1
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Ferric Carboxymaltose and Erythropoiesis-Stimulating Agent Treatment Reduces the Rate of Blood Transfusion in Refractory Anemia. J Clin Med 2022; 11:jcm11164744. [PMID: 36012983 PMCID: PMC9410338 DOI: 10.3390/jcm11164744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/05/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Erythropoiesis-stimulating agents (ESAs) are used to treat refractory anemia (RA). Guidelines suggest iron supplementation for unresponsive patients, regardless of iron deficiency. The primary aim of this study was to evaluate the effect of iron supplementation with ferric carboxymaltose (FCM) on the reduction of red blood cell transfusion (RBCT) rate in transfusion-dependent RA patients. Methods: This was a prospective quasi-randomized study, wherein patients were randomly assigned into three groups: (A) ESAs alone, (B) ferric gluconate (FG) and ESAs, and (C) FCM and ESAs. Hemoglobin and ferritin levels, as well as the number of RBCTs at 4 and 28 weeks were compared. Economic evaluation was also performed. Results: A total of 113 RA patients were enrolled. In total, 43 were treated with intravenous FG and ESAs, 38 with FCM and ESAs, and 32 with ESAs alone. At both follow-ups, erythropoietic response was increased in those receiving iron as compared with those with ESAs alone (p = 0.001), regardless of the type of iron. At one month, ferritin levels were higher in the FCM and ESA groups (p = 0.001). RBCTs were lower in both iron groups. The less costly treatment strategy was FCM, followed by FG, and lastly ESAs. Conclusions: Addition of iron to ESAs in RA reduced RBCT requirement and improved hemoglobin values.
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2
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Salazar GJT, Ecker A, Adefegha SA, da Costa JGM. Advances in Evaluation of Antioxidant and Toxicological Properties of Stryphnodendron rotundifolium Mart. in Drosophila melanogaster Model. Foods 2022; 11:foods11152236. [PMID: 35954004 PMCID: PMC9368094 DOI: 10.3390/foods11152236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/12/2022] [Accepted: 07/19/2022] [Indexed: 12/10/2022] Open
Abstract
This study investigated the flavonoid content, antioxidant activity, and toxicological properties of the acetone–water fraction of stem bark of Stryphnodendron rotundifolium Mart. (TFSR). The total flavonoid content and antioxidant activity were determined, as typified by DPPH● and ABTS●+ radical scavenging abilities, Fe3+ reducing antioxidant power (FRAP), relative antioxidant capacity (RAC), and the inhibition of thiobarbituric acid reactive species (TBARs) in Drosophila melanogaster tissue. Toxicity and locomotor functions were evaluated in adult D. melanogaster flies through aging and survival assays, startle-induced negative geotaxis, and centrophobic responses with video-assisted open field motion tracking. The flavonoid content of dry TFSR (DF) was 3.36 mg quercetin/g. Furthermore, the significant antioxidant activity of TFSR was revealed through scavenging 95.3% of the ABTS●+ radical and 82.4% of the DPPH● radical, as well reducing 74.7% of Fe3+ in the FRAP assay and 80% Mo6+ in the RAC assay. TFSR conferred 70.25% protection against lipid peroxidation in Drosophila tissue. Survival rates ranged from 84.65 to 103.98% in comparison to the non-supplemented control and no evident deterioration of locomotor functions and centrophobia responses was observed. These results revealed that TFSR has potent antioxidant activity and low toxicity in vivo, profiling TFSR as a promising natural product in the treatment/management of iron overload and associated conditions.
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Affiliation(s)
- Gerson Javier Torres Salazar
- Postgraduate Program in Ethnobiology and Nature Conservation, Regional University of Cariri, Coronel Antônio Luíz Street, 1161-Pimenta, Crato 63105-010, CE, Brazil;
| | - Assis Ecker
- Postgraduate Program in Toxicological Biochemistry, Department of Biochemistry and Molecular Biology, Center of Natural and Exacts Sciences, Federal University of Santa Maria, Santa Maria 97105-900, RS, Brazil; (A.E.); (S.A.A.)
| | - Stephen Adeniyi Adefegha
- Postgraduate Program in Toxicological Biochemistry, Department of Biochemistry and Molecular Biology, Center of Natural and Exacts Sciences, Federal University of Santa Maria, Santa Maria 97105-900, RS, Brazil; (A.E.); (S.A.A.)
- Functional Foods, Nutraceuticals and Phytomedicine Laboratory, Department of Biochemistry, Federal University of Technology, Akure 340001, Nigeria
| | - José Galberto Martins da Costa
- Postgraduate Program in Ethnobiology and Nature Conservation, Regional University of Cariri, Coronel Antônio Luíz Street, 1161-Pimenta, Crato 63105-010, CE, Brazil;
- Postgraduate Program in Biological Chemistry, Regional University of Cariri, Coronel Antônio Luíz Street, 1161-Pimenta, Crato 63105-010, CE, Brazil
- Correspondence: ; Tel.: +55-88-99698-5037
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3
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Parisi S, Finelli C. Prognostic Factors and Clinical Considerations for Iron Chelation Therapy in Myelodysplastic Syndrome Patients. J Blood Med 2021; 12:1019-1030. [PMID: 34887690 PMCID: PMC8651046 DOI: 10.2147/jbm.s287876] [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: 06/17/2021] [Accepted: 09/15/2021] [Indexed: 01/19/2023] Open
Abstract
Iron chelation therapy (ICT) is an important tool in the treatment of transfusion-dependent lower-risk myelodysplastic syndrome (MDS) patients. ICT is effective in decreasing iron overload and consequently in limiting its detrimental effects on several organs, such as the heart, liver, and endocrine glands. Besides this effect, ICT also proved to be effective in improving peripheral cytopenia in a significant number of MDS patients, thus further increasing the clinical interest of this therapeutic tool. In the first part of the review, we will analyze the toxic effect of iron overload and its mechanism. Subsequently, we will revise the clinical role of ICT in various subsets of MDS patients (low, intermediate, and high risk MDS, patients who are candidates for allogeneic stem cell transplantation).
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Affiliation(s)
- Sarah Parisi
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli”, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Carlo Finelli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli”, Bologna, Italy
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4
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Palumbo GA, Galimberti S, Barcellini W, Cilloni D, Di Renzo N, Elli EM, Finelli C, Maurillo L, Ricco A, Musto P, Russo R, Latagliata R. From Biology to Clinical Practice: Iron Chelation Therapy With Deferasirox. Front Oncol 2021; 11:752192. [PMID: 34692534 PMCID: PMC8527180 DOI: 10.3389/fonc.2021.752192] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/08/2021] [Indexed: 01/19/2023] Open
Abstract
Iron chelation therapy (ICT) has become a mainstay in heavily transfused hematological patients, with the aim to reduce iron overload (IOL) and prevent organ damage. This therapeutic approach is already widely used in thalassemic patients and in low-risk Myelodysplastic Syndrome (MDS) patients. More recently, ICT has been proposed for high-risk MDS, especially when an allogeneic bone marrow transplantation has been planned. Furthermore, other hematological and hereditary disorders, characterized by considerable transfusion support to manage anemia, could benefit from this therapy. Meanwhile, data accumulated on how iron toxicity could exacerbate anemia and other clinical comorbidities due to oxidative stress radical oxygen species (ROS) mediated by free iron species. Taking all into consideration, together with the availability of approved oral iron chelators, we envision a larger use of ICT in the near future. The aim of this review is to better identify those non-thalassemic patients who can benefit from ICT and give practical tips for management of this therapeutic strategy.
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Affiliation(s)
- Giuseppe A Palumbo
- Department of Scienze Mediche Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia, " University of Catania, Catania, Italy
| | - Sara Galimberti
- Section of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Wilma Barcellini
- Hematology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico di Milano and University of Milan, Milan, Italy
| | - Daniela Cilloni
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Nicola Di Renzo
- Hematology and Transplant Unit, Ospedale Vito Fazzi, Lecce, Italy
| | - Elena Maria Elli
- Division of Hematology and Bone Marrow Unit, Ospedale San Gerardo, Aziende Socio Sanitarie Territoriali (ASST), Monza, Italy
| | - Carlo Finelli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - Luca Maurillo
- Department of Onco-hematology, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Alessandra Ricco
- Unit of Hematology and Stem Cell Transplantation, Azienda Ospedaliera Universitaria (AOU) Consorziale Policlinico, Bari, Italy
| | - Pellegrino Musto
- Unit of Hematology and Stem Cell Transplantation, Azienda Ospedaliera Universitaria (AOU) Consorziale Policlinico, Bari, Italy.,Department of Emergency and Organ Transplantation, "Aldo Moro" University School of Medicine, Bari, Italy
| | - Rodolfo Russo
- Clinica Nefrologica, Dialisi e Trapianto, Department of Integrated Medicine with the Territory, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Roberto Latagliata
- Unità Operativa Complessa (UOC) Ematologia, Ospedale Belcolle, Viterbo and Division of Cellular Biotechnology and Hematology, Sapienza University, Rome, Italy
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5
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Ma J, Ge Z. Comparison Between Decitabine and Azacitidine for Patients With Acute Myeloid Leukemia and Higher-Risk Myelodysplastic Syndrome: A Systematic Review and Network Meta-Analysis. Front Pharmacol 2021; 12:701690. [PMID: 34483903 PMCID: PMC8416074 DOI: 10.3389/fphar.2021.701690] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/14/2021] [Indexed: 12/24/2022] Open
Abstract
Background: The hypomethylating agents (HMAs) azacitidine (AZA) and decitabine (DAC) have been widely used in patients with acute myeloid leukemia (AML) and higher-risk myelodysplastic syndrome (HR-MDS). However, few direct clinical trials have been carried out to compare the efficacy and adverse events (AEs) between these two agents. The clinical choice between them is controversial. A systematic review and network meta-analysis (NMA) was performed to compare the efficacy, safety, and survival of DAC and AZA in AML and HR-MDS patients. Methods: We systematically searched MEDLINE, Embase, Web of Science, and Cochrane Library through March 15, 2021. Randomized controlled trials (RCTs) on AML or HR-MDS patients comparing the efficacy and safety between DAC and AZA or comparing one of HMAs to conventional care regimens (CCR) were selected. Results: Eight RCTs (n = 2,184) were identified in the NMA. Four trials compared AZA to CCR, and four compared DAC to CCR. Direct comparisons indicated that, compared to CCR, both AZA and DAC were associated with higher overall response (OR) rate (AZA vs. CCR: relative risk (RR) = 1.48, 95% CI 1.05–2.1; DAC vs. CCR: RR = 2.14, 95% CI 1.21–3.79) and longer overall survival (OS) (AZA vs. CCR: HR = 0.64, 95% CI 0.50–0.82; DAC vs. CCR: HR = 0.84, 95% CI 0.72–0.98), and AZA showed higher rate of complete remission with incomplete blood count recovery (CRi) (HR = 2.52, 95% CI 1.27–5). For the indirect method, DAC showed a higher complete remission (CR) rate than AZA in patients with both AML (RR = 2.28, 95% CI 1.12–4.65) and MDS (RR = 7.57, 95% CI 1.26–45.54). Additionally, DAC significantly increased the risk of 3/4 grade anemia (RR = 1.61, 95% CI: 1.03–2.51), febrile neutropenia (RR = 4.03, 95% CI: 1.41–11.52), and leukopenia (RR = 3.43, 95% CI 1.64–7.16) compared with AZA. No statistical significance was found for the other studied outcomes. Conclusion: Compared to CCR, both AZA and DAC can promote outcomes in patients with AML and HR-MDS. DAC showed higher efficacy especially CR rate than AZA (low-certainty evidence), while AZA experienced lower frequent grade 3/4 cytopenia than patients receiving DAC treatment.
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Affiliation(s)
- Jiale Ma
- Department of Hematology, Zhongda Hospital, School of Medicine, Southeast University, Institute of Hematology Southeast University, Nanjing, China.,Department of Hematology, Xuzhou Central Hospital, Xuzhou, China
| | - Zheng Ge
- Department of Hematology, Zhongda Hospital, School of Medicine, Southeast University, Institute of Hematology Southeast University, Nanjing, China
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6
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A Remarkable Remission: Treating HMA Refractory Transforming MDS with Single-Agent Low-Dose Cytarabine Leading to an Ongoing Six-Year OS. Case Rep Med 2020; 2020:1540370. [PMID: 32110242 PMCID: PMC7042518 DOI: 10.1155/2020/1540370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 12/31/2019] [Accepted: 01/06/2020] [Indexed: 11/25/2022] Open
Abstract
Hypomethylating agents (HMA) are the standard of care for patients ≥65 years with intermediate-high risk myelodysplastic syndrome (MDS) unsuitable for intensive therapy or stem cell transplant (SCT). However, many patients will develop relapse/refractory disease, at which point limited treatment options remain. There has been a lot of research into investigational agents following HMA failure, especially now into targeted therapy, but there is no final consensus or convincing data to guide clinicians. Low-dose cytarabine (LDAC) has been in the armamentarium for some time, but the value of LDAC is judged differently by various guidelines. Nevertheless, in a subgroup of patients who fail on a HMA and wish to continue treatment, LDAC may still have the potential to improve overall survival (OS). In this case report, we present an 85-year-old gentleman with HMA refractory high-risk/transforming MDS (with a noncomplex karyotype) achieving an ongoing six-year OS with single-agent second-line LDAC. LDAC may therefore still be considered by clinicians as a therapeutic option, but when available, patients should be enrolled on a clinical trial.
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7
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Acar S, Gözmen S, Bayraktaroğlu S, Acar SO, Tahta N, Aydınok Y, Vergin RC. Evaluation of Liver Iron Content by Magnetic Resonance Imaging in Children with Acute Lymphoblastic Leukemia after Cessation of Treatment. Turk J Haematol 2020; 37:263-270. [PMID: 32077272 PMCID: PMC7702656 DOI: 10.4274/tjh.galenos.2020.2019.0364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Objective There are a limited number of studies evaluating iron overload in childhood leukemia by magnetic resonance imaging (MRI). The aim of this study was to determine liver iron content (LIC) by MRI in children with acute lymphoblastic leukemia (ALL) who had completed treatment and to compare those values with serum iron parameters. Materials and Methods A total of 30 patients between the ages of 7 and 18 who had completed ALL treatment were included in the study. Serum iron parameters (serum iron, serum ferritin [SF], and total iron-binding capacity) and liver function tests were studied. R2 MRI was performed for determining LIC. Results Normal LIC was detected in 22 (63.4%) of the cases. Seven (23.3%) had mild and 1 (3.3%) had moderate liver iron deposition. In contrast, severe iron overload was not detected in any of the cases. LIC levels were correlated with the numbers of packed red blood cell (pRBC) transfusions (r=0.637, p<0.001), pRBC transfusion volume (r=0.449, p<0.013), SF levels (r=0.561, p=0.001), and transferrin saturation (r=0.353, p=0.044). In addition, a positive correlation was found between the number of pRBC transfusions and SF levels (r=0.595, p<0.001). Conclusion We showed that the frequency of liver iron deposition was low and clinically less significant after the end of treatment in childhood ALL patients. LIC was demonstrated to be related to SF and transfusion history. These findings support that SF and transfusion history may be used as references for monitoring iron accumulation or identifying cases for further examinations such as MRI.
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Affiliation(s)
- Sezer Acar
- Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Department of Pediatrics, İzmir, Turkey
| | - Salih Gözmen
- Dr. Behcet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Division of Pediatric Hematology and Oncology, İzmir, Turkey
| | | | - Sultan O. Acar
- Dr. Behcet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Division of Pediatric Hematology and Oncology, İzmir, Turkey
| | - Neryal Tahta
- Dr. Behcet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Division of Pediatric Hematology and Oncology, İzmir, Turkey
| | - Yeşim Aydınok
- Ege University Faculty of Medicine, Division of Pediatric Hematology and Oncology, İzmir, Turkey
| | - Raziye C. Vergin
- Dr. Behcet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Division of Pediatric Hematology and Oncology, İzmir, Turkey
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8
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Giordano G, Cutuli MA, Lucchesi A, Magnifico I, Venditti N, Vergalito F, Gasperi M, Di Marco R. Iron Support in Erythropoietin Treatment in Myelodysplastic Syndrome Patients Affected by Low-Risk Refractory Anaemia: Real-Life Evidence from an Italian Setting. Acta Haematol 2019; 143:155-162. [PMID: 31533096 DOI: 10.1159/000501329] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 06/01/2019] [Indexed: 11/19/2022]
Abstract
Refractory anaemia (RA) among myelodysplastic syndrome (MDS) is associated with a partial functional iron deficit and may require transfusions. In low-risk lymphoma and solid tumour patients, iron support improves erythropoietin (EPO) cost-effectiveness in treating anaemia. The aim of this study is to see if oral sucrosomial iron support improves the cost-effectiveness of EPO treatment in MDS patients affected by low-risk RA. We treated patients with EPO only or with EPO plus oral sucrosomial iron or intravenous (i.v.) iron. The need for transfusions was lowest in the group taking oral iron (p = 0.016) or not receiving supplementation at all (p = 0.022). We compared costs of EPO with i.v. ferric gluconate or oral sucrosomial iron supplementation or no iron supplementation. The oral iron group had fewer side effects, fewer patient medical visits in the out-patient setting, and fewer transfusions; this led to higher savings on direct hospital costs and indirect patient costs (lost days at work) and translated into a 50% abatement of overall expenditures. EPO treatment-related expenditures in MDS-RA patients were lowest with oral sucrosomial iron supplementation (Sideral®), with a longer interval between EPO administration in maintenance treatment, quicker hemoglobin recovery, lower ferritin increase and fewer blood transfusions.
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Affiliation(s)
- Giulio Giordano
- Division of Internal Medicine, Hematology Service, Regional Hospital "A. Cardarelli,", Campobasso, Italy,
| | - Marco Alfio Cutuli
- Department of Medicine and Health Sciences "V. Tiberio," University of Molise, Campobasso, Italy
| | - Alessandro Lucchesi
- Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Irene Magnifico
- Department of Medicine and Health Sciences "V. Tiberio," University of Molise, Campobasso, Italy
| | - Noemi Venditti
- Department of Medicine and Health Sciences "V. Tiberio," University of Molise, Campobasso, Italy
| | - Franca Vergalito
- Department of Medicine and Health Sciences "V. Tiberio," University of Molise, Campobasso, Italy
| | - Maurizio Gasperi
- Division of Internal Medicine, Hematology Service, Regional Hospital "A. Cardarelli,", Campobasso, Italy
- Division of Internal Medicine, Regional Hospital "A. Cardarelli,", Campobasso, Italy
| | - Roberto Di Marco
- Department of Medicine and Health Sciences "V. Tiberio," University of Molise, Campobasso, Italy
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9
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Aapro M, Beguin Y, Bokemeyer C, Dicato M, Gascón P, Glaspy J, Hofmann A, Link H, Littlewood T, Ludwig H, Österborg A, Pronzato P, Santini V, Schrijvers D, Stauder R, Jordan K, Herrstedt J. Management of anaemia and iron deficiency in patients with cancer: ESMO Clinical Practice Guidelines. Ann Oncol 2018; 29:iv96-iv110. [PMID: 29471514 DOI: 10.1093/annonc/mdx758] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Affiliation(s)
- M Aapro
- Genolier Cancer Centre, Clinique de Genolier, Genolier, Switzerland
| | - Y Beguin
- University of Liège, Liège
- CHU of Liège, Liège, Belgium
| | - C Bokemeyer
- Department of Oncology, Hematology and BMT with Section Pneumology, University of Hamburg, Hamburg, Germany
| | - M Dicato
- Hématologie-Oncologie, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - P Gascón
- Department of Haematology-Oncology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - J Glaspy
- Division of Hematology and Oncology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - A Hofmann
- Medical Society for Blood Management, Laxenburg, Austria
| | - H Link
- Klinik für Innere Medizin I, Westpfalz-Klinikum, Kaiserslautern, Germany
| | - T Littlewood
- Department of Haematology, John Radcliffe Hospital, Oxford, UK
| | - H Ludwig
- Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria
| | - A Österborg
- Karolinska Institute and Karolinska Hospital, Stockholm, Sweden
| | - P Pronzato
- Medica Oncology, IRCCS Asiana Pedaliter Universitaria San Martino - IST, Institutor Nazionale per la Ricercars sol Chancre, Genova
| | - V Santini
- Department of Experimental and Clinical Medicine, Haematology, University of Florence, Florence, Italy
| | - D Schrijvers
- Department of Medical Oncology, Ziekenhuisnetwerk Antwerpen, Antwerp, Belgium
| | - R Stauder
- Department of Internal Medicine V (Haematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
| | - K Jordan
- Department of Medicine V, University of Heidelberg, Heidelberg, Germany
| | - J Herrstedt
- Department of Oncology, Zealand University Hospital Roskilde, Roskilde
- University of Copenhagen, Copenhagen, Denmark
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10
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Leitch HA, Buckstein R, Zhu N, Nevill TJ, Yee KWL, Leber B, Keating MM, St Hilaire E, Kumar R, Delage R, Geddes M, Storring JM, Shamy A, Elemary M, Wells RA. Iron overload in myelodysplastic syndromes: Evidence based guidelines from the Canadian consortium on MDS. Leuk Res 2018; 74:21-41. [PMID: 30286330 DOI: 10.1016/j.leukres.2018.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 08/08/2018] [Accepted: 09/15/2018] [Indexed: 01/19/2023]
Abstract
In 2008 the first evidence-based Canadian consensus guideline addressing the diagnosis, monitoring and management of transfusional iron overload in patients with myelodysplastic syndromes (MDS) was published. The Canadian Consortium on MDS, comprised of hematologists from across Canada with a clinical and academic interest in MDS, reconvened to update these guidelines. A literature search was updated in 2017; topics reviewed include mechanisms of iron overload induced cellular damage, evidence for clinical endpoints impacted by iron overload including organ dysfunction, infections, marrow failure, overall survival, acute myeloid leukemia progression, and endpoints around hematopoietic stem-cell transplant. Evidence for an impact of iron reduction on the same endpoints is discussed, guidelines are updated, and areas identified where evidence is suboptimal. The guidelines address common questions around the diagnosis, workup and management of iron overload in clinical practice, and take the approach of who, when, why and how to treat iron overload in MDS. Practical recommendations for treatment and monitoring are made. Evidence levels and grading of recommendations are provided for all clinical endpoints examined.
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Affiliation(s)
- Heather A Leitch
- Hematology, St. Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada.
| | - Rena Buckstein
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Nancy Zhu
- Hematology/Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Thomas J Nevill
- Leukemia/BMT Program of British Columbia, Division of Hematology, Vancouver, BC, Canada
| | - Karen W L Yee
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Brian Leber
- McMaster University, Hamilton, Ontario, Canada
| | | | - Eve St Hilaire
- Centre d'Oncologie, Dr-Leon-Richard, Moncton, New Brunswick, Canada
| | - Rajat Kumar
- Hematology/Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Robert Delage
- Hematology Department, Centre Hospitalier Universitaire, Laval University, Quebec, QC, Canada
| | - Michelle Geddes
- Department of Medicine/Hematology, Foothills Medical Centre, Calgary, Alberta, Canada
| | | | - April Shamy
- Sir Mortimer B Davis Hospital, McGill University, Montreal, Quebec, Canada
| | - Mohamed Elemary
- Saskatoon Cancer Center, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Richard A Wells
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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11
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Messa E, Gioia D, Masiera E, Castiglione A, Ceccarelli M, Salvi F, Danise P, Sanna A, Allione B, Balleari E, Poloni A, Cametti G, Ferrero D, Tassara R, Finelli C, Bonferroni M, Musto P, Saglio G, Levis A, Santini V. Effects of erythropoiesis-stimulating agents on overall survival of International Prognostic Scoring System Low/Intermediate-1 risk, transfusion-independent myelodysplastic syndrome patients: a cohort study. Haematologica 2018; 104:e4-e8. [PMID: 30076178 DOI: 10.3324/haematol.2017.183590] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Emanuela Messa
- Division of Hematology, ASLTO 4, Ivrea (Turin).,Fondazione Italiana Sindromi Mielodisplastiche Onlus, Alessandria
| | - Daniela Gioia
- Fondazione Italiana Sindromi Mielodisplastiche Onlus, Alessandria
| | - Elisa Masiera
- Fondazione Italiana Sindromi Mielodisplastiche Onlus, Alessandria
| | - Anna Castiglione
- Unit of Clinical Epidemiology, "Città della Salute e della Scienza di Torino" Hospital, Turin
| | - Manuela Ceccarelli
- Unit of Clinical Epidemiology, "Città della Salute e della Scienza di Torino" Hospital, Turin
| | - Flavia Salvi
- Division of Hematology, "SS. Antonio e Biagio" Hospital, Alessandria.,Fondazione Italiana Sindromi Mielodisplastiche Onlus, Alessandria
| | - Paolo Danise
- Division of Onco-Hematology Nocera-Pagani, ASL Salerno.,Fondazione Italiana Sindromi Mielodisplastiche Onlus, Alessandria
| | - Alessandro Sanna
- Division of Hematology, Azienda Ospedaliera Universitaria Careggi, University of Florence.,Fondazione Italiana Sindromi Mielodisplastiche Onlus, Alessandria
| | - Bernardino Allione
- Division of Hematology, Azienda Ospedaliero-Universitaria "Città della Salute e della Scienza di Torino", Turin.,Fondazione Italiana Sindromi Mielodisplastiche Onlus, Alessandria
| | - Enrico Balleari
- Internal Medicine Department, IRCCS San Martino, Genoa, Italy.,Fondazione Italiana Sindromi Mielodisplastiche Onlus, Alessandria
| | - Antonella Poloni
- Division of Hematology, "Ospedali Riuniti", Ancona.,Fondazione Italiana Sindromi Mielodisplastiche Onlus, Alessandria
| | - Giovanni Cametti
- Division of Internal Medicine ASLTO5 Chieri (Turin).,Fondazione Italiana Sindromi Mielodisplastiche Onlus, Alessandria
| | - Dario Ferrero
- Division of Hematology, Azienda Ospedaliero-Universitaria "Città della Salute e della Scienza di Torino", University of Turin.,Fondazione Italiana Sindromi Mielodisplastiche Onlus, Alessandria
| | - Rodolfo Tassara
- Division of Medicine and Hematology, ASL2 Savonese, Savona.,Fondazione Italiana Sindromi Mielodisplastiche Onlus, Alessandria
| | - Carlo Finelli
- Institute of Hematology "L. e A. Seràgnoli", "Sant'Orsola-Malpighi" University Hospital, Bologna.,Fondazione Italiana Sindromi Mielodisplastiche Onlus, Alessandria
| | - Margherita Bonferroni
- Division of Hematology, "Santa Croce e Carle" Hospital, Cuneo, Italy.,Fondazione Italiana Sindromi Mielodisplastiche Onlus, Alessandria
| | - Pellegrino Musto
- IRCCS-CROB Regional Cancer Center of Basilicata, Rionero in Vulture, Potenza.,Fondazione Italiana Sindromi Mielodisplastiche Onlus, Alessandria
| | - Giuseppe Saglio
- Division of Hematology, "Mauriziano" Hospital, Turin, Italy.,Fondazione Italiana Sindromi Mielodisplastiche Onlus, Alessandria
| | - Alessandro Levis
- Fondazione Italiana Sindromi Mielodisplastiche Onlus, Alessandria
| | - Valeria Santini
- Division of Hematology, Azienda Ospedaliera Universitaria Careggi, University of Florence .,Fondazione Italiana Sindromi Mielodisplastiche Onlus, Alessandria
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12
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Rose C, Lenoir C, Gyan E, Hacini M, Amé S, Corront B, Beyne-Rauzy O, Adiko D, Loppinet E, Ali-Ammar N, Laribi K, Wattel E, Dreyfus F, Roué CS, Cheze S. Prospective evaluation of the effect of deferasirox on hematologic response in transfusion-dependent patients with low-risk MDS and iron overload. Eur J Haematol 2018; 101:165-173. [PMID: 29719933 DOI: 10.1111/ejh.13088] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To assess the reduction of transfusions rate in transfusion-dependent patients with low-risk myelodysplastic syndrome (MDS) with iron overload treated with deferasirox. METHODS Prospective observational study. Primary endpoint was reduction in transfusion requirements (RTR) at 3 months, (assessed on 8-week period). Secondary endpoints were hematologic improvement according to International Working Group (IWG) 2006 criteria at 3, 6, and 12 months. RESULTS Fifty-seven patients were evaluable. After 3 months of chelation, no effect was seen on transfusion requirement (5.9 packed red blood cells (PRBC) vs 5.8 before chelation). According to the Kaplan-Meier analysis, the probability of RTR at 3, 6, and 12 months was assessed as 3.5%, 9.1%, and 18.7%, respectively. Median duration of RTR was 182 days. However, during the 12-month follow-up after deferasirox initiation, 17 patients (31.5%) achieved minor erythroid response [HI-E] according to IWG criteria, 10 of whom having achieved Hb improvement at month 12. CONCLUSION After 3 months of treatment, deferasirox had no impact on transfusion requirement in regularly transfused patients with low-risk MDS. However, deferasirox could induce 31% of erythroid response during the 12-month follow-up period thus suggesting that iron chelation therapy with deferasirox may induce an effect on hematopoiesis in a subset of patients with MDS and iron overload.
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Affiliation(s)
- Christian Rose
- Hospital Saint Vincent de Paul, Catholic University of Lille, Lille, France
| | | | - Emmanuel Gyan
- Hospital Bretonneau, University of Tours, Tours, France
| | | | - Shanti Amé
- Hospital Hautepierre, University of Strasbourg, Strasbourg, France
| | | | | | | | | | | | | | - Eric Wattel
- Hospital Lyon-Sud, University of Lyon, Pierre-Bénite, France
| | | | | | - Stephane Cheze
- Hospital Côte de Nacre, University of Caen, Caen, France
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13
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Díez-Campelo M, Lorenzo JI, Itzykson R, Rojas SM, Berthon C, Luño E, Beyne-Rauzy O, Perez-Oteyza J, Vey N, Bargay J, Park S, Cedena T, Bordessoule D, Muñoz JA, Gyan E, Such E, Visanica S, López-Cadenas F, de Botton S, Hernández-Rivas JM, Ame S, Stamatoullas A, Delaunay J, Salanoubat C, Isnard F, Guieze R, Pérez Guallar J, Badiella L, Sanz G, Cañizo C, Fenaux P. Azacitidine improves outcome in higher-risk MDS patients with chromosome 7 abnormalities: a retrospective comparison of GESMD and GFM registries. Br J Haematol 2018; 181:350-359. [DOI: 10.1111/bjh.15190] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 01/29/2018] [Indexed: 11/29/2022]
Affiliation(s)
- María Díez-Campelo
- Haematology, Hospital Universitario de Salamanca; Salamanca Spain
- Institute of Biomedical Research of Salamanca (IBSAL); Salamanca Spain
| | - Jose I. Lorenzo
- Haematology Department; Hospital Universitario y Politécnico La Fe; Valencia Spain
| | - Raphael Itzykson
- Service d'Hematologie; St Louis, assistance publique hôpitaux de Paris and Paris Diderot University; Paris France
| | - Silvia M. Rojas
- Haematology, Hospital Universitario de Salamanca; Salamanca Spain
| | - Céline Berthon
- Maladies du Sang; Hopital Huriez; CHRU de Lille; Lille France
| | - Elisa Luño
- Haematology; Hospital Universitario Central de Asturias; Oviedo Spain
| | | | | | - Norbert Vey
- Haematology department; Institut Paoli Calmettes; Marseille France
| | - Joan Bargay
- Hospital Sont Llatzer; Palma de Mallorca Spain
| | - Sophie Park
- Haematology; Clinique Universitaire d′Hématologie; CHU de Grenoble; Grenoble France
| | | | - Dominique Bordessoule
- Unité de Recherche Clinique; Service d'Hématologie Clinique et Thérapie Cellulaire; Limoges France
| | | | - Emmanuel Gyan
- Service d'hématologie et thérapie cellulaire; CHRU de Tours; Team 3 UMR CNRS 7292; Université François Rabelais; Tours France
| | - Esperanza Such
- Haematology Department; Hospital Universitario y Politécnico La Fe; Valencia Spain
| | - Sorin Visanica
- Hématologie - Hôpital Bon Secours; Metz-Thionville; Thionville France
| | | | | | - Jesús M. Hernández-Rivas
- Haematology, Hospital Universitario de Salamanca; Salamanca Spain
- Institute of Biomedical Research of Salamanca (IBSAL); Salamanca Spain
| | - Shanti Ame
- Haematology Department; Hôpital Civil; Strasbourg France
| | | | | | | | - Françoise Isnard
- Department of Haematology; Assistance Publique-Hopitaux de Paris (AP-HP) Saint-Antoine; Universite Pierre et Marie Curie; Paris France
| | | | - Joan Pérez Guallar
- Department of application statistics; Universidad Autónoma de Barcelona; Barcelona Spain
| | - Llorenc Badiella
- Department of application statistics; Universidad Autónoma de Barcelona; Barcelona Spain
| | - Guillermo Sanz
- Haematology Department; Hospital Universitario y Politécnico La Fe; Valencia Spain
| | - Consuelo Cañizo
- Haematology, Hospital Universitario de Salamanca; Salamanca Spain
- Institute of Biomedical Research of Salamanca (IBSAL); Salamanca Spain
| | - Pierre Fenaux
- Service d'Hematologie; St Louis, assistance publique hôpitaux de Paris and Paris Diderot University; Paris France
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14
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A phase 3 randomized, placebo-controlled study assessing the efficacy and safety of epoetin-α in anemic patients with low-risk MDS. Leukemia 2018; 32:2648-2658. [PMID: 29895954 PMCID: PMC6286328 DOI: 10.1038/s41375-018-0118-9] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/21/2017] [Accepted: 02/14/2018] [Indexed: 11/24/2022]
Abstract
Erythropoiesis-stimulating agents are first choice for treating anemia in low-risk MDS. This double-blind, placebo-controlled study assessed the efficacy and safety of epoetin-α in IPSS low- or intermediate-1 risk (i.e., low-risk) MDS patients with Hb ≤ 10.0 g/dL, with no or moderate RBC transfusion dependence (≤4 RBC units/8 weeks). Patients were randomized, 2:1, to receive epoetin-α 450 IU/kg/week or placebo for 24 weeks, followed by treatment extension in responders. The primary endpoint was erythroid response (ER) through Week 24. Dose adjustments were driven by weekly Hb-levels and included increases, and dose reductions/discontinuation if Hb > 12 g/dL. An independent Response Review Committee (RRC) blindly reviewed all responses, applying IWG-2006 criteria but also considering dose adjustments, drug interruptions and longer periods of observation. A total of 130 patients were randomized (85 to epoetin-α and 45 to placebo). The ER by IWG-2006 criteria was 31.8% for epoetin-α vs 4.4% for placebo (p < 0.001); after RRC review, the ER was 45.9 vs 4.4% (p < 0.001), respectively. Epoetin-α reduced RBC transfusions and increased the time-to-first-transfusion compared with placebo. Thus, epoetin-α significantly improved anemia outcomes in low-risk MDS. IWG-2006 criteria for ER may require amendments to better apply to clinical studies.
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15
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Zeidan AM, Griffiths EA. To chelate or not to chelate in MDS: That is the question! Blood Rev 2018; 32:368-377. [PMID: 29602612 DOI: 10.1016/j.blre.2018.03.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 02/16/2018] [Accepted: 03/06/2018] [Indexed: 01/19/2023]
Abstract
Myelodysplastic syndromes (MDS) are a heterogeneous group of hemopathies that exhibit physical manifestations with clinical consequences of bone marrow failure and inherent risk of progression to acute myeloid leukemia. Iron overload (IO) is common in MDS due to chronic transfusion support and disease-related alterations in iron metabolism. IO has been conclusively associated with inferior outcomes among MDS patients. Despite lack of randomized trials showing a survival impact of iron chelation therapy (ICT), ICT is recommended by experts and guidelines for select MDS patients with IO and is often used. The availability of effective oral ICT agents has reignited the controversy regarding ICT use in patients with MDS and IO. Here we summarize the studies evaluating the value of ICT in MDS and suggest a practical approach for use of these therapies. We also highlight controversies regarding use of ICT in MDS and discuss some ongoing efforts to answer these questions.
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Affiliation(s)
- Amer M Zeidan
- Section of Hematology, Department of Medicine, Yale University, Yale Cancer Center, New Haven, CT, USA.
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16
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The impact of anaemia, transfusion dependency, comorbidities and polypharmacy in elderly patients with low-risk myelodysplastic syndromes. Med Oncol 2018; 35:33. [PMID: 29417235 DOI: 10.1007/s12032-018-1094-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 01/31/2018] [Indexed: 10/18/2022]
Abstract
Myelodysplastic syndromes (MDS) are heterogeneous clonal disorders ranging from indolent conditions with a near-normal life expectancy to forms approaching acute myeloid leukaemia. Comorbid conditions have rarely been systematically studied among patients with MDS. Older age per se has a negative impact on survival of MDS patients, in particular of those with lower risk. However, age indirectly affects also the survival of higher-risk patients by limiting their eligibility to intensive treatments. In addition, ageing is associated with an increasingly high risk of developing comorbidity, and a high prevalence of comorbid diseases has indeed been reported in MDS patients. The impact of multi-morbidities/comorbidities and polypharmacy in patients with low-risk MDS patients is a poorly explored topic. We focused on medications, multi-morbidities and comorbidities of 155 low-risk MDS patients followed in the haematological outpatients clinics or in medical/oncology wards of our University Hospital. One or more comorbidities were present at diagnosis in 24 younger patients with MDS syndromes (31%), whereas 56 older patients with MDS (75%) presented 1 or more comorbidities (P < 0.001).The most frequent comorbidity was cardiac comorbidity 18% in younger patients and 25% in older patients. With no statistical significance between older and younger patients, congestive heart failure was the most frequent observed disease. Our study has shown a statistical correlation between transfusion dependency and polypathology (P = 0.0014). These data were also confirmed in a subanalysis of the younger group of patients. Our study has shown that comorbidity is very common among patients with MDS, potentially affecting the clinical course and outcome of MDS patients.
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17
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Meunier M, Ancelet S, Lefebvre C, Arnaud J, Garrel C, Pezet M, Wang Y, Faure P, Szymanski G, Duployez N, Preudhomme C, Biard D, Polack B, Cahn JY, Moulis JM, Park S. Reactive oxygen species levels control NF-κB activation by low dose deferasirox in erythroid progenitors of low risk myelodysplastic syndromes. Oncotarget 2017; 8:105510-105524. [PMID: 29285268 PMCID: PMC5739655 DOI: 10.18632/oncotarget.22299] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 08/26/2017] [Indexed: 11/25/2022] Open
Abstract
Anemia is a frequent cytopenia in myelodysplastic syndromes (MDS) and most patients require red blood cell transfusion resulting in iron overload (IO). Deferasirox (DFX) has become the standard treatment of IO in MDS and it displays positive effects on erythropoiesis. In low risk MDS samples, mechanisms improving erythropoiesis after DFX treatment remain unclear. Herein, we addressed this question by using liquid cultures with iron overload of erythroid precursors treated with low dose of DFX (3μM), which corresponds to DFX 5 mg/kg/day, an unusual dose used for iron chelation. We highlight a decreased apoptosis rate and an increased proportion of cycling cells, both leading to higher proliferation rates. The iron chelation properties of low dose DFX failed to activate the Iron Regulatory Proteins and to support iron depletion, but low dose DFX dampers intracellular reactive oxygen species. Furthermore low concentrations of DFX activate the NF-κB pathway in erythroid precursors triggering anti-apoptotic and anti-inflammatory signals. Establishing stable gene silencing of the Thioredoxin (TRX) 1 genes, a NF-κB modulator, showed that fine-tuning of reactive oxygen species (ROS) levels regulates NF-κB. These results justify a clinical trial proposing low dose DFX in MDS patients refractory to erythropoiesis stimulating agents.
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Affiliation(s)
- Mathieu Meunier
- CHU Grenoble Alpes, University Clinic of Hematology, Grenoble, France.,Université Grenoble Alpes, CNRS UMR 5525, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG ThEREx, Grenoble, France
| | - Sarah Ancelet
- Université Grenoble Alpes, CNRS UMR 5525, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG ThEREx, Grenoble, France
| | | | - Josiane Arnaud
- Unité de Biochimie Hormonale et Nutritionnelle, Département de Biologie - Toxicologie - Pharmacologie, CHU Grenoble Alpes, Grenoble, France
| | - Catherine Garrel
- Unité de Biochimie Hormonale et Nutritionnelle, Département de Biologie - Toxicologie - Pharmacologie, CHU Grenoble Alpes, Grenoble, France
| | - Mylène Pezet
- Plateforme de Microscopie Photonique - Cytométrie en Flux, Institut Albert Bonniot, La Tronche, France
| | - Yan Wang
- Université Grenoble Alpes, CNRS UMR 5525, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG ThEREx, Grenoble, France
| | - Patrice Faure
- Unité de Biochimie Hormonale et Nutritionnelle, Département de Biologie - Toxicologie - Pharmacologie, CHU Grenoble Alpes, Grenoble, France
| | | | - Nicolas Duployez
- Laboratory of Hematology and Tumor Bank, INSERM UMR-S 1172, Cancer Research Institute of Lille, CHRU of Lille, University Lille Nord de France, Lille, France
| | - Claude Preudhomme
- Laboratory of Hematology and Tumor Bank, INSERM UMR-S 1172, Cancer Research Institute of Lille, CHRU of Lille, University Lille Nord de France, Lille, France
| | - Denis Biard
- CEA, Institut de Biologie François Jacob, SEPIA, Team Cellular Engineering and Human Syndromes, Université Paris-Saclay, Fontenay-aux-Roses, France
| | - Benoit Polack
- Université Grenoble Alpes, CNRS UMR 5525, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG ThEREx, Grenoble, France.,Laboratory of Hematology, CHU Grenoble Alpes, Grenoble, France
| | - Jean-Yves Cahn
- CHU Grenoble Alpes, University Clinic of Hematology, Grenoble, France.,Université Grenoble Alpes, CNRS UMR 5525, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG ThEREx, Grenoble, France
| | - Jean Marc Moulis
- Université Grenoble Alpes, Laboratory of Fundamental and Applied Bioenergetics, and Environmental and Systems Biology, Grenoble, France.,INSERM U1055, Grenoble, France.,CEA-Grenoble, Bioscience and Biotechnology Institute, Grenoble, France
| | - Sophie Park
- CHU Grenoble Alpes, University Clinic of Hematology, Grenoble, France.,Université Grenoble Alpes, CNRS UMR 5525, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG ThEREx, Grenoble, France
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18
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Castelli R, Bergamaschini L, Schiavon R, Lambertenghi-Deliliers G. Personalized treatment strategies for elderly patients with myelodysplastic syndromes. Expert Rev Hematol 2017; 10:1077-1086. [DOI: 10.1080/17474086.2017.1397509] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Roberto Castelli
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Luigi Bergamaschini
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Riccardo Schiavon
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
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19
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Dodillet H, Kreuzer K, Monsef I, Skoetz N. Thrombopoietin mimetics for patients with myelodysplastic syndromes. Cochrane Database Syst Rev 2017; 9:CD009883. [PMID: 28962071 PMCID: PMC6483680 DOI: 10.1002/14651858.cd009883.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Myelodysplastic syndrome (MDS) is one of the most frequent haematologic malignancies of the elderly population and characterised by progenitor cell dysplasia with ineffective haematopoiesis and a high rate of transformation to acute myeloid leukaemia (AML). Thrombocytopenia represents a common problem for patients with MDS. ranging from mild to serious bleeding events and death. To manage thrombocytopenia, the current standard treatment includes platelet transfusion, unfortunately leading to a range of side effects. Thrombopoietin (TPO) mimetics represent an alternative treatment option for MDS patients with thrombocytopenia. However, it remains unclear, whether TPO mimetics influence the increase of blast cells and therefore to premature progression to AML. OBJECTIVES To evaluate the efficacy and safety of thrombopoietin (TPO) mimetics for patients with MDS. SEARCH METHODS We searched for randomised controlled trials in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (January 2000 to August 2017), trials registries (ISRCTN, EU clinical trials register and clinicaltrials.gov) and conference proceedings. We did not apply any language restrictions. Two review authors independently screened search results, disagreements were solved by discussion. SELECTION CRITERIA We included randomised controlled trials comparing TPO mimetics with placebo, no further treatment or another TPO mimetic in patients with MDS of all risk groups, without gender, age or ethnicity restrictions. Additional chemotherapeutic treatment had to be equal in both arms. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the quality of trials, disagreements were resolved by discussion. Risk ratio (RR) was used to analyse mortality during study, transformation to AML, incidence of bleeding events, transfusion requirement, all adverse events, adverse events >= grade 3, serious adverse events and platelet response. Overall survival (OS) and progression-free survival (PFS) have been extracted as hazard ratios, but could not be pooled as results were reported in heterogenous ways. Health-related quality of life and duration of thrombocytopenia would have been analysed as standardised mean differences, but no trial reported these outcomes. MAIN RESULTS We did not identify any trial comparing one TPO mimetic versus another. We analysed six eligible trials involving 746 adult patients. All trials were reported as randomised and double-blind trials including male and female patients. Two trials compared TPO mimetics (romiplostim or eltrombopag) with placebo, one trial evaluated eltrombopag in addition to the hypomethylating agent azacitidine, two trials analysed romiplostim additionally to a hypomethylating agent (azacitidine or decitabine) and one trial evaluated romiplostim in addition to the immunomodulatory drug lenalidomide. There are more data on romiplostim (four included, completed, full-text trials) than on eltrombopag (two trials included: one full-text publication, one abstract publication). Due to small sample sizes and imbalances in baseline characteristics in three trials and premature termination of two studies, we judged the potential risk of bias of all included trials as high.Due to heterogenous reporting, we were not able to pool data for OS. Instead of that, we analysed mortality during study. There is little or no evidence for a difference in mortality during study for thrombopoietin mimetics compared to placebo (RR 0.97, 95% confidence interval (CI) 0.73 to 1.27, N = 6 trials, 746 patients, low-quality evidence). It is unclear whether the use of TPO mimetics induces an acceleration of transformation to AML (RR 1.02, 95% CI 0.59 to 1.77, N = 5 trials, 372 patients, very low-quality evidence).Thrombopoietin mimetics probably improve the incidence of all bleeding events (RR 0.92, 95% CI 0.86 to 0.99, N = 5 trials, 390 patients, moderate-quality evidence). This means that in the study population, 713 out of 1000 in the placebo arm will have a bleeding event, compared to 656 of 1000 (95% CI 613 to 699) in the TPO mimetics arm. There is little or no evidence for a difference that TPO mimetics significantly diminish the rate of transfusion requirement (RR 0.83, 95% CI 0.66 to 1.05, N = 4 trials, 358 patients, low-quality evidence). No studies were found that looked at quality of life or duration of thrombocytopenia.There is no evidence that patients given TPO mimetics suffer more all adverse events (RR 1.01, 95% CI 0.96 to 1.07, N = 5 trials, 390 patients, moderate-quality evidence). There is uncertainty whether the number of serious adverse events decrease under therapy with TPO mimetics (RR 0.89, 95% CI 0.54 to 1.46, N = 4 trials, 356 patients, very low-quality evidence).We identified one ongoing study and one study marked as completed (March 2015), but without publication of results for MDS patients (only results reported for AML and MDS patients together). Both studies evaluate MDS patients receiving eltrombopag in comparison to placebo. AUTHORS' CONCLUSIONS No trial evaluated one TPO mimetic versus another.Six trials including adult patients analysed one TPO mimetic versus placebo, sometimes combined with standard therapy in both arms. Given the uncertainty of the quality of evidence, meta-analyses show that there is little or no evidence for a difference in mortality during study and premature progress to AML. However, these assumptions have to be further explored. Treatment with TPO mimetics resulted in a lower number of MDS patients suffering from bleeding events.There is no evidence for a difference between study groups regarding transfusion requirement. Enlarged sample sizes and a longer follow-up of future trials should improve the estimate of safety and efficacy of TPO mimetics, moreover health-related quality of life should be evaluated. As two ongoing studies currently investigate eltrombopag (one already completed, but without published results), we are awaiting results for this drug.
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Affiliation(s)
- Helga Dodillet
- University Hospital of CologneDepartment I of Internal MedicineKerpener Str. 62CologneGermany50924
| | - Karl‐Anton Kreuzer
- University Hospital of CologneDepartment I of Internal MedicineKerpener Str. 62CologneGermany50924
| | - Ina Monsef
- University Hospital of CologneCochrane Haematological Malignancies Group, Department I of Internal MedicineKerpener Str. 62CologneGermany50924
| | - Nicole Skoetz
- University Hospital of CologneCochrane Haematological Malignancies Group, Department I of Internal MedicineKerpener Str. 62CologneGermany50924
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20
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Zeidan AM, Pullarkat VA, Komrokji RS. Overcoming barriers to treating iron overload in patients with lower-risk myelodysplastic syndrome. Crit Rev Oncol Hematol 2017; 117:57-66. [PMID: 28807236 DOI: 10.1016/j.critrevonc.2017.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/12/2017] [Accepted: 07/03/2017] [Indexed: 12/11/2022] Open
Abstract
Myelodysplastic syndromes (MDS) constitute a group of heterogeneous hematopoietic neoplasms characterized by ineffective erythropoiesis, anemia, and/or cytopenias. Supportive care for patients with MDS involves frequent red blood cell transfusions, which places patients with ongoing transfusional dependence (TD) at risk for iron overload (IO). Development of IO and tissue iron deposition can increase the risk of cardiac, hepatic, and endocrine toxicities, infection, and progression to acute myeloid leukemia. Iron chelation therapy (ICT) is an option for lower-risk MDS patients to reduce their degree of IO and possibly improve survival; use of these agents in thalassemia patients with TD and IO has been associated with reduced IO-associated complications and better survival. At present, there are several barriers to the regular use of ICT, such as a lack of randomized trial evidence and consistent guidance on diagnosis of IO and when to implement ICT, as well as barriers in adherence to/tolerability of ICT.
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Affiliation(s)
- Amer M Zeidan
- Department of Hematology, Yale Cancer Center, New Haven, CT, United States.
| | - Vinod A Pullarkat
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, United States
| | - Rami S Komrokji
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL, United States
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21
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Leitch HA, Parmar A, Wells RA, Chodirker L, Zhu N, Nevill TJ, Yee KWL, Leber B, Keating MM, Sabloff M, St Hilaire E, Kumar R, Delage R, Geddes M, Storring JM, Kew A, Shamy A, Elemary M, Lenis M, Mamedov A, Ivo J, Francis J, Zhang L, Buckstein R. Overall survival in lower IPSS risk MDS by receipt of iron chelation therapy, adjusting for patient-related factors and measuring from time of first red blood cell transfusion dependence: an MDS-CAN analysis. Br J Haematol 2017; 179:83-97. [PMID: 28677895 DOI: 10.1111/bjh.14825] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 05/25/2017] [Indexed: 01/23/2023]
Abstract
Analyses suggest iron overload in red blood cell (RBC) transfusion-dependent (TD) patients with myleodysplastic syndrome (MDS) portends inferior overall survival (OS) that is attenuated by iron chelation therapy (ICT) but may be biassed by unbalanced patient-related factors. The Canadian MDS Registry prospectively measures frailty, comorbidity and disability. We analysed OS by receipt of ICT, adjusting for these patient-related factors. TD International Prognostic Scoring System (IPSS) low and intermediate-1 risk MDS, at RBC TD, were included. Predictive factors for OS were determined. A matched pair analysis considering age, revised IPSS, TD severity, time from MDS diagnosis to TD, and receipt of disease-modifying agents was conducted. Of 239 patients, 83 received ICT; frailty, comorbidity and disability did not differ from non-ICT patients. Median OS from TD was superior in ICT patients (5·2 vs. 2·1 years; P < 0·0001). By multivariate analysis, not receiving ICT independently predicted inferior OS, (hazard ratio for death 2·0, P = 0·03). In matched pair analysis, OS remained superior for ICT patients (P = 0·02). In this prospective, non-randomized analysis, receiving ICT was associated with superior OS in lower IPSS risk MDS, adjusting for age, frailty, comorbidity, disability, revised IPSS, TD severity, time to TD and receiving disease-modifying agents. This provides additional evidence that ICT may confer clinical benefit.
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Affiliation(s)
- Heather A Leitch
- Hematology, St. Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada
| | | | - Richard A Wells
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Lisa Chodirker
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Nancy Zhu
- Hematology/Oncology, University of Alberta, Edmonton, AB, Canada
| | - Thomas J Nevill
- Division of Hematology, Leukemia/BMT Program of British Columbia, Vancouver, BC, Canada
| | - Karen W L Yee
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | | | | | - Eve St Hilaire
- Centre d'Oncologie, Dr-Leon-Richard, Moncton, NB, Canada
| | - Rajat Kumar
- Hematology/Oncology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Robert Delage
- Hematology Department, Centre Hospitalier Universitaire, Laval University, Quebec, QC, Canada
| | - Michelle Geddes
- Department of Medicine/Hematology, Foothills Medical Centre, Calgary, AB, Canada
| | | | - Andrea Kew
- Queen Elizabeth II Health Sciences Center, Halifax, NS, Canada
| | - April Shamy
- Sir Mortimer B Davis Hospital, McGill University, Montreal, QC, Canada
| | - Mohamed Elemary
- Saskatoon Cancer Center, University of Saskatchewan, Saskatoon, SK, Canada
| | - Martha Lenis
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Alexandre Mamedov
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Jessica Ivo
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Janika Francis
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Liying Zhang
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Rena Buckstein
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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22
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Schuh AC, Döhner H, Pleyer L, Seymour JF, Fenaux P, Dombret H. Azacitidine in adult patients with acute myeloid leukemia. Crit Rev Oncol Hematol 2017; 116:159-177. [PMID: 28693797 DOI: 10.1016/j.critrevonc.2017.05.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/23/2017] [Accepted: 05/28/2017] [Indexed: 01/13/2023] Open
Abstract
Azacitidine is recommended front-line treatment for older patients with acute myeloid leukemia (AML) who are not candidates for intensive treatment regimens, and was recently granted approval in the European Union for treatment of adult AML. Reviewed here is azacitidine experience in AML, including: mechanistic and pharmacokinetic data; safety and efficacy in controlled trials; treatment effects in AML subpopulations defined by disease characteristics; experience in unselected patients treated in the community setting; clinical outcomes relative to other approved AML therapies; and experience with azacitidine-based combination treatment regimens. Collectively, these data suggest that (a) azacitidine may prolong overall survival to a similar or greater extent than do other approved AML treatments, but with less toxicity, (b) azacitidine may be the preferred treatment option for older patients with unfavorable cytogenetics, and (c) experience and outcomes with azacitidine in the clinic are similar to those seen in clinical trials. Continued investigation of combination regimens on an azacitidine backbone is warranted.
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Affiliation(s)
- Andre C Schuh
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
| | | | - Lisa Pleyer
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, Paracelsus Medical University Salzburg, Austria; Salzburg Cancer Research Institute - Center for Clinical Cancer and Immunology Trials, Salzburg, Austria; Cancer Cluster Salzburg, Austria
| | - John F Seymour
- Peter MacCallum Cancer Centre, Melbourne, Australia; University of Melbourne, Parkville, Australia
| | - Pierre Fenaux
- Hôpital Saint Louis, Institut Universitaire d'Hématologie, Paris, France
| | - Hervé Dombret
- Hôpital Saint Louis, Institut Universitaire d'Hématologie, Paris, France
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23
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Varaldo R, Raiola AM, Di Grazia C, Aquino S, Beltrami G, Bregante S, Cruciani F, Dominietto A, Ghiso A, Giannoni L, Gualandi F, Ibatici A, Lamparelli T, Marani C, Van Lint MT, Santini V, Bacigalupo A, Angelucci E. Haploidentical bone marrow transplantation in patients with advanced myelodysplastic syndrome. Am J Hematol 2017; 92:E117-E119. [PMID: 28316085 DOI: 10.1002/ajh.24725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Revised: 03/11/2017] [Accepted: 03/15/2017] [Indexed: 01/16/2023]
Affiliation(s)
- Riccardo Varaldo
- U.O. Ematologia IRCCS Azienda Ospedaliera Universitaria San Martino-IST. Istituto Nazionale per la Ricerca sul Cancro; Genova Italy
| | - Anna Maria Raiola
- U.O. Ematologia IRCCS Azienda Ospedaliera Universitaria San Martino-IST. Istituto Nazionale per la Ricerca sul Cancro; Genova Italy
| | - Carmen Di Grazia
- U.O. Ematologia IRCCS Azienda Ospedaliera Universitaria San Martino-IST. Istituto Nazionale per la Ricerca sul Cancro; Genova Italy
| | - Sara Aquino
- U.O. Ematologia IRCCS Azienda Ospedaliera Universitaria San Martino-IST. Istituto Nazionale per la Ricerca sul Cancro; Genova Italy
| | - Germana Beltrami
- U.O. Ematologia IRCCS Azienda Ospedaliera Universitaria San Martino-IST. Istituto Nazionale per la Ricerca sul Cancro; Genova Italy
| | - Stefania Bregante
- U.O. Ematologia IRCCS Azienda Ospedaliera Universitaria San Martino-IST. Istituto Nazionale per la Ricerca sul Cancro; Genova Italy
| | - Fabio Cruciani
- U.O. Ematologia IRCCS Azienda Ospedaliera Universitaria San Martino-IST. Istituto Nazionale per la Ricerca sul Cancro; Genova Italy
| | - Alida Dominietto
- U.O. Ematologia IRCCS Azienda Ospedaliera Universitaria San Martino-IST. Istituto Nazionale per la Ricerca sul Cancro; Genova Italy
| | - Anna Ghiso
- U.O. Ematologia IRCCS Azienda Ospedaliera Universitaria San Martino-IST. Istituto Nazionale per la Ricerca sul Cancro; Genova Italy
| | - Livia Giannoni
- U.O. Ematologia IRCCS Azienda Ospedaliera Universitaria San Martino-IST. Istituto Nazionale per la Ricerca sul Cancro; Genova Italy
| | - Francesca Gualandi
- U.O. Ematologia IRCCS Azienda Ospedaliera Universitaria San Martino-IST. Istituto Nazionale per la Ricerca sul Cancro; Genova Italy
| | - Adalberto Ibatici
- U.O. Ematologia IRCCS Azienda Ospedaliera Universitaria San Martino-IST. Istituto Nazionale per la Ricerca sul Cancro; Genova Italy
| | - Teresa Lamparelli
- U.O. Ematologia IRCCS Azienda Ospedaliera Universitaria San Martino-IST. Istituto Nazionale per la Ricerca sul Cancro; Genova Italy
| | - Carlo Marani
- U.O. Ematologia IRCCS Azienda Ospedaliera Universitaria San Martino-IST. Istituto Nazionale per la Ricerca sul Cancro; Genova Italy
| | - Maria Teresa Van Lint
- U.O. Ematologia IRCCS Azienda Ospedaliera Universitaria San Martino-IST. Istituto Nazionale per la Ricerca sul Cancro; Genova Italy
| | - Valeria Santini
- AOU Careggi, Università degli Studi di Firenze; Firenze Italy
- FISM: Fondazione Italiana Sindromi mielodisplastiche; Alessandria Italy
| | - Andrea Bacigalupo
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Fondazione, Policlinico Universitario Gemelli Roma; Italy
| | - Emanuele Angelucci
- U.O. Ematologia IRCCS Azienda Ospedaliera Universitaria San Martino-IST. Istituto Nazionale per la Ricerca sul Cancro; Genova Italy
- FISM: Fondazione Italiana Sindromi mielodisplastiche; Alessandria Italy
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24
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Romano A, Giallongo C, La Cava P, Parrinello NL, Chiechi A, Vetro C, Tibullo D, Di Raimondo F, Liotta LA, Espina V, Palumbo GA. Proteomic Analysis Reveals Autophagy as Pro-Survival Pathway Elicited by Long-Term Exposure with 5-Azacitidine in High-Risk Myelodysplasia. Front Pharmacol 2017; 8:204. [PMID: 28491035 PMCID: PMC5405131 DOI: 10.3389/fphar.2017.00204] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 03/31/2017] [Indexed: 01/04/2023] Open
Abstract
Azacytidine (5-AZA) is the standard first-choice treatment for high-risk myelodysplasia (MDS) patients. However, the clinical outcome for those patients who interrupt treatment or whose disease failed to respond is very poor. In order to identify the cellular pathways that are modified by long-term exposure to 5-AZA, we evaluated key proteins associated with the autophagy pathway by reverse-phase microarray (RPPA). Comparing bone marrow mononucleated cells (BMMCs) obtained from 20 newly-diagnosed patients and after four 5-AZA cycles we found an increased autophagy signaling. We then evaluated ex-vivo the effect of the combination of 5-AZA with autophagy inhibitors chloroquine (CQ) and leupeptin. Since 5-AZA and CQ showed synergism due to an increase of basal autophagy after 5-AZA exposure, we adopted a sequential treatment treating BMMCs with 5 μM 5-AZA for 72 h followed by 10 μM CQ for 24 h and found increased apoptosis, associated to a reduction of G2M phase and increase in G0-G1 phase. Long-term exposure to 5-AZA induced the reduction of the autophagic marker SQSTM1/p62, reversible by CQ or leupeptin exposure. In conclusion, we identified autophagy as a compensatory pathway occurring in MDS-BM after long-term exposure to 5-AZA and we provided evidences that a sequential treatment of 5-AZA followed by CQ could improve 5-AZA efficacy, providing novel insight for tailored therapy in MDS patients progressing after 5-AZA therapy.
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Affiliation(s)
- Alessandra Romano
- Divisione di Ematologia, Azienda Ospedaliera Policlinico UniversitariaCatania, Italy.,Scuola Superiore di CataniaCatania, Italy.,Center for Applied Proteomics and Molecular Medicine, George Mason UniversityManassas, VA, USA
| | - Cesarina Giallongo
- Divisione di Ematologia, Azienda Ospedaliera Policlinico UniversitariaCatania, Italy
| | | | | | - Antonella Chiechi
- Center for Applied Proteomics and Molecular Medicine, George Mason UniversityManassas, VA, USA
| | - Calogero Vetro
- Divisione di Ematologia, Azienda Ospedaliera Policlinico UniversitariaCatania, Italy.,Scuola Superiore di CataniaCatania, Italy
| | - Daniele Tibullo
- Divisione di Ematologia, Azienda Ospedaliera Policlinico UniversitariaCatania, Italy
| | - Francesco Di Raimondo
- Divisione di Ematologia, Azienda Ospedaliera Policlinico UniversitariaCatania, Italy.,Scuola Superiore di CataniaCatania, Italy
| | - Lance A Liotta
- Center for Applied Proteomics and Molecular Medicine, George Mason UniversityManassas, VA, USA
| | - Virginia Espina
- Center for Applied Proteomics and Molecular Medicine, George Mason UniversityManassas, VA, USA
| | - Giuseppe A Palumbo
- Divisione di Ematologia, Azienda Ospedaliera Policlinico UniversitariaCatania, Italy
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25
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Musto P, Maurillo L, Simeon V, Poloni A, Finelli C, Balleari E, Ricco A, Rivellini F, Cortelezzi A, Tarantini G, Villani O, Mansueto G, Milella MR, Scapicchio D, Marziano G, Breccia M, Niscola P, Sanna A, Clissa C, Voso MT, Fenu S, Venditti A, Santini V, Angelucci E, Levis A. Iron-chelating therapy with deferasirox in transfusion-dependent, higher risk myelodysplastic syndromes: a retrospective, multicentre study. Br J Haematol 2017; 177:741-750. [PMID: 28419408 DOI: 10.1111/bjh.14621] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/27/2016] [Indexed: 01/19/2023]
Abstract
Iron chelation is controversial in higher risk myelodysplastic syndromes (HR-MDS), outside the allogeneic transplant setting. We conducted a retrospective, multicentre study in 51 patients with transfusion-dependent, intermediate-to-very high risk MDS, according to the revised international prognostic scoring system, treated with the oral iron chelating agent deferasirox (DFX). Thirty-six patients (71%) received azacitidine concomitantly. DFX was given at a median dose of 1000 mg/day (range 375-2500 mg) for a median of 11 months (range 0·4-75). Eight patients (16%) showed grade 2-3 toxicities (renal or gastrointestinal), 4 of whom (8%) required drug interruption. Median ferritin levels decreased from 1709 μg/l at baseline to 1100 μg/l after 12 months of treatment (P = 0·02). Seventeen patients showed abnormal transaminase levels at baseline, which improved or normalized under DFX treatment in eight cases. One patient showed a remarkable haematological improvement. At a median follow up of 35·3 months, median overall survival was 37·5 months. The results of this first survey of DFX in HR-MDS are comparable, in terms of safety and efficacy, with those observed in lower-risk MDS. Though larger, prospective studies are required to demonstrate real clinical benefits, our data suggest that DFX is feasible and might be considered in a selected cohort of HR-MDS patients.
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Affiliation(s)
- Pellegrino Musto
- Scientific Direction, IRCCS-CROB, "Referral Cancer Centre of Basilicata", Rionero In Vulture (Pz), Italy
| | - Luca Maurillo
- Haematology, Department of Biomedicine and Prevention, "Tor Vergata" University, Rome, Italy
| | - Vittorio Simeon
- Laboratory of Pre-clinical and Translational Research, IRCCS-CROB, "Referral Cancer Centre of Basilicata", Rionero In Vulture (Pz), Italy
| | - Antonella Poloni
- Haematology Clinic, Department of Clinic and Molecular Sciences, "Università Politecnica delle Marche", Ancona, Italy
| | - Carlo Finelli
- "Seràgnoli Institute of Haematology", University School of Medicine, Bologna, Italy
| | - Enrico Balleari
- Department of Haematology and Oncology, IRCCS AOU San Martino - IST, Genova, Italy
| | - Alessandra Ricco
- Department of Emergency and Organ Transplantation, Haematology Section, University of Bari, Bari, Italy
| | | | - Agostino Cortelezzi
- Department of Oncology and Haemato-Oncology, University of Milan and Haematology Unit, "Fondazione IRCCS Ca' Granda, Ospedale Maggiore" Policlinico, Milan, Italy
| | | | - Oreste Villani
- Department of Onco-Haematology, IRCCS-CROB, "Referral Cancer Centre of Basilicata", Rionero in Vulture (Pz), Italy
| | - Giovanna Mansueto
- Department of Onco-Haematology, IRCCS-CROB, "Referral Cancer Centre of Basilicata", Rionero in Vulture (Pz), Italy
| | - Maria R Milella
- Pharmacy Unit, IRCCS-CROB, "Referral Cancer Centre of Basilicata", Rionero In Vulture (Pz), Italy
| | - Daniele Scapicchio
- Management Control Unit, IRCCS-CROB, "Referral Cancer Centre of Basilicata", Rionero In Vulture (Pz), Italy
| | - Gioacchino Marziano
- Scientific Direction, IRCCS-CROB, "Referral Cancer Centre of Basilicata", Rionero In Vulture (Pz), Italy
| | - Massimo Breccia
- Department of Cellular Biotechnologies and Haematology, "La Sapienza" University, Rome, Italy
| | | | - Alessandro Sanna
- Haematology, University of Florence, AOU Careggi, Florence, Italy
| | - Cristina Clissa
- Haematology and Haematopoietic Stem Cell Transplant Centre, AORMN, Pesaro, Italy
| | - Maria T Voso
- Haematology, Department of Biomedicine and Prevention, "Tor Vergata" University, Rome, Italy
| | - Susanna Fenu
- Haematology, "San Giovanni" Hospital, Rome, Italy
| | - Adriano Venditti
- Haematology, Department of Biomedicine and Prevention, "Tor Vergata" University, Rome, Italy
| | - Valeria Santini
- Haematology, University of Florence, AOU Careggi, Florence, Italy
| | - Emanuele Angelucci
- Department of Haematology and Oncology, IRCCS AOU San Martino - IST, Genova, Italy
| | - Alessandro Levis
- FISM, Fondazione Italiana Sindromi Mielodisplastiche, Alessandria, Italy
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26
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Leitch HA, Fibach E, Rachmilewitz E. Toxicity of iron overload and iron overload reduction in the setting of hematopoietic stem cell transplantation for hematologic malignancies. Crit Rev Oncol Hematol 2017; 113:156-170. [PMID: 28427505 DOI: 10.1016/j.critrevonc.2017.03.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 02/13/2017] [Accepted: 03/04/2017] [Indexed: 01/19/2023] Open
Abstract
Iron is an essential element for key cellular metabolic processes. However, transfusional iron overload (IOL) may result in significant cellular toxicity. IOL occurs in transfusion dependent hematologic malignancies (HM), may lead to pathological clinical outcomes, and IOL reduction may improve outcomes. In hematopoietic stem cell transplantation (SCT) for HM, IOL may have clinical importance; endpoints examined regarding an impact of IOL and IOL reduction include transplant-related mortality, organ function, infection, relapse risk, and survival. Here we review the clinical consequences of IOL and effects of IOL reduction before, during and following SCT for HM. IOL pathophysiology is discussed as well as available tests for IOL quantification including transfusion history, serum ferritin level, transferrin saturation, hepcidin, labile plasma iron and other parameters of iron-catalyzed oxygen free radicals, and organ IOL by imaging. Data-based recommendations for IOL measurement, monitoring and reduction before, during and following SCT for HM are made.
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Affiliation(s)
- Heather A Leitch
- Division of Hematology, St. Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada.
| | - Eitan Fibach
- Hematology Branch, Hadassah - Hebrew University Medical Center, Ein-Kerem, Jerusalem, Israel
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27
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Myelodysplastic Syndromes and Iron Chelation Therapy. Mediterr J Hematol Infect Dis 2017; 9:e2017021. [PMID: 28293409 PMCID: PMC5333736 DOI: 10.4084/mjhid.2017.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 01/27/2017] [Indexed: 01/19/2023] Open
Abstract
Over recent decades we have been fortunate to witness the advent of new technologies and of an expanded knowledge and application of chelation therapies to the benefit of patients with iron overload. However, extrapolation of learnings from thalassemia to the myelodysplastic syndromes (MDS) has resulted in a fragmented and uncoordinated clinical evidence base. We’re therefore forced to change our understanding of MDS, looking with other eyes to observational studies that inform us about the relationship between iron and tissue damage in these subjects. The available evidence suggests that iron accumulation is prognostically significant in MDS, but levels of accumulation historically associated with organ damage (based on data generated in the thalassemias) are infrequent. Emerging experimental data have provided some insight into this paradox, as our understanding of iron-induced tissue damage has evolved from a process of progressive bulking of organs through high-volumes iron deposition, to one of ‘toxic’ damage inflicted through multiple cellular pathways. Damage from iron may, therefore, occur prior to reaching reference thresholds, and similarly, chelation may be of benefit before overt iron overload is seen. In this review, we revisit the scientific and clinical evidence for iron overload in MDS to better characterize the iron overload phenotype in these patients, which differs from the classical transfusional and non-transfusional iron overload syndrome. We hope this will provide a conceptual framework to better understand the complex associations between anemia, iron and clinical outcomes, to accelerate progress in this area.
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28
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Low dose cytarabine monotherapy for myelodysplastic syndromes. Hippokratia 2016. [DOI: 10.1002/14651858.cd009499.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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29
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Del Corso L, Biale L, Parodi EL, Russo R, Filiberti R, Arboscello E. Multidisciplinary evaluation at baseline and during treatment improves the rate of compliance and efficacy of deferasirox in elderly myelodysplastic patients. Int J Clin Oncol 2016; 22:380-386. [PMID: 27771776 DOI: 10.1007/s10147-016-1042-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 09/12/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Deferasirox (DFX) is used to reduce iron levels in patients with myelodysplastic syndrome (MDS) who develop iron overload after chronic red blood cell infusions. However, DFX can be associated with renal and gastrointestinal toxicities, which may cause treatment interruption or discontinuation. This study aimed to determine the effectiveness and safety of DFX in patients with MDS. METHODS This multicenter, retrospective, observational study was conducted at two hospitals in Italy. Elderly patients with transfusion-dependent MDS received DFX for up to 12 months and were divided into two groups: group A comprised patients who were not under multidisciplinary assessment; group B comprised patients under multidisciplinary control. Treatment effectiveness was estimated by monitoring the serum ferritin (SF) levels throughout the study. Any treatment-related adverse events (AEs), clinically relevant analytical alterations, and reasons for treatment discontinuation were monitored. RESULTS The study included 44 patients (13 female, 31 male; median age 77.0 years). At 3 months, SF levels decreased by ≥20 % in 29 and 31 % of patients in groups A and B, respectively, in 17 and 36 % of patients at 6 months, and in 22 and 58 % at 12 months. The most common AEs were diarrhea and increased serum creatinine, which were more frequent in group A. The discontinuation rate after renal AE was 15 and 5 % in groups A and B, respectively. CONCLUSION Multidisciplinary evaluation can be an effective strategy for monitoring renal function in patients on DFX therapy, to improve treatment adherence and overall efficacy in elderly patients with MDS.
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Affiliation(s)
- Lisette Del Corso
- Internal Medicine, Department of Hematology and Oncology, IRCCS AOU San Martino-IST, Largo R. Benzi, 10, 16132, Genoa, Italy
| | - Lucia Biale
- Blood Bank, Department of Health Management, AOU City Health Presidium Molinette, Corso Bramante 88, 10126, Turin, Italy
| | - Emanuele Luigi Parodi
- Nephrology, Department of Internal Medicine and Medical Specialties, IRCCS AOU San Martino-IST, Largo R. Benzi, 10, 16132, Genoa, Italy
| | - Rodolfo Russo
- Nephrology, Department of Internal Medicine and Medical Specialties, IRCCS AOU San Martino-IST, Largo R. Benzi, 10, 16132, Genoa, Italy
| | - Rosa Filiberti
- Clinical Epidemiology, IRCCS AOU San Martino-IST, Largo R. Benzi, 10, 16132, Genoa, Italy
| | - Eleonora Arboscello
- Internal Medicine, Department of Hematology and Oncology, IRCCS AOU San Martino-IST, Largo R. Benzi, 10, 16132, Genoa, Italy.
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30
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Fozza C, Crobu V, Isoni MA, Dore F. The immune landscape of myelodysplastic syndromes. Crit Rev Oncol Hematol 2016; 107:90-99. [PMID: 27823655 DOI: 10.1016/j.critrevonc.2016.08.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 08/15/2016] [Accepted: 08/31/2016] [Indexed: 12/25/2022] Open
Abstract
Even though the pathogenesis of myelodysplastic syndromes (MDS) is dominated by specific molecular defects involving hematopoietic precursors, also immune mechanisms seem to play a fundamental functional role. In this review we will first describe the clinical and laboratory autoimmune manifestations often detectable in MDS patients. We will then focus on studies addressing the possible influence of different immune cell subpopulations on the disease onset and evolution. We will finally consider therapeutic approaches based on immunomodulation, ranging from immunosuppressants to vaccination and transplantation strategies.
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Affiliation(s)
- Claudio Fozza
- Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 12, 07100 Sassari, Italy.
| | - Valeria Crobu
- Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 12, 07100 Sassari, Italy
| | - Maria Antonia Isoni
- Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 12, 07100 Sassari, Italy
| | - Fausto Dore
- Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 12, 07100 Sassari, Italy
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31
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Gidaro A, Deliliers GL, Gallipoli P, Arquati M, Wu MA, Castelli R. Laboratory and clinical risk assessment to treat myelodysplatic syndromes. ACTA ACUST UNITED AC 2016; 54:1411-26. [DOI: 10.1515/cclm-2015-0789] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 11/11/2015] [Indexed: 12/11/2022]
Abstract
Abstract
Myelodisplastic syndromes (MDS) are heterogeneous myeloid disorders characterized by peripheral cytopenias and increased risk of transformation into acute myelogenous leukemia (AML). MDS are generally suspected in the presence of cytopenia on routine analysis and the evaluation of bone marrow cells morphology and cellularity leads to correct diagnosis of MDS. The incidence of MDS is approximately five cases per 100,000 people per year in the general population, but it increases up to 50 cases per 100,000 people per year after 60 years of age. Typically MDS affect the elderly, with a median age at diagnosis of 65–70 years. Here the current therapeutic approaches for MDS are evaluated by searching the PubMed database. Establishing the prognosis in MDS patients is a key element of therapy. In fact an accurate estimate of prognosis drives decisions about the choice and timing of the therapeutic options. Therapy is selected based on prognostic risk assessment, cytogenetic pattern, transfusion needs and biological characteristics of the disease, comorbidities and clinical condition of the patients. In lower-risk patients the goals of therapy are different from those in higher-risk patients. In lower-risk patients, the aim of therapy is to reduce transfusion needs and transformation to higher risk disease or AML, improving the quality of life and survival. In higher-risk patients, the main goal of therapy is to prolong survival and to reduce the risk of AML transformation. Current therapies include growth factor support, lenalidomide, immunomodulatory and hypomethylating agents, intensive chemotherapy, and allogenic stem cell transplantation. The challenge when dealing with MDS patients is to select the optimal treatment by balancing efficacy and toxicity.
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Hutzschenreuter F, Monsef I, Kreuzer K, Engert A, Skoetz N. Granulocyte and granulocyte-macrophage colony stimulating factors for newly diagnosed patients with myelodysplastic syndromes. Cochrane Database Syst Rev 2016; 2:CD009310. [PMID: 26880256 PMCID: PMC10405220 DOI: 10.1002/14651858.cd009310.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Myelodysplastic syndromes (MDS) are a heterogeneous group of haematological diseases which are characterised by a uni- or multilineage dysplasia of haematological stem cells. Standard treatment is supportive care of the arising symptoms including red blood cell transfusions or the administration of erythropoiesis-stimulating agents (ESAs) in the case of anaemia or the treatment with granulocyte (G-CSF) and granulocyte-macrophage colony stimulating factors (GM-CSF) in cases of neutropenia. OBJECTIVES The objective of this review is to assess the evidence for the treatment of patients with MDS with G-CSF and GM-CSF in addition to standard therapy in comparison to the same standard therapy or the same standard therapy and placebo. SEARCH METHODS We searched MEDLINE (from 1950 to 3 December 2015) and CENTRAL (Cochrane Central Register of Controlled Trials until 3 December 2015), as well as conference proceedings (American Society of Hematology, American Society of Clinical Oncology, European Hematology Association, European Society of Medical Oncology) for randomised controlled trials (RCTs). Two review authors independently screened search results. SELECTION CRITERIA We included RCTs examining G-CSF or GM-CSF in addition to standard therapy in patients with newly diagnosed MDS. DATA COLLECTION AND ANALYSIS We used hazard ratios (HR) as effect measure for overall survival (OS), progression-free survival (PFS) and time to progression, and risk ratios for response rates, adverse events, antibiotic use and hospitalisation. Two independent review authors extracted data and assessed risk of bias. Investigators of two trials were contacted for subgroup information, however, no further data were provided. G-CSF and GM-CSF were analysed separately. MAIN RESULTS We screened a total of 566 records. Seven RCTs involving 486 patients were identified, but we could only meta-analyse the two evaluating GM-CSF. We judged the potential risk of bias of these trials as unclear, mostly due to missing information. All trials were randomised and open-label studies. However, three trials were published as abstracts only, therefore we were not able to assess the potential risk of bias for these trials in detail. Overall, data were not reported in a comparable way and patient-related outcomes like survival, time to progression to acute myeloid leukaemia (AML) or the incidence of infections was reported in two trials only.Five RCTs (N = 337) assessed the efficacy of G-CSF in combination with standard therapy (supportive care, chemotherapy or erythropoietin). We were not able to perform meta-analyses for any of the pre-planned outcomes due to inconsistent and insufficient reporting of data. There is no evidence for a difference for overall survival (hazard ratio (HR) 0.80, 95% confidence interval (CI) 0.44 to 1.47), progression-free survival (only P value provided), progression to AML, incidence of infections and number of red blood transfusions (average number of 12 red blood cell transfusions in each arm). We judged the quality of evidence for all these outcomes as very low, due to very high imprecision and potential publication bias, as three trials were published as abstracts only. Data about quality of life and serious adverse events were not reported in any of the included trials.Two RCTs (N = 149) evaluated GM-CSF in addition to standard therapy (chemotherapy). For mortality (two RCTs; HR 0.88, 95% CI 0.62 to 1.26), we found no evidence for a difference (low-quality evidence). Data for progression-free survival and serious adverse events were not comparable across both studies, without evidence for a difference between both arms (low-quality evidence). For infections, red blood cell and platelet transfusions, we found no evidence for a difference, however, these outcomes were reported by one trial only (low-quality evidence). Time to progression to AML and quality of life were not reported at all.Moreover, we identified two cross-over trials, including 244 patients and evaluating GM-CSF versus placebo, without publishing results for each arm before crossing over. In addition, we identified two ongoing studies, one of which was discontinued due to withdrawal of pharmaceutical support, the other was terminated early, both without publishing results. AUTHORS' CONCLUSIONS Although we identified seven trials with a total number of 486 patients, and two unpublished, prematurely finished studies, this systematic review mainly shows that there is a substantial lack of data, which might inform the use of G-CSF and GM-CSF for the prevention of infections, prolonging of survival and improvement of quality of life. The impact on progression to AML remains unclear.
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Affiliation(s)
- Franz Hutzschenreuter
- University Hospital of CologneCochrane Haematological Malignancies Group, Department I of Internal MedicineCologneGermany
| | - Ina Monsef
- University Hospital of CologneCochrane Haematological Malignancies Group, Department I of Internal MedicineCologneGermany
| | - Karl‐Anton Kreuzer
- University Hospital of CologneDepartment I of Internal MedicineCologneGermany
| | - Andreas Engert
- University Hospital of CologneDepartment I of Internal MedicineCologneGermany
| | - Nicole Skoetz
- University Hospital of CologneCochrane Haematological Malignancies Group, Department I of Internal MedicineCologneGermany
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Bauer K, Hutzschenreuter F, Skoetz N, Kreuzer KA, Monsef I, Engert A. Hypomethylating agents for patients with myelodysplastic syndrome. Hippokratia 2016. [DOI: 10.1002/14651858.cd009340.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Kathrin Bauer
- Spitzenverband Bund der Krankenkassen; Reinhardtstraße 30 Berlin Germany 10117
| | - Franz Hutzschenreuter
- University Hospital of Cologne; Cochrane Haematological Malignancies Group, Department I of Internal Medicine; Cologne Germany
| | - Nicole Skoetz
- University Hospital of Cologne; Cochrane Haematological Malignancies Group, Department I of Internal Medicine; Cologne Germany
| | - Karl-Anton Kreuzer
- University Hospital of Cologne; Department I of Internal Medicine; Cologne Germany
| | - Ina Monsef
- University Hospital of Cologne; Cochrane Haematological Malignancies Group, Department I of Internal Medicine; Cologne Germany
| | - Andreas Engert
- University Hospital of Cologne; Department I of Internal Medicine; Cologne Germany
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Xicoy B, Germing U, Jimenez MJ, Garcia O, Garcia R, Schemenau J, Pedro C, Luño E, Bernal T, González B, Strupp C, Ardanaz M, Kuendgen A, Cedena MT, Neukirchen J, Calabuig M, Brunet S, Medina A, Amigo ML, Ramos F, Callejas M, Díez-Campelo M, Bailén A, Collado R, Vicente A, Arnan M, Valcarcel D, Arilla MJ, Zamora L, Benlloch L, Sanz G. Response to erythropoietic-stimulating agents in patients with chronic myelomonocytic leukemia. Eur J Haematol 2015; 97:33-8. [DOI: 10.1111/ejh.12679] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2015] [Indexed: 12/29/2022]
Affiliation(s)
| | - Ulrich Germing
- Department of Hematology; Oncology and Clinical Immunology; Heinrich-Heine Universitätsklinikum Düsseldorf; Düsseldorf Germany
| | | | | | | | - Jeniffer Schemenau
- Department of Hematology; Oncology and Clinical Immunology; Heinrich-Heine Universitätsklinikum Düsseldorf; Düsseldorf Germany
| | | | | | | | | | - Corinna Strupp
- Department of Hematology; Oncology and Clinical Immunology; Heinrich-Heine Universitätsklinikum Düsseldorf; Düsseldorf Germany
| | | | - Andrea Kuendgen
- Department of Hematology; Oncology and Clinical Immunology; Heinrich-Heine Universitätsklinikum Düsseldorf; Düsseldorf Germany
| | | | - Judith Neukirchen
- Department of Hematology; Oncology and Clinical Immunology; Heinrich-Heine Universitätsklinikum Düsseldorf; Düsseldorf Germany
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35
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Niscola P, Tendas A, Merola R, Orlandi G, Scaramucci L, de Fabritiis P. Regaining the response to erythropoietin following azacitidine in chronic myelomonocytic leukemia previously evolved from refractory anemia. Blood Res 2015; 50:181-2. [PMID: 26457287 PMCID: PMC4595586 DOI: 10.5045/br.2015.50.3.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 11/01/2014] [Accepted: 07/27/2015] [Indexed: 11/17/2022] Open
Affiliation(s)
- Pasquale Niscola
- Hematology Unit, S. Eugenio Hospital Rome, Clinical Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Andrea Tendas
- Hematology Unit, S. Eugenio Hospital Rome, Clinical Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Roberta Merola
- Hematology Unit, S. Eugenio Hospital Rome, Clinical Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Giulia Orlandi
- Hematology Unit, S. Eugenio Hospital Rome, Clinical Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Laura Scaramucci
- Hematology Unit, S. Eugenio Hospital Rome, Clinical Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Paolo de Fabritiis
- Hematology Unit, S. Eugenio Hospital Rome, Clinical Pathology, Regina Elena National Cancer Institute, Rome, Italy
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Fozza C, Corda G, Barraqueddu F, Virdis P, Contini S, Galleu A, Isoni A, Dore F, Angelucci E, Longinotti M. Azacitidine improves the T-cell repertoire in patients with myelodysplastic syndromes and acute myeloid leukemia with multilineage dysplasia. Leuk Res 2015. [DOI: 10.1016/j.leukres.2015.06.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Giordano G, Mondello P, Tambaro R, Perrotta N, D'Amico F, D'Aveta A, Berardi G, Carabellese B, Patriarca A, Corbi GM, DI Marzio L, Licianci A, Berardi D, DI Lullo L, DI Marco R. Biosimilar epoetin α is as effective as originator epoetin-α plus liposomal iron (Sideral®), vitamin B12 and folates in patients with refractory anemia: A retrospective real-life approach. Mol Clin Oncol 2015; 3:781-784. [PMID: 26171179 DOI: 10.3892/mco.2015.555] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 03/12/2015] [Indexed: 11/06/2022] Open
Abstract
Several biosimilar versions of recombinant human erythropoietin are currently approved for use in Europe, including a biosimilar epoetin-α. The aim of this the study was to verify that biosimilar epoetin-α is similar in terms of efficacy, safety and cost to originator epoetin-α for the treatment of refractory anemia in patients with myelodysplastic syndrome. A total of 92 patients with myelodysplasia and refractory anemia were investigated. The patients received either originator (group A) or biosimilar (group B) epoetin-α. In addition, they received liposomal iron (Sideral®), calcium levofolinate and vitamin B12. Moreover, the median monthly overall costs were calculated for each group. The results demonstrated that hemoglobin (Hb) levels increased by 1 g/dl after a median time of 5 weeks in group A and 4 weeks in group B. In group A, a Hb level of >12 g/dl was achieved after 12 weeks, while in group B after 10.5 weeks. The median cost of therapy was 1,536 euros/month in group A and 1,354 euros/month in group B. A total of 5 patients required transfusion support in group A and 7 in group B. In conclusion, biosimilar epoetin-α appears to be comparable to originator epoetin-α in terms of efficacy and safety for the treatment of refractory anemia.
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Affiliation(s)
- Giulio Giordano
- General Medicine and Hematology Regional Hospital 'A. Cardarelli', I-86100 Campobasso, Molise, Italy
| | - Patrizia Mondello
- Department of Oncology, G. Martino University Hospital, I-98100 Messina, Messina, Italy
| | - Rosa Tambaro
- G. Pascale Cancer Institute, I-80100 Naples, Campania, Italy
| | - Nicola Perrotta
- Faculty of Pharmacology, G. D'Annunzio University, I-66100 Chieti, Chieti, Italy
| | - Fabio D'Amico
- School of Medicine, University of Molise, I-86100 Campobasso, Molise, Italy
| | - Antonietta D'Aveta
- General Medicine and Hematology Regional Hospital 'A. Cardarelli', I-86100 Campobasso, Molise, Italy
| | - Giuseppe Berardi
- Family Medicine, Regional Health Service, A. Cardelli, I-86100 Campobasso, Molise, Italy
| | - Bruno Carabellese
- Services Department, Cardarelli Hospital, I-86100 Campobasso, Molise, Italy
| | - Andrea Patriarca
- Medicine and Hematology Unit, Public Hospital, I-13900 Biella, Italy
| | - Grazia Maria Corbi
- School of Medicine, University of Molise, I-86100 Campobasso, Molise, Italy
| | - Luigi DI Marzio
- Services Department, Cardarelli Hospital, I-86100 Campobasso, Molise, Italy
| | | | - Donata Berardi
- Faculty of Medicine, University 'La Sapienza', I-00185 Rome, Italy
| | - Liberato DI Lullo
- Department of Oncology, Regional Health Service, A. Cardelli, I-86100 Campobasso, Molise, Italy
| | - Roberto DI Marco
- School of Medicine, University of Molise, I-86100 Campobasso, Molise, Italy
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Manduzio P. Deferasirox in a refractory anemia after other treatment options: case report and literature review. Clin Case Rep 2015; 3:361-7. [PMID: 26185629 PMCID: PMC4498843 DOI: 10.1002/ccr3.262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 12/17/2014] [Accepted: 02/20/2015] [Indexed: 01/19/2023] Open
Abstract
Deferasirox, represents an effective iron chelator drug in lower risk myelodysplastic syndromes. Reduction in oxidative stress is responsible of the hematologic improvement but further explanation may impact on its benefit. Biological and clinical studies are necessary to better define mechanisms of action, assess toxicities, and predicting factors of response.
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Affiliation(s)
- Palma Manduzio
- Department of Clinical Pathology, Riuniti University Hospital, Immunohematology and Transfusion Medicine Foggia, Italy ; Department of Oncology and Haematology, Marche Nord Hospital, Haematology and Haematopoietic Stem Cell Transplant Center Pesaro, Italy
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39
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Tendas A, Niscola P, Cupelli L, Scaramucci L, Giovannini M, Piccioni D, Dentamaro T, Perrotti AP, de Fabritiis P. Clinical Complications in Outpatient Myelodysplastic Syndromes. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2015. [DOI: 10.1177/1084822314534259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of our research is to evaluate the rate, the type, the severity, the causative factors, and the pathogenesis of complications during the course of myelodysplastic syndromes (MDS). Complications among MDS patients on outpatient management were prospectively recorded and classified. During an 18-month observation period, complications emerging in 48 outpatients with MDS, of whom 15 (31%) were on active treatment and 33 (69%) were receiving best supportive care alone, were recorded and analyzed. Out of 48 patients (median age, 72 years), 34 (71%) experienced complications; a total number of 92 events were recorded; most frequently observed events were infections (43 events, 47%) and bleeding (11 events, 12%). Complications are a frequent issue in MDS; preventive measures should be directed toward the most frequently observed complications.
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van Spronsen MF, Ossenkoppele GJ, Holman R, van de Loosdrecht AA. Improved risk stratification by the integration of the revised international prognostic scoring system with the myelodysplastic syndromes comorbidity index. Eur J Cancer 2014; 50:3198-205. [PMID: 25454415 DOI: 10.1016/j.ejca.2014.09.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 08/30/2014] [Accepted: 09/22/2014] [Indexed: 12/20/2022]
Abstract
Myelodysplastic syndromes (MDS) comprise bone marrow failure diseases with a diverse clinical outcome. For improved risk stratification, the International Prognostic Scoring System (IPSS) has recently been revised (IPSS-R). This single-centre study aimed to validate the IPSS-R and to evaluate prior prognostic scoring systems for MDS. We retrospectively analysed 363 patients diagnosed with MDS according to the FAB criteria between 2000 and 2012. The IPSS, MD Anderson Risk Model Score (MDAS), World Health Organisation (WHO)-classification based Prognostic Scoring System (WPSS), refined WPSS (WPSS-R), IPSS-R and MDS-Comorbidity Index (MDS-CI) were applied to 222 patients considered with primary MDS following the WHO criteria and their prognostic power was investigated. According to the IPSS-R, 18 (8%), 81 (37%), 50 (23%), 43 (19%) and 30 (13%) patients were classified as very low, low, intermediate, high and very high risk with, respectively, a median overall survival of 96 (95% Confidence interval (CI) not reached), 49 (95% CI 34-64), 22 (95% CI 0-49), 19 (95% CI 11-27) and 10 (95% CI 6-13) months (p<.000). The IPSS-R showed improved prognostic power as compared to the IPSS, MDAS, WPSS and WPSS-R. Furthermore, the MDS-CI refined the risk stratification of MDS patients stratified according to the IPSS-R. In conclusion, accounting for the disease status by means of the IPSS-R and comorbidity through the MDS-CI considerably improves the prognostic assessment in MDS patients.
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Affiliation(s)
- M F van Spronsen
- Department of Hematology, Cancer Center Amsterdam (CCA), VU University Medical Center, Amsterdam, The Netherlands
| | - G J Ossenkoppele
- Department of Hematology, Cancer Center Amsterdam (CCA), VU University Medical Center, Amsterdam, The Netherlands
| | - R Holman
- Department of Biostatistics, Cancer Center Amsterdam (CCA), VU University Medical Center, Amsterdam, The Netherlands
| | - A A van de Loosdrecht
- Department of Hematology, Cancer Center Amsterdam (CCA), VU University Medical Center, Amsterdam, The Netherlands.
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Díez Campelo M, Sánchez-Barba M, de Soria VGG, Martino R, Sanz G, Insunza A, Bernal T, Duarte R, Amigo M, Xicoy B, Tormo M, Iniesta F, Bailén A, Benlloch L, Córdoba I, López-Villar O, del Cañizo M. Results of allogeneic stem cell transplantation in the Spanish MDS registry: Prognostic factors for low risk patients. Leuk Res 2014; 38:1199-206. [DOI: 10.1016/j.leukres.2014.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 07/06/2014] [Accepted: 07/25/2014] [Indexed: 01/15/2023]
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Ko BS, Chang CS, Chang MC, Chen TY, Chiou TJ, Chiu CF, Huang WL, Kao WY, Lan YJ, Lin SF, Tan TD, Tang JL, Tzeng CH, Wang PN, Yet SP, Tien HF. Guidelines for treating iron overload in myelodysplastic syndromes: a Taiwan consensus statement. Int J Hematol 2014; 100:7-15. [DOI: 10.1007/s12185-014-1607-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 05/27/2014] [Accepted: 05/28/2014] [Indexed: 01/19/2023]
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Finelli C, Clissa C, Stanzani M. Use of deferasirox in transfusion-dependent myelodysplastic syndromes with iron overload. Int J Hematol Oncol 2014. [DOI: 10.2217/ijh.14.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
SUMMARY In myelodysplastic syndromes (MDS), transfusion-dependent anemia has been established as an independent risk factor for decreased survival. Although evidence from prospective studies is still lacking, several guidelines recommend iron-chelating therapy in MDS patients with a longer life expectancy. With the recent introduction of deferasirox, an oral active iron-chelating drug, which has shown dose-dependent efficacy and acceptable tolerability, this therapeutic option has become feasible even in the elderly. Several retrospective and prospective studies showed that in MDS patients deferasirox is effective in reducing iron burden and in maintaining the circulating toxic iron fraction within the normal range. Moreover, in a substantial fraction of patients treated with deferasirox a significant improvement of peripheral cytopenias may occur.
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Affiliation(s)
- Carlo Finelli
- Institute of Hematology, “Seràgnoli”, Sant’Orsola-Malpighi University Hospital, Via Massarenti 9 – 40138 Bologna, Italy
| | - Cristina Clissa
- Institute of Hematology, “Seràgnoli”, Sant’Orsola-Malpighi University Hospital, Via Massarenti 9 – 40138 Bologna, Italy
| | - Marta Stanzani
- Institute of Hematology, “Seràgnoli”, Sant’Orsola-Malpighi University Hospital, Via Massarenti 9 – 40138 Bologna, Italy
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Delforge M, Selleslag D, Beguin Y, Triffet A, Mineur P, Theunissen K, Graux C, Trullemans F, Boulet D, Van Eygen K, Noens L, Van Steenweghen S, Lemmens J, Pierre P, D’hondt R, Ferrant A, Deeren D, Van De Velde A, Wynendaele W, André M, De Bock R, Efira A, Breems D, Deweweire A, Geldhof K, Pluymers W, Harrington A, MacDonald K, Abraham I, Ravoet C. Adequate iron chelation therapy for at least six months improves survival in transfusion-dependent patients with lower risk myelodysplastic syndromes. Leuk Res 2014; 38:557-63. [DOI: 10.1016/j.leukres.2014.02.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Revised: 02/03/2014] [Accepted: 02/05/2014] [Indexed: 01/25/2023]
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45
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Angelucci E, Santini V, Di Tucci AA, Quaresmini G, Finelli C, Volpe A, Quarta G, Rivellini F, Sanpaolo G, Cilloni D, Salvi F, Caocci G, Molteni A, Vallisa D, Voso MT, Fenu S, Borin L, Latte G, Alimena G, Storti S, Piciocchi A, Fazi P, Vignetti M, Tura S. Deferasirox for transfusion-dependent patients with myelodysplastic syndromes: safety, efficacy, and beyond (GIMEMA MDS0306 Trial). Eur J Haematol 2014; 92:527-36. [DOI: 10.1111/ejh.12300] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2014] [Indexed: 01/08/2023]
Affiliation(s)
- Emanuele Angelucci
- Hematology and Bone Marrow Transplantation Unit; Ospedale Oncologico di Riferimento Regionale “Armando Businco”; Cagliari Italy
| | - Valeria Santini
- Division of Hematology; University of Florence; Florence Italy
| | - Anna Angela Di Tucci
- Hematology and Bone Marrow Transplantation Unit; Ospedale Oncologico di Riferimento Regionale “Armando Businco”; Cagliari Italy
| | - Giulia Quaresmini
- Hematology and Bone Marrow Transplant Unit; Azienda Ospedaliera Papa Giovanni XXIII; Bergamo Italy
| | - Carlo Finelli
- Division of Hematology; Policlinico S. Orsola-Malpighi; Bologna Italy
| | - Antonio Volpe
- Division of Hematology; San Giuseppe Moscati Hospital; Avellino Italy
| | | | - Flavia Rivellini
- UO Medicina Interna e Onco-Ematologica P.O. “Umberto I”; Nocera Inferiore Italy
| | - Grazia Sanpaolo
- Division of Hematology; IRCCS “Casa Sollievo della Sofferenza”; San Giovanni Rotondo Italy
| | - Daniela Cilloni
- Department of Clinical and Biological Sciences; University of Turin; Turin Italy
| | - Flavia Salvi
- Division of Hematology; A.O. Nazionale Santi Antonio e Biagio e C. Arrigo; Alessandria Italy
| | - Giovanni Caocci
- Bone Marrow Transplantation Center; R. Binaghi Hospital; Cagliari Italy
| | - Alfredo Molteni
- Division of Hematology; Niguarda Ca’ Granda Hospital; Milan Italy
| | - Daniele Vallisa
- Division of Medical Oncology and Hematology; Hospital of Piacenza; Piacenza Italy
| | - Maria Teresa Voso
- Division of Hematology; Università Cattolica del Sacro Cuore; Rome Italy
| | - Susanna Fenu
- Division of Hematology; San Giovanni Hospital; Rome Italy
| | | | | | - Giuliana Alimena
- Division of Hematology; “Sapienza”University of Rome; Rome Italy
| | - Sergio Storti
- Division of Hematology and Medical Oncology; Campobasso University; Campobasso Italy
| | | | - Paola Fazi
- GIMEMA Data Center; GIMEMA Foundation; Rome Italy
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Castelli R, Deliliers GL, Colombo R, Moreo G, Gallipoli P, Pantaleo G. Biosimilar epoetin in elderly patients with low-risk myelodysplastic syndromes improves anemia, quality of life, and brain function. Ann Hematol 2014; 93:1523-9. [DOI: 10.1007/s00277-014-2070-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 03/26/2014] [Indexed: 10/25/2022]
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47
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Dinmohamed AG, Visser O, van Norden Y, Huijgens PC, Sonneveld P, van de Loosdrecht AA, Jongen-Lavrencic M. Trends in incidence, initial treatment and survival of myelodysplastic syndromes: A population-based study of 5144 patients diagnosed in the Netherlands from 2001 to 2010. Eur J Cancer 2014; 50:1004-12. [DOI: 10.1016/j.ejca.2013.12.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 11/28/2013] [Accepted: 12/03/2013] [Indexed: 12/13/2022]
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48
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Iron overload and chelation therapy in myelodysplastic syndromes. Crit Rev Oncol Hematol 2014; 91:64-73. [PMID: 24529413 DOI: 10.1016/j.critrevonc.2014.01.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 12/21/2013] [Accepted: 01/14/2014] [Indexed: 01/19/2023] Open
Abstract
Iron overload remains a concern in MDS patients especially those requiring recurrent blood transfusions. The consequence of iron overload may be more relevant in patients with low and intermediate-1 risk MDS who may survive long enough to experience such manifestations. It is a matter of debate whether this overload has time to yield organ damage, but it is quite evident that cellular damage and DNA genotoxic effect are induced. Iron overload may play a critical role in exacerbating pre-existing morbidity or even unmask silent ones. Under these circumstances, iron chelation therapy could play an integral role in the management of these patients. This review entails an in depth analysis of iron overload in MDS patients; its pathophysiology, effect on survival, associated risks and diagnostic options. It also discusses management options in relation to chelation therapy used in MDS patients and the impact it has on survival, hematologic response and organ function.
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Distribution of serum erythropoietin levels in lower risk myelodysplastic syndrome cases with anemia. Int J Hematol 2013; 99:53-6. [PMID: 24307517 DOI: 10.1007/s12185-013-1485-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 11/21/2013] [Accepted: 11/21/2013] [Indexed: 10/25/2022]
Abstract
International guidelines for myelodysplastic syndrome (MDS) state that the standard therapy for lower risk MDS patients with symptomatic anemia of serum erythropoietin (EPO) <500 IU/L is erythroid-stimulating agents (ESAs). The objective of this study is to examine the distribution of EPO levels in lower risk MDS patients, and to inquire into the relationship of EPO distribution to hemoglobin levels and transfusions. Twenty cases of lower risk MDS (low or intermediate-1 by the International Prognostic Scoring System) with hemoglobin level <90 g/L at our institution were enrolled. Eight received more than two units of transfusions per month. Median hemoglobin level was 78 g/L. EPO levels ranged between 26.4 and 11300 IU/L (median 645 IU/L), including 10 cases (50 %) with >500 IU/L. EPO levels were inversely correlated to hemoglobin levels, especially in the cases without transfusion support (p < 0.001, R = 0.92). The rate of the cases with EPO <500 IU/L was significantly higher in the group without transfusion than the others (p = 0.020). Considering that, in Japan, the indication for transfusion is around 70 g/L of hemoglobin for chronic diseases, it may be possible to improve anemia in a subset of lower risk MDS cases by administration of ESAs before transfusions are required.
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Steensma DP, Gattermann N. When is iron overload deleterious, and when and how should iron chelation therapy be administered in myelodysplastic syndromes? Best Pract Res Clin Haematol 2013; 26:431-44. [DOI: 10.1016/j.beha.2013.09.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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