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Yang LH, Su P, Luedke C, Lu CM, Louissaint A, McCall CM, Rapisardo S, Vallangeon B, Wang E. Chronic Myeloid Leukemia Following Treatment for Primary Neoplasms or Other Medical Conditions. Am J Clin Pathol 2018; 150:246-258. [PMID: 29992292 DOI: 10.1093/ajcp/aqy050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Therapy-related chronic myeloid leukemia (CML) has been reported, but its clinical presentation and pathologic features have not yet been well characterized. METHODS Twenty-one cases of CML following treatment for primary diseases were collected and retrospectively analyzed. RESULTS The clinical presentation, pathologic features, and cytogenetic profile were similar to de novo CML. In particular, those with an isolated Philadelphia chromosome constituted 88.9% of our cases, and additional aberrations characteristic of therapy-related acute myeloid leukemia/myelodysplastic syndrome (AML/MDS) were not identified in this study. The patients responded to imatinib/derivatives and survived with limited follow-up. CONCLUSIONS Therapy-related CML has a clinical presentation, pathologic features, and cytogenetic profile akin to de novo CML. Absence of additional significant aberrations seems to suggest a pathogenesis different from therapy-related AML/MDS. Therapy-related CML exhibits a robust therapeutic response to imatinib/derivatives and favorable clinical outcomes similar to de novo CML.
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Affiliation(s)
- Lian-He Yang
- Department of Pathology, First Affiliated Hospital and College of Basic Sciences of China Medical University, Shenyang, China
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Pu Su
- Department of Pathology, Duke University Medical Center, Durham, NC
- Department of Medicine, East Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - Catherine Luedke
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Chuanyi Mark Lu
- Department of Laboratory Medicine, University of California San Francisco
| | - Abner Louissaint
- Department of Pathology and Laboratory Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Chad M McCall
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Sarah Rapisardo
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Bethany Vallangeon
- Department of Pathology, East Carolina University Medical Center, Greenville, NC
| | - Endi Wang
- Department of Pathology, Duke University Medical Center, Durham, NC
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Lichtman SM, Harvey RD, Damiette Smit MA, Rahman A, Thompson MA, Roach N, Schenkel C, Bruinooge SS, Cortazar P, Walker D, Fehrenbacher L. Modernizing Clinical Trial Eligibility Criteria: Recommendations of the American Society of Clinical Oncology–Friends of Cancer Research Organ Dysfunction, Prior or Concurrent Malignancy, and Comorbidities Working Group. J Clin Oncol 2017; 35:3753-3759. [DOI: 10.1200/jco.2017.74.4102] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Patients with organ dysfunction, prior or concurrent malignancies, and comorbidities are often excluded from clinical trials. Excluding patients on the basis of these factors results in clinical trial participants who are healthier and younger than the overall population of patients with cancer. Methods ASCO and Friends of Cancer Research established a multidisciplinary working group that included experts in trial design and conduct to examine how eligibility criteria could be more inclusive. The group analyzed current eligibility criteria; conducted original data analysis; considered safety concerns, potential benefits, research, and potential hurdles of this approach through discussion; and reached consensus on recommendations regarding updated eligibility criteria that prioritize inclusiveness without compromising patient safety. Results If renal toxicity and clearance are not of direct treatment-related concern, then patients with lower creatinine clearance values of > 30 mL/min should be included in trials. Inclusion of patients with mild to moderate hepatic dysfunction may be possible when the totality of the available nonclinical and clinical data indicates that inclusion is safe. Ejection fraction values should be used with investigator assessment of a patient’s risk for heart failure to determine eligibility. Patients with laboratory parameters out of normal range as a result of hematologic disease should be included in trials. Measures of patient functional status should be included in trials to better assess fit versus frail patients. Conclusion Expanding inclusion of these patients will increase the number and diversity of patients in clinical trials and result in a more appropriate population of patients.
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Affiliation(s)
- Stuart M. Lichtman
- Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, Commack, NY; R. Donald Harvey, Emory University School of Medicine, Atlanta, GA; Marie-Anne Damiette Smit and Atiqur Rahman, US Food and Drug Administration, Silver Spring, MD; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Caroline Schenkel and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Patricia Cortazar, Genentech, South San Francisco; Louis
| | - R. Donald Harvey
- Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, Commack, NY; R. Donald Harvey, Emory University School of Medicine, Atlanta, GA; Marie-Anne Damiette Smit and Atiqur Rahman, US Food and Drug Administration, Silver Spring, MD; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Caroline Schenkel and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Patricia Cortazar, Genentech, South San Francisco; Louis
| | - Marie-Anne Damiette Smit
- Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, Commack, NY; R. Donald Harvey, Emory University School of Medicine, Atlanta, GA; Marie-Anne Damiette Smit and Atiqur Rahman, US Food and Drug Administration, Silver Spring, MD; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Caroline Schenkel and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Patricia Cortazar, Genentech, South San Francisco; Louis
| | - Atiqur Rahman
- Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, Commack, NY; R. Donald Harvey, Emory University School of Medicine, Atlanta, GA; Marie-Anne Damiette Smit and Atiqur Rahman, US Food and Drug Administration, Silver Spring, MD; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Caroline Schenkel and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Patricia Cortazar, Genentech, South San Francisco; Louis
| | - Michael A. Thompson
- Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, Commack, NY; R. Donald Harvey, Emory University School of Medicine, Atlanta, GA; Marie-Anne Damiette Smit and Atiqur Rahman, US Food and Drug Administration, Silver Spring, MD; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Caroline Schenkel and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Patricia Cortazar, Genentech, South San Francisco; Louis
| | - Nancy Roach
- Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, Commack, NY; R. Donald Harvey, Emory University School of Medicine, Atlanta, GA; Marie-Anne Damiette Smit and Atiqur Rahman, US Food and Drug Administration, Silver Spring, MD; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Caroline Schenkel and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Patricia Cortazar, Genentech, South San Francisco; Louis
| | - Caroline Schenkel
- Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, Commack, NY; R. Donald Harvey, Emory University School of Medicine, Atlanta, GA; Marie-Anne Damiette Smit and Atiqur Rahman, US Food and Drug Administration, Silver Spring, MD; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Caroline Schenkel and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Patricia Cortazar, Genentech, South San Francisco; Louis
| | - Suanna S. Bruinooge
- Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, Commack, NY; R. Donald Harvey, Emory University School of Medicine, Atlanta, GA; Marie-Anne Damiette Smit and Atiqur Rahman, US Food and Drug Administration, Silver Spring, MD; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Caroline Schenkel and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Patricia Cortazar, Genentech, South San Francisco; Louis
| | - Patricia Cortazar
- Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, Commack, NY; R. Donald Harvey, Emory University School of Medicine, Atlanta, GA; Marie-Anne Damiette Smit and Atiqur Rahman, US Food and Drug Administration, Silver Spring, MD; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Caroline Schenkel and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Patricia Cortazar, Genentech, South San Francisco; Louis
| | - Dana Walker
- Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, Commack, NY; R. Donald Harvey, Emory University School of Medicine, Atlanta, GA; Marie-Anne Damiette Smit and Atiqur Rahman, US Food and Drug Administration, Silver Spring, MD; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Caroline Schenkel and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Patricia Cortazar, Genentech, South San Francisco; Louis
| | - Louis Fehrenbacher
- Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, Commack, NY; R. Donald Harvey, Emory University School of Medicine, Atlanta, GA; Marie-Anne Damiette Smit and Atiqur Rahman, US Food and Drug Administration, Silver Spring, MD; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; Nancy Roach, Fight Colorectal Cancer, Springfield, MO; Caroline Schenkel and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Patricia Cortazar, Genentech, South San Francisco; Louis
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