alvarez S, Bernal Del Castillo T. Pivotal role of BCL11B in the immune, hematopoietic and nervous systems: a review of the BCL11B-associated phenotypes from the genetic perspective. Genes Immun 2024:10.1038/s41435-024-00263-w. [PMID: 38472338 DOI: 10.1038/s41435-024-00263-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 02/19/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024]
Abstract
The transcription factor BCL11B plays an essential role in the development of central nervous system and T cell differentiation by regulating the expression of numerous genes involved in several pathways. Monoallelic defects in the BCL11B gene leading to loss-of-function are associated with a wide spectrum of phenotypes, including neurological disorders with or without immunological features and susceptibility to hematological malignancies. From the genetic point of view, the landscape of BCL11B mutations reported so far does not fully explain the genotype-phenotype correlation. In this review, we sought to compile the phenotypic and genotypic variables associated with previously reported mutations in this gene in order to provide a better understanding of the consequences of deleterious variants. We also highlight the importance of a careful evaluation of the mutation type, its location and the pattern of inheritance of the variants in order to assign the most accurate pathogenicity and actionability of the genetic findings.
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Affiliation(s)
- José María García-Aznar
- Healthincode, A Coruña, Spain.
- Universitary Institute of Oncology of Principado de Asturias (IUOPA), Oviedo, Spain.
- Health Research Institute of Principado de Asturias, Oviedo, Spain.
| | - Sara Alonso Alvarez
- Universitary Institute of Oncology of Principado de Asturias (IUOPA), Oviedo, Spain
- Health Research Institute of Principado de Asturias, Oviedo, Spain
- Hematology Department, Hospital Universitario Clínico de Asturias, Oviedo, Spain
| | - Teresa Bernal Del Castillo
- Universitary Institute of Oncology of Principado de Asturias (IUOPA), Oviedo, Spain
- Health Research Institute of Principado de Asturias, Oviedo, Spain
- Hematology Department, Hospital Universitario Clínico de Asturias, Oviedo, Spain
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2
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Montoro MJ, Pomares H, Coll R, Bernal Del Castillo T, Tormo M, Jiménez A, Brunet S, Casaño J, Oiartzabal I, Díez-Campelo M, Ramos F, Romero R, Salido-Fiérrez E, Pedro C, Bargay J, Muñoz-Novas C, López R, Rafel M, Valcárcel D. Evaluation of the outcomes of newly diagnosed patients with high-risk myelodysplastic syndrome according to the initial therapeutical strategies chosen in usual clinical practice. Leuk Lymphoma 2023; 64:679-690. [PMID: 36577016 DOI: 10.1080/10428194.2022.2154604] [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] [Indexed: 12/29/2022]
Abstract
Myelodysplastic syndromes (MDS) are a heterogeneous group of diseases without a care standard and show variability in treatment outcomes. This Spanish, observational, prospective study ERASME (CEL-SMD-2012-01) assessed the evolution of newly diagnosed and treatment-naïve high-risk MDS patients (according to IPPS-R). 204 patients were included: median age 73.0 years, 54.4% males, 69.6% 0-1 ECOG, and 94.6% with comorbidities. Active treatment was the most common strategy (52.0%) vs. stem cell transplantation (25.5%) and supportive care/watchful-waiting (22.5%). Overall (median) event-free survival was 7.9 months (9.1, 8.3, and 5.3); progression-free survival: 10.1 months (12.9, 12.8, and 4.3); and overall survival: 13.8 months (15.4, 14.9; 8.4), respectively, with significant differences among groups. Adverse events (AEs) of ≥3 grade were reported in 72.6% of patients; serious AEs reported in 60.6%. 33.1% of patients died due to AEs. Three patients developed second primary malignant neoplasms (median: 8.2 months). Our study showed better outcomes in patients receiving active therapy early after diagnosis.
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Affiliation(s)
- Maria Julia Montoro
- Department of Hematology, Hospital Universitari Vall d´Hebron, Barcelona, Spain
| | - Helena Pomares
- ICO-Hospital Duran i Reynals, IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Rosa Coll
- ICO-Hospital Universitari Doctor Josep Trueta, Girona, Spain
| | | | - Mar Tormo
- Hospital Clínico Universitario de Valencia e Instituto de Investigación INCLIVA, Valencia, Spain
| | - Ana Jiménez
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Salut Brunet
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Javier Casaño
- Hospital Universitario Reina Sofía, IMIBIC, Córdoba, Spain
| | | | | | | | - Rafael Romero
- Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | | | | | - Joan Bargay
- Hospital Son Llàtzer, Palma de Mallorca, Spain
| | | | - Rocío López
- Celgene S.L.U., a Bristol-Myers Squibb Company, Madrid, Spain
| | | | - David Valcárcel
- Department of Hematology, Hospital Universitari Vall d´Hebron, Barcelona, Spain
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Kayser S, Martínez-Cuadrón D, Rodriguez-Veiga R, Hänel M, Tormo M, Schäfer-Eckart K, Botella C, Stölzel F, Del Castillo TB, Keller U, Rodriguez-Medina C, Held G, Amigo ML, Schliemann C, Colorado M, Kaufmann M, Garcia MB, Krause SW, Görner M, Jost E, Steffen B, Zukunft S, Platzbecker U, Ho AD, Baldus CD, Serve H, Müller-Tidow C, Thiede C, Bornhäuser M, Montesinos P, Röllig C, Schlenk RF. Impact of trisomy 19 on outcome according to genetic makeup in patients with acute myeloid leukemia. Haematologica 2023. [PMID: 36815361 PMCID: PMC10388269 DOI: 10.3324/haematol.2022.282127] [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: 10/28/2022] [Indexed: 02/24/2023] Open
Abstract
We retrospectively studied 97 AML patients with trisomy 19 (tris-19; median age at diagnosis 57 years; range, 17-83 years) treated between 2001 and 2019 within two multicenter study groups. Tris-19 occurred solely in 10 (10.5%), with additional abnormalities in non-complex karyotypes in 8 (8%) and within complex karyotypes in 79 (82%) patients. Altogether, karyotypes characterized by trisomies only were present in 27 (28%) patients. Data on response and outcome of intensively treated patients were available in 92 patients and median follow-up was 6.4 years (95%-CI, 2.9-9.0 years). Complete remission (CR) after induction therapy was achieved in 52% (n=48) and early death rate was 10% (n=9). Notably, patients with tris-19 as sole abnormality had a CR rate of 89%. An allogeneic hematopoietic stem cell transplantation (allo-HCT) was performed in 34 (35%) patients (CR, n=19; active disease, n=15). Five-year relapse-free and overall survival (OS) rates were 26% (95%-CI, 16-43%) and 20% (95%-CI, 13-31%), respectively. OS rates were significantly higher in patients with tris-19 as sole abnormality or within karyotypes characterized by trisomies only (P=0.05). An Andersen-Gill model including allo-HCT as a time dependent covariable on OS revealed tris-19 as sole abnormality or within karyotypes characterized by trisomies only as favorable factors (HR, 0.47; P=0.021); higher age at diagnosis had an adverse impact (10 years difference; HR, 1.29; P=0.002), whereas allo-HCT had no beneficial impact (OR, 1.45; P=0.21). In our cohort, patients with tris-19 as sole abnormality or within karyotypes characterized by trisomies only had a high CR rate and better clinical outcome.
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Affiliation(s)
- Sabine Kayser
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, German Red Cross Blood Service Baden-Württemberg-Hessen, Mannheim, Germany; NCT Trial Center, National Center of Tumor Diseases, German Cancer Research Center (DKFZ), Heidelberg, Germany; Medical Clinic and Policlinic I, Hematology and Cellular Therapy, University Hospital Leipzig, Leipzig.
| | - David Martínez-Cuadrón
- Hematology Department, Hospital Universitari i Politècnic, La Fe, València, Spain; CIBERONC, Instituto Carlos III, Madrid
| | | | | | - Mar Tormo
- Hematology Department, Hospital Clínico Universitario, INCLIVA Research Institute, University of Valencia, Valencia
| | | | | | - Friedrich Stölzel
- Department of Medicine I, University Hospital Carl-Gustav-Carus, Dresden
| | | | - Ulrich Keller
- Department of Hematology, Oncology and Cancer Immunology, Charité-University Medical Center, Campus Benjamin Franklin, Berlin
| | - Carlos Rodriguez-Medina
- Hematology Department, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria
| | | | | | | | | | | | | | - Stefan W Krause
- Department of Internal Medicine 5 - Hematology/Oncology, University Hospital of Erlangen, Erlangen
| | - Martin Görner
- Klinik für Hämatologie, Onkologie und Palliativmedizin, Klinikum Bielefeld Mitte
| | - Edgar Jost
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, University Hospital RWTH Aachen, Aachen
| | - Björn Steffen
- Department of Internal Medicine II, University Hospital of Frankfurt Main
| | - Sven Zukunft
- Department of Medicine I, University Hospital Carl-Gustav-Carus, Dresden
| | - Uwe Platzbecker
- Medical Clinic and Policlinic I, Hematology and Cellular Therapy, University Hospital Leipzig, Leipzig
| | - Anthony D Ho
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg
| | - Claudia D Baldus
- Department of Internal Medicine II, University Hospital of Kiel, Kiel Germany
| | - Hubert Serve
- Department of Internal Medicine II, University Hospital of Frankfurt Main
| | | | - Christian Thiede
- Department of Medicine I, University Hospital Carl-Gustav-Carus, Dresden
| | - Martin Bornhäuser
- Department of Medicine I, University Hospital Carl-Gustav-Carus, Dresden
| | - Pau Montesinos
- Hematology Department, Hospital Universitari i Politècnic, La Fe, València, Spain; CIBERONC, Instituto Carlos III, Madrid
| | - Christoph Röllig
- Department of Medicine I, University Hospital Carl-Gustav-Carus, Dresden
| | - Richard F Schlenk
- NCT Trial Center, National Center of Tumor Diseases, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany; Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg
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4
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Ito T, Sanford D, Tomuleasa C, Hsiao HH, Olivera LJE, Enjeti AK, Conca AG, Del Castillo TB, Girshova L, Martelli MP, Guvenc B, Bui CN, Delgado A, Duan Y, Guijarro BG, Llamas C, Lee JH. Healthcare resource utilization trends in patients with acute myeloid leukemia ineligible for intensive chemotherapy receiving first-line systemic treatment or best supportive care: A multicenter international study. Eur J Haematol 2022; 109:58-68. [PMID: 35298049 PMCID: PMC9324937 DOI: 10.1111/ejh.13769] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 12/12/2022]
Abstract
Objectives This retrospective chart review examined real‐world healthcare resource utilization (HRU) in patients with AML ineligible for intensive therapy who received first‐line systemic therapy or best supportive care (BSC). Methods Data were collected anonymously on patients with AML who initiated first‐line hypomethylating agents (HMA), low‐dose cytarabine (LDAC), other systemic therapy, or BSC. HRU endpoints included hospitalizations, outpatient consultations, transfusions, and supportive care. Results Of 1762 patients included, 46% received HMA, 11% received LDAC, 17% received other systemic therapy, 26% received BSC; median treatment durations were 118, 35, 33, and 57 days, respectively. Most patients were hospitalized, most commonly for treatment administration, transfusion, or infection (HMA 82%, LDAC 93%, other systemic therapy 83%, BSC 83%). A median number of hospitalizations were 2–6 across systemic groups and two for BSC, with median durations of 8–18 days. Transfusion rates and outpatient consultations were highest for HMA (80% and 79%) versus LDAC (57% and 53%), other systemic therapy (57% and 63%), and BSC (71% and 66%). Antivirals/antibiotics and antifungals were used more frequently than growth factors (72–92%, 34–63%, and 7–27%, respectively). Conclusion Patients with AML ineligible for intensive therapy have high HRU; novel therapies are needed to alleviate this burden.
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Affiliation(s)
- Tomoki Ito
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - David Sanford
- Leukemia/Bone Marrow Transplant Program of BC, Division of Hematology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ciprian Tomuleasa
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj-Napoca, Romania
| | - Hui-Hua Hsiao
- Division of Hematology and Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | - Anoop Kumar Enjeti
- Calvary Mater Newcastle, University of Newcastle, Waratah, New South Wales, Australia.,NSW Health Pathology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | | | | | - Larisa Girshova
- Federal State Budgetary Institution "Almazov National Medical Research Centre" of the Ministry of Health of the Russian Federation, St Petersburg, Russia
| | - Maria Paola Martelli
- Department of Medicine and Surgery - Section of Hematology and Clinical Immunology, Santa Maria della Misericordia" Hospital, Perugia University, Perugia, Italy
| | - Birol Guvenc
- Department of Hematology, Cukurova University, Adana, Turkey
| | - Cat N Bui
- AbbVie, Inc., North Chicago, Illinois, USA
| | | | | | | | | | - Je-Hwan Lee
- Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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5
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Miyamoto T, Sanford D, Tomuleasa C, Hsiao HH, Olivera LJE, Enjeti AK, Gimenez Conca A, Castillo TBD, Girshova L, Martelli MP, Guvenc B, Delgado A, Duan Y, Garbayo Guijarro B, Llamas C, Lee JH. Real-world treatment patterns and clinical outcomes in patients with AML unfit for first-line intensive chemotherapy . Leuk Lymphoma 2022; 63:928-938. [PMID: 35147482 DOI: 10.1080/10428194.2021.2002321] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Acute myeloid leukemia (AML) predominantly affects the elderly, and prognosis declines with age. Induction chemotherapy plus consolidation therapy is standard of care for fit patients; options for unfit patients include hypomethylating agents (HMA), low-dose cytarabine (LDAC), targeted therapies, and best supportive care (BSC). This retrospective chart review evaluated clinical outcomes in unfit patients with AML who initiated first-line treatment or BSC 01/01/2015-12/31/2018. Overall survival (OS), progression-free survival (PFS), time-to-treatment failure (TTF), and response rates were assessed. Of 1762 patients, 1310 received systemic therapies: 809 HMA, 199 LDAC, and 302 other therapies; 452 received BSC. Median OS was 9.9, 7.9, 5.4, and 2.5 months for HMA, LDAC, other, and BSC, respectively. Median PFS was 7.5, 5.3, 4.1, and 2.1 months for HMA, LDAC, other, and BSC, respectively; median TTF was 4.9, 2.1, 2.2, and 2.1 months, respectively. Our findings highlight the unmet need for novel therapies for unfit patients.
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Affiliation(s)
- Toshihiro Miyamoto
- Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - David Sanford
- Division of Hematology, Leukemia/Bone Marrow Transplant Program of BC, The University of British Columbia, Vancouver, BC, Canada
| | - Ciprian Tomuleasa
- Department of Hematology - Medfuture Research Center for Advanced Medicine, Ion Chiricuta Clinical Cancer Center, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Hui-Hua Hsiao
- Department of Internal Medicine, Division of Hematology-Oncology, Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | - Anoop Kumar Enjeti
- Calvary Mater Newcastle, University of Newcastle and New South Wales Health Pathology, Waratah, Australia
| | | | - Teresa Bernal Del Castillo
- Servicio de Hematología y Hemoterapia, University Hospital Central de Asturias, ISPA, IUOPA, Oviedo, Spain
| | - Larisa Girshova
- Federal State Budgetary Institution 'Almazov National Medical Research Centre' of the Ministry of Health of the Russian Federation, St. Petersburg, Russia
| | - Maria Paola Martelli
- Department of Medicine and Surgery - Section of Hematology and Clinical Immunology, Perugia University, 'Santa Maria della Misericordia' Hospital, Perugia, Italy
| | - Birol Guvenc
- Department of Hematology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | | | | | | | | | - Je-Hwan Lee
- Department of Hematology, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
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Palanques-Pastor T, Megías-Vericat JE, Martínez P, López Lorenzo JL, Cornago Navascués J, Rodriguez Macias G, Cano I, Arnan Sangerman M, Vidriales Vicente MB, Algarra Algarra JL, Foncillas MÁ, Herrera P, Botella Prieto C, Vives S, Figuera Álvarez Á, Cuevas Palomares L, Sobas M, Contento Gonzalo A, Cuello García R, Amutio Diez ME, De Miguel Llorente D, Navas Elorza B, Bergua Burgues JM, Bernal Del Castillo T, Mateos Rodríguez MC, de Cabo López E, Franco Villegas AC, García Boyero R, Escolano Escobar C, Seri Merino C, Cervero C, Roldán Pérez A, Hermosín Ramos L, Cervera Calvo M, Olave MT, Villafuerte Gutiérrez P, de Laiglesiai A, Serrano J, Najera Irazu MJ, Piñana JL, Sanz MÁ, Martínez-López J, Montesinos P. Characteristics, clinical outcomes, and risk factors of SARS-COV-2 infection in adult acute myeloid leukemia patients: experience of the PETHEMA group. Leuk Lymphoma 2021; 62:2928-2938. [PMID: 34292118 DOI: 10.1080/10428194.2021.1948031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection produces higher morbidity and mortality in hematological malignancies, but evidence in acute myeloid leukemia (AML) is scarce. A multicenter observational study was conducted to determine the clinical outcomes and assess the impact of therapeutic approaches in adult AML patients with SARS-CoV-2 infection in the first wave (March-May 2020). Overall, 108 patients were included: 51.9% with active leukemia and 70.4% under therapeutic schedules for AML. Signs and symptoms of SARS-CoV-2 were present in 96.3% of patients and 82.4% received specific treatment for SARS-CoV-2. The mortality rate was 43.5% and was correlated with age, gender, active leukemia, dyspnea, severe SARS-CoV-2, intensive care measures, neutrophil count, and D-dimer levels. A protective effect was found with azithromycin, lopinavir/ritonavir, and normal liver enzyme levels. During the SARS-CoV-2 first wave, our findings suggested an increased mortality in AML in a short period. SARS-CoV-2 management could be guided by risk factors in AML patients.
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Affiliation(s)
| | | | - Pilar Martínez
- Hematology and Hemotherapy Department, Hospital Universitario, Madrid, Spain
| | - José Luis López Lorenzo
- Hematology and Hemotherapy Department, Hospital Universitario Fundación Jiménez Díaz, Valencia, Spain
| | - Javier Cornago Navascués
- Hematology and Hemotherapy Department, Hospital Universitario Fundación Jiménez Díaz, Valencia, Spain
| | - Gabriela Rodriguez Macias
- Hematology and Hemotherapy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Isabel Cano
- Hematology and Hemotherapy Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | | | | | | | - Pilar Herrera
- Hematology and Hemotherapy Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Carmen Botella Prieto
- Hematology and Hemotherapy Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - Susana Vives
- Clinic Hematology Department, Instituto Catalán de Oncología, Badalona, Spain
| | - Ángela Figuera Álvarez
- Hematology and Hemotherapy Department, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Marta Sobas
- Haematology, Blood Neoplasms, and Bone Marrow Transplantation, Wroclaw Medical University, Wrocław, Poland
| | | | - Rebeca Cuello García
- Hematology and Hemotherapy Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | | | - Begoña Navas Elorza
- Hematology and Hemotherapy Department, Hospital HLA Universitario Moncloa, Madrid, Spain
| | | | | | | | - Erik de Cabo López
- Hematology Department, Hospital Universitario del Bierzo, Ponferrada, Spain
| | | | - Raimundo García Boyero
- Hematology and Hemotherapy Department, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | | | - Cristina Seri Merino
- Hematology and Hemotherapy Department, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain
| | - Carlos Cervero
- Hematology Department, Hospital Virgen de la Luz, Cuenca, Spain
| | - Alicia Roldán Pérez
- Hematology and Hemotherapy Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Spain
| | - Lourdes Hermosín Ramos
- Hematology and Hemotherapy Department, Hospital Jerez de la Frontera, Jerez de la Frontera, Spain
| | | | - María Telesa Olave
- Hematology and Hemotherapy Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - Almudena de Laiglesiai
- Hematology and Hemotherapy Department, Hospital Universitario Puerta del Hierro, Majadahonda, Spain
| | - Josefina Serrano
- Hematology Department, Hospital Universitario Reina Sofía, Córdoba, Spain
| | | | - José Luis Piñana
- Hematology and Hemotherapy Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Miguel Ángel Sanz
- Hematology and Hemotherapy Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Pau Montesinos
- Hematology and Hemotherapy Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
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7
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Pleyer L, Leisch M, Kourakli A, Padron E, Maciejewski JP, Xicoy Cirici B, Kaivers J, Ungerstedt J, Heibl S, Patiou P, Hunter AM, Mora E, Geissler K, Dimou M, Jimenez Lorenzo MJ, Melchardt T, Egle A, Viniou AN, Patel BJ, Arnan M, Valent P, Roubakis C, Bernal Del Castillo T, Galanopoulos A, Calabuig Muñoz M, Bonadies N, Medina de Almeida A, Cermak J, Jerez A, Montoro MJ, Cortés A, Avendaño Pita A, Lopez Andrade B, Hellstroem-Lindberg E, Germing U, Sekeres MA, List AF, Symeonidis A, Sanz GF, Larcher-Senn J, Greil R. Outcomes of patients with chronic myelomonocytic leukaemia treated with non-curative therapies: a retrospective cohort study. Lancet Haematol 2021; 8:e135-e148. [PMID: 33513373 DOI: 10.1016/s2352-3026(20)30374-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Approval of hypomethylating agents in patients with chronic myelomonocytic leukaemia is based on trials done in patients with myelodysplastic syndromes. We aimed to investigate whether hypomethylating agents provide a benefit in subgroups of patients with chronic myelomonocytic leukaemia compared with other treatments. METHODS For this retrospective cohort study, data were retrieved between Nov 30, 2017, and Jan 5, 2019, from 38 centres in the USA and Europe. We included non-selected, consecutive patients diagnosed with chronic myelomonocytic leukaemia, who received chronic myelomonocytic leukaemia-directed therapy. Patients with acute myeloid leukaemia according to 2016 WHO criteria at initial diagnosis (ie, ≥20% blasts in the bone marrow or peripheral blood) or with unavailability of treatment data were excluded. Outcomes assessed included overall survival, time to next treatment, and time to transformation to acute myeloid leukaemia. Analyses were adjusted by age, sex, platelet count, and Chronic myelomonocytic leukaemia-Specific Prognostic Scoring System (CPSS). Patients were grouped by first received treatment with either hydroxyurea, hypomethylating agents, or intensive chemotherapy, and stratified by risk according to blast count, French-American-British subtype, CPSS, WHO 2016 subtype, and the eligibility criteria of the DACOTA trial (NCT02214407). FINDINGS 949 patients diagnosed with chronic myelomonocytic leukaemia between April 13, 1981, and Oct 26, 2018, were included. Median follow-up was 23·4 months (IQR 11·5-42·3) from diagnosis and 16·2 months (6·6-31·6) from start of first-line treatment. 412 (43%) of 949 patients received hypomethylating agents as first treatment, 391 (41%) hydroxyurea, and 83 (9%) intensive chemotherapy. Adjusted median overall survival for patients treated with hydroxyurea versus hypomethylating agents was 15·6 months (95% CI 13·1-17·3) versus 20·7 months (17·9-23·4); hazard ratio (HR) 1·39 (1·17-1·65; p=0·0002) and 14·0 months (9·8-17·2) versus 20·7 months (17·9-23·4; HR 1·55 [1·16-2·05]; p=0·0027) for those treated with intensive chemotherapy versus hypomethylating agents. In patients with myeloproliferative chronic myelomonocytic leukaemia (myeloproliferative CMML), median overall survival was 12·6 months (10·7-15·0) versus 17·6 months (14·8-21·5; HR 1·38 [1·12-1·70]; p=0·0027) for patients treated with hydroxyurea versus hypomethylating agents, and 12·3 months (8·4-16·6) versus 17·6 months (14·8-21·5; HR 1·44 [1·02-2·03]; p=0·040) for intensive chemotherapy versus hypomethylating agents. Hypomethylating agents did not confer an overall survival advantage for patients classified as having lower-risk disease (ie, myelodysplastic chronic myelomonocytic leukaemia with <10% blasts, CMML-0, or lower-risk CPSS). INTERPRETATION These data suggest hypomethylating agents as the preferred therapy for patients with higher-risk chronic myelomonocytic leukaemia and those with myeloproliferative CMML. Our findings also suggest that CPSS is a valuable tool to identify patients who are most likely to benefit from hypomethylating agents. Further evidence from prospective cohorts would be desirable. FUNDING The Austrian Group for Medical Tumor Therapy.
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Affiliation(s)
- Lisa Pleyer
- Third Medical Department with Hematology, Medical Oncology, Rheumatology and Infectiology, Paracelsus Medical University, Salzburg, Austria; Salzburg Cancer Research Institute Center for Clinical Cancer and Immunology Trials, Salzburg, Austria.
| | - Michael Leisch
- Third Medical Department with Hematology, Medical Oncology, Rheumatology and Infectiology, Paracelsus Medical University, Salzburg, Austria; Salzburg Cancer Research Institute Center for Clinical Cancer and Immunology Trials, Salzburg, Austria
| | - Alexandra Kourakli
- Hematology Division, Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Eric Padron
- Malignant Hematology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jaroslaw Pawel Maciejewski
- Leukemia Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Blanca Xicoy Cirici
- Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Jennifer Kaivers
- Department of Hematology, Oncology, and Clinical Immunology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Johanna Ungerstedt
- Center for Hematology and Regenerative Medicine, Department of Medicine, Huddinge, Karolinska Institute, and Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Sonja Heibl
- Department of Internal Medicine IV, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Peristera Patiou
- Hematology Division, Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Anthony Michael Hunter
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Elvira Mora
- Department of Hematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Klaus Geissler
- Fifth Medical Department, Hospital Hietzing, Vienna, Austria
| | - Maria Dimou
- 141st Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Maria-José Jimenez Lorenzo
- Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Thomas Melchardt
- Third Medical Department with Hematology, Medical Oncology, Rheumatology and Infectiology, Paracelsus Medical University, Salzburg, Austria; Salzburg Cancer Research Institute Center for Clinical Cancer and Immunology Trials, Salzburg, Austria
| | - Alexander Egle
- Third Medical Department with Hematology, Medical Oncology, Rheumatology and Infectiology, Paracelsus Medical University, Salzburg, Austria; Salzburg Cancer Research Institute Center for Clinical Cancer and Immunology Trials, Salzburg, Austria
| | - Athina-Nora Viniou
- 141st Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Bhumika Jayantibhai Patel
- Leukemia Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Montserrat Arnan
- Institut Català d'Oncologia-Hospital Duran y Reynals, Hospitalet de Llobregat, Barcelona, Spain
| | - Peter Valent
- Department of Internal Medicine, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | | | - Teresa Bernal Del Castillo
- Hospital Universitario Central Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, University Institute of Oncology of Asturias-Cajastur Social Programme, Oviedo, Spain
| | | | | | - Nicolas Bonadies
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Antonio Medina de Almeida
- Hospital da Luz, Lisbon, Portugal; Centro de Investigação Interdisciplinar em Saúde, Universidade Católica Portuguesa de Lisboa, Lisbon, Portugal
| | - Jaroslav Cermak
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Andrés Jerez
- Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación, Universidad de Murcia, IMIB, Murcia, Spain
| | - Maria Julia Montoro
- Hematology Department, Vall d'Hebron Hospital Universitari, Experimental Hematology, Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Albert Cortés
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - Eva Hellstroem-Lindberg
- Center for Hematology and Regenerative Medicine, Department of Medicine, Huddinge, Karolinska Institute, and Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Ulrich Germing
- Department of Hematology, Oncology, and Clinical Immunology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Mikkael Aaron Sekeres
- Leukemia Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alan Francis List
- Malignant Hematology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Argiris Symeonidis
- Hematology Division, Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Guillermo Francisco Sanz
- Department of Hematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Centro de Investigacion Biomedica en Red Cance, Instituto Carlos III, Madrid, Spain
| | | | - Richard Greil
- Third Medical Department with Hematology, Medical Oncology, Rheumatology and Infectiology, Paracelsus Medical University, Salzburg, Austria; Salzburg Cancer Research Institute Center for Clinical Cancer and Immunology Trials, Salzburg, Austria
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8
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Rodríguez-Arbolí E, Martínez-Cuadrón D, Rodríguez-Veiga R, Carrillo-Cruz E, Gil-Cortés C, Serrano-López J, Bernal Del Castillo T, Martínez-Sánchez MDP, Rodríguez-Medina C, Vidriales B, Bergua JM, Benavente C, García-Boyero R, Herrera-Puente P, Algarra L, Sayas-Lloris MJ, Fernández R, Labrador J, Lavilla-Rubira E, Barrios-García M, Tormo M, Serrano-Maestro A, Sossa-Melo CL, García-Belmonte D, Vives S, Rodríguez-Gutiérrez JI, Albo-López C, Garrastazul-Sánchez MP, Colorado-Araujo M, Mariz J, Sanz MÁ, Pérez-Simón JA, Montesinos P. Long-Term Outcomes After Autologous Versus Allogeneic Stem Cell Transplantation in Molecularly-Stratified Patients With Intermediate Cytogenetic Risk Acute Myeloid Leukemia: A PETHEMA Study. Transplant Cell Ther 2021; 27:311.e1-311.e10. [PMID: 33836871 DOI: 10.1016/j.jtct.2020.12.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/07/2020] [Revised: 12/20/2020] [Accepted: 12/24/2020] [Indexed: 12/12/2022]
Abstract
Acute myeloid leukemia (AML) with intermediate risk cytogenetics (IRcyto) comprises a variety of biological entities with distinct mutational landscapes that translate into differential risks of relapse and prognosis. Optimal postremission therapy choice in this heterogeneous patient population is currently unsettled. In the current study, we compared outcomes in IRcyto AML recipients of autologous (autoSCT) (n = 312) or allogeneic stem cell transplantation (alloSCT) (n = 279) in first complete remission (CR1). Molecular risk was defined based on CEBPA, NPM1, and FLT3-ITD mutational status, per European LeukemiaNet 2017 criteria. Five-year overall survival (OS) in patients with favorable molecular risk (FRmol) was 62% (95% confidence interval [CI], 50-72) after autoSCT and 66% (95% CI, 41-83) after matched sibling donor (MSD) alloSCT (P = .68). For patients of intermediate molecular risk (IRmol), MSD alloSCT was associated with lower cumulative incidence of relapse (P < .001), as well as with increased nonrelapse mortality (P = .01), as compared to autoSCT. The 5-year OS was 47% (95% CI, 34-58) after autoSCT and 70% (95% CI, 59-79) after MSD alloSCT (P = .02) in this patient subgroup. In a propensity-score matched IRmol subcohort (n = 106), MSD alloSCT was associated with superior leukemia-free survival (hazard ratio [HR] 0.33, P = .004) and increased OS in patients alive 1 year after transplantation (HR 0.20, P = .004). These results indicate that, within IRcyto AML in CR1, autoSCT may be a valid option for FRmol patients, whereas MSD alloSCT should be the preferred postremission strategy in IRmol patients.
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Affiliation(s)
- Eduardo Rodríguez-Arbolí
- Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), University of Seville, Seville, Spain
| | | | | | - Estrella Carrillo-Cruz
- Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), University of Seville, Seville, Spain
| | - Cristina Gil-Cortés
- Department of Hematology, Hospital General Universitario de Alicante, Alicante, Spain
| | - Josefina Serrano-López
- Department of Hematology, Reina Sofía University Hospital/Maimónides Biomedical Research Institute of Córdoba (IMIBIC)/University of Córdoba, Córdoba, Spain
| | | | | | - Carlos Rodríguez-Medina
- Department of Hematology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Belén Vidriales
- Department of Hematology, University Hospital of Salamanca (HUS/IBSAL), CIBERONC- CB16/12/00233 and Center for Cancer Research-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Juan Miguel Bergua
- Department of Hematology, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - Celina Benavente
- Department of Hematology, Hospital Clínico San Carlos, Madrid, Spain
| | - Raimundo García-Boyero
- Department of Hematology, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | | | - Lorenzo Algarra
- Department of Hematology, Hospital General de Albacete, Albacete, Spain
| | | | - Rosa Fernández
- Department of Hematology, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Jorge Labrador
- Department of Hematology and Research Unit, Hospital Universitario de Burgos, Burgos, Spain
| | | | | | - Mar Tormo
- Deparment of Hematology, Hospital Clínico Universitario de Valencia, Instituto de Investigación INCLIVA, Valencia, Spain
| | | | | | | | - Susana Vives
- Department of Hematology - ICO Hospital Germans Trias i Pujol , Josep Carreras Leukemia Research Institute, Badalona , Spain
| | | | - Carmen Albo-López
- Department of Hematology, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | | | | | - José Mariz
- Department of Hematology, Instituto Português de Oncologia do Porto FG, Porto, Portugal
| | - Miguel Ángel Sanz
- Department of Hematology, Hospital Universitario La Fe, Valencia, Spain
| | - José Antonio Pérez-Simón
- Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), University of Seville, Seville, Spain.
| | - Pau Montesinos
- Department of Hematology, Hospital Universitario La Fe, Valencia, Spain
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9
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Rodríguez-Medina C, Martínez-Cuadrón D, Cano I, Gil C, Tormo M, Del Pilar Martínez-Sánchez M, Del Castillo TB, Serrano-López J, Benavente C, Herrera-Puente P, García-Boyero R, Lavilla-Rubira E, Luz Amigo M, Sayas-Lloris M, Bergua-Burgues JM, Pérez-Simón JA, Rodríguez G, Espadana A, Vidriales-Vicente B, Fernández R, López-Lorenzo JL, López M, García-Fortes M, Gómez JL, Colorado-Araujo M, Sossa-Melo CL, Aguilar E, Montesinos P. Corrigendum to "Performance of prognostic scoring systems in elderly patients with acute myeloid leukaemia on intensive chemotherapy: A PETHEMA registry study" [Leuk. Res. 92 (March) (2020) 106352]. Leuk Res 2020; 96:106388. [PMID: 32680618 DOI: 10.1016/j.leukres.2020.106388] [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: 10/23/2022]
Affiliation(s)
- Carlos Rodríguez-Medina
- Hospital Universitario de Gran Canaria Doctor Negrín, Calle Barranco de la Ballena, s/n, CP 35010 Las Palmas de Gran Canaria, Spain.
| | - David Martínez-Cuadrón
- Hospital Universitari i Politècnic La Fe, Avinguda de Fernando Abril Martorell, 106, 46026 Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Isabel Cano
- Hospital Universitari i Politècnic La Fe, Avinguda de Fernando Abril Martorell, 106, 46026 Valencia, Spain
| | - Cristina Gil
- Hospital General Universitario de Alicante, Pintor Baeza, 11, 03010 Alicante, Spain
| | - Mar Tormo
- Hospital Clínico Universitario, INCLIVA Biomedical Research Institute, Av. de Blasco Ibáñez, 17, 46010 Valencia, Spain
| | | | - Teresa Bernal Del Castillo
- Hospital Universitario Central de Asturias, Calle de la aldea de Cerdeño esquina con, Av. del Hospital Universitario, 33011 Oviedo, Spain
| | | | - Celina Benavente
- Hospital Clínico San Carlos, C/ Profesor Martín Lagos, s/n. Madrid, Spain
| | | | - Raimundo García-Boyero
- Hospital General Universitari de Castelló, Avinguda de Benicàssim, 128, 12004 Castelló de la Plana, Spain
| | | | - Mª Luz Amigo
- Hospital General Universitario Morales Meseguer, Av Marqués de los Vélez, s/n, 30008 Murcia, Spain
| | - MªJose Sayas-Lloris
- Hospital Universitari Doctor Peset, Av. de Gaspar Aguilar, 90, 46017 Valencia, Spain
| | | | | | - Gabriela Rodríguez
- Hospital Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007 Madrid, Spain
| | - Ana Espadana
- Centro Hospitalar e Universitário de Coimbra, Quinta dos Vales, São Martinho do Bispo 108, 3041-801 Coimbra, Portugal
| | - Belén Vidriales-Vicente
- Complejo Asistencial Universitario de Salamanca, Paseo de San Vicente, 182, 37007 Salamanca, Spain
| | - Rosa Fernández
- Hospital Universitario Insular de Gran Canaria, Calle Francisco Hernández González, 1, 35016 Las Palmas de Gran Canaria, Spain
| | - Jose Luis López-Lorenzo
- Hospital Universitario Fundación Jiménez Díaz, Av. de los Reyes Católicos, 2, 28040 Madrid, Spain
| | - María López
- Hospital General de Valencia, Av. de les Tres Creus, 2, 46014 Valencia, Spain
| | - María García-Fortes
- Hospital Universitario Virgen de la Victoria, Campus de Teatinos, S/N, 29010 Málaga, Spain
| | | | | | - Claudia Lucia Sossa-Melo
- Clínica FOSCAL, Production Unity of Advanced Therapy, Fundación Ofalmológica de Santander, Clínica Carlos Ardila Lulle (FOSCAL Internacional), Bucaramanga, Colombia
| | - Eliana Aguilar
- Centro Hospitalar São João, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Pau Montesinos
- Hospital Universitari i Politècnic La Fe, Avinguda de Fernando Abril Martorell, 106, 46026 Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain
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10
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Rodríguez-Medina C, Martínez-Cuadrón D, Cano I, Gil C, Tormo M, Del Pilar Martínez-Sánchez M, Del Castillo TB, Serrano-López J, Benavente C, Herrera-Puente P, García-Boyero R, Lavilla-Rubira E, Amigo ML, Sayas-Lloris M, Bergua-Burgues JM, Pérez-Simón JA, Rodríguez G, Espadana A, Vidriales-Vicente B, Fernández R, López-Lorenzo JL, López M, García-Fortes M, Labrador Gómez J, Colorado-Araujo M, Sossa-Melo CL, Aguilar E, Montesinos Fernández P. Performance of prognostic scoring systems in elderly patients with acute myeloid leukaemia on intensive chemotherapy: A PETHEMA registry study. Leuk Res 2020; 92:106352. [PMID: 32240863 DOI: 10.1016/j.leukres.2020.106352] [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: 11/06/2019] [Revised: 03/16/2020] [Accepted: 03/18/2020] [Indexed: 11/30/2022]
Abstract
Selection of elderly patients (aged ≥60 years) for intensive chemotherapy treatment of acute myeloblastic leukaemia (AML) remains challenging. Several cooperative groups such as Acute Leukaemia French Association (ALFA), Haematological Oncology Clinical Studies Group (HOCSG) and MD Anderson Cancer Center (MDACC) have developed predictive models to select those patients who can benefit from intensive chemotherapy. Our purpose is to validate and compare these three models in a cohort of patients treated in real-life setting. For this, a total of 1724 elderly AML patients and treated with intensive chemotherapy regimens were identified in the PETHEMA registry. Median age was 67.2 years (range, 60-84,9) and median overall survival [OS] 9 months (95 % confidence interval [CI], 8.2-9.7). Taking into account the ALFA group's model, patients likely to benefit from intensive chemotherapy had longer OS (14 months, 95 % CI 12.3-15.7) than those unlikely to benefit (5 months, 95 % CI 4.1-5.9; p < 0.001). Significant differences in OS were observed between patients with favourable risk (17 months, 95 % CI 13.2-20.7), intermediate risk (11 months, 95 % CI 9.3-12.6) and adverse risk (6 months, 95 % CI 5.1-6.4; p < 0.001) according to the HOCSG model. No significant differences in OS were observed between patients with 0, 1, 2 or ≥3 points according to the MDACC model. However, when patients with ≥1 point were compared with those with 0 points, median OS was significantly longer in the latter [15 months (95 % CI 12.1-17.8) vs 7 (95 % CI 5.7-8.5)]. This retrospective study validates predictive models proposed by the ALFA, HOCSG and MDACC groups in this real-life cohort.
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Affiliation(s)
- Carlos Rodríguez-Medina
- Hospital Universitario de Gran Canaria Doctor Negrín, Calle Barranco de la Ballena, s/n, CP 35010 Las Palmas de Gran Canaria, Spain.
| | - David Martínez-Cuadrón
- Hospital Universitari i Politècnic La Fe, Avinguda de Fernando Abril Martorell, 106, 46026 Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Isabel Cano
- Hospital Universitari i Politècnic La Fe, Avinguda de Fernando Abril Martorell, 106, 46026 Valencia, Spain
| | - Cristina Gil
- Hospital General Universitario de Alicante, Pintor Baeza, 11, 03010 Alicante, Spain
| | - Mar Tormo
- Hospital Clínico Universitario, INCLIVA Biomedical Research Institute, Av. de Blasco Ibáñez, 17, 46010 Valencia, Spain
| | | | - Teresa Bernal Del Castillo
- Hospital Universitario Central de Asturias, Calle de la aldea de Cerdeño esquina con, Av. del Hospital Universitario, 33011 Oviedo, Spain
| | | | - Celina Benavente
- Hospital Clínico San Carlos, C/ Profesor Martín Lagos, s/n, Madrid, Spain
| | | | - Raimundo García-Boyero
- Hospital General Universitari de Castelló, Avinguda de Benicàssim, 128, 12004 Castelló de la Plana, Spain
| | | | - Mª Luz Amigo
- Hospital General Universitario Morales Meseguer, Av Marqués de los Vélez, s/n, 30008 Murcia, Spain
| | - MªJose Sayas-Lloris
- Hospital Universitari Doctor Peset, Av. de Gaspar Aguilar, 90, 46017 Valencia, Spain
| | | | | | - Gabriela Rodríguez
- Hospital Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007 Madrid, Spain
| | - Ana Espadana
- Centro Hospitalar e Universitário de Coimbra, Quinta dos Vales, São Martinho do Bispo 108, 3041-801 Coimbra, Portugal
| | - Belén Vidriales-Vicente
- Complejo Asistencial Universitario de Salamanca, Paseo de San Vicente, 182, 37007 Salamanca, Spain
| | - Rosa Fernández
- Hospital Universitario Insular de Gran Canaria, Calle Francisco Hernández González, 1, 35016 Las Palmas de Gran Canaria, Spain
| | - Jose Luis López-Lorenzo
- Hospital Universitario Fundación Jiménez Díaz, Av. de los Reyes Católicos, 2, 28040 Madrid, Spain
| | - María López
- Hospital General de Valencia, Av. de les Tres Creus, 2, 46014 Valencia, Spain
| | - María García-Fortes
- Hospital Universitario Virgen de la Victoria, Campus de Teatinos, S/N, 29010 Málaga, Spain
| | | | | | - Claudia Lucia Sossa-Melo
- Clínica FOSCAL, Production Unity of Advanced Therapy, Fundación Ofalmológica de Santander, Clínica Carlos Ardila Lulle (FOSCAL Internacional), Bucaramanga, Colombia
| | - Eliana Aguilar
- Centro Hospitalar São João, Alameda Professor Hernâni Monteir, 4200-319 Porto, Portugal
| | - Pau Montesinos Fernández
- Hospital Universitari i Politècnic La Fe, Avinguda de Fernando Abril Martorell, 106, 46026 Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain
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11
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Seymour JF, Döhner H, Butrym A, Wierzbowska A, Selleslag D, Jang JH, Kumar R, Cavenagh J, Schuh AC, Candoni A, Récher C, Sandhu I, Del Castillo TB, Al-Ali HK, Falantes J, Stone RM, Minden MD, Weaver J, Songer S, Beach CL, Dombret H. Azacitidine improves clinical outcomes in older patients with acute myeloid leukaemia with myelodysplasia-related changes compared with conventional care regimens. BMC Cancer 2017; 17:852. [PMID: 29241450 PMCID: PMC5731212 DOI: 10.1186/s12885-017-3803-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 11/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Compared with World Health Organization-defined acute myeloid leukaemia (AML) not otherwise specified, patients with AML with myelodysplasia-related changes (AML-MRC) are generally older and more likely to have poor-risk cytogenetics, leading to poor response and prognosis. More than one-half of all older (≥65 years) patients in the phase 3 AZA-AML-001 trial had newly diagnosed AML-MRC. METHODS We compared clinical outcomes for patients with AML-MRC treated with azacitidine or conventional care regimens (CCR; induction chemotherapy, low-dose cytarabine, or supportive care only) overall and within patient subgroups defined by cytogenetic risk (intermediate or poor) and age (65-74 years or ≥75 years). The same analyses were used to compare azacitidine with low-dose cytarabine in patients who had been preselected to low-dose cytarabine before they were randomized to receive azacitidine or CCR (ie, low-dose cytarabine). RESULTS Median overall survival was significantly prolonged with azacitidine (n = 129) versus CCR (n = 133): 8.9 versus 4.9 months (hazard ratio 0.74, [95%CI 0.57, 0.97]). Among patients with intermediate-risk cytogenetics, median overall survival with azacitidine was 16.4 months, and with CCR was 8.9 months (hazard ratio 0.73 [95%CI 0.48, 1.10]). Median overall survival was significantly improved for patients ages 65-74 years treated with azacitidine compared with those who received CCR (14.2 versus 7.3 months, respectively; hazard ratio 0.64 [95%CI 0.42, 0.97]). Within the subgroup of patients preselected to low-dose cytarabine before randomization, median overall survival with azacitidine was 9.5 months versus 4.6 months with low-dose cytarabine (hazard ratio 0.77 [95%CI 0.55, 1.09]). Within the low-dose cytarabine preselection group, patients with intermediate-risk cytogenetics who received azacitidine had a median overall survival of 14.1 months versus 6.4 months with low-dose cytarabine, and patients aged 65-74 years had median survival of 14.9 months versus 5.2 months, respectively. Overall response rates were similar with azacitidine and CCR (24.8% and 17.3%, respectively), but higher with azacitidine versus low-dose cytarabine (27.2% and 13.9%). Adverse events were generally comparable between the treatment arms. CONCLUSIONS Azacitidine may be the preferred treatment for patients with AML-MRC who are not candidates for intensive chemotherapy, particularly patients ages 65-74 years and those with intermediate-risk cytogenetics. TRIAL REGISTRATION This study was registered at clinicalTrials.gov on February 16, 2010 ( NCT01074047 ).
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Affiliation(s)
- John F Seymour
- Department of Haematology, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett St, East Melbourne, VIC, 8006, Australia. .,University of Melbourne, Parkville, Australia.
| | | | | | | | | | - Jun Ho Jang
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | | | | | - Anna Candoni
- Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | | | | | | | | | - Jose Falantes
- Hospital Universitario Virgen del Rocio/Instituto de BioMedicinia de Sevilla, Sevilla, Spain
| | | | | | | | | | - C L Beach
- Celgene Corporation, Summit, NJ, USA
| | - Hervé Dombret
- Hôpital Saint Louis, Institut Universitaire d'Hématologie, University Paris Diderot, Paris, France
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