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Al-Kali A, Tibes R, Atherton P, Palmer J, Alkhateeb HB, Patnaik M, Begna K, Gangat N, Hashmi S, He R, Litzow M. A phase II study of combination daunorubicin, cytarabine (Ara-c), and nilotinib (TAsigna) (DATA) in patients newly diagnosed with acute myeloid leukemia with KIT expression. Am J Hematol 2023; 98:472-480. [PMID: 36625066 DOI: 10.1002/ajh.26831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 12/09/2022] [Accepted: 12/14/2022] [Indexed: 01/11/2023]
Abstract
Acute myeloid leukemia (AML) is a challenging cancer in terms of achieving and maintaining long-duration remissions. Many novel therapies have been added to the standard regimen (combining cytarabine and anthracycline "7 + 3") to achieve such goals. Nilotinib is an oral multikinase inhibitor that is active against KIT tyrosine kinase, an important stem cell target. In this trial, we combined nilotinib with 7 + 3 induction (daunorubicin 60 mg/m2), high-dose cytarabine consolidation, and subsequently, if the patient was a candidate, for 2 years' maintenance therapy in patients with AML and KIT (CD117) expression. Patients were allowed to proceed to allogeneic hematopoietic cell transplantation (HCT) if deemed necessary. Our primary goal was increased complete remission rate with this combination. Thirty-four patients (with a median age 58.5 years) were enrolled on a single-arm phase II bi-institutional study; 21 (62%) patients achieved remission. The complete remission rate was 78% in evaluable patients. Thirteen of 34 (38%) patients had allogeneic HCT, all thirteen of which are still alive (100%). Common (>20%) grade 3 non-hematological toxicities included febrile neutropenia, hypophosphatemia, elevated liver enzymes, and hypertension. Only one patient (3%) died in induction due to liver failure, which was thought secondary to daunorubicin. Our current study reveals good outcomes in patients who received HCT and may warrant a larger study to confirm our findings in that specific population.
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Affiliation(s)
- Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Raoul Tibes
- AstraZeneca, Cambridge, UK.,Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Pamela Atherton
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeanne Palmer
- Division of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, Arizona, USA
| | | | - Mrinal Patnaik
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kebede Begna
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Naseema Gangat
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Shahrukh Hashmi
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rong He
- Division of hematopathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark Litzow
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
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Murray HC, Miller K, Brzozowski JS, Kahl RGS, Smith ND, Humphrey SJ, Dun MD, Verrills NM. Synergistic Targeting of DNA-PK and KIT Signaling Pathways in KIT Mutant Acute Myeloid Leukemia. Mol Cell Proteomics 2023; 22:100503. [PMID: 36682716 PMCID: PMC9986649 DOI: 10.1016/j.mcpro.2023.100503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 12/19/2022] [Accepted: 01/13/2023] [Indexed: 01/21/2023] Open
Abstract
Acute myeloid leukemia (AML) is the most common and aggressive form of acute leukemia, with a 5-year survival rate of just 24%. Over a third of all AML patients harbor activating mutations in kinases, such as the receptor tyrosine kinases FLT3 (receptor-type tyrosine-protein kinase FLT3) and KIT (mast/stem cell growth factor receptor kit). FLT3 and KIT mutations are associated with poor clinical outcomes and lower remission rates in response to standard-of-care chemotherapy. We have recently identified that the core kinase of the non-homologous end joining DNA repair pathway, DNA-PK (DNA-dependent protein kinase), is activated downstream of FLT3; and targeting DNA-PK sensitized FLT3-mutant AML cells to standard-of-care therapies. Herein, we investigated DNA-PK as a possible therapeutic vulnerability in KIT mutant AML, using isogenic FDC-P1 mouse myeloid progenitor cell lines transduced with oncogenic mutant KIT (V560G and D816V) or vector control. Targeted quantitative phosphoproteomic profiling identified phosphorylation of DNA-PK in the T2599/T2605/S2608/S2610 cluster in KIT mutant cells, indicative of DNA-PK activation. Accordingly, proliferation assays revealed that KIT mutant FDC-P1 cells were more sensitive to the DNA-PK inhibitors M3814 or NU7441, compared with empty vector controls. DNA-PK inhibition combined with inhibition of KIT signaling using the kinase inhibitors dasatinib or ibrutinib, or the protein phosphatase 2A activators FTY720 or AAL(S), led to synergistic cell death. Global phosphoproteomic analysis of KIT-D816V cells revealed that dasatinib and M3814 single-agent treatments inhibited extracellular signal-regulated kinase and AKT (RAC-alpha serine/threonine-protein kinase)/MTOR (serine/threonine-protein kinase mTOR) activity, with greater inhibition of both pathways when used in combination. Combined dasatinib and M3814 treatment also synergistically inhibited phosphorylation of the transcriptional regulators MYC and MYB. This study provides insight into the oncogenic pathways regulated by DNA-PK beyond its canonical role in DNA repair and demonstrates that DNA-PK is a promising therapeutic target for KIT mutant cancers.
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Affiliation(s)
- Heather C Murray
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, and Hunter Cancer Research Alliance and Precision Medicine Program, Hunter Medical Research Institute, Callaghan, New South Wales, Australia
| | - Kasey Miller
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, and Hunter Cancer Research Alliance and Precision Medicine Program, Hunter Medical Research Institute, Callaghan, New South Wales, Australia
| | - Joshua S Brzozowski
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, and Hunter Cancer Research Alliance and Precision Medicine Program, Hunter Medical Research Institute, Callaghan, New South Wales, Australia
| | - Richard G S Kahl
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, and Hunter Cancer Research Alliance and Precision Medicine Program, Hunter Medical Research Institute, Callaghan, New South Wales, Australia
| | - Nathan D Smith
- Analytical and Biomolecular Research Facility, Advanced Mass Spectrometry Unit, University of Newcastle, Callaghan, New South Wales, Australia
| | - Sean J Humphrey
- School of Life and Environmental Sciences, and The Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Matthew D Dun
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, and Hunter Cancer Research Alliance and Precision Medicine Program, Hunter Medical Research Institute, Callaghan, New South Wales, Australia
| | - Nicole M Verrills
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, and Hunter Cancer Research Alliance and Precision Medicine Program, Hunter Medical Research Institute, Callaghan, New South Wales, Australia.
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Nabil R, Hassan NM, Abdellateif MS, Gawdat RM, Elshazly SS. The prognostic role of C-KIT, TET1 and TET2 gene expression in Acute Myeloid Leukemia. Mol Biol Rep 2023; 50:641-653. [PMID: 36371552 PMCID: PMC9884250 DOI: 10.1007/s11033-022-08000-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/03/2022] [Indexed: 11/15/2022]
Abstract
AIM was to assess the role of C-KIT, TET1 and TET2 expression in the diagnosis and prognosis of acute myeloblastic leukemia (AML). METHODS The expression levels of C-KIT, TET1 and TET2 were assessed in the bone marrow (BM) aspirate of 152 AML patients compared to 20 healthy control using quantitative real-time polymerase chain reaction (qRT-PCR). Data were correlated with the clinico-pathological features of the patients, response to treatment, disease-free survival (DFS), and overall survival (OS) rates. RESULTS C-KIT, TET1 and TET2 were significantly upregulated in AML patients [0.25 (0-11.6), 0.0113 (0-3.301), and 0.07 (0-4); respectively], compared to the control group [0.013 (0.005-0.250), P < 0.001, 0.001 (0-0.006), P < 0.001, and 0.02 (0.008-0.055), P = 0.019; respectively]. The sensitivity, specificity, and area under curve of of C-KIT were (48.7%, 100%, 0.855; respectively, P = 0.001), and that of TET1 were (63.4%, 100%, 0.897; respectively, P = 0.001), while that of TET2 were (56.8%, 100%, 0.766; respectively, P = 0.019). When combining the three markers, the sensitivity was 77.5%, however it reached the highest sensitivity (78.6%) and specificity (100%) when combining both c-KIT + TET1 together for the diagnosis of AML. C-KIT overexpression associated with shorter DFS (P = 0.05) and increased incidence of relapse (P = 0.019). Lymph nodes involvement [HR = 2.200, P = 0.005] is an independent risk factor for shorter OS rate of AML patients. Increased BM blast % [HR = 7.768, P = 0.002], and FLT3-ITD mutation [HR = 2.989, P = 0.032] are independent risk factors for shorter DSF rate of the patients. CONCLUSION C-KIT, TET1, and TET2 could be used as possible useful biomarkers for the diagnosis of AML.
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Affiliation(s)
- Reem Nabil
- Clinical pathology Department, National Cancer Institute, Cairo University, Giza, Egypt
| | - Naglaa M Hassan
- Clinical pathology Department, National Cancer Institute, Cairo University, Giza, Egypt
| | - Mona S Abdellateif
- Medical Biochemistry and molecular biology, Cancer Biology Department, National Cancer Institute, Cairo University, Giza, Egypt.
| | - Rania M Gawdat
- Clinical and chemical pathology department, Faculty of medicine, Beni Suef university, Beni Suef, Egypt
| | - Samar Sami Elshazly
- Clinical pathology Department, National Cancer Institute, Cairo University, Giza, Egypt
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4
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Thakral D, Gupta R, Khan A. Leukemic stem cell signatures in Acute myeloid leukemia- targeting the Guardians with novel approaches. Stem Cell Rev Rep 2022; 18:1756-1773. [DOI: 10.1007/s12015-022-10349-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2022] [Indexed: 11/09/2022]
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Advani AS, Tse W, Li H, Jia X, Elson P, Cooper B, Ali-Osman F, Park J, Rao AV, Rizzieri DA, Wang ES, Cotta CV, Kalaycio M, Sobecks RM, Rouphail B, Maciejewski JP, Fensterl J, Carew JS, Foster B, Rush ML, Tripp B, Adams D, Corrigan D, Griffiths EA, Sekeres MA. A Phase II Trial of Imatinib Mesylate as Maintenance Therapy for Patients With Newly Diagnosed C-kit-positive Acute Myeloid Leukemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 21:113-118. [PMID: 33422470 DOI: 10.1016/j.clml.2020.11.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Adults with acute myeloid leukemia (AML) have a high rate of remission; however, more than 50% relapse. C-kit is expressed in approximately 60% of patients with de novo AML and represents a potential therapeutic target. MATERIALS AND METHODS Patients with newly diagnosed AML received 12 months of imatinib mesylate as maintenance therapy after the completion of post-remission therapy. The primary objective was to determine whether this approach improved progression-free survival (defined as no relapse and no death) compared with historical controls. RESULTS The median progression-free survival of patients < 60 years of age was 52.1 months (historical control, 13 months) and for patients ≥ 60 years of age was 10.7 months (historical control, 8 months). The median level of AF1q expression was high (9.59), and 84% of patients had moderate or high levels of drug-resistance factors. CONCLUSIONS Imatinib maintenance therapy may improve the outcome of newly diagnosed patients with AML who are < 60 years of age.
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Affiliation(s)
- Anjali S Advani
- Department of Hematology/ Oncology, Cleveland Clinic Taussig Cancer Institute Leukemia Program, Cleveland, OH.
| | - William Tse
- Department of Hematology/ Oncology, Metro Health, Cleveland, OH
| | - Hong Li
- Cleveland Clinic, Quantitative Health Sciences, Cleveland, OH
| | - Xuefei Jia
- Cleveland Clinic, Quantitative Health Sciences, Cleveland, OH
| | - Paul Elson
- Cleveland Clinic, Quantitative Health Sciences, Cleveland, OH
| | - Brenda Cooper
- Department of Hematology/ Oncology, University Hospitals of Cleveland, Cleveland, OH
| | | | - Jino Park
- James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY
| | - Arati V Rao
- Duke Cancer Institute, Duke University, Durham, NC; Current affiliation: PACT Pharma, South San Francisco, CA
| | | | - Eunice S Wang
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY
| | | | - Matt Kalaycio
- Department of Hematology/ Oncology, Cleveland Clinic Taussig Cancer Institute Leukemia Program, Cleveland, OH
| | - Ronald M Sobecks
- Department of Hematology/ Oncology, Cleveland Clinic Taussig Cancer Institute Leukemia Program, Cleveland, OH
| | - Basel Rouphail
- Department of Hematology/ Oncology, Cleveland Clinic Taussig Cancer Institute Leukemia Program, Cleveland, OH
| | - Jaroslaw P Maciejewski
- Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Jaime Fensterl
- Department of Hematology/ Oncology, Cleveland Clinic Taussig Cancer Institute Leukemia Program, Cleveland, OH
| | - Jennifer S Carew
- University of Arizona Cancer Center, Leon Levy Cancer Center, Tuscon, AZ
| | - Bethany Foster
- Department of Hematology/ Oncology, Cleveland Clinic Taussig Cancer Institute Leukemia Program, Cleveland, OH
| | - Mary Lynn Rush
- Department of Hematology/ Oncology, Cleveland Clinic Taussig Cancer Institute Leukemia Program, Cleveland, OH
| | - Barbara Tripp
- Department of Hematology/ Oncology, Cleveland Clinic Taussig Cancer Institute Leukemia Program, Cleveland, OH
| | - Donna Adams
- Department of Hematology/ Oncology, Duke University, Durham, NC
| | - Donna Corrigan
- Department of Hematology/ Oncology, Cleveland Clinic Taussig Cancer Institute Leukemia Program, Cleveland, OH
| | | | - Mikkael A Sekeres
- Department of Hematology/ Oncology, Cleveland Clinic Taussig Cancer Institute Leukemia Program, Cleveland, OH
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Martini V, Bernardi S, Giordano A, Comazzi S. Flow cytometry expression pattern of CD44 and CD18 markers on feline leukocytes. J Vet Diagn Invest 2020; 32:706-709. [PMID: 32718218 DOI: 10.1177/1040638720945670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The paucity of specific feline antibodies for flow cytometry (FC) is an ongoing challenge. Flow cytometrists must extrapolate information from relatively few markers. We evaluated the expression pattern of the panleukocyte markers CD18 and CD44 on leukocyte (white blood cell, WBC) subclasses in the peripheral blood (PB) of 14 healthy cats. The degree of expression of CD18 and CD44 was calculated as the ratio between the median fluorescence intensity (MFI) value of antibody-stained cells and autofluorescence. All samples were acquired with the same cytometer with constant photomultiplier setting and compensation matrices. Both molecules were expressed at higher levels on monocytes, intermediate levels on polymorphonuclear cells (PMNs), and lower levels on lymphocytes. CD18-MFI discriminated well among the 3 populations, whereas CD44-MFI mostly overlapped between monocytes and PMNs. However, CD44-MFI had a lower intra-population variability. Evaluation of CD18 and CD44, together with morphologic parameters, was useful for discriminating among WBC subclasses in healthy cats. This information may be helpful for future studies given that an increase in CD18-MFI may indicate reactive changes, whereas fluctuations in CD44-MFI may suggest neoplasia.
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Affiliation(s)
- Valeria Martini
- Department of Veterinary Medicine (Martini, Bernardi, Giordano, Comazzi) and Veterinary Teaching Hospital (Martini, Bernardi, Giordano, Comazzi), University of Milan, Lodi, Italy
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7
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NCAM1 (CD56) promotes leukemogenesis and confers drug resistance in AML. Blood 2019; 133:2305-2319. [PMID: 30814062 DOI: 10.1182/blood-2018-12-889725] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 02/21/2019] [Indexed: 02/07/2023] Open
Abstract
Neural cell adhesion molecule 1 (NCAM1; CD56) is expressed in up to 20% of acute myeloid leukemia (AML) patients. NCAM1 is widely used as a marker of minimal residual disease; however, the biological function of NCAM1 in AML remains elusive. In this study, we investigated the impact of NCAM1 expression on leukemogenesis, drug resistance, and its role as a biomarker to guide therapy. Beside t(8;21) leukemia, NCAM1 expression was found in most molecular AML subgroups at highly heterogeneous expression levels. Using complementary genetic strategies, we demonstrated an essential role of NCAM1 in the regulation of cell survival and stress resistance. Perturbation of NCAM1 induced cell death or differentiation and sensitized leukemic blasts toward genotoxic agents in vitro and in vivo. Furthermore, Ncam1 was highly expressed in leukemic progenitor cells in a murine leukemia model, and genetic depletion of Ncam1 prolonged disease latency and significantly reduced leukemia-initiating cells upon serial transplantation. To further analyze the mechanism of the NCAM1-associated phenotype, we performed phosphoproteomics and transcriptomics in different AML cell lines. NCAM1 expression strongly associated with constitutive activation of the MAPK-signaling pathway, regulation of apoptosis, or glycolysis. Pharmacological inhibition of MEK1/2 specifically inhibited proliferation and sensitized NCAM1+ AML cells to chemotherapy. In summary, our data demonstrate that aberrant expression of NCAM1 is involved in the maintenance of leukemic stem cells and confers stress resistance, likely due to activation of the MAPK pathway. Targeting MEK1/2 sensitizes AML blasts to genotoxic agents, indicating a role for NCAM1 as a biomarker to guide AML treatment.
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Velasco-Hernandez T, Soneji S, Hidalgo I, Erlandsson E, Cammenga J, Bryder D. Hif-1α Deletion May Lead to Adverse Treatment Effect in a Mouse Model of MLL-AF9-Driven AML. Stem Cell Reports 2018; 12:112-121. [PMID: 30595549 PMCID: PMC6335588 DOI: 10.1016/j.stemcr.2018.11.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/30/2018] [Accepted: 11/30/2018] [Indexed: 12/14/2022] Open
Abstract
Relapse of acute myeloid leukemia (AML) remains a significant clinical challenge due to limited therapeutic options and poor prognosis. Leukemic stem cells (LSCs) are the cellular units responsible for relapse in AML, and strategies that target LSCs are thus critical. One proposed potential strategy to this end is to break the quiescent state of LSCs, thereby sensitizing LSCs to conventional cytostatics. The hypoxia-inducible factor (HIF) pathway is a main driver of cellular quiescence and a potential therapeutic target, with precedence from both solid cancers and leukemias. Here, we used a conditional knockout Hif-1α mouse model together with a standard chemotherapy regimen to evaluate LSC targeting in AML. Contrary to expectation, our studies revealed that Hif-1α-deleted-leukemias displayed a faster disease progression after chemotherapy. Our studies thereby challenge the general notion of cancer stem cell sensitization by inhibition of the HIF pathway, and warrant caution when applying HIF inhibition in combination with chemotherapy in AML. Deletion of Hif-1α accelerates the progression of chemotherapy-treated MLL-AF9-AML Deletion of Hif-1α does not decrease LSC frequency after chemotherapy Chemotherapy targets more mature cells indicated by transcriptional analysis Hif-1α deletion affects few transcriptional pathways in AML cells
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Affiliation(s)
- Talia Velasco-Hernandez
- Division of Molecular Hematology, Lund Stem Cell Center, Lund University, BMC B12, Sölvegatan 17, 22184 Lund, Sweden.
| | - Shamit Soneji
- Division of Molecular Hematology, Lund Stem Cell Center, Lund University, BMC B12, Sölvegatan 17, 22184 Lund, Sweden
| | - Isabel Hidalgo
- Division of Molecular Hematology, Lund Stem Cell Center, Lund University, BMC B12, Sölvegatan 17, 22184 Lund, Sweden
| | - Eva Erlandsson
- Division of Molecular Hematology, Lund Stem Cell Center, Lund University, BMC B12, Sölvegatan 17, 22184 Lund, Sweden
| | - Jörg Cammenga
- Department of Hematology, Linköping University Hospital, 58183 Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, 58183 Linköping, Sweden
| | - David Bryder
- Division of Molecular Hematology, Lund Stem Cell Center, Lund University, BMC B12, Sölvegatan 17, 22184 Lund, Sweden; Sahlgrenska Cancer Center, Gothenburg University, 40530 Gothenburg, Sweden.
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Larsen CM, Villarraga HR, Begna KH, Litzow MR, Al-Kali A, Herrmann J. Cardiovascular effects of the addition of nilotinib to standard therapy for acute myeloid leukemia. Leuk Lymphoma 2017; 59:229-232. [PMID: 28592197 DOI: 10.1080/10428194.2017.1323268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Carolyn M Larsen
- a Department of Cardiovascular Medicine , Mayo Clinic , Rochester , MN , USA
| | - Hector R Villarraga
- a Department of Cardiovascular Medicine , Mayo Clinic , Rochester , MN , USA
| | - Kebede H Begna
- b Division of Hematology, Department of Medicine , Mayo Clinic , Rochester , MN , USA
| | - Mark R Litzow
- b Division of Hematology, Department of Medicine , Mayo Clinic , Rochester , MN , USA
| | - Aref Al-Kali
- b Division of Hematology, Department of Medicine , Mayo Clinic , Rochester , MN , USA
| | - Joerg Herrmann
- a Department of Cardiovascular Medicine , Mayo Clinic , Rochester , MN , USA
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Zheng Z, Li X, Zhu Y, Gu W, Xie X, Jiang J. Prognostic nomogram for previously untreated adult patients with acute myeloid leukemia. Oncotarget 2016; 7:71526-71535. [PMID: 27689396 PMCID: PMC5342098 DOI: 10.18632/oncotarget.12245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 09/19/2016] [Indexed: 12/26/2022] Open
Abstract
This study was designed to perform an acceptable prognostic nomogram for acute myeloid leukemia. The clinical data from 311 patients from our institution and 165 patients generated with Cancer Genome Atlas Research Network were reviewed. A prognostic nomogram was designed according to the Cox's proportional hazard model to predict overall survival (OS). To compare the capacity of the nomogram with that of the current prognostic system, the concordance index (C-index) was used to validate the accuracy as well as the calibration curve. The nomogram included 6 valuable variables: age, risk stratifications based on cytogenetic abnormalities, status of FLT3-ITD mutation, status of NPM1 mutation, expression of CD34, and expression of HLA-DR. The C-indexes were 0.71 and 0.68 in the primary and validation cohort respectively, which were superior to the predictive capacity of the current prognostic systems in both cohorts. The nomogram allowed both patients with acute myeloid leukemia and physicians to make prediction of OS individually prior to treatment.
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Affiliation(s)
- Zhuojun Zheng
- Department of Hematology, The Third Affiliated Hospital of Soochow University, China.,Department of Tumor Biological Treatment, The Third Affiliated Hospital of Soochow University, China.,Cancer Immunotherapy Engineering Research Center of Jiangsu Province, China.,Institute of Cell Therapy, Soochow University, China
| | - Xiaodong Li
- Department of Tumor Biological Treatment, The Third Affiliated Hospital of Soochow University, China.,Cancer Immunotherapy Engineering Research Center of Jiangsu Province, China.,Institute of Cell Therapy, Soochow University, China.,Department of Oncology, The Third Affiliated Hospital of Soochow University, China
| | - Yuandong Zhu
- Department of Hematology, The Third Affiliated Hospital of Soochow University, China
| | - Weiying Gu
- Department of Hematology, The Third Affiliated Hospital of Soochow University, China
| | - Xiaobao Xie
- Department of Hematology, The Third Affiliated Hospital of Soochow University, China
| | - Jingting Jiang
- Department of Tumor Biological Treatment, The Third Affiliated Hospital of Soochow University, China.,Cancer Immunotherapy Engineering Research Center of Jiangsu Province, China.,Institute of Cell Therapy, Soochow University, China
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García-Dabrio MC, Hoyos M, Brunet S, Tormo M, Ribera JM, Esteve J, Gallardo D, Duarte RF, de Llano MPQ, Bargay J, Martí-Tutusaus JM, Heras I, Garcia A, Salamero O, Aventin A, Lecrevisse Q, Orfao A, Sierra J, Nomdedéu JF. Complex measurements may be required to establish the prognostic impact of immunophenotypic markers in AML. Am J Clin Pathol 2015; 144:484-92. [PMID: 26276779 DOI: 10.1309/ajcprl6xsvfmlh9v] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES The prognostic impact of immunophenotypic markers in acute myeloid leukemia (AML) is controversial. METHODS We retrospectively analyzed the value of CD34, CD117, CD7, and CD123 expression in a consecutive series of 592 adult patients with de novo AML. RESULTS CD34+ measured as a percentage (≥2.88%) and CD34 mean fluorescence intensity (MFI) (≥146.79, arbitrary units [AU]) expression had a prognostic impact in terms of overall survival (OS; P = .005, P = .003), leukemia-free survival (LFS; P = .011, P < .001), and cumulative incidence of relapse (CIR; P = .014, P =. 001). The percentage of CD117+ cells (61.29%) was associated with shorter LFS (P =. 043), and CD117 MFI (≥284.01 AU) was associated with a shorter OS (P =. 033) and LFS (P =. 028). In the multivariate analysis, high CD34 MFI retained the independent value as predictor of LFS and CIR (P =. 012; hazard ratio [HR], 1.59; 95% confidence interval [CI], 1.11-2.28 and P =. 045; HR, 1.58; 95% CI, 1.01-2.46). CONCLUSIONS CD34 positivity threshold with prognostic relevance is low (3% positive cells). Immunophenotypic findings in AML probably could only be fully exploited after a complex analysis that takes into account unconventional thresholds and the MFI.
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Affiliation(s)
| | - Montserrat Hoyos
- Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona, Spain
| | - Salut Brunet
- Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona, Spain
| | - Mar Tormo
- Department of Hematology, Hospital Clínic, Valencia, Spain
| | - Josep-Maria Ribera
- Department of Hematology, Hospital ICO Germans Trias i Pujol, Badalona, Spain
| | - Jordi Esteve
- Department of Hematology, Hospital Clínic, IDIBAPS, Barcelona, Spain
| | - David Gallardo
- Department of Hematology, Hospital ICO Hospital Josep Trueta, Girona, Spain
| | - Rafael F. Duarte
- Department of Hematology, Hospital ICO Duran i Reynalds, L’Hospitalet, Barcelona, Spain
| | | | - Joan Bargay
- Department of Hematology, Hospital Sont Llatzer, Palma de Mallorca, Spain
| | | | - Inmaculada Heras
- Department of Hematology, Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Antoni Garcia
- Department of Hematology, Hospital Arnau de Vilanova, Lleida, Spain
| | - Olga Salamero
- Department of Hematology, Hospital de la Vall d’ Hebrón, Barcelona, Spain; and
| | | | - Quentin Lecrevisse
- Cancer Research Center (IBMCC, USAL-CSIC), Department of Medicine and Cytometry Service (NUCLEUS), University of Salamanca (USAL) and Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain, on behalf of the Spanish CETLAM Group
| | - Alberto Orfao
- Cancer Research Center (IBMCC, USAL-CSIC), Department of Medicine and Cytometry Service (NUCLEUS), University of Salamanca (USAL) and Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain, on behalf of the Spanish CETLAM Group
| | - Jorge Sierra
- Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona, Spain
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12
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Gelain ME, Martini V, Giantin M, Aricò A, Poggi A, Aresu L, Riondato F, Dacasto M, Comazzi S. CD44 in canine leukemia: analysis of mRNA and protein expression in peripheral blood. Vet Immunol Immunopathol 2014; 159:91-6. [PMID: 24629892 DOI: 10.1016/j.vetimm.2014.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 02/17/2014] [Accepted: 02/19/2014] [Indexed: 02/01/2023]
Abstract
Hyaluronan receptor CD44 mediates interaction between cells and extracellular matrix. The expression of standard form and its variants is dysregulated in human leukemias and is associated with metastasis and prognosis. The aim of this work is the evaluation of CD44 mRNA and protein expression in canine leukemia. Peripheral blood from 20 acute leukemias (AL) (10 acute lymphoblastic, 6 acute myeloid and 4 acute undifferentiated leukemias), 21 chronic lymphocytic leukemias (CLL) and thirteen healthy dogs were collected. The mRNA expression of all CD44 variants presenting exons 1-5 and/or 16-20 (CD44_ex1-5 and CD44_ex16-20) and CD44 protein were determined by real-time RT-PCR and flow cytometry, using the mean fluorescent index (MFI), respectively. CD44 MFI was significantly higher in leukemic samples compared to controls and a higher expression was found in AL in respect with CLL. No significant differences were found when considering different phenotypic subtypes of AL and CLL. CD44_ex1-5 mRNA expression was significantly higher in AL compared to controls, whereas there was no difference in CLL compared to controls and AL. CD44_es16-20 showed the same trend, but without differences among groups. The high CD44 expression found in canine leukemias could be considered a step toward the definition of their molecular features.
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Affiliation(s)
- M E Gelain
- Dipartimento di Biomedicina Comparata e Alimentazione, Università degli Studi di Padova, viale Università 16, 35020 Agripolis-Legnaro, PD, Italy.
| | - V Martini
- Dipartimento di Scienze Veterinarie e Sanità Pubblica, Università degli Studi di Milano, via Celoria 10, 20133 Milano, Italy
| | - M Giantin
- Dipartimento di Biomedicina Comparata e Alimentazione, Università degli Studi di Padova, viale Università 16, 35020 Agripolis-Legnaro, PD, Italy
| | - A Aricò
- Dipartimento di Biomedicina Comparata e Alimentazione, Università degli Studi di Padova, viale Università 16, 35020 Agripolis-Legnaro, PD, Italy
| | - A Poggi
- Dipartimento di Scienze veterinarie, Università degli Studi di Torino, via Leonardo da Vinci 44, 10095 Grugliasco, TO, Italy
| | - L Aresu
- Dipartimento di Biomedicina Comparata e Alimentazione, Università degli Studi di Padova, viale Università 16, 35020 Agripolis-Legnaro, PD, Italy
| | - F Riondato
- Dipartimento di Scienze veterinarie, Università degli Studi di Torino, via Leonardo da Vinci 44, 10095 Grugliasco, TO, Italy
| | - M Dacasto
- Dipartimento di Biomedicina Comparata e Alimentazione, Università degli Studi di Padova, viale Università 16, 35020 Agripolis-Legnaro, PD, Italy
| | - S Comazzi
- Dipartimento di Scienze Veterinarie e Sanità Pubblica, Università degli Studi di Milano, via Celoria 10, 20133 Milano, Italy
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13
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Giantin M, Aresu L, Aricò A, Gelain ME, Riondato F, Comazzi S, Dacasto M. Evaluation of tyrosine-kinase receptor c-kit mutations, mRNA and protein expression in canine lymphoma: might c-kit represent a therapeutic target? Vet Immunol Immunopathol 2013; 154:153-9. [PMID: 23791075 DOI: 10.1016/j.vetimm.2013.05.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 04/15/2013] [Accepted: 05/22/2013] [Indexed: 12/14/2022]
Abstract
c-kit plays an important role in proliferation, survival and differentiation of hematopoietic progenitor cells. In human hematopoietic malignancies, c-kit is mostly expressed by progenitor cell neoplasms and seldom by mature cell neoplasms. Aim of this study was to evaluate c-kit expression in canine lymphoma. Twenty-five B-cell lymphomas and 21 T-cell lymphomas were enrolled in the study. c-kit mRNA and protein expression was measured in lymph node fine needle aspirates by quantitative real-time RT-PCR, flow cytometry and immunocytochemistry, while the occurrence of KIT mutations on exons 8-11 and 17 was investigated by direct cDNA sequencing. KIT mRNA was amplifiable but below the limit of quantification in 76% of B-cell lymphomas and 33% of T-cell lymphomas. Remaining samples showed a very low expression of KIT, except for some high grade (HG) T-cell lymphomas where a comparatively higher mRNA amount was observed. Transcriptional data were confirmed at the protein level. No gain-of-function mutations were observed. Among canine lymphomas, T-cell lymphoma typically shows an aggressive biological behavior, partly being attributable to the lack of efficacious treatment options, and the evidence of c-kit expression in HG T-cell lymphomas might represent the rationale for its routinely diagnostic evaluation and the use of tyrosine kinase inhibitors in future clinical trials.
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Affiliation(s)
- M Giantin
- Dipartimento di Biomedicina Comparata e Alimentazione, Università degli Studi di Padova, viale Università 16, 35020 Agripolis-Legnaro Padova, Italy.
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14
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Lee-Sherick AB, Eisenman KM, Sather S, McGranahan A, Armistead PM, McGary CS, Hunsucker SA, Schlegel J, Martinson H, Cannon C, Keating AK, Earp HS, Liang X, DeRyckere D, Graham DK. Aberrant Mer receptor tyrosine kinase expression contributes to leukemogenesis in acute myeloid leukemia. Oncogene 2013; 32:5359-68. [PMID: 23474756 PMCID: PMC3898106 DOI: 10.1038/onc.2013.40] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 12/14/2012] [Accepted: 12/30/2012] [Indexed: 01/13/2023]
Abstract
Acute myeloid leukemia (AML) continues to be extremely difficult to treat successfully, and the unacceptably low overall survival rates mandate that we assess new potential therapies to ameliorate poor clinical response to conventional therapy. Abnormal tyrosine kinase activation in AML has been associated with poor prognosis and provides strategic targets for novel therapy development. We found that Mer receptor tyrosine kinase was over-expressed in a majority of pediatric (29/36, 80%) and adult (10/10, 100%) primary AML patient blasts at the time of diagnosis, and 100% of patient samples at the time of relapse. Mer was also found to be expressed in 12 of 14 AML cell lines (86%). In contrast, normal bone marrow myeloid precursors expressed little to no Mer. Following AML cell line stimulation with Gas6, a Mer ligand, we observed activation of prosurvival and proliferative signaling pathways, including phosphorylation of ERK1/2, p38, MSK1, CREB, ATF1, AKT and STAT6. To assess the phenotypic role of Mer in AML, two independent short-hairpin RNA (shRNA) constructs were used to decrease Mer expression in the AML cell lines Nomo-1 and Kasumi-1. Reduction of Mer protein levels significantly increased rates of myeloblast apoptosis two to threefold in response to serum starvation. Furthermore, myeloblasts with knocked-down Mer demonstrated decreased colony formation by 67-87%, relative to control cell lines (P<0.01). NOD-SCID-gamma mice transplanted with Nomo-1 myeloblasts with reduced levels of Mer had a significant prolongation in survival compared with mice transplanted with the parental or control cell lines (median survival 17 days in parental and control cell lines, versus 32-36 days in Mer knockdown cell lines, P<0.0001). These data suggest a role for Mer in acute myeloid leukemogenesis and indicate that targeted inhibition of Mer may be an effective therapeutic strategy in pediatric and adult AML.
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Affiliation(s)
- A B Lee-Sherick
- Department of Pediatrics, Division of Hematology, Oncology, and Bone Marrow Transplantation, Aurora, CO, USA
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15
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Giantin M, Aresu L, Aricò A, Gelain ME, Riondato F, Martini V, Comazzi S, Dacasto M. Evaluation of tyrosine-kinase receptor c-KIT (c-KIT) mutations, mRNA and protein expression in canine leukemia: might c-KIT represent a therapeutic target? Vet Immunol Immunopathol 2013; 152:325-32. [PMID: 23375718 DOI: 10.1016/j.vetimm.2013.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 12/28/2012] [Accepted: 01/09/2013] [Indexed: 11/26/2022]
Abstract
The tyrosine-kinase receptor c-KIT (c-KIT) plays an important role in proliferation, survival and differentiation of progenitor cells in normal hematopoietic cells. In human hematological malignancies, c-KIT is mostly expressed by progenitor cell neoplasia and seldom by those involving mature cells. Tyrosine kinase inhibitors (TKIs) are actually licensed for the first- and second-line treatment of human hematologic disorders. Aim of the present study was to evaluate c-KIT mRNA and protein expression and complementary DNA (cDNA) mutations in canine leukemia. Eleven acute lymphoblastic leukemia (ALL) and acute undifferentiated leukemia (AUL) and 12 chronic lymphocytic leukemia (CLL) were enrolled in this study. The amounts of c-KIT mRNA and protein were determined, in peripheral blood samples, by using quantitative real time RT-PCR, flow cytometry and immunocytochemistry, respectively. The presence of mutations on c-KIT exons 8-11 and 17 were investigated by cDNA sequencing. Higher amounts of c-KIT mRNA were found in ALL/AUL compared to CLL, and this latter showed a lower pattern of gene expression. Transcriptional data were confirmed at the protein level. No significant gain-of-function mutations were ever observed in both ALL/AUL and CLL. Among canine hematological malignancies, ALL/AUL typically show a very aggressive biological behavior, partly being attributable to the lack of efficacious therapeutic options. The high level of c-KIT expression found in canine ALL/AUL might represent the rationale for using TKIs in future clinical trials.
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Affiliation(s)
- M Giantin
- Dipartimento di Biomedicina Comparata e Alimentazione, Università di Padova, viale Università 16, Agripolis-Legnaro, Padua, Italy.
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16
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Ouerhani S, Gharbi H, Menif S, Safra I, Douzi K, Abbes S. KIT mutation detection in Tunisian patients with newly diagnosed myelogenous leukemia: prevalence and prognostic significance. Cancer Genet 2012; 205:436-41. [PMID: 22939396 DOI: 10.1016/j.cancergen.2012.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 04/19/2012] [Accepted: 05/15/2012] [Indexed: 11/28/2022]
Abstract
The KIT gene encodes a class III tyrosine kinase receptor in which specific somatic mutations have been found to be associated with many diseases. In this work, we investigated the prevalence of KIT mutations in patients with chronic and acute myelogenous leukemia (CML and AML) and their prognostic significance. A total of 157 subjects were included in the present study (84 patients with CML, 33 with AML, and 40 healthy controls). Patients were analyzed at the first diagnosis, and the KIT mutations were screened by polymerase chain reaction (PCR) and direct sequencing technologies. The results demonstrated the presence of a G/A transition at codon 796, which is associated with the R796K protein variation. This mutation was detected at 21.42% in the CML subgroup and was absent in both AML patients and healthy controls; however, no correlation was found between this mutation and clinical parameters such as the molecular response to Gleevec. In conclusion, we retain that the KIT gene is highly mutated in the CML subgroup, but its role as a prognostic factor needs to be further elucidated.
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Affiliation(s)
- Slah Ouerhani
- Laboratory of Molecular and Cellular Haematology, Pasteur Institute of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Thomadaki H, Floros KV, Pavlovic S, Tosic N, Gourgiotis D, Colovic M, Scorilas A. Overexpression of the novel member of the BCL2 gene family, BCL2L12, is associated with the disease outcome in patients with acute myeloid leukemia. Clin Biochem 2012; 45:1362-7. [DOI: 10.1016/j.clinbiochem.2012.06.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 05/31/2012] [Accepted: 06/12/2012] [Indexed: 10/28/2022]
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18
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Yang Y, Huang Q, Lu Y, Li X, Huang S. Reactivating PP2A by FTY720 as a novel therapy for AML with C-KIT tyrosine kinase domain mutation. J Cell Biochem 2012; 113:1314-22. [PMID: 22109829 DOI: 10.1002/jcb.24003] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The tyrosine kinase domain (TKD) mutations of receptor tyrosine kinase C-KIT are associated with a poor prognosis in acute myeloid leukemia (AML). However, the underlying mechanisms are not fully understood. We found the activity of protein phosphatase 2A (PP2A), a human tumor suppressor whose dysfunction contributes to malignant cell behavior, was significantly decreased in AML subgroups harboring C-KIT/D816V and AML cell line Kasumi-1 bearing C-KIT/N822K mutation. Primary AML cells and various AML cell lines were treated with PP2A activator FTY720. FTY720 showed a toxic effect in all leukemic cells, especially for cells harboring C-KIT/TKD mutation. Furthermore, FTY720-induced toxicity in AML leukemic cells was mediated by restoration of PP2A activity, via down-regulation of PP2A inhibitor SET, dephosporylation of PP2A-C(TYR307), and up-regulation of relevant PP2A subunit A and B55α. Our research indicates that the decreased PP2A activity in AML harboring C-KIT/TKD mutation may make the restoration of PP2A activity a novel therapy for AML patients with C-KIT/TKD mutation.
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Affiliation(s)
- Yan Yang
- Center for Stem Cell Research and Application, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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19
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Hoffmann MH, Klausen TW, Boegsted M, Larsen SF, Schmitz A, Leinoe EB, Schmiegelow K, Hasle H, Bergmann OJ, Sorensen S, Nyegaard M, Dybkaer K, Johnsen HE. Clinical impact of leukemic blast heterogeneity at diagnosis in cytogenetic intermediate-risk acute myeloid leukemia. CYTOMETRY PART B: CLINICAL CYTOMETRY 2012; 82B:123-131. [DOI: 10.1002/cyto.b.20633] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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20
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Cesano A, Rosen DB, O'Meara P, Putta S, Gayko U, Spellmeyer DC, Cripe LD, Sun Z, Uno H, Litzow MR, Tallman MS, Paietta E. Functional pathway analysis in acute myeloid leukemia using single cell network profiling assay: effect of specimen source (bone marrow or peripheral blood) on assay readouts. CYTOMETRY PART B-CLINICAL CYTOMETRY 2012; 82:158-72. [PMID: 22334473 DOI: 10.1002/cyto.b.21007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 12/06/2011] [Accepted: 12/17/2011] [Indexed: 11/05/2022]
Abstract
BACKGROUND Single cell network profiling (SCNP) is used to simultaneously measure the effects of modulators on signaling networks at the single cell level. SCNP-based biomarker assays predictive of response to induction therapy and relapse risk in acute myeloid leukemia (AML) patients are being developed. Such assays have typically used bone marrow (BM) as the sample source of blasts. Because circulating peripheral blasts are detectable in ∼65% of AML patients and peripheral blood (PB) sampling is less invasive than BM sampling, this study was performed to assess the effect of sample source on AML blasts signaling as measured in SCNP assay. METHODS SCNP using multiparametric flow cytometry was used to evaluate the activation state of intracellular signaling molecules in leukemic blasts under basal conditions and after treatment with modulators in 46 pairs of BM mononuclear cells/PB mononuclear cells. The relationship between readouts of modulated intracellular proteins ("nodes") was measured using linear regression, Bland-Altman method, and Lin's concordance correlation coefficient. RESULTS The majority (156/161) of signaling nodes show strong correlations between paired PB and BM samples independently from the statistical method used. Notable exceptions were two PB samples with almost undetectable levels of circulating blasts compared with paired BM samples. CONCLUSIONS Our results demonstrate that specimen source (BM or PB) does not significantly affect proteomic signaling in patients with AML and circulating blasts. The ability to use PB as a sample source will facilitate the monitoring of cellular signaling effects following administration of targeted therapies and at time points when BM aspirates are not clinically justifiable.
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Affiliation(s)
- Alessandra Cesano
- Clinical Affairs, Nodality Inc., South San Francisco, California 94080, USA.
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21
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Brandwein JM, Hedley DW, Chow S, Schimmer AD, Yee KWL, Schuh AC, Gupta V, Xu W, Kamel-Reid S, Minden MD. A phase I/II study of imatinib plus reinduction therapy for c-kit-positive relapsed/refractory acute myeloid leukemia: inhibition of Akt activation correlates with complete response. Leukemia 2011; 25:945-52. [PMID: 21403650 DOI: 10.1038/leu.2011.34] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This phase I/II study evaluated imatinib as a c-kit inhibitor combined with mitoxantrone, etoposide and cytarabine therapy for patients with primary refractory or relapsed c-kit+ acute myeloid leukemia (AML). Imatinib was escalated through three dose levels in successive six patient cohorts. The combination was well tolerated up to 400 mg/day imatinib. Of 21 patients treated at this dose, 13 (62%) achieved complete response (CR), 7 (33%) were non-responders and one died during induction. The CR rate was 80% in patients with standard-risk karyotype versus 33% in patients with adverse karyotype. The CR rate for primary non-responders was 6/14 (43%) versus 7/7 (100%) for relapsed patients. AML blasts from peripheral blood were assayed for phosphorylated Akt (pAkt) and phosphorylated ERK (pERK) by flow cytometry before to and after imatinib dosing. Of eight patients achieving CR with reinduction, seven demonstrated marked (≥60%) pAkt inhibition with imatinib therapy. In contrast, all the six non-responders to reinduction demonstrated <60% pAkt inhibition (P=0.005). There was no correlation between pERK inhibition and response to therapy. These results indicate that lack of pAkt inhibition in vivo is associated with resistance to reinduction therapy using this regimen. Further studies using agents that are able to inhibit Akt more effectively are warranted.
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Affiliation(s)
- J M Brandwein
- Department of Medical Oncology and Hematology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada.
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Motyckova G, Stone RM. The role of molecular tests in acute myelogenous leukemia treatment decisions. Curr Hematol Malig Rep 2010; 5:109-17. [PMID: 20425404 DOI: 10.1007/s11899-010-0049-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The prognosis for patients with acute myelogenous leukemia (AML) is dependent on age, karyotype, and the genetics of the neoplastic cell. The molecular markers with prognostic impact include mutations in FLT3, NPM1, MLL, WT1, c-KIT, and expression levels of BAALC, NM1, ERG, and CXCR4. Gene expression profiles and microRNA expression patterns in AML may prove highly useful in defining the prognosis of AML. Cytogenetic and, increasingly, molecular findings are used in determining the best therapy for AML patients, especially the choice of whether to perform allogeneic stem cell transplantation.
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Kornblau SM, Minden MD, Rosen DB, Putta S, Cohen A, Covey T, Spellmeyer DC, Fantl WJ, Gayko U, Cesano A. Dynamic single-cell network profiles in acute myelogenous leukemia are associated with patient response to standard induction therapy. Clin Cancer Res 2010; 16:3721-33. [PMID: 20525753 DOI: 10.1158/1078-0432.ccr-10-0093] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE Complete response to induction chemotherapy is observed in approximately 60% of patients with newly diagnosed non-M3 acute myelogenous leukemia (AML). However, no methods exist to predict with high accuracy at the individual patient level the response to standard AML induction therapy. EXPERIMENTAL DESIGN We applied single-cell network profiling (SCNP) using flow cytometry, a tool that allows a comprehensive functional assessment of intracellular signaling pathways in heterogeneous tissues, to two training cohorts of AML samples (n = 34 and 88) to predict the likelihood of response to induction chemotherapy. RESULTS In the first study, univariate analysis identified multiple signaling "nodes" (readouts of modulated intracellular signaling proteins) that correlated with response (i.e., AUC(ROC) > or = 0.66; P < or = 0.05) at a level greater than age. After accounting for age, similar findings were observed in the second study. For patients <60 years old, complete response was associated with the presence of intact apoptotic pathways. In patients > or =60 years old, nonresponse was associated with FLT3 ligand-mediated increase in phosphorylated Akt and phosphorylated extracellular signal-regulated kinase. Results were independent of cytogenetics, FLT3 mutational status, and diagnosis of secondary AML. CONCLUSIONS These data emphasize the value of performing quantitative SCNP under modulated conditions as a basis for the development of tests highly predictive for response to induction chemotherapy. SCNP provides information distinct from other known prognostic factors such as age, secondary AML, cytogenetics, and molecular alterations and is potentially combinable with the latter to improve clinical decision making. Independent validation studies are warranted.
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Affiliation(s)
- Steven M Kornblau
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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24
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Advani AS, Tiu R, Saunthararajah Y, Maciejewski J, Copelan EA, Sobecks R, Sekeres MA, Bates J, Rush ML, Tripp B, Salvado A, Noon E, Howard M, Jin T, Hsi E, Egorin MJ, Lim K, Cotta CV, Price C, Kalaycio M. A Phase 1 study of imatinib mesylate in combination with cytarabine and daunorubicin for c-kit positive relapsed acute myeloid leukemia. Leuk Res 2010; 34:1622-6. [PMID: 20427086 DOI: 10.1016/j.leukres.2010.03.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2010] [Revised: 02/20/2010] [Accepted: 03/09/2010] [Indexed: 11/25/2022]
Abstract
The c-kit receptor is expressed in 95% of relapsed acute myeloid leukemias (AMLs) and mediates leukemic proliferation. We conducted a Phase 1 study of the c-kit inhibitor, imatinib mesylate (IM), in combination with cytarabine and daunorubicin (7+3) in c-kit+ relapsed AML. IM was dose escalated using a 3 by 3 design. Phosphorylated STAT5 was absent to minimally present in residual blasts on day 14 bone marrows. The maximum tolerated dose of IM was 300 mg. The dose-limiting toxicity was Grade 3-4 hepatic toxicity. The CR/CRp rate was 57%. Cytotoxic therapy that includes IM for relapsed AML is well-tolerated and effective.
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Affiliation(s)
- Anjali S Advani
- Department of Hematologic Oncology and Blood Disorders, Cleveland Clinic, Taussig Cancer Institute, Cleveland, OH 44195, USA.
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25
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Han L, Schuringa JJ, Mulder A, Vellenga E. Dasatinib impairs long-term expansion of leukemic progenitors in a subset of acute myeloid leukemia cases. Ann Hematol 2010; 89:861-71. [PMID: 20387067 PMCID: PMC2908401 DOI: 10.1007/s00277-010-0948-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 03/17/2010] [Indexed: 11/25/2022]
Abstract
A number of signaling pathways might be frequently disrupted in acute myeloid leukemia (AML). We questioned whether the dual SRC/ABL kinase inhibitor dasatinib can affect AML cells and whether differences can be observed with normal CD34(+) cells. First, we demonstrated that normal cord blood (CB) CD34(+) cells were unaffected by dasatinib at a low concentration (0.5 nM) in the long-term culture on MS5 stromal cells. No changes were observed in proliferation, differentiation, and colony formation. In a subset of AML cases (3/15), a distinct reduction in cell proliferation was observed, ranging from 48% to 91% inhibition at 0.5 nM of dasatinib, in particular, those characterized by BCR-ABL or KIT mutations. Moreover, the inhibitory effects of dasatinib were cytokine specific. Stem cell factor-mediated proliferation was significantly impaired, associated with a reduced phosphorylation of ERK1/2 and STAT5, whereas no effect was observed on interleukin-3 and thrombopoietin-mediated signaling despite SRC activation. In conclusion, this study demonstrates that dasatinib is a potential inhibitor in a subgroup of AML, especially those that express BCR-ABL or KIT mutations.
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Affiliation(s)
- Lina Han
- Department of Hematology, University of Groningen and University Medical Center Groningen, P.O. Box 30001, 9700 RB Groningen, the Netherlands
- Department of Hematology, The First Clinical College of Harbin Medical University, Harbin, China
| | - Jan Jacob Schuringa
- Department of Hematology, University of Groningen and University Medical Center Groningen, P.O. Box 30001, 9700 RB Groningen, the Netherlands
| | - André Mulder
- Department of Clinical Chemistry, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands
| | - Edo Vellenga
- Department of Hematology, University of Groningen and University Medical Center Groningen, P.O. Box 30001, 9700 RB Groningen, the Netherlands
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27
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Regenbrecht CRA, Lehrach H, Adjaye J. Stemming cancer: functional genomics of cancer stem cells in solid tumors. ACTA ACUST UNITED AC 2009; 4:319-28. [PMID: 18561035 PMCID: PMC2758383 DOI: 10.1007/s12015-008-9034-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cancer stem cells (CSCs) were discovered about 15 years ago in hematopoietic cancers. Subsequently, cancer stem cells were discovered in various solid tumors. Based on parallels with normal stem cells, a developmental process of cancer stem cells follows paths of organized, hierarchical structure of cells with different degrees of maturity. While some investigators have reported particular markers as identification of cancer stem cells, these markers require further research. In this review, we focus on the functional genomics of cancer stem cells. Functional genomics provides useful information on the signaling pathways which are consecutively activated or inactivated amongst those cells. This information is of particular importance for cancer research and clinical treatment in many respects. (1) Understanding of self-renewal mechanisms crucial to tumor growth. (2) Allow the identification of new, more specific marker for CSCs, and (3) pathways that are suitable as future targets for anti-cancer drugs. This is of particular importance, because today's chemotherapy targets the proliferating cancer cells sparing the relatively slow dividing cancer stem cells. The first step on this long road therefore is to analyze genome-wide expression-profiles within the same type of cancer and then between different types of cancer, encircling those target genes and pathways, which are specific to these cells.
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Affiliation(s)
- C R A Regenbrecht
- Department of Vertebrate Genomics, Max Planck Institute for Molecular Genetics (Molecular Embryology and Aging group), Ihnestrasse 73, 14195 Berlin, Germany
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Current Awareness in Hematological Oncology. Hematol Oncol 2008. [DOI: 10.1002/hon.833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Schäfer HS, Becker H, Schmitt-Gräff A, Lübbert M. Granulocytic sarcoma of Core-binding Factor (CBF) acute myeloid leukemia mimicking pancreatic cancer. Leuk Res 2008; 32:1472-5. [PMID: 18456326 DOI: 10.1016/j.leukres.2008.02.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2007] [Revised: 02/10/2008] [Accepted: 02/10/2008] [Indexed: 12/16/2022]
Abstract
Granulocytic sarcoma mimicking a synchronous second primary neoplasm (SPN) constitutes a diagnostic and therapeutic challenge particularly in elderly patients. We report on a 75-year-old female presenting with a Core-binding Factor (CBF) AML of M4eo subtype. The patient also had jaundice, highly elevated bilirubin, lipase, alkaline phosphatase (AP), CA 19-9, and a pancreatic mass highly suspicious of infiltrating pancreatic carcinoma. However, a biopsy demonstrated granulocytic sarcoma. Since the patient had no comorbidities and had been in excellent performance status until the diagnosis of AML, induction chemotherapy was initiated, with subsequent normalization of bilirubin, CA 19-9, lipase and AP. Complete hematologic remission of AML was attained and the pancreatic mass could not be detected anymore. Retrospective analysis of the c-kit protooncogene did not disclose activating mutations of exons 8 or 17. Following one consolidation treatment, the patient remained in excellent health until relapse occurred 7 months later and she succumbed to AML. In conclusion, AML can rarely mimic the clinical picture of pancreatic cancer. The initially good response of this CBF leukemia highlights the principal usefulness of aggressive induction chemotherapy also in older AML patients, if they are carefully selected not only according to biological risk factors such as cytogenetics, but also to "host factors" (good performance status, lack of comorbidities, etc.).
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A Wells D, Loken MR. Flow cytometric mean fluorescence intensity: the biophysics behind the number. Leuk Res 2007; 32:845-6. [PMID: 18023867 DOI: 10.1016/j.leukres.2007.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2007] [Revised: 09/30/2007] [Accepted: 10/03/2007] [Indexed: 10/22/2022]
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