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Roy Moulik N, Keerthivasagam S, Pandey A, Agiwale J, Hegde K, Chatterjee G, Dhamne C, Prasad M, Chichra A, Srinivasan S, Mohanty P, Jain H, Shetty D, Tembhare P, Patkar N, Narula G, Subramanian PG, Banavali S. Treatment and follow-up of children with chronic myeloid leukaemia in chronic phase (CML-CP) in the tyrosine kinase inhibitor (TKI) era-Two decades of experience from the Tata Memorial Hospital paediatric CML (pCML) cohort. Br J Haematol 2024; 204:1249-1261. [PMID: 38098201 DOI: 10.1111/bjh.19251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/04/2023] [Accepted: 11/28/2023] [Indexed: 04/11/2024]
Abstract
Tyrosine kinase inhibitors (TKIs) have drastically improved the outcomes of pCML (paediatric CML) but data on long-term off-target toxicities of TKIs in children are scarce. In this single-centre, retrospective cum prospective study of pCML in chronic phase, we report our experience of treating 173 children with imatinib and following them for long-term toxicities. Mean (SD) time to attain CHR, CCyR and MMR were 3.05 (2.1), 10.6 (8.4) and 43.4 (31.8) months respectively. DMR was not attained in 59 (34%) patients at last follow-up. Ten patients were switched to second-generation TKIs (2G-TKIs; nilotinib = 1/dasatinib = 9) due to poor/loss in response, of which seven had kinase domain mutations. Three patients progressed to the blastic phase. At a median follow-up of 84 (3-261) months, the 5-year EFS and OS for the entire cohort were 96.9% (95% CI: 93.4-100) and 98.7% (95% CI: 96.9-100) respectively. Screening for long-term toxicities revealed low bone density and hypovitaminosis D in 70% and 80% respectively. Other late effects included short stature (27%), delayed puberty (15%), poor sperm quality (43%) and miscellaneous endocrinopathies (8%). Children younger than 5 years at diagnosis were more susceptible to growth and endocrine toxicities (p = 0.009). Regular monitoring for long-term toxicities, timely intervention and trial of discontinuation whenever feasible are likely to improve the long-term outlook of pCML.
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Affiliation(s)
- Nirmalya Roy Moulik
- Pediatric Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | | | - Ankita Pandey
- Pediatric Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Jayesh Agiwale
- Pediatric Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Kriti Hegde
- Pediatric Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Gaurav Chatterjee
- Homi Bhabha National Institute, Mumbai, India
- Hematopathology, Tata Memorial Hospital, Mumbai, India
| | - Chetan Dhamne
- Pediatric Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Maya Prasad
- Pediatric Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Akanksha Chichra
- Pediatric Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Shyam Srinivasan
- Pediatric Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Purvi Mohanty
- Homi Bhabha National Institute, Mumbai, India
- Cancer Cytogenetics, Tata Memorial Hospital, Mumbai, India
| | - Hemani Jain
- Homi Bhabha National Institute, Mumbai, India
- Cancer Cytogenetics, Tata Memorial Hospital, Mumbai, India
| | - Dhanlaxmi Shetty
- Homi Bhabha National Institute, Mumbai, India
- Cancer Cytogenetics, Tata Memorial Hospital, Mumbai, India
| | - Prashant Tembhare
- Homi Bhabha National Institute, Mumbai, India
- Hematopathology, Tata Memorial Hospital, Mumbai, India
| | - Nikhil Patkar
- Homi Bhabha National Institute, Mumbai, India
- Hematopathology, Tata Memorial Hospital, Mumbai, India
| | - Gaurav Narula
- Pediatric Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Papagudi G Subramanian
- Homi Bhabha National Institute, Mumbai, India
- Hematopathology, Tata Memorial Hospital, Mumbai, India
| | - Shripad Banavali
- Pediatric Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
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Jackmann N, Gustafsson J, Utriainen P, Magnusson P, Harila A, Atanasova D, Rinaldo C, Frisk P, Mäkitie O. Demographic and disease-related factors impact bone turnover and vitamin D in children with hemato-oncological diseases. JBMR Plus 2024; 8:ziae017. [PMID: 38523666 PMCID: PMC10961176 DOI: 10.1093/jbmrpl/ziae017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
Children with hemato-oncological diseases may have significant skeletal morbidity, not only during and after treatment but also at the time of diagnosis before cancer treatment. This study was designed to evaluate the vitamin D status and circulating bone metabolic markers and their determinants in children at the time of diagnostic evaluation for hemato-oncological disease. This cross-sectional study included 165 children (91 males, median age 6.9 yr range 0.2-17.7 yr). Of them, 76 patients were diagnosed with extracranial or intracranial solid tumors, 83 with leukemia, and 6 with bone marrow failure. Bone metabolism was assessed by measuring serum 25OHD, PTH, bone alkaline phosphatase, intact N-terminal propeptide of type I procollagen, and C-terminal cross-linked telopeptide of type I collagen. Vitamin D deficiency was found in 30.9% of children. Lower 25OHD levels were associated with older age, lack of vitamin D supplementation, season outside summer, and a country of parental origin located between latitudes -45° and 45°. Children diagnosed with leukemia had lower levels of markers of bone formation and bone resorption than those who had solid tumors or bone marrow failure. In conclusion, vitamin D deficiency was observed in one-third of children with newly diagnosed cancer. Bone turnover markers were decreased in children with leukemia, possibly because of the suppression of osteoblasts and osteoclasts by leukemic cells. The identification of patients with suboptimal vitamin D status and compromised bone remodeling at cancer diagnosis may aid in the development of supportive treatment to reduce the adverse effects of cancer and its treatment.
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Affiliation(s)
- Natalja Jackmann
- Department of Women’s and Children’s Health, Uppsala University and University Children’s Hospital, Uppsala 75185, Sweden
| | - Jan Gustafsson
- Department of Women’s and Children’s Health, Uppsala University and University Children’s Hospital, Uppsala 75185, Sweden
| | - Pauliina Utriainen
- Children’s Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki 00014, Finland
| | - Per Magnusson
- Department of Clinical Chemistry, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping 58183, Sweden
| | - Arja Harila
- Department of Women’s and Children’s Health, Uppsala University and University Children’s Hospital, Uppsala 75185, Sweden
| | - Diana Atanasova
- Department of Clinical Chemistry, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping 58183, Sweden
| | - Carina Rinaldo
- Department of Women's and Children's Health, Karolinska Institute, Stockholm 17177, Sweden
| | - Per Frisk
- Department of Women’s and Children’s Health, Uppsala University and University Children’s Hospital, Uppsala 75185, Sweden
| | - Outi Mäkitie
- Children’s Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki 00014, Finland
- Department of Molecular Medicine and Surgery, Karolinska Institute, and Clinical Genetics, Karolinska University Hospital, Stockholm 17177, Sweden
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Brivio E, Pennesi E, Willemse ME, Huitema AD, Jiang Y, van Tinteren HD, van der Velden VH, Beverloo BH, den Boer ML, Rammeloo LA, Hudson C, Heerema N, Kowalski K, Zhao H, Kuttschreuter L, Bautista Sirvent FJ, Bukowinski A, Rizzari C, Pollard J, Murillo-Sanjuán L, Kutny M, Zarnegar-Lumley S, Redell M, Cooper S, Bertrand Y, Petit A, Krystal J, Metzler M, Lancaster D, Bourquin JP, Motwani J, van der Sluis IM, Locatelli F, Roth ME, Hijiya N, Zwaan CM. Bosutinib in Resistant and Intolerant Pediatric Patients With Chronic Phase Chronic Myeloid Leukemia: Results From the Phase I Part of Study ITCC054/COG AAML1921. J Clin Oncol 2024; 42:821-831. [PMID: 38033284 PMCID: PMC10906575 DOI: 10.1200/jco.23.00897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/29/2023] [Accepted: 10/02/2023] [Indexed: 12/02/2023] Open
Abstract
PURPOSE Bosutinib is approved for adults with chronic myeloid leukemia (CML): 400 mg once daily in newly diagnosed (ND); 500 mg once daily in resistant/intolerant (R/I) patients. Bosutinib has a different tolerability profile than other tyrosine kinase inhibitors (TKIs) and potentially less impact on growth (preclinical data). The primary objective of this first-in-child trial was to determine the recommended phase II dose (RP2D) for pediatric R/I and ND patients. PATIENTS AND METHODS In the phase I part of this international, open-label trial (ClinicalTrials.gov identifier: NCT04258943), children age 1-18 years with R/I (per European LeukemiaNet 2013) Ph+ CML were enrolled using a 6 + 4 design, testing 300, 350, and 400 mg/m2 once daily with food. The RP2D was the dose resulting in 0/6 or 1/10 dose-limiting toxicities (DLTs) during the first cycle and achieving adult target AUC levels for the respective indication. As ND participants were only enrolled in phase II, the ND RP2D was selected based on data from R/I patients. RESULTS Thirty patients were enrolled; 27 were evaluable for DLT: six at 300 mg/m2, 11 at 350 mg/m2 (one DLT), and 10 at 400 mg/m2 (one DLT). The mean AUCs at 300 mg/m2, 350 mg/m2, and 400 mg/m2 were 2.20 μg h/mL, 2.52 μg h/mL, and 2.66 μg h/mL, respectively. The most common adverse event was diarrhea (93%; ≥grade 3: 11%). Seven patients stopped because of intolerance and eight because of insufficient response. Complete cytogenetic and major molecular response to bosutinib appeared comparable with other published phase I/II trials with second-generation TKIs in children. CONCLUSION Bosutinib was safe and effective. The pediatric RP2D was 400 mg/m2 once daily (max 600 mg/d) with food in R/I patients and 300 mg/m2 once daily (max 500 mg/d) with food in ND patients, which achieved targeted exposures as per adult experience.
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Affiliation(s)
- Erica Brivio
- Department of Pediatric Oncology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Edoardo Pennesi
- Department of Pediatric Oncology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Marieke E. Willemse
- Department of Pediatric Oncology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Alwin D.R. Huitema
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- The Netherlands Cancer Institute, Amsterdam, the Netherlands
- University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Yilin Jiang
- Department of Pediatric Oncology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | | | - Berna H. Beverloo
- Department of Clinical Genetics, Erasmus MC, Rotterdam, the Netherlands
| | - Monique L. den Boer
- Department of Pediatric Oncology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Lukas A.J. Rammeloo
- Department of Pediatric Cardiology, Amsterdam UMC, Emma Children's Hospital, Amsterdam, the Netherlands
| | | | | | | | | | | | - Francisco J. Bautista Sirvent
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Pediatric Oncology and Hematology Department, Hospital Niño Jesús, Madrid, Spain
| | - Andrew Bukowinski
- Pediatric Hematology and Oncology Alabama, University of Alabama at Birmingham, Birmingham, AL
| | - Carmelo Rizzari
- Department of Pediatrics, University of Milano-Bicocca, IRCCS San Gerardo dei Tintori, Monza, Italy
| | | | | | | | | | - Michele Redell
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX
| | - Stacy Cooper
- Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD
| | | | | | - Julie Krystal
- The Steven and Alexandra Cohen Children's Medical Center of New York, New York, NY
| | | | - Donna Lancaster
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | | | - Inge M. van der Sluis
- Department of Pediatric Oncology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Franco Locatelli
- IRCCS Ospedale Pediatrico Bambino Gesù, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Nobuko Hijiya
- Columbia University Irving Medical Center, New York, NY
| | - Christian M. Zwaan
- Department of Pediatric Oncology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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Hijiya N, Maschan A, Rizzari C, Shimada H, Dufour C, Goto H, Kang HJ, Guinipero T, Karakas Z, Bautista F, Ducassou S, Yoo KH, Zwaan CM, Millot F, Patterson BC, Samis J, Izquierdo M, Titorenko K, Li S, Sosothikul D. The long-term efficacy and safety of nilotinib in pediatric patients with CML: a 5-year update of the DIALOG study. Blood Adv 2023; 7:7279-7289. [PMID: 37738125 PMCID: PMC10711170 DOI: 10.1182/bloodadvances.2023010122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/31/2023] [Accepted: 09/07/2023] [Indexed: 09/24/2023] Open
Abstract
The efficacy and safety of nilotinib in pediatric patients with imatinib/dasatinib resistant/intolerant (R/I) or newly diagnosed (ND) Philadelphia chromosome-positive (Ph+) chronic myeloid leukemia in chronic phase (CML-CP) was demonstrated in the phase 2, open-label DIALOG study. In this final analysis, long-term efficacy and safety are presented for patients who completed 66 cycles (of 28 days) of treatment with nilotinib (230 mg/m2 twice daily) or discontinued early. Overall, 59 patients were enrolled and 58 were treated (R/I, n = 33; ND, n = 25; median time on treatment: 60.5 and 51.9 months, respectively). In the R/I cohort, the cumulative major molecular response (MMR; BCR::ABL1 international scale [IS] ≤ 0.1%) rate was 60.6%, and no patients had a confirmed loss of MMR. Among ND patients, the best overall MMR rate was 76.0%; 3 patients had a confirmed loss of MMR. The cumulative molecular response MR4 (BCR::ABL1IS ≤ 0.01%) and MR4.5 (BCR::ABL1IS ≤ 0.0032%) rates by 66 cycles were 27.3% and 12.1% in the R/I cohort, and 56.0% and 44.0% in the ND cohort, respectively. The safety profile of nilotinib was consistent with those of earlier reports. No on-treatment deaths occurred. These long-term (up to ∼5 years) data support the efficacy and safety of nilotinib in pediatric patients with Ph+ CML-CP. This trial was registered at www.clinicaltrials.gov.uk as #NCT01844765.
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Affiliation(s)
- Nobuko Hijiya
- Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, Columbia University Irving Medical Center, New York, NY
| | - Alexey Maschan
- Dmitrii Rogachev Federal Research Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Carmelo Rizzari
- Pediatria, Fondazione IRCSS San Gerardo dei Tintori, Universitá di Milano-Bicocca, Monza, Italy
| | - Hiroyuki Shimada
- Department of Pediatrics, Keio University School of Medicine, Shinjuku-ku, Japan
| | - Carlo Dufour
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genova, Italy
| | - Hiroaki Goto
- Division of Hematology/Oncology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Hyoung Jin Kang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
- Seoul National University Cancer Research Institute, Seoul, South Korea
- Seoul National University Children's Hospital, Seoul, South Korea
- Wide River Institute of Immunology, Hongcheon-gun, South Korea
| | - Terri Guinipero
- Nationwide Children's Hospital, The Ohio State University, Columbus, OH
| | - Zeynep Karakas
- Pediatric Hematology/Oncology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Francisco Bautista
- Department of Pediatric Oncology, Hematology and Stem Cell Transplantation, Hospital Niño Jesús, Madrid, Spain
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Keon Hee Yoo
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Christian Michel Zwaan
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Frédéric Millot
- Unité d'Onco-Hématologie Pédiatrique, Centre d'Investigation Clinique (CIC) 1402 INSERM, Centre Hospitalier Universitaire (CHU) de Poitiers, Poitiers, France
| | - Briana C. Patterson
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA
| | - Jill Samis
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | | | | | - Sai Li
- Novartis Pharma AG, Basel, Switzerland
| | - Darintr Sosothikul
- Intergrative and Innovative Hematology/Oncology Research Unit, Division of Hematology/Oncology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Volz C, Zerjatke T, Gottschalk A, Semper S, Suttorp M, Glauche I, Krumbholz M, Metzler M. Continuous therapy response references for BCR::ABL1 monitoring in pediatric chronic myeloid leukemia. Sci Rep 2023; 13:18199. [PMID: 37875583 PMCID: PMC10598002 DOI: 10.1038/s41598-023-45364-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/18/2023] [Indexed: 10/26/2023] Open
Abstract
Response to tyrosine kinase inhibitor (TKI) therapy in patients with chronic myeloid leukemia (CML) is monitored by quantification of BCR::ABL1 transcript levels. Milestones for assessing optimal treatment response have been defined in adult CML patients and are applied to children and adolescents although it is questionable whether transferability to pediatric patients is appropriate regarding genetic and clinical differences. Therefore, we analyzed the molecular response kinetics to TKI therapy in 129 pediatric CML patients and investigated whether response assessment based on continuous references can support an early individual therapy adjustment. We applied a moving quantiles approach to establish a high-resolution response target curve and contrasted the median responses in all patients with the median of the ideal target curve obtained from a subgroup of optimal responders. The high-resolution response target curve of the optimal responder group presents a valuable tool for continuous therapy monitoring of individual pediatric CML patients in addition to the fixed milestones. By further comparing BCR::ABL1 transcript levels with BCR::ABL1 fusion gene copy numbers, it is also possible to model the differential dynamics of BCR::ABL1 expression and cell number under therapy. The developed methodology can be transferred to other biomarkers for continuous therapy monitoring.
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Affiliation(s)
- Christian Volz
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Erlangen, Germany
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Thomas Zerjatke
- Faculty of Medicine Carl Gustav Carus, Institute for Medical Informatics and Biometry, Technische Universität Dresden, Dresden, Germany
| | - Andrea Gottschalk
- Faculty of Medicine Carl Gustav Carus, Institute for Medical Informatics and Biometry, Technische Universität Dresden, Dresden, Germany
| | - Sabine Semper
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Meinolf Suttorp
- Pediatric Hemato-Oncology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Ingmar Glauche
- Faculty of Medicine Carl Gustav Carus, Institute for Medical Informatics and Biometry, Technische Universität Dresden, Dresden, Germany
| | - Manuela Krumbholz
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Erlangen, Germany.
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany.
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany.
| | - Markus Metzler
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany
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6
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Cai J, Liu H, Chen Y, Yu J, Gao J, Jiang H, Zhai X, Ju X, Wu X, Wang N, Tian X, Liang C, Fang Y, Zhou F, Li H, Sun L, Yang L, Guo J, Liu A, Li CK, Zhu Y, Tang J, Yang JJ, Shen S, Cheng C, Pui CH. Effect of the tyrosine kinase inhibitors on the growth in children with Philadelphia chromosome-positive acute lymphoblastic leukemia: a case-control study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 38:100818. [PMID: 37790080 PMCID: PMC10544282 DOI: 10.1016/j.lanwpc.2023.100818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/10/2023] [Accepted: 05/24/2023] [Indexed: 10/05/2023]
Abstract
Background First-generation ABL-targeted tyrosine kinase inhibitor (TKI) imatinib is known to retard growth in children but it is not known if the second-generation ABL-targeted TKI dasatinib has the same effect. We aimed to determine the impact of the first- or second-generation TKI on the growth of children treated for Philadelphia chromosome-positive (Ph+) childhood acute lymphoblastic leukemia (ALL). Methods We evaluated the longitudinal growth changes in 140 children with Ph+ ALL treated with imatinib or dasatinib in additional to intensive cytotoxic chemotherapy and 280 matched controls treated with the same intensity of cytotoxic chemotherapy without TKI on Chinese Children's Cancer Group ALL-2015 protocol between 2015 and 2019. We retrospectively reviewed the height data obtained during routine clinic visits at 4 time points: at diagnosis, the end of therapy, 1 year and 2 years off therapy. Height z Scores were derived with the aid of WHO Anthro version 3.2.2 and WHO AnthroPlus version 1.0.4, global growth monitoring tool. Findings This study consisted only patients who have completed all treatment in continuous complete remission without major events, including 33 patients randomized to receive imatinib, 43 randomized to receive dasatinib, and 64 assigned to receive dasatinib. Similar degree of loss of height z scores from diagnosis to the end of therapy was observed for the 33 imatinib- and the 107 dasatinib-treated patients (median △ = -0.84 vs. -0.88, P = 0.41). Adjusting for height z score at diagnosis, puberty status, and sex, there was no significant difference in the longitudinal mean height z scores between patients treated with imatinib and those with dasatinib (0.08, 95% CI, -0.22 to 0.38, P = 0.60). The degree of loss of height z scores from diagnosis to end of therapy was significantly greater in the 140 TKI-treated patients than the 280 controls (median △ = -0.88 vs. -0.18, P < 0.001). The longitudinal mean height z scores in the TKI-treated patients were significantly lower than those of the controls (-0.84, 95% CI, -0.98 to -0.69; P < 0.001). Interpretation These data suggest that dasatinib and imatinib have the similar adverse impact on the growth of children with Ph+ ALL. Funding This study was supported by the National Natural Science Foundation of China (grant 81670136 [JCai and JT]), the fourth round of Three-Year Public Health Action Plan (2015-2017; GWIV-25 [SS]), Shanghai Health Commission Clinical Research Project (202140161 [JCai]), the US National Cancer institute (CA21765 [C-H Pui]), and the American Lebanese Syrian Associated Charities (CC, JJY, and C-HP). The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the US National Institutes of Health.
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Affiliation(s)
- Jiaoyang Cai
- Department of Hematology/Oncology, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Key Laboratory of Pediatric Hematology & Oncology of China Ministry of Health, and National Children’s Medical Center, Shanghai, China
| | - Hu Liu
- Department of Hematology/Oncology, Children's Hospital of Soochow University, Suzhou, China
| | - Yumei Chen
- Department of Pediatrics, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Jie Yu
- Department of Hematology/Oncology, Chongqing Medical University Affiliated Children's Hospital, Chongqing, China
| | - Ju Gao
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Disease of Women and Children, Ministry of Education, Chengdu, China
| | - Hua Jiang
- Department of Hematology/Oncology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Xiaowen Zhai
- Department of Hematology/Oncology, Children's Hospital of Fudan University, Shanghai, China
| | - Xiuli Ju
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, China
| | - Xuedong Wu
- Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ningling Wang
- Department of Pediatrics, Anhui Medical University Second Affiliated Hospital, Anhui, China
| | - Xin Tian
- Department of Hematology/Oncology, KunMing Children’s Hospital, Kunming, China
| | - Changda Liang
- Department of Hematology/Oncology, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Yongjun Fang
- Department of Hematology/Oncology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Fen Zhou
- Department of Pediatrics, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hong Li
- Department of Hematology/Oncology, Shanghai Children's Hospital, Shanghai, China
| | - Lirong Sun
- Department of Pediatrics, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Liangchun Yang
- Department of Pediatrics, Xiangya Hospital Central South University, Changsha, China
| | - Jing Guo
- Department of Hematology/Oncology, Xi 'an Northwest Women's and Children's Hospital, Xi 'an, China
| | - Aiguo Liu
- Department of Pediatrics, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chi-kong Li
- Department of Pediatrics, Hong Kong Children’s Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yiping Zhu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Disease of Women and Children, Ministry of Education, Chengdu, China
| | - Jingyan Tang
- Department of Hematology/Oncology, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Key Laboratory of Pediatric Hematology & Oncology of China Ministry of Health, and National Children’s Medical Center, Shanghai, China
| | - Jun J. Yang
- Departments of Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Shuhong Shen
- Department of Hematology/Oncology, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Key Laboratory of Pediatric Hematology & Oncology of China Ministry of Health, and National Children’s Medical Center, Shanghai, China
| | - Cheng Cheng
- Departments of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Ching-Hon Pui
- Departments of Oncology, Pathology, and Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, USA
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7
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Gupta P, Banothu KK, Haldar P, Gupta AK, Meena JP. Effect of Imatinib Mesylate on Growth in Pediatric Chronic Myeloid Leukemia: A Systematic Review and Meta-analysis. J Pediatr Hematol Oncol 2023; 45:227-234. [PMID: 37027248 DOI: 10.1097/mph.0000000000002660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/13/2023] [Indexed: 04/08/2023]
Abstract
The outcomes of pediatric chronic myeloid leukemia (CML) have improved with the use of imatinib mesylate (IM). Multiple reports of growth deceleration with IM have raised concerns, necessitating careful monitoring and evaluation in children with CML. We systematically searched the databases of PubMed, EMBASE, Scopus, CENTRAL, and conferences-abstracts, reporting the effect of IM on growth among children with CML, and published in the English language from inception till March 2022. For observational studies, the modified Newcastle Ottawa Scale was used to assess the risk of bias. Pooled estimates were derived using a random-effects meta-analysis, and heterogeneity was assessed using Cochrane Q statistic test of heterogeneity and I2 statistic. Of the 757 studies identified through electronic search, 15 (n=265) were included in the final analysis. Six studies (n=178) were included in the meta-analysis of the primary outcome. There was a significant deleterious effect of IM on height-standardized mean difference (SMD): -0.52 (95% CI: -0.76; -0.28) ( I2 =13%). The adverse effect of IM on height was significant among studies with a follow-up period <3 years [SMD: -0.66 (95% CI: -0.93, -0.40), I2 =0%, P =0.59] but not in studies with follow-up period ≥3 years [SMD: -0.26 (95% CI: -0.63, 0.11), I2 =0, P =0.44], indicating that the effect of IM on height is a short-term effect. The effect of IM on height was not dependent upon pubertal status at the initiation of therapy. Prospective studies with adequate sample size are required to confirm the findings of the effect of IM on height in children with CML.
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Affiliation(s)
- Priyanka Gupta
- Department of Pediatrics, ESIC Medical College and hospital, Sanathnagar
| | | | - Partha Haldar
- Center for Community Medicine, All India Institute of Medical Sciences
| | - Aditya Kumar Gupta
- Division of Pediatric Oncology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Jagdish Prasad Meena
- Division of Pediatric Oncology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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8
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Testi AM, Moleti ML, Angi A, Bianchi S, Barberi W, Capria S. Pediatric Autologous Hematopoietic Stem Cell Transplantation: Safety, Efficacy, and Patient Outcomes. Literature Review. Pediatric Health Med Ther 2023; 14:197-215. [PMID: 37284518 PMCID: PMC10239625 DOI: 10.2147/phmt.s366636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/12/2023] [Indexed: 06/08/2023] Open
Abstract
Autologous stem cell transplantation (auto-HSCT) is a part of the therapeutic strategy for various oncohematological diseases. The auto-HSCT procedure enables hematological recovery after high-dose chemotherapy, otherwise not tolerable, by the infusion of autologous hematopoietic stem cells. Unlike allogeneic transplant (allo-HSCT), auto-HSCT has the advantage of lacking acute-graft-versus-host disease (GVHD) and prolonged immunosuppression, however, these advantages are counterbalanced by the absence of graft-versus-leukemia. Moreover, in hematological malignancies, the autologous hematopoietic stem cell source may be contaminated by neoplastic cells, leading to disease reappearance. In recent years, allogeneic transplant-related mortality (TRM) has progressively decreased, almost approaching auto-TRM, and many alternative donor sources are available for the majority of patients eligible for transplant procedures. In adults, the role of auto-HSCT compared to conventional chemotherapy (CT) in hematological malignancies has been well defined in many extended randomized trials; however, such trials are lacking in pediatric cohorts. Therefore, the role of auto-HSCT in pediatric oncohematology is limited, in both first- and second-line therapies and still remains to be defined. Nowadays, the accurate stratification in risk groups, according to the biological characteristics of the tumors and therapy response, and the introduction of new biological therapies, have to be taken into account in order to assign auto-HSCT a precise role in the therapeutic strategies, also considering that in the developmental age, auto-HSCT has a clear advantage over allo-HSCT, in terms of late sequelae, such as organ damage and second neoplasms. The purpose of this review is to report the results obtained with auto-HSCT in the different pediatric oncohematological diseases, focusing on the most significant literature data in the context of the various diseases and discussing this data in the light of the current therapeutic landscape.
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Affiliation(s)
- Anna Maria Testi
- Department of Translational and Precision Medicine, Sapienza, University of Rome, Rome, Italy
| | - Maria Luisa Moleti
- Department of Translational and Precision Medicine, Sapienza, University of Rome, Rome, Italy
| | - Alessia Angi
- Department of Translational and Precision Medicine, Sapienza, University of Rome, Rome, Italy
| | - Simona Bianchi
- Department of Translational and Precision Medicine, Sapienza, University of Rome, Rome, Italy
| | - Walter Barberi
- Department of Translational and Precision Medicine, Sapienza, University of Rome, Rome, Italy
| | - Saveria Capria
- Department of Translational and Precision Medicine, Sapienza, University of Rome, Rome, Italy
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9
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Li C, Wen L, Dong J, Li L, Huang J, Yang J, Liang T, Li T, Xia Z, Chen C. Alterations in cellular metabolisms after TKI therapy for Philadelphia chromosome-positive leukemia in children: A review. Front Oncol 2022; 12:1072806. [PMID: 36561525 PMCID: PMC9766352 DOI: 10.3389/fonc.2022.1072806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
Incidence rates of chronic myeloid leukemia (CML) and Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL) are lower but more aggressive in children than in adults due to different biological and host factors. After the clinical application of tyrosine kinase inhibitor (TKI) blocking BCR/ABL kinase activity, the prognosis of children with CML and Ph+ ALL has improved dramatically. Yet, off-target effects and drug tolerance will occur during the TKI treatments, contributing to treatment failure. In addition, compared to adults, children may need a longer course of TKIs therapy, causing detrimental effects on growth and development. In recent years, accumulating evidence indicates that drug resistance and side effects during TKI treatment may result from the cellular metabolism alterations. In this review, we provide a detailed summary of the current knowledge on alterations in metabolic pathways including glucose metabolism, lipid metabolism, amino acid metabolism, and other metabolic processes. In order to obtain better TKI treatment outcomes and avoid side effects, it is essential to understand how the TKIs affect cellular metabolism. Hence, we also discuss the relevance of cellular metabolism in TKIs therapy to provide ideas for better use of TKIs in clinical practice.
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Affiliation(s)
- Chunmou Li
- Department of Pediatrics, the Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, Guangdong, China
| | - Luping Wen
- Department of Pharmacy, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, Guangdong, China
| | - Junchao Dong
- Key Laboratory of Tropical Disease Control, Ministry of Education, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Lindi Li
- Department of Pediatrics, the Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, Guangdong, China
| | - Junbin Huang
- Department of Pediatrics, the Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, Guangdong, China
| | - Jing Yang
- Department of Pediatrics, the Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, Guangdong, China
| | - Tianqi Liang
- Department of Pediatrics, the Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, Guangdong, China
| | - Tianwen Li
- Department of Pediatrics, the Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, Guangdong, China
| | - Zhigang Xia
- Department of Pediatrics, the Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, Guangdong, China
| | - Chun Chen
- Department of Pediatrics, the Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, Guangdong, China,*Correspondence: Chun Chen,
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10
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Elsbernd A, Boulouadnine B, Ahmed A, Farooqi M, Sandritter T, Shakhnovich V, Blanding D, Demoulin JB, Thompson J. Novel Oncogenic PDGFRB Variant in Severe Infantile Myofibromatosis With Response to Imatinib Using Therapeutic Drug Monitoring. JCO Precis Oncol 2022; 6:e2200250. [DOI: 10.1200/po.22.00250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Abbey Elsbernd
- Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, MO
| | | | - Atif Ahmed
- Department of Laboratory Medicine and Pathology, Seattle Children's Hospital, Seattle, WA
| | - Midhat Farooqi
- Department of Pathology & Laboratory Medicine, Children's Mercy Hospitals and Clinics, Kansas City, MO
- Department of Pathology, University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Tracy Sandritter
- Division of Clinical Pharmacology, Toxicology & Therapeutic Innovation, Children's Mercy Hospitals and Clinics, Kansas City, MO
| | - Valentina Shakhnovich
- Division of Clinical Pharmacology, Toxicology & Therapeutic Innovation, Children's Mercy Hospitals and Clinics, Kansas City, MO
- Division of Gastroenterology, Hepatology & Nutrition, Children's Mercy Hospitals and Clinics, Kansas City, MO
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Darius Blanding
- Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, MO
| | | | - Joel Thompson
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO
- Division of Pediatric Hematology/Oncology/BMT, Children's Mercy Hospitals and Clinics, Kansas City, MO
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11
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Smith SM, Zhang S, Sundaram V, Roth M, Andolina JR, Schapira L, Sakamoto KM, Kolb EA, Hijiya N, Chaudhury S. Physician risk perceptions and surveillance practices for tyrosine kinase inhibitor long-term effects in pediatric CML. Pediatr Hematol Oncol 2022; 39:453-467. [PMID: 34918996 DOI: 10.1080/08880018.2021.2017085] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Chronic myeloid leukemia (CML) is effectively treated with long-term tyrosine kinase inhibitor (TKI) therapy, yet little is known about risks of prolonged TKI exposure in young patients, and long-term effect monitoring is not standardized. We surveyed North American pediatric oncologists (n = 119) to evaluate perceived risk of and surveillance practices for potential toxicities associated with prolonged TKI exposure in children and adolescents/young adults (AYAs) with CML. Survey domains included general and specific risk perceptions and surveillance practices for asymptomatic patients on chronic TKI therapy. We analyzed data descriptively and explored relationships between risk perceptions and surveillance. Risk perceptions varied among oncologists but were similar across six categories (thyroid, cardiac, vascular, metabolic, fertility, psychologic), with less than one-third rating each risk as moderate or high in pediatric and AYA patients. More oncologists perceived moderate or high risk of growth abnormalities in children (62% pediatric, 14% AYA) and financial toxicity in all patients (60% pediatric, 64% AYA). A greater proportion of oncologists with moderate or high perceived risk of thyroid abnormalities reported testing thyroid function compared to those with lower perceived risk; patterns for metabolic risk/lipid tests and cardiac risk/tests were similar. In summary, we found that pediatric oncologists had variable risk perceptions and surveillance practices for potential toxicities associated with prolonged TKI exposure. Standardizing surveillance would help quantify risks and refine recommendations.Supplemental data for this article is available online at https://doi.org/10.1080/08880018.2021.2017085 .
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Affiliation(s)
- Stephanie M Smith
- Department of Pediatrics, Division of Hematology, Oncology, Stem Cell Transplant and Regenerative Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Shiqi Zhang
- Department of Medicine, Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, California, USA
| | - Vandana Sundaram
- Department of Medicine, Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, California, USA
| | - Michael Roth
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey R Andolina
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, New York, USA
| | - Lidia Schapira
- Department of Medicine, Division of Oncology, Stanford Cancer Institute and Stanford University School of Medicine, Palo Alto, California, USA
| | - Kathleen M Sakamoto
- Department of Pediatrics, Division of Hematology, Oncology, Stem Cell Transplant and Regenerative Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - E Anders Kolb
- Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Nemours Center for Cancer and Blood Disorders, Wilmington, Delaware, USA
| | - Nobuko Hijiya
- Pediatric Hematology, Oncology, and Stem Cell Transplant, Columbia University Irving Medical Center, New York, New York, USA
| | - Sonali Chaudhury
- Department of Pediatrics, Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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12
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Lipton JH, Brümmendorf TH, Gambacorti-Passerini C, Garcia-Gutiérrez V, Deininger MW, Cortes JE. Long-term safety review of tyrosine kinase inhibitors in chronic myeloid leukemia - What to look for when treatment-free remission is not an option. Blood Rev 2022; 56:100968. [DOI: 10.1016/j.blre.2022.100968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 12/14/2022]
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13
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Kesana S, Radhakrishnan V, Kalaiyarasi JP, Mehra N, Selvarajan G, Karunakaran P, Kannan K, Dhanushkodi M, Sundersingh S, Mani S, Ganesan TS, Sagar TG. Real-World Experience of Treating Pediatric Chronic Myeloid Leukemia: Retrospective Study from a Cancer Center in Southern India. Indian J Med Paediatr Oncol 2021. [DOI: 10.1055/s-0041-1740951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Introduction Chronic myeloid leukemia (CML) is rare in children and constitutes 2% of all leukemia. We present our institute experience in treating pediatric CML for 20 years.
Objectives There is a paucity of data on pediatric CML from India, hence we would like to present treatment responses and survival rates in our pediatric population treated with tyrosine kinase inhibitors at our center.
Materials and Methods Patients aged less than 18 years, diagnosed with CML from 2000 to 2019, and treated with imatinib were analyzed retrospectively considering demographic features, treatment characteristics, and survival outcomes. Descriptive analysis was done for the baseline characteristics. Event-free survival (EFS) and overall survival (OS) were calculated using the Kaplan-Meier method and the factors were compared using the log-rank test.
Results During the study period, 95 patients were diagnosed with CML of which 54 (56.8%) were males. The most common stage at presentation was the chronic phase (CP) with 84 (88.4%) patients followed by accelerated phase (AP) and blast crisis (BC) with 6 (6.3%) and 5 (5.3%) patients respectively. The median duration of follow-up for all patients was 98 months. EFS and OS at 8 years for patients with CML-CP were 43.1% and 80.4% respectively. Complete hematological response, complete cytogenetic response, and major molecular response was documented in 91 (95.7%), 73 (76.8%), and 63 (66.3%) patients respectively.
Conclusion Outcomes in pediatric CML are comparable to that of adults. Imatinib is well tolerated in children.
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Affiliation(s)
- Sivasree Kesana
- Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India
| | | | | | - Nikita Mehra
- Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India
| | - Gangothri Selvarajan
- Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India
| | - Parathan Karunakaran
- Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India
| | - Krishnarathinam Kannan
- Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India
| | - Manikandan Dhanushkodi
- Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India
| | | | - Samson Mani
- Molecular Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India
| | - Trivadi S. Ganesan
- Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India
| | - Tenali Gnana Sagar
- Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India
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14
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Vemurafenib provides a rapid and robust clinical response in pediatric Langerhans cell histiocytosis with the BRAF V600E mutation but does not eliminate low-level minimal residual disease per ddPCR using cell-free circulating DNA. Int J Hematol 2021; 114:725-734. [PMID: 34383272 DOI: 10.1007/s12185-021-03205-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 08/04/2021] [Accepted: 08/04/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) is a disease that arises from myeloid cells that phenotypically resemble Langerhans cells (LC), which is typically driven by the BRAF V600E mutation. High-risk LCH has a poor prognosis. PROCEDURE Fifteen children with BRAF V600E + LCH received vemurafenib between March 2016 and February 2020. The median age at LCH onset was 2 months and the median age at the start of vemurafenib treatment was 22 months. The median disease activity score (DAS) at the start of vemurafenib treatment was 12 points. RESULTS The median duration of vemurafenib treatment was 29 months. All patients responded to treatment, with median DAS of 4 points at week 4 and 1 point at 6 months. Two patients died: 1 of hepatic failure after NSAID overdose and 1 of neutropenic sepsis. Cessation of vemurafenib resulted in relapse in 5 patients and was only possible for 1 patient. Serial measurements of BRAF V600E using cell-free circulating DNA revealed that 7 patients had persistently high mutant allele levels. CONCLUSION Vemurafenib is effective in children with BRAF V600E + LCH. However, treatment with vemurafenib does not eradicate the disease and its long-term toxicity has not been established.
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15
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Kwaśnik P, Giannopoulos K. Treatment-Free Remission-A New Aim in the Treatment of Chronic Myeloid Leukemia. J Pers Med 2021; 11:697. [PMID: 34442340 PMCID: PMC8399881 DOI: 10.3390/jpm11080697] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/16/2021] [Accepted: 07/20/2021] [Indexed: 02/08/2023] Open
Abstract
Tyrosine kinases inhibitors (TKIs) revolutionized chronic myeloid leukemia (CML) treatment for many years, prolonging patients' life expectancy to be comparable to age-matched healthy individuals. According to the latest the European LeukemiaNet (ELN) recommendations, CML treatment aims to achieve long-term remission without treatment (TFR), which is feasible in more than 40% of patients. Nearly all molecular relapses occur during the first 6 months after TKI withdrawal and do not progress to clinical relapse. The mechanisms that are responsible for CML relapses remain unexplained. It is suggested that maintaining TFR is not directly related to the total disposing of the gene transcript BCR-ABL1, but it might be a result of the restoration of the immune surveillance in CML. The importance of the involvement of immunocompetent cells in the period of TKI withdrawal is also emphasized by the presence of specific symptoms in some patients with "withdrawal syndrome". The goal of this review is to analyze data from studies regarding TFRs in order to characterize the elements of the immune system of patients that might prevent CML molecular relapse. The role of modern droplet digital polymerase chain reaction (ddPCR) and next-generation sequencing (NGS) in better identification of low levels of BCR-ABL1 transcripts was also taken into consideration for refining the eligibility criteria to stop TKI therapy.
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Affiliation(s)
- Paulina Kwaśnik
- Department of Experimental Hematooncology, Medical University of Lublin, 20-093 Lublin, Poland;
| | - Krzysztof Giannopoulos
- Department of Experimental Hematooncology, Medical University of Lublin, 20-093 Lublin, Poland;
- Department of Hematology, St John’s Cancer Center, 20-090 Lublin, Poland
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16
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Smith SM, Sabnis HS, Lewis RW, Effinger KE, Bergsagel J, Patterson B, Mertens A, Sakamoto KM, Schapira L, Castellino SM. Patterns of surveillance for late effects of BCR-ABL tyrosine kinase inhibitors in survivors of pediatric Philadelphia chromosome positive leukemias. BMC Cancer 2021; 21:474. [PMID: 33926411 PMCID: PMC8082962 DOI: 10.1186/s12885-021-08182-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/13/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Targeted anticancer therapies such as BCR-ABL tyrosine kinase inhibitors (TKIs) have improved outcomes for chronic myeloid leukemia (CML) and Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph + ALL). However, little is known about long-term risks of TKIs in children. Exposure-based survivorship guidelines do not include TKIs, thus surveillance practices may be variable. METHODS We retrospectively examined surveillance for cardiac and endocrine late effects in children receiving TKIs for Ph + leukemias, diagnosed at < 21 years between 2000 and 2018. Frequency of echocardiogram (ECHO), electrocardiogram (EKG), thyroid stimulating hormone (TSH), dual-energy x-ray absorptiometry (DXA), and bone age testing were abstracted. Descriptive statistics were stratified by leukemia type. RESULTS 66 patients (CML n = 44; Ph + ALL n = 22) met inclusion criteria. Among patients with CML, ≥1 evaluation was done: ECHO (50.0%), EKG (48.8%), TSH (43.9%), DXA (2.6%), bone age (7.4%). Among patients with Ph + ALL, ≥1 evaluation was done: ECHO (86.4%), EKG (68.2%), TSH (59.1%), DXA (63.6%), bone age (44.4%). Over a median 6.3 and 5.7 years of observation, respectively, 2% of patients with CML and 57% with Ph + ALL attended a survivorship clinic. CONCLUSIONS Despite common exposure to TKIs in survivors of Ph + leukemias, patterns of surveillance for late effects differed in CML and Ph + ALL, with the latter receiving more surveillance likely due to concomitant chemotherapy exposures. Targeted therapies such as TKIs are revolutionizing cancer treatment, but surveillance for late effects and referral to survivorship clinics are variable despite the chronicity of exposure. Evidence based guidelines and longer follow-up are needed.
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Affiliation(s)
- Stephanie M Smith
- Division of Hematology/Oncology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Himalee S Sabnis
- Department of Pediatrics, Division of Hematology/Oncology/Bone Marrow Transplantation, Emory University, Atlanta, GA, USA. .,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA.
| | | | - Karen E Effinger
- Department of Pediatrics, Division of Hematology/Oncology/Bone Marrow Transplantation, Emory University, Atlanta, GA, USA.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - John Bergsagel
- Department of Pediatrics, Division of Hematology/Oncology/Bone Marrow Transplantation, Emory University, Atlanta, GA, USA.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Briana Patterson
- Department of Pediatrics, Division of Hematology/Oncology/Bone Marrow Transplantation, Emory University, Atlanta, GA, USA.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA.,Department of Pediatrics, Division of Endocrinology, Emory University, Atlanta, GA, USA
| | - Ann Mertens
- Department of Pediatrics, Division of Hematology/Oncology/Bone Marrow Transplantation, Emory University, Atlanta, GA, USA.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Kathleen M Sakamoto
- Division of Hematology/Oncology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Lidia Schapira
- Stanford Cancer Institute and Division of Medical Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Sharon M Castellino
- Department of Pediatrics, Division of Hematology/Oncology/Bone Marrow Transplantation, Emory University, Atlanta, GA, USA.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
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17
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Smith SM, Hijiya N, Sakamoto KM. Chronic Myelogenous Leukemia in Childhood. Curr Oncol Rep 2021; 23:40. [PMID: 33718985 DOI: 10.1007/s11912-021-01025-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW Chronic myelogenous leukemia (CML) is rare in children, requiring extrapolation from treatment of adults. In this review, we explore similarities and differences between adult and pediatric CML with a focus on therapeutic advances and emerging clinical questions. RECENT FINDINGS Pediatric CML is effectively treated with long-term targeted therapy using tyrosine kinase inhibitors (TKIs). Newly diagnosed pediatric patients in chronic phase can now be treated with imatinib, dasatinib, or nilotinib without allogeneic hematopoietic stem cell transplantation. While treatment-free remission is possible in adults in chronic phase with optimal response to therapy, data are currently insufficient to support stopping TKI in pediatrics outside of a clinical trial. Knowledge gaps remain regarding long-term and late effects of TKIs in pediatric CML. Targeted therapy has markedly improved outcomes for pediatric CML, while raising a number of clinical questions, including the possibility of treatment-free remission and long-term health implications of prolonged TKI exposure at a young age.
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Affiliation(s)
- Stephanie M Smith
- Division of Hematology/Oncology, Department of Pediatrics, Stanford University School of Medicine, CCSR-1215C, 269 Campus Drive, Stanford, CA, USA
| | - Nobuko Hijiya
- Division of Pediatric Hematology, Oncology and Stem Cell Transplant, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Kathleen M Sakamoto
- Division of Hematology/Oncology, Department of Pediatrics, Stanford University School of Medicine, CCSR-1215C, 269 Campus Drive, Stanford, CA, USA.
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18
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Cai Y, Liu C, Guo Y, Chen X, Zhang L, Chen Y, Zou Y, Yang W, Zhu X. Long-term safety and efficacy of imatinib in pediatric patients with chronic myeloid leukemia: single-center experience from China. Int J Hematol 2021; 113:413-421. [PMID: 33386594 DOI: 10.1007/s12185-020-03042-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 11/14/2020] [Accepted: 11/17/2020] [Indexed: 12/18/2022]
Abstract
Chronic myeloid leukemia (CML) is a rare disease among children. A retrospective study was conducted from November 2002 to March 2019 at a single institution in China. A total of 36 pediatric CML patients (25 male and 11 female) were enrolled. Median follow-up time was 51 months (range 8-144), and 5-year overall survival and event-free survival were 95.5 ± 4.4% and 88.9 ± 6.0%, respectively. Among the 25 patients whose response to imatinib mesylate (IM) was regularly monitored, 92.0% achieved complete hematologic response at 3 months, 80.0% achieved complete cytogenetic response at 12 months, and 64.0% achieved major molecular response at 18 months after IM therapy. A higher WBC count at diagnosis was associated with failure to achieve early molecular response (EMR). Height standard deviation score after long-term treatment was significantly and positively correlated with age at diagnosis and at the start of IM therapy. Overall, IM therapy was effective in treating pediatric CML, and WBC count at diagnosis might be an ideal predictor of EMR. Moreover, retardation of height and weight growth due to IM tended to affect patients younger than 9 years old at diagnosis, and longitudinal growth might normalize further into treatment.
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Affiliation(s)
- Yuli Cai
- Department of Pediatric Hematology, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
| | - Chao Liu
- Department of Pediatric Hematology, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
| | - Ye Guo
- Department of Pediatric Hematology, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
| | - Xiaojuan Chen
- Department of Pediatric Hematology, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
| | - Li Zhang
- Department of Pediatric Hematology, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
| | - Yumei Chen
- Department of Pediatric Hematology, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
| | - Yao Zou
- Department of Pediatric Hematology, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
| | - Wenyu Yang
- Department of Pediatric Hematology, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
| | - Xiaofan Zhu
- Department of Pediatric Hematology, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China.
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19
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Zheng FY, Zhang Y, Zhang LQ, Liu BC, Meng L, Jin J, Liu HL, Sun ZM, Lin LE, Lei PC, Zhu XF, Ma HX, Lu ZS, Jiang H, Zhao YH, Lin H, Zhang X, Yang GP, Zhu HL, Chen SN, You Y, Li WM, Bai QX, Zhao XL, Li ZY, Shen XM, Zhang LP, Jiang Q. [Effect of imatinib on the height of children with chronic myeloid leukemia in the chronic phase]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2020; 41:545-551. [PMID: 32810960 PMCID: PMC7449767 DOI: 10.3760/cma.j.issn.0253-2727.2020.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
目的 评估伊马替尼对慢性髓性白血病慢性期(CML-CP)儿童身高的影响。 方法 2018年7月至2019年7月,在全国范围内对诊断时年龄<18周岁、接受伊马替尼治疗至少3个月的CML儿童或其家长发放问卷,调查受访者伊马替尼治疗前后身高的变化。主要评价指标为身高标准差积分值(HtSDS)以及标准差积分的差值(ΔHtSDS),并分析其相关影响因素。 结果 共有238例受访者符合标准并被纳入研究,男性138例(58.0%),初诊时中位年龄11.0(1.4~17.9)岁,青春期前93例(39.0%),至填写答卷时,中位年龄15.0(2.0~34.0)岁,中位伊马替尼服药时间28(3~213)个月。受访者填写答卷时HtSDS(−0.063±1.361)较治疗前HtSDS(0.391±1.244)显著下降(P<0.001),71.0%的患儿出现身高增长减慢。青春期前服药者治疗后HtSDS下降显著(P<0.05),而青春期开始后服药者HtSDS变化不明显(P>0.05)。多因素分析显示,服药初始年龄较小(偏回归系数为0.122,B=0.572,t=10.733,P<0.001)和服药时间较长(偏回归系数为−0.006,B=−0.211,t=−4.062,P<0.001)是伊马替尼抑制身高增长的独立影响因素。 结论 伊马替尼引起CML-CP儿童身高增长障碍,服药初始年龄越小、服药时间越长,伊马替尼对身高的影响越明显。
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Affiliation(s)
- F Y Zheng
- Peking University People's Hospital, Beijing 100044, China
| | - Yanli Zhang
- Henan Cancer Hospital, Zhengzhou 450008, China
| | - L Q Zhang
- Beijing Children's Hospital Affiliated to Capital Medical University, Beijing 100045, China
| | - B C Liu
- Institute of Hematology and Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
| | - L Meng
- Tongji Hospital Affiliated to Huazhong University of Science and Technology, Wuhan 430030, China
| | - J Jin
- The First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou 310003, China
| | - H L Liu
- Affiliated Provincial Hospital of Anhui Medical University, Hefei 230001, China
| | - Z M Sun
- Affiliated Provincial Hospital of Anhui Medical University, Hefei 230001, China
| | - L E Lin
- Hainan General Hospital, Haikou 570311, China
| | - P C Lei
- Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - X F Zhu
- Institute of Hematology and Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
| | - H X Ma
- The Third Hospital of Zhengzhou, Zhengzhou 450003, China
| | - Z S Lu
- Guangdong General Hospital, Guangzhou 510080, China
| | - H Jiang
- Guangzhou Women and Children's Medical Center, Guangzhou 510623, China
| | - Y H Zhao
- The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - H Lin
- Jilin University First Hospital, Changchun 130021, China
| | - X Zhang
- Maoming People's Hospital, Maoming 525000, China
| | - G P Yang
- The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - H L Zhu
- West China Hospital of Sichuan University, Chengdu 610041, China
| | - S N Chen
- The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Y You
- Union Hospital Affiliated to Huazhong University of Science and Technology, Wuhan 430022, China
| | - W M Li
- Union Hospital Affiliated to Huazhong University of Science and Technology, Wuhan 430022, China
| | - Q X Bai
- Xijing Hospital of Air Force Medical University, Xi'an 710032, China
| | - X L Zhao
- Xiangya Hospital of Central South University, Changsha 410008, China
| | - Z Y Li
- Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China
| | - X M Shen
- The First People's Hospital of Yunnan Province, Kunming 650034, China
| | - L P Zhang
- Peking University People's Hospital, Beijing 100044, China
| | - Q Jiang
- Peking University People's Hospital, Beijing 100044, China
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PDGFR-β mediated growth failure in pediatric CML cases on Imatinib. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2020. [DOI: 10.1016/j.phoj.2020.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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21
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Totadri S, Thipparapu S, Aggarwal R, Sharma M, Naseem S, Jain R, Trehan A, Malhotra P, Varma N, Bansal D. Imatinib-Induced Hypogammaglobulinemia in Children and Adolescents with Chronic Myeloid Leukemia. Pediatr Hematol Oncol 2020; 37:539-544. [PMID: 32364815 DOI: 10.1080/08880018.2020.1759739] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Imatinib-induced tyrosine kinase inhibition extends beyond the BCR-ABL mutation, resulting in adverse effects. We evaluated hypogammaglobulinemia as a potential 'off-target' action of imatinib in children with CML. A cross-sectional, observational study was performed. Patients with CML in chronic phase, age <18-years at diagnosis, receiving imatinib for a duration exceeding 6-months were enrolled. Serum immunoglobulin G, A, and M were measured by end-point nephelometry. Thirty patients were enrolled. The mean age at diagnosis was 10.4 ± 3.1 years (range: 5-18). The mean age at enrollment was 16.4 ± 4.1 years (range: 9-23). The median dose of imatinib was 287.5 mg/m2 (IQR: 267.3, 345.0). The median duration of imatinib-therapy was 6-years (IQR: 3.0, 10.3). The median (IQR) normalized levels of IgG, IgA, and IgM were 33.0% (IQR: -12.8, 58.7), 28.1% (IQR: -17.0, 90.1) and 15.9% (IQR: -9.3, 40.5), respectively. The IgG, IgA, and IgM levels were reduced in 9 (30%), 8 (27%), and 10 (33%) patients, respectively. Five (17%) patients had pan-hypogammaglobulinemia. We suggest checking immunoglobulin levels in patients with CML receiving imatinib with recurrent/unusual infections.
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Affiliation(s)
- Sidharth Totadri
- Pediatric Hematology-Oncology Unit, Dept. of Pediatrics, Advanced Pediatrics Center, Chandigarh, India
| | - Shankar Thipparapu
- Pediatric Hematology-Oncology Unit, Dept. of Pediatrics, Advanced Pediatrics Center, Chandigarh, India
| | | | | | | | - Richa Jain
- Pediatric Hematology-Oncology Unit, Dept. of Pediatrics, Advanced Pediatrics Center, Chandigarh, India
| | - Amita Trehan
- Pediatric Hematology-Oncology Unit, Dept. of Pediatrics, Advanced Pediatrics Center, Chandigarh, India
| | - Pankaj Malhotra
- Clinical Hematology Unit, Dept. of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Deepak Bansal
- Pediatric Hematology-Oncology Unit, Dept. of Pediatrics, Advanced Pediatrics Center, Chandigarh, India
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22
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Zheng FY, Lu AD, Zuo YX, Jia YP, Wu J, Zhang LP. Impact of tyrosine kinase inhibitors on the statural growth in children with acute lymphoblastic leukemia. Leuk Res 2020; 95:106405. [PMID: 32590107 DOI: 10.1016/j.leukres.2020.106405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 06/12/2020] [Accepted: 06/13/2020] [Indexed: 01/23/2023]
Abstract
PURPOSE To investigate the effect of tyrosine kinase inhibitors (TKIs) on the statural growth in children with acute lymphoblastic leukemia (ALL). METHODS We retrospectively collected data from 344 children with ALL younger than 17 years old at diagnosis identified in pediatric department of Peking University People's Hospital. The children were divided into three groups: conventional chemotherapy group, imatinib group and dasatinib group. Height was expressed as standard deviation score(HtSDS). In the three groups, we compared the HtSDS and △HtSDS at the start of treatment and during follow-up period and also compared the adult height and median parental height(MPH). We further compared the HtSDS classified by age and gender in imatinib group. At last, univariate analysis was used to analyze the influencing factors on the deceleration of height growth by imatinib. RESULTS There were 298 children in conventional chemotherapy group, 39 in imatinib group and 7 in dasatinib group. In imatinib group, the mean HtSDS of children at follow-up time was significantly lower than that at the start of treatment (P < 0.05), regardless of age and gender. In imatinib group, the decrease of HtSDS in girls was more obvious than in boys(P = 0.031). The HtSDS gradually decreased in the first and the second year in imatinib group. After discontinuation of imatinib, the HtSDS had no obvious change. Multivariate analysis showed that the HtSDS at the start of imatinib was negatively correlated with severe growth impairment on imatinib therapy. The HtSDS in dasatinib group and conventional chemotherapy group maintained a high degree of consistency. CONCLUSION Imatinib can affect growth velocity in children with ALL, regardless of age and gender. With the discontinuation of imatinib, the inhibitory effect will not continue. The lower HtSDS at the start of imatinib therapy, the more obvious effect of imatinib on growth impairment will be, and the effect will be more obvious in girls than boys.
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Affiliation(s)
- Fang-Yuan Zheng
- Peking University People's Hospital, Department of Pediatrics, Beijing, 100044, China
| | - Ai-Dong Lu
- Peking University People's Hospital, Department of Pediatrics, Beijing, 100044, China
| | - Ying-Xi Zuo
- Peking University People's Hospital, Department of Pediatrics, Beijing, 100044, China
| | - Yue-Ping Jia
- Peking University People's Hospital, Department of Pediatrics, Beijing, 100044, China
| | - Jun Wu
- Peking University People's Hospital, Department of Pediatrics, Beijing, 100044, China
| | - Le-Ping Zhang
- Peking University People's Hospital, Department of Pediatrics, Beijing, 100044, China.
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Bansal D. Chronic Myeloid Leukemia in Children: Challenges and Opportunities : Based on 7th Dr. I. C. Verma Excellence Award for Young Pediatricians Delivered as Oration on 29th Sept. 2019. Indian J Pediatr 2020; 87:443-450. [PMID: 32086760 DOI: 10.1007/s12098-020-03234-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 02/03/2020] [Indexed: 02/06/2023]
Abstract
Treatment with tyrosine kinase inhibitors (TKI) is an effective therapy for children and adolescents with chronic phase of chronic myeloid leukemia (CML). For the majority of patients with CML in low- and middle-income countries (LMIC), imatinib is the TKI of choice for reasons of cost, availability, and experience. Children are exposed to therapy for a greater proportion of their lifetime as compared to adults. The adverse effects of prolonged administration of TKI is a subject of ongoing research, as more experience is collected. Therapy with TKI is currently considered to be life-long. Trials on stopping treatment are ongoing to explore if it may be feasible in selected patients, as reported in adults. Growth-failure is a concerning adverse effect. Currently, it seems unclear if the final height attained is within the expected range of the mid-parenteral height and growth standards. Whether the children will achieve a normal height at the end of their growth potential or remain below the predicted range is critical to decide if therapeutic interventions (E.g., growth hormone therapy, or interruption in TKI) should be considered during the period of growth potential. Research on CML in children is at a relatively slow pace, largely due to the rarity of the disease. This provides a unique opportunity for research in population-dense LMICs, as several tertiary centers tend to have a sizable cohort of children and adolescents with CML on follow-up. This narrative summarises the challenges and opportunities in dealing with CML in children, particularly in reference to a center in LMIC.
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Affiliation(s)
- Deepak Bansal
- Hematology-Oncology Unit, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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24
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Walia R, Aggarwal A, Bhansali A, Aggarwal A, Varma N, Sachdeva N, Khandelwal N, Bansal D. Acquired neuro-secretory defect in growth hormone secretion due to Imatinib mesylate and the efficacy of growth hormone therapy in children with chronic myeloid leukemia. Pediatr Hematol Oncol 2020; 37:99-108. [PMID: 31747806 DOI: 10.1080/08880018.2019.1689320] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Imatinib results in growth retardation in children with chronic myeloid leukemia (CML). The study was planned to assess the GHRH-GH-IGF1 axis in children with CML, receiving Imatinib and to evaluate the efficacy of human growth hormone (hGH) therapy. Twenty children with CML, receiving Imatinib for a period exceeding 6 months, with resultant growth retardation were included. The GHRH-GH-IGF1 axis was assessed using growth hormone stimulation tests. IGF-1 generation test was performed for the evaluation of GH insensitivity. The mean age at inclusion was 15.2 years. The mean duration of treatment with Imatinib was 5.7 years. The mean decrease in height SDS since the start of Imatinib was -0.95 (p = 0.008). IGF-1 SDS was <-2 in all the patients. 71.4% of patients had a suboptimal GH response following stimulation with GHRH-Arginine. All patients had stimulable, although a delayed GH response with glucagon stimulation. 20% of patients had GH insensitivity. Four patients were treated with hGH for a mean duration of 5.75 months, achieved normalization of IGF-1 levels and improvement in growth velocity improved from 0.21 to 0.86 cm/month. Imatinib results in an acquired neurosecretory defect in GH secretion. Treatment with growth hormone leads to an improvement in growth velocity and normalization of IGF-1.
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Affiliation(s)
- Rama Walia
- Department of Endocrinology, PGIMER Chandigarh, Chandigarh, India
| | | | - Anil Bhansali
- Department of Endocrinology, PGIMER Chandigarh, Chandigarh, India
| | - Anshita Aggarwal
- Department of Endocrinology, PGIMER Chandigarh, Chandigarh, India
| | - Neelam Varma
- Department of Pathology, PGIMER Chandigarh, Chandigarh, India
| | - Naresh Sachdeva
- Department of Endocrinology, PGIMER Chandigarh, Chandigarh, India
| | | | - Deepak Bansal
- Department of Pediatrics (Hemat-Oncology Unit), PGIMER Chandigarh, Chandigarh, India
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Giona F, Malaspina F, Putti MC, Ladogana S, Mura R, Burnelli R, Vacca N, Rizzo L, Bianchi S, Moleti ML, Testi AM, Biondi A, Locatelli F, Saglio G, Foà R. Results and outcome of intermittent imatinib (ON/OFF schedule) in children and adolescents with chronic myeloid leukaemia. Br J Haematol 2020; 188:e101-e105. [DOI: 10.1111/bjh.16388] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Fiorina Giona
- Department of Translational and Precision Medicine Sapienza University Rome Italy
| | - Francesco Malaspina
- Department of Translational and Precision Medicine Sapienza University Rome Italy
| | - Maria Caterina Putti
- Hemato‐Oncology Unit Department of Women’s and Children’s Health University of Padua Padua Italy
| | - Saverio Ladogana
- Department of Pediatrics Hemato‐Oncology Unit ‘Casa Sollievo della Sofferenza’ Hospital San Giovanni Rotondo Italy
| | - Rosamaria Mura
- Pediatric Hemato‐Oncology Unit Ospedale Regionale per le Microcitemie Cagliari Italy
| | | | - Nadia Vacca
- Pediatric Unit Ospedale di Sassari Sassari Italy
| | - Lorenzo Rizzo
- Department of Translational and Precision Medicine Sapienza University Rome Italy
| | - Simona Bianchi
- Department of Translational and Precision Medicine Sapienza University Rome Italy
| | - Maria Luisa Moleti
- Department of Translational and Precision Medicine Sapienza University Rome Italy
| | - Anna Maria Testi
- Department of Translational and Precision Medicine Sapienza University Rome Italy
| | - Andrea Biondi
- Department of Pediatrics University of Milano‐Bicocca Monza Italy
| | - Franco Locatelli
- Department of Pediatrics Pediatric Hematology‐Oncology University of Pavia IRCCS Ospedale Pediatrico Bambino Gesù Rome Italy
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences University of Turin at Orbassano Turin Italy
| | - Robin Foà
- Department of Translational and Precision Medicine Sapienza University Rome Italy
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Abstract
Chronic myeloid leukemia (CML) has different disease biology with a more aggressive clinical course in children. Achieving treatment-free remission is the ideal goal for the pediatric CML population to avoid long-term toxicities of tyrosine kinase inhibitors. Here, we present our experience of stopping Imatinib in a pediatric patient of CML who had excessive weight gain with Imatinib. He is currently maintaining treatment-free remission for 15 months after stopping therapy at the time of last follow-up. The patient also had normalization of body mass index with the stopping of Imatinib.
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Zheng FY, Lu AD, Zhang LP, Zuo YX, Jia YP, Wu J. [Influence of dasatinib treatment on body height in children with acute myeloid leukemia]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020; 22:47-52. [PMID: 31948524 PMCID: PMC7389709 DOI: 10.7499/j.issn.1008-8830.2020.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/04/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To study the influence of dasatinib treatment on body height in children with acute myeloid leukemia (AML). METHODS A retrospective analysis was performed for the clinical data of 86 AML children aged <17 years. According to the treatment regimen, these children were divided into a conventional chemotherapy group and a dasatinib chemotherapy group. The 57 children in the conventional chemotherapy group were given conventional chemotherapy drugs without tyrosine kinase inhibitor, and the 29 children in the dasatinib chemotherapy group were given conventional chemotherapy drugs and dasatinib. The two groups were compared in terms of height standard deviation score (HtSDS) at the beginning of treatment and after treatment, as well as the change in HtSDS after 1 and 2 years of treatment. RESULTS There was no significant difference in HtSDS between the conventional and dasatinib chemotherapy groups before treatment. Within the first two years of treatment, the dasatinib chemotherapy group had a similar change trend of HtSDS as the conventional chemotherapy group. Four children in the dasatinib chemotherapy group reached the final adult height during follow-up, which was significantly lower than the target height (P=0.044). In the conventional chemotherapy group, there was no significant difference between final adult height and target height. In the dasatinib chemotherapy group, the children in adolescence had a significant change in HtSDS after treatment (P=0.032). CONCLUSIONS Dasatinib treatment may affect the final height of children with AML, and the use of dasatinib after the beginning of adolescence may lead to growth disorder, but dasatinib treatment has little effect on body height in the short-term treatment.
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Affiliation(s)
- Fang-Yuan Zheng
- Department of Pediatrics, Peking University People's Hospital, Beijing 100044, China.
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Pushpam D, Bakhshi S. Paediatric chronic myeloid leukaemia: Is it really a different disease? Indian J Med Res 2019; 149:600-609. [PMID: 31417027 PMCID: PMC6702689 DOI: 10.4103/ijmr.ijmr_331_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Paediatric chronic myeloid leukaemia (CML) has biological and clinical differences from adult CML. Management of paediatric CML presents unique challenges in growing children, and there are no specific guidelines for paediatric CML. This review focusses on the clinical characteristics, diagnostic issues and management of paediatric CML. Major studies that provide the basis of managing paediatric CML are summerized here. Studies conducted on adult CML patients were used to guide the management of places where studies were lacking in paediatric CML. Recently, dasatinib and nilotinib have been approved for treatment of paediatric CML, and their role has been discussed in the current management perspective. Allogeneic transplant, fertility and vaccination in paediatric CML, have also been discussed.
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Affiliation(s)
- Deepam Pushpam
- Department of Medical Oncology, Dr. B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Boddu D, Thankamony P, Guruprasad CS, Nair M, Rajeswari B, Seetharam S. Effect of imatinib on growth in children with chronic myeloid leukemia. Pediatr Hematol Oncol 2019; 36:189-197. [PMID: 31298597 DOI: 10.1080/08880018.2019.1610119] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Imatinib is a preferred drug for pediatric Chronic Myeloid Leukemia (CML). Long-term use has inhibitory effects on other tyrosine kinase pathways causing off-target complications such as growth impairment. Our aim was to evaluate impact of long-term use on longitudinal growth in children with CML in Kerala. We hypothesized that the impact would be lesser compared to Northern India as Kerala has the lowest rates of underweight and stunting, with a high literacy rate and per capita income. Children ≤14 years of age, diagnosed with CML and received imatinib for at least 1 year were included. Girls >9 years of age and boys >11 years were considered pubertal. Height Z scores were derived using WHO AnthroPlus. Paired t test compared difference of Z scores in prepubertal and postpubertal age groups. Height Z scores were compared with mid-parental height and sibling height Z scores. Thirty-six children were included (M = 21; F = 15). Median duration of imatinib exposure was 84 months. Decrease in longitudinal growth affected children in both prepubertal and postpubertal age groups. Decrease in height Z scores was more in prepubertal age group when imatinib therapy was initiated (p = .0018). Of 10 patients currently above 19 years (of whom 8 were in pubertal age and 2 in prepubertal age at start of imatinib) none are stunted. Patient's height Z scores was lesser compared to sibling height Z scores (p = .027). Children on continuous imatinib showed a significant stunting when treatment was initiated during prepubertal age. There is a catch-up of growth as the final height reached is within normal limits of WHO reference values.
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Affiliation(s)
- Deepthi Boddu
- a Department of Pediatric Oncology, Regional Cancer Centre , Thiruvananthapuram , Kerala, India
| | - Priyakumari Thankamony
- a Department of Pediatric Oncology, Regional Cancer Centre , Thiruvananthapuram , Kerala, India
| | - C S Guruprasad
- a Department of Pediatric Oncology, Regional Cancer Centre , Thiruvananthapuram , Kerala, India
| | - Manjusha Nair
- a Department of Pediatric Oncology, Regional Cancer Centre , Thiruvananthapuram , Kerala, India
| | - Binitha Rajeswari
- a Department of Pediatric Oncology, Regional Cancer Centre , Thiruvananthapuram , Kerala, India
| | - Shwetha Seetharam
- a Department of Pediatric Oncology, Regional Cancer Centre , Thiruvananthapuram , Kerala, India
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30
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How I treat chronic myeloid leukemia in children and adolescents. Blood 2019; 133:2374-2384. [PMID: 30917954 DOI: 10.1182/blood.2018882233] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 03/21/2019] [Indexed: 12/15/2022] Open
Abstract
Evidence-based recommendations have been established for treatment of chronic myeloid leukemia (CML) in adults treated with tyrosine kinase inhibitors (TKIs), but the rarity of this leukemia in children and adolescents makes it challenging to develop similar recommendations in pediatrics. In addition to imatinib, which was approved for pediatric CML in 2003, the second-generation TKIs dasatinib and nilotinib were recently approved for use in children, expanding the therapeutic options and pushing allogeneic stem cell transplantation to a third-line treatment of most pediatric cases. Yet, without sufficient data on efficacy and safety specific to pediatric patients, the selection of a TKI continues to rely on clinical experience in adults. Here, we present 4 case scenarios highlighting common yet challenging issues encountered in the treatment of pediatric CML (suboptimal response, poor treatment adherence, growth retardation, and presentation in advanced phases). Limited experience with very young children, the transition of teenagers to adult medicine, and the goal of achieving treatment-free remission for this rare leukemia are additional significant obstacles that require further clinical investigation through international collaboration.
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31
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Secrétan PH, Karoui M, Sadou Yayé H, Levi Y, Tortolano L, Solgadi A, Yagoubi N, Do B. Imatinib: Major photocatalytic degradation pathways in aqueous media and the relative toxicity of its transformation products. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 655:547-556. [PMID: 30476834 DOI: 10.1016/j.scitotenv.2018.11.270] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/13/2018] [Accepted: 11/18/2018] [Indexed: 06/09/2023]
Abstract
Imatinib (IMA) is a highly potent tyrosine kinase inhibitor used as first-line anti-cancer drug in the treatment of chronic myeloid leukemia. Due to its universal mechanism of action, IMA also has endocrine and mutagenic disrupting effects in vivo and in vitro, which raises the question of its environmental impact. However, to date, very little information is available on its environmental fate and the potential role of its transformation products (TPs) on aquatic organisms. Given the IMA resistance to hydrolysis and direct photolysis according to the literature, we sought to generate TPs through oxidative and radical conditions using the AOPs pathway. Thus, the reactivity of the cytotoxic drug IMA in water in the presence of OH and h+ was investigated for the first time in the present work. In this regard, a non-targeted screening approach was applied in order to reveal its potential TPs. The tentative structural elucidation of the detected TPs was performed by LC-HRMSn. The proposed approach allowed detecting a total of twelve TPs, among which eleven are being described for the first time in this work. Although the structures of these TPs could not be positively confirmed due to lack of standards, their chemical formulas and product ions can be added to databases, which will allow their screening in future monitoring studies. Using the quantitative structure-activity relationship (QSAR) approach and rule-based software, we have shown that the detected TPs possess, like their parent molecule, comparable acute toxicity as well as mutagenic and estrogenic potential. In addition to the in silico studies, we also found that the samples obtained at different exposure times to oxidative conditions, including those where IMA is no longer detected, retained toxicity in vitro. Such results suggest further studies are needed to increase our knowledge of the impact of imatinib on the environment.
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Affiliation(s)
- P H Secrétan
- University of Paris-Sud, Department of Pharmacy, Laboratory "Matériaux et Santé" EA 401, 5 rue Jean Baptiste Clément, 92296 Châtenay-Malabry, France; Assistance Publique-Hôpitaux de Paris, Hôpital Necker, Department of Pharmacy, 149 Rue de Sèvres, 75015 Paris, France.
| | - M Karoui
- University of Paris-Sud, Department of Pharmacy, Laboratory "Matériaux et Santé" EA 401, 5 rue Jean Baptiste Clément, 92296 Châtenay-Malabry, France
| | - H Sadou Yayé
- University of Paris-Sud, Department of Pharmacy, Laboratory "Matériaux et Santé" EA 401, 5 rue Jean Baptiste Clément, 92296 Châtenay-Malabry, France; Assistance Publique-Hôpitaux de Paris, Groupe Pitié-Salpétrière, Department of Pharmacy, 47-83 Boulevard de l'Hôpital, 75013, Paris
| | - Y Levi
- University of Paris-Sud, Faculté de Pharmacie, UMR 8079, CNRS, AgroParisTech, Paris, France
| | - L Tortolano
- University of Paris-Sud, Department of Pharmacy, Laboratory "Matériaux et Santé" EA 401, 5 rue Jean Baptiste Clément, 92296 Châtenay-Malabry, France; Assistance Publique-Hôpitaux de Paris, Groupe hospitalier Henri Mondor, Department of Pharmacy, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - A Solgadi
- University of Paris-Sud, Faculté de Pharmacie, Service d'Analyse des Médicaments et Métabolites, Institut d'Innovation Thérapeutique, 5 rue Jean Baptiste Clément, 92296 Chatenay-Malabry, France
| | - N Yagoubi
- University of Paris-Sud, Department of Pharmacy, Laboratory "Matériaux et Santé" EA 401, 5 rue Jean Baptiste Clément, 92296 Châtenay-Malabry, France
| | - B Do
- University of Paris-Sud, Department of Pharmacy, Laboratory "Matériaux et Santé" EA 401, 5 rue Jean Baptiste Clément, 92296 Châtenay-Malabry, France; Assistance Publique-Hôpitaux de Paris, Groupe hospitalier Henri Mondor, Department of Pharmacy, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
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32
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Practice Patterns of Physician Treatment for Pediatric Chronic Myelogenous Leukemia. Biol Blood Marrow Transplant 2019; 25:321-327. [DOI: 10.1016/j.bbmt.2018.09.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 09/21/2018] [Indexed: 12/20/2022]
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Sabnis HS, Keenum C, Lewis RW, Patterson B, Bergsagel J, Effinger KE, Silverman E, Mertens AC, Castellino SM. Growth disturbances in children and adolescents receiving long-term tyrosine kinase inhibitor therapy for Chronic Myeloid Leukaemia or Philadelphia Chromosome-positive Acute Lymphoblastic Leukaemia. Br J Haematol 2018; 185:795-799. [PMID: 30407613 DOI: 10.1111/bjh.15633] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Himalee S Sabnis
- Department of Pediatrics, Division of Haematology/Oncology/Bone Marrow Transplantation, Emory University, Atlanta, GA, USA.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Caroline Keenum
- Department of Pediatrics, Division of Haematology/Oncology/Bone Marrow Transplantation, Emory University, Atlanta, GA, USA
| | - Rebecca W Lewis
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Briana Patterson
- Department of Pediatrics, Division of Haematology/Oncology/Bone Marrow Transplantation, Emory University, Atlanta, GA, USA.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA.,Department of Pediatrics, Division of Endocrinology, Emory University, Atlanta, GA, USA
| | - John Bergsagel
- Department of Pediatrics, Division of Haematology/Oncology/Bone Marrow Transplantation, Emory University, Atlanta, GA, USA.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Karen E Effinger
- Department of Pediatrics, Division of Haematology/Oncology/Bone Marrow Transplantation, Emory University, Atlanta, GA, USA.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Emily Silverman
- Department of Pediatrics, Division of Haematology/Oncology/Bone Marrow Transplantation, Emory University, Atlanta, GA, USA
| | - Ann C Mertens
- Department of Pediatrics, Division of Haematology/Oncology/Bone Marrow Transplantation, Emory University, Atlanta, GA, USA.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Sharon M Castellino
- Department of Pediatrics, Division of Haematology/Oncology/Bone Marrow Transplantation, Emory University, Atlanta, GA, USA.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
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Burdach SEG, Westhoff MA, Steinhauser MF, Debatin KM. Precision medicine in pediatric oncology. Mol Cell Pediatr 2018; 5:6. [PMID: 30171420 PMCID: PMC6119176 DOI: 10.1186/s40348-018-0084-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 08/01/2018] [Indexed: 01/06/2023] Open
Abstract
Outcome in treatment of childhood cancers has improved dramatically since the 1970s. This success was largely achieved by the implementation of cooperative clinical research trial groups that standardized and developed treatment of childhood cancer. Nevertheless, outcome in certain types of malignancies is still unfavorable. Intensification of conventional chemotherapy and radiotherapy improved outcome only marginally at the cost of acute and long-term side effects. Hence, it is necessary to develop targeted therapy strategies.Here, we review the developments and perspectives in precision medicine in pediatric oncology with a special focus on targeted drug therapies like kinase inhibitors and inducers of apoptosis, the impact of cancer genome sequencing and immunotherapy.
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Affiliation(s)
- Stefan E G Burdach
- Department of Pediatrics and Children's Cancer Research Center (CCRC), Technische Universität München, Koelner Platz 1, 80804, Munich, Germany. .,CCC München-Comprehensive Cancer Center and German Translational Cancer Research Consortium (DKTK), Partner Site Munich, Munich, Germany.
| | - Mike-Andrew Westhoff
- Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Eythstr. 24, 89075, Ulm, Germany
| | - Maximilian Felix Steinhauser
- Department of Pediatrics and Children's Cancer Research Center (CCRC), Technische Universität München, Koelner Platz 1, 80804, Munich, Germany
| | - Klaus-Michael Debatin
- Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Eythstr. 24, 89075, Ulm, Germany
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Suttorp M, Schulze P, Glauche I, Göhring G, von Neuhoff N, Metzler M, Sedlacek P, de Bont ESJM, Balduzzi A, Lausen B, Aleinikova O, Sufliarska S, Henze G, Strauss G, Eggert A, Kremens B, Groll AH, Berthold F, Klein C, Groß-Wieltsch U, Sykora KW, Borkhardt A, Kulozik AE, Schrappe M, Nowasz C, Krumbholz M, Tauer JT, Claviez A, Harbott J, Kreipe HH, Schlegelberger B, Thiede C. Front-line imatinib treatment in children and adolescents with chronic myeloid leukemia: results from a phase III trial. Leukemia 2018; 32:1657-1669. [PMID: 29925908 DOI: 10.1038/s41375-018-0179-9] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 04/26/2018] [Accepted: 05/01/2018] [Indexed: 12/16/2022]
Abstract
A total of 156 patients (age range 1.3-18.0 years, median 13.2 years; 91 (58.3%) male) with newly diagnosed CML (N = 146 chronic phase (CML-CP), N = 3 accelerated phase (CML-AP), N = 7 blastic phase (CML-BP)) received imatinib up-front (300, 400, 500 mg/m2, respectively) within a prospective phase III trial. Therapy response, progression-free survival, causes of treatment failure, and side effects were analyzed in 148 children and adolescents with complete data. Event-free survival rate by 18 months for patients in CML-CP (median follow-up time 25 months, range: 1-120) was 97% (95% CI, 94.2-99.9%). According to the 2006 ELN-criteria complete hematologic response by month 3, complete cytogenetic response (CCyR) by month 12, and major molecular response (MMR) by month 18 were achieved in 98, 63, and 59% of the patients, respectively. By month 36, 86% of the patients achieved CCyR and 74% achieved MMR. Thirty-eight patients (27%) experienced imatinib failure because of unsatisfactory response or intolerance (N = 9). In all, 28/148 patients (19%) underwent stem cell transplantation (SCT). In the SCT sub-cohort 2/23 patients diagnosed in CML-CP, 0/1 in CML-AP, and 2/4 in CML-BP, respectively, died of relapse (N = 3) or SCT-related complications (N = 2). This large pediatric trial extends and confirms data from smaller series that first-line imatinib in children is highly effective.
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Affiliation(s)
- Meinolf Suttorp
- Pediatric Hematology and Oncology, Department of Pediatrics, University Hospital "Carl Gustav Carus", TU Dresden, Dresden, Germany.
| | - Philipp Schulze
- Institute for Medical Informatics and Biometry, Faculty of Medicine "Carl Gustav Carus", TU Dresden, Dresden, Germany
| | - Ingmar Glauche
- Institute for Medical Informatics and Biometry, Faculty of Medicine "Carl Gustav Carus", TU Dresden, Dresden, Germany
| | - Gudrun Göhring
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Nils von Neuhoff
- Department of Human Genetics, Hannover Medical School, Hannover, Germany.,Department of Pediatrics III, University Hospital, University of Duisburg-Essen, Duisberg, Germany
| | - Markus Metzler
- Pediatric Hematology and Oncology, University Children's Hospital, Erlangen, Germany
| | - Petr Sedlacek
- Pediatric Hematology and Oncology, Teaching Hospital Motol, 2nd Medical School, Charles University Motol, Prague, Czech Republic
| | - Eveline S J M de Bont
- Pediatric Hematology and Oncology, University Children's Hospital, Groningen, The Netherlands.,Dutch Childhood Oncology Group (DCOG), The Hague, The Netherlands
| | - Adriana Balduzzi
- Pediatric Hematology and Hematopoietic Stem Cell Transplantation Unit, Clinica Pediatrica Università degli Studi di Milano Bicocca, Ospedale San Gerardo, Monza, Italy
| | - Birgitte Lausen
- Department of Pediatric and Adolescent Medicine, University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Olga Aleinikova
- Belarus Research Center for Pediatric Oncology, Hematology, and Immunology, Minsk, Belarus
| | - Sabina Sufliarska
- Department of Pediatrics, BMT Unit, Comenius University Children's Hospital, Bratislava, Slovakia
| | - Günter Henze
- Pediatric Hematology and Oncology, University Children's Hospital, Charité Berlin, Germany
| | - Gabriele Strauss
- Pediatric Hematology and Oncology, University Children's Hospital, Charité Berlin, Germany.,Pediatric Hematology and Oncology, Helios KlinikenBerlin-Buch, Berlin, Germany
| | - Angelika Eggert
- Pediatric Hematology and Oncology, University Children's Hospital, Charité Berlin, Germany
| | - Bernhard Kremens
- Department of Pediatrics III, University Hospital, University of Duisburg-Essen, Duisberg, Germany
| | - Andreas H Groll
- Pediatric Hematology and Oncology, University Children's Hospital, Münster, Germany
| | - Frank Berthold
- Pediatric Hematology and Oncology, University Children's Hospital, Cologne, Germany
| | - Christoph Klein
- University Children's Hospital, Ludwig Maximilians University, Munich, Germany
| | - Ute Groß-Wieltsch
- Pediatric Oncology, Hematology, Immunology, Stuttgart Cancer Center, Klinikum Stuttgart-Olgahospital, Stuttgart, Germany
| | - Karl Walter Sykora
- Paediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Arndt Borkhardt
- Pediatric Hematology, Oncology, and Clinical Immunology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Andreas E Kulozik
- Pediatric Oncology, Hematology, and Immunology, University Children's Hospital, Heidelberg, Germany
| | - Martin Schrappe
- Pediatric Hematology and Oncology, University Children's Hospital, Kiel, Germany
| | - Christina Nowasz
- Pediatric Hematology and Oncology, Department of Pediatrics, University Hospital "Carl Gustav Carus", TU Dresden, Dresden, Germany
| | - Manuela Krumbholz
- Pediatric Hematology and Oncology, University Children's Hospital, Erlangen, Germany
| | - Josephine T Tauer
- Pediatric Hematology and Oncology, Department of Pediatrics, University Hospital "Carl Gustav Carus", TU Dresden, Dresden, Germany.,Shriners Hospitals for Children, Montréal, Canada
| | - Alexander Claviez
- Pediatric Hematology and Oncology, University Children's Hospital, Kiel, Germany
| | - Jochen Harbott
- Oncogenetic Laboratory, Pediatric Hematology and Oncology, University Children's Hospital, Giessen, Germany
| | - Hans H Kreipe
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | | | - Christian Thiede
- Medical Department I, University Hospital "Carl Gustav Carus", TU Dresden, Dresden, Germany
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Tahlan A, Varma N, Naseem S, Bansal D, Binota J, Sood A, Sachdeva MUS, Malhotra P, Varma S. Comparative Study of Clinico-hematological Features, Molecular Spectrum and Response to Imatinib in Chronic Myelogenous Leukemia Patients: Pediatric and Adolescent Versus Adults. Indian J Hematol Blood Transfus 2018; 34:19-24. [PMID: 29398795 DOI: 10.1007/s12288-017-0827-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 05/04/2017] [Indexed: 10/19/2022] Open
Abstract
Chronic myelogenous leukemia (CML) is a rare disease in children, accounting for approximately 3% of leukemias in children and adolescents, with an annual incidence of 1 case per million children in western countries. This study was conducted, at PGIMER, Chandigarh. Ninety eight patients, 48 in children and adolescents group, and 50 in adult group were included in the study. Their hematological profiles along with the bone marrow findings were analyzed. The diagnosis of CML was confirmed by cytogenetics and/or molecular analysis. The complete hematological response (CHR) was analyzed at 3 months and cytogentic response (CgR) at 12 months after starting imatinib therapy. Compared to adults, pediatric and adolescent patients were more symptomatic at presentation (93.5 vs. 75%). Among symptomatic patients, massive splenomegaly (>10 cm), higher total leucocyte and platelet counts were seen more frequently in pediatric patients. The most common transcript in both groups was e14a2. The distribution of pediatric and adolescent cases in Sokal, Hasford and EUTOS score, showed only statistically significant difference for low risk Sokal group, which had more patients in pediatric group. Compared to adults, pediatric and adolescent patients had similar CHR rate (91.3 vs. 92%), but showed lesser major CgR rate (90.9 vs. 95.5%) however, this was not statistically significant.
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Affiliation(s)
- Anita Tahlan
- 1Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Neelam Varma
- 1Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Shano Naseem
- 1Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Deepak Bansal
- 2Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jogeshwar Binota
- 1Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Anil Sood
- 1Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Man Updesh Singh Sachdeva
- 1Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Pankaj Malhotra
- 3Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subhash Varma
- 3Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Gupta P, Rai A, Mukherjee KK, Sachdeva N, Radotra BD, Punia RPS, Vashista RK, Hota D, Srinivasan A, Dhandapani S, Gupta SK, Bhansali A, Dutta P. Imatinib Inhibits GH Secretion From Somatotropinomas. Front Endocrinol (Lausanne) 2018; 9:453. [PMID: 30210447 PMCID: PMC6120347 DOI: 10.3389/fendo.2018.00453] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 07/24/2018] [Indexed: 11/30/2022] Open
Abstract
Background: Imatinib, a tyrosine kinase inhibitor, causes growth failure in children with chronic myeloid leukemia probably by targeting the growth hormone (GH)/insulin like growth factor-1 (IGF-1) axis. We aim to explore the imatinib targets expression in pituitary adenomas and study the effect of imatinib on GH secretion in somatotropinoma cells and GH3 cell line. Materials and Methods: The expression pattern of imatinib's targets (c-kit, VEGF, and PDGFR-α/β) was studied using immunohistochemistry and immunoblotting 157 giant (≥4 cm) pituitary adenomas (121 non-functioning pituitary adenomas, 32 somatotropinomas, and four prolactinomas) and compared to normal pituitary (n = 4) obtained at autopsy. The effect imatinib on GH secretion, cell viability, immunohistochemistry, electron microscopy, and apoptosis was studied in primary culture of human somatotropinomas (n = 20) and in rat somato-mammotroph GH3 cell-line. A receptor tyrosine kinase array was applied to human samples to identify altered pathways. Results: Somatotropinomas showed significantly higher immunopositivity for c-kit and platelet-derived growth factor receptor-β (PDGFR-β; P < 0.009 and P < 0.001, respectively), while staining for platelet-derived growth factor receptor-α (PDGFR-α) and vascular endothelial growth factor (VEGF) revealed a weaker expression (P < 0.001) compared to normal pituitary. Imatinib inhibited GH secretion from both primary culture (P < 0.01) and GH3 cells (P < 0.001), while it did not affect cell viability and apoptosis. The receptor tyrosine kinase array showed that imatinib inhibits GH signaling via PDGFR-β pathway. Conclusion: Imatinib inhibits GH secretion in somatotropinoma cells without affecting cell viability and may be used as an adjunct therapy for treating GH secreting pituitary adenomas.
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Affiliation(s)
- Prakamya Gupta
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashutosh Rai
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kanchan Kumar Mukherjee
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naresh Sachdeva
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bishan Das Radotra
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Raj Pal Singh Punia
- Department of Histopathology, Government Medical College and Hospital, Chandigarh, India
| | - Rakesh Kumar Vashista
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Debasish Hota
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anand Srinivasan
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sivashanmugam Dhandapani
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Kumar Gupta
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anil Bhansali
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pinaki Dutta
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- *Correspondence: Pinaki Dutta
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Suttorp M, Bornhäuser M, Metzler M, Millot F, Schleyer E. Pharmacology and pharmacokinetics of imatinib in pediatric patients. Expert Rev Clin Pharmacol 2017; 11:219-231. [PMID: 29076384 DOI: 10.1080/17512433.2018.1398644] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The tyrosine kinase inhibitor (TKI) imatinib was rationally designed to target BCR-ABL1 which is constitutively activated in chronic myeloid leukemia (CML). Following the tremendous success in adults, imatinib also became licensed for treatment of CML in minors. The rarity of pediatric CML hampers the conduction of formal trials. Thus, imatinib is still the single TKI approved for CML treatment in childhood. Areas covered: This review attempts to provide an overview of the literature on pharmacology, pharmacokinetic, and pharmacogenetic of imatinib concerning pediatric CML treatment. Articles were identified through a PubMed search and by reviewing abstracts from relevant hematology congresses. Additional information was provided from the authors' libraries and expertise and from our own measurements of imatinib trough plasma levels in children. Pharmacokinetic variables (e.g. alpha 1-acid glycoprotein binding, drug-drug/food-drug interactions via cytochrome P450 3A4/5, cellular uptake mediated via OCT-1-influx variations and P-glycoprotein-mediated drug efflux) still await to be addressed in pediatric patients systematically. Expert commentary: TKI response rates vary among different individuals and pharmacokinetic variables all can influence CML treatment success. Adherence to imatinib intake may be the most prominent factor influencing treatment outcome in teenagers thus pointing towards the potential benefits of regular drug monitoring.
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Affiliation(s)
- Meinolf Suttorp
- a Pediatric Hematology and Oncology , University Hospital 'Carl Gustav Carus' , Dresden , Germany
| | - Martin Bornhäuser
- b I. Medical Clinic , University Hospital 'Carl Gustav Carus' , Dresden , Germany
| | - Markus Metzler
- c Department of Paediatrics and Adolescent Medicine , University Hospital Erlangen , Erlangen , Germany
| | - Frédéric Millot
- d Pediatric Oncology Unit , CIC 802 INSERM, University Hospital , Poitiers , France
| | - Eberhard Schleyer
- b I. Medical Clinic , University Hospital 'Carl Gustav Carus' , Dresden , Germany
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Abstract
Background In the last decade, the use of imatinib has brought a paradigm shift in the management of chronic myeloid leukemia (CML). In India, imatinib has been available for more than a decade and has been made accessible to all segments of the population because of patient assistance programs and cheaper generic versions. Despite improvements in survival, there are unique challenges in the Indian context. Methods We reviewed published data pertaining to CML in India for the period of 1990 to 2016, using PubMed advanced search with the terms chronic myeloid leukemia and India, and included studies that reported on epidemiology, monitoring for therapy, treatment outcomes, and resistance. Additionally, the references in retrieved articles were also reviewed. Results Thirty-seven studies were identified. The incidence of CML may be slightly lower in India than in the West, but there was only a single article reporting population-based data. Indian patients presented with more advanced disease. Most centers have access to imatinib as first-line therapy, but there is limited availability of molecular monitoring and second-line therapy. Most of the outcome data were retrospective but seemed comparable with that reported in Western centers. Drug adherence was impaired in at least one third of patients and contributed to poor survival. Conclusion Focused prospective studies and cooperative studies might improve the quality of data available. Future studies should focus on adherence, its effects on outcomes, and methods to address this problem.
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Affiliation(s)
- Prasanth Ganesan
- , Cancer Institute (WIA), Chennai; and , All India Institute of Medical Sciences, New Delhi, India
| | - Lalit Kumar
- , Cancer Institute (WIA), Chennai; and , All India Institute of Medical Sciences, New Delhi, India
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40
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Lee JW, Cho B. Prognostic factors and treatment of pediatric acute lymphoblastic leukemia. KOREAN JOURNAL OF PEDIATRICS 2017; 60:129-137. [PMID: 28592975 PMCID: PMC5461276 DOI: 10.3345/kjp.2017.60.5.129] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 03/30/2017] [Accepted: 04/11/2017] [Indexed: 12/13/2022]
Abstract
The event-free survival (EFS) for pediatric acute lymphoblastic leukemia (ALL) has shown remarkable improvement in the past several decades. In Korea also, a recent study showed 10-year EFS of 78.5%. Much of the improved outcome for pediatric ALL stems from the accurate identification of prognostic factors, the designation of risk group based on these factors, and treatment of appropriate duration and intensity according to risk group, done within the setting of cooperative clinical trials. The schema of first-line therapy for ALL remains mostly unchanged, although many groups have now reported on the elimination of cranial irradiation in all patients with low rates of central nervous system relapse. Specific high risk subgroups, such as Philadelphia chromosome-positive (Ph+) ALL and infant ALL continue to have significantly lower survival than other ALL patients. The introduction of tyrosine kinase inhibitors into therapy has led to enhanced outcome for Ph+ ALL patients. Infant ALL patients, particularly those with MLL rearrangements, continue to have poor outcome, despite treatment intensification including allogeneic hematopoietic cell transplantation. Relapsed ALL is a leading cause of mortality in pediatric cancer. Recent advances in immunotherapy targeting the CD19 of the ALL blast have shown remarkable efficacy in some of these relapsed and refractory patients. With improved survival, much of the current focus is on decreasing the long-term toxicities of treatment.
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Affiliation(s)
- Jae Wook Lee
- Division of Hematology and Oncology, Department of Pediatrics, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Bin Cho
- Division of Hematology and Oncology, Department of Pediatrics, The Catholic University of Korea, College of Medicine, Seoul, Korea
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Choeyprasert W, Yansomdet T, Natesirinilkul R, Wejaphikul K, Charoenkwan P. Adverse effects of imatinib in children with chronic myelogenous leukemia. Pediatr Int 2017; 59:286-292. [PMID: 27541072 DOI: 10.1111/ped.13136] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 07/19/2016] [Accepted: 08/16/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Imatinib mesylate (IM) is a selective tyrosine kinase inhibitor and is approved for indefinite treatment of pediatric chronic myelogenous leukemia (CML). Potential side-effects regarding growth failure and bone metabolism have been reported but data are still scarce in pediatric CML. METHODS Six chronic-phase CML children on IM treatment with a median age of 9.87 years (range, 5.33-12.67 years) were enrolled in the study. Growth, bone mineral density (BMD), bone parameters, 25(OH)-vitamin D3 (25-OHD3) and blood tests including parathyroid hormone, insulin-like growth factor-1 (IGF-1), IGF binding protein 3, thyroid function test and sex hormones were assessed. RESULTS Median duration of IM treatment was 78.5 months. Height velocity was suppressed during the first 30 months of treatment and improved gradually afterwards. Two patients (33.3%) had decreased lumbar spine BMD z-scores (<1.5 SD). Patients with decreased BMD had higher mean IM exposure time than those with normal BMD. The majority of patients (n = 5) had low 25-OHD3 (<30 ng/mL), but there was no correlation between BMD and 25-OHD3 status. Other blood tests were normal. CONCLUSIONS This study supports and confirms the need for monitoring the side-effects of IM treatment on growth, bone density and vitamin D status in pediatric CML. Prolonged IM treatment was associated with low BMD without disturbing bone parameters. There was high prevalence of vitamin D insufficiency. Therefore, the beneficial effect of vitamin D supplement should be explored with regard to the effects on height velocity and BMD in CML patients with vitamin D insufficiency.
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Affiliation(s)
- Worawut Choeyprasert
- Division of Pediatric Hematology-Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Thitinun Yansomdet
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Rungrote Natesirinilkul
- Division of Pediatric Hematology-Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Karn Wejaphikul
- Division of Pediatric Endocrinology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pimlak Charoenkwan
- Division of Pediatric Hematology-Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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42
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Proschmann R, Baldow C, Rothe T, Suttorp M, Thiede C, Tauer JT, Müller MC, Hochhaus A, Roeder I, Glauche I. Response dynamics of pediatric patients with chronic myeloid leukemia on imatinib therapy. Haematologica 2016; 102:e39-e42. [PMID: 27856510 DOI: 10.3324/haematol.2016.154138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Rick Proschmann
- Faculty of Medicine Carl Gustav Carus, Institute for Medical Informatics and Biometry, Technische Universität Dresden, Mannheim, Germany
| | - Christoph Baldow
- Faculty of Medicine Carl Gustav Carus, Institute for Medical Informatics and Biometry, Technische Universität Dresden, Mannheim, Germany
| | - Tino Rothe
- Faculty of Medicine Carl Gustav Carus, Institute for Medical Informatics and Biometry, Technische Universität Dresden, Mannheim, Germany
| | - Meinolf Suttorp
- Pediatric Hematology and Oncology, Department of Pediatrics, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Mannheim, Germany
| | - Christian Thiede
- Department of Internal Medicine, Medical Clinic I, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Mannheim, Germany
| | - Josephine T Tauer
- Pediatric Hematology and Oncology, Department of Pediatrics, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Mannheim, Germany
| | - Martin C Müller
- Department of Internal Medicine, Medical Clinic III, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
| | - Andreas Hochhaus
- Abteilung Hämatologie/Onkologie, Klinik für Innere Medizin II, Universitätsklinikum Jena, Germany
| | - Ingo Roeder
- Faculty of Medicine Carl Gustav Carus, Institute for Medical Informatics and Biometry, Technische Universität Dresden, Mannheim, Germany.,National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany
| | - Ingmar Glauche
- Faculty of Medicine Carl Gustav Carus, Institute for Medical Informatics and Biometry, Technische Universität Dresden, Mannheim, Germany
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43
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Complicaciones endocrinas precoces en supervivientes de neoplasias infantiles. Med Clin (Barc) 2016; 147:329-333. [DOI: 10.1016/j.medcli.2016.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 05/31/2016] [Accepted: 06/02/2016] [Indexed: 11/21/2022]
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44
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Karalexi MA, Baka M, Ryzhov A, Zborovskaya A, Dimitrova N, Zivkovic S, Eser S, Antunes L, Sekerija M, Zagar T, Bastos J, Demetriou A, Agius D, Florea M, Coza D, Polychronopoulou S, Stiakaki E, Moschovi M, Hatzipantelis E, Kourti M, Graphakos S, Pombo-de-Oliveira MS, Adami HO, Petridou ET. Survival trends in childhood chronic myeloid leukaemia in Southern-Eastern Europe and the United States of America. Eur J Cancer 2016; 67:183-190. [PMID: 27677054 DOI: 10.1016/j.ejca.2016.08.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 08/02/2016] [Accepted: 08/16/2016] [Indexed: 02/07/2023]
Abstract
AIM To assess trends in survival and geographic disparities among children (0-14 years) with chronic myeloid leukaemia (CML) before and after the introduction of molecular therapy, namely tyrosine kinase inhibitors (TKIs) in Southern-Eastern European (SEE) countries and the USA. METHODS We calculated survival among children with CML, acute lymphoblastic (ALL) and acute myeloid leukaemia (AML) in 14 SEE (1990-2014) cancer registries and the U.S. Surveillance, Epidemiology and End Results Program (SEER, 1990-2012). We used Kaplan-Meier curves and multivariate Cox regression models to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). RESULTS Among 369 CML cases, substantial improvements were noted in 2-year survival during the post-TKI (range: 81-89%) compared to pre-TKI period (49-66%; HR: 0.37, 95% CI: 0.23-0.60). Risk of death was three times higher for <5-year-old children versus those aged 10-14 years (HR: 3.03, 95% CI: 1.85-4.94) and 56% higher for those living in SEE versus SEER (HR: 1.56, 95% CI: 1.01-2.42). Regardless of geographic area and period of TKI administration, however, age seems to be a significant determinant of CML prognosis (pre-TKI period, HR0-4y: 2.71, 95% CI: 1.53-4.79; post-TKI period, HR0-4y: 3.38, 95% CI: 1.29-8.85). Noticeably, post-TKI survival in CML overall approximates that for ALL, whereas therapeutic advancements for AML remain modest. CONCLUSION Registry data show that introduction of molecular therapies coincides with revolutionised therapeutic outcomes in childhood CML entailing dramatically improved survival which is now similar to that in ALL. Given that age disparities in survival remain substantial, offering optimal therapy to entire populations is an urgent priority.
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Affiliation(s)
- Maria A Karalexi
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, 75 Mikras Asias Str, Athens, 11527, Greece
| | - Margarita Baka
- Department of Pediatric Hematology-Oncology, "Pan & Agl. Kyriakou" Children's Hospital, Thivon and Papadiamantopoulou Str, 11527, Athens, Greece
| | - Anton Ryzhov
- National Cancer Registry of Ukraine, National Institute of Cancer, Lomonosova str, 33/43, Kyiv, 03022, Ukraine
| | - Anna Zborovskaya
- Belarusian Research Center for Pediatric Oncology, Hematology and Immunology, Childhood Cancer Subregistry of Belarus, Lesnoe-2, 223040, Minsk Region, Belarus
| | - Nadya Dimitrova
- Bulgarian National Cancer Registry, National Oncology Hospital, 6, Plovdivsko Pole Street, Sofia, 1756, Bulgaria
| | - Snezana Zivkovic
- Institute of Public Health of Serbia, Dr Subotica 5, Belgrade, 11000, Serbia
| | - Sultan Eser
- Izmir Cancer Registry, Izmir Hub, Izmir & Hacettepe University Institute of Public Health, Zubeyde Hanim Caddesi No:100, Karsiyaka, Izmir, 35067, Turkey
| | - Luis Antunes
- North Region Cancer Registry of Portugal (RORENO), Portuguese Oncology Institute of Porto, Rua António Bernardino da Almeida, Porto, 4200-072, Portugal
| | - Mario Sekerija
- Croatian National Cancer Registry, Croatian Institute of Public Health, Rockefellerova 7, Zagreb, 10000, Croatia
| | - Tina Zagar
- Cancer Registry of Republic of Slovenia, Institute of Oncology, Zaloška cesta 2, SI-1000, Ljubljana, Slovenia
| | - Joana Bastos
- Central Region Cancer Registry of Portugal (ROR-Centro), Portuguese Oncology Institute of Coimbra, Av. Bissaya Barreto 98, 3000-075, Coimbra, Portugal
| | - Anna Demetriou
- Cyprus Cancer Registry-Health Monitoring Unit, Ministry of Health, 1 Prodromou Str & 17 Chilonos Str, Nicosia, 1448, Cyprus
| | - Domenic Agius
- Malta National Cancer Registry, Department of Health Information and Research, 95, Guardamangia Hill, Guardamangia, MSD 08, Malta
| | - Margareta Florea
- Regional Cancer Registry of Iasio, National Institute of Public Health, 14 Victor Babes Street 700465, Iasi, Romania
| | - Daniela Coza
- Regional Cancer Registry of Cluj, Oncological Institute "Ion Chiricuta", Republicii Str no. 34-36, Cluj Napoca, 400015, Romania
| | - Sophia Polychronopoulou
- Department of Pediatric Haematology-Oncology, "Aghia Sophia" Children's Hospital, Thivon and Livadias, Goudi, Athens, 115 27, Greece
| | - Eftichia Stiakaki
- Department of Pediatric Hematology-Oncology, University of Crete, University Hospital of Heraklion, Arsinois 23, Heraklion Crete, 71303, Greece
| | - Maria Moschovi
- Haematology-Oncology Unit, First Department of Pediatrics, Athens University Medical School, "Aghia Sophia" Children's Hospital, Thivon and Livadias, Goudi, Athens, 115 27, Greece
| | - Emmanuel Hatzipantelis
- 2nd Department of Pediatrics, Aristotelion University of Thessaloniki, AHEPA General Hospital, Thessaloniki, Greece
| | - Maria Kourti
- Department of Pediatric Hematology and Oncology, Hippokration Hospital, Konstantinoupoleos Str 49, Thessaloniki, 54642, Greece
| | - Stelios Graphakos
- Stem Cell Transplantion Unit, Aghia Sophia Children's Hospital, Thivon and Livadias, Goudi, Athens, 115 27, Greece
| | - Maria S Pombo-de-Oliveira
- Pediatric Hematology-Oncology Program, Research Center, Instituto Nacional de Câncer, Rua Andre Cavalcanti, 37, Rio de Janeiro, 20230-130, Brazil
| | - Hans Olov Adami
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Harvard T.H., Chan School of Public Health, Boston, MA, USA; Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Kirkeveien 166, Frederik Holsts hus, Oslo, 0450, Norway
| | - Eleni Th Petridou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, 75 Mikras Asias Str, Athens, 11527, Greece.
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Samis J, Lee P, Zimmerman D, Arceci RJ, Suttorp M, Hijiya N. Recognizing Endocrinopathies Associated With Tyrosine Kinase Inhibitor Therapy in Children With Chronic Myelogenous Leukemia. Pediatr Blood Cancer 2016; 63:1332-8. [PMID: 27100618 DOI: 10.1002/pbc.26028] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 03/18/2016] [Indexed: 01/19/2023]
Abstract
Side effects of tyrosine kinase inhibitor (TKI) treatment vary in children and adults with chronic myelogenous leukemia (CML). As children have a much longer life expectancy than adults, TKI therapy may continue for decades and with long-term consequences that differ from adults. Children may develop endocrinopathies related to "off-target" effects of TKIs, such as delayed growth, changes in bone metabolism, thyroid abnormalities, and effects on puberty and fertility. These endocrinopathies present additional challenges for pediatric patients with CML. This review critically evaluates the literature on long-term endocrine side effects of TKIs in the pediatric CML population and provides suggested recommendations.
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Affiliation(s)
- Jill Samis
- Division of Pediatric Endocrinology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Paul Lee
- Division of Pediatric Hematology Oncology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Donald Zimmerman
- Division of Pediatric Endocrinology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Robert J Arceci
- Department of Child Health, The Ron Matricaria Institute of Molecular Medicine at Phoenix Children's Hospital, University of Arizona College of Medicine, Phoenix, Arizona
| | - Meinolf Suttorp
- Pediatric Hematology, Oncology & Stem Cell Transplantation, Department of Pediatrics, Children's Hospital, Technical University of Dresden, Dresden, Germany
| | - Nobuko Hijiya
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Division of Pediatric Hematology Oncology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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46
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Chaudhury S, Sparapani R, Hu ZH, Nishihori T, Abdel-Azim H, Malone A, Olsson R, Hamadani M, Daly A, Bacher U, Wirk BM, Kamble RT, Gale RP, Wood WA, Hale G, Wiernik PH, Hashmi SK, Marks D, Ustun C, Munker R, Savani BN, Alyea E, Popat U, Sobecks R, Kalaycio M, Maziarz R, Hijiya N, Saber W. Outcomes of Allogeneic Hematopoietic Cell Transplantation in Children and Young Adults with Chronic Myeloid Leukemia: A CIBMTR Cohort Analysis. Biol Blood Marrow Transplant 2016; 22:1056-1064. [PMID: 26964698 DOI: 10.1016/j.bbmt.2016.02.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 02/16/2016] [Indexed: 12/13/2022]
Abstract
Chronic myeloid leukemia (CML) in children and young adults is uncommon. Young patients have long life expectancies and low morbidity with hematopoietic cell transplantation (HCT). Prolonged tyrosine kinase inhibitor (TKI) use may cause significant morbidity. In addition, indication for HCT in patients in the first chronic phase is not established. We hence retrospectively evaluated outcomes in 449 CML patients with early disease receiving myeloablative HCT reported to the CIBMTR. We analyzed various factors affecting outcome, specifically the effect of age and pre-HCT TKI in pediatric patients (age < 18 years, n = 177) and young adults (age 18 to 29 years, n = 272) with the goal of identifying prognostic factors. Post-HCT probability rates of 5-year overall survival (OS) and leukemia-free survival (LFS) were 75% and 59%, respectively. Rates of OS and LFS were 76% and 57% in <18-year and 74% and 60% in 18- to 29-year group, respectively, by univariate analysis (P = .1 and = .6). Five-year rates of OS for HLA matched sibling donor (MSD) and bone marrow (BM) stem cell source were 83% and 80%, respectively. In multivariate analysis there was no effect of age (<18 versus 18 to 29) or pre-HCT TKI therapy on OS, LFS, transplant related mortality, or relapse. Favorable factors for OS were MSD (P < .001) and recent HCT (2003 to 2010; P = .04). LFS was superior with MSD (P < .001), BM as graft source (P = .001), and performance scores > 90 (P = .03) compared with unrelated or mismatched peripheral blood stem cells donors and recipients with lower performance scores. Older age was associated with increased incidence of chronic graft-versus-host disease (P = .0002). In the current era, HCT outcomes are similar in young patients and children with early CML, and best outcomes are achieved with BM grafts and MSD.
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Affiliation(s)
- Sonali Chaudhury
- Department of Pediatrics-Hematology, Oncology and Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Rodney Sparapani
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Zhen-Huan Hu
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Taiga Nishihori
- Department of Blood & Marrow Transplantation, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Hisham Abdel-Azim
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Adriana Malone
- Bone Marrow and Stem Cell Transplantation, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Richard Olsson
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Mehdi Hamadani
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Froedtert Memorial Lutheran Hospital, Milwaukee, Wisconsin
| | - Andrew Daly
- Cumming School of Medicine, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
| | - Ulrike Bacher
- Interdisciplinary Clinic for Stem Cell Transplantation, University Cancer Centre Hamburg, Hamburg, Germany
| | - Baldeep M Wirk
- Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, Washington
| | - Rammurti T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine Center for Cell and Gene Therapy, Houston, Texas
| | - Robert P Gale
- Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, UK
| | - William A Wood
- Division of Hematology/Oncology, University of North Carolina, Chapel Hill, North Carolina
| | - Gregory Hale
- Department of Hematology/Oncology, All Children's Hospital, St. Petersburg, Florida
| | | | - Shahrukh K Hashmi
- Department of Blood and Marrow Transplantation, Mayo Clinic, Rochester, Minnesota
| | - David Marks
- Pediatric Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, UK
| | - Celalettin Ustun
- Division of Hematology, Oncology, and Transplantation, University of Minneapolis, Minneapolis, Minnesota
| | - Reinhold Munker
- Section of Hematology/Oncology, Department of Internal Medicine, Louisiana State University Health Shreveport, Shreveport, Louisiana
| | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Edwin Alyea
- Division of Hematologic Malignancies and Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Uday Popat
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ronald Sobecks
- Blood and Marrow Transplant Program, Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | - Matt Kalaycio
- Blood and Marrow Transplant Program, Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | - Richard Maziarz
- Adult Blood and Marrow Stem Cell Transplant Program, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | - Nobuko Hijiya
- Department of Pediatrics-Hematology, Oncology and Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Wael Saber
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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47
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Tanizawa A. Optimal management for pediatric chronic myeloid leukemia. Pediatr Int 2016; 58:171-9. [PMID: 26646444 DOI: 10.1111/ped.12876] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 11/19/2015] [Accepted: 12/01/2015] [Indexed: 12/11/2022]
Abstract
Chronic myeloid leukemia (CML) is rare among childhood leukemias. Its incidence increases with age, from 0.09/100 000 at ≤15 years old to 7.88/100 000 at ≥75 years old. There are several biological and clinical differences between pediatric and adult CML. Markedly increased leukocyte count and a higher incidence of splenomegaly are characteristic features at diagnosis in pediatric patients. The therapeutic approach to CML has changed since the introduction of the tyrosine kinase inhibitor (TKI) imatinib, followed by dasatinib and nilotinib. Given the efficacy of TKI in adult CML, TKI are regarded as the established first-line treatment in adult patients. In 2011, a prospective phase IV study in pediatric patients showed the excellent efficacy and safety of imatinib. Imatinib is also accepted as a first-line option for childhood chronic phase CML. Although the efficacy of dasatinib and nilotinib reported in adult studies seems very attractive for pediatric patients, neither drug has been prospectively investigated in a large pediatric cohort. TKI are designed to inhibit BCR-ABL1 kinase, but they have unfavorable effects, so-called "off-target" complications, such as growth impairment. Long-term morbidity due to TKI is unknown. Furthermore, the adverse effects on growing children have not been clearly elucidated, even though the exposure period to imatinib is relatively short. To establish the standard therapeutic management for pediatric CML, it is important to prospectively confirm the attractive outcomes obtained in adult studies via pediatric clinical trials with a careful monitoring system for TKI-induced adverse effects, especially in growing children.
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Affiliation(s)
- Akihiko Tanizawa
- Department of Human Resource Development for Cancer, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
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48
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Bleckmann K, Schrappe M. Advances in therapy for Philadelphia-positive acute lymphoblastic leukaemia of childhood and adolescence. Br J Haematol 2016; 172:855-69. [DOI: 10.1111/bjh.13896] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Kirsten Bleckmann
- Department of Paediatrics; University Medical Centre Schleswig-Holstein; Kiel Germany
| | - Martin Schrappe
- Department of Paediatrics; University Medical Centre Schleswig-Holstein; Kiel Germany
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49
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Broglie L, Hijiya N, Helenowski IB, Dilley K, Schneiderman J, Tse W, Duerst R, Kletzel M, Morgan E, Chaudhury S. Long-term follow-up of children with chronic myeloid leukemia after hematopoietic stem cell transplantation and tyrosine kinase inhibitor therapy. Leuk Lymphoma 2015; 57:949-52. [PMID: 26694579 DOI: 10.3109/10428194.2015.1065981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Larisa Broglie
- a Department of Pediatrics, Division of Hematology , Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - Nobuko Hijiya
- a Department of Pediatrics, Division of Hematology , Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - Irene B Helenowski
- b Department of Preventive Medicine , Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - Kimberley Dilley
- a Department of Pediatrics, Division of Hematology , Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - Jen Schneiderman
- a Department of Pediatrics, Division of Hematology , Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - William Tse
- a Department of Pediatrics, Division of Hematology , Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - Reggie Duerst
- a Department of Pediatrics, Division of Hematology , Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - Morris Kletzel
- a Department of Pediatrics, Division of Hematology , Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - Elaine Morgan
- a Department of Pediatrics, Division of Hematology , Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - Sonali Chaudhury
- a Department of Pediatrics, Division of Hematology , Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine , Chicago , IL , USA
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Abstract
Abstract
The past 70 years have seen childhood acute lymphoblastic leukemia move from a fatal disease with a survival of barely 4 months to a curable disease in >85% of patients. It has become clear that as treatment has intensified, more children are cured but at the expense of increased toxicity which for some can cause significant long-term morbidity and even mortality. The drive in more recent years has been to identify sensitive markers of disease and response to treatment to allow a reduction in therapy in those who do not require it and more intensive treatment in those who do. Clinical characteristics have been used to stratify patients into different risk groups and this, coupled with following response at a molecular level, has done much to tailor treatment to the patient. Considerable research has been focused on the molecular characteristics of the leukemia itself to elucidate the biologic mechanisms underlying both the disease and the comparative or absolute resistance of some types of leukemia. These molecular markers can also act as targets for novel therapies, which require newer trial methodologies to prove their utility. There has been less focus on the biology of the patient but it is clear that some patients are more susceptible to adverse events and toxicities than others. Through the use of pharmacogenomics, modification to therapy may be appropriate in certain patients based on their genetic profile. As novel therapies become available, suitable controlled trials in children are essential for their safe use in this population and will ensure that children are not denied timely access to advances in treatment.
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