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Ansari AS, K C R, Morales LC, Nasrullah M, Meenakshi Sundaram DN, Kucharski C, Jiang X, Brandwein J, Uludağ H. Lipopolymer mediated siRNA delivery targeting aberrant oncogenes for effective therapy of myeloid leukemia in preclinical animal models. J Control Release 2024; 367:821-836. [PMID: 38360178 DOI: 10.1016/j.jconrel.2024.02.018] [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: 11/20/2023] [Revised: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 02/17/2024]
Abstract
The clinical development of tyrosine kinase inhibitors (TKI) has led to great strides in improving the survival of chronic myeloid leukemia (CML) and acute myeloid leukemia (AML) patients. But even the new generation TKIs are rendered futile in the face of evolving landscape of acquired mutations leading to drug resistance, necessitating the pursuit of alternative therapeutic approaches. In contrast to exploiting proteins as targets like most conventional drugs and TKIs, RNA Interference (RNAi) exerts its therapeutic action towards disease-driving aberrant genes. To realize the potential of RNAi, the major challenge is to efficiently deliver the therapeutic mediator of RNAi, small interfering RNA (siRNA) molecules. In this study, we explored the feasibility of using aliphatic lipid (linoleic acid and lauric acid)-grafted polymers (lipopolymers) for the delivery of siRNAs against the FLT3 oncogene in AML and BCR-ABL oncogene in CML. The lipopolymer delivered siRNA potently suppressed the proliferation AML and CML cells via silencing of the targeted oncogenes. In both AML and CML subcutaneous xenografts generated in NCG mice, intravenously administered lipopolymer/siRNA complexes displayed significant inhibitory effect on tumor growth. Combining siFLT3 complexes with gilteritinib allowed for reduction of effective drug dosage, longer duration of remission, and enhanced survival after relapse, compared to gilteritinib monotherapy. Anti-leukemic activity of siBCR-ABL complexes was similar in wild-type and TKI-resistant cells, and therapeutic efficacy was confirmed in vivo through prolonged survival of the NCG hosts systemically implanted with TKI-resistant cells. These results demonstrate the preclinical efficacy of lipopolymer facilitated siRNA delivery, providing a novel therapeutic platform for myeloid leukemias.
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MESH Headings
- Humans
- Animals
- Mice
- RNA, Small Interfering
- Fusion Proteins, bcr-abl/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/genetics
- Oncogenes
- Models, Animal
- Protein Kinase Inhibitors/therapeutic use
- Protein Kinase Inhibitors/pharmacology
- Drug Resistance, Neoplasm
- Aniline Compounds
- Pyrazines
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Affiliation(s)
- Aysha S Ansari
- Department of Chemical and Materials Engineering, Faculty of Engineering, University of Alberta, Edmonton T6G 1H9, Alberta, Canada
| | - Remant K C
- Department of Chemical and Materials Engineering, Faculty of Engineering, University of Alberta, Edmonton T6G 1H9, Alberta, Canada
| | - Luis C Morales
- Department of Chemical and Materials Engineering, Faculty of Engineering, University of Alberta, Edmonton T6G 1H9, Alberta, Canada
| | - Mohammad Nasrullah
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton T6G 2H1, Alberta, Canada
| | | | - Cezary Kucharski
- Department of Chemical and Materials Engineering, Faculty of Engineering, University of Alberta, Edmonton T6G 1H9, Alberta, Canada
| | - Xiaoyan Jiang
- Department of Molecular Genetics and Terry Fox Labs, University of British Columbia, Vancouver V5Z 1L3, British Columbia, Canada
| | - Joseph Brandwein
- Division of Hematology, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton T6G 2E1, Alberta, Canada
| | - Hasan Uludağ
- Department of Chemical and Materials Engineering, Faculty of Engineering, University of Alberta, Edmonton T6G 1H9, Alberta, Canada; Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton T6G 2H1, Alberta, Canada.
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Lai J, Yang C, Shang C, Chen W, Chu MP, Brandwein J, Lai R, Wang P. ULK2 Is a Key Pro-Autophagy Protein That Contributes to the High Chemoresistance and Disease Relapse in FLT3-Mutated Acute Myeloid Leukemia. Int J Mol Sci 2024; 25:646. [PMID: 38203816 PMCID: PMC10780038 DOI: 10.3390/ijms25010646] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/19/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
We recently demonstrated that a small subset of cells in FLT3-mutated acute myeloid leukemia (AML) cell lines exhibit SORE6 reporter activity and cancer stem-like features including chemoresistance. To study why SORE6+ cells are more chemoresistant than SORE6- cells, we hypothesized that these cells carry higher autophagy, a mechanism linked to chemoresistance. We found that cytarabine (Ara-C) induced a substantially higher protein level of LC3B-II in SORE6+ compared to SORE6- cells. Similar observations were made using a fluorescence signal-based autophagy assay. Furthermore, chloroquine (an autophagy inhibitor) sensitized SORE6+ but not SORE6- cells to Ara-C. To decipher the molecular mechanisms underlying the high autophagic flux in SORE6+ cells, we employed an autophagy oligonucleotide array comparing gene expression between SORE6+ and SORE6- cells before and after Ara-C treatment. ULK2 was the most differentially expressed gene between the two cell subsets. To demonstrate the role of ULK2 in conferring higher chemoresistance in SORE6+ cells, we treated the two cell subsets with a ULK1/2 inhibitor, MRT68921. MRT68921 significantly sensitized SORE6+ but not SORE6- cells to Ara-C. Using our in vitro model for AML relapse, we found that regenerated AML cells contained higher ULK2 expression compared to pretreated cells. Importantly, inhibition of ULK2 using MRT68921 prevented in vitro AML relapse. Lastly, using pretreatment and relapsed AML patient bone marrow samples, we found that ULK2 expression was higher in relapsed AML. To conclude, our results supported the importance of autophagy in the relapse of FLT3-mutated AML and highlighted ULK2 in this context.
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Affiliation(s)
- Justine Lai
- Department of Medicine, Division of Hematology, University of Alberta, Edmonton, AB T6G 2R3, Canada; (J.L.); (M.P.C.); (J.B.)
| | - Claire Yang
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2R3, Canada; (C.Y.); (C.S.); (W.C.)
| | - Chuquan Shang
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2R3, Canada; (C.Y.); (C.S.); (W.C.)
| | - Will Chen
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2R3, Canada; (C.Y.); (C.S.); (W.C.)
| | - Michael P. Chu
- Department of Medicine, Division of Hematology, University of Alberta, Edmonton, AB T6G 2R3, Canada; (J.L.); (M.P.C.); (J.B.)
- Department of Medical Oncology, Cross Cancer Institute, Edmonton, AB T6G 1Z2, Canada
| | - Joseph Brandwein
- Department of Medicine, Division of Hematology, University of Alberta, Edmonton, AB T6G 2R3, Canada; (J.L.); (M.P.C.); (J.B.)
| | - Raymond Lai
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2R3, Canada; (C.Y.); (C.S.); (W.C.)
- Department of Medical Oncology, Cross Cancer Institute, Edmonton, AB T6G 1Z2, Canada
| | - Peng Wang
- Department of Medicine, Division of Hematology, University of Alberta, Edmonton, AB T6G 2R3, Canada; (J.L.); (M.P.C.); (J.B.)
- Department of Medical Oncology, Cross Cancer Institute, Edmonton, AB T6G 1Z2, Canada
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Lai J, Shang C, Chen W, Izevbaye I, Chu MP, Sandhu I, Brandwein J, Lai R, Wang P. An In Vitro Model for Acute Myeloid Leukemia Relapse Using the SORE6 Reporter. Int J Mol Sci 2023; 25:496. [PMID: 38203669 PMCID: PMC10779023 DOI: 10.3390/ijms25010496] [Citation(s) in RCA: 1] [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: 10/19/2023] [Revised: 12/13/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
Many patients diagnosed with acute myeloid leukemia (AML) relapse within two years of the initial remission. The biology of AML relapse is incompletely understood, although cancer stem-like (CSL) cells have been hypothesized to be important. To test this hypothesis, we employed SORE6, a reporter designed to detect the transcriptional activity of the embryonic stem cell proteins Oct4 and Sox2, to identify/purify CSL cells in two FLT3-mutated AML cell lines. Both cell lines contained ~10% of SORE6+ cells in the steady state. Compared to SORE6- cells, SORE6+ cells exhibited more characteristics of CSL cells, with significantly higher chemoresistance and rates of spheroid formation. SORE6+ cells had substantially higher expression of Myc and FLT3 proteins, which are drivers of SORE6 activity. Using a mixture of SORE6-/SORE6+ cells that were molecularly barcoded, we generated an in vitro study model for AML relapse. Specifically, after 'in vitro remission' induced by Ara-C, both cell lines regenerated after 13 ± 3 days. Barcode analysis revealed that most of the regenerated cells were derived from the original SORE6+ cells. Regenerated cells exhibited more CSL features than did the original SORE6+ cells, even though a proportion of them lost SORE6 activity. In bone marrow samples from a patient cohort, we found that relapsed blasts expressed significantly higher levels of Myc, a surrogate marker of SORE6 activity, compared to pre-treatment blasts. To conclude, using our in vitro model, we have provided evidence that CSL cells contribute to AML relapse.
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Affiliation(s)
- Justine Lai
- Department of Medicine, Division of Hematology, University of Alberta, Edmonton, AB T6G 2R3, Canada; (M.P.C.); (I.S.); (J.B.)
| | - Chuquan Shang
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2R3, Canada; (C.S.); (W.C.); (I.I.); (R.L.)
| | - Will Chen
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2R3, Canada; (C.S.); (W.C.); (I.I.); (R.L.)
| | - Iyare Izevbaye
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2R3, Canada; (C.S.); (W.C.); (I.I.); (R.L.)
| | - Michael P. Chu
- Department of Medicine, Division of Hematology, University of Alberta, Edmonton, AB T6G 2R3, Canada; (M.P.C.); (I.S.); (J.B.)
- Department of Medical Oncology, Cross Cancer Institute, Edmonton, AB T6G 2R3, Canada
| | - Irwindeep Sandhu
- Department of Medicine, Division of Hematology, University of Alberta, Edmonton, AB T6G 2R3, Canada; (M.P.C.); (I.S.); (J.B.)
- Department of Medical Oncology, Cross Cancer Institute, Edmonton, AB T6G 2R3, Canada
| | - Joseph Brandwein
- Department of Medicine, Division of Hematology, University of Alberta, Edmonton, AB T6G 2R3, Canada; (M.P.C.); (I.S.); (J.B.)
| | - Raymond Lai
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2R3, Canada; (C.S.); (W.C.); (I.I.); (R.L.)
- Department of Medical Oncology, Cross Cancer Institute, Edmonton, AB T6G 2R3, Canada
| | - Peng Wang
- Department of Medicine, Division of Hematology, University of Alberta, Edmonton, AB T6G 2R3, Canada; (M.P.C.); (I.S.); (J.B.)
- Department of Medical Oncology, Cross Cancer Institute, Edmonton, AB T6G 2R3, Canada
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Ubeda Gutierrez AM, Remant Bahadur KC, Brandwein J, Uludağ H. Exploring the Potential of siRNA Delivery in Acute Myeloid Leukemia for Therapeutic Silencing. Nanomaterials (Basel) 2023; 13:3167. [PMID: 38133064 PMCID: PMC10745893 DOI: 10.3390/nano13243167] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/07/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
We investigated the feasibility of using siRNA therapy for acute myeloid leukemia (AML) by developing macromolecular carriers that facilitated intracellular delivery of siRNA. The carriers were derived from low-molecular-weight (<2 kDa) polyethyleneimine (PEI) and modified with a range of aliphatic lipids. We identified linoleic acid and lauric acid-modified PEI as optimal carriers for siRNA delivery to AML cell lines KG1 and KG1a, as well as AML patient-derived mononuclear cells. As they have been proven to be potent targets in the treatment of AML, we examined the silencing of BCL2L12 and survivin and showed how it leads to the decrease in proliferation of KG1 and stem-cell-like KG1a cells. By optimizing the transfection schedule, we were able to enhance the effect of the siRNAs on proliferation over a period of 10 days. We additionally showed that with proper modifications of PEI, other genes, including MAP2K3, CDC20, and SOD-1, could be targeted to decrease the proliferation of AML cells. Our studies demonstrated the versatility of siRNA delivery with modified PEI to elicit an effect in leukemic cells that are difficult to transfect, offering an alternative to conventional drugs for more precise and targeted treatment options.
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Affiliation(s)
- Anyeld M. Ubeda Gutierrez
- Department of Biomedical Engineering, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - K. C. Remant Bahadur
- Department of Chemical & Materials Engineering, Faculty of Engineering, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Joseph Brandwein
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Hasan Uludağ
- Department of Chemical & Materials Engineering, Faculty of Engineering, University of Alberta, Edmonton, AB T6G 2R3, Canada
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB T6G 2R3, Canada
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Fenaux P, Gobbi M, Kropf PL, Issa JPJ, Roboz GJ, Mayer J, Krauter J, Robak T, Kantarjian H, Novak J, Jedrzejczak WW, Thomas X, Ojeda-Uribe M, Miyazaki Y, Min YH, Yeh SP, Brandwein J, Gercheva-Kyuchukova L, Demeter J, Griffiths E, Yee K, Döhner K, Hao Y, Keer H, Azab M, Döhner H. Guadecitabine vs treatment choice in newly diagnosed acute myeloid leukemia: a global phase 3 randomized study. Blood Adv 2023; 7:5027-5037. [PMID: 37276510 PMCID: PMC10471926 DOI: 10.1182/bloodadvances.2023010179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/16/2023] [Accepted: 05/21/2023] [Indexed: 06/07/2023] Open
Abstract
This phase 3 study evaluated the efficacy and safety of the new hypomethylating agent guadecitabine (n = 408) vs a preselected treatment choice (TC; n = 407) of azacitidine, decitabine, or low-dose cytarabine in patients with acute myeloid leukemia unfit to receive intensive induction chemotherapy. Half of the patients (50%) had poor Eastern Cooperative Oncology Group Performance Status (2-3). The coprimary end points were complete remission (19% and 17% of patients for guadecitabine and TC, respectively [stratified P = .48]) and overall survival (median survival 7.1 and 8.5 months for guadecitabine and TC, respectively [hazard ratio, 0.97; 95% confidence interval, 0.83-1.14; stratified log-rank P = .73]). One- and 2-year survival estimates were 37% and 18% for guadecitabine and 36% and 14% for TC, respectively. A large proportion of patients (42%) received <4 cycles of treatment in both the arms. In a post hoc analysis of patients who received ≥4 treatment cycles, guadecitabine was associated with longer median survival vs TC (15.6 vs 13.0 months [hazard ratio, 0.78; 95% confidence interval, 0.64-0.96; log-rank P = .02]). There was no significant difference in the proportion of patients with grade ≥3 adverse events (AEs) between guadecitabine (92%) and TC (88%); however, grade ≥3 AEs of febrile neutropenia, neutropenia, and pneumonia were higher with guadecitabine. In conclusion, no significant difference was observed in the efficacy of guadecitabine and TC in the overall population. This trial was registered at www.clinicaltrials.gov as #NCT02348489.
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Affiliation(s)
| | - Marco Gobbi
- Ospedale Policlinico San Martino, Genova, Italy
| | | | | | | | - Jiri Mayer
- Fakultní Nemocnice, Brno, Česká Republika
| | - Jürgen Krauter
- Städtisches Klinikum Braunschweig gGmbH, Braunschweig, Germany
| | - Tadeusz Robak
- Medical University of Lodz and Copernicus Memorial Hospital, Lodz, Poland
| | | | - Jan Novak
- Univerzita Karlova, Praha, Česká Republika
| | | | | | | | | | - Yoo Hong Min
- Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Su-Peng Yeh
- China Medical University Hospital, Taichung City, Taiwan
| | | | | | | | | | - Karen Yee
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Yong Hao
- Astex Pharmaceuticals Inc, Pleasanton, CA
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Montesinos P, Kota V, Brandwein J, Bousset P, Benner RJ, Vandendries E, Chen Y, McMullin MF. A phase IV study evaluating QT interval, pharmacokinetics, and safety following fractionated dosing of gemtuzumab ozogamicin in patients with relapsed/refractory CD33-positive acute myeloid leukemia. Cancer Chemother Pharmacol 2023; 91:441-446. [PMID: 36892676 PMCID: PMC9996548 DOI: 10.1007/s00280-023-04516-9] [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: 10/27/2022] [Accepted: 02/24/2023] [Indexed: 03/10/2023]
Abstract
PURPOSE Gemtuzumab ozogamicin (GO) is indicated for treatment of relapsed/refractory (R/R) acute myeloid leukemia (AML). The QT interval, pharmacokinetics (PK), and immunogenicity following the fractionated GO dosing regimen have not been previously assessed. This phase IV study was designed to obtain this information in patients with R/R AML. METHODS Patients aged ≥ 18 years with R/R AML received the fractionated dosing regimen of GO 3 mg/m2 on Days 1, 4, and 7 of each cycle, up to 2 cycles. The primary endpoint was mean change from baseline in QT interval corrected for heart rate (QTc). RESULTS Fifty patients received ≥ 1 dose of GO during Cycle 1. The upper limit of the 2-sided 90% confidence interval for least squares mean differences in QTc using Fridericia's formula (QTcF) was < 10 ms for all time points during Cycle 1. No patients had a post-baseline QTcF > 480 ms or a change from baseline > 60 ms. Treatment-emergent adverse events (TEAEs) occurred in 98% of patients; 54% were grade 3-4. The most common grade 3-4 TEAEs were febrile neutropenia (36%) and thrombocytopenia (18%). The PK profiles of both conjugated and unconjugated calicheamicin mirror that of total hP67.6 antibody. The incidence of antidrug antibodies (ADAs) and neutralizing antibodies was 12% and 2%, respectively. CONCLUSION Fractionated GO dosing regimen (3 mg/m2/dose) is not predicted to pose a clinically significant safety risk for QT interval prolongation in patients with R/R AML. TEAEs are consistent with GO's known safety profile, and ADA presence appears unassociated with potential safety issues. TRIAL REGISTRY Clinicaltrials.gov ID: NCT03727750 (November 1, 2018).
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Affiliation(s)
- Pau Montesinos
- Department of Hematology, Hospital Universitario y Politècnico La Fe, Avda. Fernando Abril Martorell, 106-Torre A, 4º planta, 46026, Valencia, Spain.
| | - Vamsi Kota
- Department of Medicine: Hematology and Oncology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Joseph Brandwein
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | | | | | | | - Ying Chen
- Pfizer Oncology, Pfizer Inc., La Jolla, CA, USA
| | - Mary Frances McMullin
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
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Gamma J, Iyer A, Yap M, Zak Z, Vincent K, Ekstrom C, Liu Q, Beauchamp E, Postovit L, Wang J, Mackey JR, Pemmaraju N, Borthakur G, Brandwein J, Berthiaume L. Abstract 5662: Targeting N-myristoylation for therapy of adult acute myeloid leukemia. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-5662] [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] [Indexed: 11/16/2022]
Abstract
Abstract
Two N-myristoyltransferases (NMTs) NMT1 and NMT2 catalyze the reaction. NMT1 is ubiquitous expressed and is essential for cell survival while NMT2 is more variably expressed and non-essential suggesting that their substrate specificity and activity levels differ. Historically, inhibition of myristoylation was suggested as a therapeutic anti-cancer target since NMTs expression were shown to be increased in numerous types of cancers and myristoylation was shown to be essential for proper localization and activity of some important proto-oncogenes such as Src Family Kinases (SFKs). Recently, we showed NMT2 expression is lost in numerous haematological cancer cell lines (including AML) and that these haematological cancer cell lines are exquisitely sensitive to the pan-NMT inhibitor PCLX-001. PCLX-001 recently entered human clinical trials as once daily oral therapy for relapsed/refractory B-cell Non-Hodgkin Lymphoma and advanced solid malignances. Dysregulation and oncogenic activity of SFKs occurs frequently in AML, suggesting NMT inhibition could provide therapeutic benefit in this indication. Data analysis from the TCGA transcriptome database revealed that high NMT1 and low NMT2 were associated with reduced overall and event-free survival in adult AML. Moreover, high NMT1 - but not NMT2 - expression is associated with proliferative gene sets in AML cell lines. AML cell lines treated with PCLX-001 showed a significant reduction in total protein myristoylation, reduced levels of SFK proteins and SFK phosphorylation as well as significant increases in ER stress marker BIP protein and caspase 3 cleavage. PCLX-001 induced apoptosis in AML cell lines and patient blasts at concentrations that spared a large proportion of peripheral blood lymphocytes and monocytes from healthy individuals. PCLX-001 monotherapy had dose-dependent anticancer activity in an AML MV-4-11 cell line derived xenograft (CDX) and two AML patient derived xenografts (PDXs) and produced complete remissions in subcutaneous AML CDX. In tail-vein injected PDX models, PCLX-001 treatment resulted in up to 95% reduction of human CD45+ cells in peripheral blood and bone marrow. PCLX-001 preferentially targeted AML cells inducing apoptosis and reducing leukemic burden. These findings validate NMT inhibition as a novel therapeutic strategy for AML and warrant the evaluation of PCLX-001 in clinical trials for adult AML.
Citation Format: Jay Gamma, Aishwarya Iyer, Megan Yap, Zoulika Zak, Krista Vincent, Cassidy Ekstrom, Qiang Liu, Erwan Beauchamp, Lynne Postovit, Jean Wang, John R. Mackey, Naveen Pemmaraju, Gautam Borthakur, Joseph Brandwein, Luc Berthiaume. Targeting N-myristoylation for therapy of adult acute myeloid leukemia [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5662.
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Affiliation(s)
- Jay Gamma
- 1University of Alberta, Edmonton, Alberta, Canada
| | | | - Megan Yap
- 1University of Alberta, Edmonton, Alberta, Canada
| | - Zoulika Zak
- 1University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Qiang Liu
- 2University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Jean Wang
- 2University Health Network, University of Toronto, Toronto, Ontario, Canada
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Bozorgmehr N, Okoye I, Oyegbami O, Xu L, Fontaine A, Cox-Kennett N, Larratt LM, Hnatiuk M, Fagarasanu A, Brandwein J, Peters AC, Elahi S. Expanded antigen-experienced CD160 +CD8 +effector T cells exhibit impaired effector functions in chronic lymphocytic leukemia. J Immunother Cancer 2021; 9:jitc-2020-002189. [PMID: 33931471 PMCID: PMC8098955 DOI: 10.1136/jitc-2020-002189] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Accepted: 03/26/2021] [Indexed: 12/12/2022] Open
Abstract
Background T cell exhaustion compromises antitumor immunity, and a sustained elevation of co-inhibitory receptors is a hallmark of T cell exhaustion in solid tumors. Similarly, upregulation of co-inhibitory receptors has been reported in T cells in hematological cancers such as chronic lymphocytic leukemia (CLL). However, the role of CD160, a glycosylphosphatidylinositol-anchored protein, as one of these co-inhibitory receptors has been contradictory in T cell function. Therefore, we decided to elucidate how CD160 expression and/or co-expression with other co-inhibitory receptors influence T cell effector functions in patients with CLL. Methods We studied 56 patients with CLL and 25 age-matched and sex-matched healthy controls in this study. The expression of different co-inhibitory receptors was analyzed in T cells obtained from the peripheral blood or the bone marrow. Also, we quantified the properties of extracellular vesicles (EVs) in the plasma of patients with CLL versus healthy controls. Finally, we measured 29 different cytokines, chemokines or other biomarkers in the plasma specimens of patients with CLL and healthy controls. Results We found that CD160 was the most upregulated co-inhibitory receptor in patients with CLL. Its expression was associated with an exhausted T cell phenotype. CD160+CD8+ T cells were highly antigen-experienced/effector T cells, while CD160+CD4+ T cells were more heterogeneous. In particular, we identified EVs as a source of CD160 in the plasma of patients with CLL that can be taken up by T cells. Moreover, we observed a dominantly proinflammatory cytokine profile in the plasma of patients with CLL. In particular, interleukin-16 (IL-16) was highly elevated and correlated with the advanced clinical stage (Rai). Furthermore, we observed that the incubation of T cells with IL-16 results in the upregulation of CD160. Conclusions Our study provides a novel insight into the influence of CD160 expression/co-expression with other co-inhibitory receptors in T cell effector functions in patients with CLL. Besides, IL-16-mediated upregulation of CD160 expression in T cells highlights the importance of IL-16/CD160 as potential immunotherapy targets in patients with CLL. Therefore, our findings propose a significant role for CD160 in T cell exhaustion in patients with CLL.
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Affiliation(s)
- Najmeh Bozorgmehr
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Isobel Okoye
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Olaide Oyegbami
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Lai Xu
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Amelie Fontaine
- Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Nanette Cox-Kennett
- Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Loree M Larratt
- Division of Hematology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Mark Hnatiuk
- Division of Hematology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Andrei Fagarasanu
- Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Joseph Brandwein
- Division of Hematology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Anthea C Peters
- Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Shokrollah Elahi
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada .,Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Medical Microbiology and Immunology, Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
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9
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Whiteside S, Chin A, Tripathi G, Dharmani-Khan P, Markova M, Keslova P, Sedlacek P, Geddes MN, Lewis V, Modi M, Kalra A, Dabas R, Akhter A, Larratt L, van Slyke T, Brandwein J, Spellman SR, Leigh R, Daly A, Khan FM, Storek J. Curability and transferability of atopy with allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2020; 55:1282-1289. [PMID: 32231249 DOI: 10.1038/s41409-020-0876-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 03/07/2020] [Accepted: 03/16/2020] [Indexed: 12/29/2022]
Abstract
Atopy is excessive production of IgE in response to allergens. We evaluated in patients undergoing allogeneic hematopoietic cell transplantation (HCT) the following hypotheses: (1) Atopy is "curable" in atopic patients receiving HCT from a nonatopic donor (D-R+), and (2) Atopy is transferable from atopic donors to nonatopic recipients (D+R-). Atopic patients with atopic donors (D+R+) and non-atopic patients with non-atopic donors (D-R-) served as controls. We measured levels of multiallergen-specific IgE (A-IgE, atopy defined as ≥0.35 kUA/L) in sera from 54 patients and their donors pre HCT and from the patients at ≥2 years post HCT. Only 7/12 (58%) D- R+ patients became nonatopic after HCT. Only 1/11 (9%) D+R- patients became atopic. Eleven of 13 (85%) D-R- patients remained nonatopic. Unexpectedly, 11/18 (61%) D+R+ patients became nonatopic. In conclusion, contrary to our hypothesis and previous reports, the "cure" of atopy may occur in only some D-R+ patients and the transfer of atopy may occur rarely. The "cure" may not be necessarily due to the exchange of atopic for nonatopic immune system, as the "cure" may also occur in D+R+ patients.
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Affiliation(s)
| | - Alex Chin
- University of Calgary, Calgary, AB, Canada.,Alberta Public Laboratories, Calgary, AB, Canada
| | - Gaurav Tripathi
- University of Calgary, Calgary, AB, Canada.,Alberta Health Services, Calgary and Edmonton, AB, Canada
| | - Poonam Dharmani-Khan
- University of Calgary, Calgary, AB, Canada.,Alberta Health Services, Calgary and Edmonton, AB, Canada
| | - Marketa Markova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Petra Keslova
- 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Petr Sedlacek
- 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Michelle N Geddes
- University of Calgary, Calgary, AB, Canada.,Alberta Health Services, Calgary and Edmonton, AB, Canada
| | - Victor Lewis
- University of Calgary, Calgary, AB, Canada.,Alberta Health Services, Calgary and Edmonton, AB, Canada
| | | | - Amit Kalra
- University of Calgary, Calgary, AB, Canada
| | - Rosy Dabas
- University of Calgary, Calgary, AB, Canada
| | | | - Loree Larratt
- Alberta Health Services, Calgary and Edmonton, AB, Canada.,University of Alberta, Edmonton, AB, Canada
| | - Tiffany van Slyke
- Alberta Health Services, Calgary and Edmonton, AB, Canada.,University of Alberta, Edmonton, AB, Canada
| | - Joseph Brandwein
- Alberta Health Services, Calgary and Edmonton, AB, Canada.,University of Alberta, Edmonton, AB, Canada
| | - Stephen R Spellman
- Immunobiology Research, Center for International Blood and Marrow Transplant Research, Minneapolis, MN, USA
| | - Richard Leigh
- University of Calgary, Calgary, AB, Canada.,Alberta Health Services, Calgary and Edmonton, AB, Canada
| | - Andrew Daly
- University of Calgary, Calgary, AB, Canada.,Alberta Health Services, Calgary and Edmonton, AB, Canada
| | - Faisal M Khan
- University of Calgary, Calgary, AB, Canada.,Alberta Public Laboratories, Calgary, AB, Canada
| | - Jan Storek
- University of Calgary, Calgary, AB, Canada.,Alberta Health Services, Calgary and Edmonton, AB, Canada
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10
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England JT, Saini L, Hogge D, Forrest D, Narayanan S, Power M, Nevill T, Kuchenbauer F, Hudoba M, Szkotak A, Brandwein J, Sanford D. Day 14 Bone Marrow Evaluation During Acute Myeloid Leukemia Induction in a Real-world Canadian Cohort. Clin Lymphoma Myeloma Leuk 2020; 20:e427-e436. [PMID: 32201130 DOI: 10.1016/j.clml.2020.02.012] [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] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The 2017 National Comprehensive Cancer Network guidelines for acute myeloid leukemia have recommended performing bone marrow (BM) aspiration and BM trephine biopsy (BMTB) 14 to 21 days after starting induction therapy (commonly referred to as "day 14 [D14] marrow"). Those who do not achieve a hypoplastic marrow, with cellularity < 20% and blasts < 5%, are recommended to undergo 2-cycle induction (2CI). We performed a retrospective analysis to determine the impact of D14 BM characteristics in predicting for remission, association with overall survival (OS), and the effect of 2CI according to the D14 BM results. PATIENTS AND METHODS Patients aged 18 to 70 years undergoing induction therapy with standard "7 + 3" regimens were included. D14 cellularity was determined from BMTB samples and the blast percentage was assessed by morphology on BM aspiration and BMTB samples. The outcomes evaluated included the rates of complete remission (CR) and OS. RESULTS A total of 486 patients with results from D14 BM evaluation were included in the present study. On multivariate analysis, cytogenetic risk and D14 blasts < 5% were predictive of CR/CR with incomplete count recovery (P < .001). Cytogenetic risk (P < .001), age < 60 years (P = .001), and D14 blasts < 5% (P = .045) predicted for OS. 2CI was performed in 131 patients (27%). Patients with hypocellular D14 BM but residual blasts (n = 106) underwent 2CI in 46% of cases, with improved remission rates (43.9% vs. 72.0%; P = .004) but no difference in OS. CONCLUSIONS The results from D14 BM evaluations are predictive of subsequent remission and OS. Our findings did not show a survival benefit with D14 BM-driven 2CI.
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Affiliation(s)
- James T England
- Leukemia/Bone Marrow Transplant Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Lalit Saini
- Division of Hematology, Department of Medicine, Western University, London, ON, Canada
| | - Donna Hogge
- Leukemia/Bone Marrow Transplant Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Donna Forrest
- Leukemia/Bone Marrow Transplant Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Sujaatha Narayanan
- Leukemia/Bone Marrow Transplant Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Maryse Power
- Leukemia/Bone Marrow Transplant Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Thomas Nevill
- Leukemia/Bone Marrow Transplant Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Florian Kuchenbauer
- Leukemia/Bone Marrow Transplant Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Monika Hudoba
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Artur Szkotak
- Division of Hematology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Joseph Brandwein
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - David Sanford
- Leukemia/Bone Marrow Transplant Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
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11
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Valencia-Serna J, Kucharski C, Chen M, Kc R, Jiang X, Brandwein J, Uludağ H. siRNA-mediated BCR-ABL silencing in primary chronic myeloid leukemia cells using lipopolymers. J Control Release 2019; 310:141-154. [PMID: 31430499 DOI: 10.1016/j.jconrel.2019.08.018] [Citation(s) in RCA: 6] [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] [Received: 06/18/2019] [Accepted: 08/16/2019] [Indexed: 01/18/2023]
Abstract
Despite development of effective tyrosine kinase inhibitors for treatment of chronic myeloid leukemia (CML), some patients do not effectively respond to the therapy and can display resistance in response to the drug therapy. To develop an alternative approach to CML therapy, we are exploring siRNA mediated silencing of the primary CML oncogene, BCR-ABL, by using non-viral (polymeric) delivery systems. In this study, a group of lipopolymers derived from low molecular PEIs substituted with linoleic acid (LA), α-linolenic acid (αLA) and cholesterol (Chol) was investigated for the first time for siRNA delivery to CML primary samples. The delivery efficiency in primary cells was equivalent to CML K562 cell line, and the lipopolymers gave effective internalization of siRNA depending on the nature of lipid substituent. The PEI-αLA (2.5 αLA/PEI), PEI-Chol (2.2 Chol/PEI), and PEI-LA (2.6 LA/PEI) lipopolymers used as BCR-ABL siRNA carriers (at 60 nM siRNA) reduced the BCR-ABL mRNA expression by 17% to 45%, and inhibited the formation of colonies by 24% to 41% in comparison with control siRNA in mononuclear cells. BCR-ABL siRNA treatment reduced the BCR-ABL mRNA expression by 50% in one of two CD34+ samples tested, and combination of BCR-ABL siRNA with imatinib (IM) treatment decreased the colony formation by 65% in one of two samples evaluated. The fact that no single polymer was universally effective in all patient samples may suggest patient-to-patient variability in terms of therapeutic responses to siRNA therapy. These results showed that a low dose of BCR-ABL siRNA could be used with lipopolymers to reduce BCR-ABL mRNA expression, CML cell survival and colony formation. This proof of principle study in CML primary cells can be applied to silencing of other therapeutic targets besides BCR-ABL and a study with larger patient samples is warranted for better identification of effective siRNA carriers.
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Affiliation(s)
- Juliana Valencia-Serna
- Department of Biomedical Engineering, Faculty of Medicine & Dentistry, University of Alberta, AB, Canada.
| | - Cezary Kucharski
- Department of Chemical & Materials Engineering, Faculty of Engineering, University of Alberta, AB, Canada
| | - Min Chen
- Terry Fox Laboratory, British Columbia Cancer Agency, Department of Medical Genetics, Faculty of Medicine, University of British Columbia, BC, Canada
| | - Remant Kc
- Department of Chemical & Materials Engineering, Faculty of Engineering, University of Alberta, AB, Canada
| | - Xiaoyan Jiang
- Terry Fox Laboratory, British Columbia Cancer Agency, Department of Medical Genetics, Faculty of Medicine, University of British Columbia, BC, Canada
| | - Joseph Brandwein
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Hasan Uludağ
- Department of Biomedical Engineering, Faculty of Medicine & Dentistry, University of Alberta, AB, Canada; Department of Chemical & Materials Engineering, Faculty of Engineering, University of Alberta, AB, Canada; Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, AB, Canada.
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12
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Refaei M, Radhwi O, Sandhu I, Brandwein J, Sun HWL, Saini L. A strategy of Day14 bone marrows and early intervention is not superior to a strategy of noDay14 bone marrows and delayed intervention in patients with acute myeloid leukemia. Leuk Lymphoma 2019; 60:1749-1757. [PMID: 31043109 DOI: 10.1080/10428194.2018.1543878] [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
We conducted a retrospective study of 364 acute myeloid leukemia patients treated using a Day14 or a noDay14 strategy. Under the Day14 strategy, patients received an interim marrow at 7-10 days following chemotherapy and, in case of residual disease, received immediate reinduction chemotherapy. Under the noDay14 strategy patients were only evaluated at end-of-induction (EOI). Overall induction mortality was higher in the Day14 cohort (8.3 vs. 3.6%, p = .12) but rates of remission (75.4 vs. 83%, p = .13) and refractory disease (14.3 vs. 13.4%, p = .87) at EOI were similar in the Day14 and noDay14 cohorts as were relapse rates (37.9% vs. 34.3%, p = .616), median relapse-free survival (14.8 vs. 15 months, p = .658) and median overall survival (25.3 vs. 37.2 months, p = .264). In multivariate analysis, the use of a Day14 strategy did not impact outcomes suggesting that a Day14 strategy is not superior to a noDay14 strategy.
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Affiliation(s)
- Mohammad Refaei
- a Department of Medicine , University of Alberta , Edmonton , Canada
| | - Osman Radhwi
- a Department of Medicine , University of Alberta , Edmonton , Canada
| | - Irwindeep Sandhu
- a Department of Medicine , University of Alberta , Edmonton , Canada
| | - Joseph Brandwein
- a Department of Medicine , University of Alberta , Edmonton , Canada
| | - Hao Wei Linda Sun
- a Department of Medicine , University of Alberta , Edmonton , Canada
| | - Lalit Saini
- a Department of Medicine , University of Alberta , Edmonton , Canada
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13
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Saini L, Brandwein J, Szkotak A, Ghosh S, Sandhu I. Persistent cytogenetic abnormalities in patients undergoing intensive chemotherapy for acute myeloid leukemia. Leuk Lymphoma 2017; 59:121-128. [PMID: 28540755 DOI: 10.1080/10428194.2017.1326032] [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
We evaluated the impact of bone marrow sample characteristics on the detection of persistent cytogenetic abnormalities (PCA) following induction chemotherapy for acute myeloid leukemia (AML). PCA's were identified in 20.4% of patients and were more common with complete remission without count recovery (CRi) vs. those with count recovery (CR, 45.8 vs. 13.5%, p = .001), with >2% blasts vs. ≤2% blasts (42 vs. 12%, p = .001) and with hypocellular trephine biopsies relative to those with normo/hypercellular biopsies (42.1 vs. 17.3%, p = .03), although in a multivariate analysis only CRi and blast count >2% were independently associated with a PCA. PCA's were not observed in patients with favorable risk karyotype. Amongst patients with intermediate and unfavorable risk karyotypes PCA were not associated with differences in overall or, amongst non-transplanted patients, relapse free survival. Thus, although PCAs are common post-induction it is unclear whether they provide any independent prognostic information beyond the diagnostic karyotype.
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Affiliation(s)
- Lalit Saini
- a Department of Medicine , University of Alberta , Edmonton , Canada
| | - Joseph Brandwein
- a Department of Medicine , University of Alberta , Edmonton , Canada
| | - Artur Szkotak
- b Department of Laboratory Medicine and Pathology , University of Alberta , Edmonton , Canada
| | - Sunita Ghosh
- c Department of Medical Oncology , University of Alberta , Edmonton , Canada
| | - Irwindeep Sandhu
- a Department of Medicine , University of Alberta , Edmonton , Canada
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14
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Saini L, Brandwein J. New Treatment Strategies for Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia. Curr Hematol Malig Rep 2017; 12:136-142. [DOI: 10.1007/s11899-017-0372-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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15
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Reed GA, Schiller GJ, Kambhampati S, Tallman MS, Douer D, Minden MD, Yee KW, Gupta V, Brandwein J, Jitkova Y, Gronda M, Hurren R, Shamas-Din A, Schuh AC, Schimmer AD. A Phase 1 study of intravenous infusions of tigecycline in patients with acute myeloid leukemia. Cancer Med 2016; 5:3031-3040. [PMID: 27734609 PMCID: PMC5119957 DOI: 10.1002/cam4.845] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [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: 06/01/2016] [Revised: 06/07/2016] [Accepted: 07/08/2016] [Indexed: 01/27/2023] Open
Abstract
Acute myeloid leukemia (AML) cells meet the higher energy, metabolic, and signaling demands of the cell by increasing mitochondrial biogenesis and mitochondrial protein translation. Blocking mitochondrial protein synthesis through genetic and chemical approaches kills human AML cells at all stages of development in vitro and in vivo. Tigecycline is an antimicrobial that we found inhibits mitochondrial protein synthesis in AML cells. Therefore, we conducted a phase 1 dose‐escalation study of tigecycline administered intravenously daily 5 of 7 days for 2 weeks to patients with AML. A total of 27 adult patients with relapsed and refractory AML were enrolled in this study with 42 cycles being administered over seven dose levels (50–350 mg/day). Two patients experienced DLTs related to tigecycline at the 350 mg/day level resulting in a maximal tolerated dose of tigecycline of 300 mg as a once daily infusion. Pharmacokinetic experiments showed that tigecycline had a markedly shorter half‐life in these patients than reported for noncancer patients. No significant pharmacodynamic changes or clinical responses were observed. Thus, we have defined the safety of once daily tigecycline in patients with refractory AML. Future studies should focus on schedules of the drug that permit more sustained target inhibition.
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Affiliation(s)
| | - Gary J Schiller
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | - Martin S Tallman
- Leukemia Service, Department of Medicine, Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Dan Douer
- Leukemia Service, Department of Medicine, Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mark D Minden
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Karen W Yee
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Vikas Gupta
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Joseph Brandwein
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Yulia Jitkova
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Marcela Gronda
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Rose Hurren
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Aisha Shamas-Din
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Andre C Schuh
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Aaron D Schimmer
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
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16
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Refaei M, Fernandes B, Brandwein J, Goodyear MD, Pokhrel A, Wu C. Incidence of catheter-related thrombosis in acute leukemia patients: a comparative, retrospective study of the safety of peripherally inserted vs. centrally inserted central venous catheters. Ann Hematol 2016; 95:2057-2064. [PMID: 27542955 DOI: 10.1007/s00277-016-2798-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 08/09/2016] [Indexed: 11/29/2022]
Abstract
Central venous catheters are a leading cause of upper-extremity deep vein thrombosis. Concomitant severe thrombocytopenia makes anticoagulation for catheter-related thrombosis (CRT) in patients with acute leukemia (AL) a challenge. Incidence of CRT has been reported to be increased in those with peripherally inserted central catheters (PICC) vs. those with centrally inserted ones (CICC). Our objective is to compare the incidence rate of CRT in leukemia inpatients who received either a PICC vs. CICC. We retrospectively reviewed adult inpatients admitted to hematology wards with a new diagnosis of AL and who received either a PICC or a CICC. Baseline patient and catheter characteristics were recorded. Our primary outcome was the incidence rate of CRT in each group. The secondary outcomes included rates of infectious and mechanical complications. Six hundred sixty-three patients received at least one PICC (338) or CICC (325) insertion. A total of 1331 insertions were recorded, with 82 (11.7 %) and 41 (6.5 %) CRT in the PICC and CICC groups, respectively. The incidence rates were 1.89 and 0.52 per 1000 catheter day in the PICC and CICC groups, respectively. A PICC, when compared to CICC, was a significant risk factor for CRT (sHR 2.5, p < 0.0001). The prevalence and incidence rates of CRT in our AL patients were higher than predicted for a general cancer patient population. These rates were higher in the PICC group compared to the CICC group. We recommend careful consideration of thrombotic and bleeding risks of AL inpatients when choosing a central venous catheter.
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Affiliation(s)
- Mohammad Refaei
- Division of Internal Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Bruna Fernandes
- Department of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Joseph Brandwein
- Division of Hematology, Department of Medicine, University of Alberta, 4-112 Clinical Sciences Building, University of Alberta Hospital, 11350-83 Ave, Edmonton, Alberta, T6G2G3, Canada
| | - Marilyn Dawn Goodyear
- Division of Hematology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Arun Pokhrel
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Cynthia Wu
- Division of Hematology, Department of Medicine, University of Alberta, 4-112 Clinical Sciences Building, University of Alberta Hospital, 11350-83 Ave, Edmonton, Alberta, T6G2G3, Canada.
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17
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Timilshina N, Breunis H, Tomlinson G, Brandwein J, Alibhai SM. Do quality of life, physical function, or the Wheatley index at diagnosis predict 1-year mortality with intensive chemotherapy in older acute myeloid leukemia patients? Leuk Res 2016; 47:142-8. [DOI: 10.1016/j.leukres.2016.06.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 05/21/2016] [Accepted: 06/02/2016] [Indexed: 11/25/2022]
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18
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Yee KWL, Chen HWT, Hedley DW, Chow S, Brandwein J, Schuh AC, Schimmer AD, Gupta V, Sanfelice D, Johnson T, Le LW, Arnott J, Bray MR, Sidor C, Minden MD. A phase I trial of the aurora kinase inhibitor, ENMD-2076, in patients with relapsed or refractory acute myeloid leukemia or chronic myelomonocytic leukemia. Invest New Drugs 2016; 34:614-24. [PMID: 27406088 DOI: 10.1007/s10637-016-0375-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 07/04/2016] [Indexed: 01/07/2023]
Abstract
ENMD-2076 is a novel, orally-active molecule that inhibits Aurora A kinase, as well as c-Kit, FLT3 and VEGFR2. A phase I study was conducted to determine the maximum tolerated dose (MTD), recommended phase 2 dose (RP2D) and toxicities of ENMD-2076 in patients with acute myeloid leukemia (AML) and chronic myelomonocytic leukemia (CMML). Patients received escalating doses of ENMD-2076 administered orally daily [225 mg (n = 7), 375 mg (n = 6), 325 mg (n = 9), or 275 mg (n = 5)]. Twenty-seven patients were treated (26 AML; 1 CMML-2). The most common non-hematological toxicities of any grade, regardless of association with drug, were fatigue, diarrhea, dysphonia, dyspnea, hypertension, constipation, and abdominal pain. Dose-limiting toxicities (DLTs) consisted of grade 3 fatigue, grade 3 typhilitis, grade 3 syncope and grade 3 QTc prolongation). Of the 16 evaluable patients, one patient achieved a complete remission with incomplete count recovery (CRi), three experienced a morphologic leukemia-free state (MLFS) with a major hematologic improvement in platelets (HI-P), and 5 other patients had a reduction in marrow blast percentage (i.e. 11-65 %). The RP2D in this patient population is 225 mg orally once daily.
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Affiliation(s)
- Karen W L Yee
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON, M5G 2M9, Canada.
| | - Hsiao-Wei T Chen
- Ontario Cancer Institute, University of Toronto, Toronto, ON, Canada
| | - David W Hedley
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON, M5G 2M9, Canada.,Ontario Cancer Institute, University of Toronto, Toronto, ON, Canada
| | - Sue Chow
- Ontario Cancer Institute, University of Toronto, Toronto, ON, Canada
| | - Joseph Brandwein
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON, M5G 2M9, Canada.,Division of Clinical Hematology, University of Alberta, Edmonton, AB, Canada
| | - Andre C Schuh
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Aaron D Schimmer
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Vikas Gupta
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Deborah Sanfelice
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Tara Johnson
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Lisa W Le
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | | | - Mark D Minden
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
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19
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Saini L, Brandwein J, Turner R, Larratt L, Hamilton M, Peters A, Wu C, Zhu N, Patterson JM, Bolster L, Mant M, Ritchie B, Liew E, Ghosh S, Sandhu I. The fludarabine, cytarabine, and granulocyte colony-stimulating factor (FLAG) chemotherapy regimen is an alternative to anthracycline-based therapy for the treatment of acute myeloid leukemia for patients with pre-existing cardiac disease. Eur J Haematol 2016; 97:471-478. [PMID: 27028202 DOI: 10.1111/ejh.12757] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2016] [Indexed: 11/29/2022]
Abstract
We conducted a retrospective study assessing FLAG (fludarabine, cytarabine, and granulocyte colony-stimulating factor) as first-line treatment in 56 newly diagnosed acute myeloid leukemia patients considered ineligible for anthracycline-based treatment due to advanced age, significant comorbidities, or pre-existing cardiac disease. The median age was 69 (21-80); 46% received FLAG for pre-existing cardiac disease and others due to age (32%), non-cardiac comorbidities (20%), or previous anthracycline exposure (2%). The induction mortality was 16% and, among evaluable patients, 48% achieved a complete remission after the first induction course with an additional patient achieving a remission after a second course for a total complete remission rate of 50%. Four patients proceeded to an allogeneic stem cell transplant including two with pre-existing cardiac disease. Among non-transplanted patients, the relapse rate (RR) was 47%. When censored at time of stem cell transplant, the median relapse-free survival was 14.7 months. The median overall survival was 9.3 months with 1- and 2-yr survivals of 44% and 22%, respectively. There was no difference in clinical outcomes between patients treated with FLAG for cardiac reasons vs. other reasons. In conclusion, FLAG is a useful alternative to anthracycline-based induction for Acute myeloid leukemia in those with significant comorbidities including pre-existing cardiac disease.
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Affiliation(s)
- Lalit Saini
- Division of Hematology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
| | - Joseph Brandwein
- Division of Hematology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Robert Turner
- Division of Hematology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Loree Larratt
- Division of Hematology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Marlene Hamilton
- Division of Hematology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Anthea Peters
- Division of Hematology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Cynthia Wu
- Division of Hematology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Nancy Zhu
- Division of Hematology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Jeffery M Patterson
- Division of Hematology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Lauren Bolster
- Division of Hematology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Michael Mant
- Division of Hematology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Bruce Ritchie
- Division of Hematology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Elena Liew
- Division of Hematology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Sunita Ghosh
- Department of Medical Oncology, University of Alberta, Edmonton, AB, Canada
| | - Irwindeep Sandhu
- Division of Hematology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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20
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Saini L, Brandwein J, Turner R, Larratt L, Hamilton M, Peters A, Wu C, Zhu N, Taparia M, Patterson JM, Bolster L, Mant M, Ritchie B, Liew E, Mirza I, Quest G, Nahirniak S, Ghosh S, Sandhu I. Incremental value of the bone marrow trephine biopsy in detecting residual leukemia following treatment for Acute Myeloid Leukemia. Leuk Res 2016; 45:47-52. [PMID: 27092851 DOI: 10.1016/j.leukres.2016.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 03/29/2016] [Accepted: 04/07/2016] [Indexed: 11/25/2022]
Abstract
Most guidelines suggest that only the bone marrow aspirate (BMA) is necessary to assess residual disease following intensive chemotherapy for Acute Myeloid Leukemia (AML) with the bone marrow trephine biopsy (BMTB) recommended in cases of a poor quality BMA. We performed a retrospective study evaluating this in a cohort of patients receiving intensive chemotherapy for AML. Residual disease was assessed by morphological examination of the BMA and BMTB±immunohistochemistry. Of the 647 marrows 32.6% were interim marrows performed prior to peripheral count recovery, 41.7% were end of induction (EOI) marrows and the remaining were 'other marrows'. The BMA and BMTB findings were concordant in 92.8% of cases. The BMTB led to a change in diagnosis from 'no leukemia' to 'residual leukemia' in 5.2% of interim, 3.7% of EOI and 2.4% of 'other' marrows. The BMA alone had a sensitivity of 86.8% in detecting residual leukemia and of 82.3%, 82.5% and 94.2% for interim, EOI and 'other marrows', respectively. Despite the high concordance between the BMA and the BMTB the poor sensitivity of the BMA in detecting residual leukemia, particularly at EOI, may lead to an overestimation of the complete remission rates which may have therapeutic and clinical trial implications.
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Affiliation(s)
- Lalit Saini
- Department of Medicine, University of Alberta, 116 St. & 85 Ave, Edmonton, AB, Canada T6G 2R3, Canada.
| | - Joseph Brandwein
- Department of Medicine, University of Alberta, 116 St. & 85 Ave, Edmonton, AB, Canada T6G 2R3, Canada.
| | - Robert Turner
- Department of Medicine, University of Alberta, 116 St. & 85 Ave, Edmonton, AB, Canada T6G 2R3, Canada.
| | - Loree Larratt
- Department of Medicine, University of Alberta, 116 St. & 85 Ave, Edmonton, AB, Canada T6G 2R3, Canada.
| | - Marlene Hamilton
- Department of Medicine, University of Alberta, 116 St. & 85 Ave, Edmonton, AB, Canada T6G 2R3, Canada.
| | - Anthea Peters
- Department of Medicine, University of Alberta, 116 St. & 85 Ave, Edmonton, AB, Canada T6G 2R3, Canada.
| | - Cynthia Wu
- Department of Medicine, University of Alberta, 116 St. & 85 Ave, Edmonton, AB, Canada T6G 2R3, Canada.
| | - Nancy Zhu
- Department of Medicine, University of Alberta, 116 St. & 85 Ave, Edmonton, AB, Canada T6G 2R3, Canada.
| | - Minakshi Taparia
- Department of Medicine, University of Alberta, 116 St. & 85 Ave, Edmonton, AB, Canada T6G 2R3, Canada.
| | - Jeffery M Patterson
- Department of Medicine, University of Alberta, 116 St. & 85 Ave, Edmonton, AB, Canada T6G 2R3, Canada.
| | - Lauren Bolster
- Department of Medicine, University of Alberta, 116 St. & 85 Ave, Edmonton, AB, Canada T6G 2R3, Canada.
| | - Michael Mant
- Department of Medicine, University of Alberta, 116 St. & 85 Ave, Edmonton, AB, Canada T6G 2R3, Canada.
| | - Bruce Ritchie
- Department of Medicine, University of Alberta, 116 St. & 85 Ave, Edmonton, AB, Canada T6G 2R3, Canada.
| | - Elena Liew
- Department of Medicine, University of Alberta, 116 St. & 85 Ave, Edmonton, AB, Canada T6G 2R3, Canada.
| | - Imran Mirza
- Pathology & Laboratory Medicine Institute, Cleveland Clinic Abu Dhabi, Al-Maryah Island, P.O. BOX 112412, Abu Dhabi, UAE.
| | - Graeme Quest
- Department of Laboratory Medicine and Pathology, University of Alberta, 4B1.22 Walter Mackenzie Centre, 8440 112 Street, Edmonton, AB, Canada T6G 2B7, Canada.
| | - Susan Nahirniak
- Department of Laboratory Medicine and Pathology, University of Alberta, 4B1.22 Walter Mackenzie Centre, 8440 112 Street, Edmonton, AB, Canada T6G 2B7, Canada.
| | - Sunita Ghosh
- Department of Medical Oncology, University of Alberta, 116 St. & 85 Ave, Edmonton, AB, Canada T6G 2R3, Canada.
| | - Irwindeep Sandhu
- Department of Medicine, University of Alberta, 116 St. & 85 Ave, Edmonton, AB, Canada T6G 2R3, Canada.
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21
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How J, Minden MD, Brian L, Chen EX, Brandwein J, Schuh AC, Schimmer AD, Gupta V, Webster S, Degelder T, Haines P, Stayner LA, McGill S, Wang L, Piekarz R, Wong T, Siu LL, Espinoza-Delgado I, Holleran JL, Egorin MJ, Yee KWL. A phase I trial of two sequence-specific schedules of decitabine and vorinostat in patients with acute myeloid leukemia. Leuk Lymphoma 2015; 56:2793-802. [PMID: 25682963 PMCID: PMC4688006 DOI: 10.3109/10428194.2015.1018248] [Citation(s) in RCA: 27] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This phase I trial evaluated two schedules of escalating vorinostat in combination with decitabine every 28 days: (i) sequential or (ii) concurrent. There were three dose-limiting toxicities: grade 3 fatigue and generalized muscle weakness on the sequential schedule (n = 1) and grade 3 fatigue on the concurrent schedule (n = 2). The maximum tolerated dose was not reached on both planned schedules. The overall response rate (ORR) was 23% (three complete response [CR], two CR with incomplete incomplete blood count recovery [CRi], one partial response [PR] and two morphological leukemic free state [MLFS]). The ORR for all and previously untreated patients in the sequential arm was 13% (one CRi; one MLFS) and 0% compared to 30% (three CR; one CRi; one PR; one MLFS) and 36% in the concurrent arm (p = 0.26 for both), respectively. Decitabine plus vorinostat was safe and has clinical activity in patients with previously untreated acute myeloid leukemia. Responses appear higher with the concurrent dose schedule. Cumulative toxicities may limit long-term usage on the current dose/schedules.
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Affiliation(s)
- Jonathan How
- a Princess Margaret Phase I Consortium , Toronto , ON , Canada
| | - Mark D Minden
- a Princess Margaret Phase I Consortium , Toronto , ON , Canada
| | - Leber Brian
- a Princess Margaret Phase I Consortium , Toronto , ON , Canada
| | - Eric X Chen
- a Princess Margaret Phase I Consortium , Toronto , ON , Canada
| | | | - Andre C Schuh
- a Princess Margaret Phase I Consortium , Toronto , ON , Canada
| | | | - Vikas Gupta
- a Princess Margaret Phase I Consortium , Toronto , ON , Canada
| | - Sheila Webster
- a Princess Margaret Phase I Consortium , Toronto , ON , Canada
| | - Tammy Degelder
- a Princess Margaret Phase I Consortium , Toronto , ON , Canada
| | - Patricia Haines
- a Princess Margaret Phase I Consortium , Toronto , ON , Canada
| | | | - Shauna McGill
- a Princess Margaret Phase I Consortium , Toronto , ON , Canada
| | - Lisa Wang
- a Princess Margaret Phase I Consortium , Toronto , ON , Canada
| | - Richard Piekarz
- b Investigational Drug Branch, Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute , Bethesda , MD , USA
| | - Tracy Wong
- a Princess Margaret Phase I Consortium , Toronto , ON , Canada
| | - Lillian L Siu
- a Princess Margaret Phase I Consortium , Toronto , ON , Canada
| | - Igor Espinoza-Delgado
- b Investigational Drug Branch, Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute , Bethesda , MD , USA
| | - Julianne L Holleran
- c Departments of Medicine and Pharmacology and Cancer Institute , University of Pittsburgh , Pittsburgh , PA , USA
| | - Merrill J Egorin
- c Departments of Medicine and Pharmacology and Cancer Institute , University of Pittsburgh , Pittsburgh , PA , USA
| | - Karen W L Yee
- a Princess Margaret Phase I Consortium , Toronto , ON , Canada
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22
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Othus M, Appelbaum FR, Petersdorf SH, Kopecky KJ, Slovak M, Nevill T, Brandwein J, Larson RA, Stiff PJ, Walter RB, Tallman MS, Stenke L, Erba HP. Fate of patients with newly diagnosed acute myeloid leukemia who fail primary induction therapy. Biol Blood Marrow Transplant 2014; 21:559-64. [PMID: 25536215 DOI: 10.1016/j.bbmt.2014.10.025] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [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: 10/03/2014] [Accepted: 10/28/2014] [Indexed: 11/30/2022]
Abstract
The aim of this study was to describe the fate of patients with newly diagnosed acute myeloid leukemia (AML) who did not achieve an initial remission while being treated on a contemporary cooperative group trial. We analyzed the outcome of patients entered into S0106, a recently reported cooperative group trial for patients with newly diagnosed AML. A total of 589 eligible patients was treated, of whom 150 (25%) did not achieve a remission while on study and were available for further analysis. The 4-year survival rate for the entire cohort of 150 patients was 23%. Among the 64 patients who received an allogeneic hematopoietic cell transplant, the 4-year survival rate was 48% compared with 4% for the 86 patients who did not undergo transplantation. Among those transplanted, we could not detect a difference in outcome according to remission status, donor source, type of preparative regimen, or cytogenetic risk category. More than 20% of patients with newly diagnosed AML who fail induction therapy can still be cured, particularly if they are able to receive an allogeneic hematopoietic cell transplant. These results suggest that early HLA typing and donor identification are important components of the initial therapy of AML.
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Affiliation(s)
- Megan Othus
- Public Health Sciences, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Frederick R Appelbaum
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
| | | | - Kenneth J Kopecky
- Public Health Sciences, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Public Health Sciences, SWOG Statistical Center, Seattle, Washington
| | | | - Thomas Nevill
- Haematology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Richard A Larson
- Hematologic Malignancies, University of Chicago, Chicago, Illinois
| | - Patrick J Stiff
- Hematology/Oncology, Loyola University Medical Center, Maywood, Illinois
| | - Roland B Walter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Leif Stenke
- Karolinska University Hospital, Stockholm, Sweden
| | - Harry P Erba
- University of Alabama at Birmingham, Birmingham, Alabama
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23
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Patterson JM, Bolster L, Larratt L, Hamilton M, Brandwein J. Very late relapse of Philadelphia chromosome positive acute megakaryoblastic leukemia. Leuk Lymphoma 2014; 56:2203-5. [PMID: 25495169 DOI: 10.3109/10428194.2014.994178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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24
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Kuo KHM, Callum JL, Panzarella T, Jacks LM, Brandwein J, Crump M, Curtis JE, Gupta V, Lipton JH, Minden MD, Sher GD, Schimmer AD, Schuh AC, Yee KWL, Keating A, Messner HA. A retrospective observational study of leucoreductive strategies to manage patients with acute myeloid leukaemia presenting with hyperleucocytosis. Br J Haematol 2014; 168:384-94. [DOI: 10.1111/bjh.13146] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Accepted: 07/13/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Kevin H. M. Kuo
- Division of Medical Oncology and Hematology; Princess Margaret Hospital; University Health Network; Toronto ON Canada
| | - Jeannie L. Callum
- Department of Clinical Pathology; Sunnybrook Health Sciences Centre; Toronto ON Canada
| | - Tony Panzarella
- Biostatistics Department; Princess Margaret Hospital; Toronto ON Canada
| | - Lindsay M. Jacks
- ErinoakKids Centre for Treatment and Development; Mississauga ON Canada
| | - Joseph Brandwein
- Division of Hematology; Department of Medicine; University of Alberta; Edmonton AB Canada
| | - Michael Crump
- Division of Medical Oncology and Hematology; Princess Margaret Hospital; University Health Network; Toronto ON Canada
| | - John E. Curtis
- London Regional Cancer Program; London Health Sciences Centre; London Canada
| | - Vikas Gupta
- Division of Medical Oncology and Hematology; Princess Margaret Hospital; University Health Network; Toronto ON Canada
| | - Jeffrey H. Lipton
- Division of Medical Oncology and Hematology; Princess Margaret Hospital; University Health Network; Toronto ON Canada
| | - Mark D. Minden
- Division of Medical Oncology and Hematology; Princess Margaret Hospital; University Health Network; Toronto ON Canada
| | | | - Aaron D. Schimmer
- Division of Medical Oncology and Hematology; Princess Margaret Hospital; University Health Network; Toronto ON Canada
| | - Andre C. Schuh
- Division of Medical Oncology and Hematology; Princess Margaret Hospital; University Health Network; Toronto ON Canada
| | - Karen W. L. Yee
- Division of Medical Oncology and Hematology; Princess Margaret Hospital; University Health Network; Toronto ON Canada
| | - Armand Keating
- Division of Medical Oncology and Hematology; Princess Margaret Hospital; University Health Network; Toronto ON Canada
| | - Hans A. Messner
- Division of Medical Oncology and Hematology; Princess Margaret Hospital; University Health Network; Toronto ON Canada
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25
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Yee KWL, Brandwein J, Schimmer AD, Gupta V, Del Bel R, Xu W, Minden MD, Schuh AC. Salvage induction chemotherapy after azacitdine treatment failure in patients who received azacitidine as a bridge to allogeneic stem cell transplantation. Br J Haematol 2014; 166:303-6. [PMID: 24650042 DOI: 10.1111/bjh.12844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 02/05/2014] [Indexed: 12/20/2022]
Affiliation(s)
- Karen W L Yee
- Division Medical Oncology & Haematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
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26
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Dang H, Chen Y, Kamel-Reid S, Brandwein J, Chang H. CD34 expression predicts an adverse outcome in patients with NPM1-positive acute myeloid leukemia. Hum Pathol 2013; 44:2038-46. [PMID: 23701943 DOI: 10.1016/j.humpath.2013.03.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 03/16/2013] [Accepted: 03/20/2013] [Indexed: 11/15/2022]
Abstract
Patients with acute myeloid leukemia (AML) harboring an NPM1 mutation exhibit a heterogeneous clinical outcome. Recent studies have shown that the absence of FLT3 internal tandem duplication (FLT3-ITD) mutation confers a favorable prognosis in NPM1-positive AML. However, the prognostic impact of immunophenotypes in this subgroup remains unclear. In this study, FLT3 mutation status and immunophenotypic profile of 85 NPM1-positive patients with de novo AML were retrospectively analyzed and correlated with their clinical features and survival outcomes. Univariate analysis detected 5 markers with prognostic relevance: older age (≥60 years), high white blood cell (WBC) count (>30 × 10(9)/L), FLT3-ITD, CD7, and CD34 expression. Multivariate analysis showed that high WBC count was the only independent predictor of a lower complete remission rate (P = .019). Older age (P = .035), high WBC count (P = .008), FLT3-ITD (P = .012), and CD34 expression (P = .006) were independent predictors of a shorter event-free survival (EFS). High WBC count (P = .014), FLT3-ITD (P = .005), and CD34 expression (P = .047) were independent predictors of a shorter overall survival (OS). Furthermore, based on FLT3-ITD status in NPM1 mutation-positive patients, we showed that both high WBC and CD34 expression conferred a poor EFS (P = .010 and P = .016, respectively) and OS (P = .032 and P = .001, respectively) in the FLT3-ITD-negative group, whereas high WBC predicted a poor EFS (P = .016) and OS (P = .027) in the FLT3-ITD-positive group. Our results confirm the prognostic value of assessing FLT3-ITD mutations in NPM1-positive AML and identify the adverse prognostic impact of high WBC and CD34 expression in this subgroup of AML.
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Affiliation(s)
- Harry Dang
- Department of Laboratory Hematology, University Health Network, Toronto, Ontario, Canada M5G 2C4; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada M5S 1A1
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27
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Alibhai SM, Breunis H, Timilshina N, Minden MD, Gupta V, Buckstein R, Li M, Tomlinson GA, Brandwein J. Quality of life (QOL) and physical function in one-year adult and elderly survivors of acute myeloid leukemia (AML). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.7071] [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] [Indexed: 11/20/2022] Open
Abstract
7071 Background: The treatment of AML with intensive chemotherapy (IC) is associated with significant short-term toxicities. We previously showed similar impairments in QOL and physical function among younger (age 18-59) and older (age 60+) patients with AML at diagnosis, with similar recovery over 3 cycles of IC. We now comprehensively describe QOL and physical function recovery over 1 year from diagnosis. Methods: Younger and older AML patients undergoing IC without stem cell transplant were enrolled in a prospective, longitudinal study. Assessments were done at baseline (pre-IC) and at 7 time points over the next year. At each visit, patients completed the EORTC QLQ-C30 and the FACT-Fatigue to measure QOL and fatigue, respectively, in addition to 3 physical function tests (grip strength, 2-minute walk test (2MWT), and timed chair stands). Analyses involved multivariable linear regression analyses stratified by age group. Results: 243 patients were recruited (147 younger and 96 older, 56% male). Attrition was greater in older adults due to death or disease progression/relapse. Among patients remaining in remission after IC, global QOL and fatigue improved significantly over time (p<0.001 for both); trends were similar between older and younger patients. All 5 QOL domains improved or remained stable over time; the greatest improvements were seen in social function and role function and were similar in both age groups. Grip strength increased slightly over time (p=0.04) whereas both timed chair stands (p<0.001) and the 2MWT (p<0.001) had moderate to large improvements, with trends toward greater improvement in younger patients (p=0.07 and 0.09, respectively). Results were similar when missing data were imputed. Conclusions: Survivors of AML after successful conventional chemotherapy achieve significant improvements in QOL, fatigue, and physical function over time. The course of recovery is remarkably similar in younger and older AML patients, although significant attrition in older adults is a noteworthy limitation. These data suggest that appropriately selected older patients do well following IC for AML.
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Affiliation(s)
| | | | | | | | - Vikas Gupta
- Princess Margaret Cancer Center, Toronto, ON, Canada
| | | | - Madeline Li
- University Health Network, Toronto, ON, Canada
| | | | - Joseph Brandwein
- Princess Margaret Hospital, University Health Network, Toronto, ON, Canada
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28
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Timilshina N, Breunis H, Brandwein J, Minden MD, Gupta V, Li M, Tomlinson GA, Buckstein R, Alibhai SM. Do quality of life and physical function at diagnosis predict short-term outcomes during intensive chemotherapy in acute myeloid leukemia patients? J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.7067] [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] [Indexed: 11/20/2022] Open
Abstract
7067 Background: Intensive chemotherapy (IC) used to treat acute myeloid leukemia (AML) is associated with multiple short-term toxicities including mortality, particularly in older adults. Emerging data suggest that baseline quality of life (QOL) assessment and/or objective physical function tests may predict outcomes in oncology, although there are no data in AML patients. We investigated the association between baseline QOL and physical function with short-term treatment outcomes in adult and elderly AML patients. Methods: We conducted a prospective, longitudinal study of adult (age 18+) AML patients undergoing IC. Prior to starting IC, patients completed the EORTC QLQ-C30 and FACT-Fatigue in addition to physical function tests (grip strength, timed chair stands, and 2-minute walk test). Outcomes included 60-day mortality, intensive care unit (ICU) admission, and achievement of complete remission (CR). Univariate and multivariable logistic regression were performed to evaluate each outcome. Results: Of the 243 patients (median age 57.5 y), 56.7% were male and median Charlson comorbidity score was 0. 60-day mortality, ICU admission, and CR occurred in 9 (3.4%), 15 (6.2%), and 171 (70.4%), respectively. In univariate regressions, neither QOL nor physical function tests were predictive of 60-day mortality (all P>0.05), whereas cytogenetic risk group (P=0.04), ICU admission (P=<0.001), and remission status at 30 days (P=0.006) were. Fatigue was a significant predictor of ICU admission (p=0.02) whereas QOL and baseline physical function were not significant predictors. In univariate analyses, higher Charlson score was found to be a significant predictor of both ICU admission (P=0.01) and remission status at 30 days (P=0.002). Cytogenetic risk group was correlated with achievement of CR whereas neither QOL nor physical function were predictive (all P>0.05). Findings were similar when the subset of 96 elderly patients (age 60+) were examined. Conclusions: Baseline QOL and physical function tests in this prospective study were not associated with short-term mortality, ICU admission, or achievement of CR after the 1st cycle of chemotherapy.
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Affiliation(s)
| | | | - Joseph Brandwein
- Princess Margaret Hospital, University Health Network, Toronto, ON, Canada
| | | | - Vikas Gupta
- Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Madeline Li
- University Health Network, Toronto, ON, Canada
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29
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Yee KWL, Brandwein J, Schimmer AD, Gupta V, Minden MD, Schuh AC. The role of salvage induction chemotherapy after azacitidine (AZA) treatment failure. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.7078] [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] [Indexed: 11/20/2022] Open
Abstract
7078 Background: Hypomethylating agents (HMA) such as AZA, are considered standard of care for patients (pts) with IPSS Int-2 or High-risk MDS. These agents are not curative. Many centers have used HMAs as a bridge to alloSCT in pts with MDS in an attempt to reduce tumor burden and prolong time to progression to AML. However, pts are at risk of AZA treatment failure, which may delay or prevent subsequent alloSCT. Recent data have demonstrated poor responses to intensive chemotherapy after AZA failure [ORR of 0% (0 of 4 pts) to 14% (3 of 22 pts) (J Clin Oncol 2011; Br J Haematol 2012)]. Methods: This retrospective analysis evaluates the outcomes of 18 pts with MDS, CMML and AML, who failed AZA therapy, and subsequently received induction chemotherapy at the Princess Margaret between July 2009 and December 2012. Results: Median age was 57.7 y (range, 19 - 75 y); only 1 pt was > 70 y. 56% were male. Of the 18 pts, 83% were treated for MDS, 6% CMML-2, and 11% AML. IPSS was Int-2/High-risk in 16 pts and Int-1 risk in 2 pts. 83% of pts had been treated with AZA as first-line therapy. Two pts had received growth factors & 1 pt hydroxyurea prior to AZA. Median number of AZA cycles administered was 5.5 (range, 1 - 18) with 72% of pts receiving < 6 cycles. Eleven (61%) pts had primary AZA failure, 5 (28%) secondary AZA failure, and 2 (11%) were taken off AZA to receive induction chemotherapy as an HLA-identical donor was found. At the time of induction chemotherapy, 15 pts had s/tAML, 2 RAEB-2 and 1 CMML-2. Cytogenetic risk was intermediate in 4 and poor in 11 pts, respectively. Karyotype analysis was not done or inconclusive in 3 pts. ORR was 44% and 37.5% in all pts and in AZA failures only, respectively. CR rate was 22% and 25%, CRi 27% and 12.5%, and MLFS 6% and 0% in all pts and in AZA failures only, respectively. Four pts died during induction. Four of 8 responders received an alloSCT, with the remaining 4 pts relapsing (3 while awaiting an alloSCT). Median F/U of all pts was 12.6 mos, with a median OS of 8.3 mos. Conclusions: Contrary to prior reports, salvage induction chemotherapy can yield responses in a significant number of pts who have failed AZA therapy. However, response duration and OS remain poor for AZA treatment failures. There is an unmet need for novel therapeutic agents in this group of patients.
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Affiliation(s)
| | | | | | - Vikas Gupta
- The Princess Margaret Cancer Centre, Toronto, ON, Canada
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30
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Dang H, Jiang A, Kamel-Reid S, Brandwein J, Chang H. Prognostic value of immunophenotyping and gene mutations in elderly patients with acute myeloid leukemia with normal karyotype. Hum Pathol 2013; 44:55-61. [DOI: 10.1016/j.humpath.2012.04.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 04/12/2012] [Accepted: 04/13/2012] [Indexed: 10/28/2022]
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31
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Minnema BJ, Husain S, Mazzulli T, Hosseini-Mogaddam SM, Patel M, Brandwein J, Reece D, Lipton JH, Rotstein C. Clinical characteristics and outcome associated with pandemic (2009) H1N1 influenza infection in patients with hematologic malignancies: a retrospective cohort study. Leuk Lymphoma 2012; 54:1250-5. [PMID: 23072372 DOI: 10.3109/10428194.2012.740558] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Pandemic H1N1 (pH1N1) influenza has been associated with a worldwide outbreak of febrile respiratory illness. Although impaired immunity, such as that caused by hematologic malignancy, has been identified as a risk factor for severe infection with this virus, the course of this infection has not been adequately characterized in patients with underlying hematologic malignancy in comparison with immune competent controls. We report our experience with severe pH1N1 infection in patients with hematologic cancers and compare this group to non-immunosuppressed patients. Data were retrospectively collected on all patients admitted to our institution with confirmed pH1N1 infection. Clinical characteristics, treatments and outcomes were compared between patients with hematologic malignancies and non-immunocompromised controls. Fifteen patients with hematologic malignancy and 49 controls were identified. The control group had higher baseline rates of asthma (p = 0.01) and smoking (p = 0.05) at baseline. Clinical features of infection in the two groups were similar, except for a higher prevalence of abnormalities on chest imaging in the group with malignancy (p = 0.05). No statistically significant difference in mortality was observed between the groups. Mean duration of hospitalization (22.1 days vs. 9.2 days, p = 0.04) and duration of antiviral treatment (9.9 days vs. 6.7 days, p < 0.05) were greater in the hematologic malignancy group. Hospitalized patients with hematologic malignancies with pH1N1 infection had greater durations of hospitalization and treatment than non-immunocompromised controls, possibly reflecting decreased clearance of the virus as a consequence of impaired immunity.
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Affiliation(s)
- Brian J Minnema
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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32
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Macdonald DA, Assouline SE, Brandwein J, Kamel-Reid S, Eisenhauer EA, Couban S, Caplan S, Foo A, Walsh W, Leber B. A phase I/II study of sorafenib in combination with low dose cytarabine in elderly patients with acute myeloid leukemia or high-risk myelodysplastic syndrome from the National Cancer Institute of Canada Clinical Trials Group: trial IND.186. Leuk Lymphoma 2012; 54:760-6. [PMID: 23061485 DOI: 10.3109/10428194.2012.737917] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Sorafenib is active in patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). The National Cancer Institute of Canada (NCIC) Clinical Trials Group initiated a phase I/II study of the combination of sorafenib with cytarabine in older patients with AML or high-risk MDS who were unsuitable for intensive chemotherapy. FLT3 mutational status was determined in all patients. Twenty-one patients were enrolled (four MDS, 17 AML) with a median age of 77 years. The recommended phase II dose (RP2D) was cytarabine 10 mg bid days 1-10 and sorafenib 600 mg/day days 2-28. Dose-limiting toxicities were fatigue, sepsis and skin rash. Of 15 evaluable patients treated at the RP2D, two patients responded. The overall response rate for eligible patients was 10%. FLT3 mutations were found in only three patients. We conclude that this combination of sorafenib and cytarabine has limited activity in this unselected cohort of elderly patients with AML/MDS in which FLT3 mutations seemed underrepresented.
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Chen MH, Atenafu E, Craddock KJ, Brandwein J, Chang H. CD11b expression correlates with monosomal karyotype and predicts an extremely poor prognosis in cytogenetically unfavorable acute myeloid leukemia. Leuk Res 2012; 37:122-8. [PMID: 23092917 DOI: 10.1016/j.leukres.2012.09.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 09/17/2012] [Accepted: 09/23/2012] [Indexed: 11/19/2022]
Abstract
Several cytogenetic features, including monosomal karyotype (MK), have been associated with unfavorable prognosis in acute myeloid leukemia (AML). However, little is known about the prognostic significance of immunophenotypes in AML patients with unfavorable-risk cytogenetics. We evaluated immunophenotypes, cytogenetics, clinical features and survival outcomes in 233 uniformly treated AML patients who harbored unfavorable cytogenetics. CD11b expression was observed in 145 (70%) of 208 patients and emerged as an independent prognostic factor for inferior overall survival in multivariate analysis (p=0.024). MK and age ≥ 60 years were predictors for lower complete remission rate (p=0.017, p<0.0001, respectively) and shorter overall survival (p=0.024, p<0.0001), while complex karyotype (CK) predicted a shorter overall survival (p=0.013). CD11b expression was strongly correlated with MK and identified a subset of patients with MK who had extremely poor overall survival. We proposed a prognostic scoring model using CD11b positivity, age ≥ 60 years, the presence of MK and the presence of CK to classify the patients into distinct risk groups. We identified the poor prognosis of CD11b expression and validated the adverse influence of MK, CK and age ≥ 60 years in cytogenetically unfavorable AML patients. Our proposed scoring model may be adapted in clinical practice to further the stratification of this high-risk population.
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Affiliation(s)
- Mei-Hsi Chen
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
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34
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Schimmer AD, Jitkova Y, Gronda M, Wang Z, Brandwein J, Chen C, Gupta V, Schuh A, Yee K, Chen J, Ackloo S, Booth T, Keays S, Minden MD. A phase I study of the metal ionophore clioquinol in patients with advanced hematologic malignancies. Clin Lymphoma Myeloma Leuk 2012; 12:330-6. [PMID: 22683301 DOI: 10.1016/j.clml.2012.05.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 04/16/2012] [Accepted: 05/03/2012] [Indexed: 11/25/2022]
Abstract
UNLABELLED Clioquinol is a small-molecule metal ionophore that inhibits the proteasome through a metal-dependent mechanism. Here, we report a phase I study of clioquinol in patients with refractory hematologic malignancies. Neuropathy and abdominal pain were dose-limiting toxicities. Minimal pharmacodynamic effects were observed, and there were no clinical responses. BACKGROUND Clioquinol is a small-molecule metal ionophore that inhibits the enzymatic activity of the proteasome and displays preclinical efficacy in hematologic malignancies in vitro and in vivo. Therefore, we conducted a phase I clinical trial of clioquinol in patients with refractory hematologic malignancies to assess its safety and determine its biological activity in this patient population. METHODS Patients with refractory hematologic malignancies were treated with increasing doses of oral clioquinol twice daily for 15 doses. Plasma and intracellular levels of clioquinol were measured. Enzymatic activity of the proteasome was measured before and after drug administration. RESULTS Sixteen cycles of clioquinol were administered to 11 patients with 5 patients reenrolled at the next dose level as per the permitted intrapatient dose escalation. Dose-limiting neurotoxicity and abdominal pain were observed at a dose of 1600 mg twice daily. Intracellular drug levels were low. Minimal inhibition of the proteasome was observed. No clinical responses were observed. CONCLUSION In patients with refractory hematologic malignancies, the maximal tolerated dose of clioquinol was determined. Minimal inhibition of the proteasome was observed at tolerable doses, likely due to low intracellular levels of the drug.
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Affiliation(s)
- Aaron D Schimmer
- Princess Margaret Hospital, Ontario Cancer Institute, Toronto, Ontario, Canada.
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35
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Rodin G, Yuen D, Mischitelle A, Minden MD, Brandwein J, Schimmer A, Marmar C, Gagliese L, Lo C, Rydall A, Zimmermann C. Traumatic stress in acute leukemia. Psychooncology 2011; 22:299-307. [PMID: 22081505 DOI: 10.1002/pon.2092] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 10/05/2011] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Acute leukemia is a condition with an acute onset that is associated with considerable morbidity and mortality. However, the psychological impact of this life-threatening condition and its intensive treatment has not been systematically examined. In the present study, we investigate the prevalence and correlates of post-traumatic stress symptoms in this population. METHODS Patients with acute myeloid, lymphocytic, and promyelocytic leukemia who were newly diagnosed, recently relapsed, or treatment failures were recruited at a comprehensive cancer center in Toronto, Canada. Participants completed the Stanford Acute Stress Reaction Questionnaire, Memorial Symptom Assessment Scale, CARES Medical Interaction Subscale, and other psychosocial measures. A multivariate regression analysis was used to assess independent predictors of post-traumatic stress symptoms. RESULTS Of the 205 participants, 58% were male, mean age was 50.1 ± 15.4 years, 86% were recently diagnosed, and 94% were receiving active treatment. The mean Stanford Acute Stress Reaction Questionnaire score was 30.2 ± 22.5, with 27 of 200 (14%) patients meeting criteria for acute stress disorder and 36 (18%) for subsyndromal acute stress disorder. Post-traumatic stress symptoms were associated with more physical symptoms, physical symptom distress, attachment anxiety, and perceived difficulty communicating with health-care providers, and poorer spiritual well-being (all p < 0.05). CONCLUSIONS The present study demonstrates that clinically significant symptoms of traumatic stress are common in acute leukemia and are linked to the degree of physical suffering, to satisfaction with relationships with health-care providers, and with individual psychological characteristics. Longitudinal study is needed to determine the natural history, but these findings suggest that intervention may be indicated to alleviate or prevent traumatic stress in this population.
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Affiliation(s)
- Gary Rodin
- Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Canada.
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36
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O'Neill S, Fisher-Schlombs K, Breunis H, Culos-Reed SN, Klepin HD, Brandwein J, Tomlinson GA, Alibhai SMH. A pilot study of an exercise intervention for AML patients undergoing induction chemotherapy. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e19555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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37
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Mohamedali HZ, Breunis H, Brandwein J, Li M, Timilshina N, Minden M, Tomlinson GA, Alibhai SMH. Age-dependent effects of intensive chemotherapy (IC) on quality of life (QOL) and physical function in patients with acute myeloid leukemia (AML). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.9088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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38
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Jiang A, Jiang H, Brandwein J, Kamel-Reid S, Chang H. Prognostic factors in normal karyotype acute myeloid leukemia in the absence of the FLT3-ITD mutation. Leuk Res 2011; 35:492-8. [DOI: 10.1016/j.leukres.2010.07.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 07/13/2010] [Accepted: 07/13/2010] [Indexed: 11/16/2022]
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39
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Chen CI, Bergsagel PL, Paul H, Xu W, Lau A, Dave N, Kukreti V, Wei E, Leung-Hagesteijn C, Li ZH, Brandwein J, Pantoja M, Johnston J, Gibson S, Hernandez T, Spaner D, Trudel S. Single-agent lenalidomide in the treatment of previously untreated chronic lymphocytic leukemia. J Clin Oncol 2010; 29:1175-81. [PMID: 21189385 DOI: 10.1200/jco.2010.29.8133] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Lenalidomide is an oral immunomodulatory drug with multiple effects on the immune system and tumor cell microenvironment leading to inhibition of malignant cell growth. Based on encouraging reports of lenalidomide in relapsed and refractory chronic lymphocytic leukemia (CLL), we investigated the first-line use of single-agent lenalidomide in CLL. PATIENTS AND METHODS Using a starting dose of lenalidomide 10 mg/d for 21 days of a 28-day cycle and weekly 5-mg dose escalations to a target of 25 mg, we encountered severe toxicities (tumor lysis, fatal sepsis) in the first two patients enrolled. The study was halted and the protocol amended to a more conservative regimen: starting dose of lenalidomide 2.5 mg with monthly escalations to a target dose of 10 mg, and extended tumor lysis prophylaxis and monitoring. Gene expression profiles from patient samples before and after 7 days of lenalidomide were performed. RESULTS Twenty-five patients were enrolled on the amended protocol. No further tumor lysis events were reported. Tumor flare was common (88%) but mild. Grade 3 to 4 neutropenia occurred in 72% of patients, with only five episodes of febrile neutropenia. The overall response rate was 56% (no complete responses). Although rapid peripheral lymphocyte reductions were observed, rebound lymphocytoses during the week off-therapy were common. Lenalidomide-induced molecular changes enriched for cytoskeletal and immune-related genes were identified. CONCLUSION Lenalidomide is clinically active as first-line CLL therapy and is well-tolerated if a conservative approach with slow dose escalation is used. A lenalidomide-induced molecular signature provides insights into its immunomodulatory mechanisms of action in CLL.
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Affiliation(s)
- Christine I Chen
- Princess Margaret Hospital/Ontario Cancer Institute, Toronto, Ontario, Canada.
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40
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Zimmermann C, Lo C, Rydall A, Chan A, Andrews J, Minden M, Schimmer A, Brandwein J, Rodin G. Post-traumatic stress in patients with acute leukemia. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.9143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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41
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Fisher-Schlombs K, Culos-Reed SN, Brandwein J, Minden MD, Tomlinson GA, Alibhai SM. A pilot study of a home-based exercise intervention for adult patients with AML. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e19570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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42
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Macdonald DA, Assouline SE, Brandwein J, Kamel-Reid S, Eisenhauer EA, Couban S, Foo A, Leber B. Phase I/II study of low-dose cytarabine (LDAC) with sorafenib as first-line therapy of elderly patients with AML or high-risk myelodysplastic syndrome (MDS). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.6564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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43
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Rodin G, Lo C, Rydall A, Chan A, Andrews J, Minden M, Schimmer A, Brandwein J, Zimmermann C. Comparison of distress in patients with acute leukemia and advanced solid tumors. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e19537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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44
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Crump M, Hedley D, Kamel-Reid S, Leber B, Wells R, Brandwein J, Buckstein R, Kassis J, Minden M, Matthews J, Robinson S, Turner R, Mcintosh L, Eisenhauer E, Seymour L. A randomized phase I clinical and biologic study of two schedules of sorafenib in patients with myelodysplastic syndrome or acute myeloid leukemia: a NCIC (National Cancer Institute of Canada) Clinical Trials Group Study. Leuk Lymphoma 2010; 51:252-60. [DOI: 10.3109/10428190903585286] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Chang H, Jiang A, Brandwein J. Prognostic relevance of CD20 in adult B-cell precursor acute lymphoblastic leukemia. Haematologica 2010; 95:1040-2; author reply 1042. [PMID: 20107157 DOI: 10.3324/haematol.2009.021089] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Luo J, Qi C, Xu W, Kamel-Reid S, Brandwein J, Chang H. Cytoplasmic expression of nucleophosmin accurately predicts mutation in the nucleophosmin gene in patients with acute myeloid leukemia and normal karyotype. Am J Clin Pathol 2010; 133:34-40. [PMID: 20023256 DOI: 10.1309/ajcpci1ffe2drxiv] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Mutations in the nucleophosmin (NPM1) exon 12 resulting in delocalization of NPM1 into the cytoplasm occur in 50% to 60% of acute myeloid leukemia cases with a normal karyotype (AML-NK). As recent studies suggest such patients have a favorable prognosis and there are discordant reports of the immunohistochemical detection of cytoplasmic NPM1 (NPMc+) for predicting NPM1 gene mutations, we correlated the immunohistochemical detection of NPMc+, NPM1 gene mutations, and prognosis in 57 cases of AML-NK. All 31 NPMc+ cases (54% of total) had NPM1 mutations, but none of the 26 nucleus-restricted (NPMc-) cases (46% of total) had NPM1 mutations (P < .0001). NPM1 mutations were correlated with FLT3-internal tandem duplication (ITD) (P = .0062), absence of CD34 (P = .0001), and absence of CD7 (P = .041). There was a favorable survival outcome in AML-NK cases that were NPM1 mutated and FLT3-ITD nonmutated. Our data confirm that cytoplasmic NPM1 immunoreactivity predicts NPM1 mutations and warrants inclusion in the routine diagnostic and prognostic workup of AML.
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Kohli R, Xu W, Brandwein J, Minden MD, Schimmer A, Schuh AC, Lipton JH, Yee K, Messner HA, Gupta V. Long-term outcomes in adult patients below the age of 55 years with acute lymphoblastic leukemia treated with chemotherapy or allogeneic BM transplant in first CR. Bone Marrow Transplant 2009; 45:1256-8. [DOI: 10.1038/bmt.2009.324] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Blum KA, Advani A, Fernandez L, Van Der Jagt R, Brandwein J, Kambhampati S, Kassis J, Davis M, Bonfils C, Dubay M, Dumouchel J, Drouin M, Lucas DM, Martell RE, Byrd JC. Phase II study of the histone deacetylase inhibitor MGCD0103 in patients with previously treated chronic lymphocytic leukaemia. Br J Haematol 2009; 147:507-14. [PMID: 19747365 PMCID: PMC2779118 DOI: 10.1111/j.1365-2141.2009.07881.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [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: 11/29/2022]
Abstract
MGCD0103, an orally available class I histone deacetylase (HDAC) inhibitor, was examined for pre-clinical activity in chronic lymphocytic leukaemia (CLL). A phase II clinical trial was performed, starting at a dose of 85 mg/d, three times per week. Dose escalation to 110 mg or the addition of rituximab was permitted in patients without a response after two or more cycles. MGCD0103 demonstrated pre-clinical activity against CLL cells with a LC(50) (concentration lethal to 50%) of 0.23 micromol/l and increased acetylation of the HDAC class I specific target histone H3. Twenty-one patients received a median of two cycles of MGCD0103 (range, 0-12). All patients had previously received fludarabine, 33% were fludarabine refractory, and 71% had del(11q22.3) or del(17p13.1). No responses according to the National Cancer Institutes 1996 criteria were observed. Three patients received 110 mg and four patients received concomitant rituximab, with no improvement in response. Grade 3-4 toxicity consisted of infections, thrombocytopenia, anaemia, diarrhoea, and fatigue. HDAC inhibition was observed in six out of nine patients on day 8. Limited activity was observed with single agent MGCD0103 in high risk patients with CLL. Future investigations in CLL should focus on broad HDAC inhibition, combination strategies, and approaches to diminish constitutional symptoms associated with this class of drugs.
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MESH Headings
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Benzamides/administration & dosage
- Benzamides/adverse effects
- Benzamides/therapeutic use
- Chromosome Aberrations
- Dose-Response Relationship, Drug
- Drug Administration Schedule
- Female
- Histone Deacetylase Inhibitors/administration & dosage
- Histone Deacetylase Inhibitors/adverse effects
- Histone Deacetylase Inhibitors/therapeutic use
- Histone Deacetylases/metabolism
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/enzymology
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Male
- Middle Aged
- Pyrimidines/administration & dosage
- Pyrimidines/adverse effects
- Pyrimidines/therapeutic use
- Rituximab
- Treatment Outcome
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Affiliation(s)
- Kristie A Blum
- Division of Hematology/Oncology, Ohio State University Medical Center, Columbus, OH 43210, USA.
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Schimmer AD, Estey EH, Borthakur G, Carter BZ, Schiller GJ, Tallman MS, Altman JK, Karp JE, Kassis J, Hedley DW, Brandwein J, Xu W, Mak DH, LaCasse E, Jacob C, Morris SJ, Jolivet J, Andreeff M. Phase I/II trial of AEG35156 X-linked inhibitor of apoptosis protein antisense oligonucleotide combined with idarubicin and cytarabine in patients with relapsed or primary refractory acute myeloid leukemia. J Clin Oncol 2009; 27:4741-6. [PMID: 19652057 DOI: 10.1200/jco.2009.21.8172] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE X-linked inhibitor of apoptosis protein (XIAP) is an inhibitor of caspases 3 and 9 which are overexpressed in acute myeloid leukemia (AML) and may contribute to chemoresistance. We report on a phase I/II trial of the XIAP antisense oligonucleotide AEG35156 in combination with reinduction chemotherapy. PATIENTS AND METHODS Twenty-four patients with rapidly relapsed or refractory AML were treated with escalating doses of AEG35156 (12 to 250 mg/m(2)) as an intravenous solution over 2 hours and 32 patients were treated with the highest planned dose of 350 mg/m(2) in combination with idarubicin and high-dose cytarabine reinduction chemotherapy. Correlative studies were conducted to determine the effects of AEG35156 on levels of XIAP mRNA. RESULTS Knockdown of XIAP mRNA during treatment increased with the dose of the antisense. All patients who received 350 mg/m(2) of AEG35156 had higher than 30% target knockdown with a median maximal knockdown of 90% (range, 48% to 100%). The overall response rate was higher among the patients receiving the highest dose of AEG35156. In this group, 15 (47%) of 32 patients achieved complete response (CR)/CR with incomplete platelet count recovery (CRp) compared with only one (4%) of 24 receiving 12 to 250 mg/m(2) AEG35156. Among the patients receiving 350 mg/m(2) of AEG35156 in combination with chemotherapy, 10 (91%) of 11 who were refractory to a single induction chemotherapy regimen achieved CR/CRp after reinduction with AEG35156 and chemotherapy. AEG35156 was well tolerated save for two cases of peripheral neuropathy in patients receiving multiple doses of AEG35156. CONCLUSION At the highest dose tested, AEG35156 knocks down its target and appears very effective when combined with chemotherapy in patients with AML refractory to a single induction regimen.
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Affiliation(s)
- Aaron D Schimmer
- Princess Margaret Hospital, Ontario Cancer Institute, Toronto, Ontario, Canada M5G 2M9.
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Lourenco MT, Walsh A, Boon H, Al-Khabouri M, Brandwein J, Gupta V, Schuh A, Yee K, Rodin G, Schimmer AD. Superstition but not distrust in the medical system predicts the use of complementary and alternative medicine in a group of patients with acute leukemia. Leuk Lymphoma 2009; 49:339-41. [DOI: 10.1080/10428190701742480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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