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Göker H, Çınar OE, Demiroğlu H, Malkan ÜY, Aladağ Karakulak E, Büyükaşık Y. Venetoclax and Azacitidine Treatment in Relapsed Acute Myeloid Leukemia after Hematopoietic Stem Cell Transplantation: A Cohort Study in the Real-World Setting of a Tertiary Center. Turk J Haematol 2023; 40:213-215. [PMID: 37314288 PMCID: PMC10476247 DOI: 10.4274/tjh.galenos.2023.2023.0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/23/2023] [Indexed: 09/01/2023] Open
Affiliation(s)
- Hakan Göker
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Türkiye
| | - Olgu Erkin Çınar
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Türkiye
| | - Haluk Demiroğlu
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Türkiye
| | - Ümit Yavuz Malkan
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Türkiye
| | - Elifcan Aladağ Karakulak
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Türkiye
| | - Yahya Büyükaşık
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Türkiye
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Göker H, Çınar OE, Demiroğlu H, Malkan ÜY, Aladağ Karakulak E, Büyükaşık Y. Venetoclax and Azacitidine Treatment in Relapsed Acute Myeloid Leukemia After Hematopoietic Stem Cell Transplantation: A Cohort Study in a Tertiary Center Real-World Setting. Turk J Haematol 2023. [PMID: 37314288 DOI: 10.4274/tjh.galenos.2023.2023-0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Affiliation(s)
- Hakan Göker
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Türkiye
| | - Olgu Erkin Çınar
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Türkiye
| | - Haluk Demiroğlu
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Türkiye
| | - Ümit Yavuz Malkan
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Türkiye
| | - Elifcan Aladağ Karakulak
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Türkiye
| | - Yahya Büyükaşık
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Türkiye
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Zhao P, Ni M, Ma D, Fang Q, Zhang Y, Li Y, Huang Y, Chen Y, Chai X, Zhan Y, Li Y, Kang Q, Zhao M, Liu M, Zhang F, Huang S, Wen S, Deng B, Wang J. Venetoclax plus azacitidine and donor lymphocyte infusion in treating acute myeloid leukemia patients who relapse after allogeneic hematopoietic stem cell transplantation. Ann Hematol 2021; 101:119-130. [PMID: 34568973 PMCID: PMC8720738 DOI: 10.1007/s00277-021-04674-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/21/2021] [Indexed: 12/19/2022]
Abstract
This study aimed to evaluate the efficacy and safety of venetoclax plus azacitidine and donor lymphocyte infusion (DLI) in treating patients with relapsed acute myeloid leukemia (AML) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Twenty-six AML patients who relapsed after allo-HSCT were enrolled and treated with venetoclax plus azacitidine and DLI. Complete remission with incomplete recovery (CRi), partial remission (PR), and objective remission rate (ORR) were assessed, and then event-free survival (EFS) and overall survival (OS) were evaluated. Besides, adverse events were documented. Additionally, whole exome sequencing was performed in bone marrow samples. The CRi, PR, and ORR rates were 26.9%, 34.6%, and 61.5%, respectively. The median time of EFS and OS was 120 (95% CI: 71–610) days and 284.5 (95% CI: 81–610) days, respectively. The most common adverse events were hematologic system adverse events including agranulocytosis, anemia, and thrombocytopenia, while the adverse events of other systems were relatively less and milder. In addition, no serious adverse events existed. Of note, there were 6 (23.1%) patients who developed GVHD. As for gene mutation, 49 mutated genes were found, which were categorized as first-, second-, and third-class mutations, and then further analysis revealed that the first-class mutations were not correlated with EFS or OS. Additionally, the most frequent mutated genes were FLT3, CEBPA, DNMT3A, KIT, KRAS, and NRAS. Venetoclax plus azacitidine and DLI is efficient and tolerant in treating patients with relapsed AML after allo-HSCT, implying this combined therapy as a potential treatment option in the studied patients.
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Affiliation(s)
- Peng Zhao
- Department of Hematology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, People's Republic of China.,Guizhou Province Hematopoietic Stem Cell Transplantation Center, Key Laboratory of Hematological Disease Diagnostic & Treat Centre of Guizhou Province, Department of Hematology, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, People's Republic of China
| | - Ming Ni
- Guizhou Province Hematopoietic Stem Cell Transplantation Center, Key Laboratory of Hematological Disease Diagnostic & Treat Centre of Guizhou Province, Department of Hematology, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, People's Republic of China
| | - Dan Ma
- Guizhou Province Hematopoietic Stem Cell Transplantation Center, Key Laboratory of Hematological Disease Diagnostic & Treat Centre of Guizhou Province, Department of Hematology, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, People's Republic of China
| | - Qin Fang
- Department of Pharmacy, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, People's Republic of China
| | - Yan Zhang
- Guizhou Province Hematopoietic Stem Cell Transplantation Center, Key Laboratory of Hematological Disease Diagnostic & Treat Centre of Guizhou Province, Department of Hematology, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, People's Republic of China
| | - Yanju Li
- Guizhou Province Hematopoietic Stem Cell Transplantation Center, Key Laboratory of Hematological Disease Diagnostic & Treat Centre of Guizhou Province, Department of Hematology, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, People's Republic of China
| | - Yi Huang
- Department of Hematology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, People's Republic of China.,Guizhou Province Hematopoietic Stem Cell Transplantation Center, Key Laboratory of Hematological Disease Diagnostic & Treat Centre of Guizhou Province, Department of Hematology, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, People's Republic of China
| | - Ying Chen
- Department of Hematology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, People's Republic of China.,Guizhou Province Hematopoietic Stem Cell Transplantation Center, Key Laboratory of Hematological Disease Diagnostic & Treat Centre of Guizhou Province, Department of Hematology, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, People's Republic of China
| | - Xiao Chai
- Department of Hematology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, People's Republic of China.,Guizhou Province Hematopoietic Stem Cell Transplantation Center, Key Laboratory of Hematological Disease Diagnostic & Treat Centre of Guizhou Province, Department of Hematology, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, People's Republic of China
| | - Yun Zhan
- Guizhou Province Hematopoietic Stem Cell Transplantation Center, Key Laboratory of Hematological Disease Diagnostic & Treat Centre of Guizhou Province, Department of Hematology, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, People's Republic of China
| | - Yan Li
- Guizhou Province Hematopoietic Stem Cell Transplantation Center, Key Laboratory of Hematological Disease Diagnostic & Treat Centre of Guizhou Province, Department of Hematology, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, People's Republic of China
| | - Qian Kang
- Department of Hematology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, People's Republic of China.,Guizhou Province Hematopoietic Stem Cell Transplantation Center, Key Laboratory of Hematological Disease Diagnostic & Treat Centre of Guizhou Province, Department of Hematology, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, People's Republic of China
| | - Mei Zhao
- Guizhou Province Hematopoietic Stem Cell Transplantation Center, Key Laboratory of Hematological Disease Diagnostic & Treat Centre of Guizhou Province, Department of Hematology, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, People's Republic of China
| | - Min Liu
- Guizhou Province Hematopoietic Stem Cell Transplantation Center, Key Laboratory of Hematological Disease Diagnostic & Treat Centre of Guizhou Province, Department of Hematology, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, People's Republic of China
| | - Fengqi Zhang
- Guizhou Province Hematopoietic Stem Cell Transplantation Center, Key Laboratory of Hematological Disease Diagnostic & Treat Centre of Guizhou Province, Department of Hematology, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, People's Republic of China
| | - Shisi Huang
- Guizhou Province Hematopoietic Stem Cell Transplantation Center, Key Laboratory of Hematological Disease Diagnostic & Treat Centre of Guizhou Province, Department of Hematology, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, People's Republic of China
| | - Shuangshuang Wen
- Guizhou Province Hematopoietic Stem Cell Transplantation Center, Key Laboratory of Hematological Disease Diagnostic & Treat Centre of Guizhou Province, Department of Hematology, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, People's Republic of China
| | - Bo Deng
- Guizhou Province Hematopoietic Stem Cell Transplantation Center, Key Laboratory of Hematological Disease Diagnostic & Treat Centre of Guizhou Province, Department of Hematology, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, People's Republic of China
| | - Jishi Wang
- Department of Hematology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, People's Republic of China. .,Guizhou Province Hematopoietic Stem Cell Transplantation Center, Key Laboratory of Hematological Disease Diagnostic & Treat Centre of Guizhou Province, Department of Hematology, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, People's Republic of China.
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Heinicke T, Krahl R, Kahl C, Cross M, Scholl S, Wolf HH, Hähling D, Hegenbart U, Peter N, Schulze A, Florschütz A, Schmidt V, Reifenrath K, Zojer N, Junghanss C, Sayer HG, Maschmeyer G, Späth C, Hochhaus A, Fischer T, Al-Ali HK, Niederwieser D. Allogeneic hematopoietic stem cell transplantation improves long-term outcome for relapsed AML patients across all ages: results from two East German Study Group Hematology and Oncology (OSHO) trials. Ann Hematol 2021; 100:2387-2398. [PMID: 34232360 PMCID: PMC8357692 DOI: 10.1007/s00277-021-04565-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 06/04/2021] [Indexed: 12/14/2022]
Abstract
Relapse of acute leukemia is a frequent complication with uncertain outcome and poorly defined risk factors. From 1621 patients entered into two prospective clinical trials (AML02; n = 740 and AML04; n = 881), 74.2% reached complete remission (CR) 1 after induction(s) and 59 patients after additional induction ± hematopoietic cell transplantation (HCT). Of the non-refractory patients, 48.4% with a median age of 63 (range 17-85) years relapsed. Relapses occurred within 6 months after CR in 46.5%, between 7 and 18 months in 38.7%, and after 18 months in 14.8% of patients. Relapse treatment resulted in CR2 in 39% of patients depending upon age (54.5% of ≤ 60 and 28.6% of > 60 years), duration of CR1, and treatment of relapse. Overall survival (OS) was 10.9 (7.4-16.2) %, but OS after HCT ± intensive chemotherapy (ICT) was 39.3% (31.8-48.6) at 5 years and not different in younger and older patients. Donor lymphocyte infusion ± chemotherapy and ICT alone resulted only in OS of 15.4% and of 5%, respectively. Independent favorable factors for OS were long CR1 duration, and HCT, while non-monosomal disease was beneficial for OS in elderly patients. Leukemia-free survival [LFS; 24.9 (19.5-31.7) % at 10 years] was affected by similar risk factors. In a competing risk model, the relapse incidence at 5 years was 53.5 ± 3.5% and the non-relapse mortality rate 21.7 ± 2.9%. Lower relapse incidence was observed in patents with HCT, long CR1 duration, and female gender. Risk factors for non-relapse mortality were HCT in younger and type of AML in elderly patients. In conclusion, allogeneic HCT ± IC improved the results in relapsed AML in younger and elderly patients. Increasing CR2 rates and HCT frequency will be the challenge for the next years. Relapse of the disease remains the major problem.
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Affiliation(s)
- Thomas Heinicke
- Department of Hematology and Oncology, University of Magdeburg, Magdeburg, Germany
| | - Rainer Krahl
- University Hospital Leipzig, 04106, Leipzig, Germany
| | - Christoph Kahl
- Department of Hematology and Oncology, Hospital Magdeburg, Magdeburg, Germany
| | - Michael Cross
- University Hospital Leipzig, 04106, Leipzig, Germany
| | - Sebastian Scholl
- Klinik Für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Hans-Heinrich Wolf
- Department of Hematology and Oncology, University Hospital, Halle, Germany
| | - Detlev Hähling
- Department of Hematology and Oncology, Klinikum Schwerin, Schwerin, Germany
| | - Ute Hegenbart
- Departement of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Norma Peter
- Medizinische Klinik, Carl-Thieme-Klinikum GmbH, Cottbus, Germany
| | - Antje Schulze
- Department of Hematology and Oncology, Helios Klinikum Erfurt, Erfurt, Germany
| | | | - Volker Schmidt
- Department of Hematology and Oncology, Helios Klinikum Erfurt, Erfurt, Germany
| | | | - Niklas Zojer
- Department of Medicine I, Wilhelminen Cancer Research Institute, Wilhelminenhospital, , Vienna, Austria
| | - Christian Junghanss
- Hematology, Oncology, Palliative Medicine, University of Rostock, Rostock, Germany
| | - Herbert G Sayer
- Department of Hematology and Oncology, Helios Klinikum Erfurt, Erfurt, Germany
| | - Georg Maschmeyer
- Department of Hematology, Oncology and Palliative Care, Ernst Von Bergmann Hospital, Potsdam, Germany
| | - Christian Späth
- Hematology and Oncology, University of Greifswald, Greifswald, Germany
| | - Andreas Hochhaus
- Klinik Für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Thomas Fischer
- Department of Hematology and Oncology, University of Magdeburg, Magdeburg, Germany
| | | | - Dietger Niederwieser
- University Hospital Leipzig, 04106, Leipzig, Germany.
- Lithuanian University of Health Sciences, Kaunas, Lithuania.
- Aichi Medical University, Nagakute, Japan.
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Cui Q, Qian C, Xu N, Kang L, Dai H, Cui W, Song B, Yin J, Li Z, Zhu X, Qu C, Liu T, Shen W, Zhu M, Yu L, Wu D, Tang X. CD38-directed CAR-T cell therapy: a novel immunotherapy strategy for relapsed acute myeloid leukemia after allogeneic hematopoietic stem cell transplantation. J Hematol Oncol 2021; 14:82. [PMID: 34034795 PMCID: PMC8152118 DOI: 10.1186/s13045-021-01092-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [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: 02/06/2021] [Accepted: 05/10/2021] [Indexed: 11/12/2022] Open
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potentially curative treatment for acute myeloid leukemia (AML). However, most patients experience relapse after allo-HSCT, with a poor prognosis, and treatment options are limited. The lack of an ideal targetable antigen is a major obstacle for treating patients with relapsed AML. CD38 is known to be expressed on most AML and myeloma cells, and its lack of expression on hematopoietic stem cells (HSCs) renders it a potential therapeutic target for relapsed AML. To investigate the clinical therapeutic efficacy and safety of CD38-targeted chimeric antigen receptor T (CAR-T-38) cells, we enrolled 6 AML patients who experienced relapse post-allo-HSCT (clinicaltrials.gov: NCT04351022). Prior to CAR-T-38 treatment, the blasts in the bone marrow of these patients exhibited a median of 95% (92–99%) CD38 positivity. Four weeks after the initial infusion of CAR-T-38 cells, four of six (66.7%) patients achieved complete remission (CR) or CR with incomplete count recovery (CRi); the median CR or CRi time was 191 (range 117–261) days. The cumulative relapse rate at 6 months was 50%. The median overall survival (OS) and leukemia-free survival (LFS) times were 7.9 and 6.4 months, respectively. One case relapsed 117 days after the first CAR-T-38 cell infusion, with remission achieved after the second CAR-T-38 cell infusion. All six patients experienced clinically manageable side effects. In addition, multiparameter flow cytometry (FCM) revealed that CAR-T-38 cells eliminated CD38 positive blasts without off-target effects on monocytes and lymphocytes. Although this prospective study has a limited number of cases and a relatively short follow-up time, our preliminary data highlight the clinical utility and safety of CAR-T-38 cell therapy in treating relapsed AML post-allo-HSCT.
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Affiliation(s)
- Qingya Cui
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.,Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, 215123, China
| | - Chongsheng Qian
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.,Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, 215123, China
| | - Nan Xu
- School of Chemistry and Molecular Engineering, East China Normal University, Shanghai, 200062, China.,Shanghai Unicar-Therapy Bio-Medicine Technology Co., Ltd., Shanghai, 201203, China
| | - Liqing Kang
- School of Chemistry and Molecular Engineering, East China Normal University, Shanghai, 200062, China.,Shanghai Unicar-Therapy Bio-Medicine Technology Co., Ltd., Shanghai, 201203, China
| | - Haiping Dai
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.,Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, 215123, China
| | - Wei Cui
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.,Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, 215123, China
| | - Baoquan Song
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.,Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, 215123, China
| | - Jia Yin
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.,Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, 215123, China
| | - Zheng Li
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.,Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, 215123, China
| | - Xiaming Zhu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.,Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, 215123, China
| | - Changju Qu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.,Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, 215123, China
| | - Tianhui Liu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.,Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Institute of Blood and Marrow Transplantation of Soochow University, Suzhou, 215000, China
| | - Wenhong Shen
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.,Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, 215123, China
| | - Mingqing Zhu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.,Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, 215123, China
| | - Lei Yu
- School of Chemistry and Molecular Engineering, East China Normal University, Shanghai, 200062, China. .,Shanghai Unicar-Therapy Bio-Medicine Technology Co., Ltd., Shanghai, 201203, China.
| | - Depei Wu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China. .,Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, 215123, China.
| | - Xiaowen Tang
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China. .,Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, 215123, China.
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Bista R, Lee DW, Pepper OB, Azorsa DO, Arceci RJ, Aleem E. Disulfiram overcomes bortezomib and cytarabine resistance in Down-syndrome-associated acute myeloid leukemia cells. J Exp Clin Cancer Res 2017; 36:22. [PMID: 28143565 PMCID: PMC5286849 DOI: 10.1186/s13046-017-0493-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 01/26/2017] [Indexed: 02/02/2023]
Abstract
Background Children with Down syndrome (DS) have increased risk for developing AML (DS-AMKL), and they usually experience severe therapy-related toxicities compared to non DS-AMKL. Refractory/relapsed disease has very poor outcome, and patients would benefit from novel, less toxic, therapeutic strategies that overcome resistance. Relapse/resistance are linked to cancer stem cells with high aldehyde dehydrogenase (ALDH) activity. The purpose of the present work was to study less toxic alternative therapeutic agents for relapsed/refractory DS-AMKL. Methods Fourteen AML cell lines including the DS-AMKL CMY and CMK from relapsed/refractory AML were used. Cytarabine (Ara-C), bortezomib (BTZ), disulfiram/copper (DSF/Cu2+) were evaluated for cytotoxicity, depletion of ALDH-positive cells, and resistance. BTZ-resistant CMY and CMK variants were generated by continuous BTZ treatment. Cell viability was assessed using CellTiter-Glo®, ALDH activity by ALDELUORTM, and proteasome inhibition by western blot of ubiquitinated proteins and the Proteasome-Glo™ Chymotrypsin-Like (CT-like) assay, apoptosis by Annexin V Fluos/Propidium iodide staining, and mutations were detected using PCR, cloning and sequencing. Results Ara-C-resistant AML cell lines were sensitive to BTZ and DSF/Cu2+. The Ara-C-resistant DS-AMKL CMY cells had a high percentage of ALDHbright “stem-like” populations that may underlie Ara-C resistance. One percent of these cells were still resistant to BTZ but sensitive to DSF/Cu2+. To understand the mechanism of BTZ resistance, BTZ resistant (CMY-BR) and (CMK-BR) were generated. A novel mutation PSMB5 Q62P underlied BTZ resistance, and was associated with an overexpression of the β5 proteasome subunit. BTZ-resistance conferred increased resistance to Ara-C due to G1 arrest in the CMY-BR cells, which protected the cells from S-phase damage by Ara-C. CMY-BR and CMK-BR cells were cross-resistant to CFZ and MG-132 but sensitive to DSF/Cu2+. In this setting, DSF/Cu2+ induced apoptosis and proteasome inhibition independent of CT-like activity inhibition. Conclusions We provide evidence that DSF/Cu2+ overcomes Ara-C and BTZ resistance in cell lines from DS-AMKL patients. A novel mutation underlying BTZ resistance was detected that may identify BTZ-resistant patients, who may not benefit from treatment with CFZ or Ara-C, but may be responsive to DSF/Cu2+. Our findings support the clinical development of DSF/Cu2+ as a less toxic efficacious treatment approach in patients with relapsed/refractory DS-AMKL. Electronic supplementary material The online version of this article (doi:10.1186/s13046-017-0493-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ranjan Bista
- Institute of Molecular Medicine at Phoenix Children's Hospital, Phoenix, AZ, USA
| | - David W Lee
- Institute of Molecular Medicine at Phoenix Children's Hospital, Phoenix, AZ, USA.,Department of Child Health, University of Arizona College of Medicine-Phoenix, Biosciences Partnership Building (BSPB), 5th floor, 475 N 5th Street, Phoenix, AZ, 85004, USA
| | - Oliver B Pepper
- Department of Child Health, University of Arizona College of Medicine-Phoenix, Biosciences Partnership Building (BSPB), 5th floor, 475 N 5th Street, Phoenix, AZ, 85004, USA.,Department of Biology and Biochemistry, University of Bath, Bath, UK
| | - David O Azorsa
- Institute of Molecular Medicine at Phoenix Children's Hospital, Phoenix, AZ, USA.,Department of Child Health, University of Arizona College of Medicine-Phoenix, Biosciences Partnership Building (BSPB), 5th floor, 475 N 5th Street, Phoenix, AZ, 85004, USA
| | - Robert J Arceci
- Institute of Molecular Medicine at Phoenix Children's Hospital, Phoenix, AZ, USA.,Department of Child Health, University of Arizona College of Medicine-Phoenix, Biosciences Partnership Building (BSPB), 5th floor, 475 N 5th Street, Phoenix, AZ, 85004, USA
| | - Eiman Aleem
- Institute of Molecular Medicine at Phoenix Children's Hospital, Phoenix, AZ, USA. .,Department of Child Health, University of Arizona College of Medicine-Phoenix, Biosciences Partnership Building (BSPB), 5th floor, 475 N 5th Street, Phoenix, AZ, 85004, USA. .,Department of Zoology, Faculty of Science, Alexandria University, Alexandria, Egypt.
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