1
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Johnson SM, Haberberger J, Galeotti J, Ramkissoon L, Coombs CC, Richardson DR, Foster MC, Duncan D, Montgomery ND, Ferguson NL, Zeidner JF. Comprehensive genomic profiling reveals molecular subsets of ASXL1-mutated myeloid neoplasms. Leuk Lymphoma 2024; 65:209-218. [PMID: 37921062 DOI: 10.1080/10428194.2023.2277672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/24/2023] [Indexed: 11/04/2023]
Abstract
A large-scale genomic analysis of patients with ASXL1-mutated myeloid disease has not been performed to date. We reviewed comprehensive genomic profiling results from 6043 adults to characterize clinicopathologic features and co-mutation patterns by ASXL1 mutation status. ASXL1 mutations occurred in 1414 patients (23%). Mutation co-occurrence testing revealed strong co-occurrence (p < 0.01) between mutations in ASXL1 and nine genes (SRSF2, U2AF1, RUNX1, SETBP1, EZH2, STAG2, CUX1, CSF3R, CBL). Further analysis of patients with these co-mutations yielded several novel findings. Co-mutation patterns supported that ASXL1/SF3B1 co-mutation may be biologically distinct from ASXL1/non-SF3B1 spliceosome co-mutation. In AML, ASXL1/SRSF2 co-mutated patients frequently harbored STAG2 mutations (42%), which were dependent on the presence of both ASXL1 and SRSF2 mutation (p < 0.05). STAG2 and SETBP1 mutations were also exclusive in ASXL1/SRSF2 co-mutated patients and associated with divergent chronic myeloid phenotypes. Our findings support that certain multi-mutant genotypes may be biologically relevant in ASXL1-mutated myeloid disease.
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Affiliation(s)
- Steven M Johnson
- Department of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | | | - Jonathan Galeotti
- Department of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Lori Ramkissoon
- Department of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Catherine C Coombs
- Division of Hematology, Department of Medicine, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- UC Irvine, Irvine, CA, USA
| | - Daniel R Richardson
- Division of Hematology, Department of Medicine, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Matthew C Foster
- Division of Hematology, Department of Medicine, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- Novartis Pharmaceuticals, Cambridge, MA, USA
| | - Daniel Duncan
- Foundation Medicine, Inc, Cambridge, MA, USA
- GRAIL, Inc, Durham, NC, USA
| | - Nathan D Montgomery
- Department of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
- NeoGenomics Laboratories, Aliso Viejo, CA, USA
| | | | - Joshua F Zeidner
- Division of Hematology, Department of Medicine, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
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2
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Abbas HA, Ayoub E, Sun H, Kanagal-Shamanna R, Short NJ, Issa G, Yilmaz M, Pierce S, Rivera D, Cham B, Wing S, Li Z, Hammond D, Jabbour E, Borthakur G, Garcia-Manero G, Andreeff M, Daver N, Kadia T, Konopleva M, DiNardo C, Ravandi F. Clinical and molecular profiling of AML patients with chromosome 7 or 7q deletions in the context of TP53 alterations and venetoclax treatment. Leuk Lymphoma 2022; 63:3105-3116. [PMID: 36089905 PMCID: PMC9772202 DOI: 10.1080/10428194.2022.2118533] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/11/2022] [Accepted: 08/19/2022] [Indexed: 01/26/2023]
Abstract
Deletions in chromosome 7 (del(7)) or its long arm (del(7q)) constitute the most common adverse cytogenetic events in acute myeloid leukemia (AML). We retrospectively analyzed 243 treatment-naive patients with AML and del(7) (168/243; 69%) or del(7q) (75/243; 31%) who did not receive any myeloid-directed therapy prior to AML diagnosis. This is the largest comprehensive clinical and molecular analysis of AML patients with del(7) and del(7q). Our results show that relapse-free survival was significantly longer for AML patients with del(7q) compared to del(7), but the overall survival and remission duration were similar. TP53 mutations and del5/5q were the most frequent co-occurring mutations and cytogenetic abnormalities, and conferred worse outcomes in del(7) and del(7q) patients. Venetoclax-based treatments were associated with worse outcomes in TP53 mutated AML patients with del(7) or del(7q), as well as del(7) with TP53 wildtype status, requiring further investigation.
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Affiliation(s)
- Hussein A. Abbas
- Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Hematology and Medical Oncology, The University of Texas Health Science Center, Houston, TX, USA
| | - Edward Ayoub
- Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hanxiao Sun
- Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Biostatistics, Division of Basic Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rashmi Kanagal-Shamanna
- Department of Hematopathology, Division of Pathology-Lab Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nicholas J Short
- Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ghayas Issa
- Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Musa Yilmaz
- Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sherry Pierce
- Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Daniel Rivera
- Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brent Cham
- Department of Internal Medicine, The University of Texas Health Science Center, Houston, TX, USA
| | - Shane Wing
- Department of Internal Medicine, The University of Texas Health Science Center, Houston, TX, USA
| | - Ziyi Li
- Department of Biostatistics, Division of Basic Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Danielle Hammond
- Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elias Jabbour
- Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gautam Borthakur
- Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Guillermo Garcia-Manero
- Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael Andreeff
- Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Naval Daver
- Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tapan Kadia
- Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marina Konopleva
- Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Courtney DiNardo
- Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Farhad Ravandi
- Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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3
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Banaszak LG, Reinig E, Lasarev MR, Mattison RJ. Clinical utility and real-world application of molecular genetic sequencing in the management of patients with acute myeloid leukemia and myelodysplastic syndromes. Leuk Lymphoma 2021; 63:684-693. [PMID: 34865601 DOI: 10.1080/10428194.2021.1999435] [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: 10/19/2022]
Abstract
Recurrently mutated genes in acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) have proven useful in risk stratification and clinical decision-making. Sequencing technologies that detect these genetic mutations are now widely available, though there is variability in the use of such data among hematologists. Molecular genetic sequencing trends were assessed in 470 patients presenting to a single institution with AML or MDS to determine how molecular data impacts clinical management of patients with myeloid malignancies. Patients with AML were more likely to have molecular genetic sequencing performed compared to patients with MDS, and clinicians were more likely to reference molecular data in decision-making for patients with AML. Furthermore, the presence of molecular data was associated with an increased odd of bone marrow transplantation (BMT). This study demonstrates the real-world application of molecular data in the management of myeloid malignancies and also highlights disparities in the use of such data based on diagnosis.
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Affiliation(s)
- Lauren G Banaszak
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Erica Reinig
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Michael R Lasarev
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA
| | - Ryan J Mattison
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA.,University of Wisconsin Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
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4
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Bergstrom CP, Dahiya S, Chen W, Zhang CC, Zhu H, Yan J, Madanat Y, Patel P, Vusirkala M, Ramakrishnan P, Rizvi S, Chung S, Awan F, Anderson LD, Collins R, Kansagra A. The association of leukocyte immunoglobulin-like receptor subfamily B-4 expression in acute myeloid leukemia and central nervous system involvement. Leuk Res 2020; 100:106480. [PMID: 33285315 DOI: 10.1016/j.leukres.2020.106480] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 11/30/2022]
Abstract
Central nervous system (CNS) involvement in patients with acute myeloid leukemia (AML) varies, ranging from 0.6%-46%. Leukocyte immunoglobulin-like receptor B4 (LILRB4) has been shown to be critical in orchestration of infiltration of AML cells into the CNS in animal models, however it is unknown if an association exists between LILRB4 and CNS involvement (CNS+) in human patients with AML. LILRB4 was measured by flow cytometry in a heterogeneous population of fifty-six AML patients. Patients were then followed clinically for the development of CNS + . LILRB4 was positive in 91 % of patients with CNS + compared to 38 % without CNS involvement (p < 0.002). In logistic analysis: age, BMI, serum albumin and positive LILRB4 were predictive for CNS+ [OR, 95 % CI, p-value]: 0.95, 0.92-0.99, p < 0.01; 0.85, 0.73-0.998, p < 0.05; 0.23, 0.066-0.78, p < 0.02; 16.46, 1.93-140.2, p < 0.02, respectively. This finding of the association of LILRB4 with CNS + in combination with earlier findings suggests that LILRB4 has a mechanistic role in infiltration of the CNS and may provide insight into the pathogenesis of AML seeding the CNS. Moreover, this proof of concept and the findings in the present study may lead to the development of innovative and novel therapies to improve the lives of patients with AML.
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Affiliation(s)
- Colin P Bergstrom
- Department of Medicine, UT Southwestern Medical Center, Dallas, USA.
| | - Saurabh Dahiya
- Department of Medicine, Department of Hematology and Oncology, Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Weina Chen
- Department of Pathology, Department of Medicine, UT Southwestern Medical Center, Dallas, USA
| | - Cheng Cheng Zhang
- Department of Physiology, University of Texas Southwestern Medical Center, Dallas, USA
| | - Hong Zhu
- Department of Population and Data Science, Simmons Comprehensive Cancer Center, Dallas, USA
| | - Jingsheng Yan
- Department of Population and Data Science, Simmons Comprehensive Cancer Center, Dallas, USA
| | - Yazan Madanat
- Department of Medicine, Division of Hematology and Oncology, UT Southwestern Medical Center, Dallas, USA
| | - Prapti Patel
- Department of Medicine, Division of Hematology and Oncology, UT Southwestern Medical Center, Dallas, USA
| | - Madhuri Vusirkala
- Department of Medicine, Division of Hematology and Oncology, UT Southwestern Medical Center, Dallas, USA
| | - Praveen Ramakrishnan
- Department of Medicine, Division of Hematology and Oncology, UT Southwestern Medical Center, Dallas, USA
| | - Syed Rizvi
- Department of Medicine, Division of Hematology and Oncology, UT Southwestern Medical Center, Dallas, USA
| | - Stephen Chung
- Department of Medicine, Division of Hematology and Oncology, UT Southwestern Medical Center, Dallas, USA
| | - Farrukh Awan
- Department of Medicine, Division of Hematology and Oncology, UT Southwestern Medical Center, Dallas, USA
| | - Larry D Anderson
- Department of Medicine, Division of Hematology and Oncology, UT Southwestern Medical Center, Dallas, USA
| | - Robert Collins
- Department of Medicine, Division of Hematology and Oncology, UT Southwestern Medical Center, Dallas, USA
| | - Ankit Kansagra
- Department of Medicine, Division of Hematology and Oncology, UT Southwestern Medical Center, Dallas, USA
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5
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Applebaum AJ, Polacek LC, Walsh L, Reiner AS, Lynch K, Benvengo S, Buthorn J, Atkinson TM, Mao JJ, Panageas KS, Diamond EL. The unique burden of rare cancer caregiving: caregivers of patients with Erdheim-Chester disease. Leuk Lymphoma 2020; 61:1406-1417. [PMID: 32090658 DOI: 10.1080/10428194.2020.1719090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Research examining the experience of informal caregivers (ICs) for patients with rare cancers is limited. This was a mixed-methods pilot study of 14 ICs for patients with Erdheim-Chester disease (ECD), an ultra-rare neoplasm. Participants were predominantly female and over half provided at least 60% of their loved one's care. Participants completed measures of the impact of caregiving, caregiver burden, unmet needs, quality of life, anxiety, and depression. Participants reported substantial impact of caregiving, including limiting (50%) or discontinuing (21%) paid employment, and exhausting financial savings (43%). ICs reported a moderate level of burden with five (38%) reporting risk for burnout. While participants reported anxiety (64%) and depression (14%), their overall quality of life was favorable. Semi-structured interviews highlighted factors related to the distress and isolation of navigating a rare cancer. ECD ICs report burden and distress shaped by the experience of providing care for a patient with a rare cancer.
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Affiliation(s)
- Allison J Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Laura C Polacek
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Leah Walsh
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anne S Reiner
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kathleen Lynch
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stephanie Benvengo
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Justin Buthorn
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Thomas M Atkinson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jun J Mao
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Katherine S Panageas
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eli L Diamond
- Weill Cornell Medical College, New York, NY, USA.,Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Supportive Care Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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6
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Abstract
B-cell leukemia/lymphoma-2 (BCL-2) inhibition with the targeted oral agent venetoclax (ABT-199) has reshaped the treatment landscape for multiple hematological malignancies. Venetoclax in combination with hypomethylating agents (HMAs) or low-dose cytarabine (LDAC) has led to improved outcomes in acute myeloid leukemia (AML) and represents a new standard of care for frontline AML treatment in older patients or those unfit for intensive chemotherapy. Combinations of venetoclax with standard induction therapy or targeted agents such as FLT-3 inhibitors and IDH inhibitors are leading to improved clinical outcomes, representing major advancements in a field that has been without significant changes in treatments for the last 30 years. This review provides biological and clinical rationale for current venetoclax based treatments in AML, addresses common adverse events encountered with venetoclax based therapy, and explores emerging clinical data regarding combinations of novel targeted therapeutics used in conjunction with venetoclax for the treatment of AML.
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Affiliation(s)
- Curtis Lachowiez
- Division of Cancer Medicine, M. D. Anderson Cancer Center, Houston, TX, USA
| | | | - Marina Konopleva
- Department of Leukemia, M. D. Anderson Cancer Center, Houston, TX, USA
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7
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Chen Z, Mai W, Li Z, Zhang H, Zheng Y, Hong S, Yang W, Xiao W, Chen Z, Wang S. The epidemiological trend of acute promyelocytic leukemia over past four decades: a population-based analysis. Leuk Lymphoma 2019; 60:3470-3481. [PMID: 31305195 DOI: 10.1080/10428194.2019.1639164] [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: 10/26/2022]
Abstract
The treatment regimens for acute promyelocytic leukemia (APL) dramatically changed over time. However, its survival trend, based on a large sample size has not been reported. Patients diagnosed with APL were accessed from the Surveillance, Epidemiology, and End Results database. Their incidence and survival trend were evaluated in overall and subgroup levels. The overall incidence of APL increased with an annual percentage change of 5.5% from 1992 to 2006 and remained stable thereafter. In addition, the 5-year relative survival rates of APL improved significantly, from 12.3 to 32.2% to 59.5 to 72.1% over past four decades (p < .0001), sharing similar trend with different subgroups. Importantly, survival disparities exist among races and different socioeconomic status groups, with superior survival in whites and patients in low-poverty regions. Increasing incidence urges for increased awareness of clinicians over diagnosis of APL. In addition, a wider insurance coverage may help balance survival gap.
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Affiliation(s)
- Ziren Chen
- Department of Hematology and Oncology, Shenzhen University General Hospital, Shenzhen, China
| | - Wei Mai
- Department of Nephrology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Zhengxiong Li
- Department of Intensive Care Unit, Shenzhen Longhua District Central Hospital, Shenzhen, China
| | - Haoyang Zhang
- School of Biomedical Engineering, Sun Yat-sen University, Guangzhou, China
| | - Yu Zheng
- BGI-Shenzhen, BGI Genomics, Shenzhen, China
| | - Shunrong Hong
- Department of Radiology, Puning People's Hospital, Puning, China
| | - Wencong Yang
- Department of Cardiology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Weiliang Xiao
- Department of Intervention, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhilin Chen
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, China
| | - Shuncong Wang
- Theragnostic Laboratory, Department of Imaging and Pathology, Biomedical Sciences Group, KU Leuven, Leuven, Belgium
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8
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Im H, Rao V, Sridhar K, Bentley J, Mishra T, Chen R, Hall J, Graber A, Zhang Y, Li X, Mias GI, Snyder MP, Greenberg PL. Distinct transcriptomic and exomic abnormalities within myelodysplastic syndrome marrow cells. Leuk Lymphoma 2018; 59:2952-2962. [PMID: 29616851 DOI: 10.1080/10428194.2018.1452210] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 01/08/2023]
Abstract
To provide biologic insights into mechanisms underlying myelodysplastic syndromes (MDS) we evaluated the CD34+ marrow cells transcriptome using high-throughput RNA sequencing (RNA-Seq). We demonstrated significant differential gene expression profiles (GEPs) between MDS and normal and identified 41 disease classifier genes. Additionally, two main clusters of GEPs distinguished patients based on their major clinical features, particularly between those whose disease remained stable versus patients who transformed into acute myeloid leukemia within 12 months. The genes whose expression was associated with disease outcome were involved in functional pathways and biologic processes highly relevant for MDS. Combined with exomic analysis we identified differential isoform usage of genes in MDS mutational subgroups, with consequent dysregulation of distinct biologic functions. This combination of clinical, transcriptomic and exomic findings provides valuable understanding of mechanisms underlying MDS and its progression to a more aggressive stage and also facilitates prognostic characterization of MDS patients.
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Affiliation(s)
- Hogune Im
- a Department of Genetics , Stanford University School of Medicine , Stanford , CA , USA
| | - Varsha Rao
- a Department of Genetics , Stanford University School of Medicine , Stanford , CA , USA
| | - Kunju Sridhar
- b Hematology Division , Stanford University School of Medicine, Stanford Cancer Institute , Stanford , CA , USA
| | - Jason Bentley
- c Quantitative Science Unit , Stanford University , Stanford , CA , USA
| | - Tejaswini Mishra
- a Department of Genetics , Stanford University School of Medicine , Stanford , CA , USA
| | - Rui Chen
- a Department of Genetics , Stanford University School of Medicine , Stanford , CA , USA
| | - Jeff Hall
- d Genoptix Inc. , Carlsbad , CA , USA
| | | | - Yan Zhang
- e Department of Hematology , Jiaotong University, 6th Hospital , Shanghai , China
| | - Xiao Li
- e Department of Hematology , Jiaotong University, 6th Hospital , Shanghai , China
| | - George I Mias
- f Department of Biochemistry and Molecular Biology , Michigan State University , East Lansing , MI , USA
| | - Michael P Snyder
- a Department of Genetics , Stanford University School of Medicine , Stanford , CA , USA
| | - Peter L Greenberg
- b Hematology Division , Stanford University School of Medicine, Stanford Cancer Institute , Stanford , CA , USA
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9
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Almeida A, Fenaux P, Garcia-Manero G, Goldberg SL, Gröpper S, Jonasova A, Vey N, Castaneda C, Zhong J, Beach CL, Santini V. Safety profile of lenalidomide in patients with lower-risk myelodysplastic syndromes without del(5q): results of a phase 3 trial. Leuk Lymphoma 2018; 59:2135-2143. [PMID: 29322849 DOI: 10.1080/10428194.2017.1421758] [Citation(s) in RCA: 4] [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] [Indexed: 12/12/2022]
Abstract
The safety profile of lenalidomide use in lower-risk myelodysplastic syndromes (MDS) patients with del(5q) is well-established, but less is known in non-del(5q) patients. We provide safety data from a randomized, phase 3 trial evaluating lenalidomide in 239 patients with lower-risk non-del(5q) MDS ineligible/refractory to erythropoiesis-stimulating agents (ESAs). Compared with placebo, lenalidomide was associated with a higher incidence of grade 3-4 treatment-emergent adverse events (TEAEs; 86% vs. 44%), but not risk of infection (p = .817) or hemorrhagic events (p = 1.000). Grade 3-4 non-hematologic TEAEs were rare (the incidence of grade 3-4 pneumonia, e.g. was 5.6% in the lenalidomide group and 2.5% in the placebo group). Common grade 1-2 non-hematologic TEAEs did not require dose modifications or treatment discontinuation. Acute myeloid leukemia and second primary malignancies incidence was similar across treatment groups. Lenalidomide had a predictable and manageable safety profile in lower-risk non-del(5q) MDS patients ineligible/refractory to ESAs. Guidance on managing lenalidomide-related TEAEs is provided to help maintain patients on therapy to achieve maximum clinical benefit. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01029262.
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Affiliation(s)
- Antonio Almeida
- a Departamento de Hematologia , Instituto Português de Oncologia de Lisboa Francisco Gentil , Lisbon , Portugal
| | - Pierre Fenaux
- b Service d'Hématologie Séniors, Hôpital Saint-Louis, Université Paris 7 , Paris , France
| | | | - Stuart L Goldberg
- d John Theurer Cancer Center, Hackensack University Medical Center , Hackensack , NJ , USA
| | | | - Anna Jonasova
- f First Faculty of Medicine , Charles University General Hospital , Prague , Czech Republic
| | - Norbert Vey
- g Institut Paoli-Calmettes, Centre Régional de Lutte Contre le Cancer , Marseilles , France
| | | | | | - C L Beach
- h Celgene Corporation , Summit , NJ , USA
| | - Valeria Santini
- i Azienda Ospedaliero Universitaria Careggi, University of Florence , Florence , Italy
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10
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Ma J, Dunlap J, Paliga A, Traer E, Press R, Shen L, Fan G. DNMT3A co-mutation is required for FLT3-ITD as an adverse prognostic indicator in intermediate-risk cytogenetic group AML. Leuk Lymphoma 2017; 59:1938-1948. [PMID: 29165010 DOI: 10.1080/10428194.2017.1397659] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This single institution cohort study of 132 AML patients investigated the clinical implications of co-mutations detected with a 42-gene NGS panel. In the intermediate-risk cytogenetic group, FLT3-ITD is an adverse prognostic indicator only in the presence of a DNMT3A co-mutation, regardless of NPM1 mutation status. In the absence of a concomitant DNMT3A mutation, there was no significant difference in overall survival between FLT3-ITD positive and FLT3-ITD negative patients. Furthermore, mutation analysis on post-induction specimens showed that residual FLT3-ITD and/or DNMT3A mutations were associated with a high frequency of therapy resistance or relapse in AML. While FLT3-ITD positive patients are currently considered high risk, incorporation of DNMT3A mutation status may be needed to refine prognostication and guide clinical management in AML. Multi-gene mutation testing is essential to provide novel insights related to diagnostic and prognostic information.
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Affiliation(s)
- Juan Ma
- a Department of Clinical Laboratory , Xinhua Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , PR China
| | - Jennifer Dunlap
- b Department of Pathology and Laboratory Medicine , Oregon Health & Science University , Portland , OR , USA
| | | | - Elie Traer
- d Division of Hematology & Medical Oncology, Knight Cancer Institute , Oregon Health & Science University , Portland , OR , USA
| | - Richard Press
- b Department of Pathology and Laboratory Medicine , Oregon Health & Science University , Portland , OR , USA
| | - Lisong Shen
- a Department of Clinical Laboratory , Xinhua Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , PR China
| | - Guang Fan
- b Department of Pathology and Laboratory Medicine , Oregon Health & Science University , Portland , OR , USA
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11
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Abstract
Patients diagnosed with chronic myeloid leukemia (CML) and treated with BCR-ABL1 tyrosine kinase inhibitors (TKIs) have long life spans. Selection of an appropriate first-line therapy can be difficult as both the unique characteristics of each TKI and patient need to be taken into account to find the optimal match. Patient characteristics include comorbidities, concomitant medications, lifestyle, risk factors, BCR-ABL1 transcript type (e.g. b2a2 or b3a2) and additional chromosomal abnormalities. Just as patients differ, side effects, drug-drug interactions, administration plans, dosing schedules and treatment-related expenses across TKIs also vary. Alignment of these characteristics with the appropriate TKI is key to successfully initiating CML treatment. Continued success relies on communication between the patient and the healthcare team, adherence and optimization of therapy once it is initiated. In this review, we discuss these factors, in addition to TKI efficacy and safety, the cost of therapy, the future of treating CML and treatment-free remission.
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Affiliation(s)
- Giuseppe Saglio
- a Clinical and Biological Sciences of the University of Turin, San Luigi Hospital , Orbassano-Torino , Italy
| | - Elias Jabbour
- b Department of Leukemia, Division of Cancer Medicine , The University of Texas MD Anderson Cancer Center , Houston , Texas
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12
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Annereau M, Willekens C, El Halabi L, Chahine C, Saada V, Auger N, Danu A, Bermudez E, Lazarovici J, Ghez D, Leary A, Pistilli B, Lemare F, Solary E, de Botton S, Desmaris RP, Micol JB. Use of 5-azacitidine for therapy-related myeloid neoplasms in patients with concomitant active neoplastic disease. Leuk Res 2017; 55:58-64. [PMID: 28131982 DOI: 10.1016/j.leukres.2017.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 08/09/2016] [Revised: 10/31/2016] [Accepted: 01/17/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Patients diagnosed with therapy-related myeloid neoplasms (TRMN) with concomitant active neoplastic disorder (CAND) are usually proposed for best supportive care (BSC). We evaluated the feasibility of using 5-azacytidine (AZA) in this setting. METHODS All patients referred to Gustave Roussy between 2010 and 2015 for TRMN diagnosis (less than 30% blast) and eligible for AZA treatment were included. Patients with CAND proposed for BSC were also described. Patient's outcomes were analyzed based on the presence or not of a CAND. RESULTS Fifty-two patients with TRMN were analyzed, including 19 patients with CAND (14 eligible for AZA) and 33 without CAND eligible for AZA. The 5 patients with CAND ineligible for AZA had a worst performance status (p=0.016) at diagnosis and a shorter overall survival (OS) (0.62 months). Baseline characteristics of patients eligible for AZA were similar in the 2 groups except a trend for best performance status in patients with CAND (p=0.06). Overall response rate (71.4% vs 60.3%), transfusion independence (50.0% vs 45.5%) and OS (12.7 months vs 10.8 months) were similar between patients with and without CAND respectively (p=ns). CONCLUSION Here we report the feasibility and efficacy of AZA for selected patients with TRMN and a CAND.
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Affiliation(s)
- M Annereau
- Gustave Roussy, Université Paris-Saclay, Département de Pharmacie, Villejuif F-94805, France
| | - C Willekens
- Gustave Roussy, Université Paris-Saclay, Département d'hématologie, Villejuif F-94805, France
| | - L El Halabi
- Gustave Roussy, Université Paris-Saclay, Département d'hématologie, Villejuif F-94805, France
| | - C Chahine
- Gustave Roussy, Université Paris-Saclay, Département d'hématologie, Villejuif F-94805, France
| | - V Saada
- Gustave Roussy, Université Paris-Saclay, Département de biologie et pathologie médicales, Villejuif F-94805, France
| | - N Auger
- Gustave Roussy, Université Paris-Saclay, Département de biologie et pathologie médicales, Villejuif F-94805, France
| | - A Danu
- Gustave Roussy, Université Paris-Saclay, Département d'hématologie, Villejuif F-94805, France
| | - E Bermudez
- Gustave Roussy, Université Paris-Saclay, Département de Pharmacie, Villejuif F-94805, France
| | - J Lazarovici
- Gustave Roussy, Université Paris-Saclay, Département d'hématologie, Villejuif F-94805, France
| | - D Ghez
- Gustave Roussy, Université Paris-Saclay, Département d'hématologie, Villejuif F-94805, France
| | - A Leary
- Gustave Roussy, Université Paris-Saclay, Département de médecine oncologique, Villejuif F-94805, France
| | - B Pistilli
- Gustave Roussy, Université Paris-Saclay, Département de médecine oncologique, Villejuif F-94805, France
| | - F Lemare
- Gustave Roussy, Université Paris-Saclay, Département de Pharmacie, Villejuif F-94805, France
| | - E Solary
- Gustave Roussy, Université Paris-Saclay, Département d'hématologie, Villejuif F-94805, France; Inserm UMR1170, Gustave Roussy, Université Paris-Saclay, Villejuif F-94805, France
| | - S de Botton
- Gustave Roussy, Université Paris-Saclay, Département d'hématologie, Villejuif F-94805, France; Inserm UMR1170, Gustave Roussy, Université Paris-Saclay, Villejuif F-94805, France
| | - R-P Desmaris
- Gustave Roussy, Université Paris-Saclay, Département de Pharmacie, Villejuif F-94805, France
| | - J-B Micol
- Gustave Roussy, Université Paris-Saclay, Département d'hématologie, Villejuif F-94805, France; Inserm UMR1170, Gustave Roussy, Université Paris-Saclay, Villejuif F-94805, France.
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13
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Guo Y, Strickland SA, Mohan S, Li S, Bosompem A, Vickers KC, Zhao S, Sheng Q, Kim AS. MicroRNAs and tRNA-derived fragments predict the transformation of myelodysplastic syndromes to acute myeloid leukemia. Leuk Lymphoma 2017; 58:1-15. [PMID: 28084850 DOI: 10.1080/10428194.2016.1272680] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Myelodysplastic syndromes (MDS) are clonal hematopoietic disorders of the elderly that carry an increased risk of progression to acute myeloid leukemia (AML). Since small non-coding RNAs (sRNAs), including microRNA (miRNAs), act as regulators of cellular differentiation, we hypothesized that changes to sRNAs might be implicated in the progression of MDS to AML. We conducted sRNA sequencing on three sets of patients: Group A (MDS patients who never progressed to AML); Group B (MDS patients who later progressed to an AML); and Group C (AML patients with myelodysplasia-related changes, including patients with a known preceding diagnosis of MDS). We identified five miRNAs that differentiated Groups A and B, independent of bone marrow blast percentage, including three members of the miR-181 family, as well as differential patterns of miRNA isoforms (isomiRs) and tDRs. Thus, we have identified sRNA biomarkers that predict MDS cases that are likely to progress to AML.
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Affiliation(s)
- Yan Guo
- a Center for Quantitative Sciences , Vanderbilt University , Nashville , TN , USA
| | - Stephen A Strickland
- b Department of Medicine, Division of Hematology/Oncology , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Sanjay Mohan
- b Department of Medicine, Division of Hematology/Oncology , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Shaoying Li
- c Hematopathology Department , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Amma Bosompem
- d Department of Pathology , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Kasey C Vickers
- e Department of Medicine , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Shilin Zhao
- f Department of Cancer Biology , Vanderbilt University , Nashville , TN , USA
| | - Quanhu Sheng
- f Department of Cancer Biology , Vanderbilt University , Nashville , TN , USA
| | - Annette S Kim
- g Department of Pathology, Brigham and Women's Hospital , Boston , MA , USA
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14
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Gover-Proaktor A, Granot G, Shapira S, Raz O, Pasvolsky O, Nagler A, Lev DL, Inbal A, Lubin I, Raanani P, Leader A. Ponatinib reduces viability, migration, and functionality of human endothelial cells. Leuk Lymphoma 2016; 58:1455-1467. [PMID: 27733071 DOI: 10.1080/10428194.2016.1239258] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Tyrosine kinase inhibitors (TKIs) have revolutionized the prognosis of chronic myeloid leukemia. With the advent of highly efficacious therapy, the focus has shifted toward managing TKI adverse effects, such as vascular adverse events (VAEs). We used an in vitro angiogenesis model to investigate the TKI-associated VAEs. Our data show that imatinib, nilotinib, and ponatinib reduce human umbilical vein endothelial cells (HUVECs) viability. Pharmacological concentrations of ponatinib induced apoptosis, reduced migration, inhibited tube formation of HUVECs, and had a negative effect on endothelial progenitor cell (EPC) function. Furthermore, in HUVECs transfected with VEGF receptor 2 (VEGFR2), the effect of ponatinib on tube formation and on all parameters representing normal endothelial cell function was less prominent than in control cells. This is the first report regarding the pathogenesis of ponatinib-associated VAEs. The antiangiogenic effect of ponatinib, possibly mediated by VEGFR2 inhibition, as shown in our study, is another piece in the intricate puzzle of TKI-associated VAEs.
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Affiliation(s)
| | - Galit Granot
- a Felsenstein Medical Research Center , Tel Aviv , Israel
| | - Saar Shapira
- a Felsenstein Medical Research Center , Tel Aviv , Israel.,b The Sackler School of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Oshrat Raz
- a Felsenstein Medical Research Center , Tel Aviv , Israel
| | - Oren Pasvolsky
- b The Sackler School of Medicine , Tel Aviv University , Tel Aviv , Israel.,c Division of Hematology, Davidoff Cancer Center , Beilinson Hospital, Rabin Medical Center , Petah- Tikva , Israel
| | - Arnon Nagler
- b The Sackler School of Medicine , Tel Aviv University , Tel Aviv , Israel.,d Division of Hematology , Chaim Sheba Medical Center , Tel Aviv , Israel
| | - Dorit L Lev
- a Felsenstein Medical Research Center , Tel Aviv , Israel
| | - Aida Inbal
- c Division of Hematology, Davidoff Cancer Center , Beilinson Hospital, Rabin Medical Center , Petah- Tikva , Israel
| | - Ido Lubin
- a Felsenstein Medical Research Center , Tel Aviv , Israel.,b The Sackler School of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Pia Raanani
- b The Sackler School of Medicine , Tel Aviv University , Tel Aviv , Israel.,c Division of Hematology, Davidoff Cancer Center , Beilinson Hospital, Rabin Medical Center , Petah- Tikva , Israel
| | - Avi Leader
- b The Sackler School of Medicine , Tel Aviv University , Tel Aviv , Israel.,c Division of Hematology, Davidoff Cancer Center , Beilinson Hospital, Rabin Medical Center , Petah- Tikva , Israel
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15
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Chantepie SP, Reboursiere E, Mear JB, Gac AC, Salaun V, Benabed K, Cheze S, Johnsonansah H, Macro M, Vilque JP, Reman O. Gemtuzumab ozogamicin in combination with intensive chemotherapy in relapsed or refractory acute myeloid leukemia. Leuk Lymphoma 2015; 56:2326-30. [PMID: 25393676 DOI: 10.3109/10428194.2014.986478] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The prognosis of refractory/relapsed acute myeloid leukemia (AML) remains poor. The complete response (CR) rate after relapse is around 25%, with 11% of patients still alive after 5 years. The efficacy and toxicity of fractionated gemtuzumab ozogamicin (fGO; 3 mg/m2, days 1, 4, 7) in combination with intensive chemotherapy were retrospectively evaluated in patients with refractory/relapsed AML. Thirty-six patients (median age 54 years) were included. European LeukemiaNet classification was as follows: favorable (n=6), intermediate-I (n=13), intermediate-II (n=8), adverse (n=9). Median CR duration was 7.16 months (1.63-96.8). The overall response rate was 38.8%, with CR in eight patients (22.2%) and CR with incomplete platelet recovery (CRp) in six patients (16.7%). Two-year overall survival was 26% (95% confidence interval [CI]: 12-42) and 2-year relapse free-survival was 18.5% (95% CI: 6.6-35.0). Salvage therapy with fractionated GO in patients with very high-risk disease produced a 38.8% response rate and may be considered as a bridge therapy to transplant.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jean-Pierre Vilque
- c Department of Hematology , François Baclesse Cancer Center , Caen , France
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16
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Mattison R, Jumonville A, Flynn PJ, Moreno-Aspitia A, Erlichman C, LaPlant B, Juckett MB. A phase II study of AZD2171 (cediranib) in the treatment of patients with acute myeloid leukemia or high-risk myelodysplastic syndrome. Leuk Lymphoma 2014; 56:2061-6. [PMID: 25329007 DOI: 10.3109/10428194.2014.977886] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 11/13/2022]
Abstract
Patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) not fit for intensive treatment need novel therapy options. Vascular endothelial growth factor (VEGF) receptor inhibition is one potential mechanism by which AML and MDS could be treated. The receptor tyrosine kinase inhibitor AZD2171 (cediranib) has activity against VEGF receptors KDR and FLT-1. This multicenter phase II study was designed to test cediranib's activity in patients with AML or high-risk MDS. The primary endpoint was confirmed disease response defined as a composite of complete remission, partial remission or hematologic improvement. The study enrolled 23 subjects in the AML cohort and 16 subjects in the MDS cohort. There were no confirmed responses in either group. Since the study met the stopping rule after the first stage of enrollment, the trial was closed to further accrual. Common adverse events in both cohorts included thrombocytopenia, neutropenia, anemia, fatigue, dyspnea, diarrhea, nausea and dehydration.
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Affiliation(s)
- Ryan Mattison
- Carbone Comprehensive Cancer Center, University of Wisconsin , Madison, WI , USA
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17
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Mughal TI, Barbui T, Abdel-Wahab O, Kralovics R, Jamieson C, Kvasnicka HM, Mullaly A, Rampal R, Mesa R, Kiladjian JJ, Deininger M, Prchal J, Hehlmann R, Saglio G, Van Etten RA. Novel insights into the biology and treatment of chronic myeloproliferative neoplasms. Leuk Lymphoma 2014; 56:1938-48. [PMID: 25330439 DOI: 10.3109/10428194.2014.974594] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Myeloproliferative neoplasms (MPNs) are clonal disorders of hematopoiesis characterized by a high frequency of genetic alterations, and include chronic myeloid leukemia (CML) and the BCR-ABL1-negative MPNs. Herein we summarize recent advances and controversies in our understanding of the biology and therapy of these disorders, as discussed at the 8th post-American Society of Hematology CML-MPN workshop. The principal areas addressed include the breakthrough discovery of CALR mutations in patients with JAK2/MPL wild type MPN, candidate therapies based on novel genetic findings in leukemic transformation and new therapeutic targets in MPNs, and an appraisal of bone marrow histopathology in MPNs with a focus on the potential new clinical entity of "masked" polycythemia vera. An update on clinical trials of Janus kinase (JAK) inhibitors is presented as well as current understanding regarding the definitions and mechanisms of resistance to JAK inhibitors, and updated information on the safety and efficacy of discontinuation of tyrosine kinase inhibitors in patients with CML.
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18
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Chen Y, Estrov Z, Pierce S, Qiao W, Borthakur G, Ravandi F, Kadia T, Brandt M, O'Brien S, Jabbour E, Garcia-Manero G, Cortes J, Beran M. Myeloid neoplasms after breast cancer: "therapy-related" not an independent poor prognostic factor. Leuk Lymphoma 2014; 56:1012-9. [PMID: 25048874 DOI: 10.3109/10428194.2014.946023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 12/15/2022]
Abstract
Two hundred and thirty-five consecutive patients presenting to a single center with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) after breast cancer treatment were compared with matched patients with de novo AML or MDS. There was no significant difference in median overall survival (OS) times between patients with therapy-related AML and those with de novo AML (8.7 months vs.10.2 months; p = 0.17). Patients with therapy-related MDS had slightly lower median baseline platelet counts and a higher frequency of poor cytogenetics than those with de novo MDS, but the two groups had similar OS times (13.6 months vs. 18.9 months; p = 0.06). Multivariate analysis revealed that cytogenetic risk, baseline white blood cell count, age and performance status were predictive for OS time in AML and that cytogenetic risk and performance status were predictive for OS time in MDS. Having therapy-related disease is not an independent risk factor in patients with myeloid neoplasms and with a history of breast cancer. Clinical trials should be designed to serve both populations.
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Affiliation(s)
- Yiming Chen
- Department of Leukemia, The University of Texas M. D. Anderson Cancer Center , Houston, TX
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19
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Bryant A, Sheppard D, Sabloff M, Delbaere M, Maze R, Allan D, Atkins H, Bence-Bruckler I, Faught C, Huebsch L, Tay J, Zanke B, Bredeson C. A single-institution analysis of the utility of pre-induction ejection fraction measurement in patients newly diagnosed with acute myeloid leukemia. Leuk Lymphoma 2014; 56:135-40. [PMID: 24913512 DOI: 10.3109/10428194.2014.883072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Anthracyclines, a standard component of induction therapy for acute myeloid leukemia (AML) are known to be cardiotoxic. Existing evidence supporting routine baseline pre-induction cardiac function testing is limited. We conducted a retrospective analysis of 119 consecutive patients diagnosed with AML at our center from 2009 to 2012. In the 76 patients for whom induction chemotherapy was planned, baseline ejection fraction measurements were rarely abnormal (four cases), and in none of these abnormal cases did the result change management decisions. Awaiting LVEF evaluation results led to a delay in chemotherapy administration by a mean of approximately 2 days at significant additional costs to the healthcare system. Routine baseline ejection fraction measurement should be abandoned as it does not change management, results in treatment delay and unnecessary healthcare expenditures. More selective baseline testing, preferentially in patients in whom there is a clinical reason of cardiac disease, should be pursued.
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Affiliation(s)
- Adam Bryant
- The Ottawa Hospital and Department of Medicine, University of Ottawa , Ottawa, ON , Canada
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20
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Czemerska M, Pluta A, Szmigielska-Kaplon A, Wawrzyniak E, Cebula-Obrzut B, Medra A, Smolewski P, Robak T, Wierzbowska A. Jagged-1: a new promising factor associated with favorable prognosis in patients with acute myeloid leukemia. Leuk Lymphoma 2014; 56:401-6. [PMID: 24844362 DOI: 10.3109/10428194.2014.917638] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 12/15/2022]
Abstract
In this study Jagged-1 and Dll-1 surface expression as well as Notch-1 receptor intracellular domain (Notch-1-IC) expression were assessed by multi-color flow cytometry in leukemic blasts obtained from 88 patients with acute myeloid leukemia (AML). CD34+peripheral blood stem cells (PBSCs) were used as a control. The median expression of Jagged-1 and Dll-1 was significantly higher in AML blasts than in PBSCs (p=0.001 and p=0.002, respectively). Higher expression of Notch-1-IC was detected in patients with poor-risk karyotype as compared to good- and intermediate-risk groups (p=0.035). In our study, poor-risk cytogenetics and low (<median) expression of Jagged-1 were the only factors associated with significantly shorter overall survival in intensively treated patients according to multivariate analysis. In conclusion, high Jagged-1 surface level in leukemic cells is an independent favorable prognostic factor in patients with AML. To our knowledge, this is the first study evaluating the prognostic role of Notch-1-IC in AML blasts.
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21
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Jabbour EJ, Hughes TP, Cortés JE, Kantarjian HM, Hochhaus A. Potential mechanisms of disease progression and management of advanced-phase chronic myeloid leukemia. Leuk Lymphoma 2014; 55:1451-62. [PMID: 24050507 PMCID: PMC4186697 DOI: 10.3109/10428194.2013.845883] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [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] [Indexed: 11/13/2022]
Abstract
Despite vast improvements in the treatment of Philadelphia chromosome-positive chronic myeloid leukemia (CML) in chronic phase (CP), advanced stages of CML, accelerated phase or blast crisis, remain notoriously difficult to treat. Treatments that are highly effective against CML-CP produce disappointing results against advanced disease. Therefore, a primary goal of therapy should be to maintain patients in CP for as long as possible, by (1) striving for deep, early molecular response to treatment; (2) using tyrosine kinase inhibitors that lower risk of disease progression; and (3) more closely observing patients who demonstrate cytogenetic risk factors at diagnosis or during treatment.
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MESH Headings
- Blast Crisis/diagnosis
- Blast Crisis/etiology
- Blast Crisis/therapy
- Disease Management
- Disease Progression
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/etiology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Leukemia, Myeloid, Accelerated Phase/diagnosis
- Leukemia, Myeloid, Accelerated Phase/drug therapy
- Leukemia, Myeloid, Accelerated Phase/etiology
- Neoplasm Staging
- Prognosis
- Treatment Outcome
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Affiliation(s)
- Elias J. Jabbour
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Timothy P. Hughes
- Department of Hematology, The University of Adelaide, Adelaide, Australia
| | - Jorge E. Cortés
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hagop M. Kantarjian
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Andreas Hochhaus
- Abteilung Hämatologie/Onkologie, Universitätsklinikum Jena, Jena, Germany
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