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Tarlock K, Gerbing RB, Ries RE, Smith JL, Leonti A, Huang BJ, Kirkey D, Robinson L, Peplinksi JH, Lange B, Cooper TM, Gamis AS, Kolb EA, Aplenc R, Pollard JA, Alonzo TA, Meshinchi S. Prognostic impact of cooccurring mutations in FLT3-ITD pediatric acute myeloid leukemia. Blood Adv 2024; 8:2094-2103. [PMID: 38295280 PMCID: PMC11063409 DOI: 10.1182/bloodadvances.2023011980] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/28/2023] [Accepted: 01/11/2024] [Indexed: 02/02/2024] Open
Abstract
ABSTRACT We sought to define the cooccurring mutational profile of FLT3-ITD-positive (ITDpos) acute myeloid leukemia (AML) in pediatric and young adult patients and to define the prognostic impact of cooperating mutations. We identified 464 patients with FLT3-ITD mutations treated on Children's Oncology Group trials with available sequencing and outcome data. Overall survival, event-free survival (EFS), and relapse risk were determined according to the presence of cooccurring risk stratifying mutations. Among the cohort, 79% of patients had cooccurring alterations across 239 different genes that were altered through mutations or fusions. Evaluation of the prognostic impact of the cooccurring mutations demonstrated that patients with ITDpos AML experienced significantly different outcomes according to the cooccurring mutational profile. Patients with ITDpos AML harboring a cooccurring favorable-risk mutation of NPM1, CEBPA, t(8;21), or inv(16) experienced a 5-year EFS of 64%, which was significantly superior to of 22.2% for patients with ITDpos AML and poor-risk mutations of WT1, UBTF, or NUP98::NSD1 as well to 40.9% for those who lacked either favorable-risk or poor-risk mutation (ITDpos intermediate; P < .001 for both). Multivariable analysis demonstrated that cooccurring mutations had significant prognostic impact, whereas allelic ratio had no impact. Therapy intensification, specifically consolidation transplant in remission, resulted in significant improvements in survival for ITDpos AML. However, patients with ITDpos/NUP98::NSD1 continued to have poor outcomes with intensified therapy, including sorafenib. Cooccurring mutational profile in ITDpos AML has significant prognostic impacts and is critical to determining risk stratification and therapeutic allocation. These clinical trials were registered at www.clinicaltrials.gov as NCT00002798, NCT00070174, NCT00372593, and NCT01371981.
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Affiliation(s)
- Katherine Tarlock
- Division of Hematology/Oncology, Seattle Children’s Hospital, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | | | - Rhonda E. Ries
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Jenny L. Smith
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Amanda Leonti
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Benjamin J. Huang
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA
| | - Danielle Kirkey
- Division of Hematology/Oncology, Seattle Children’s Hospital, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Leila Robinson
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Jack H. Peplinksi
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Beverly Lange
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Todd M. Cooper
- Division of Hematology/Oncology, Seattle Children’s Hospital, Seattle, WA
| | - Alan S. Gamis
- Divisions of Hematology/Oncology, Children’s Mercy Hospital and Clinics, Kansas City, MO
| | - E. Anders Kolb
- Nemours Center for Cancer and Blood Disorders, Alfred I. DuPont Hospital for Children, Wilmington, DE
| | - Richard Aplenc
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Jessica A. Pollard
- Pediatric Oncology, Dana Farber Cancer Institute, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Todd A. Alonzo
- Children’s Oncology Group, Monrovia, CA
- University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Soheil Meshinchi
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
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2
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Abla O, Ries RE, Triche T, Gerbing RB, Hirsch B, Raimondi S, Cooper T, Farrar JE, Buteyn N, Harmon LM, Wen H, Deshpande AJ, Kolb EA, Gamis AS, Aplenc R, Alonzo T, Meshinchi S. Structural variants involving MLLT10 fusion are associated with adverse outcomes in pediatric acute myeloid leukemia. Blood Adv 2024; 8:2005-2017. [PMID: 38306602 PMCID: PMC11024924 DOI: 10.1182/bloodadvances.2023010805] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 01/15/2024] [Accepted: 01/23/2024] [Indexed: 02/04/2024] Open
Abstract
ABSTRACT MLLT10 gene rearrangements with KMT2A occur in pediatric acute myeloid leukemia (AML) and confer poor prognosis, but the prognostic impact of MLLT10 in partnership with other genes is unknown. We conducted a retrospective study with 2080 children and young adults with AML registered on the Children's Oncology Group AAML0531 (NCT00372593) and AAML1031 trials (NCT01371981). Transcriptome profiling and/or karyotyping were performed to identify leukemia-associated fusions associated with prognosis. Collectively, 127 patients (6.1%) were identified with MLLT10 fusions: 104 (81.9%) with KMT2A::MLLT10, 13 (10.2%) with PICALM::MLLT10, and 10 (7.9%) X::MLLT10: (2 each of DDX3X and TEC), with 6 partners (DDX3Y, CEP164, SCN2B, TREH, NAP1L1, and XPO1) observed in single patients. Patients with MLLT10 (n = 127) demonstrated adverse outcomes, with 5-year event-free survival (EFS) of 18.6% vs 49% in patients without MLLT10 (n = 1953, P < .001), inferior 5-year overall survival (OS) of 38.2% vs 65.7% (P ≤ .001), and a higher relapse risk of 76% vs 38.6% (P < .001). Patients with KMT2A::MLLT10 had an EFS from study entry of 19.5% vs 12.7% (P = .628), and an OS from study entry of 40.4% vs 27.6% (P = .361) in those with other MLLT10 fusion partners. Patients with PICALM::MLLT10 had an EFS of 9.2% vs 20% in other MLLT10- without PICALM (X::MLLT10; P = .788). Patients with PICALM::MLLT10 and X::MLLT10 fusions exhibit a DNA hypermethylation signature resembling NUP98::NSD1 fusions, whereas patients with KMT2A::MLLT10 bear aberrations primarily affecting distal regulatory elements. Regardless of the fusion partner, patients with AML harboring MLLT10 fusions exhibit very high-risk features and should be prioritized for alternative therapeutic interventions.
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Affiliation(s)
- Oussama Abla
- Division of Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Rhonda E. Ries
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Tim Triche
- Center for Epigenetics, Van Andel Institute, Grand Rapids, MI
| | | | - Betsy Hirsch
- Division of Laboratory Medicine, University of Minnesota Medical Center, Minneapolis, MN
| | - Susana Raimondi
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
| | - Todd Cooper
- Division of Hematology-Oncology, Seattle Children's Hospital, University of Washington, Seattle, WA
| | - Jason E. Farrar
- Department of Pediatrics, Hematology-Oncology Section, Arkansas Children's Research Institute, Little Rock, AR
| | | | | | - Hong Wen
- Center for Epigenetics, Van Andel Institute, Grand Rapids, MI
| | | | - E. Anders Kolb
- Nemours Center for Cancer and Blood Disorders and Alfred I. DuPont Hospital for Children, Wilmington, DE
| | - Alan S. Gamis
- Division of Hematology, Oncology and Bone Marrow Transplantation, Children's Mercy Hospitals and Clinics, Kansas City, MO
| | | | - Todd Alonzo
- Department of Translational Genomics, University of Southern California, Los Angeles, CA
| | - Soheil Meshinchi
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
- Division of Hematology-Oncology, Seattle Children's Hospital, University of Washington, Seattle, WA
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3
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van Weelderen RE, Harrison CJ, Klein K, Jiang Y, Abrahamsson J, Alonzo T, Aplenc R, Arad-Cohen N, Bart-Delabesse E, Buldini B, De Moerloose B, Dworzak MN, Elitzur S, Fernández Navarro JM, Gamis AS, Gerbing RB, Goemans BF, de Groot-Kruseman HA, Guest EM, Ha SY, Hasle H, Kelaidi C, Lapillonne H, Leverger G, Locatelli F, Miyamura T, Noren-Nystrom U, Polychronopoulou S, Rasche M, Rubnitz JE, Stary J, Tierens A, Tomizawa D, Zwaan MC, Kaspers GJL. Optimized Cytogenetic Risk-Group Stratification of KMT2A-Rearranged Pediatric Acute Myeloid Leukemia. Blood Adv 2024:bloodadvances.2023011771. [PMID: 38621200 DOI: 10.1182/bloodadvances.2023011771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 03/04/2024] [Accepted: 03/22/2024] [Indexed: 04/17/2024] Open
Abstract
Comprehensive international consensus on cytogenetic risk-group stratification of KMT2A-rearranged (KMT2A-r) pediatric acute myeloid leukemia (AML) is lacking. This retrospective (2005-2016) International Berlin-Frankfurt-Münster Study Group study on 1,256 children with KMT2A-r AML aimed to validate the prognostic value of established recurring KMT2A fusions and additional cytogenetic aberrations (ACAs), and secondly, to define additional, recurring KMT2A fusions and ACAs, evaluating their prognostic relevance. Compared to our previous study, three additional, recurring KMT2A-r groups were defined: Xq24/KMT2A::SEPT6, 1p32/KMT2A::EPS15, 17q12/t(11;17)(q23;q12). Across 13 KMT2A-r groups, 5-year event-free survival probabilities varied significantly (21.8% to 76.2%; P<0.01). ACAs occurred in 46.8% of 1,200 patients with complete karyotypes, correlating with inferior overall survival (56.8% vs 67.9%; P<0.01). Multivariable analyses confirmed independent associations of 4q21/KMT2A::AFF1, 6q27/KMT2A::AFDN, 10p12/KMT2A::MLLT10, 10p11.2/KMT2A::ABI1, and 19p13.3/KMT2A::MLLT1 with adverse outcomes, but not those of 1q21/KMT2A::MLLT11 and trisomy 19 with favorable and adverse outcomes, respectively. Newly identified ACAs with independent adverse prognoses were monosomy 10, trisomies 1, 6, 16, and X, add(12p), and del(9q). Among patients with 9p22/KMT2A::MLLT3, the independent association of French-American-British-type M5 with favorable outcome was confirmed, and those of trisomy 6 and measurable residual disease at end of induction with adverse outcomes were identified. We provide evidence to incorporate the five adverse-risk KMT2A fusions into the cytogenetic risk-group stratification of KMT2A-r pediatric AML, to revise the favorable-risk classification of 1q21/KMT2A::MLLT11 to intermediate risk, and to refine risk-stratification of 9p22/KMT2A::MLLT3 AML. Future studies should validate the associations between the newly identified ACAs and outcome, and unravel the underlying biological pathogenesis of KMT2A fusions and ACAs.
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Affiliation(s)
| | | | - Kim Klein
- Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, Netherlands
| | - Yilin Jiang
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Jonas Abrahamsson
- Institute of Clinical Sciences, Queen Silvias Childrens Hospital, Gothenburg, Sweden
| | - Todd Alonzo
- University of Southern California, Monrovia, California, United States
| | - Richard Aplenc
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | | | - Emmanuelle Bart-Delabesse
- IUC Toulouse-Oncopole, Laboratoire d'Hématologie secteur Génétique des Hémopathies, Toulouse, France
| | - Barbara Buldini
- Pediatric Hematology, Oncology and Stem Cell Transplant Division, Maternal and Child Health Department, University of Padova, Padova, Italy
| | | | - Michael N Dworzak
- Children's Cancer Research Institute and St. Anna Children's Hospital, Vienna, Austria
| | - Sarah Elitzur
- Schneider Children's Medical Center, Petah Tikva, Israel
| | | | - Alan S Gamis
- Children's Mercy Hospital, Kansas City, Missouri, United States
| | | | - Bianca F Goemans
- Princess Máxima center for pediatric oncology, Utrecht, Netherlands
| | | | - Erin M Guest
- Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Shau Yin Ha
- Hong Kong Children's Hospital, Hong Kong, Hong Kong
| | | | | | | | | | - Franco Locatelli
- Bambino Gesù Children's Hospital, Catholic University of Sacred Heart, Rome, Italy
| | | | | | | | | | - Jeffrey E Rubnitz
- St. Jude Children's Research Hospital, Memphis, Tennessee, United States
| | - Jan Stary
- Charles University and University Hospital Motol
| | | | | | | | - Gertjan J L Kaspers
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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4
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Renaud J, Goemans BF, Locatelli F, Pigazzi M, Redmond S, Kuehni CE, Destaillats A, Alonzo TA, Gerbing RB, Gamis A, Aplenc R, Renella R, Cooper T, Ceppi F. Characteristics and treatment of acute myeloid neoplasms with cutaneous involvement in infants up to 6 months of age: A retrospective study. Pediatr Blood Cancer 2024:e31006. [PMID: 38616361 DOI: 10.1002/pbc.31006] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/19/2024] [Accepted: 03/27/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Myeloid neoplasms account for 50% of cases of pediatric leukemias in infants. Approximately 25%-50% of patients with newborn leukemia have cutaneous extramedullary disease (EMD). In less than 10% of patients, aleukemic leukemia cutis or isolated extramedullary disease with cutaneous involvement (cEMD) occurs when skin lesions appear prior to bone marrow involvement and systemic symptoms. Interestingly, in acute myeloid leukemia with cutaneous EMD (AML-cEMD) and cEMD, spontaneous remissions have been reported. METHOD This is a multicentric retrospective cohort study aiming to describe characteristics, treatment, and outcome of infants with either cEMD or presence of cutaneous disease with involvement of the bone marrow (AML-cEMD). This study included patients born between 1990 and 2018 from Italy, the Netherlands, Switzerland, and the United States, diagnosed between 0 and 6 months of life with cEMD or AML-cEMD. Descriptive statistics, Fisher's exact test, Kaplan-Meier method, and log rank test were applied. RESULTS The cohort consisted of n = 50 patients, including 42 AML-cEMD and eight cEMD patients. The most common genetic mutation found was a KMT2A rearrangement (n = 26, 52%). Overall 5-year event-free survival (EFS) and overall survival (OS) were 66% [confidence interval (CI): 51-78] and 75% [CI: 60-85], respectively. In two patients, complete spontaneous remission occurred without any therapy. Central nervous system (CNS) involvement was found in 25% of cEMD patients. No difference in outcomes was observed between the AML-cEMD and cEMD groups, but none of the latter patients included in the study died. KMT2A rearrangements were not associated with poorer prognosis. CONCLUSION In the largest cohort to date, our study describes the characteristics of infants with cutaneous involvement of myeloid neoplasms including cytomolecular findings and survival rates. Further prospective biologic and clinical studies of these infants with myeloid neoplasms will be required to individualize therapy for this rare patient population.
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Affiliation(s)
- Juliette Renaud
- Pediatric Hematology-Oncology Unit, Division of Pediatrics, Department Woman-Mother-Child, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Bianca F Goemans
- Princess Máxima Center for pediatric oncology, Utrecht, Netherlands
| | - Franco Locatelli
- Department of Haematology/Oncology and Cell and Gene Therapy, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
- Department of Life Sciences and Public Health, Catholic University of the Sacred Heart, Rome, Italy
| | - Martina Pigazzi
- Department of Women's and Children's Health, University of Padova, Padua, Italy
| | - Shelagh Redmond
- Institute of Social and Preventive Medicine (ISPM), University of Bern and Childhood Cancer Registry (ChCR), Bern, Switzerland
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine (ISPM), University of Bern and Childhood Cancer Registry (ChCR), Bern, Switzerland
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Alice Destaillats
- Sponsor Research Office, Direction of Innovation and Clinical Research (DIRC), Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Todd A Alonzo
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Children's Oncology Group, Monrovia, California, USA
| | | | - Alan Gamis
- Department of Hematology-Oncology, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
| | - Richard Aplenc
- Division of Pediatric Oncology/Stem Cell Transplant, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Raffaele Renella
- Pediatric Hematology-Oncology Unit, Division of Pediatrics, Department Woman-Mother-Child, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Todd Cooper
- Pediatric Hematology-Oncology Unit, Seattle Children Hospital, Seattle, Washington, USA
| | - Francesco Ceppi
- Pediatric Hematology-Oncology Unit, Division of Pediatrics, Department Woman-Mother-Child, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
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5
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van Dijk AD, Hoff FW, Qiu Y, Hubner SE, Go RL, Ruvolo VR, Leonti AR, Gerbing RB, Gamis AS, Aplenc R, Kolb EA, Alonzo TA, Meshinchi S, de Bont ESJM, Horton TM, Kornblau SM. Chromatin Profiles Are Prognostic of Clinical Response to Bortezomib-Containing Chemotherapy in Pediatric Acute Myeloid Leukemia: Results from the COG AAML1031 Trial. Cancers (Basel) 2024; 16:1448. [PMID: 38672531 PMCID: PMC11048007 DOI: 10.3390/cancers16081448] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/01/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
The addition of the proteasome inhibitor bortezomib to standard chemotherapy did not improve survival in pediatric acute myeloid leukemia (AML) when all patients were analyzed as a group in the Children's Oncology Group phase 3 trial AAML1031 (NCT01371981). Proteasome inhibition influences the chromatin landscape and proteostasis, and we hypothesized that baseline proteomic analysis of histone- and chromatin-modifying enzymes (HMEs) would identify AML subgroups that benefitted from bortezomib addition. A proteomic profile of 483 patients treated with AAML1031 chemotherapy was generated using a reverse-phase protein array. A relatively high expression of 16 HME was associated with lower EFS and higher 3-year relapse risk after AML standard treatment compared to low expressions (52% vs. 29%, p = 0.005). The high-HME profile correlated with more transposase-accessible chromatin, as demonstrated via ATAC-sequencing, and the bortezomib addition improved the 3-year overall survival compared with standard therapy (62% vs. 75%, p = 0.033). These data suggest that there are pediatric AML populations that respond well to bortezomib-containing chemotherapy.
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Affiliation(s)
- Anneke D. van Dijk
- Division of Pediatric Oncology and Hematology, Department of Pediatrics, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (F.W.H.)
- Department of Leukemia, M.D. Anderson Cancer Center, The University of Texas, Houston, TX 78712, USA
| | - Fieke W. Hoff
- Division of Pediatric Oncology and Hematology, Department of Pediatrics, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (F.W.H.)
- Department of Leukemia, M.D. Anderson Cancer Center, The University of Texas, Houston, TX 78712, USA
| | - Yihua Qiu
- Department of Leukemia, M.D. Anderson Cancer Center, The University of Texas, Houston, TX 78712, USA
| | - Stefan E. Hubner
- Department of Leukemia, M.D. Anderson Cancer Center, The University of Texas, Houston, TX 78712, USA
| | - Robin L. Go
- Department of Leukemia, M.D. Anderson Cancer Center, The University of Texas, Houston, TX 78712, USA
| | - Vivian R. Ruvolo
- Department of Molecular Therapy and Hematology, M.D. Anderson Cancer Center, The University of Texas, Houston, TX 78712, USA
| | - Amanda R. Leonti
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | | | - Alan S. Gamis
- Department of Hematology-Oncology, Children’s Mercy Hospitals and Clinics, Kansas City, MO 64108, USA
| | - Richard Aplenc
- Division of Pediatric Oncology and Stem Cell Transplant, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Edward A. Kolb
- Nemours Center for Cancer and Blood Disorders, Alfred I. DuPont Hospital for Children, Wilmington, DE 19803, USA
| | - Todd A. Alonzo
- COG Statistics and Data Center, Monrovia, CA 91016, USA
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90007, USA
| | - Soheil Meshinchi
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Eveline S. J. M. de Bont
- Division of Pediatric Oncology and Hematology, Department of Pediatrics, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (F.W.H.)
| | - Terzah M. Horton
- Texas Children’s Cancer and Hematology Centers, Baylor College of Medicine, Houston, TX 77030, USA
| | - Steven M. Kornblau
- Department of Leukemia, M.D. Anderson Cancer Center, The University of Texas, Houston, TX 78712, USA
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6
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Leger KJ, Robison N, Narayan HK, Smith AM, Tsega T, Chung J, Daniels A, Chen Z, Englefield V, Demissei BG, Lefebvre B, Morrow G, Dizon I, Gerbing RB, Pabari R, Getz KD, Aplenc R, Pollard JA, Chow EJ, Tang WHW, Border WL, Sachdeva R, Alonzo TA, Kolb EA, Cooper TM, Ky B. Rationale and design of the Children's Oncology Group study AAML1831 integrated cardiac substudies in pediatric acute myeloid leukemia therapy. Front Cardiovasc Med 2023; 10:1286241. [PMID: 38107263 PMCID: PMC10722184 DOI: 10.3389/fcvm.2023.1286241] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/07/2023] [Indexed: 12/19/2023] Open
Abstract
Background Pediatric acute myeloid leukemia (AML) therapy is associated with substantial short- and long-term treatment-related cardiotoxicity mainly due to high-dose anthracycline exposure. Early left ventricular systolic dysfunction (LVSD) compromises anthracycline delivery and is associated with inferior event-free and overall survival in de novo pediatric AML. Thus, effective cardioprotective strategies and cardiotoxicity risk predictors are critical to optimize cancer therapy delivery and enable early interventions to prevent progressive LVSD. While dexrazoxane-based cardioprotection reduces short-term cardiotoxicity without compromising cancer survival, liposomal anthracycline formulations have the potential to mitigate cardiotoxicity while improving antitumor efficacy. This overview summarizes the rationale and methodology of cardiac substudies within AAML1831, a randomized Children's Oncology Group Phase 3 study of CPX-351, a liposomal formulation of daunorubicin and cytarabine, in comparison with standard daunorubicin/cytarabine with dexrazoxane in the treatment of de novo pediatric AML. Methods/design Children (age <22 years) with newly diagnosed AML were enrolled and randomized to CPX-351-containing induction 1 and 2 (Arm A) or standard daunorubicin and dexrazoxane-containing induction (Arm B). Embedded cardiac correlative studies aim to compare the efficacy of this liposomal anthracycline formulation to dexrazoxane for primary prevention of cardiotoxicity by detailed core lab analysis of standardized echocardiograms and serial cardiac biomarkers throughout AML therapy and in follow-up. In addition, AAML1831 will assess the ability of early changes in sensitive echo indices (e.g., global longitudinal strain) and cardiac biomarkers (e.g., troponin and natriuretic peptides) to predict subsequent LVSD. Finally, AAML1831 establishes expert consensus-based strategies in cardiac monitoring and anthracycline dose modification to balance the potentially competing priorities of cardiotoxicity reduction with optimal leukemia therapy. Discussion This study will inform diagnostic, prognostic, preventative, and treatment strategies regarding cardiotoxicity during pediatric AML therapy. Together, these measures have the potential to improve leukemia-free and overall survival and long-term cardiovascular health in children with AML. Clinical trial registration: https://clinicaltrials.gov/, identifier NCT04293562.
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Affiliation(s)
- Kasey J. Leger
- Division of Pediatric Hematology/Oncology, Seattle Children’s Hospital, University of Washington, Seattle, WA, United States
| | - Nora Robison
- Division of Pediatric Hematology/Oncology, Seattle Children’s Hospital, University of Washington, Seattle, WA, United States
| | - Hari K. Narayan
- Division of Cardiology, Department of Pediatrics, Rady Children’s Hospital San Diego, University of California San Diego, La Jolla, CA, United States
| | - Amanda M. Smith
- Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Tenaadam Tsega
- Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Jade Chung
- Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Amber Daniels
- Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Zhen Chen
- Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Virginia Englefield
- Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Biniyam G. Demissei
- Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Benedicte Lefebvre
- Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Gemma Morrow
- Division of Cardiology, Children’s Healthcare of Atlanta, Atlanta, GA, United States
| | - Ilona Dizon
- Division of Cardiology, Seattle Children’s Hospital, Seattle, WA, United States
| | | | - Reena Pabari
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Kelly D. Getz
- Division of Oncology, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Richard Aplenc
- Division of Oncology, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jessica A. Pollard
- Division of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Eric J. Chow
- Division of Pediatric Hematology/Oncology, Seattle Children’s Hospital, University of Washington, Seattle, WA, United States
- Clinical Research and Public Health Sciences Divisions, Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - W. H. Wilson Tang
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States
| | - William L. Border
- Division of Cardiology, Children’s Healthcare of Atlanta, Atlanta, GA, United States
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Ritu Sachdeva
- Division of Cardiology, Children’s Healthcare of Atlanta, Atlanta, GA, United States
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Todd A. Alonzo
- Children’s Oncology Group, Monrovia, CA, United States
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - E. Anders Kolb
- Nemours Center for Cancer and Blood Disorders, Alfred I. DuPont Hospital for Children, Wilmington, DE, United States
| | - Todd M. Cooper
- Division of Pediatric Hematology/Oncology, Seattle Children’s Hospital, University of Washington, Seattle, WA, United States
| | - Bonnie Ky
- Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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7
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Hoff FW, Qiu Y, Brown BD, Gerbing RB, Leonti AR, Ries RE, Gamis AS, Aplenc R, Kolb EA, Alonzo TA, Meshinchi S, Jenkins GN, Horton T, Kornblau SM. Valosin-containing protein (VCP/p97) is prognostically unfavorable in pediatric AML, and negatively correlates with unfolded protein response proteins IRE1 and GRP78: A report from the Children's Oncology Group. Proteomics Clin Appl 2023; 17:e2200109. [PMID: 37287368 PMCID: PMC10700663 DOI: 10.1002/prca.202200109] [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: 12/08/2022] [Revised: 04/25/2023] [Accepted: 05/25/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE The endoplasmic reticulum (ER) is the major site of protein synthesis and folding in the cell. ER-associated degradation (ERAD) and unfolded protein response (UPR) are the main mechanisms of ER-mediated cell stress adaptation. Targeting the cell stress response is a promising therapeutic approach in acute myeloid leukemia (AML). EXPERIMENTAL DESIGN Protein expression levels of valosin-containing protein (VCP), a chief element of ERAD, were measured in peripheral blood samples from in 483 pediatric AML patients using reverse phase protein array methodology. Patients participated in the Children's Oncology Group AAML1031 phase 3 clinical trial that randomized patients to standard chemotherapy (cytarabine (Ara-C), daunorubicin, and etoposide [ADE]) versus ADE plus bortezomib (ADE+BTZ). RESULTS Low-VCP expression was significantly associated with favorable 5-year overall survival (OS) rate compared to middle-high-VCP expression (81% versus 63%, p < 0.001), independent of additional bortezomib treatment. Multivariable Cox regression analysis identified VCP as independent predictor of clinical outcome. UPR proteins IRE1 and GRP78 had significant negative correlation with VCP. Five-year OS in patients characterized by low-VCP, moderately high-IRE1 and high-GRP78 improved after treatment with ADE+BTZ versus ADE (66% versus 88%, p = 0.026). CONCLUSION AND CLINICAL RELEVANCE Our findings suggest the potential of the protein VCP as biomarker in prognostication prediction in pediatric AML.
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Affiliation(s)
- Fieke W. Hoff
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Yihua Qiu
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Brandon D. Brown
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Amanda R. Leonti
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Rhonda E. Ries
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Alan S. Gamis
- Department of Hematology-Oncology, Children’s Mercy Hospitals and Clinics, Kansas City, MO
| | - Richard Aplenc
- Division of Pediatric Oncology/Stem Cell Transplant, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - E. Anders Kolb
- Nemours Center for Cancer and Blood Disorders, Alfred I. DuPont Hospital for Children, Wilmington, DE
| | - Todd A. Alonzo
- COG Statistics and Data Center, Monrovia, CA
- Keck School of Medicine, University of Southern California, CA
| | - Soheil Meshinchi
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Gaye N Jenkins
- Department of Pediatrics, Baylor College of Medicine/Dan L. Duncan Cancer Center and Texas Children’s Cancer Center, Houston, Texas
| | - Terzah Horton
- Department of Pediatrics, Baylor College of Medicine/Dan L. Duncan Cancer Center and Texas Children’s Cancer Center, Houston, Texas
| | - Steven M. Kornblau
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
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8
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Zarnegar-Lumley S, Alonzo TA, Gerbing RB, Othus M, Sun Z, Ries RE, Wang J, Leonti A, Kutny MA, Ostronoff F, Radich JP, Appelbaum FR, Pogosova-Agadjanyan EL, O’Dwyer K, Tallman MS, Litzow M, Atallah E, Cooper TM, Aplenc RA, Abdel-Wahab O, Gamis AS, Luger S, Erba H, Levine R, Kolb EA, Stirewalt DL, Meshinchi S, Tarlock K. Characteristics and prognostic impact of IDH mutations in AML: a COG, SWOG, and ECOG analysis. Blood Adv 2023; 7:5941-5953. [PMID: 37267439 PMCID: PMC10562769 DOI: 10.1182/bloodadvances.2022008282] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/12/2023] [Accepted: 05/08/2023] [Indexed: 06/04/2023] Open
Abstract
Somatic mutations in isocitrate dehydrogenase (IDH) genes occur frequently in adult acute myeloid leukemia (AML) and less commonly in pediatric AML. The objective of this study was to describe the prevalence, mutational profile, and prognostic significance of IDH mutations in AML across age. Our cohort included 3141 patients aged between <1 month and 88 years treated on Children's Cancer Group/Children's Oncology Group (n = 1872), Southwest Oncology Group (n = 359), Eastern Cooperative Oncology Group (n = 397) trials, and in Beat AML (n = 333) and The Cancer Genome Atlas (n = 180) genomic characterization cohorts. We retrospectively analyzed patients in 4 age groups (age range, n): pediatric (0-17, 1744), adolescent/young adult (18-39, 444), intermediate-age (40-59, 640), older (≥60, 309). IDH mutations (IDHmut) were identified in 9.2% of the total cohort (n = 288; IDH1 [n = 123, 42.7%]; IDH2 [n = 165, 57.3%]) and were strongly correlated with increased age: 3.4% pediatric vs 21% older, P < .001. Outcomes were similar in IDHmut and IDH-wildtype (IDHWT) AML (event-free survival [EFS]: 35.6% vs 40.0%, P = .368; overall survival [OS]: 50.3% vs 55.4%, P = .196). IDH mutations frequently occurred with NPM1 (47.2%), DNMT3A (29.3%), and FLT3-internal tandem duplication (ITD) (22.4%) mutations. Patients with IDHmut AML with NPM1 mutation (IDHmut/NPM1mut) had significantly improved survival compared with the poor outcomes experienced by patients without (IDHmut/NPM1WT) (EFS: 55.1% vs 17.0%, P < .001; OS: 66.5% vs 35.2%, P < .001). DNTM3A or FLT3-ITD mutations in otherwise favorable IDHmut/NPM1mut AML led to inferior outcomes. Age group analysis demonstrated that IDH mutations did not abrogate the favorable prognostic impact of NPM1mut in patients aged <60 years; older patients had poor outcomes regardless of NPM1 status. These trials were registered at www.clinicaltrials.gov as #NCT00070174, #NCT00372593, #NCT01371981, #NCT00049517, and #NCT00085709.
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Affiliation(s)
- Sara Zarnegar-Lumley
- Division of Hematology/Oncology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Todd A. Alonzo
- Children’s Oncology Group, Monrovia, CA
- University of Southern California Keck School of Medicine, Los Angeles, CA
| | | | - Megan Othus
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Zhuoxin Sun
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA
| | - Rhonda E. Ries
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jim Wang
- Children’s Oncology Group, Monrovia, CA
| | - Amanda Leonti
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Matthew A. Kutny
- Division of Hematology/Oncology, Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, AL
| | - Fabiana Ostronoff
- Intermountain Blood and Marrow Transplant and Acute Leukemia Program, Intermountain Healthcare, Salt Lake City, UT
| | - Jerald P. Radich
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Departments of Oncology and Hematology, University of Washington, Seattle, WA
| | - Frederick R. Appelbaum
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Departments of Oncology and Hematology, University of Washington, Seattle, WA
| | | | - Kristen O’Dwyer
- Department of Medicine, Wilmot Cancer Institute, University of Rochester, Rochester, NY
| | - Martin S. Tallman
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mark Litzow
- Department of Internal Medicine and Division of Hematology, Mayo Clinic College of Medicine, Rochester, MN
| | - Ehab Atallah
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Todd M. Cooper
- Division of Hematology/Oncology, Seattle Children’s Hospital Cancer and Blood Disorders Center, University of Washington, Seattle, WA
| | - Richard A. Aplenc
- Division of Oncology and Center for Childhood Cancer Research, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Omar Abdel-Wahab
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alan S. Gamis
- Division of Hematology/Oncology/Bone Marrow Transplantation, Children’s Mercy Hospitals and Clinics, Kansas City, MO
| | - Selina Luger
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Harry Erba
- Division of Hematologic Malignancies and Cellular Therapies, Department of Medicine, Duke Cancer Institute, Durham, NC
| | - Ross Levine
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - E. Anders Kolb
- Nemours Center for Cancer and Blood Disorders, Alfred I. DuPont Hospital for Children, Wilmington, DE
| | - Derek L. Stirewalt
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Departments of Oncology and Hematology, University of Washington, Seattle, WA
| | - Soheil Meshinchi
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Katherine Tarlock
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Hematology/Oncology, Seattle Children’s Hospital Cancer and Blood Disorders Center, University of Washington, Seattle, WA
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9
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van Weelderen RE, Klein K, Harrison CJ, Jiang Y, Abrahamsson J, Arad-Cohen N, Bart-Delabesse E, Buldini B, De Moerloose B, Dworzak MN, Elitzur S, Fernández Navarro JM, Gerbing RB, Goemans BF, de Groot-Kruseman HA, Guest E, Ha SY, Hasle H, Kelaidi C, Lapillonne H, Leverger G, Locatelli F, Masetti R, Miyamura T, Norén-Nyström U, Polychronopoulou S, Rasche M, Rubnitz JE, Stary J, Tierens A, Tomizawa D, Zwaan CM, Kaspers GJ. Measurable Residual Disease and Fusion Partner Independently Predict Survival and Relapse Risk in Childhood KMT2A-Rearranged Acute Myeloid Leukemia: A Study by the International Berlin-Frankfurt-Münster Study Group. J Clin Oncol 2023; 41:2963-2974. [PMID: 36996387 PMCID: PMC10414713 DOI: 10.1200/jco.22.02120] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/22/2022] [Accepted: 02/01/2023] [Indexed: 04/01/2023] Open
Abstract
PURPOSE A previous study by the International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) on childhood KMT2A-rearranged (KMT2A-r) AML demonstrated the prognostic value of the fusion partner. This I-BFM-SG study investigated the value of flow cytometry-based measurable residual disease (flow-MRD) and evaluated the benefit of allogeneic stem-cell transplantation (allo-SCT) in first complete remission (CR1) in this disease. METHODS A total of 1,130 children with KMT2A-r AML, diagnosed between January 2005 and December 2016, were assigned to high-risk (n = 402; 35.6%) or non-high-risk (n = 728; 64.4%) fusion partner-based groups. Flow-MRD levels at both end of induction 1 (EOI1) and 2 (EOI2) were available for 456 patients and were considered negative (<0.1%) or positive (≥0.1%). End points were 5-year event-free survival (EFS), cumulative incidence of relapse (CIR), and overall survival (OS). RESULTS The high-risk group had inferior EFS (30.3% high risk v 54.0% non-high risk; P < .0001), CIR (59.7% v 35.2%; P < .0001), and OS (49.2% v 70.5%; P < .0001). EOI2 MRD negativity was associated with superior EFS (n = 413; 47.6% MRD negativity v n = 43; 16.3% MRD positivity; P < .0001) and OS (n = 413; 66.0% v n = 43; 27.9%; P < .0001), and showed a trend toward lower CIR (n = 392; 46.1% v n = 26; 65.4%; P = .016). Similar results were obtained for patients with EOI2 MRD negativity within both risk groups, except that within the non-high-risk group, CIR was comparable with that of patients with EOI2 MRD positivity. Allo-SCT in CR1 only reduced CIR (hazard ratio, 0.5 [95% CI, 0.4 to 0.8]; P = .00096) within the high-risk group but did not improve OS. In multivariable analyses, EOI2 MRD positivity and high-risk group were independently associated with inferior EFS, CIR, and OS. CONCLUSION EOI2 flow-MRD is an independent prognostic factor and should be included as risk stratification factor in childhood KMT2A-r AML. Treatment approaches other than allo-SCT in CR1 are needed to improve prognosis.
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Affiliation(s)
- Romy E. van Weelderen
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Kim Klein
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, the Netherlands
| | - Christine J. Harrison
- Leukemia Research Cytogenetics Group, Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Newcastle-upon-Tyne, United Kingdom
| | - Yilin Jiang
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Jonas Abrahamsson
- Department of Pediatrics, Institute of Clinical Sciences, Salgrenska University Hospital, Gothenburg, Sweden
| | - Nira Arad-Cohen
- Pediatric Hemato-Oncology Department, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Emmanuelle Bart-Delabesse
- IUC Toulouse-Oncopole, Laboratoire d’Hématologie secteur Génétique des Hémopathies, Toulouse, France
| | - Barbara Buldini
- Pediatric Hematology, Oncology and Stem Cell Transplant Division, Maternal and Child Health Department, Padua University, Padua, Italy
| | - Barbara De Moerloose
- Department of Pediatric Hematology-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Michael N. Dworzak
- St. Anna Children's Hospital, Department of Pediatrics, Medical University of Vienna, and St Anna Children's Cancer Research Institute, Vienna, Austria
| | - Sarah Elitzur
- Department of Pediatric Hematology and Oncology, Schneider Children's Medical Center and Tel Aviv University, Tel Aviv, Israel
| | | | - Robert B. Gerbing
- Department of Statistics, The Children's Oncology Group, Monrovia, California
| | - Bianca F. Goemans
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Hester A. de Groot-Kruseman
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- DCOG, Dutch Childhood Oncology Group, Utrecht, the Netherlands
| | - Erin Guest
- Children's Mercy Kansas City, Kansas City, MO
| | - Shau-Yin Ha
- Department of Pediatrics & Adolescent Medicine, Hong Kong Children's Hospital, Kowloon, Hong Kong
| | - Henrik Hasle
- Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Charikleia Kelaidi
- Department of Pediatric Hematology and Oncology, Aghia Sophia Children's Hospital, Athens, Greece
| | - Hélène Lapillonne
- Pediatric Hematology and Oncology Department, Hôpital Armand Trousseau, Paris, France
| | - Guy Leverger
- Pediatric Hematology and Oncology Department, Hôpital Armand Trousseau, Paris, France
| | - Franco Locatelli
- Department of Pediatric Hematology and Oncology and Cell and Gene Therapy, IRCCS Ospedale Pediatrico Bambino Gesù, Catholic University of the Sacred Heart, Rome, Italy
| | - Riccardo Masetti
- Pediatric Oncology and Hematology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
| | - Takako Miyamura
- Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Japan
| | | | - Sophia Polychronopoulou
- Department of Pediatric Hematology and Oncology, Aghia Sophia Children's Hospital, Athens, Greece
| | - Mareike Rasche
- Department of Pediatric Hematology and Oncology, University Hospital Essen, Essen, Germany
| | - Jeffrey E. Rubnitz
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Jan Stary
- Department of Pediatric Hematology and Oncology, University Hospital Motol and 2 Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Anne Tierens
- Department of Pathobiology and Laboratory Medicine, University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | - Daisuke Tomizawa
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - C. Michel Zwaan
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Pediatric Oncology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Gertjan J.L. Kaspers
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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10
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Lamble AJ, Hagiwara K, Gerbing RB, Smith JL, Kolekar P, Ries RE, Kolb EA, Alonzo TA, Ma X, Meshinchi S. CREBBP alterations are associated with a poor prognosis in de novo AML. Blood 2023; 141:2156-2159. [PMID: 36634304 PMCID: PMC10273087 DOI: 10.1182/blood.2022017545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 01/14/2023] Open
Affiliation(s)
- Adam J. Lamble
- Division of Hematology and Oncology, Seattle Children's Hospital, Seattle, WA
| | - Kohei Hagiwara
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN
| | | | - Jenny L. Smith
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Pandurang Kolekar
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Rhonda E. Ries
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Edward A. Kolb
- Division of Oncology, Nemours Alfred I. duPont Hospital for Children, Wilmington, DE
| | - Todd A. Alonzo
- Children's Oncology Group, Monrovia, CA
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Xiaotu Ma
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Soheil Meshinchi
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
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11
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Stevens AM, Horton TM, Glasser CL, Gerbing RB, Aplenc R, Alonzo TA, Redell MS. IL-10 and TNFα are associated with decreased survival in low-risk pediatric acute myeloid leukemia; a children's oncology group report. Pediatr Hematol Oncol 2023; 40:147-158. [PMID: 35838057 PMCID: PMC10498011 DOI: 10.1080/08880018.2022.2089790] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/23/2022] [Accepted: 05/30/2022] [Indexed: 02/07/2023]
Abstract
Pediatric acute myeloid leukemia (AML) is a devastating disease with a high risk of relapse. Current risk classification designates patients as high or low risk (LR) based on molecular features and therapy response. However, 30% of LR patients still suffer relapse, indicating a need for improvement in risk stratification. Cytokine levels, such as IL-6 and IL-10, have been shown to be prognostic in adult AML but have not been well studied in children. Previously, we reported elevated IL-6 levels in pediatric AML bone marrow to be associated with inferior prognosis. Here, we expanded our investigation to assess cytokine levels in diagnostic peripheral blood plasma (PBP) of pediatric AML patients and determined correlation with outcome. Diagnostic PBP was obtained from 80 patients with LR AML enrolled on the Children's Oncology Group AAML1031 study and normal PBP from 11 controls. Cytokine levels were measured and correlation with clinical outcome was assessed. IL-6, TNFα, MIP-3a, and IL-1β were significantly higher in AML patients versus controls when corrected by the Bonferroni method. Furthermore, elevated TNFα and IL-10 were significantly associated with inferior outcomes. Our data demonstrate that in diagnostic PBP of LR pediatric AML patients, certain cytokine levels are elevated as compared to healthy controls and that elevated TNFα and IL-10 are associated with inferior outcomes, supporting the idea that an abnormal inflammatory state may predict poor outcomes. Studies are needed to determine the mechanisms by which these cytokines impact survival, and to further evaluate their use as prognostic biomarkers in pediatric AML.
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Affiliation(s)
- Alexandra M. Stevens
- Division of Pediatric Hematology/Oncology, Baylor College of Medicine, Houston, TX
| | - Terzah M. Horton
- Division of Pediatric Hematology/Oncology, Baylor College of Medicine, Houston, TX
| | - Chana L. Glasser
- Division of Pediatric Hematology/Oncology, NYU Langone Hospital - Long Island, Mineola, NY
| | | | - Richard Aplenc
- Division of Pediatric Oncology/Stem Cell Transplant, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Todd A. Alonzo
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA
| | - Michele S. Redell
- Division of Pediatric Hematology/Oncology, Baylor College of Medicine, Houston, TX
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12
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Huang BJ, Smith JL, Farrar JE, Wang YC, Umeda M, Ries RE, Leonti AR, Crowgey E, Furlan SN, Tarlock K, Armendariz M, Liu Y, Shaw TI, Wei L, Gerbing RB, Cooper TM, Gamis AS, Aplenc R, Kolb EA, Rubnitz J, Ma J, Klco JM, Ma X, Alonzo TA, Triche T, Meshinchi S. Integrated stem cell signature and cytomolecular risk determination in pediatric acute myeloid leukemia. Nat Commun 2022; 13:5487. [PMID: 36123353 PMCID: PMC9485122 DOI: 10.1038/s41467-022-33244-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 09/07/2022] [Indexed: 11/30/2022] Open
Abstract
Relapsed or refractory pediatric acute myeloid leukemia (AML) is associated with poor outcomes and relapse risk prediction approaches have not changed significantly in decades. To build a robust transcriptional risk prediction model for pediatric AML, we perform RNA-sequencing on 1503 primary diagnostic samples. While a 17 gene leukemia stem cell signature (LSC17) is predictive in our aggregated pediatric study population, LSC17 is no longer predictive within established cytogenetic and molecular (cytomolecular) risk groups. Therefore, we identify distinct LSC signatures on the basis of AML cytomolecular subtypes (LSC47) that were more predictive than LSC17. Based on these findings, we build a robust relapse prediction model within a training cohort and then validate it within independent cohorts. Here, we show that LSC47 increases the predictive power of conventional risk stratification and that applying biomarkers in a manner that is informed by cytomolecular profiling outperforms a uniform biomarker approach. Relapsed pediatric acute myeloid leukemia is associated with poor prognosis. Here, the authors use RNA-seq data from 1503 primary samples to create a combined transcriptional and cytomolecular signature to improve relapse risk prediction.
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Affiliation(s)
- Benjamin J Huang
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA. .,Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA.
| | - Jenny L Smith
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Jason E Farrar
- University of Arkansas for Medical Sciences & Arkansas Children's Research Institute, Little Rock, AR, USA
| | | | - Masayuki Umeda
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Rhonda E Ries
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Erin Crowgey
- Nemours Center for Cancer and Blood Disorders and Alfred I. DuPont Hospital for Children, Wilmington, DE, USA
| | - Scott N Furlan
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Division of Hematology/Oncology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Katherine Tarlock
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Division of Hematology/Oncology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Marcos Armendariz
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Yanling Liu
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Timothy I Shaw
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Lisa Wei
- Michael Smith Genome Sciences Centre, Vancouver, BC, Canada
| | | | - Todd M Cooper
- Division of Hematology/Oncology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Alan S Gamis
- Children's Mercy Hospitals and Clinics, Kansas City, MO, USA
| | - Richard Aplenc
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - E Anders Kolb
- Nemours Center for Cancer and Blood Disorders and Alfred I. DuPont Hospital for Children, Wilmington, DE, USA
| | - Jeffrey Rubnitz
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jing Ma
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jeffery M Klco
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Xiaotu Ma
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Todd A Alonzo
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Soheil Meshinchi
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Division of Hematology/Oncology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
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13
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van Dijk AD, Hoff FW, Qiu Y, Gerbing RB, Gamis AS, Aplenc R, Kolb EA, Alonzo TA, Meshinchi S, Jenkins G, de Bont ESJM, Kornblau SM, Horton TM. Bortezomib is significantly beneficial for de novo pediatric AML patients with low phosphorylation of the NF-κB subunit RelA. Proteomics Clin Appl 2022; 16:e2100072. [PMID: 34719869 PMCID: PMC9041833 DOI: 10.1002/prca.202100072] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/30/2021] [Accepted: 10/27/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE The addition of the proteasome inhibitor (PI) bortezomib to standard chemotherapy (ADE: cytarabine [Ara-C], daunorubicin, and etoposide) did not improve overall outcome of pediatric AML patients in the Children's Oncology Group AAML1031 phase 3 randomized clinical trial (AAML1031) . Bortezomib prevents protein degradation, including RelA via the intracellular NF-kB pathway. In this study, we hypothesized that subgroups of pediatric AML patients benefitting from standard therapy plus bortezomib (ADEB) could be identified based on pre-treatment RelA expression and phosphorylation status. EXPERIMENTAL DESIGN RelA-total and phosphorylation at serine 536 (RelA-pSer536 ) were measured in 483 patient samples using reverse phase protein array technology. RESULTS In ADEB-treated patients, low-RelA-pSer536 was favorably prognostic when compared to high-RelA-pSer536 (3-yr overall survival (OS): 81% vs. 68%, p = 0.032; relapse risk (RR): 30% vs. 49%, p = 0.004). Among low-RelA-pSer536 patients, RR significantly decreased with ADEB compared to ADE (RR: 30% vs. 44%, p = 0.035). Correlation between RelA-pSer536 and 295 other assayed proteins identified a strong correlation with HSF1-pSer326 , another protein previously identified as modifying ADEB response. The combination of low-RelA-pSer536 and low-HSF1-pSer326 was a significant predictor of ADEB response (3-yr OS: 86% vs. 67%, p = 0.013). CONCLUSION AND CLINICAL RELEVANCE Bortezomib may improve clinical outcome in a subgroup of AML patients identified by low-RelA-pSer536 and low-HSF1-pSer326 .
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Affiliation(s)
- Anneke D. van Dijk
- Divison of Pediatric Oncology/Hematology, Department of Pediatrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Fieke W. Hoff
- Divison of Pediatric Oncology/Hematology, Department of Pediatrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands,Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Yihua Qiu
- Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | | | - Alan S. Gamis
- Department of Hematology-Oncology, Children’s Mercy Hospitals and Clinics, Kansas City, MO
| | - Richard Aplenc
- Division of Pediatric Oncology/Stem Cell Transplant, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - E. Anders Kolb
- Nemours Center for Cancer and Blood Disorders, Alfred I. DuPont Hospital for Children, Wilmington, DE
| | - Todd A. Alonzo
- Keck School of Medicine, University of Southern California, CA
| | - Soheil Meshinchi
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Gaye Jenkins
- Department of Pediatrics, Baylor College of Medicine/Dan L. Duncan Cancer Center and Texas Children’s Cancer Center, Houston, Texas
| | - Eveline S. J. M. de Bont
- Divison of Pediatric Oncology/Hematology, Department of Pediatrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Steven M. Kornblau
- Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Terzah M. Horton
- Department of Pediatrics, Baylor College of Medicine/Dan L. Duncan Cancer Center and Texas Children’s Cancer Center, Houston, Texas
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14
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Hoff FW, Van Dijk AD, Qiu Y, Hu CW, Ries RE, Ligeralde A, Jenkins GN, Gerbing RB, Gamis AS, Aplenc R, Kolb EA, Alonzo TA, Meshinchi S, Qutub AA, De Bont ESJM, Horton TM, Kornblau SM. Clinical relevance of proteomic profiling in de novo pediatric acute myeloid leukemia: a Children's Oncology Group study. Haematologica 2022; 107:2329-2343. [PMID: 35021602 PMCID: PMC9521248 DOI: 10.3324/haematol.2021.279672] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Indexed: 11/23/2022] Open
Abstract
Pediatric acute myeloid leukemia (AML) remains a fatal disease for at least 30% of patients, stressing the need for improved therapies and better risk stratification. As proteins are the unifying feature of (epi)genetic and environmental alterations, and are often targeted by novel chemotherapeutic agents, we studied the proteomic landscape of pediatric AML. Protein expression and activation levels were measured in 500 bulk leukemic patients’ samples and 30 control CD34+ cell samples, using reverse phase protein arrays with 296 strictly validated antibodies. The multistep MetaGalaxy analysis methodology was applied and identified nine protein expression signatures (PrSIG), based on strong recurrent protein expression patterns. PrSIG were associated with cytogenetics and mutational state, and with favorable or unfavorable prognosis. Analysis based on treatment (i.e., ADE vs. ADE plus bortezomib) identified three PrSIG that did better with ADE plus bortezomib than with ADE alone. When PrSIG were studied in the context of cytogenetic risk groups, PrSIG were independently prognostic after multivariate analysis, suggesting a potential value for proteomics in combination with current classification systems. Proteins with universally increased (n=7) or decreased (n=17) expression were observed across PrSIG. Certain proteins significantly differentially expressed from normal could be identified, forming a hypothetical platform for personalized medicine.
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Affiliation(s)
- Fieke W Hoff
- Department of Pediatric Oncology/Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Anneke D Van Dijk
- Department of Pediatric Oncology/Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Yihua Qiu
- Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Chenyue W Hu
- Department of Bioengineering, Rice University, Houston, TX, USA
| | - Rhonda E Ries
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | | | - Gaye N Jenkins
- Department of Pediatrics, Texas Children's Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | | | - Alan S Gamis
- Department of Hematology-Oncology, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA
| | - Richard Aplenc
- Division of Pediatric Oncology/Stem Cell Transplant, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - E Anders Kolb
- Nemours Center for Cancer and Blood Disorders, Emory University, Atlanta GA, USA
| | - Todd A Alonzo
- University of Southern California, Los Angeles, CA, USA
| | - Soheil Meshinchi
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Amina A Qutub
- Department of Biomedical Engineering, The University of Texas at San Antonio, USA
| | - Eveline S J M De Bont
- Department of Pediatric Oncology/Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Terzah M Horton
- Department of Pediatrics, Texas Children's Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Steven M Kornblau
- Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
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15
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Getz KD, Alonzo TA, Sung L, Meshinchi S, Gerbing RB, Raimondi S, Hirsch B, Loken M, Brodersen LE, Kahwash S, Choi J, Kolb EA, Gamis A, Aplenc R. Cytarabine dose reduction in patients with low-risk acute myeloid leukemia: A report from the Children's Oncology Group. Pediatr Blood Cancer 2022; 69:e29313. [PMID: 34472213 PMCID: PMC8919970 DOI: 10.1002/pbc.29313] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/09/2021] [Accepted: 08/14/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND The optimal number of chemotherapy courses for low-risk (LR) pediatric acute myeloid leukemia (AML) is not known. OBJECTIVE To compare outcomes for four (21.6 g/m2 cytarabine) versus five (45.6 g/m2 cytarabine) chemotherapy courses for LR-AML using data from Children's Oncology Group (COG) AAML0531 and AAML1031. METHODS We compared relapse risk (RR), disease-free survival (DFS), and overall survival (OS), and the differential impact in LR subgroups for patients receiving four versus five chemotherapy courses. Cox (OS and DFS) and risk (RR) regressions were used to estimate hazard ratios (HR) to compare outcomes. RESULTS A total of 923 LR-AML patients were included; 21% received five courses. Overall, LR-AML patients who received four courses had higher RR (40.9% vs. 31.4%; HR = 1.40, 95% confidence interval [CI]: 1.06-1.85), and worse DFS (56.0% vs. 67.0%; HR = 1.45, 95% CI: 1.10-1.91). There was a similar decrement in OS though it was not statistically significant (77.0% vs. 83.5%; HR = 1.45, 95% CI: 0.97-2.17). Stratified analyses revealed the detrimental effects of cytarabine dose de-escalation to be most pronounced in the LR-AML subgroup with uninformative cytogenetic/molecular features who were minimal residual disease (MRD) negative after the first induction course (EOI1). The absolute decrease in DFS with four courses for patients with favorable cytogenetic/molecular features and positive MRD was similar to that observed for patients with uninformative cytogenetic/molecular features and negative MRD at EOI1, though not statistically significant. CONCLUSIONS Our results support de-escalation of cytarabine exposure through the elimination of a fifth chemotherapy course only for LR-AML patients who have both favorable cytogenetic/molecular features and negative MRD after the first induction cycle.
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Affiliation(s)
- Kelly D. Getz
- Children’s Hospital of Philadelphia, Division of Oncology, Philadelphia, Pennsylvania, USA,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Todd A. Alonzo
- University of Southern California, Los Angeles, California, USA
| | - Lillian Sung
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Soheil Meshinchi
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | | | - Susana Raimondi
- St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Betsy Hirsch
- University of Minnesota, Minneapolis, Minnesota, USA
| | | | | | | | - John Choi
- St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - E. Anders Kolb
- Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Alan Gamis
- Children’s Mercy Hospital and Clinics, Kansas City, Missouri, USA
| | - Richard Aplenc
- Children’s Hospital of Philadelphia, Division of Oncology, Philadelphia, Pennsylvania, USA,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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16
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Elgarten CW, Wood AC, Li Y, Alonzo TA, Brodersen LE, Gerbing RB, Getz KD, Huang YSV, Loken M, Meshinchi S, Pollard JA, Sung L, Woods WG, Kolb EA, Gamis AS, Aplenc R. Outcomes of intensification of induction chemotherapy for children with high-risk acute myeloid leukemia: A report from the Children's Oncology Group. Pediatr Blood Cancer 2021; 68:e29281. [PMID: 34596937 PMCID: PMC8717610 DOI: 10.1002/pbc.29281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/15/2021] [Accepted: 07/26/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND High-risk pediatric acute myeloid leukemia confers a poor prognosis, and alternative strategies are needed to improve outcomes. We hypothesized that intensifying induction on the AAML1031 clinical trial would improve outcomes compared to the predecessor trial AAML0531. METHODS Patients on AAML0531 received cytarabine (1600 mg/m2 )/daunorubicin (150 mg/m2 )/etoposide (ADE) for induction II and patients on AAML1031 received mitoxantrone (48 mg/m2 )/cytarabine (8000 mg/m2 ) (MA). Stem cell transplant (SCT) conditioning included busulfan/cyclophosphamide on AAML0531, whereas AAML1031 used busulfan/fludarabine and liberalized donor eligibility. Patients were included in this analysis if they met high-risk criteria common to the two trials by cytogenics or poor disease response after induction I ADE. RESULTS MA provided no benefit over ADE at: induction II response (complete response [CR]: 64% vs. 62%, p = .87; measurable residual disease [MRD]+: 57% vs. 46%, p = .34); or intensification I response (CR: 79% vs. 94%, p = .27; MRD+: 27% vs. 20%, p = 1.0). When considered with altered SCT approach, MA did not improve 5-year disease-free survival (24% ± 9% vs. 18% ± 15%, p = .63) or 5-year overall survival (35% ± 10% vs. 38% ± 18%, p = .66). MA was associated with slower neutrophil recovery (median 34 vs. 27 days, p = .007) and platelet recovery (median 29 vs. 24.5 days, p = .04) and longer hospital stay (32 vs. 28 days, p = .01) during induction II. CONCLUSION Intensification of induction II did not improve treatment response or survival, but did increase toxicity and resource utilization. Alternative strategies are urgently needed to improve outcomes for pediatric patients with high-risk acute myeloid leukemia (trials registered at clinicaltrials.gov NCT01371981, NCT00372593).
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Affiliation(s)
- Caitlin W. Elgarten
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Yimei Li
- Department of Biostatistics, Epidemiology, and Informatics, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Todd A. Alonzo
- University of Southern California, Los Angeles, California, USA
| | | | | | - Kelly D. Getz
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Department of Biostatistics, Epidemiology, and Informatics, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Y-S Vera Huang
- Department of Biomedical Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Soheil Meshinchi
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Jessica A. Pollard
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA,Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Lillian Sung
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - William G. Woods
- Aflac Cancer and Blood Disorders Center, Emory University/Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - E. Anders Kolb
- Alfred I.duPont Hospital for Children, Wilmington, Delaware, USA
| | - Alan S. Gamis
- Children’s Mercy Hospital and Clinics, Kansas City, Missouri, USA
| | - Richard Aplenc
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Department of Biostatistics, Epidemiology, and Informatics, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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17
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Kutny MA, Alonzo TA, Abla O, Rajpurkar M, Gerbing RB, Wang YC, Hirsch BA, Raimondi S, Kahwash S, Hardy KK, Hardy S, Meshinchi S, Gamis AS, Kolb EA, Feusner JH, Gregory J. Assessment of Arsenic Trioxide and All-trans Retinoic Acid for the Treatment of Pediatric Acute Promyelocytic Leukemia: A Report From the Children's Oncology Group AAML1331 Trial. JAMA Oncol 2021; 8:79-87. [PMID: 34762093 DOI: 10.1001/jamaoncol.2021.5206] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance All-trans retinoic acid (ATRA) and arsenic trioxide therapy without the use of maintenance therapy has been found to be beneficial for the treatment of adults with standard-risk acute promyelocytic leukemia (APL). However, it is unclear whether similar regimens are safe and beneficial for the treatment of high-risk APL or pediatric patients with standard-risk APL. Objective To assess whether treatment with an ATRA and arsenic trioxide-based regimen is safe and allows for the elimination or substantial reduction of chemotherapy use among pediatric patients with standard-risk or high-risk APL, respectively. Design, Setting, and Participants The Children's Oncology Group AAML1331 study is a nonrandomized, noninferiority trial that examined survival outcomes among 154 pediatric patients with APL compared with a historical control group of patients with APL from the AAML0631 study. Patients aged 1 to 21 years were enrolled at 85 pediatric oncology centers (members of the Children's Oncology Group) in Australia, Canada, and the US from June 29, 2015, to May 7, 2019, with follow-up until October 31, 2020. All patients had newly diagnosed APL and were stratified into standard-risk APL (white blood cell count <10 000/μL) and high-risk APL (white blood cell count ≥10 000/μL) cohorts. Interventions All patients received ATRA and arsenic trioxide continuously during induction therapy and intermittently during 4 consolidation cycles. Patients with high-risk APL received 4 doses of idarubicin during induction therapy only. The duration of therapy was approximately 9 months, and no maintenance therapy was administered. Main Outcomes and Measures Event-free survival (EFS) at 2 years after diagnosis. Results Among 154 patients (median age, 14.4 years [range, 1.1-21.7 years]; 81 male participants [52.6%]) included in the analysis, 98 patients (63.6%) had standard-risk APL, and 56 patients (36.4%) had high-risk APL. The median follow-up duration was 24.7 months (range, 0-49.5 months) for patients with standard-risk APL and 22.8 months (range, 0-47.7 months) for patients with high-risk APL. Patients with standard-risk APL had a 2-year EFS rate of 98.0% and an overall survival rate of 99.0%; adverse events included 1 early death during induction therapy and 1 relapse. Patients with high-risk APL had a 2-year EFS rate of 96.4% and an overall survival rate of 100%; adverse events included 2 relapses and 0 deaths. These outcomes met predefined noninferiority criteria (noninferiority margin of 10% among those with standard-risk APL and 14.5% among those with high-risk APL). Conclusions and Relevance In this nonrandomized, noninferiority trial, pediatric patients with standard-risk APL who received treatment with a chemotherapy-free ATRA and arsenic trioxide regimen experienced positive outcomes. Patients with high-risk APL also had positive outcomes when treated with a novel ATRA and arsenic trioxide-based regimen that included 4 doses of idarubicin during induction therapy only and no maintenance therapy. The 2-year EFS estimates were noninferior to the historical comparator group, and advantages of the regimen included shorter treatment duration, lower exposure to anthracycline and intrathecal chemotherapy, and fewer days hospitalized. Trial Registration ClinicalTrials.gov Identifier: NCT02339740.
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Affiliation(s)
- Matthew A Kutny
- Division of Hematology/Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham
| | - Todd A Alonzo
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles
| | - Oussama Abla
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Madhvi Rajpurkar
- Pediatric Hematology/Oncology, Wayne State University, Detroit, Michigan
| | | | | | - Betsy A Hirsch
- Division of Laboratory Medicine, University of Minnesota Medical Center-Fairview, Minneapolis
| | - Susana Raimondi
- Department of Pathology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Samir Kahwash
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Kristina K Hardy
- Division of Behavioral Medicine/Neuropsychology, Children's National Medical Center, Washington, District of Columbia
| | - Steven Hardy
- Division of Behavioral Medicine/Neuropsychology, Children's National Medical Center, Washington, District of Columbia
| | - Soheil Meshinchi
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Alan S Gamis
- Division of Hematology/Oncology, Children's Mercy Hospital and Clinics, Kansas City, Missouri
| | - Edward A Kolb
- Division of Pediatric Hematology/Oncology, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, Delaware
| | - James H Feusner
- Division of Hematology/Oncology, Benioff Children's Hospital Oakland, Oakland, California
| | - John Gregory
- Division of Pediatric Hematology/Oncology, Atlantic Health System, Goryeb Children's Hospital, Morristown, New Jersey
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18
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Tarlock K, Lamble AJ, Wang YC, Gerbing RB, Ries RE, Loken MR, Brodersen LE, Pardo L, Leonti A, Smith JL, Hylkema TA, Woods WG, Cooper TM, Kolb EA, Gamis AS, Aplenc R, Alonzo TA, Meshinchi S. CEBPA-bZip mutations are associated with favorable prognosis in de novo AML: a report from the Children's Oncology Group. Blood 2021; 138:1137-1147. [PMID: 33951732 PMCID: PMC8570058 DOI: 10.1182/blood.2020009652] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/03/2021] [Indexed: 11/20/2022] Open
Abstract
Biallelic CEBPA mutations are associated with favorable outcomes in acute myeloid leukemia (AML). We evaluated the clinical and biologic implications of CEBPA-basic leucine zipper (CEBPA-bZip) mutations in children and young adults with newly diagnosed AML. CEBPA-bZip mutation status was determined in 2958 patients with AML enrolled on Children's Oncology Group trials (NCT00003790, NCT0007174, NCT00372593, NCT01379181). Next-generation sequencing (NGS) was performed in 1863 patients (107 with CEBPA mutations) to characterize the co-occurring mutations. CEBPA mutational status was correlated with disease characteristics and clinical outcomes. CEBPA-bZip mutations were identified in 160 (5.4%) of 2958 patients, with 132 (82.5%) harboring a second CEBPA mutation (CEBPA-double-mutated [CEBPA-dm]) and 28 (17.5%) had a single CEBPA-bZip only mutation. The clinical and laboratory features of the 2 CEBPA cohorts were very similar. Patients with CEBPA-dm and CEBPA-bZip experienced identical event-free survival (EFS) of 64% and similar overall survival (OS) of 81% and 89%, respectively (P = .259); this compared favorably to EFS of 46% and OS of 61% in patients with CEBPA-wild-type (CEBPA-WT) (both P < .001). Transcriptome analysis demonstrated similar expression profiles for patients with CEBPA-bZip and CEBPA-dm. Comprehensive NGS of patients with CEBPA mutations identified co-occurring CSF3R mutations in 13.1% of patients and GATA2 mutations in 21.5% of patients. Patients with dual CEBPA and CSF3R mutations had an EFS of 17% vs 63% for patients with CEBPA-mutant or CSF3R-WT (P < .001) with a corresponding relapse rate (RR) of 83% vs 22%, respectively (P < .001); GATA2 co-occurrence did not have an impact on outcome. CEBPA-bZip domain mutations are associated with favorable clinical outcomes, regardless of monoallelic or biallelic status. Co-occurring CSF3R and CEBPA mutations are associated with a high RR that nullifies the favorable prognostic impact of CEBPA mutations.
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Affiliation(s)
- Katherine Tarlock
- Division of Hematology/Oncology, Seattle Children's Hospital, University of Washington, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Adam J Lamble
- Division of Hematology/Oncology, Seattle Children's Hospital, University of Washington, Seattle, WA
| | | | | | - Rhonda E Ries
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | | | | | - Amanda Leonti
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jenny L Smith
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Tiffany A Hylkema
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - William G Woods
- Aflac Cancer, Children's Healthcare of Atlanta, Emory University, Atlanta, GA
| | - Todd M Cooper
- Division of Hematology/Oncology, Seattle Children's Hospital, University of Washington, Seattle, WA
| | - E Anders Kolb
- Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE
| | - Alan S Gamis
- Children's Mercy Hospital and Clinics, Kansas City, MO
| | - Richard Aplenc
- The Children's Hospital of Philadelphia, Philadelphia, PA; and
| | - Todd A Alonzo
- Children's Oncology Group, Monrovia, CA
- University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Soheil Meshinchi
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
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19
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Pollard JA, Guest E, Alonzo TA, Gerbing RB, Loken MR, Brodersen LE, Kolb EA, Aplenc R, Meshinchi S, Raimondi SC, Hirsch B, Gamis AS. Gemtuzumab Ozogamicin Improves Event-Free Survival and Reduces Relapse in Pediatric KMT2A-Rearranged AML: Results From the Phase III Children's Oncology Group Trial AAML0531. J Clin Oncol 2021; 39:3149-3160. [PMID: 34048275 DOI: 10.1200/jco.20.03048] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE We investigated the impact of the CD33-targeted agent gemtuzumab ozogamicin (GO) on survival in pediatric patients with KMT2A-rearranged (KMT2A-r) acute myeloid leukemia (AML) enrolled in the Children's Oncology Group trial AAML0531 (NCT01407757). METHODS Patients with KMT2A-r AML were identified and clinical characteristics described. Five-year overall survival (OS), event-free survival (EFS), disease-free survival (DFS), and relapse risk (RR) were determined overall and for higher-risk versus not high-risk translocation partners. GO's impact on response was determined and outcomes based on consolidation approach (hematopoietic stem cell transplant [HSCT] v chemotherapy) described. RESULTS Two hundred fifteen (21%) of 1,022 patients enrolled had KMT2A-r AML. Five-year EFS and OS from study entry were 38% and 58%, respectively. EFS was superior with GO treatment (EFS 48% with GO v 29% without, P = .003), although OS was comparable (63% v 53%, P = .054). For patients with KMT2A-r AML who achieved complete remission, GO was associated with lower RR (40% GO v 66% patients who did not receive GO [No-GO], P = .001) and improved 5-year DFS (GO 57% v No-GO 33%, P = .002). GO benefit was observed in both higher-risk and not high-risk KMT2A-r subsets. For patients who underwent HSCT, prior GO exposure was associated with decreased relapse (5-year RR: 28% GO and HSCT v 73% No-GO and HSCT, P = .006). In multivariable analysis, GO was independently associated with improved EFS, improved DFS, and reduced RR. CONCLUSION GO added to conventional chemotherapy improved outcomes for KMT2A-r AML; consolidation with HSCT may further enhance outcomes. Future clinical trials should study CD33-targeted agents in combination with HSCT for pediatric KMT2A-r AML.
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Affiliation(s)
- Jessica A Pollard
- Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA.,Department of Pediatrics, Harvard Medical School, Boston, MA
| | | | - Todd A Alonzo
- University of Southern California Keck School of Medicine, Los Angeles, CA.,Children's Oncology Group, Monrovia, CA
| | | | | | | | | | | | - Soheil Meshinchi
- Fred Hutchinson Cancer Research Center, Seattle, WA.,University of Washington School of Medicine, Seattle, WA
| | | | - Betsy Hirsch
- University of Minnesota Cancer Center, Minneapolis, MN
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20
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Narayanan P, Man TK, Gerbing RB, Ries R, Stevens AM, Wang YC, Long X, Gamis AS, Cooper T, Meshinchi S, Alonzo TA, Redell MS. Aberrantly low STAT3 and STAT5 responses are associated with poor outcome and an inflammatory gene expression signature in pediatric acute myeloid leukemia. Clin Transl Oncol 2021; 23:2141-2154. [PMID: 33948920 PMCID: PMC8390401 DOI: 10.1007/s12094-021-02621-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/07/2021] [Indexed: 12/19/2022]
Abstract
The relapse rate for children with acute myeloid leukemia is nearly 40% despite aggressive chemotherapy and often stem cell transplant. We sought to understand how environment-induced signaling responses are associated with clinical response to treatment. We previously reported that patients whose AML cells showed low G-CSF-induced STAT3 activation had inferior event-free survival compared to patients with stronger STAT3 responses. Here, we expanded the paradigm to evaluate multiple signaling parameters induced by a more physiological stimulus. We measured STAT3, STAT5 and ERK1/2 responses to G-CSF and to stromal cell-conditioned medium for 113 patients enrolled on COG trials AAML03P1 and AAML0531. Low inducible STAT3 activity was independently associated with inferior event-free survival in multivariate analyses. For inducible STAT5 activity, those with the lowest and highest responses had inferior event-free survival, compared to patients with intermediate STAT5 responses. Using existing RNA-sequencing data, we compared gene expression profiles for patients with low inducible STAT3/5 activation with those for patients with higher inducible STAT3/5 signaling. Genes encoding hematopoietic factors and mitochondrial respiratory chain subunits were overexpressed in the low STAT3/5 response groups, implicating inflammatory and metabolic pathways as potential mechanisms of chemotherapy resistance. We validated the prognostic relevance of individual genes from the low STAT3/5 response signature in a large independent cohort of pediatric AML patients. These findings provide novel insights into interactions between AML cells and the microenvironment that are associated with treatment failure and could be targeted for therapeutic interventions.
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Affiliation(s)
- P Narayanan
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - T-K Man
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - R B Gerbing
- Children's Oncology Group, Monrovia, CA, USA
| | - R Ries
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - A M Stevens
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Y-C Wang
- Children's Oncology Group, Monrovia, CA, USA
| | - X Long
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - A S Gamis
- Children's Mercy Hospital and Clinics, Kansas, MO, USA
| | - T Cooper
- Seattle Children's Hospital, Seattle, WA, USA
| | - S Meshinchi
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - T A Alonzo
- Children's Oncology Group, Monrovia, CA, USA.,Division of Biostatistics, University of Southern California, Los Angeles, CA, USA
| | - M S Redell
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, TX, USA.
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21
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Hoff FW, van Dijk AD, Qiu Y, Ruvolo PP, Gerbing RB, Leonti AR, Jenkins GN, Gamis AS, Aplenc R, Kolb EA, Alonzo TA, Meshinchi S, de Bont ESJM, Bruggeman SWM, Kornblau SM, Horton TM. Heat shock factor 1 (HSF1-pSer326) predicts response to bortezomib-containing chemotherapy in pediatric AML: a COG report. Blood 2021; 137:1050-1060. [PMID: 32959058 PMCID: PMC7907722 DOI: 10.1182/blood.2020005208] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 08/25/2020] [Indexed: 11/20/2022] Open
Abstract
Bortezomib (BTZ) was recently evaluated in a randomized phase 3 clinical trial by the Children's Oncology Group (COG) that compared standard chemotherapy (cytarabine, daunorubicin, and etoposide [ADE]) vs standard therapy with BTZ (ADEB) for de novo pediatric acute myeloid leukemia (AML). Although the study concluded that BTZ did not improve outcome overall, we examined patient subgroups benefiting from BTZ-containing chemotherapy using proteomic analyses. The proteasome inhibitor BTZ disrupts protein homeostasis and activates cytoprotective heat shock responses. Total heat shock factor 1 (HSF1) and phosphorylated HSF1 (HSF1-pSer326) were measured in leukemic cells from 483 pediatric patients using reverse phase protein arrays. HSF1-pSer326 phosphorylation was significantly lower in pediatric AML compared with CD34+ nonmalignant cells. We identified a strong correlation between HSF1-pSer326 expression and BTZ sensitivity. BTZ significantly improved outcome of patients with low-HSF1-pSer326 with a 5-year event-free survival of 44% (ADE) vs 67% for low-HSF1-pSer326 treated with ADEB (P = .019). To determine the effect of HSF1 expression on BTZ potency in vitro, cell viability with HSF1 gene variants that mimicked phosphorylated (S326A) and nonphosphorylated (S326E) HSF1-pSer326 were examined. Those with increased HSF1 phosphorylation showed clear resistance to BTZ vs those with wild-type or reduced HSF1-phosphorylation. We hypothesize that HSF1-pSer326 expression could identify patients who benefit from BTZ-containing chemotherapy.
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Affiliation(s)
- Fieke W Hoff
- Department of Pediatric Oncology/Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anneke D van Dijk
- Department of Pediatric Oncology/Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Peter P Ruvolo
- Department of Leukemia and
- Section of Molecular Hematology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Amanda R Leonti
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Gaye N Jenkins
- Department of Pediatrics, Baylor College of Medicine/Dan L. Duncan Cancer Center and Texas Children's Cancer and Hematology Centers, Houston, TX
| | - Alan S Gamis
- Department of Hematology-Oncology, Children's Mercy Hospitals and Clinics, Kansas City, MO
| | - Richard Aplenc
- Division of Pediatric Oncology/Stem Cell Transplant, Children's Hospital of Philadelphia, Philadelphia, PA
| | - E Anders Kolb
- Nemours/Alfred I. duPont Hospital for Children, Atlanta, GA
| | - Todd A Alonzo
- COG Statistics and Data Center, Monrovia, CA
- Keck School of Medicine, University of Southern California, Los Angeles, CA; and
| | - Soheil Meshinchi
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Eveline S J M de Bont
- Department of Pediatric Oncology/Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sophia W M Bruggeman
- European Research Institute for the Biology of Ageing (ERIBA), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Terzah M Horton
- Department of Pediatrics, Baylor College of Medicine/Dan L. Duncan Cancer Center and Texas Children's Cancer and Hematology Centers, Houston, TX
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22
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Noort S, Wander P, Alonzo TA, Smith J, Ries RE, Gerbing RB, Dolman MEM, Locatelli F, Reinhardt D, Baruchel A, Stary J, Molenaar JJ, Stam RW, van den Heuvel-Eibrink MM, Zwaan MC, Meshinchi S. The clinical and biological characteristics of NUP98-KDM5A in pediatric acute myeloid leukemia. Haematologica 2021; 106:630-634. [PMID: 32381579 PMCID: PMC7849578 DOI: 10.3324/haematol.2019.236745] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 04/29/2020] [Indexed: 12/25/2022] Open
Affiliation(s)
- Sanne Noort
- Pediatric Oncology/Hematology, Erasmus MC-Sophia Children Hospital Rotterdam, The Netherlands
| | - Priscilla Wander
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Todd A Alonzo
- Children's Oncology Group, Monrovia, California, USA
| | - Jenny Smith
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Rhonda E Ries
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | | | - M Emmy M Dolman
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Franco Locatelli
- IRCCS Ospedale Bambino Gesú, Sapienza, University of Rome, Rome, Italy
| | - Dirk Reinhardt
- AML-BFM Study Group, Pediatric Hematology and Oncology, Essen, Germany
| | - Andre Baruchel
- University Hospital Robert Debré and Paris Diderot University, Paris, France
| | - Jan Stary
- CPH, University Hospital Motol and Charles University, Prague, Czech Republic
| | - Jan J Molenaar
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Ronald W Stam
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Michel C Zwaan
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Soheil Meshinchi
- Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, USA
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23
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Leger KJ, Absalon M, Demissei BG, Gerbing RB, Alonzo TA, Hirsch BA, Pollard JA, Razzouk BI, Kolb EA, Aplenc R, Ky B, Cooper TM. Change in cardiac function with CPX-351 in relapsed pediatric AML: A Children’s Oncology Group (COG) report from AAML1421. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.10532] [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
10532 Background: Anthracyclines (AC) are highly effective in treating acute myeloid leukemia (AML), but limited by cardiotoxicity (CTX). CPX-351, a liposomal preparation of daunorubicin (DNR) and cytarabine, may provide therapeutic benefit with less CTX. We evaluated acute changes in cardiovascular (CV) function and biomarkers after 1 cycle of CPX-351 in children with relapsed AML within the phase 1/2 study, AAML1421. Methods: Patients (pts) received 135 units/m2/dose of CPX-351 on days 1, 3, and 5. Echocardiograms were centrally quantified at baseline (BL) and day 29 (end of cycle (EOC)). High sensitivity troponin (cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were measured at BL and days 5, 8, 15, 22, and 29. Differences between BL and post-CPX-351 echo/biomarker measurements were analyzed using pre-specified Wilcoxon signed rank tests. The relationship between EOC ejection fraction (EF) and clinical variables was assessed using repeated measures linear regression. Results: In 32 included pts, the median AC exposure prior to study entry was 337 mg/m2 DNR equivalents. At baseline, markers of CV function and stress were abnormal (Table). Over 1 cycle, there was a statistically significant decrease in EF and circumferential strain (Table). NT-proBNP and cTnT did not increase significantly over time. In multivariable analysis, only increasing body surface area was significantly associated with lower EOC EF (b:-5.9, 95% CI -10.8,-0.9). Cancer therapy–related cardiac dysfunction, defined as ≥10% decline in EF to < 50%, occurred in 6/32 pts at EOC. Conclusions: In this single arm study of AC pre-treated children, baseline abnormalities in CV function were common. CPX-351 was associated with a statistically significant decline in CV function without a rise in cardiac biomarkers. Absent a comparator population, it is not known how these cardiac trends compare to non-liposomal AC or non-AC salvage regimens. The COG AAML1831 trial will determine if CPX-351 offers cardioprotection compared to standard AC in pts with de novo AML. Clinical trial information: NCT02642965. [Table: see text]
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Affiliation(s)
| | - Michael Absalon
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Biniyam G Demissei
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | | | - Todd Allen Alonzo
- University of Southern California Children's Oncology Group, Arcadia, CA
| | | | | | | | | | | | - Bonnie Ky
- Hospital of the University of Pennsylvania, Philadelphia, PA
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24
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Cooper TM, Absalon MJ, Alonzo TA, Gerbing RB, Leger KJ, Hirsch BA, Pollard J, Razzouk BI, Aplenc R, Kolb EA. Phase I/II Study of CPX-351 Followed by Fludarabine, Cytarabine, and Granulocyte-Colony Stimulating Factor for Children With Relapsed Acute Myeloid Leukemia: A Report From the Children's Oncology Group. J Clin Oncol 2020; 38:2170-2177. [PMID: 32401633 DOI: 10.1200/jco.19.03306] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Effective regimens are needed for children with relapsed acute myeloid leukemia (AML). AAML1421 is a phase I/II study of CPX-351, a liposomal preparation of daunorubicin and cytarabine. AAML1421 sought to determine the recommended phase II dose (RP2D) of CPX-351 and the response rate after up to 2 cycles of therapy. PATIENTS AND METHODS Children > 1 and ≤ 21 years of age with relapsed/refractory AML were eligible for dose finding; those in first relapse were eligible for the efficacy phase. Dose-limiting toxicity (DLT) assessment occurred during cycle 1. Two cycles of therapy were offered (cycle 1: CPX-351; cycle 2: FLAG [fludarabine 30 mg/m2/dose on days 1-5; cytarabine 2,000 mg/m2/dose on days 1-5; and granulocyte-colony stimulating factor 5 µg/kg/dose, days 1-5 and day 15 through absolute neutrophil count > 500/µL]). Response was assessed after each cycle. RESULTS Thirty-eight patients enrolled: 6 in the dose-finding phase and 32 in the efficacy phase. During dose finding, 1/6 patients experienced a DLT (grade 3 decrease in ejection fraction). The RP2D was 135 units/m2 on days 1, 3, and 5. Toxicities of grade ≥ 3 during cycle 1 included fever/neutropenia (45%), infection (47%), and rash (40%). There was no toxic mortality. Best responses included 20 complete response (CR; 54%), 5 CR with partial recovery of platelet count (CRp; 14%), and 5 CR with incomplete blood count recovery (14%). Twenty-one of 25 with CR/CRp had no detectable residual disease (RD; 84%) by flow cytometry. Hematopoietic stem cell transplantation (HSCT) was used as consolidation in 29/30 responders (96.7%); 20/25 (80%) had no RD before HSCT. CONCLUSION The RP2D of CPX-351 is 135 units/m2/dose on days 1, 3, and 5. Toxicity was manageable, and protocol therapy was effective. Response rates are superior to prior published North American cooperative group clinical trials for children with AML in first relapse.
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Affiliation(s)
- Todd M Cooper
- Department of Hematology/Oncology, Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, WA
| | | | - Todd A Alonzo
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | | | - Kasey J Leger
- Department of Hematology/Oncology, Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, WA
| | | | - Jessica Pollard
- Dana-Farber Cancer Institute/Boston Children's Hospital, Boston, MA
| | - Bassem I Razzouk
- Peyton Manning Children's Hospital at St Vincent, Indianapolis, IN
| | | | - E Anders Kolb
- Nemours Center for Cancer and Blood Disorders/Alfred I. DuPont Hospital for Children, Wilmington, DE
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25
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Getz KD, Sung L, Alonzo TA, Leger KJ, Gerbing RB, Pollard JA, Cooper T, Kolb EA, Gamis AS, Ky B, Aplenc R. Effect of Dexrazoxane on Left Ventricular Systolic Function and Treatment Outcomes in Patients With Acute Myeloid Leukemia: A Report From the Children's Oncology Group. J Clin Oncol 2020; 38:2398-2406. [PMID: 32343641 DOI: 10.1200/jco.19.02856] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To determine whether dexrazoxane provides effective cardioprotection during frontline treatment of pediatric acute myeloid leukemia (AML) without increasing relapse risk or noncardiac toxicities of the chemotherapy regimens. PATIENTS AND METHODS This was a multicenter study of all pediatric patients with AML without high allelic ratio FLT3/ITD treated in the Children's Oncology Group trial AAML1031 between 2011 and 2016. Median follow-up was 3.5 years. Dexrazoxane was administered at the discretion of treating physicians and documented at each course. Ejection fraction (EF) and shortening fraction (SF) were recorded after each course and at regular intervals in follow-up. Per protocol, anthracyclines were to be withheld if there was evidence of left ventricular systolic dysfunction (LVSD) defined as SF < 28% or EF < 55%. Occurrence of LVSD, trends in EF and SF, 5-year event-free survival (EFS) and overall survival (OS), and treatment-related mortality (TRM) were compared by dexrazoxane exposure. RESULTS A total of 1,014 patients were included in the analyses; 96 were exposed to dexrazoxane at every anthracycline course, and 918 were never exposed. Distributions of sex, age, race, presenting WBC count, risk group, treatment arm, and compliance with cardiac monitoring were similar for dexrazoxane-exposed and -unexposed patients. Dexrazoxane-exposed patients had significantly smaller EF and SF declines than unexposed patients across courses and a lower risk for LVSD (26.5% v 42.2%; hazard ratio, 0.55; 95% CI, 0.36 to 0.86; P = .009). Dexrazoxane-exposed patients had similar 5-year EFS (49.0% v 45.1%; P = .534) and OS (65.0% v 61.9%; P = .613) to those unexposed; however, there was a suggestion of lower TRM with dexrazoxane (5.7% v 12.7%; P = .068). CONCLUSION Dexrazoxane preserved cardiac function without compromising EFS and OS or increasing noncardiac toxicities. Dexrazoxane should be considered for cardioprotection during frontline treatment of pediatric AML.
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Affiliation(s)
- Kelly D Getz
- Children's Hospital of Philadelphia, Philadelphia, PA.,University of Pennsylvania, Philadelphia, PA
| | - Lillian Sung
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | - Jessica A Pollard
- Boston Children's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | - E Anders Kolb
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE
| | - Alan S Gamis
- Children's Mercy Hospital and Clinics, Kansas City, MO
| | - Bonnie Ky
- University of Pennsylvania, Philadelphia, PA
| | - Richard Aplenc
- Children's Hospital of Philadelphia, Philadelphia, PA.,University of Pennsylvania, Philadelphia, PA
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26
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Phillips CL, Lane A, Gerbing RB, Alonzo TA, Wilkey A, Radloff G, Lange B, Gamazon ER, Dolan ME, Davies SM. Genomic Variants of Cytarabine Sensitivity Associated with Treatment-Related Mortality in Pediatric AML: A Report from the Children's Oncology Group. Clin Cancer Res 2020; 26:2891-2897. [PMID: 32122921 DOI: 10.1158/1078-0432.ccr-19-3117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/10/2020] [Accepted: 02/26/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Cytarabine is an effective treatment for AML with associated toxicities including treatment related mortality (TRM). The purpose is to determine the clinical relevance of SNPs identified through the use of HapMap lymphoblastoid cell-based models, in predicting cytarabine response and toxicity in AML. EXPERIMENTAL DESIGN We tested clinical significance of SNPs associated with cytarabine sensitivity in children with AML treated on Children's Oncology Group regimens (CCG 2941/2961). Endpoints included overall survival (OS), event-free survival (EFS), and TRM. Patients who received bone marrow transplant were excluded. We tested 124 SNPs associated with cytarabine sensitivity in HapMap cell lines in 348 children to determine whether any associated with treatment outcomes. In addition, we tested five SNPs previously associated with TRM in children with AML in our independent dataset of 385 children. RESULTS Homozygous variant genotypes of rs2025501 and rs6661575 had increased in vitro cellular sensitivity to cytarabine and were associated with increased TRM. TRM was particularly increased in children with variant genotype randomized to high-dose cytarabine (rs2025501: P = 0.0024 and rs6661575 P = 0.0188). In analysis of previously reported SNPs, only the variant genotype rs17202778 C/C was significantly associated with TRM (P < 0.0001). CONCLUSIONS We report clinical importance of two SNPs not previously associated with cytarabine toxicity. Moreover, we confirm that SNP rs17202778 significantly impacts TRM in pediatric AML. Cytarabine sensitivity genotypes may predict TRM and could be used to stratify to standard versus high-dose cytarabine regimens, warranting further study in prospective AML trials.
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Affiliation(s)
- Christine L Phillips
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio. .,Cancer and Blood Diseases Institute, Cincinnati Children's Hospital, Cincinnati Ohio
| | - Adam Lane
- Division of Biostatics and Epidemiology, Cincinnati Children's Hospital, Cincinnati, Ohio
| | | | - Todd A Alonzo
- University of Southern California, Los Angeles, California
| | - Alyss Wilkey
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital, Cincinnati Ohio
| | - Gretchen Radloff
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital, Cincinnati Ohio
| | - Beverly Lange
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Eric R Gamazon
- Vanderbilt Genetics Institute and the Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Clare Hall, University of Cambridge, Cambridge, United Kingdom
| | - M Eileen Dolan
- Section of Hematology/Oncology, The University of Chicago, Chicago, Illinois
| | - Stella M Davies
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Cancer and Blood Diseases Institute, Cincinnati Children's Hospital, Cincinnati Ohio
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27
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Smith JL, Ries RE, Hylkema T, Alonzo TA, Gerbing RB, Santaguida MT, Eidenschink Brodersen L, Pardo L, Cummings CL, Loeb KR, Le Q, Imren S, Leonti AR, Gamis AS, Aplenc R, Kolb EA, Farrar JE, Triche TJ, Nguyen C, Meerzaman D, Loken MR, Oehler VG, Bolouri H, Meshinchi S. Comprehensive Transcriptome Profiling of Cryptic CBFA2T3-GLIS2 Fusion-Positive AML Defines Novel Therapeutic Options: A COG and TARGET Pediatric AML Study. Clin Cancer Res 2019; 26:726-737. [PMID: 31719049 DOI: 10.1158/1078-0432.ccr-19-1800] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/09/2019] [Accepted: 11/07/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE A cryptic inv(16)(p13.3q24.3) encoding the CBFA2T3-GLIS2 fusion is associated with poor outcome in infants with acute megakaryocytic leukemia. We aimed to broaden our understanding of the pathogenesis of this fusion through transcriptome profiling. EXPERIMENTAL DESIGN Available RNA from children and young adults with de novo acute myeloid leukemia (AML; N = 1,049) underwent transcriptome sequencing (mRNA and miRNA). Transcriptome profiles for those with the CBFA2T3-GLIS2 fusion (N = 24) and without (N = 1,025) were contrasted to define fusion-specific miRNAs, genes, and pathways. Clinical annotations defined distinct fusion-associated disease characteristics and outcomes. RESULTS The CBFA2T3-GLIS2 fusion was restricted to infants <3 years old (P < 0.001), and the presence of this fusion was highly associated with adverse outcome (P < 0.001) across all morphologic classifications. Further, there was a striking paucity of recurrent cooperating mutations, and transduction of cord blood stem cells with this fusion was sufficient for malignant transformation. CBFA2T3-GLIS2 positive cases displayed marked upregulation of genes with cell membrane/extracellular matrix localization potential, including NCAM1 and GABRE. Additionally, miRNA profiling revealed significant overexpression of mature miR-224 and miR-452, which are intronic miRNAs transcribed from the GABRE locus. Gene-set enrichment identified dysregulated Hippo, TGFβ, and hedgehog signaling, as well as NCAM1 (CD56) interaction pathways. Therapeutic targeting of fusion-positive leukemic cells with CD56-directed antibody-drug conjugate caused significant cytotoxicity in leukemic blasts. CONCLUSIONS The CBFA2T3-GLIS2 fusion defines a highly refractory entity limited to infants that appears to be sufficient for malignant transformation. Transcriptome profiling elucidated several highly targetable genes and pathways, including the identification of CD56, providing a highly plausible target for therapeutic intervention.
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Affiliation(s)
- Jenny L Smith
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
| | - Rhonda E Ries
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Tiffany Hylkema
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Todd A Alonzo
- Children's Oncology Group, Monrovia, California.,Division of Biostatistics, University of Southern California, Los Angeles, California.,Children's Oncology Group, Department of Preventive Medicine, University of Southern California, Monrovia, California
| | | | | | | | - Laura Pardo
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Hematologics Inc, Seattle, Washington
| | - Carrie L Cummings
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Keith R Loeb
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Quy Le
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Suzan Imren
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Amanda R Leonti
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Alan S Gamis
- Children's Mercy Cancer Center, Kansas City, Missouri
| | - Richard Aplenc
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - E Anders Kolb
- Nemours Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Jason E Farrar
- UAMS, Arkansas Children's Hospital, Little Rock, Arkansas
| | | | - Cu Nguyen
- Center for Biomedical Informatics and Information Technology, NCI, Rockville, Maryland
| | - Daoud Meerzaman
- Center for Biomedical Informatics and Information Technology, NCI, Rockville, Maryland
| | | | - Vivian G Oehler
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Hamid Bolouri
- Informatics and Computational Biology, Allen Institute, Seattle, Washington
| | - Soheil Meshinchi
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington. .,Children's Oncology Group, Monrovia, California.,Department of Pediatrics, University of Washington, Seattle, Washington
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28
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Pardo LM, Voigt AP, Alonzo TA, Wilson ER, Gerbing RB, Paine DJ, Dai F, Menssen AJ, Raimondi SC, Hirsch BA, Gamis AS, Meshinchi S, Wells DA, Brodersen LE, Loken MR. Deciphering the Significance of CD56 Expression in Pediatric Acute Myeloid Leukemia: A Report from the Children's Oncology Group. Cytometry B Clin Cytom 2019; 98:52-56. [PMID: 31294507 DOI: 10.1002/cyto.b.21829] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 05/22/2019] [Accepted: 05/30/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND In patients with acute myeloid leukemia (AML), CD56 expression has been associated with adverse clinical outcome. We reported on a phenotype associated with very poor prognosis (RAM) in children enrolled in the Children's Oncology Group trial AAML0531 (Brodersen et al. Leukemia 30 (2016) 2077-2080). RAM is also characterized in part by high-intensity expression of the CD56 antigen. Herein, we investigate underlying biological and clinical differences among CD56-positive AMLs for patients in AAML0531. METHODS For 769 newly diagnosed pediatric patients with de novo AML enrolled in AAML0531, bone marrow specimens were submitted for flow cytometric analysis. For each patient, an immunophenotypic expression profile (IEP) was defined by mean fluorescent intensities of assayed surface antigens. Unsupervised hierarchical clustering analysis (HCA) was completed to group patients with similar immunophenotypes. Clusters were then evaluated for CD56 expression. Principal component analysis (PCA) was subsequently applied to determine whether CD56-positive patient groups were nonoverlapping. RESULTS HCA of IEPs revealed three unique phenotypic clusters of patients with CD56-positive AML, and PCA showed that these three cohorts are distinct. Cohort 1 (N = 77) showed a prevalence of t(8;21) patients (72%), Cohort 2 (N = 52) a prevalence of 11q23 patients (69%), and Cohort 3 (RAM) (N = 16) a prevalence of patients with co-occurrence of the CBFA2T3-GLIS2 fusion transcript (63%). The 5-year event-free survival (EFS) for Cohorts 1, 2, and 3 were 69, 39, and 19%, respectively. CONCLUSIONS When leukemia is considered by its multidimensional immunophenotype and not by the expression of a single antigen, correlations are seen between genotype and there are significant differences in patient outcomes. © 2019 International Clinical Cytometry Society.
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Affiliation(s)
- Laura M Pardo
- Hematologics, Inc., Seattle, Washington.,Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Todd A Alonzo
- Children's Oncology Group, Monrovia, California.,University of Southern California, Los Angeles, California
| | | | | | | | | | | | | | - Betsy A Hirsch
- University of Minnesota Medical Center, Minneapolis, Minnesota
| | - Alan S Gamis
- Children's Mercy Hospitals & Clinics, Kansas City, Missouri
| | - Soheil Meshinchi
- Fred Hutchinson Cancer Research Center, Seattle, Washington.,Children's Oncology Group, Monrovia, California
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Tarlock K, Alonzo TA, Wang YC, Gerbing RB, Ries R, Loken MR, Pardo L, Hylkema T, Joaquin J, Sarukkai L, Raimondi SC, Hirsch B, Sung L, Aplenc R, Bernstein I, Gamis AS, Meshinchi S, Pollard JA. Functional Properties of KIT Mutations Are Associated with Differential Clinical Outcomes and Response to Targeted Therapeutics in CBF Acute Myeloid Leukemia. Clin Cancer Res 2019; 25:5038-5048. [PMID: 31182436 DOI: 10.1158/1078-0432.ccr-18-1897] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 01/03/2019] [Accepted: 05/31/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE KIT mutations (KIT +) are common in core binding factor (CBF) AML and have been associated with varying prognostic significance. We sought to define the functional and clinical significance of distinct KIT mutations in CBF pediatric AML. EXPERIMENTAL DESIGN Following transfection of exon 17 (E17) and exon 8 (E8) mutations into HEK293 and Ba/F3 cells, KIT phosphorylation, cytokine-independent growth, and response to tyrosine kinase inhibitors (TKI) were evaluated. Clinical outcomes of patients treated on COG AAML0531 (NCT01407757), a phase III study of gemtuzumab ozogamicin (GO), were analyzed according to mutation status [KIT + vs. wild-type KIT (KIT -)] and mutation location (E8 vs. E17). RESULTS KIT mutations were detected in 63 of 205 patients (31%); 22 (35%) involved only E8, 32 (51%) only E17, 6 (10%) both exons, and 3 (5%) alternative exons. Functional studies demonstrated that E17, but not E8, mutations result in aberrant KIT phosphorylation and growth. TKI exposure significantly affected growth of E17, but not E8, transfected cells. Patients with KIT + CBF AML had overall survival similar to those with KIT - (78% vs. 81%, P = 0.905) but higher relapse rates (RR = 43% vs. 21%; P = 0.005). E17 KIT + outcomes were inferior to KIT - patients [disease-free survival (DFS), 51% vs. 73%, P = 0.027; RR = 21% vs. 46%, P = 0.007)], although gemtuzumab ozogamicin abrogated this negative prognostic impact. E8 mutations lacked significant prognostic effect, and GO failed to significantly improve outcome. CONCLUSIONS E17 mutations affect prognosis in CBF AML, as well as response to GO and TKIs; thus, clinical trials using both agents should be considered for KIT + patients.
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Affiliation(s)
- Katherine Tarlock
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington. .,Division of Hematology/Oncology, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Todd A Alonzo
- University of Southern California Keck School of Medicine, Los Angeles, California.,Children's Oncology Group, Monrovia, California
| | | | | | - Rhonda Ries
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | - Tiffany Hylkema
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Jason Joaquin
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Leela Sarukkai
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Betsy Hirsch
- University of Minnesota Cancer Center, Minneapolis, Minnesota
| | - Lillian Sung
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Richard Aplenc
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Irwin Bernstein
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Division of Hematology/Oncology, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Alan S Gamis
- Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | - Soheil Meshinchi
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Division of Hematology/Oncology, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Jessica A Pollard
- Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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30
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Cooper TM, Absalon M, Alonzo TA, Gerbing RB, Leger KJ, Hirsch BA, Pollard JA, Razzouk BI, Aplenc R, Kolb EA. AAML 1421, a phase I/II study of CPX-351 followed by fludarabine, cytarabine, and G-CSF (FLAG) for children with relapsed acute myeloid leukemia (AML): A Report from the Children’s Oncology Group. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.10003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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
10003 Background: Effective regimens with favorable toxicity profiles are needed for heavily pre-treated children with relapsed AML. AAML1421 is a Phase I/II study of CPX-351, a liposomal preparation of cytarabine and daunorubicin demonstrating efficacy in adults. AAML1421 sought to determine the recommended Phase 2 Dose (RPD2) of CPX-351 and the response rate (complete response (CR) + complete response without platelet recovery (CRp)) after up to 2 cycles of therapy. Methods: Children > 1 and ≤ 21 years of age with relapsed/refractory AML were eligible for dose finding, and those in first relapse were eligible for efficacy. A modified rolling six design was used for dose-limiting toxicity (DLT) assessment which occurred in Cycle 1. Dose level 1 (DL1) was 135 units/m2 on days 1, 3, and 5 with a single dose de-escalation to 100 units/m2 if DL1 was intolerable. The Efficacy Phase used a Simon-two stage design. The response rate was determined after up to 2 cycles of therapy (Cycle 1: CPX-351; Cycle 2: FLAG). The Overall Response Rate (ORR) was defined as CR+CRp+CRi (CRi = CR with incomplete hematologic recovery). Results: Thirty-eight patients (pts) enrolled: 6 in dose-finding and 32 in the efficacy phase. DLT occurred in 1/6 patients and was a grade 3 decrease in ejection fraction(EF). This was the only Grade 3 cardiac toxicity. Therefore, 135 units/m2 on days 1, 3, 5 was the RP2D. All dose finding pts were eligible for efficacy determination. One pt in the efficacy phase was unevaluable. The most common ≥ Grade 3 toxicities in Cycle 1 included fever/neutropenia (45%), infection (47%), and rash (40%). There was no toxic mortality. Best responses included 20 CR (54%), 5 CRp (14%), and 5 CRi (14%). Seventy percent achieved best response after cycle 1. Twenty-one of 25 patients with CR/CRp had no detectable residual disease (RD) (84%) by flow cytometry. HSCT was used as consolidation in 23/29 responders (79%); 18 of 23 (78%) had no detectable RD prior to HSCT. Conclusions: The RP2D of CPX-351 is 135 units/m2/dose on days 1, 3, 5. CPX-351 was well tolerated and protocol therapy was effective with CR+CRp rates of 68.3% (90% CI 52.9% to 78.0%) and ORR (CR+CRp+CRi) of 81.1% (90% CI 67.4% to 88.8%). AAML1421 response rates are superior to any published North American cooperative group clinical trial for children with AML in first relapse. Clinical trial information: NCT02642965.
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Affiliation(s)
- Todd Michael Cooper
- Seattle Children's Cancer and Blood Disorders Center, University of Washington, Seattle, WA
| | - Michael Absalon
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Todd Allen Alonzo
- University of Southern California Children's Oncology Group, Arcadia, CA
| | | | - Kasey Joanne Leger
- Seattle Children's Hospital, Cancer and Blood Disorders Center, Seattle, WA
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Aplenc R, Sung L, Pollard JA, Brodersen L, Loken M, Gerbing RB, Getz KD, Meshinchi S, Woods WG, Kolb EA, Alonzo TA, Gamis AS. Effect of intensification of induction II chemotherapy and liberalization of stem cell donor source on outcome for children with high risk acute myeloid leukemia: A report from the Children’s Oncology Group. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.10002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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
10002 Background: Patients with residual acute myeloid leukemia (AML) after induction fare poorly. The recently completed AAML1031 Phase III clinical trial intensified Induction II chemotherapy, altered the stem cell transplant (SCT) conditioning regimen, and liberalized SCT donor source criteria. We sought to test whether these practice changes improved clinical outcomes. Methods: Patients on AAML0531 and AAML1031, sequential Phase III trials for AML with shared high risk features of both > 15% residual blasts by morphology and ≥ 0.1% minimal residual disease (MRD) by flow cytometry with uninformative cytogenetics or high risk cytogenetic features (-7 or -5/5q-) were included. Gemtuzmab exposed and patients with high allelic ratio FLT3 ITD were excluded. Patients were observed from the start of Induction II through last available follow up. Induction II chemotherapy (ADE or AraC/Mito) was the exposure of interest. Disease free and overall survival (DFS, OS) were the primary outcomes. Standard descriptive statistics were used to compare patient characteristics and secondary outcomes; Kaplan Meier analyses were used to evaluate DFS/OS. Results: A total of 47 patients from AAML0531 (ADE) and 95 patients from AAML1031 (AraC/Mito) were included and did not differ in baseline characteristics. Five year DFS ±2SE was 17.5 ± 11.4 for ADE and 23.9 ± 8.8 for AraC/Mito, p = 0.528. Five year OS was 38.1 ± 14.2 for ADE and 33.3 ± 10.7 for AraC/Mito, p = 0.364. End of Induction II disease response and MRD did not differ between ADE and AraC/Mito. Patients receiving ADE had a higher probability of neutrophil recovery (74% vs 53%, p = 0.019) and recovered neutrophils a median of 7 days more quickly (27 vs 34 days), p = < 0.001. ADE patients also had fewer inpatient hospital days (28 days versus 32 days, p = 0.002). The percentage of patients receiving SCT did not differ, 34% vs 44%, p = 0.253 and post-SCT outcomes did not differ. Conclusions: The intensification of Induction II chemotherapy, change in SCT conditioning regimen, and liberalization of SCT donor source was not associated with improved clinical outcomes. Intensification of Induction II was associated with increased hematologic toxicity and length of stay. These data do not support the intensification of Induction II chemotherapy with AraC/Mitoxantrone. Clinical trial information: NCT01371981.
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Affiliation(s)
| | - Lillian Sung
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | | | | | | | - Kelly D. Getz
- The Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - William G. Woods
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta and Emory University, Atlanta, GA
| | | | - Todd Allen Alonzo
- University of Southern California Children's Oncology Group, Arcadia, CA
| | - Alan S. Gamis
- Children's Mercy Hospital and Clinics, Kansas City, MO
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Getz KD, Sung L, Ky B, Gerbing RB, Leger KJ, Leahy AB, Sack L, Woods WG, Alonzo T, Gamis A, Aplenc R. Occurrence of Treatment-Related Cardiotoxicity and Its Impact on Outcomes Among Children Treated in the AAML0531 Clinical Trial: A Report From the Children's Oncology Group. J Clin Oncol 2019; 37:12-21. [PMID: 30379624 PMCID: PMC6354770 DOI: 10.1200/jco.18.00313] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2018] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Late cardiotoxicity after pediatric acute myeloid leukemia therapy causes substantial morbidity and mortality. The impact of early-onset cardiotoxicity on treatment outcomes is less well understood. Thus, we evaluated the risk factors for incident early cardiotoxicity and the impacts of cardiotoxicity on event-free survival (EFS) and overall survival (OS). METHODS Cardiotoxicity was ascertained through adverse event monitoring over the course of follow-up among 1,022 pediatric patients with acute myeloid leukemia treated in the Children's Oncology Group trial AAML0531. It was defined as grade 2 or higher left ventricular systolic dysfunction on the basis of Common Terminology Criteria for Adverse Events (version 3) definitions. RESULTS Approximately 12% of patients experienced cardiotoxicity over a 5-year follow-up, with more than 70% of incident events occurring during on-protocol therapy. Documented cardiotoxicity during on-protocol therapy was significantly associated with subsequent off-protocol toxicity. Overall, the incidence was higher among noninfants and black patients, and in the setting of a bloodstream infection. Both EFS (hazard ratio [HR], 1.6; 95% CI, 1.2 to 2.1; P = .004) and OS (HR, 1.6; 95% CI, 1.2 to 2.2, P = .005) were significantly worse in patients with documented cardiotoxicity. Impacts on EFS were equivalent whether the incident cardiotoxicity event occurred in the absence (HR, 1.6; 95% CI, 1.1 to 2.2; P = .017) or presence of infection (HR, 1.6; 95% CI, 1.0 to 2.7; P = .069) compared with patients without documented cardiotoxicity. However, the reduction in OS was more pronounced for cardiotoxicity not associated with infection (HR, 1.7; 95% CI, 1.2 to 2.5; P = .004) than for infection-associated cardiotoxicity (HR, 1.3; 95% CI, 0.7 to 2.4; P = .387). CONCLUSION Early treatment-related cardiotoxicity may be associated with decreased EFS and OS. Cardioprotective strategies are urgently needed to improve relapse risk and both short- and long-term mortality outcomes.
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Affiliation(s)
- Kelly D. Getz
- The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Lillian Sung
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Bonnie Ky
- University of Pennsylvania, Philadelphia, PA
| | | | | | | | - Leah Sack
- The Children’s Hospital of Philadelphia, Philadelphia, PA
| | | | - Todd Alonzo
- University of Southern California, Los Angeles, CA
| | - Alan Gamis
- Children’s Mercy Hospital and Clinics, Kansas City, MO
| | - Richard Aplenc
- The Children’s Hospital of Philadelphia, Philadelphia, PA
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33
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Narayanan P, Dubrulle J, Gerbing RB, Alonzo TA, Stossi F, Redell MS. Abstract 3550: Lipid rafts contribute to ligand-induced signaling and survival in pediatric AML. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-3550] [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
Pediatric acute myeloid leukemia (pAML) is an aggressive malignancy with high mortality due to therapy resistance and relapse. We previously reported that the failure of pAML cells to phosphorylate STAT3 upon G-CSF or IL-6 stimulation was associated with inferior survival. The defect in STAT3 signaling was not due to low expression of receptors or of STAT3. We hypothesized that the signaling failure seen in some pAML samples is not specific for STAT3, but rather a generalized dysfunction due to abnormal lipid raft function. Lipid rafts (LR) are highly ordered plasma membrane microdomains rich in glycosphingolipids and cholesterol. Two types of LR - flat planar and invaginated caveolar - contain different membrane proteins and serve distinct but overlapping cellular functions. Both types of LR organize receptors, downstream mediators, and repressors for efficient signaling. The role of LRs in signaling and clinical outcome is not yet established in pAML. Primary samples (n=95) from the Children's Oncology Group (COG) were stimulated with HS5 stromal cell conditioned medium (HS5CM), which contains IL-6 and dozens of physiological ligands. Basal and induced phospho-STAT3 (pSTAT3), pSTAT5, pAKT and pERK1/2 were measured by intracellular flow cytometry, and the fold change in the mean fluorescence intensity (ΔMFI) was calculated. The HS5CM-induced ΔMFI for pSTAT3 was positively correlated with that for pSTAT5 (p<0.0001, r=0.5), and pAKT (p=0.0002, r=0.4). Samples that failed to increase pSTAT3 failed to activate other pathways, suggesting a generalized signaling dysfunction. In AML cells with intact signaling, disruption of LRs with methylβcyclodextrin markedly reduced HS5CM-induced pSTATs, recapitulating the dysfunctional phenotype. LRs were assessed by immunocytochemistry in 29 primary samples with and without HS5CM stimulation. Choleratoxin B, which binds ganglioside GM-1, stained LRs. Antibodies to caveolin-1 (cav-1) marked caveolar LRs. We also stained for gp130, the signaling subunit of the IL-6 receptor. Images were captured by deconvolution fluorescence microscopy. Expression was quantified by pixel intensity for average of 30 cells per condition. Colocalization of gp130 with LR markers was determined by the Manders Overlap Coefficient (MOC). Intensities and MOCs varied between samples. The MOC of gp130 with cav-1 correlated significantly with pSTAT3 ΔMFI (p=0.02, r=0.43). MOC of gp130 with GM-1 did not correlate with pSTAT3 ΔMFI (p=0.85, r=0.03), suggesting that cav-1 facilitates IL-6/STAT3 signaling. Interestingly, patients whose samples demonstrated basal cav-1 and GM-1 intensities below the median had inferior 5-year event-free survival compared to those with intensities above the median (log-rank p=0.079 for cav-1; p=0.013 for GM-1). Our results suggest that LRs contribute to ligand-induced signaling and possibly to chemotherapy response. Further studies of LR biology in AML are warranted.
Citation Format: Padmini Narayanan, Julien Dubrulle, Robert B. Gerbing, Todd A. Alonzo, Fabio Stossi, Michele S. Redell. Lipid rafts contribute to ligand-induced signaling and survival in pediatric AML [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 3550.
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Getz KD, Sung L, Leger K, Alonzo TA, Gerbing RB, Cooper TM, Kolb E, Gamis AS, Ky B, Aplenc R. Effect of dexrazoxane on left ventricular function and treatment outcomes in patients with acute myeloid leukemia: A Children’s Oncology Group report. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.10501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kelly D. Getz
- The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Lillian Sung
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Todd Allen Alonzo
- University of Southern California Children's Oncology Group, Arcadia, CA
| | | | | | - Edward Kolb
- Nemours Alfred I. duPont Hospital for Children, Wilmington, DE, US
| | - Alan S. Gamis
- Children's Mercy Hospital and Clinics, Kansas City, MO
| | - Bonnie Ky
- Hospital of the University of Pennsylvania, Philadelphia, PA
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Gerbing RB, Alonzo TA, Sung L, Gamis AS, Meshinchi S, Plon SE, Bertuch AA, Gramatges MM. Shorter Remission Telomere Length Predicts Delayed Neutrophil Recovery After Acute Myeloid Leukemia Therapy: A Report From the Children's Oncology Group. J Clin Oncol 2017; 34:3766-3772. [PMID: 27354474 DOI: 10.1200/jco.2016.66.9622] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Purpose Suboptimal outcomes for children with acute myeloid leukemia (AML) necessitate maximally intensive therapy. Consequently, serious adverse events, such as prolonged periods of profound myelosuppression, contribute to AML treatment-related mortality. Telomeres, the repetitive DNA-protein structures at chromosome ends, influence cellular replicative capacity in that critically short telomeres can induce cell senescence or apoptosis. Our objective was to evaluate the impact of telomere length on duration of post-therapy neutropenia in a pediatric AML cohort. Patients and Methods Patients were diagnosed with de novo AML, enrolled in Children's Oncology Group study AAML0531, and included those with (n = 53) and without (n = 62) significantly delayed neutrophil recovery after chemotherapy. We used quantitative polymerase chain reaction to measure telomere content (TC), a validated proxy for telomere length, from remission bone marrow samples obtained after the second induction chemotherapy course. Results Less TC was significantly associated with prolonged neutropenia after the fourth ( P < .001) and fifth chemotherapy courses ( P = .002). Cox regression adjusting for age at diagnosis confirmed that TC remained independently predictive of time to recovery of absolute neutrophil count for both the fourth and fifth courses ( P = .002 and .009, respectively). DNA from patients was analyzed for germline mutations in four telomere maintenance genes associated with telomere biology disorders. Sequence analysis revealed no enrichment of rare or novel variants in the delayed recovery group. Conclusion Our results suggest that TC at end of AML induction is associated with hematopoietic reconstitution capacity independently of age and may identify those at highest risk for markedly delayed bone marrow recovery after AML therapy.
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Affiliation(s)
- Robert B Gerbing
- Robert B. Gerbing and Todd A. Alonzo, Children's Oncology Group, Monrovia; Todd A. Alonzo, University of Southern California, Los Angeles, CA; Lillian Sung, Hospital for Sick Children, Toronto, Ontario, Canada; Alan S. Gamis, Children's Mercy Hospitals and Clinics, Kansas City, MO; Soheil Meshinchi, University of Washington School of Medicine, Seattle, WA; and Sharon E. Plon, Alison A. Bertuch, and Maria M. Gramatges, Baylor College of Medicine, Houston, TX
| | - Todd A Alonzo
- Robert B. Gerbing and Todd A. Alonzo, Children's Oncology Group, Monrovia; Todd A. Alonzo, University of Southern California, Los Angeles, CA; Lillian Sung, Hospital for Sick Children, Toronto, Ontario, Canada; Alan S. Gamis, Children's Mercy Hospitals and Clinics, Kansas City, MO; Soheil Meshinchi, University of Washington School of Medicine, Seattle, WA; and Sharon E. Plon, Alison A. Bertuch, and Maria M. Gramatges, Baylor College of Medicine, Houston, TX
| | - Lillian Sung
- Robert B. Gerbing and Todd A. Alonzo, Children's Oncology Group, Monrovia; Todd A. Alonzo, University of Southern California, Los Angeles, CA; Lillian Sung, Hospital for Sick Children, Toronto, Ontario, Canada; Alan S. Gamis, Children's Mercy Hospitals and Clinics, Kansas City, MO; Soheil Meshinchi, University of Washington School of Medicine, Seattle, WA; and Sharon E. Plon, Alison A. Bertuch, and Maria M. Gramatges, Baylor College of Medicine, Houston, TX
| | - Alan S Gamis
- Robert B. Gerbing and Todd A. Alonzo, Children's Oncology Group, Monrovia; Todd A. Alonzo, University of Southern California, Los Angeles, CA; Lillian Sung, Hospital for Sick Children, Toronto, Ontario, Canada; Alan S. Gamis, Children's Mercy Hospitals and Clinics, Kansas City, MO; Soheil Meshinchi, University of Washington School of Medicine, Seattle, WA; and Sharon E. Plon, Alison A. Bertuch, and Maria M. Gramatges, Baylor College of Medicine, Houston, TX
| | - Soheil Meshinchi
- Robert B. Gerbing and Todd A. Alonzo, Children's Oncology Group, Monrovia; Todd A. Alonzo, University of Southern California, Los Angeles, CA; Lillian Sung, Hospital for Sick Children, Toronto, Ontario, Canada; Alan S. Gamis, Children's Mercy Hospitals and Clinics, Kansas City, MO; Soheil Meshinchi, University of Washington School of Medicine, Seattle, WA; and Sharon E. Plon, Alison A. Bertuch, and Maria M. Gramatges, Baylor College of Medicine, Houston, TX
| | - Sharon E Plon
- Robert B. Gerbing and Todd A. Alonzo, Children's Oncology Group, Monrovia; Todd A. Alonzo, University of Southern California, Los Angeles, CA; Lillian Sung, Hospital for Sick Children, Toronto, Ontario, Canada; Alan S. Gamis, Children's Mercy Hospitals and Clinics, Kansas City, MO; Soheil Meshinchi, University of Washington School of Medicine, Seattle, WA; and Sharon E. Plon, Alison A. Bertuch, and Maria M. Gramatges, Baylor College of Medicine, Houston, TX
| | - Alison A Bertuch
- Robert B. Gerbing and Todd A. Alonzo, Children's Oncology Group, Monrovia; Todd A. Alonzo, University of Southern California, Los Angeles, CA; Lillian Sung, Hospital for Sick Children, Toronto, Ontario, Canada; Alan S. Gamis, Children's Mercy Hospitals and Clinics, Kansas City, MO; Soheil Meshinchi, University of Washington School of Medicine, Seattle, WA; and Sharon E. Plon, Alison A. Bertuch, and Maria M. Gramatges, Baylor College of Medicine, Houston, TX
| | - Maria M Gramatges
- Robert B. Gerbing and Todd A. Alonzo, Children's Oncology Group, Monrovia; Todd A. Alonzo, University of Southern California, Los Angeles, CA; Lillian Sung, Hospital for Sick Children, Toronto, Ontario, Canada; Alan S. Gamis, Children's Mercy Hospitals and Clinics, Kansas City, MO; Soheil Meshinchi, University of Washington School of Medicine, Seattle, WA; and Sharon E. Plon, Alison A. Bertuch, and Maria M. Gramatges, Baylor College of Medicine, Houston, TX
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Johnston DL, Alonzo TA, Gerbing RB, Aplenc R, Woods WG, Meshinchi S, Gamis AS. Central nervous system disease in pediatric acute myeloid leukemia: A report from the Children's Oncology Group. Pediatr Blood Cancer 2017; 64:10.1002/pbc.26612. [PMID: 28453910 PMCID: PMC5647219 DOI: 10.1002/pbc.26612] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 01/10/2017] [Revised: 03/19/2017] [Accepted: 03/27/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND The prognostic impact of central nervous system (CNS) involvement in children with acute myeloid leukemia (AML) has varied in past trials, and controversy exists over the degree of involvement requiring intensified CNS therapy. Two recent Children's Oncology Group protocols, AAML03P1 and AAML0531, directed additional intrathecal (IT) therapy to patients with CNS2 (≤5 white blood cell [WBC] with blasts) or CNS3 (>5 WBC with blasts or CNS symptoms) disease at diagnosis. METHODS We examined disease characteristics and outcomes of the 1,344 patients on these protocols, 949 with CNS1 (no blasts), 217 with CNS2, and 178 with CNS3, with the latter two receiving additional IT therapy. RESULTS Young age (P = 0.003), hyperleukocytosis (P < 0.001), and the presence of inversion 16 (P < 0.001) were the only factors more prevalent in patients with CNS2 or CNS3 disease. Complete remission at the end of induction (EOI) 2 was achieved less often in patients with CNS involvement (P < 0.001). From diagnosis, event-free survival (EFS) for patients with CNS involvement was significantly worse (P < 0.001), whereas overall survival (OS) was not (P = 0.16). From the EOI1, there was a higher relapse rate (RR) and worse disease-free survival (DFS), but less impact on OS (CNS1:DFS 58.9%, RR 34.1%, OS 69.3%; CNS2:DFS 53.2%, RR 40.9%, OS 74.7%; CNS3:DFS 45.2%, RR 48.8%, OS 60.8%; P = 0.006, P < 0.001, P = 0.045, respectively). Multivariable analysis showed that independently CNS2 and CNS3 status adversely affected RR and DFS. Traumatic diagnostic lumbar puncture was not associated with worse outcome. CONCLUSIONS CNS leukemia confers greater relapse risk despite more aggressive locally directed therapy. Novel approaches need to be investigated in this group of patients.
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Affiliation(s)
- Donna L. Johnston
- Division of Hematology/Oncology, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Todd A. Alonzo
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | | | - Richard Aplenc
- Division of Hematology/Oncology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - William G. Woods
- Aflac Cancer Center and Blood Disorders Service, Children’s Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Soheil Meshinchi
- Division of Hematology Oncology, Seattle Children’s Hospital, Seattle, Washington
| | - Alan S. Gamis
- Division of Hematology/Oncology/Bone Marrow Transplantation, Children’s Mercy Hospitals and Clinic, Kansas City, Missouri
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Lim EL, Trinh DL, Ries RE, Wang J, Gerbing RB, Ma Y, Topham J, Hughes M, Pleasance E, Mungall AJ, Moore R, Zhao Y, Aplenc R, Sung L, Kolb EA, Gamis A, Smith M, Gerhard DS, Alonzo TA, Meshinchi S, Marra MA. MicroRNA Expression-Based Model Indicates Event-Free Survival in Pediatric Acute Myeloid Leukemia. J Clin Oncol 2017; 35:3964-3977. [PMID: 29068783 PMCID: PMC5721230 DOI: 10.1200/jco.2017.74.7451] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Purpose Children with acute myeloid leukemia (AML) whose disease is refractory to standard induction chemotherapy therapy or who experience relapse after initial response have dismal outcomes. We sought to comprehensively profile pediatric AML microRNA (miRNA) samples to identify dysregulated genes and assess the utility of miRNAs for improved outcome prediction. Patients and Methods To identify miRNA biomarkers that are associated with treatment failure, we performed a comprehensive sequence-based characterization of the pediatric AML miRNA landscape. miRNA sequencing was performed on 1,362 samples-1,303 primary, 22 refractory, and 37 relapse samples. One hundred sixty-four matched samples-127 primary and 37 relapse samples-were analyzed by using RNA sequencing. Results By using penalized lasso Cox proportional hazards regression, we identified 36 miRNAs the expression levels at diagnosis of which were highly associated with event-free survival. Combined expression of the 36 miRNAs was used to create a novel miRNA-based risk classification scheme (AMLmiR36). This new miRNA-based risk classifier identifies those patients who are at high risk (hazard ratio, 2.830; P ≤ .001) or low risk (hazard ratio, 0.323; P ≤ .001) of experiencing treatment failure, independent of conventional karyotype or mutation status. The performance of AMLmiR36 was independently assessed by using 878 patients from two different clinical trials (AAML0531 and AAML1031). Our analysis also revealed that miR-106a-363 was abundantly expressed in relapse and refractory samples, and several candidate targets of miR-106a-5p were involved in oxidative phosphorylation, a process that is suppressed in treatment-resistant leukemic cells. Conclusion To assess the utility of miRNAs for outcome prediction in patients with pediatric AML, we designed and validated a miRNA-based risk classification scheme. We also hypothesized that the abundant expression of miR-106a could increase treatment resistance via modulation of genes that are involved in oxidative phosphorylation.
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Affiliation(s)
- Emilia L Lim
- Emilia L. Lim, Diane L. Trinh, Yussanne Ma, James Topham, Erin Pleasance, Andrew J. Mungall, Richard Moore, Yongjun Zhao, and Marco A. Marra, Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency; Marco A. Marra, University of British Columbia, Vancouver, British Columbia; Lillian Sung, The Hospital for Sick Children, Toronto, Ontario, Canada; Rhonda E. Ries, Maya Hughes, and Soheil Meshinchi, Fred Hutchinson Cancer Research Center; Rhonda E. Ries, Maya Hughes, and Soheil Meshinchi, University of Washington, Seattle, WA; Jim Wang, Robert B. Gerbing, E. Anders Kolb, Alan Gamis, and Todd A. Alonzo, Children's Oncology Group, Monrovia; Todd A. Alonzo, University of Southern California, Los Angeles, CA; Richard Aplenc, The Children's Hospital of Philadelphia, Philadelphia, PA; Malcolm Smith and Daniela S. Gerhard, Office of Cancer Genomics, National Cancer Institute, Bethesda, MD; and Robert J. Arceci, Phoenix Children's Hospital, Phoenix. AZ
| | - Diane L Trinh
- Emilia L. Lim, Diane L. Trinh, Yussanne Ma, James Topham, Erin Pleasance, Andrew J. Mungall, Richard Moore, Yongjun Zhao, and Marco A. Marra, Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency; Marco A. Marra, University of British Columbia, Vancouver, British Columbia; Lillian Sung, The Hospital for Sick Children, Toronto, Ontario, Canada; Rhonda E. Ries, Maya Hughes, and Soheil Meshinchi, Fred Hutchinson Cancer Research Center; Rhonda E. Ries, Maya Hughes, and Soheil Meshinchi, University of Washington, Seattle, WA; Jim Wang, Robert B. Gerbing, E. Anders Kolb, Alan Gamis, and Todd A. Alonzo, Children's Oncology Group, Monrovia; Todd A. Alonzo, University of Southern California, Los Angeles, CA; Richard Aplenc, The Children's Hospital of Philadelphia, Philadelphia, PA; Malcolm Smith and Daniela S. Gerhard, Office of Cancer Genomics, National Cancer Institute, Bethesda, MD; and Robert J. Arceci, Phoenix Children's Hospital, Phoenix. AZ
| | - Rhonda E Ries
- Emilia L. Lim, Diane L. Trinh, Yussanne Ma, James Topham, Erin Pleasance, Andrew J. Mungall, Richard Moore, Yongjun Zhao, and Marco A. Marra, Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency; Marco A. Marra, University of British Columbia, Vancouver, British Columbia; Lillian Sung, The Hospital for Sick Children, Toronto, Ontario, Canada; Rhonda E. Ries, Maya Hughes, and Soheil Meshinchi, Fred Hutchinson Cancer Research Center; Rhonda E. Ries, Maya Hughes, and Soheil Meshinchi, University of Washington, Seattle, WA; Jim Wang, Robert B. Gerbing, E. Anders Kolb, Alan Gamis, and Todd A. Alonzo, Children's Oncology Group, Monrovia; Todd A. Alonzo, University of Southern California, Los Angeles, CA; Richard Aplenc, The Children's Hospital of Philadelphia, Philadelphia, PA; Malcolm Smith and Daniela S. Gerhard, Office of Cancer Genomics, National Cancer Institute, Bethesda, MD; and Robert J. Arceci, Phoenix Children's Hospital, Phoenix. AZ
| | - Jim Wang
- Emilia L. Lim, Diane L. Trinh, Yussanne Ma, James Topham, Erin Pleasance, Andrew J. Mungall, Richard Moore, Yongjun Zhao, and Marco A. Marra, Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency; Marco A. Marra, University of British Columbia, Vancouver, British Columbia; Lillian Sung, The Hospital for Sick Children, Toronto, Ontario, Canada; Rhonda E. Ries, Maya Hughes, and Soheil Meshinchi, Fred Hutchinson Cancer Research Center; Rhonda E. Ries, Maya Hughes, and Soheil Meshinchi, University of Washington, Seattle, WA; Jim Wang, Robert B. Gerbing, E. Anders Kolb, Alan Gamis, and Todd A. Alonzo, Children's Oncology Group, Monrovia; Todd A. Alonzo, University of Southern California, Los Angeles, CA; Richard Aplenc, The Children's Hospital of Philadelphia, Philadelphia, PA; Malcolm Smith and Daniela S. Gerhard, Office of Cancer Genomics, National Cancer Institute, Bethesda, MD; and Robert J. Arceci, Phoenix Children's Hospital, Phoenix. AZ
| | - Robert B Gerbing
- Emilia L. Lim, Diane L. Trinh, Yussanne Ma, James Topham, Erin Pleasance, Andrew J. Mungall, Richard Moore, Yongjun Zhao, and Marco A. Marra, Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency; Marco A. Marra, University of British Columbia, Vancouver, British Columbia; Lillian Sung, The Hospital for Sick Children, Toronto, Ontario, Canada; Rhonda E. Ries, Maya Hughes, and Soheil Meshinchi, Fred Hutchinson Cancer Research Center; Rhonda E. Ries, Maya Hughes, and Soheil Meshinchi, University of Washington, Seattle, WA; Jim Wang, Robert B. Gerbing, E. Anders Kolb, Alan Gamis, and Todd A. Alonzo, Children's Oncology Group, Monrovia; Todd A. Alonzo, University of Southern California, Los Angeles, CA; Richard Aplenc, The Children's Hospital of Philadelphia, Philadelphia, PA; Malcolm Smith and Daniela S. Gerhard, Office of Cancer Genomics, National Cancer Institute, Bethesda, MD; and Robert J. Arceci, Phoenix Children's Hospital, Phoenix. AZ
| | - Yussanne Ma
- Emilia L. Lim, Diane L. Trinh, Yussanne Ma, James Topham, Erin Pleasance, Andrew J. Mungall, Richard Moore, Yongjun Zhao, and Marco A. Marra, Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency; Marco A. Marra, University of British Columbia, Vancouver, British Columbia; Lillian Sung, The Hospital for Sick Children, Toronto, Ontario, Canada; Rhonda E. Ries, Maya Hughes, and Soheil Meshinchi, Fred Hutchinson Cancer Research Center; Rhonda E. Ries, Maya Hughes, and Soheil Meshinchi, University of Washington, Seattle, WA; Jim Wang, Robert B. Gerbing, E. Anders Kolb, Alan Gamis, and Todd A. Alonzo, Children's Oncology Group, Monrovia; Todd A. Alonzo, University of Southern California, Los Angeles, CA; Richard Aplenc, The Children's Hospital of Philadelphia, Philadelphia, PA; Malcolm Smith and Daniela S. Gerhard, Office of Cancer Genomics, National Cancer Institute, Bethesda, MD; and Robert J. Arceci, Phoenix Children's Hospital, Phoenix. AZ
| | - James Topham
- Emilia L. Lim, Diane L. Trinh, Yussanne Ma, James Topham, Erin Pleasance, Andrew J. Mungall, Richard Moore, Yongjun Zhao, and Marco A. Marra, Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency; Marco A. Marra, University of British Columbia, Vancouver, British Columbia; Lillian Sung, The Hospital for Sick Children, Toronto, Ontario, Canada; Rhonda E. Ries, Maya Hughes, and Soheil Meshinchi, Fred Hutchinson Cancer Research Center; Rhonda E. Ries, Maya Hughes, and Soheil Meshinchi, University of Washington, Seattle, WA; Jim Wang, Robert B. Gerbing, E. Anders Kolb, Alan Gamis, and Todd A. Alonzo, Children's Oncology Group, Monrovia; Todd A. Alonzo, University of Southern California, Los Angeles, CA; Richard Aplenc, The Children's Hospital of Philadelphia, Philadelphia, PA; Malcolm Smith and Daniela S. Gerhard, Office of Cancer Genomics, National Cancer Institute, Bethesda, MD; and Robert J. Arceci, Phoenix Children's Hospital, Phoenix. AZ
| | - Maya Hughes
- Emilia L. Lim, Diane L. Trinh, Yussanne Ma, James Topham, Erin Pleasance, Andrew J. Mungall, Richard Moore, Yongjun Zhao, and Marco A. Marra, Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency; Marco A. Marra, University of British Columbia, Vancouver, British Columbia; Lillian Sung, The Hospital for Sick Children, Toronto, Ontario, Canada; Rhonda E. Ries, Maya Hughes, and Soheil Meshinchi, Fred Hutchinson Cancer Research Center; Rhonda E. Ries, Maya Hughes, and Soheil Meshinchi, University of Washington, Seattle, WA; Jim Wang, Robert B. Gerbing, E. Anders Kolb, Alan Gamis, and Todd A. Alonzo, Children's Oncology Group, Monrovia; Todd A. Alonzo, University of Southern California, Los Angeles, CA; Richard Aplenc, The Children's Hospital of Philadelphia, Philadelphia, PA; Malcolm Smith and Daniela S. Gerhard, Office of Cancer Genomics, National Cancer Institute, Bethesda, MD; and Robert J. Arceci, Phoenix Children's Hospital, Phoenix. AZ
| | - Erin Pleasance
- Emilia L. Lim, Diane L. Trinh, Yussanne Ma, James Topham, Erin Pleasance, Andrew J. Mungall, Richard Moore, Yongjun Zhao, and Marco A. Marra, Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency; Marco A. Marra, University of British Columbia, Vancouver, British Columbia; Lillian Sung, The Hospital for Sick Children, Toronto, Ontario, Canada; Rhonda E. Ries, Maya Hughes, and Soheil Meshinchi, Fred Hutchinson Cancer Research Center; Rhonda E. Ries, Maya Hughes, and Soheil Meshinchi, University of Washington, Seattle, WA; Jim Wang, Robert B. Gerbing, E. Anders Kolb, Alan Gamis, and Todd A. Alonzo, Children's Oncology Group, Monrovia; Todd A. Alonzo, University of Southern California, Los Angeles, CA; Richard Aplenc, The Children's Hospital of Philadelphia, Philadelphia, PA; Malcolm Smith and Daniela S. Gerhard, Office of Cancer Genomics, National Cancer Institute, Bethesda, MD; and Robert J. Arceci, Phoenix Children's Hospital, Phoenix. AZ
| | - Andrew J Mungall
- Emilia L. Lim, Diane L. Trinh, Yussanne Ma, James Topham, Erin Pleasance, Andrew J. Mungall, Richard Moore, Yongjun Zhao, and Marco A. Marra, Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency; Marco A. Marra, University of British Columbia, Vancouver, British Columbia; Lillian Sung, The Hospital for Sick Children, Toronto, Ontario, Canada; Rhonda E. Ries, Maya Hughes, and Soheil Meshinchi, Fred Hutchinson Cancer Research Center; Rhonda E. Ries, Maya Hughes, and Soheil Meshinchi, University of Washington, Seattle, WA; Jim Wang, Robert B. Gerbing, E. Anders Kolb, Alan Gamis, and Todd A. Alonzo, Children's Oncology Group, Monrovia; Todd A. Alonzo, University of Southern California, Los Angeles, CA; Richard Aplenc, The Children's Hospital of Philadelphia, Philadelphia, PA; Malcolm Smith and Daniela S. Gerhard, Office of Cancer Genomics, National Cancer Institute, Bethesda, MD; and Robert J. Arceci, Phoenix Children's Hospital, Phoenix. AZ
| | - Richard Moore
- Emilia L. Lim, Diane L. Trinh, Yussanne Ma, James Topham, Erin Pleasance, Andrew J. Mungall, Richard Moore, Yongjun Zhao, and Marco A. Marra, Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency; Marco A. Marra, University of British Columbia, Vancouver, British Columbia; Lillian Sung, The Hospital for Sick Children, Toronto, Ontario, Canada; Rhonda E. Ries, Maya Hughes, and Soheil Meshinchi, Fred Hutchinson Cancer Research Center; Rhonda E. Ries, Maya Hughes, and Soheil Meshinchi, University of Washington, Seattle, WA; Jim Wang, Robert B. Gerbing, E. Anders Kolb, Alan Gamis, and Todd A. Alonzo, Children's Oncology Group, Monrovia; Todd A. Alonzo, University of Southern California, Los Angeles, CA; Richard Aplenc, The Children's Hospital of Philadelphia, Philadelphia, PA; Malcolm Smith and Daniela S. Gerhard, Office of Cancer Genomics, National Cancer Institute, Bethesda, MD; and Robert J. Arceci, Phoenix Children's Hospital, Phoenix. AZ
| | - Yongjun Zhao
- Emilia L. Lim, Diane L. Trinh, Yussanne Ma, James Topham, Erin Pleasance, Andrew J. Mungall, Richard Moore, Yongjun Zhao, and Marco A. Marra, Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency; Marco A. Marra, University of British Columbia, Vancouver, British Columbia; Lillian Sung, The Hospital for Sick Children, Toronto, Ontario, Canada; Rhonda E. Ries, Maya Hughes, and Soheil Meshinchi, Fred Hutchinson Cancer Research Center; Rhonda E. Ries, Maya Hughes, and Soheil Meshinchi, University of Washington, Seattle, WA; Jim Wang, Robert B. Gerbing, E. Anders Kolb, Alan Gamis, and Todd A. Alonzo, Children's Oncology Group, Monrovia; Todd A. Alonzo, University of Southern California, Los Angeles, CA; Richard Aplenc, The Children's Hospital of Philadelphia, Philadelphia, PA; Malcolm Smith and Daniela S. Gerhard, Office of Cancer Genomics, National Cancer Institute, Bethesda, MD; and Robert J. Arceci, Phoenix Children's Hospital, Phoenix. AZ
| | - Richard Aplenc
- Emilia L. Lim, Diane L. Trinh, Yussanne Ma, James Topham, Erin Pleasance, Andrew J. Mungall, Richard Moore, Yongjun Zhao, and Marco A. Marra, Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency; Marco A. Marra, University of British Columbia, Vancouver, British Columbia; Lillian Sung, The Hospital for Sick Children, Toronto, Ontario, Canada; Rhonda E. Ries, Maya Hughes, and Soheil Meshinchi, Fred Hutchinson Cancer Research Center; Rhonda E. Ries, Maya Hughes, and Soheil Meshinchi, University of Washington, Seattle, WA; Jim Wang, Robert B. Gerbing, E. Anders Kolb, Alan Gamis, and Todd A. Alonzo, Children's Oncology Group, Monrovia; Todd A. Alonzo, University of Southern California, Los Angeles, CA; Richard Aplenc, The Children's Hospital of Philadelphia, Philadelphia, PA; Malcolm Smith and Daniela S. Gerhard, Office of Cancer Genomics, National Cancer Institute, Bethesda, MD; and Robert J. Arceci, Phoenix Children's Hospital, Phoenix. AZ
| | - Lillian Sung
- Emilia L. Lim, Diane L. Trinh, Yussanne Ma, James Topham, Erin Pleasance, Andrew J. Mungall, Richard Moore, Yongjun Zhao, and Marco A. Marra, Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency; Marco A. Marra, University of British Columbia, Vancouver, British Columbia; Lillian Sung, The Hospital for Sick Children, Toronto, Ontario, Canada; Rhonda E. Ries, Maya Hughes, and Soheil Meshinchi, Fred Hutchinson Cancer Research Center; Rhonda E. Ries, Maya Hughes, and Soheil Meshinchi, University of Washington, Seattle, WA; Jim Wang, Robert B. Gerbing, E. Anders Kolb, Alan Gamis, and Todd A. Alonzo, Children's Oncology Group, Monrovia; Todd A. Alonzo, University of Southern California, Los Angeles, CA; Richard Aplenc, The Children's Hospital of Philadelphia, Philadelphia, PA; Malcolm Smith and Daniela S. Gerhard, Office of Cancer Genomics, National Cancer Institute, Bethesda, MD; and Robert J. Arceci, Phoenix Children's Hospital, Phoenix. AZ
| | - E Anders Kolb
- Emilia L. Lim, Diane L. Trinh, Yussanne Ma, James Topham, Erin Pleasance, Andrew J. Mungall, Richard Moore, Yongjun Zhao, and Marco A. Marra, Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency; Marco A. Marra, University of British Columbia, Vancouver, British Columbia; Lillian Sung, The Hospital for Sick Children, Toronto, Ontario, Canada; Rhonda E. Ries, Maya Hughes, and Soheil Meshinchi, Fred Hutchinson Cancer Research Center; Rhonda E. Ries, Maya Hughes, and Soheil Meshinchi, University of Washington, Seattle, WA; Jim Wang, Robert B. Gerbing, E. Anders Kolb, Alan Gamis, and Todd A. Alonzo, Children's Oncology Group, Monrovia; Todd A. Alonzo, University of Southern California, Los Angeles, CA; Richard Aplenc, The Children's Hospital of Philadelphia, Philadelphia, PA; Malcolm Smith and Daniela S. Gerhard, Office of Cancer Genomics, National Cancer Institute, Bethesda, MD; and Robert J. Arceci, Phoenix Children's Hospital, Phoenix. AZ
| | - Alan Gamis
- Emilia L. Lim, Diane L. Trinh, Yussanne Ma, James Topham, Erin Pleasance, Andrew J. Mungall, Richard Moore, Yongjun Zhao, and Marco A. Marra, Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency; Marco A. Marra, University of British Columbia, Vancouver, British Columbia; Lillian Sung, The Hospital for Sick Children, Toronto, Ontario, Canada; Rhonda E. Ries, Maya Hughes, and Soheil Meshinchi, Fred Hutchinson Cancer Research Center; Rhonda E. Ries, Maya Hughes, and Soheil Meshinchi, University of Washington, Seattle, WA; Jim Wang, Robert B. Gerbing, E. Anders Kolb, Alan Gamis, and Todd A. Alonzo, Children's Oncology Group, Monrovia; Todd A. Alonzo, University of Southern California, Los Angeles, CA; Richard Aplenc, The Children's Hospital of Philadelphia, Philadelphia, PA; Malcolm Smith and Daniela S. Gerhard, Office of Cancer Genomics, National Cancer Institute, Bethesda, MD; and Robert J. Arceci, Phoenix Children's Hospital, Phoenix. AZ
| | - Malcolm Smith
- Emilia L. Lim, Diane L. Trinh, Yussanne Ma, James Topham, Erin Pleasance, Andrew J. Mungall, Richard Moore, Yongjun Zhao, and Marco A. Marra, Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency; Marco A. Marra, University of British Columbia, Vancouver, British Columbia; Lillian Sung, The Hospital for Sick Children, Toronto, Ontario, Canada; Rhonda E. Ries, Maya Hughes, and Soheil Meshinchi, Fred Hutchinson Cancer Research Center; Rhonda E. Ries, Maya Hughes, and Soheil Meshinchi, University of Washington, Seattle, WA; Jim Wang, Robert B. Gerbing, E. Anders Kolb, Alan Gamis, and Todd A. Alonzo, Children's Oncology Group, Monrovia; Todd A. Alonzo, University of Southern California, Los Angeles, CA; Richard Aplenc, The Children's Hospital of Philadelphia, Philadelphia, PA; Malcolm Smith and Daniela S. Gerhard, Office of Cancer Genomics, National Cancer Institute, Bethesda, MD; and Robert J. Arceci, Phoenix Children's Hospital, Phoenix. AZ
| | - Daniela S Gerhard
- Emilia L. Lim, Diane L. Trinh, Yussanne Ma, James Topham, Erin Pleasance, Andrew J. Mungall, Richard Moore, Yongjun Zhao, and Marco A. Marra, Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency; Marco A. Marra, University of British Columbia, Vancouver, British Columbia; Lillian Sung, The Hospital for Sick Children, Toronto, Ontario, Canada; Rhonda E. Ries, Maya Hughes, and Soheil Meshinchi, Fred Hutchinson Cancer Research Center; Rhonda E. Ries, Maya Hughes, and Soheil Meshinchi, University of Washington, Seattle, WA; Jim Wang, Robert B. Gerbing, E. Anders Kolb, Alan Gamis, and Todd A. Alonzo, Children's Oncology Group, Monrovia; Todd A. Alonzo, University of Southern California, Los Angeles, CA; Richard Aplenc, The Children's Hospital of Philadelphia, Philadelphia, PA; Malcolm Smith and Daniela S. Gerhard, Office of Cancer Genomics, National Cancer Institute, Bethesda, MD; and Robert J. Arceci, Phoenix Children's Hospital, Phoenix. AZ
| | - Todd A Alonzo
- Emilia L. Lim, Diane L. Trinh, Yussanne Ma, James Topham, Erin Pleasance, Andrew J. Mungall, Richard Moore, Yongjun Zhao, and Marco A. Marra, Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency; Marco A. Marra, University of British Columbia, Vancouver, British Columbia; Lillian Sung, The Hospital for Sick Children, Toronto, Ontario, Canada; Rhonda E. Ries, Maya Hughes, and Soheil Meshinchi, Fred Hutchinson Cancer Research Center; Rhonda E. Ries, Maya Hughes, and Soheil Meshinchi, University of Washington, Seattle, WA; Jim Wang, Robert B. Gerbing, E. Anders Kolb, Alan Gamis, and Todd A. Alonzo, Children's Oncology Group, Monrovia; Todd A. Alonzo, University of Southern California, Los Angeles, CA; Richard Aplenc, The Children's Hospital of Philadelphia, Philadelphia, PA; Malcolm Smith and Daniela S. Gerhard, Office of Cancer Genomics, National Cancer Institute, Bethesda, MD; and Robert J. Arceci, Phoenix Children's Hospital, Phoenix. AZ
| | - Soheil Meshinchi
- Emilia L. Lim, Diane L. Trinh, Yussanne Ma, James Topham, Erin Pleasance, Andrew J. Mungall, Richard Moore, Yongjun Zhao, and Marco A. Marra, Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency; Marco A. Marra, University of British Columbia, Vancouver, British Columbia; Lillian Sung, The Hospital for Sick Children, Toronto, Ontario, Canada; Rhonda E. Ries, Maya Hughes, and Soheil Meshinchi, Fred Hutchinson Cancer Research Center; Rhonda E. Ries, Maya Hughes, and Soheil Meshinchi, University of Washington, Seattle, WA; Jim Wang, Robert B. Gerbing, E. Anders Kolb, Alan Gamis, and Todd A. Alonzo, Children's Oncology Group, Monrovia; Todd A. Alonzo, University of Southern California, Los Angeles, CA; Richard Aplenc, The Children's Hospital of Philadelphia, Philadelphia, PA; Malcolm Smith and Daniela S. Gerhard, Office of Cancer Genomics, National Cancer Institute, Bethesda, MD; and Robert J. Arceci, Phoenix Children's Hospital, Phoenix. AZ
| | - Marco A Marra
- Emilia L. Lim, Diane L. Trinh, Yussanne Ma, James Topham, Erin Pleasance, Andrew J. Mungall, Richard Moore, Yongjun Zhao, and Marco A. Marra, Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency; Marco A. Marra, University of British Columbia, Vancouver, British Columbia; Lillian Sung, The Hospital for Sick Children, Toronto, Ontario, Canada; Rhonda E. Ries, Maya Hughes, and Soheil Meshinchi, Fred Hutchinson Cancer Research Center; Rhonda E. Ries, Maya Hughes, and Soheil Meshinchi, University of Washington, Seattle, WA; Jim Wang, Robert B. Gerbing, E. Anders Kolb, Alan Gamis, and Todd A. Alonzo, Children's Oncology Group, Monrovia; Todd A. Alonzo, University of Southern California, Los Angeles, CA; Richard Aplenc, The Children's Hospital of Philadelphia, Philadelphia, PA; Malcolm Smith and Daniela S. Gerhard, Office of Cancer Genomics, National Cancer Institute, Bethesda, MD; and Robert J. Arceci, Phoenix Children's Hospital, Phoenix. AZ
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Voigt AP, Brodersen LE, Alonzo TA, Gerbing RB, Menssen AJ, Wilson ER, Kahwash S, Raimondi SC, Hirsch BA, Gamis AS, Meshinchi S, Wells DA, Loken MR. Phenotype in combination with genotype improves outcome prediction in acute myeloid leukemia: a report from Children's Oncology Group protocol AAML0531. Haematologica 2017; 102:2058-2068. [PMID: 28883080 PMCID: PMC5709105 DOI: 10.3324/haematol.2017.169029] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 09/06/2017] [Indexed: 12/17/2022] Open
Abstract
Diagnostic biomarkers can be used to determine relapse risk in acute myeloid leukemia, and certain genetic aberrancies have prognostic relevance. A diagnostic immunophenotypic expression profile, which quantifies the amounts of distinct gene products, not just their presence or absence, was established in order to improve outcome prediction for patients with acute myeloid leukemia. The immunophenotypic expression profile, which defines each patient’s leukemia as a location in 15-dimensional space, was generated for 769 patients enrolled in the Children’s Oncology Group AAML0531 protocol. Unsupervised hierarchical clustering grouped patients with similar immunophenotypic expression profiles into eleven patient cohorts, demonstrating high associations among phenotype, genotype, morphology, and outcome. Of 95 patients with inv(16), 79% segregated in Cluster A. Of 109 patients with t(8;21), 92% segregated in Clusters A and B. Of 152 patients with 11q23 alterations, 78% segregated in Clusters D, E, F, G, or H. For both inv(16) and 11q23 abnormalities, differential phenotypic expression identified patient groups with different survival characteristics (P<0.05). Clinical outcome analysis revealed that Cluster B (predominantly t(8;21)) was associated with favorable outcome (P<0.001) and Clusters E, G, H, and K were associated with adverse outcomes (P<0.05). Multivariable regression analysis revealed that Clusters E, G, H, and K were independently associated with worse survival (P range <0.001 to 0.008). The Children’s Oncology Group AAML0531 trial: clinicaltrials.gov Identifier: 00372593.
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Affiliation(s)
| | | | - Todd A Alonzo
- Children's Oncology Group, Monrovia, CA, USA.,University of Southern California, Los Angeles, CA, USA
| | | | | | | | | | | | - Betsy A Hirsch
- University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Alan S Gamis
- Children's Mercy Hospitals & Clinics, Kansas City, MO, USA
| | - Soheil Meshinchi
- Children's Oncology Group, Monrovia, CA, USA.,Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Kutny MA, Alonzo TA, Gerbing RB, Wang YC, Raimondi SC, Hirsch BA, Fu CH, Meshinchi S, Gamis AS, Feusner JH, Gregory JJ. Arsenic Trioxide Consolidation Allows Anthracycline Dose Reduction for Pediatric Patients With Acute Promyelocytic Leukemia: Report From the Children's Oncology Group Phase III Historically Controlled Trial AAML0631. J Clin Oncol 2017; 35:3021-3029. [PMID: 28767288 DOI: 10.1200/jco.2016.71.6183] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [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
Purpose The Children's Oncology Group AAML0631 trial for newly diagnosed pediatric acute promyelocytic leukemia (APL) was a phase III historically controlled trial to determine the survival of patients receiving arsenic trioxide (ATO) consolidation and reduced doses of anthracyclines. Patients and Methods Patients age 2 to 21 years with de novo APL confirmed by PML-RARα polymerase chain reaction were stratified as standard risk (SR) or high risk (HR) on the basis of diagnostic WBC count. All patients received all-trans retinoic acid (ATRA) during induction, each consolidation course, and maintenance. All patients received two cycles of ATO therapy during consolidation 1, an additional two (SR) or three (HR) consolidation courses that included high-dose cytarabine and anthracycline, and maintenance therapy comprising ATRA, oral methotrexate, and mercaptopurine. Results One hundred one patients (66 SR and 35 HR) were evaluable for outcome. The 3-year overall survival was 94%, and event-free survival (EFS) was 91%. For SR and HR patients with APL, the overall survival was 98% versus 86% ( P = .003), and EFS was 95% versus 83% ( P = .03), respectively. The EFS for SR patients in AAML0631 was noninferior to that of patients in the AIDA 0493 historical control, which used a significantly higher anthracycline dose and did not include ATO consolidation. Relapse risk for patients in AAML0631 from end consolidation 1 (after ATO treatment) was only 4% at 3 years and did not differ significantly between SR and HR patients. Conclusion ATO consolidation cycles were well tolerated in pediatric patients with APL and allowed significant reduction in cumulative anthracycline doses while maintaining excellent survival and a low relapse risk for both SR and HR patients with APL.
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Affiliation(s)
- Matthew A Kutny
- Matthew A. Kutny, University of Alabama at Birmingham, Birmingham, AL; Todd A. Alonzo, University of Southern California; Cecilia H. Fu, Children's Hospital Los Angeles, Los Angeles; Robert B. Gerbing and Yi-Cheng Wang, Children's Oncology Group, Monrovia; James H. Feusner, Children's Hospital and Research Center Oakland, Oakland, CA; Susana C. Raimondi, St Jude Children's Research Hospital, Memphis, TN; Betsy A. Hirsch, University of Minnesota Medical Center-Fairview, Minneapolis, MN; Soheil Meshinchi, Fred Hutchinson Cancer Research Center, Seattle, WA; Alan S. Gamis, Children's Mercy Hospitals and Clinics, Kansas City, MO; and John J. Gregory Jr, Goryeb Children's Hospital, Morristown, NJ
| | - Todd A Alonzo
- Matthew A. Kutny, University of Alabama at Birmingham, Birmingham, AL; Todd A. Alonzo, University of Southern California; Cecilia H. Fu, Children's Hospital Los Angeles, Los Angeles; Robert B. Gerbing and Yi-Cheng Wang, Children's Oncology Group, Monrovia; James H. Feusner, Children's Hospital and Research Center Oakland, Oakland, CA; Susana C. Raimondi, St Jude Children's Research Hospital, Memphis, TN; Betsy A. Hirsch, University of Minnesota Medical Center-Fairview, Minneapolis, MN; Soheil Meshinchi, Fred Hutchinson Cancer Research Center, Seattle, WA; Alan S. Gamis, Children's Mercy Hospitals and Clinics, Kansas City, MO; and John J. Gregory Jr, Goryeb Children's Hospital, Morristown, NJ
| | - Robert B Gerbing
- Matthew A. Kutny, University of Alabama at Birmingham, Birmingham, AL; Todd A. Alonzo, University of Southern California; Cecilia H. Fu, Children's Hospital Los Angeles, Los Angeles; Robert B. Gerbing and Yi-Cheng Wang, Children's Oncology Group, Monrovia; James H. Feusner, Children's Hospital and Research Center Oakland, Oakland, CA; Susana C. Raimondi, St Jude Children's Research Hospital, Memphis, TN; Betsy A. Hirsch, University of Minnesota Medical Center-Fairview, Minneapolis, MN; Soheil Meshinchi, Fred Hutchinson Cancer Research Center, Seattle, WA; Alan S. Gamis, Children's Mercy Hospitals and Clinics, Kansas City, MO; and John J. Gregory Jr, Goryeb Children's Hospital, Morristown, NJ
| | - Yi-Cheng Wang
- Matthew A. Kutny, University of Alabama at Birmingham, Birmingham, AL; Todd A. Alonzo, University of Southern California; Cecilia H. Fu, Children's Hospital Los Angeles, Los Angeles; Robert B. Gerbing and Yi-Cheng Wang, Children's Oncology Group, Monrovia; James H. Feusner, Children's Hospital and Research Center Oakland, Oakland, CA; Susana C. Raimondi, St Jude Children's Research Hospital, Memphis, TN; Betsy A. Hirsch, University of Minnesota Medical Center-Fairview, Minneapolis, MN; Soheil Meshinchi, Fred Hutchinson Cancer Research Center, Seattle, WA; Alan S. Gamis, Children's Mercy Hospitals and Clinics, Kansas City, MO; and John J. Gregory Jr, Goryeb Children's Hospital, Morristown, NJ
| | - Susana C Raimondi
- Matthew A. Kutny, University of Alabama at Birmingham, Birmingham, AL; Todd A. Alonzo, University of Southern California; Cecilia H. Fu, Children's Hospital Los Angeles, Los Angeles; Robert B. Gerbing and Yi-Cheng Wang, Children's Oncology Group, Monrovia; James H. Feusner, Children's Hospital and Research Center Oakland, Oakland, CA; Susana C. Raimondi, St Jude Children's Research Hospital, Memphis, TN; Betsy A. Hirsch, University of Minnesota Medical Center-Fairview, Minneapolis, MN; Soheil Meshinchi, Fred Hutchinson Cancer Research Center, Seattle, WA; Alan S. Gamis, Children's Mercy Hospitals and Clinics, Kansas City, MO; and John J. Gregory Jr, Goryeb Children's Hospital, Morristown, NJ
| | - Betsy A Hirsch
- Matthew A. Kutny, University of Alabama at Birmingham, Birmingham, AL; Todd A. Alonzo, University of Southern California; Cecilia H. Fu, Children's Hospital Los Angeles, Los Angeles; Robert B. Gerbing and Yi-Cheng Wang, Children's Oncology Group, Monrovia; James H. Feusner, Children's Hospital and Research Center Oakland, Oakland, CA; Susana C. Raimondi, St Jude Children's Research Hospital, Memphis, TN; Betsy A. Hirsch, University of Minnesota Medical Center-Fairview, Minneapolis, MN; Soheil Meshinchi, Fred Hutchinson Cancer Research Center, Seattle, WA; Alan S. Gamis, Children's Mercy Hospitals and Clinics, Kansas City, MO; and John J. Gregory Jr, Goryeb Children's Hospital, Morristown, NJ
| | - Cecilia H Fu
- Matthew A. Kutny, University of Alabama at Birmingham, Birmingham, AL; Todd A. Alonzo, University of Southern California; Cecilia H. Fu, Children's Hospital Los Angeles, Los Angeles; Robert B. Gerbing and Yi-Cheng Wang, Children's Oncology Group, Monrovia; James H. Feusner, Children's Hospital and Research Center Oakland, Oakland, CA; Susana C. Raimondi, St Jude Children's Research Hospital, Memphis, TN; Betsy A. Hirsch, University of Minnesota Medical Center-Fairview, Minneapolis, MN; Soheil Meshinchi, Fred Hutchinson Cancer Research Center, Seattle, WA; Alan S. Gamis, Children's Mercy Hospitals and Clinics, Kansas City, MO; and John J. Gregory Jr, Goryeb Children's Hospital, Morristown, NJ
| | - Soheil Meshinchi
- Matthew A. Kutny, University of Alabama at Birmingham, Birmingham, AL; Todd A. Alonzo, University of Southern California; Cecilia H. Fu, Children's Hospital Los Angeles, Los Angeles; Robert B. Gerbing and Yi-Cheng Wang, Children's Oncology Group, Monrovia; James H. Feusner, Children's Hospital and Research Center Oakland, Oakland, CA; Susana C. Raimondi, St Jude Children's Research Hospital, Memphis, TN; Betsy A. Hirsch, University of Minnesota Medical Center-Fairview, Minneapolis, MN; Soheil Meshinchi, Fred Hutchinson Cancer Research Center, Seattle, WA; Alan S. Gamis, Children's Mercy Hospitals and Clinics, Kansas City, MO; and John J. Gregory Jr, Goryeb Children's Hospital, Morristown, NJ
| | - Alan S Gamis
- Matthew A. Kutny, University of Alabama at Birmingham, Birmingham, AL; Todd A. Alonzo, University of Southern California; Cecilia H. Fu, Children's Hospital Los Angeles, Los Angeles; Robert B. Gerbing and Yi-Cheng Wang, Children's Oncology Group, Monrovia; James H. Feusner, Children's Hospital and Research Center Oakland, Oakland, CA; Susana C. Raimondi, St Jude Children's Research Hospital, Memphis, TN; Betsy A. Hirsch, University of Minnesota Medical Center-Fairview, Minneapolis, MN; Soheil Meshinchi, Fred Hutchinson Cancer Research Center, Seattle, WA; Alan S. Gamis, Children's Mercy Hospitals and Clinics, Kansas City, MO; and John J. Gregory Jr, Goryeb Children's Hospital, Morristown, NJ
| | - James H Feusner
- Matthew A. Kutny, University of Alabama at Birmingham, Birmingham, AL; Todd A. Alonzo, University of Southern California; Cecilia H. Fu, Children's Hospital Los Angeles, Los Angeles; Robert B. Gerbing and Yi-Cheng Wang, Children's Oncology Group, Monrovia; James H. Feusner, Children's Hospital and Research Center Oakland, Oakland, CA; Susana C. Raimondi, St Jude Children's Research Hospital, Memphis, TN; Betsy A. Hirsch, University of Minnesota Medical Center-Fairview, Minneapolis, MN; Soheil Meshinchi, Fred Hutchinson Cancer Research Center, Seattle, WA; Alan S. Gamis, Children's Mercy Hospitals and Clinics, Kansas City, MO; and John J. Gregory Jr, Goryeb Children's Hospital, Morristown, NJ
| | - John J Gregory
- Matthew A. Kutny, University of Alabama at Birmingham, Birmingham, AL; Todd A. Alonzo, University of Southern California; Cecilia H. Fu, Children's Hospital Los Angeles, Los Angeles; Robert B. Gerbing and Yi-Cheng Wang, Children's Oncology Group, Monrovia; James H. Feusner, Children's Hospital and Research Center Oakland, Oakland, CA; Susana C. Raimondi, St Jude Children's Research Hospital, Memphis, TN; Betsy A. Hirsch, University of Minnesota Medical Center-Fairview, Minneapolis, MN; Soheil Meshinchi, Fred Hutchinson Cancer Research Center, Seattle, WA; Alan S. Gamis, Children's Mercy Hospitals and Clinics, Kansas City, MO; and John J. Gregory Jr, Goryeb Children's Hospital, Morristown, NJ
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Getz KD, Alonzo TA, Sung L, Meshinchi S, Gerbing RB, Raimondi S, Hirsch BA, Kahwash SB, Choi J, Kolb EA, Gamis AS, Aplenc R. Four versus five chemotherapy courses in patients with low risk acute myeloid leukemia: A Children’s Oncology Group report. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.10515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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
10515 Background: For pediatric patients with low risk (LR) acute myeloid leukemia (AML), the Children’s Oncology Group (COG) trial AAML1031 used a 4-course chemotherapy backbone consisting of two induction courses of cytarabine/daunorubicin/etoposide, a third course of cytarabine/etoposide and a fourth course of cytarabine/mitoxantrone. The prior COG trial, AAML0531, included the same four courses plus a fifth course of high dose cytarabine. Removal of course 5 from AAML1031 was based in part on prior studies that suggested no benefit from a fifth course. Methods: We compared overall survival (OS), disease free survival (DFS), and relapse risk (RR) for LR patients receiving four versus five chemotherapy courses in a pooled analysis of comparable patients treated on AAML0531 and AAML1031. LR was defined as the presence of inv(16)/t(16;16) or t(8;21) cytogenetic features, NPM1 or CEBPA mutations, or MRD < 0.1% post-Induction I in those with no high risk features. AAML0531 patients assigned to gemotuzumab were excluded. Follow-up for outcomes began at the start of course 4. Cox (OS and EFS) and risk (RR) regressions were used to estimate unadjusted hazard ratios (HR) comparing outcomes for patients who received only four versus five chemotherapy courses. Start of a fifth chemotherapy course was assessed as a time-varying exposure in all analyses to avoid exposure misclassification. Results: A total of 921 LR patients (225 from AAML0531, 696 from AAML1031) were included; 191 (21%) received a fifth course. There were no significant differences in distributions of sex, age, race, or ethnicity between patients treated with four or five courses. Median times to absolute neutrophil count and platelet count recovery after course 4 were also comparable. Patients who received only four courses had significantly lower OS (HR = 1.83, 95% CI: 1.22-2.74, p = 0.003), DSF (HR = 1.49, 95% CI: 1.13-1.97, p = 0.005), and higher RR (HR = 1.42, 95% CI: 1.08-1.88, p = 0.013) compared to those who received five courses. Conclusions: Removal of a fifth cytarabine-containing course appears to result in worse OS, DFS, and RR in pediatric patients with LR AML. Multivariable analyses to further refine the estimates are ongoing.
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Affiliation(s)
- Kelly D. Getz
- The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Todd Allen Alonzo
- University of Southern California Children's Oncology Group, Arcadia, CA
| | - Lillian Sung
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | | | | | | | | | - John Choi
- St. Jude Children's Research Hospital, Memphis, TN
| | | | - Alan S. Gamis
- Children's Mercy Hospital and Clinics, Kansas City, MO
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Tarlock K, Alonzo TA, Loken MR, Gerbing RB, Ries RE, Aplenc R, Sung L, Raimondi SC, Hirsch BA, Kahwash SB, McKenney A, Kolb EA, Gamis AS, Meshinchi S. Disease Characteristics and Prognostic Implications of Cell-Surface FLT3 Receptor (CD135) Expression in Pediatric Acute Myeloid Leukemia: A Report from the Children's Oncology Group. Clin Cancer Res 2017; 23:3649-3656. [PMID: 28108543 DOI: 10.1158/1078-0432.ccr-16-2353] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 12/20/2016] [Accepted: 01/05/2017] [Indexed: 01/24/2023]
Abstract
Purpose: The FLT3 cell-surface receptor tyrosine kinase (CD135) is expressed in a majority of both acute lymphoid leukemia (ALL) and myeloid leukemia (AML). However, the prognostic significance of CD135 expression in AML remains unclear. We therefore evaluated the association between FLT3 surface expression and disease characteristics and outcomes in pediatric patients with AML.Experimental Design: We analyzed FLT3 receptor expression on AML blasts by multi-dimensional flow cytometry and its association with disease characteristics, clinical outcomes, and FLT3 transcript level in 367 children with AML treated on the Children's Oncology Group trial AAML0531.Results: There was high variability in blast CD135 cell-surface expression across specimens. CD135 expression measured by flow cytometry was not correlated with FLT3 transcript expression determined by quantitative RT-PCR. Overall, CD135 expression was not significantly different for patients with FLT3/WT, FLT3/ITD, or FLT3/ALM (P = 0.25). High cell-surface CD135 expression was associated with FAB M5 subtype (P < 0.001), KMT2A rearrangements (P = 0.009), and inversely associated with inv(16)/t(16;16) (P < 0.001). Complete remission rate, overall survival, disease-free survival, and relapse rates were not significantly different between patients with low and high CD135 expression.Conclusions: FLT3 cell-surface expression did not vary by FLT3 mutational status, but high FLT3 expression was strongly associated with KMT2A rearrangements. Our study found that there was no prognostic significance of FLT3 cell surface expression in pediatric AML. Clin Cancer Res; 23(14); 3649-56. ©2017 AACR.
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Affiliation(s)
- Katherine Tarlock
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington. .,Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Todd A Alonzo
- Children's Oncology Group, Monrovia, California.,Keck School of Medicine, University of Southern California, Los Angeles, California
| | | | | | - Rhonda E Ries
- Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Richard Aplenc
- Division of Hematology/Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lillian Sung
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario
| | | | - Betsy A Hirsch
- Division of Laboratory Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | | | | | - E Anders Kolb
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Alan S Gamis
- Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | - Soheil Meshinchi
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington
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Ramamurthy R, Hughes M, Morris V, Bolouri H, Gerbing RB, Wang YC, Loken MR, Raimondi SC, Hirsch BA, Gamis AS, Oehler VG, Alonzo TA, Meshinchi S. miR-155 expression and correlation with clinical outcome in pediatric AML: A report from Children's Oncology Group. Pediatr Blood Cancer 2016; 63:2096-2103. [PMID: 27511899 PMCID: PMC5497493 DOI: 10.1002/pbc.26157] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/22/2016] [Accepted: 06/17/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Aberrant expression of microRNA-155 (miR-155) has been implicated in acute myeloid leukemia (AML) and associated with clinical outcome. PROCEDURE We evaluated miR-155 expression in 198 children with normal karyotype AML (NK-AML) enrolled in Children's Oncology Group (COG) AML trial AAML0531 and correlated miR-155 expression levels with disease characteristics and clinical outcome. Patients were divided into quartiles (Q1-Q4) based on miR-155 expression level, and disease characteristics were then evaluated and correlated with miR-155 expression. RESULTS MiR-155 expression varied over 4-log10-fold range relative to its expression in normal marrow with a median expression level of 0.825 (range 0.043-25.630) for the entire study cohort. Increasing miR-155 expression was highly associated with the presence of FLT3/ITD mutations (P < 0.001) and high-risk disease (P < 0.001) and inversely associated with standard-risk (P = 0.008) and low-risk disease (P = 0.041). Patients with highest miR-155 expression had a complete remission (CR) rate of 46% compared with 82% in low expressers (P < 0.001) with a correspondingly lower event-free (EFS) and overall survival (OS) (P < 0.001 and P = 0.002, respectively). In a multivariate model that included molecular risk factors, high miR-155 expression remained a significant independent predictor of OS (P = 0.022) and EFS (0.019). CONCLUSIONS High miR-155 expression is an adverse prognostic factor in pediatric NK-AML patients. Specifically, high miR-155 expression not only correlates with FLT3/ITD mutation status and high-risk disease but it is also an independent predictor of worse EFS and OS.
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Affiliation(s)
| | - Maya Hughes
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington,Seattle Children's Hospital, Seattle, Washington
| | - Valerie Morris
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Hamid Bolouri
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | | | - Susana C. Raimondi
- Children's Oncology Group, Monrovia, California,Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Betsy A. Hirsch
- Children's Oncology Group, Monrovia, California,Division of Laboratory Medicine, University of Minnesota Medical Center-Fairview, Minneapolis, Minnesota
| | - Alan S. Gamis
- Children's Oncology Group, Monrovia, California,Children's Mercy Hospitals & Clinics, Kansas City, Missiouri
| | - Vivian G. Oehler
- University of Washington School of Medicine, Seattle, Washington,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Todd A. Alonzo
- Keck School of Medical Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | - Soheil Meshinchi
- University of Washington School of Medicine, Seattle, Washington. .,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington. .,Seattle Children's Hospital, Seattle, Washington. .,Children's Oncology Group, Monrovia, California.
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Laszlo GS, Alonzo TA, Gudgeon CJ, Harrington KH, Kentsis A, Gerbing RB, Wang YC, Ries RE, Raimondi SC, Hirsch BA, Gamis AS, Meshinchi S, Walter RB. Erratum to: High expression of myocyte enhancer factor 2C (MEF2C) is associated with adverse-risk features and poor outcome in pediatric acute myeloid leukemia: a report from the Children's Oncology Group. J Hematol Oncol 2016; 9:133. [PMID: 27903291 PMCID: PMC5129595 DOI: 10.1186/s13045-016-0364-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 11/28/2016] [Indexed: 11/10/2022] Open
Affiliation(s)
- George S Laszlo
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, D2-190, Seattle, WA, 98109-1024, USA
| | - Todd A Alonzo
- Department of Biostatistics, University of Southern California, Los Angeles, CA, USA.,Children's Oncology Group, Monrovia, CA, USA
| | - Chelsea J Gudgeon
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, D2-190, Seattle, WA, 98109-1024, USA
| | - Kimberly H Harrington
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, D2-190, Seattle, WA, 98109-1024, USA
| | - Alex Kentsis
- Molecular Pharmacology and Chemistry Program, Sloan Kettering Institute, New York, NY, USA.,Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Medical College of Cornell University, New York, NY, USA
| | | | | | - Rhonda E Ries
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, D2-190, Seattle, WA, 98109-1024, USA
| | - Susana C Raimondi
- Children's Oncology Group, Monrovia, CA, USA.,Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Betsy A Hirsch
- Children's Oncology Group, Monrovia, CA, USA.,Department of Laboratory Medicine and Pathology, University of Minnesota Cancer Center, Minneapolis, MN, USA
| | - Alan S Gamis
- Children's Oncology Group, Monrovia, CA, USA.,Division of Hematology-Oncology, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA
| | - Soheil Meshinchi
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, D2-190, Seattle, WA, 98109-1024, USA.,Children's Oncology Group, Monrovia, CA, USA.,Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Roland B Walter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, D2-190, Seattle, WA, 98109-1024, USA. .,Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA. .,Department of Epidemiology, University of Washington, Seattle, WA, USA.
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Sung L, Aplenc R, Alonzo TA, Gerbing RB, Wang YC, Meshinchi S, Gamis AS. Association between prolonged neutropenia and reduced relapse risk in pediatric AML: A report from the children's oncology group. Int J Cancer 2016; 139:1930-5. [PMID: 27312107 DOI: 10.1002/ijc.30236] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 05/10/2016] [Indexed: 11/09/2022]
Abstract
Objective was to describe the relationship between the number of sterile site infections and duration of neutropenia during the first four cycles of chemotherapy and the risk of recurrence and overall survival in children with newly diagnosed acute myeloid leukemia (AML). AAML0531 was a Children's Oncology Group randomized phase 3 clinical trial that included 1022 children with de novo AML. For this analysis, we focused on non-Down syndrome favorable and standard risk patients who completed at least 4 cycles of chemotherapy without recurrence or withdrawal during protocol therapy. Those receiving hematopoietic stem cell transplantation in first remission were excluded. Five hundred and sixty-nine patients were included; 274 (48.2%) were favorable risk. The median cumulative time with neutropenia between Induction II to completion of Intensification II was 96 (range 54-204) days. Number of sterile site infections did not influence the risk of relapse or overall survival. However, longer duration of neutropenia was associated with a lower risk of relapse (hazard ratio 0.81 per 20 days neutropenia, p = 0.007). Longer duration of neutropenia was associated with a reduced risk of relapse for children with favorable and standard risk AML. Toxicity may be influenced by pharmacogenomics suggesting that individualized chemotherapy dosing may be an effective strategy.
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Affiliation(s)
- Lillian Sung
- The Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Richard Aplenc
- Division of Pediatric Oncology/Stem Cell Transplant, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Todd A Alonzo
- Children's Oncology Group, Monrovia, CA, USA.,Department of Biostatistics, University of Southern California, Los Angeles, CA, USA
| | | | | | - Soheil Meshinchi
- Division of Oncology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Alan S Gamis
- Department of Hematology-Oncology, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA
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Stieglitz E, Taylor-Weiner AN, Chang TY, Gelston LC, Wang YD, Mazor T, Esquivel E, Yu A, Seepo S, Olsen SR, Rosenberg M, Archambeault SL, Abusin G, Beckman K, Brown PA, Briones M, Carcamo B, Cooper T, Dahl GV, Emanuel PD, Fluchel MN, Goyal RK, Hayashi RJ, Hitzler J, Hugge C, Liu YL, Messinger YH, Mahoney DH, Monteleone P, Nemecek ER, Roehrs PA, Schore RJ, Stine KC, Takemoto CM, Toretsky JA, Costello JF, Olshen AB, Stewart C, Li Y, Ma J, Gerbing RB, Alonzo TA, Getz G, Gruber TA, Golub TR, Stegmaier K, Loh ML. Corrigendum: The genomic landscape of juvenile myelomonocytic leukemia. Nat Genet 2016; 48:101. [PMID: 26711114 DOI: 10.1038/ng0116-101a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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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Pollard JA, Loken M, Gerbing RB, Raimondi SC, Hirsch BA, Aplenc R, Bernstein ID, Gamis AS, Alonzo TA, Meshinchi S. CD33 Expression and Its Association With Gemtuzumab Ozogamicin Response: Results From the Randomized Phase III Children's Oncology Group Trial AAML0531. J Clin Oncol 2016; 34:747-55. [PMID: 26786921 DOI: 10.1200/jco.2015.62.6846] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE CD33 is variably expressed on acute myeloid leukemia (AML) blasts and is targeted by gemtuzumab ozogamicin (GO). GO has shown benefit in both adult and pediatric AML trials, yet limited data exist about whether GO response correlates with CD33 expression level. PATIENTS AND METHODS CD33 expression levels were prospectively quantified by multidimensional flow cytometry in 825 patients enrolled in Children's Oncology Group AAML0531 and correlated with response to GO. RESULTS Patients with low CD33 expression (lowest quartile of expression [Q1]) had no benefit with the addition of GO to conventional chemotherapy (relapse risk [RR]: GO 36% v No-GO 34%, P = .731; event-free survival [EFS]: GO 53% v No-GO 58%, P = .456). However, patients with higher CD33 expression (Q2 to Q4) had significantly reduced RR (GO 32% v No-GO 49%, P < .001) and improved EFS (GO 53% v No-GO 41%, P = .005). This differential effect was observed in all risk groups. Specifically, low-risk (LR), intermediate-risk (IR), and high-risk (HR) patients with low CD33 expression had similar outcomes regardless of GO exposure, whereas the addition of GO to conventional chemotherapy resulted in a significant decrease in RR and disease-free survival (DFS) for patients with higher CD33 expression (LR RR, GO 13% v No-GO 35%, P = .001; LR DFS, GO 79% v No-GO 59%, P = .007; IR RR, GO 44% v No-GO 57%, P = .044; IR DFS, GO 51% v No-GO 40%, P = .078; HR RR, GO 40% v No-GO 73%, P = .016; HR DFS, GO 47% v No-GO 28%, P = .135). CONCLUSION We demonstrate that GO lacks clinical benefit in patients with low CD33 expression but significantly reduces RR and improves EFS in patients with high CD33 expression, which suggests a role for CD33-targeted therapeutics in subsets of pediatric AML.
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Affiliation(s)
- Jessica A Pollard
- Jessica A. Pollard, Maine Medical Center, Portland, ME; and Tufts University, Boston, MA; Michael Loken, Hematologics; Irwin D. Bernstein and Soheil Meshinchi, Fred Hutchinson Cancer Research Center; Irwin D. Bernstein and Soheil Meshinchi, University of Washington, Seattle, WA; Robert B. Gerbing and Todd A. Alonzo, Children's Oncology Group, Arcadia; Todd A. Alonzo, Keck School of Medicine of University of Southern California, Los Angeles, CA; Susana C. Raimondi, St Jude Children's Research Hospital, Memphis, TN; Betsy Hirsch, University of Minnesota Cancer Center, Minneapolis, MN; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; and Alan S. Gamis, Children's Mercy Hospitals and Clinics, Kansas City, MO.
| | - Michael Loken
- Jessica A. Pollard, Maine Medical Center, Portland, ME; and Tufts University, Boston, MA; Michael Loken, Hematologics; Irwin D. Bernstein and Soheil Meshinchi, Fred Hutchinson Cancer Research Center; Irwin D. Bernstein and Soheil Meshinchi, University of Washington, Seattle, WA; Robert B. Gerbing and Todd A. Alonzo, Children's Oncology Group, Arcadia; Todd A. Alonzo, Keck School of Medicine of University of Southern California, Los Angeles, CA; Susana C. Raimondi, St Jude Children's Research Hospital, Memphis, TN; Betsy Hirsch, University of Minnesota Cancer Center, Minneapolis, MN; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; and Alan S. Gamis, Children's Mercy Hospitals and Clinics, Kansas City, MO
| | - Robert B Gerbing
- Jessica A. Pollard, Maine Medical Center, Portland, ME; and Tufts University, Boston, MA; Michael Loken, Hematologics; Irwin D. Bernstein and Soheil Meshinchi, Fred Hutchinson Cancer Research Center; Irwin D. Bernstein and Soheil Meshinchi, University of Washington, Seattle, WA; Robert B. Gerbing and Todd A. Alonzo, Children's Oncology Group, Arcadia; Todd A. Alonzo, Keck School of Medicine of University of Southern California, Los Angeles, CA; Susana C. Raimondi, St Jude Children's Research Hospital, Memphis, TN; Betsy Hirsch, University of Minnesota Cancer Center, Minneapolis, MN; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; and Alan S. Gamis, Children's Mercy Hospitals and Clinics, Kansas City, MO
| | - Susana C Raimondi
- Jessica A. Pollard, Maine Medical Center, Portland, ME; and Tufts University, Boston, MA; Michael Loken, Hematologics; Irwin D. Bernstein and Soheil Meshinchi, Fred Hutchinson Cancer Research Center; Irwin D. Bernstein and Soheil Meshinchi, University of Washington, Seattle, WA; Robert B. Gerbing and Todd A. Alonzo, Children's Oncology Group, Arcadia; Todd A. Alonzo, Keck School of Medicine of University of Southern California, Los Angeles, CA; Susana C. Raimondi, St Jude Children's Research Hospital, Memphis, TN; Betsy Hirsch, University of Minnesota Cancer Center, Minneapolis, MN; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; and Alan S. Gamis, Children's Mercy Hospitals and Clinics, Kansas City, MO
| | - Betsy A Hirsch
- Jessica A. Pollard, Maine Medical Center, Portland, ME; and Tufts University, Boston, MA; Michael Loken, Hematologics; Irwin D. Bernstein and Soheil Meshinchi, Fred Hutchinson Cancer Research Center; Irwin D. Bernstein and Soheil Meshinchi, University of Washington, Seattle, WA; Robert B. Gerbing and Todd A. Alonzo, Children's Oncology Group, Arcadia; Todd A. Alonzo, Keck School of Medicine of University of Southern California, Los Angeles, CA; Susana C. Raimondi, St Jude Children's Research Hospital, Memphis, TN; Betsy Hirsch, University of Minnesota Cancer Center, Minneapolis, MN; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; and Alan S. Gamis, Children's Mercy Hospitals and Clinics, Kansas City, MO
| | - Richard Aplenc
- Jessica A. Pollard, Maine Medical Center, Portland, ME; and Tufts University, Boston, MA; Michael Loken, Hematologics; Irwin D. Bernstein and Soheil Meshinchi, Fred Hutchinson Cancer Research Center; Irwin D. Bernstein and Soheil Meshinchi, University of Washington, Seattle, WA; Robert B. Gerbing and Todd A. Alonzo, Children's Oncology Group, Arcadia; Todd A. Alonzo, Keck School of Medicine of University of Southern California, Los Angeles, CA; Susana C. Raimondi, St Jude Children's Research Hospital, Memphis, TN; Betsy Hirsch, University of Minnesota Cancer Center, Minneapolis, MN; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; and Alan S. Gamis, Children's Mercy Hospitals and Clinics, Kansas City, MO
| | - Irwin D Bernstein
- Jessica A. Pollard, Maine Medical Center, Portland, ME; and Tufts University, Boston, MA; Michael Loken, Hematologics; Irwin D. Bernstein and Soheil Meshinchi, Fred Hutchinson Cancer Research Center; Irwin D. Bernstein and Soheil Meshinchi, University of Washington, Seattle, WA; Robert B. Gerbing and Todd A. Alonzo, Children's Oncology Group, Arcadia; Todd A. Alonzo, Keck School of Medicine of University of Southern California, Los Angeles, CA; Susana C. Raimondi, St Jude Children's Research Hospital, Memphis, TN; Betsy Hirsch, University of Minnesota Cancer Center, Minneapolis, MN; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; and Alan S. Gamis, Children's Mercy Hospitals and Clinics, Kansas City, MO
| | - Alan S Gamis
- Jessica A. Pollard, Maine Medical Center, Portland, ME; and Tufts University, Boston, MA; Michael Loken, Hematologics; Irwin D. Bernstein and Soheil Meshinchi, Fred Hutchinson Cancer Research Center; Irwin D. Bernstein and Soheil Meshinchi, University of Washington, Seattle, WA; Robert B. Gerbing and Todd A. Alonzo, Children's Oncology Group, Arcadia; Todd A. Alonzo, Keck School of Medicine of University of Southern California, Los Angeles, CA; Susana C. Raimondi, St Jude Children's Research Hospital, Memphis, TN; Betsy Hirsch, University of Minnesota Cancer Center, Minneapolis, MN; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; and Alan S. Gamis, Children's Mercy Hospitals and Clinics, Kansas City, MO
| | - Todd A Alonzo
- Jessica A. Pollard, Maine Medical Center, Portland, ME; and Tufts University, Boston, MA; Michael Loken, Hematologics; Irwin D. Bernstein and Soheil Meshinchi, Fred Hutchinson Cancer Research Center; Irwin D. Bernstein and Soheil Meshinchi, University of Washington, Seattle, WA; Robert B. Gerbing and Todd A. Alonzo, Children's Oncology Group, Arcadia; Todd A. Alonzo, Keck School of Medicine of University of Southern California, Los Angeles, CA; Susana C. Raimondi, St Jude Children's Research Hospital, Memphis, TN; Betsy Hirsch, University of Minnesota Cancer Center, Minneapolis, MN; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; and Alan S. Gamis, Children's Mercy Hospitals and Clinics, Kansas City, MO
| | - Soheil Meshinchi
- Jessica A. Pollard, Maine Medical Center, Portland, ME; and Tufts University, Boston, MA; Michael Loken, Hematologics; Irwin D. Bernstein and Soheil Meshinchi, Fred Hutchinson Cancer Research Center; Irwin D. Bernstein and Soheil Meshinchi, University of Washington, Seattle, WA; Robert B. Gerbing and Todd A. Alonzo, Children's Oncology Group, Arcadia; Todd A. Alonzo, Keck School of Medicine of University of Southern California, Los Angeles, CA; Susana C. Raimondi, St Jude Children's Research Hospital, Memphis, TN; Betsy Hirsch, University of Minnesota Cancer Center, Minneapolis, MN; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; and Alan S. Gamis, Children's Mercy Hospitals and Clinics, Kansas City, MO
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Tarlock K, Alonzo TA, Gerbing RB, Raimondi SC, Hirsch BA, Sung L, Pollard JA, Aplenc R, Loken MR, Gamis AS, Meshinchi S. Gemtuzumab Ozogamicin Reduces Relapse Risk in FLT3/ITD Acute Myeloid Leukemia: A Report from the Children's Oncology Group. Clin Cancer Res 2015; 22:1951-7. [PMID: 26644412 DOI: 10.1158/1078-0432.ccr-15-1349] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 11/10/2015] [Indexed: 01/29/2023]
Abstract
PURPOSE Gemtuzumab ozogamicin (GO), a calicheamicin-conjugated mAb against CD33, has been used in the treatment of acute myeloid leukemia (AML). We evaluated the impact of the addition of GO to standard chemotherapy and hematopoietic stem cell transplant (HCT) in patients withFLT3/ITD. EXPERIMENTAL DESIGN We analyzed children withFLT3/ITD-positive AML (n= 183) treated on two consecutive Children's Oncology Group AML trials (NCT00070174andNCT00372593). Outcomes were assessed forFLT3/ITD patients receiving standard chemotherapy with or without GO (GO vs. No-GO, respectively), and the impact of consolidation HCT for high-riskFLT3/ITD patients [highFLT3/ITD allelic ratio (ITD-AR)]. RESULTS For allFLT3/ITD patients, complete remission (CR) rates for the GO versus No-GO cohorts were identical (64% vs. 64%;P= 0.98). Relapse rate (RR) after initial CR was 37% for GO recipients versus 59% for No-GO recipients (P= 0.02), disease-free survival (DFS) was similar (47% vs. 41%;P= 0.45), with higher treatment-related mortality (TRM) in GO recipients (16% vs. 0%;P= 0.008). Among high-riskFLT3/ITD patients with high ITD-AR, those who received HCT in first CR with prior exposure to GO had a significant reduction in RR (15% vs. 53%;P= 0.007), with a corresponding DFS of 65% versus 40% (P= 0.08), and higher TRM (19% vs. 7%;P= 0.08). CONCLUSIONS CD33 targeting with HCT consolidation may be an important therapeutic strategy in high-riskFLT3/ITD AML and its efficacy and associated toxicity warrant further investigation.
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Affiliation(s)
- Katherine Tarlock
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington.
| | - Todd A Alonzo
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Robert B Gerbing
- Department of Statistics, Children's Oncology Group, Monrovia, California
| | - Susana C Raimondi
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Betsy A Hirsch
- Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Lillian Sung
- Division of Haematology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jessica A Pollard
- Maine Children's Cancer Program, Maine Medical Center, Scarborough, Maine
| | - Richard Aplenc
- Pediatric Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Alan S Gamis
- Hematology/Oncology, Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | - Soheil Meshinchi
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
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48
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Laszlo GS, Alonzo TA, Gudgeon CJ, Harrington KH, Kentsis A, Gerbing RB, Wang YC, Ries RE, Raimondi SC, Hirsch BA, Gamis AS, Meshinchi S, Walter RB. High expression of myocyte enhancer factor 2C (MEF2C) is associated with adverse-risk features and poor outcome in pediatric acute myeloid leukemia: a report from the Children's Oncology Group. J Hematol Oncol 2015; 8:115. [PMID: 26487643 PMCID: PMC4618184 DOI: 10.1186/s13045-015-0215-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 10/13/2015] [Indexed: 11/10/2022] Open
Abstract
Background Recent studies have identified myocyte enhancer factor 2C (MEF2C) as cooperating oncogene in acute myeloid leukemia (AML) and suggested a contribution to the aggressive nature of at least some subtypes of AML, raising the possibility that MEF2C could serve as marker of poor-risk AML and, therefore, have prognostic significance. Methods To test this hypothesis, we retrospectively quantified MEF2C expression in pretreatment bone marrow specimens in participants of the AAML0531 trial by reverse-transcriptase polymerase chain reaction and correlated expression levels with disease characteristics and clinical outcome. Results In all 751 available patient specimens, MEF2C messenger RNA (mRNA) was detectable and varied >3000-fold relative to β-glucuronidase. Patients with the highest relative MEF2C expression (4th quartile) less likely achieved a complete remission after one course of chemotherapy than the other patients (67 vs. 78 %, P = 0.005). They also had an inferior overall survival (P = 0.014; at 5 years 55 ± 8 vs. 67 ± 4 %), inferior event-free survival (P < 0.001; at 5 years 38 ± 7 vs. 54 ± 4 %), and higher relapse risk than patients within the lower 3 quartiles of MEF2C expression (P < 0.001; at 5 years 53 ± 9 vs. 35 ± 5 %). These differences were accounted for by lower prevalence of cytogenetically/molecularly defined low-risk disease (16 vs. 46 %, P < 0.001) and higher prevalence of standard-risk disease (68 vs. 42 %, P < 0.001) in patients with high MEF2C expression, suggesting that MEF2C cooperates with additional pathogenic abnormalities. Conclusions High MEF2C expression identifies a subset of AML patients with adverse-risk disease features and poor outcome. With confirmation that high MEF2C mRNA expression leads to overexpression of MEF2C protein, these findings provide the rationale for therapeutic targeting of MEF2C transcriptional activation in AML.
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Affiliation(s)
- George S Laszlo
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, D2-190, Seattle, WA, 98109-1024, USA
| | - Todd A Alonzo
- Department of Biostatistics, University of Southern California, Los Angeles, CA, USA.,Children's Oncology Group, Monrovia, CA, USA
| | - Chelsea J Gudgeon
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, D2-190, Seattle, WA, 98109-1024, USA
| | - Kimberly H Harrington
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, D2-190, Seattle, WA, 98109-1024, USA
| | - Alex Kentsis
- Molecular Pharmacology and Chemistry Program, Sloan Kettering Institute, New York, NY, USA.,Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Medical College of Cornell University, New York, NY, USA
| | | | | | - Rhonda E Ries
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, D2-190, Seattle, WA, 98109-1024, USA
| | - Susana C Raimondi
- Children's Oncology Group, Monrovia, CA, USA.,Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Betsy A Hirsch
- Children's Oncology Group, Monrovia, CA, USA.,Department of Laboratory Medicine and Pathology, University of Minnesota Cancer Center, Minneapolis, MN, USA
| | - Alan S Gamis
- Children's Oncology Group, Monrovia, CA, USA.,Division of Hematology-Oncology, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA
| | - Soheil Meshinchi
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, D2-190, Seattle, WA, 98109-1024, USA.,Children's Oncology Group, Monrovia, CA, USA.,Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Roland B Walter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, D2-190, Seattle, WA, 98109-1024, USA. .,Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA. .,Department of Epidemiology, University of Washington, Seattle, WA, USA.
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49
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Stieglitz E, Taylor-Weiner AN, Chang TY, Gelston LC, Wang YD, Mazor T, Esquivel E, Yu A, Seepo S, Olsen S, Rosenberg M, Archambeault SL, Abusin G, Beckman K, Brown PA, Briones M, Carcamo B, Cooper T, Dahl GV, Emanuel PD, Fluchel MN, Goyal RK, Hayashi RJ, Hitzler J, Hugge C, Liu YL, Messinger YH, Mahoney DH, Monteleone P, Nemecek ER, Roehrs PA, Schore RJ, Stine KC, Takemoto CM, Toretsky JA, Costello JF, Olshen AB, Stewart C, Li Y, Ma J, Gerbing RB, Alonzo TA, Getz G, Gruber T, Golub T, Stegmaier K, Loh ML. The genomic landscape of juvenile myelomonocytic leukemia. Nat Genet 2015; 47:1326-1333. [PMID: 26457647 PMCID: PMC4626387 DOI: 10.1038/ng.3400] [Citation(s) in RCA: 194] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 08/17/2015] [Indexed: 12/16/2022]
Abstract
Juvenile myelomonocytic leukemia (JMML) is a myeloproliferative neoplasm (MPN) of childhood with a poor prognosis. Mutations in NF1, NRAS, KRAS, PTPN11 and CBL occur in 85% of patients, yet there are currently no risk stratification algorithms capable of predicting which patients will be refractory to conventional treatment and therefore be candidates for experimental therapies. In addition, there have been few other molecular pathways identified aside from the Ras/MAPK pathway to serve as the basis for such novel therapeutic strategies. We therefore sought to genomically characterize serial samples from patients at diagnosis through relapse and transformation to acute myeloid leukemia in order to expand our knowledge of the mutational spectrum in JMML. We identified recurrent mutations in genes involved in signal transduction, gene splicing, the polycomb repressive complex 2 (PRC2) and transcription. Importantly, the number of somatic alterations present at diagnosis appears to be the major determinant of outcome.
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Affiliation(s)
- Elliot Stieglitz
- Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA
| | | | - Tiffany Y Chang
- Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA
| | - Laura C Gelston
- Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA
| | - Yong-Dong Wang
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN
| | - Tali Mazor
- Department of Neurological Surgery, University of California, San Francisco, CA
| | - Emilio Esquivel
- Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA
| | - Ariel Yu
- Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA
| | - Sara Seepo
- Broad Institute of MIT and Harvard, Cambridge, MA
| | - Scott Olsen
- Hartwell Center for Bioinformatics and Biotechnology, St. Jude Children's Research Hospital, Memphis, TN
| | | | - Sophie L Archambeault
- Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA
| | - Ghada Abusin
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Kyle Beckman
- Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA
| | - Patrick A Brown
- Department of Pediatrics, The Johns Hopkins Hospital, Baltimore, MA
| | - Michael Briones
- Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorder Center, Atlanta, GA
| | | | - Todd Cooper
- Department of Pediatrics, Seattle Children's Hospital, Seattle, WA
| | - Gary V Dahl
- Department of Pediatrics, Stanford School of Medicine, Stanford, CA
| | - Peter D Emanuel
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Mark N Fluchel
- Department of Pediatric Hematology Oncology, University of Utah, Salt Lake City, UT
| | - Rakesh K Goyal
- Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA
| | - Robert J Hayashi
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - Johann Hitzler
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Christopher Hugge
- Pediatric Hematology Oncology, SSM Cardinal Glennon Children's Medical Center, Saint Louis, MO
| | - Y Lucy Liu
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Yoav H Messinger
- Division of Pediatric Hematology Oncology, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN
| | - Donald H Mahoney
- Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Philip Monteleone
- Pediatric Hematology Oncology, Pediatric Specialists of Lehigh Valley Hospital, Bethlehem, PA
| | - Eneida R Nemecek
- Pediatric Bone Marrow Transplant Program, Oregon Health & Science University, Portland, OR
| | - Philip A Roehrs
- Department of Pediatrics, University of North Carolina at Chapel Hill, NC
| | - Reuven J Schore
- Division of Pediatric Oncology, Children's National Medical Center, Washington, DC
| | - Kimo C Stine
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR
| | | | - Jeffrey A Toretsky
- Department of Pediatrics, Georgetown University, Washington, DC.,Department of Oncology, Georgetown University, Washington, DC
| | - Joseph F Costello
- Department of Neurological Surgery, University of California, San Francisco, CA
| | - Adam B Olshen
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA
| | - Chip Stewart
- Broad Institute of MIT and Harvard, Cambridge, MA
| | - Yongjin Li
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN
| | - Jing Ma
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
| | - Robert B Gerbing
- Department of Statistics, Children's Oncology Group, Monrovia, CA
| | - Todd A Alonzo
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Gad Getz
- Broad Institute of MIT and Harvard, Cambridge, MA.,Harvard Medical School, Boston, MA.,Department of Pathology and Cancer Center, Massachusetts General Hospital, Boston, MA
| | - Tanja Gruber
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Todd Golub
- Broad Institute of MIT and Harvard, Cambridge, MA.,Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA.,Division of Hematology/Oncology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Kimberly Stegmaier
- Broad Institute of MIT and Harvard, Cambridge, MA.,Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA.,Division of Hematology/Oncology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Mignon L Loh
- Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA.,Department of Pediatrics, Benioff Children's Hospital, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
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50
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Getz KD, Li Y, Alonzo TA, Hall M, Gerbing RB, Sung L, Huang YS, Arnold S, Seif AE, Miller TP, Bagatell R, Fisher BT, Adamson PC, Gamis A, Keren R, Aplenc R. Comparison of in-patient costs for children treated on the AAML0531 clinical trial: A report from the Children's Oncology Group. Pediatr Blood Cancer 2015; 62:1775-81. [PMID: 25946708 PMCID: PMC4546551 DOI: 10.1002/pbc.25569] [Citation(s) in RCA: 19] [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: 01/30/2015] [Accepted: 03/26/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND A better understanding of drivers of treatment costs may help identify effective cost containment strategies and prioritize resources. We aimed to develop a method for estimating inpatient costs for pediatric patients with acute myeloid leukemia (AML) enrolled on NCI-funded Phase III trials, compare costs between AAML0531 treatment arms (standard chemotherapy ± gemtuzumab ozogamicin (GMTZ)), and evaluate primary drivers of costs for newly diagnosed pediatric AML. PROCEDURE Patients from the AAML0531 trial were matched on hospital, sex, and dates of birth and diagnosis to the Pediatric Health Information Systems (PHIS) database to obtain daily billing data. Inpatient treatment costs were calculated as adjusted charges multiplied by hospital-specific cost-to-charge ratios. Generalized linear models were used to compare costs between treatment arms and courses, and by patient characteristics. RESULTS Inpatient costs did not differ by randomized treatment arm. Costs varied by course with stem cell transplant being most expensive, followed by Intensification II (cytarabine/mitoxantrone) and Induction I (cytarabine/daunorubicin/etoposide). Room/board and pharmacy were the largest contributors to inpatient treatment cost, representing 74% of the total cost. Higher AML risk group (P = 0.0003) and older age (P < 0.0001) were associated with significantly higher daily inpatient cost. CONCLUSIONS Costs from external data sources can be successfully integrated into NCI-funded Phase III clinical trials. Inpatient treatment costs did not differ by GMTZ exposure but varied by chemotherapy course. Variation in cost by course was driven by differences in duration of hospitalization through room/board charges as well as increased clinical and pharmacy charges in specific courses.
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Affiliation(s)
- Kelly D. Getz
- The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Correspondence to: Kelly Getz, Division of Oncology, The Children’s Hospital of Philadelphia, 3535 Market Street, Room 1507, Philadelphia, PA 19104.
| | - Yimei Li
- The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Todd A. Alonzo
- University of Southern California, Los Angeles, California
| | - Matthew Hall
- Children’s Hospital Association, Overland Park, Kansas
| | | | | | - Yuan-Shung Huang
- The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Staci Arnold
- Columbia University Medical Center, New York, New York
| | - Alix E. Seif
- The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Tamara P. Miller
- The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Brian T. Fisher
- The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Peter C. Adamson
- The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Alan Gamis
- Children’s Mercy Hospitals and Clinics, Kansas City, Missouri
| | - Ron Keren
- The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Richard Aplenc
- The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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