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Yoshida C, Yamaguchi H, Doki N, Murai K, Iino M, Hatta Y, Onizuka M, Yokose N, Fujimaki K, Hagihara M, Oshikawa G, Murayama K, Kumagai T, Kimura S, Najima Y, Iriyama N, Tsutsumi I, Oba K, Kojima H, Sakamaki H, Inokuchi K. Importance of TKI treatment duration in treatment-free remission of chronic myeloid leukemia: results of the D-FREE study. Int J Hematol 2023; 117:694-705. [PMID: 36739328 PMCID: PMC10121524 DOI: 10.1007/s12185-023-03549-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/21/2023] [Accepted: 01/22/2023] [Indexed: 02/05/2023]
Abstract
Treatment-free remission (TFR) is a new goal for patients with chronic myeloid leukemia in chronic phase (CML-CP) with a sustained deep molecular response (DMR) to treatment with tyrosine kinase inhibitors (TKIs). However, optimal conditions for successful TFR in patients treated with second-generation (2G)-TKIs are not fully defined. In this D-FREE study, treatment discontinuation was attempted in newly diagnosed CML-CP patients treated with the 2G-TKI dasatinib who achieved BCR-ABL1 levels of ≤ 0.0032% (MR4.5) on the international scale (BCR-ABL1IS) and maintained these levels for exactly 1 year. Of the 173 patients who received dasatinib induction therapy for up to 2 years, 123 completed and 60 (48.8%) reached MR 4.5. Among the first 21 patients who maintained MR4.5 for 1 year and discontinued dasatinib, 17 experienced molecular relapse defined as loss of major molecular response (BCR-ABL1IS > 0.1%) confirmed once, or loss of MR4 (BCR-ABL1IS > 0.01%) confirmed on 2 consecutive assessments. The estimated molecular relapse-free survival rate was 16.7% at 12 months. This study was prematurely terminated according to the protocol's safety monitoring criteria. The conclusion was that sustained DMR for just 1 year is insufficient for TFR in CML-CP patients receiving dasatinib for less than a total of 3 years of treatment.
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Affiliation(s)
- Chikashi Yoshida
- Department of Hematology, National Hospital Organization Mito Medical Center, 280 Sakuranosato, Ibarakimachi, Higashiibarakigun, Ibaraki, 311-3193, Japan.
| | | | - Noriko Doki
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Kazunori Murai
- Department of Hematology, Iwate Prefectural Central Hospital, Morioka, Japan
| | - Masaki Iino
- Department of Medical Oncology, Yamanashi Prefectural Central Hospital, Kofu, Japan
| | - Yoshihiro Hatta
- Division of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Makoto Onizuka
- Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan
| | - Norio Yokose
- Department of Hematology, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Japan
| | | | - Masao Hagihara
- Department of Hematology, EIJU General Hospital, Taito-Ku, Japan
| | - Gaku Oshikawa
- Japanese Red Cross Musashino Hospital, Musashino, Japan
| | - Kayoko Murayama
- Division of Hematology, Gunma Prefectural Cancer Center, Ohta, Japan
| | - Takashi Kumagai
- Department of Hematology, Ome Municipal General Hospital, Ome-Shi, Tokyo, Japan
| | - Shinya Kimura
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Yuho Najima
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Noriyoshi Iriyama
- Division of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Ikuyo Tsutsumi
- Department of Hematology, National Hospital Organization Mito Medical Center, 280 Sakuranosato, Ibarakimachi, Higashiibarakigun, Ibaraki, 311-3193, Japan
| | - Koji Oba
- Department of Biostatistics, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Kojima
- Ibaraki Clinical Education and Training Center, University of Tsukuba Hospital, Kasama, Japan
| | - Hisashi Sakamaki
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Koiti Inokuchi
- Department of Hematology, Nippon Medical School, Tokyo, Japan
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Cheng Y, Hao Y, Zhang A, Hu C, Jiang X, Wu Q, Xu X. Persistent STAT5-mediated ROS production and involvement of aberrant p53 apoptotic signaling in the resistance of chronic myeloid leukemia to imatinib. Int J Mol Med 2017; 41:455-463. [PMID: 29115375 DOI: 10.3892/ijmm.2017.3205] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 10/19/2017] [Indexed: 11/06/2022] Open
Abstract
The persistent activation of signal transducer and activator of transcription 5 (STAT5) may principally be attributed to breakpoint cluster region (BCR)-Abelson murine leukemia viral oncogene homolog 1 (ABL1), and have multi-faceted effects in the development of chronic myeloid leukemia (CML). The p53 protein network regulates important mechanisms in DNA damage repair, cell cycle regulation/checkpoints, and cell senescence and apoptosis, as demonstrated by its ability to positively regulate the expression of various pro-apoptotic genes, including B-cell lymphoma-2 (Bcl-2) and Bcl-2-associated X protein (Bax). In the present study, it was observed that the mRNA levels of STAT5A and STAT5B were upregulated in patients with imatinib-resistant CML and in the imatinib-resistant K562/G CML cell line. In addition, increased expression of STAT5 was observed in the BCR-ABL1 mutation group, compared with that in the non-BCR-ABL1 mutation group, regardless of patient imatinib resistance state. Elevated levels of reactive oxygen species (ROS) and DNA double-strand breaks were identified in K562/G cells using flow cytometric and phosphorylated H2AX (γ-H2AX) foci immunofluorescence assays, respectively, compared with the imatinib-sensitive K562 cells. The levels of intracellular ROS and γ-H2AX were decreased by the ROS scavenger (N-acetylcysteine), and ROS levels were also markedly reduced by STAT5 inhibitor (SH-4-54). In addition, imatinib significantly inhibited the proliferation of K562 and K562/G cells, with half maximal inhibitory concentration values of 0.17±0.07 and 14.78±0.43 µM, respectively, and the levels of apoptosis were significantly different between K562 and K562/G cells following treatment with imatinib. The mRNA and protein levels of STAT5 and mouse double minute 2 homolog (MDM2) were upregulated, whereas those of Bax were downregulated in K562/G cells, as determined using western blot analysis. Additionally, although the two cell lines exhibited relatively low protein expression levels of p53, lower levels of p53 and TPp53BP1 transcripts were detected in the K562/G cells. Taken together, these findings suggest that the resistance of CML to the tyrosine kinase inhibitor, imatinib, may be associated with persistent STAT5-mediated ROS production, and the abnormality of the p53 pathway.
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Affiliation(s)
- Yanhong Cheng
- Central Laboratory, Anhui Provincial Hospital, Anhui Medical University, Hefei, Anhui 230001, P.R. China
| | - Yingchan Hao
- Central Laboratory, Anhui Provincial Hospital, Anhui Medical University, Hefei, Anhui 230001, P.R. China
| | - Aimei Zhang
- Central Laboratory, Anhui Provincial Hospital, Anhui Medical University, Hefei, Anhui 230001, P.R. China
| | - Chaojie Hu
- Central Laboratory, Anhui Provincial Hospital, Anhui Medical University, Hefei, Anhui 230001, P.R. China
| | - Xiaoxiao Jiang
- Central Laboratory, Anhui Provincial Hospital, Anhui Medical University, Hefei, Anhui 230001, P.R. China
| | - Quan Wu
- Central Laboratory, Anhui Provincial Hospital, Anhui Medical University, Hefei, Anhui 230001, P.R. China
| | - Xiucai Xu
- Central Laboratory, Anhui Provincial Hospital, Anhui Medical University, Hefei, Anhui 230001, P.R. China
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Pietkiewicz AL, Zhang Y, Rahimi MN, Stramandinoli M, Teusner M, McAlpine SR. RITA Mimics: Synthesis and Mechanistic Evaluation of Asymmetric Linked Trithiazoles. ACS Med Chem Lett 2017; 8:401-406. [PMID: 28435526 DOI: 10.1021/acsmedchemlett.6b00488] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 03/06/2017] [Indexed: 02/07/2023] Open
Abstract
The established cytotoxic agent RITA contains a thiophene-furan-thiophene backbone and two terminal alcohol groups. Herein we investigate the effect of using thiazoles as the backbone in RITA-like molecules and modifying the terminal groups of these trithiazoles, thereby generating 41 unique structures. Incorporating side chains with varied steric bulk allowed us to investigate how size and a stereocenter impacted biological activity. Subjecting compounds to growth inhibition assays on HCT-116 cells showed that the most potent compounds 7d, 7e, and 7h had GI50 values of 4.4, 4.4, and 3.4 μM, respectively, versus RITA (GI50 of 800 nM). Analysis of these compounds in apoptosis assays proved that 7d, 7e, and 7h were as effective as RITA at inducing apoptosis. Evaluating the impact of 7h on proteins targeted by RITA (p53, c-Myc, and Mcl-1) indicated that it acts via a different mechanism of action to that of RITA. RITA suppressed Mcl-1 protein via p53, whereas compound 7h suppressed Mcl-1 expression via an alternative mechanism independent of p53.
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Affiliation(s)
| | - Yuqi Zhang
- School of Chemistry, University of New South Wales, Sydney, NSW 2052, Australia
| | - Marwa N. Rahimi
- School of Chemistry, University of New South Wales, Sydney, NSW 2052, Australia
| | | | - Matthew Teusner
- School of Chemistry, University of New South Wales, Sydney, NSW 2052, Australia
| | - Shelli R. McAlpine
- School of Chemistry, University of New South Wales, Sydney, NSW 2052, Australia
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