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Turk S, Yanpar H, Baesmat AS, Canli SD, Cinar OE, Malkan UY, Turk C, Haznedaroglu IC, Ucar G. Enterotoxins A and B produced by Staphylococcus aureus increase cell proliferation, invasion and cytarabine resistance in acute myeloid leukemia cell lines. Heliyon 2023; 9:e19743. [PMID: 37810000 PMCID: PMC10559070 DOI: 10.1016/j.heliyon.2023.e19743] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 08/25/2023] [Accepted: 08/31/2023] [Indexed: 10/10/2023] Open
Abstract
As in the case of cancer, the risk of infection increases when the host's immune system is not working properly. It has been shown that toxins produced by the bacteria responsible for bacterial infections can alter the properties of cancer cells as well as their sensitivity to chemotherapy agents. Staphylococcus aureus (S. aureus) is one of the most prevalent pathogens in acute myeloid leukemia (AML) patients and it produces several virulence factors, including Staphylococcal enterotoxin A (SEA) and Staphylococcal enterotoxin B (SEB). Cytotoxicity, transwell migration, invasion assays, and various transcriptomic and gene set enrichment (GSE) analyses were used to determine how SEA and SEB alter cell proliferation, migration, invasion, and Cytarabine (Cyt) resistance in AML cell lines. The treatment of AML cell lines with SEA/SEB caused an increase in cell proliferation and Cyt resistance. Toxins enhanced the proclivity of cells to migrate and invade, with around 50% of cells in the presence of SEA and SEB. Transcriptomic and gene set enrichment analyses, and subsequent PCR validations showed dysregulation of immune related genes and genesets. Apparently, this allows AML cells to escape and survive the undesirable environment created by toxins, possibly via the ER stress signaling pathway. Therefore, SEA and SEB can significantly alter the characteristics of AML cancer cells and evaluation of alterations in responsible immune genes and pathways may be crucial for controlling the progression of cancer. In addition, our results suggest that there may be a strong interaction between the immune related pathways and the ER signaling pathway.
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Affiliation(s)
- Seyhan Turk
- Department of Biochemistry, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
| | - Hatice Yanpar
- DS Nano and Biotechnology Product Tracing and Tracking Co., Ankara, Turkey
| | - Ayriana Safari Baesmat
- Department of Medical Microbiology, Faculty of Medicine, Lokman Hekim University, Ankara, Turkey
| | - Secil Demirkol Canli
- Molecular Pathology Application and Research Center, Hacettepe University, Ankara, Turkey
- Tumor Pathology, Cancer Institute, Hacettepe University, Ankara, Turkey
| | - Olgu Erkin Cinar
- Department of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Umit Yavuz Malkan
- Department of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Can Turk
- Department of Medical Microbiology, Faculty of Medicine, Lokman Hekim University, Ankara, Turkey
| | | | - Gulberk Ucar
- Department of Biochemistry, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
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Yedla RP, Bala SC, Pydi VR, Chennamaneni R, Kuruva SP, Konatam ML, Gundeti S. Complications during Induction Chemotherapy in Acute Promyelocytic Leukemia: An Institutional Experience. South Asian J Cancer 2023; 12:274-279. [PMID: 38047056 PMCID: PMC10691908 DOI: 10.1055/s-0042-1757303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Stalin Chowdary BalaIntroduction Acute promyelocytic leukemia (APL) has transformed from a highly fatal disease to a highly curable one. Induction deaths continue to represent one of the major impediments in modern therapy of APL. Sepsis, hemorrhage, and differentiation syndrome are the major complications during induction therapy in APL. The present study reports the incidence and prognostic factors of major complications during induction chemotherapy in patients with newly diagnosed APL. Materials and Methods The present study was a single institutional, observational, retrospective study. All cases of APL diagnosed by morphology and confirmed by RT PCR (PML RARα) were included in this study. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 25. Results A total of 73 patients were analyzed. The median age at presentation was 30 years (range, 3-60 years) with a female to male ratio of 1.02:1. The most common symptom at presentation was fever (80%), followed by fatigue (56%) and gum bleeding (37%). The majority of the patients at presentation were high risk (42.4%), followed by intermediate risk (38.4%) and low risk (19.2%). Fifty-seven (78%) patients achieved complete hematological remission and 16 (22%) succumbed during induction chemotherapy. Infection was the most common cause of induction death (50%), followed by hemorrhage (37.5%) and differentiation syndrome (12.5%). On univariate analysis of prognostic factors, bcr3 variant, grade 3/4 bleeding during induction, and low levels of albumin at presentation were significant for induction mortality ( p = 0.034, 0.041, and 0.008 respectively). On multivariate analysis, only serum albumin < 3.5 g/dL was an independent predictor for induction mortality ( p = 0.043). Conclusion The majority of patients were high risk at presentation. Sepsis was the most common complication during induction and also the leading cause of induction death. Identifying induction complications at the earliest and providing aggressive supportive measures can further improve outcomes in APL.
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Affiliation(s)
- Rajani Priya Yedla
- Department of Medical Oncology, Mahatma Gandhi Cancer Hopsital and Research Institute, Visakhapatnam, Andhra Pradesh, India
| | - Stalin Chowdary Bala
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Venkateswara Rao Pydi
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Rachana Chennamaneni
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Siva Prasad Kuruva
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Meher Lakshmi Konatam
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Sadashivudu Gundeti
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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Criscuolo M, Fracchiolla N, Farina F, Verga L, Pagano L, Busca A. A review of prophylactic regimens to prevent invasive fungal infections in hematology patients undergoing chemotherapy or stem cell transplantation. Expert Rev Hematol 2023; 16:963-980. [PMID: 38044878 DOI: 10.1080/17474086.2023.2290639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/29/2023] [Indexed: 12/05/2023]
Abstract
INTRODUCTION The recent introduction of targeted therapies, including monoclonal antibodies, tyrosine-kinase inhibitors, and immunotherapies has improved the cure rate of hematologic patients. The implication of personalized treatment on primary antifungal prophylaxis will be discussed. AREAS COVERED We reviewed the literature for clinical trials reporting the rate of invasive fungal infections during targeted and cellular therapies and stem cell transplant, and the most recent international guidelines for primary antifungal prophylaxis. EXPERT OPINION As the use of personalized therapies is growing, the risk of invasive fungal infection has emerged in various clinical settings. Therefore, it is possible that the use of mold-active antifungal prophylaxis would spread in the next years and the risk of breakthrough infections would increase. The introduction of new antifungal agents in the clinical armamentarium is expected to reduce clinical unmet needs concerning the management of primary antifungal prophylaxis and improve outcome of patients.
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Affiliation(s)
- Marianna Criscuolo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Nicola Fracchiolla
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Milan, Italy
| | | | | | - Livio Pagano
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Alessandro Busca
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Department of Oncology, SSCVD Trapianto di Cellule Staminali Torino, Torino, Italy
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Khattab F, Elkholy BM, Taha M, Abd-Elbaset A, Fawzy M. Voriconazole is superior to combined itraconazole/isotretinoin therapy and itraconazole monotherapy in recalcitrant dermatophytosis. Mycoses 2022; 65:1194-1201. [PMID: 35943822 DOI: 10.1111/myc.13517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/01/2022] [Accepted: 08/04/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND There has been an emergence of recalcitrant, recurrent, and difficult-to-treat tinea. Monotherapy with oral antifungals leads to partial clearance or high recurrence of lesions. Isotretinoin is a good adjuvant to systemic antifungals in chronic dermatophytosis. Voriconazole could be a future alternative due to its efficacy against dermatophytes and little resistance. OBJECTIVE To evaluate the efficacy and safety of oral itraconazole, combined itraconazole/isotretinoin therapy, and voriconazole for recalcitrant tinea. PATIENTS AND METHODS This study included 90 patients with chronic, recurrent, and/or recalcitrant tinea. They were equally divided into 3 groups: itraconazole monotherapy, combined itraconazole/isotretinoin therapy, and voriconazole monotherapy. All patients received treatments for 6 weeks. The clinical response was classified as either a complete or incomplete clinical cure. Potassium hydroxide microscopy and culture were performed to identify mycological cure. Patients with complete cure were followed up for another 6 months to detect any recurrence. RESULTS Complete clinical cure was observed in 53.3% of the itraconazole group, 70% of the itraconazole/isotretinoin group, and 83.3% of the voriconazole group. Mycological cure was detected in 56.7% of the itraconazole group, 83.3% of the itraconazole/isotretinoin group, and 86.7% of the voriconazole group. There was a statistically significant difference between the three groups in favor of voriconazole, then the combined group. No significant adverse effects were observed. The recurrence rate was significantly lower in the voriconazole group compared to the other two groups. CONCLUSIONS Voriconazole could be a future alternative for the treatment of recalcitrant dermatophytosis.
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Affiliation(s)
- Fathia Khattab
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Basma M Elkholy
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed Taha
- Medical Microbiology Department, Faculty of Veterinary medicine, Zagazig University, Zagazig, Egypt
| | - Aya Abd-Elbaset
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Manal Fawzy
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Shao X, Chen Y, Wang W, Du W, Zhang X, Cai M, Bing S, Cao J, Xu X, Yang B, He Q, Ying M. Blockade of deubiquitinase YOD1 degrades oncogenic PML/RARα and eradicates acute promyelocytic leukemia cells. Acta Pharm Sin B 2022; 12:1856-1870. [PMID: 35847510 PMCID: PMC9279643 DOI: 10.1016/j.apsb.2021.10.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/06/2021] [Accepted: 09/28/2021] [Indexed: 11/26/2022] Open
Abstract
In most acute promyelocytic leukemia (APL) cells, promyelocytic leukemia (PML) fuses to retinoic acid receptor α (RARα) due to chromosomal translocation, thus generating PML/RARα oncoprotein, which is a relatively stable oncoprotein for degradation in APL. Elucidating the mechanism regulating the stability of PML/RARα may help to degrade PML/RARα and eradicate APL cells. Here, we describe a deubiquitinase (DUB)-involved regulatory mechanism for the maintenance of PML/RARα stability and develop a novel pharmacological approach to degrading PML/RARα by inhibiting DUB. We utilized a DUB siRNA library to identify the ovarian tumor protease (OTU) family member deubiquitinase YOD1 as a critical DUB of PML/RARα. Suppression of YOD1 promoted the degradation of PML/RARα, thus inhibiting APL cells and prolonging the survival time of APL cell-bearing mice. Subsequent phenotypic screening of small molecules allowed us to identify ubiquitin isopeptidase inhibitor I (G5) as the first YOD1 pharmacological inhibitor. As expected, G5 notably degraded PML/RARα protein and eradicated APL, particularly drug-resistant APL cells. Importantly, G5 also showed a strong killing effect on primary patient-derived APL blasts. Overall, our study not only reveals the DUB-involved regulatory mechanism on PML/RARα stability and validates YOD1 as a potential therapeutic target for APL, but also identifies G5 as a YOD1 inhibitor and a promising candidate for APL, particularly drug-resistant APL treatment.
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Nasr M, Abd-Elhamid N, Abd-Allah D, Elkholy BM. Acitretin: Could it be a new therapeutic player in the field of onychomycosis? Mycoses 2022; 65:402-410. [PMID: 35103343 DOI: 10.1111/myc.13424] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Onychomycosis represents a therapeutic challenge. The complete cure rate with itraconazole pulse therapy remains unsatisfactory implying the need for an effective therapeutic regimen. Given the successful treatment of recurrent dermatophytosis with isotretinoin and itraconazole, we investigated the therapeutic use of acitretin in onychomycosis. AIM To evaluate and compare the efficacy of combined itraconazole and acitretin versus monotherapy with each in onychomycosis. PATIENTS AND METHODS The study included 135 adult patients with finger- and/or toe-nail onychomycosis. They were equally subdivided into 3 groups: Itraconazole pulse therapy, acitretin, and combined itraconazole/acitretin therapy. The drugs were administered for 3 months. Evaluation of severity was done by onychomycosis severity index score. Potassium hydroxide microscopy and culture were performed at baseline and at the end of the study. RESULTS Mycological and complete cure of onychomycosis was observed in 51.1% and 20% of the itraconazole group, 28.9% and 28.9% of the acitretin group, and 80% and 53.3% of the combined group. There was a statistically-significant difference between groups in favor of the combined itraconazole/acitretin therapy (P ≤ 0.05). LIMITATIONS Small sample and short therapy duration. CONCLUSIONS Acitretin could be a powerful therapeutic player in the field of onychomycosis, with greater efficacy when combined with itraconazole.
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Affiliation(s)
- Mohamed Nasr
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Nahla Abd-Elhamid
- Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Dina Abd-Allah
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Basma M Elkholy
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Cosio T, Gaziano R, Zuccari G, Costanza G, Grelli S, Di Francesco P, Bianchi L, Campione E. Retinoids in Fungal Infections: From Bench to Bedside. Pharmaceuticals (Basel) 2021; 14:ph14100962. [PMID: 34681186 PMCID: PMC8539705 DOI: 10.3390/ph14100962] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/17/2021] [Accepted: 09/22/2021] [Indexed: 12/11/2022] Open
Abstract
Retinoids-a class of chemical compounds derived from vitamin A or chemically related to it-are used especially in dermatology, oncohematology and infectious diseases. It has been shown that retinoids-from their first generation-exert a potent antimicrobial activity against a wide range of pathogens, including bacteria, fungi and viruses. In this review, we summarize current evidence on retinoids' efficacy as antifungal agents. Studies were identified by searching electronic databases (MEDLINE, EMBASE, PubMed, Cochrane, Trials.gov) and reference lists of respective articles from 1946 to today. Only articles published in the English language were included. A total of thirty-nine articles were found according to the criteria. In this regard, to date, In vitro and In vivo studies have demonstrated the efficacy of retinoids against a broad-spectrum of human opportunistic fungal pathogens, including yeast fungi that normally colonize the skin and mucosal surfaces of humans such as Candida spp., Rhodotorula mucilaginosa and Malassezia furfur, as well as environmental moulds such as Aspergillus spp., Fonsecae monofora and many species of dermatophytes associated with fungal infections both in humans and animals. Notwithstanding a lack of double-blind clinical trials, the efficacy, tolerability and safety profile of retinoids have been demonstrated against localized and systemic fungal infections.
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Affiliation(s)
- Terenzio Cosio
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (T.C.); (L.B.)
| | - Roberta Gaziano
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (R.G.); (P.D.F.)
| | - Guendalina Zuccari
- Department of Pharmacy, University of Genoa, Viale Cembrano, 16148 Genoa, Italy;
| | - Gaetana Costanza
- Department of Experimental Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (G.C.); (S.G.)
| | - Sandro Grelli
- Department of Experimental Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (G.C.); (S.G.)
| | - Paolo Di Francesco
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (R.G.); (P.D.F.)
| | - Luca Bianchi
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (T.C.); (L.B.)
| | - Elena Campione
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (T.C.); (L.B.)
- Correspondence:
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Bergamasco MD, Pereira CAP, Arrais-Rodrigues C, Ferreira DB, Baiocchi O, Kerbauy F, Nucci M, Colombo AL. Epidemiology of Invasive Fungal Diseases in Patients with Hematologic Malignancies and Hematopoietic Cell Transplantation Recipients Managed with an Antifungal Diagnostic Driven Approach. J Fungi (Basel) 2021; 7:jof7080588. [PMID: 34436127 PMCID: PMC8397156 DOI: 10.3390/jof7080588] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/13/2021] [Accepted: 07/16/2021] [Indexed: 01/05/2023] Open
Abstract
Patients with hematologic malignancies and hematopoietic cell transplant recipients (HCT) are at high risk for invasive fungal disease (IFD). The practice of antifungal prophylaxis with mold-active azoles has been challenged recently because of drug–drug interactions with novel targeted therapies. This is a retrospective, single-center cohort study of consecutive cases of proven or probable IFD, diagnosed between 2009 and 2019, in adult hematologic patients and HCT recipients managed with fluconazole prophylaxis and an antifungal diagnostic-driven approach for mold infection. During the study period, 94 cases of IFD occurred among 664 hematologic patients and 316 HCT recipients. The frequency among patients with allogeneic HCT, autologous HCT, acute leukemia and other hematologic malignancies was 8.9%, 1.6%, 17.3%, and 6.4%, respectively. Aspergillosis was the leading IFD (53.2%), followed by fusariosis (18.1%), candidiasis (10.6%), and cryptococcosis (8.5%). The overall 6-week mortality rate was 37.2%, and varied according to the host and the etiology of IFD, from 28% in aspergillosis to 52.9% in fusariosis. Although IFD occurred frequently in our cohort of patients managed with an antifungal diagnostic driven approach, mortality rates were comparable to other studies. In the face of challenges posed by the use of anti-mold prophylaxis, this strategy remains a reasonable alternative.
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Affiliation(s)
- Maria Daniela Bergamasco
- Division of Infectious Diseases, Hospital São Paulo-University Hospital, Universidade Federal de São Paulo, São Paulo 04024-002, Brazil; (M.D.B.); (C.A.P.P.); (D.B.F.)
| | - Carlos Alberto P. Pereira
- Division of Infectious Diseases, Hospital São Paulo-University Hospital, Universidade Federal de São Paulo, São Paulo 04024-002, Brazil; (M.D.B.); (C.A.P.P.); (D.B.F.)
| | - Celso Arrais-Rodrigues
- Division of Hematology, Hospital São Paulo-University Hospital, Universidade Federal de São Paulo, São Paulo 04024-002, Brazil; (C.A.-R.); (O.B.); (F.K.)
| | - Diogo B. Ferreira
- Division of Infectious Diseases, Hospital São Paulo-University Hospital, Universidade Federal de São Paulo, São Paulo 04024-002, Brazil; (M.D.B.); (C.A.P.P.); (D.B.F.)
| | - Otavio Baiocchi
- Division of Hematology, Hospital São Paulo-University Hospital, Universidade Federal de São Paulo, São Paulo 04024-002, Brazil; (C.A.-R.); (O.B.); (F.K.)
| | - Fabio Kerbauy
- Division of Hematology, Hospital São Paulo-University Hospital, Universidade Federal de São Paulo, São Paulo 04024-002, Brazil; (C.A.-R.); (O.B.); (F.K.)
| | - Marcio Nucci
- Department of Internal Medicine, Hospital Universitário Clementino Frafa Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-913, Brazil;
| | - Arnaldo Lopes Colombo
- Division of Infectious Diseases, Hospital São Paulo-University Hospital, Universidade Federal de São Paulo, São Paulo 04024-002, Brazil; (M.D.B.); (C.A.P.P.); (D.B.F.)
- Correspondence: or
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Cosio T, Di Prete M, Gaziano R, Lanna C, Orlandi A, Di Francesco P, Bianchi L, Campione E. Trifarotene: A Current Review and Perspectives in Dermatology. Biomedicines 2021; 9:biomedicines9030237. [PMID: 33652835 PMCID: PMC7996910 DOI: 10.3390/biomedicines9030237] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/06/2021] [Accepted: 02/18/2021] [Indexed: 12/12/2022] Open
Abstract
Retinoids have numerous applications in inflammatory, dyskeratotic, and oncohematology diseases. Retinoids have now reached the fourth generation, progressively reducing toxicity whilst increasing their efficacy. Trifarotene is a new fourth-generation retinoid with a selective action on RAR-γ. In this review, we reported the trials—both concluded and in progress—including the use of trifarotene in dermatological diseases. Studies were identified by searching electronic databases (MEDLINE, EMBASE, PubMed, Cochrane, Trials.gov) from 2012 to today and reference lists of respective articles. Only articles published in English language were included. Randomized trials evaluating trifarotene tolerability, safety, and efficacy in congenital ichthyosis and acne have demonstrated great results and mild side effects, leading to the approval by the FDA of trifarotene for the treatment of lamellar ichthyosis in 2014, and of acne vulgaris in October 2019. No high-quality randomized clinical trials have evaluated the treatment of primary cutaneous lymphomas with trifarotene. Finally, we are hypothesizing future perspectives in the treatment of non-melanoma skin cancers, fungal infections, photoaging, and hand-foot skin reactions with trifarotene.
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Affiliation(s)
- Terenzio Cosio
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (T.C.); (C.L.); (L.B.)
| | - Monia Di Prete
- Anatomic Pathology Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (M.D.P.); (A.O.)
| | - Roberta Gaziano
- Microbiology Section, Department of Experimental Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (R.G.); (P.D.F.)
| | - Caterina Lanna
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (T.C.); (C.L.); (L.B.)
| | - Augusto Orlandi
- Anatomic Pathology Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (M.D.P.); (A.O.)
| | - Paolo Di Francesco
- Microbiology Section, Department of Experimental Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (R.G.); (P.D.F.)
| | - Luca Bianchi
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (T.C.); (C.L.); (L.B.)
| | - Elena Campione
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (T.C.); (C.L.); (L.B.)
- Correspondence:
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Antifungal Effect of All- trans Retinoic Acid against Aspergillus fumigatus In Vitro and in a Pulmonary Aspergillosis In Vivo Model. Antimicrob Agents Chemother 2021; 65:AAC.01874-20. [PMID: 33361288 PMCID: PMC8092556 DOI: 10.1128/aac.01874-20] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/24/2020] [Indexed: 01/01/2023] Open
Abstract
Aspergillus fumigatus is the most common opportunistic fungal pathogen and causes invasive pulmonary aspergillosis (IPA), with high mortality among immunosuppressed patients. The fungistatic activity of all-trans retinoic acid (ATRA) has been recently described in vitro. Aspergillus fumigatus is the most common opportunistic fungal pathogen and causes invasive pulmonary aspergillosis (IPA), with high mortality among immunosuppressed patients. The fungistatic activity of all-trans retinoic acid (ATRA) has been recently described in vitro. We evaluated the efficacy of ATRA in vivo and its potential synergistic interaction with other antifungal drugs. A rat model of IPA and in vitro experiments were performed to assess the efficacy of ATRA against Aspergillus in association with classical antifungal drugs and in silico studies used to clarify its mechanism of action. ATRA (0.5 and 1 mM) displayed a strong fungistatic activity in Aspergillus cultures, while at lower concentrations, synergistically potentiated fungistatic efficacy of subinhibitory concentration of amphotericin B (AmB) and posaconazole (POS). ATRA also enhanced macrophagic phagocytosis of conidia. In a rat model of IPA, ATRA reduced mortality similarly to posaconazole. Fungistatic efficacy of ATRA alone and synergistically with other antifungal drugs was documented in vitro, likely by inhibiting fungal heat shock protein 90 (Hsp90) expression and Hsp90-related genes. ATRA treatment reduced mortality in a model of IPA in vivo. Those findings suggest ATRA as a suitable fungistatic agent that can also reduce dosage and adverse reactions of classical antifungal drugs and add to the development of new therapeutic strategies against IPA and systemic fungal infections.
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Jiang Y, Ji L. Severe Wernicke encephalopathy and acute pancreatitis due to all-trans-retinoic acid and arsenic trioxide during treatment of acute promyelocytic leukaemia: a case report. J Int Med Res 2020; 48:300060520959487. [PMID: 32993392 PMCID: PMC7536494 DOI: 10.1177/0300060520959487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
A 55-year-old woman developed acute promyelocytic leukaemia during treatment with
all-trans-retinoic acid and arsenic trioxide. Initially, she presented with symptoms of
epigastric pain, vomiting, and nausea, and she developed acute pancreatitis. She was
treated with parenteral nutritional supplementation for 20 days. However, the patient
continued to develop refractory hyponatraemia, hypotension, and apathy. Finally, the
patient was diagnosed with Wernicke encephalopathy (WE) using head magnetic resonance
imaging. The patient underwent high-dose intravenous thiamine administration, and her
symptoms were alleviated. WE is a rare adverse event during acute pancreatitis therapy.
Acute pancreatitis that is caused by all-trans-retinoic acid and arsenic trioxide is a
rare complication of acute promyelocytic leukaemia during chemotherapy. Further study is
essential to improve our comprehension of the risk factors for complications in patients
with acute promyelocytic leukaemia, considering that the associated complications were
potentially caused by multiple etiological factors. A better understanding of these risk
factors may help to improve the prognosis of patients with acute promyelocytic leukaemia
at an early stage.
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Affiliation(s)
- Yan Jiang
- Department of Hematology, the Affiliated Hospital of Qinghai University, Xining, Qinghai, China
| | - Linhua Ji
- Department of Hematology, Huadu District People's Hospital of Guangzhou, Guangzhou, China
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12
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Outcomes in Adult Acute Promyelocytic Leukemia: A Decade Experience. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 20:e158-e164. [PMID: 31992504 DOI: 10.1016/j.clml.2019.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 12/03/2019] [Accepted: 12/11/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Acute promyelocytic leukemia (APL), a distinct variant of acute myeloid leukemia (AML), accounts for 10% of AML cases. Over the past decade, APL has emerged from a highly fatal disease to a highly curable one. The published data on outcomes of APL from India are scant. The present study was designed to analyze the clinicopathologic features and outcomes in adult APL. MATERIALS AND METHODS The present report is a single institutional, observational, retrospective study, and data of patients diagnosed with APL from 2006 to 2018 were analyzed. All patients with APL, diagnosed by morphology and confirmed by reverse transcriptase polymerase chain reaction (promyelocytic leukemia/retinoic acid receptor alpha) and over 18 years of age, were included in this study. SPSS software v25.1 was used for statistical analysis. RESULTS A total of 1396 patients with AML were seen between January 2005 and June 2018, of which 190 (13.6%) had APL. Of these, 111 patients met the inclusion criteria and were analyzed. The median age at presentation was 33 years (range, 19-60 years). The median duration of symptoms before presentation was 15 days (range, 3-180 days). High risk, intermediate risk, and low risk were seen in 43.3%, 41.4%, and 15.3% of patients, respectively. At the end of induction chemotherapy, 88 (79%) patients achieved complete hematologic remission, and 23 (21%) succumbed during induction. The median time to attain complete hematologic remission was 30 days (range, 19-47 days). At a median follow-up of 34 months, the event-free survival and overall survival were 69.3% and 74.7%, respectively. On univariate analysis, bcr3 variant and high-risk category at presentation had significant impact on event-free survival (P = .029 and P = .003, respectively) and overall survival (P ≤ .001 and P = .007, respectively). On multivariate analysis, only high risk at presentation was significant for event-free survival (P = .04) and overall survival (P = .02). CONCLUSION APL constituted one-tenth of patients with AML. The majority of patients were high risk at presentation. Sanz high risk category and bcr3 variant at presentation had significant impact on outcomes in APL.
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13
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Silva WFD, Rosa LID, Marquez GL, Bassolli L, Tucunduva L, Silveira DRA, Buccheri V, Bendit I, Rego EM, Rocha V, Velloso EDRP. Real-life Outcomes on Acute Promyelocytic Leukemia in Brazil - Early Deaths Are Still a Problem. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 19:e116-e122. [PMID: 30509780 DOI: 10.1016/j.clml.2018.11.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/10/2018] [Accepted: 11/02/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Although a considerable improvement in survival of patients with acute promyelocytic leukemia (APL) has been seen over the past decades, real-life outcomes seem to be worse than those reported by prospective studies. We aim to describe clinical characteristics and outcomes of adult patients diagnosed with APL in an academic hospital from the University of Sao Paulo. PATIENTS AND METHODS We retrospectively reviewed the medical charts of 61 patients with APL diagnosed between January 2007 and May 2017. Baseline clinical features and follow-up data were collected, focusing on early toxicity variables such as infection, bleeding, and thrombosis in the first 30 days from diagnosis. RESULTS Among the 61 patients with APL, 54 received any chemotherapy. All patients also received all-trans retinoic acid (ATRA). Bleeding events were the main cause of death before receiving chemotherapy. Most patients belonged to the intermediate (43%) and high-risk (41%) groups, according to Sanz score. The '7 + 3 + ATRA' regimen was the most used regimen (n = 38). An early death rate of 20% was found, predominantly owing to sepsis. After a median follow-up of 5 years, only 1 relapse was diagnosed. The overall survival at 5 years was 59%. DISCUSSION In comparison with prospective trials with ATRA-based regimens, we found an inferior overall survival, mostly on account of a high early-death rate. Our results are in line with other real-life retrospective reports published in the past decades. CONCLUSION Results of real-life studies differ from those found by prospective trials. Accordingly, early actions and supportive care are still needed, aiming to decrease toxicity, especially in developing countries.
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Affiliation(s)
| | | | | | - Lucas Bassolli
- Hospital das Clinicas, University of São Paulo, São Paulo, Brazil
| | | | | | - Valeria Buccheri
- Institute of Cancer of São Paulo, University of São Paulo, São Paulo, Brazil; Hospital das Clinicas, University of São Paulo, São Paulo, Brazil
| | - Israel Bendit
- Hospital das Clinicas, University of São Paulo, São Paulo, Brazil
| | - Eduardo Magalhães Rego
- Institute of Cancer of São Paulo, University of São Paulo, São Paulo, Brazil; Hospital das Clinicas, University of São Paulo, São Paulo, Brazil
| | - Vanderson Rocha
- Institute of Cancer of São Paulo, University of São Paulo, São Paulo, Brazil; Hospital das Clinicas, University of São Paulo, São Paulo, Brazil
| | - Elvira D R P Velloso
- Institute of Cancer of São Paulo, University of São Paulo, São Paulo, Brazil; Hospital das Clinicas, University of São Paulo, São Paulo, Brazil
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14
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Lu Y, Yan JS, Xia L, Qin K, Yin QQ, Xu HT, Gao MQ, Qu XN, Sun YT, Chen GQ. 2-Bromopalmitate targets retinoic acid receptor alpha and overcomes all-trans retinoic acid resistance of acute promyelocytic leukemia. Haematologica 2018; 104:102-112. [PMID: 30076181 PMCID: PMC6312026 DOI: 10.3324/haematol.2018.191916] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 07/30/2018] [Indexed: 12/26/2022] Open
Abstract
Fatty acid oxidation dependency of leukemia cells has been documented in recent studies. Pharmacologic inhibition of fatty acid oxidation, thereby, displays significant effects in suppressing leukemia. 2-Bromopalmitate, a palmitate analogue, was initially identified as an inhibitor of fatty acid oxidation, and recently recognized as an inhibitor of protein palmitoylation. However, the effects of 2-Bromopalmitate on leukemia and its cellular targets remain obscure. Herein, we discover in cultured cell lines, a transplantable mouse model, and primary blasts that 2-Bromopalmitate presents synergistic differentiation induction with all-trans retinoic acid in acute promyelocytic leukemia. Moreover, 2-Bromopalmitate overcomes all-trans retinoic acid resistance in all-trans retinoic acid-resistant cells and leukemic mice. Mechanistically, 2-Bromopalmitate covalently binds at cysteine 105 and cysteine 174 of retinoic acid receptor alpha (RARα) and stabilizes RARα protein in the presence of all-trans retinoic acid which is known to induce RARα degradation, leading to enhanced transcription of RARα-target genes. Mutation of both cysteines largely abrogates the synergistic effect of 2-Bromopalmitate on all-trans retinoic acid-induced differentiation, demonstrating that 2-Bromopalmitate promotes all-trans retinoic acid-induced differentiation through binding RARα. All-trans retinoic acid-based regimens including arsenic trioxide or chemotherapy, as preferred therapy for acute promyelocytic leukemia, induce adverse events and irreversible resistance. We expect that combining all-trans retinoic acid with 2-Bromopalmitate would be a promising therapeutic strategy for acute promyelocytic leukemia, especially for overcoming all-trans retinoic acid resistance of relapsed acute promyelocytic leukemia patients.
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Affiliation(s)
- Ying Lu
- Department of Pathophysiology, Key Laboratory of Cell Differentiation and Apoptosis of the Chinese Ministry of Education, Shanghai Jiao Tong University School of Medicine (SJTU-SM)
| | - Jin-Song Yan
- Department of Hematology, Dalian Key Laboratory of Hematology, Liaoning Medical Center for Hematopoietic Stem Cell Transplantation, the Second Hospital of Dalian Medical University
| | - Li Xia
- Department of Pathophysiology, Key Laboratory of Cell Differentiation and Apoptosis of the Chinese Ministry of Education, Shanghai Jiao Tong University School of Medicine (SJTU-SM)
| | - Kang Qin
- Department of Pathophysiology, Key Laboratory of Cell Differentiation and Apoptosis of the Chinese Ministry of Education, Shanghai Jiao Tong University School of Medicine (SJTU-SM)
| | - Qian-Qian Yin
- Shanghai Institute for Advanced Immunochemical Studies, ShanghaiTech University, China
| | - Hong-Tao Xu
- Shanghai Institute for Advanced Immunochemical Studies, ShanghaiTech University, China
| | - Meng-Qing Gao
- Department of Hematology, Dalian Key Laboratory of Hematology, Liaoning Medical Center for Hematopoietic Stem Cell Transplantation, the Second Hospital of Dalian Medical University
| | - Xiao-Ning Qu
- Department of Hematology, Dalian Key Laboratory of Hematology, Liaoning Medical Center for Hematopoietic Stem Cell Transplantation, the Second Hospital of Dalian Medical University
| | - Yu-Ting Sun
- Department of Hematology, Dalian Key Laboratory of Hematology, Liaoning Medical Center for Hematopoietic Stem Cell Transplantation, the Second Hospital of Dalian Medical University
| | - Guo-Qiang Chen
- Department of Pathophysiology, Key Laboratory of Cell Differentiation and Apoptosis of the Chinese Ministry of Education, Shanghai Jiao Tong University School of Medicine (SJTU-SM)
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15
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Abdullah AS, Adel AM, Hussein RM, Abdullah MA, Yousaf A, Mudawi D, Mohamed SF, Nashwan AJ, Soliman D, Ibrahim F, Yassin MA. Hypercalcemia and acute pancreatitis in a male patient with acute promyelocytic leukemia and pulmonary tuberculosis. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:23-27. [PMID: 29633729 PMCID: PMC6179096 DOI: 10.23750/abm.v89i3-s.7216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Indexed: 02/06/2023]
Abstract
We report a rare case of hypercalcemia and acute pancreatitis in a subject with acute promyelocytic leukemia (APL) and pulmonary tuberculosis, during all-trans-retinoic acid (ATRA) treatment. Both associated complications were potentially due to several causes. A careful monitoring and exclusion of all causative factors must be addressed. Further research is necessary to improve our understanding of risk factors for these complications in patients with (APL). Studying these patterns may help us to improve outcomes for all children and young adults with hematologic malignancies.
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Affiliation(s)
- Ali S Abdullah
- Resident, Internal Medicine, Hamad Medical Corporation (HMC), Doha, Qatar.
| | - Ahmad M Adel
- Pharmacists, Department of Pharmacy, NCCCR, Hamad Medical Corporation (HMC), Doha, Qatar.
| | - Radwa M Hussein
- Pharmacists, Department of Pharmacy, NCCCR, Hamad Medical Corporation (HMC), Doha, Qatar.
| | - Mohammed Aj Abdullah
- Hematologists, Department of Hematology, NCCCR, Hamad Medical Corporation (HMC), Doha, Qatar.
| | - Anil Yousaf
- Hematologists, Department of Hematology, NCCCR, Hamad Medical Corporation (HMC), Doha, Qatar.
| | - Deena Mudawi
- Hematologists, Department of Hematology, NCCCR, Hamad Medical Corporation (HMC), Doha, Qatar.
| | - Shehab F Mohamed
- Hematologists, Department of Hematology, NCCCR, Hamad Medical Corporation (HMC), Doha, Qatar.
| | - Abdulqadir J Nashwan
- Nurse Research Scientist, Cancer Clinical Trials Unit, NCCCR, Hamad Medical Corporation (HMC), Doha, qatar.
| | - Dina Soliman
- Department of Laboratory Medicine and Pathology, National Center for Cancer Care and Research, Hamad Medical Corporation (HMC), Doha, Qatar and Department of Clinical Pathology, National Cancer Institute, Cairo University,Cairo, Egypt.
| | - Feryal Ibrahim
- Consultant Hematopathologist Department of Laboratory Medicine and Pathology, National Center for Cancer Care and Research, Hamad Medical Corporation (HMC), Doha, Qatar.
| | - Mohamed A Yassin
- Hematologists, Department of Hematology, NCCCR, Hamad Medical Corporation (HMC), Doha, Qatar.
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16
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Li K, Wang F, Cao WB, Lv XX, Hua F, Cui B, Yu JJ, Zhang XW, Shang S, Liu SS, Yu JM, Han MZ, Huang B, Zhang TT, Li X, Jiang JD, Hu ZW. TRIB3 Promotes APL Progression through Stabilization of the Oncoprotein PML-RARα and Inhibition of p53-Mediated Senescence. Cancer Cell 2017; 31:697-710.e7. [PMID: 28486108 DOI: 10.1016/j.ccell.2017.04.006] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 12/10/2016] [Accepted: 04/12/2017] [Indexed: 12/19/2022]
Abstract
Acute promyelocytic leukemia (APL) is driven by the oncoprotein PML-RARα, which antagonizes myeloid differentiation and promotes APL-initiating cell self-renewal. Combined all-trans retinoic acid (ATRA) with arsenic trioxide (As2O3) or chemotherapy dramatically improves the prognosis of APL patients. Here we report that expression of pseudokinase Tribble 3 (TRIB3) associates positively with APL progression and therapeutic resistance. The elevated TRIB3 expression promotes APL by interacting with PML-RARα and suppressing its sumoylation, ubiquitylation, and degradation. This represses PML nuclear body assembly, p53-mediated senescence, and cell differentiation, and supports cellular self-renewal. Genetically inhibiting TRIB3 expression or combination of a peptide disturbing TRIB3/PML-RARα interaction with ATRA/As2O3 eradicates APL by accelerating PML-RARα degradation. Our study provides insight into APL pathogenesis and a potential therapeutic option against APL.
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MESH Headings
- Animals
- Antineoplastic Combined Chemotherapy Protocols/pharmacology
- Arsenic Trioxide
- Arsenicals/pharmacology
- Cell Cycle Proteins/deficiency
- Cell Cycle Proteins/genetics
- Cell Cycle Proteins/metabolism
- Cell Differentiation/drug effects
- Cell Line, Tumor
- Cell Proliferation
- Cellular Senescence
- Disease Progression
- Drug Resistance, Neoplasm
- Female
- Gene Expression Regulation
- Gene Fusion
- HEK293 Cells
- Humans
- Leukemia, Promyelocytic, Acute/drug therapy
- Leukemia, Promyelocytic, Acute/genetics
- Leukemia, Promyelocytic, Acute/metabolism
- Leukemia, Promyelocytic, Acute/pathology
- Male
- Mice, 129 Strain
- Mice, Inbred C57BL
- Mice, Inbred NOD
- Mice, SCID
- Mice, Transgenic
- Oncogene Proteins, Fusion/genetics
- Oncogene Proteins, Fusion/metabolism
- Oxides/pharmacology
- Peptides/pharmacology
- Protein Serine-Threonine Kinases/antagonists & inhibitors
- Protein Serine-Threonine Kinases/genetics
- Protein Serine-Threonine Kinases/metabolism
- Protein Stability
- Proteolysis
- Repressor Proteins/genetics
- Repressor Proteins/metabolism
- Signal Transduction
- Sumoylation
- Time Factors
- Transfection
- Tretinoin/pharmacology
- Tumor Suppressor Protein p53/genetics
- Tumor Suppressor Protein p53/metabolism
- Ubiquitination
- Xenograft Model Antitumor Assays
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Affiliation(s)
- Ke Li
- Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, P.R. China
| | - Feng Wang
- Immunology and Cancer Pharmacology Group, State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, P.R. China
| | - Wen-Bin Cao
- Hematopoietic Stem Cell Transplantation Center, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, P.R. China
| | - Xiao-Xi Lv
- Immunology and Cancer Pharmacology Group, State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, P.R. China
| | - Fang Hua
- Immunology and Cancer Pharmacology Group, State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, P.R. China
| | - Bing Cui
- Immunology and Cancer Pharmacology Group, State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, P.R. China
| | - Jiao-Jiao Yu
- Immunology and Cancer Pharmacology Group, State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, P.R. China
| | - Xiao-Wei Zhang
- Immunology and Cancer Pharmacology Group, State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, P.R. China
| | - Shuang Shang
- Immunology and Cancer Pharmacology Group, State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, P.R. China
| | - Shan-Shan Liu
- Immunology and Cancer Pharmacology Group, State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, P.R. China
| | - Jin-Mei Yu
- Immunology and Cancer Pharmacology Group, State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, P.R. China
| | - Ming-Zhe Han
- Hematopoietic Stem Cell Transplantation Center, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, P.R. China
| | - Bo Huang
- Institute of Basic Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100005, P.R. China
| | - Ting-Ting Zhang
- Department of Pharmacy, Marine College, Shandong University, Weihai 264209, P.R. China
| | - Xia Li
- Department of Pharmacy, Marine College, Shandong University, Weihai 264209, P.R. China
| | - Jian-Dong Jiang
- Immunology and Cancer Pharmacology Group, State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, P.R. China; Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, P.R. China
| | - Zhuo-Wei Hu
- Immunology and Cancer Pharmacology Group, State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, P.R. China.
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17
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Campione E, Gaziano R, Marino D, Orlandi A. Fungistatic activity of all-trans retinoic acid against Aspergillus fumigatus and Candida albicans. DRUG DESIGN DEVELOPMENT AND THERAPY 2016; 10:1551-5. [PMID: 27199548 PMCID: PMC4857806 DOI: 10.2147/dddt.s93985] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE Fungal infections are a major complication in hematologic and neoplastic patients causing severe morbidity and mortality. Aspergillus fumigatus and Candida albicans are among the most invasive opportunistic pathogens in immunocompromised patients, and classic antifungal drugs are frequently unsuccessful in these patients. Recent reports hypothesize that the antifungal efficacy of all-trans retinoic acid (ATRA) is mainly related to its strong capacity to stimulate monocyte-mediated immunity, but no consideration was given to its potential direct fungistatic activity. Moreover, ATRA offers the opportunity for systemic therapy. METHODS AND RESULTS We investigated the efficacy of ATRA at different concentrations for its antifungal activity against opportunistic A. fumigatus and C. albicans obtained from clinical samples according to standard protocols. A fungistatic activity of ATRA on A. fumigatus and C. albicans at 0.5-1 mM concentration was documented up to 7 days. CONCLUSION This is the first evidence of a direct and strong fungistatic activity of ATRA against A. fumigatus and C. albicans. The potential adjuvant therapeutic application of ATRA might be useful in the treatment and/or prevention of systemic mycoses in immunocompromised patients. The discovery of a direct fungistatic activity, in association with its reported immunomodulatory properties, makes ATRA an excellent candidate for new combined antifungal strategies for systemic mycoses in immunocompromised and cancer patients.
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Affiliation(s)
- Elena Campione
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - Roberta Gaziano
- Department of Microbiology, University of Rome Tor Vergata, Rome, Italy
| | - Daniele Marino
- Department of Microbiology, University of Rome Tor Vergata, Rome, Italy
| | - Augusto Orlandi
- Department of Anatomic Pathology, University of Rome Tor Vergata, Rome, Italy
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18
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Friis IS, Kochanek M, Monsef I, Skoetz N, Engert A, Bauer K. Intravenous immunoglobulins for the treatment of infections in patients with haematological cancers. Hippokratia 2016. [DOI: 10.1002/14651858.cd009357.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]
Affiliation(s)
- In Sook Friis
- University Hospital of Cologne; Cochrane Haematological Malignancies Group, Department I of Internal Medicine; Cologne Germany 50924
| | - Matthias Kochanek
- University Hospital of Cologne; Department I of Internal Medicine; Kerpener Straße 62 Cologne Germany 50924
| | - Ina Monsef
- University Hospital of Cologne; Cochrane Haematological Malignancies Group, Department I of Internal Medicine; Cologne Germany 50924
| | - Nicole Skoetz
- University Hospital of Cologne; Cochrane Haematological Malignancies Group, Department I of Internal Medicine; Cologne Germany 50924
| | - Andreas Engert
- University Hospital of Cologne; Department I of Internal Medicine; Kerpener Straße 62 Cologne Germany 50924
| | - Kathrin Bauer
- Spitzenverband Bund der Krankenkassen; Reinhardtstraße 30 Berlin Germany 10117
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19
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Pagano L, Stamouli M, Tumbarello M, Verga L, Candoni A, Cattaneo C, Nadali G, Mitra ME, Mancini V, Nosari A, Garzia MG, Delia M, Storti S, Spadea A, Caramatti C, Perriello V, Sanna M, Vacca A, De Paolis MR, Potenza L, Salutari P, Castagnola C, Fanci R, Chierichini A, Melillo L, Picardi M, Facchini L, Martino B, Di Blasi R, Cesarini M, Offidani M, Vianelli N, Caira M, Lessi F, Ferrari A, Venditti A, Pavone V, Lo-Coco F, Aversa F, Busca A. Risk of invasive fungal infection in patients affected by acute promyelocytic leukaemia. A report by the SEIFEM-D registry. Br J Haematol 2015; 170:434-9. [PMID: 25626374 DOI: 10.1111/bjh.13308] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Livio Pagano
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Maria Stamouli
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy.,2nd Department of Internal Medicine Propaedeutic, Attikon University Hospital, Athens, Greece
| | - Mario Tumbarello
- Istituto di Malattie Infettive, Università Cattolica Del Sacro Duore, Rome, Italy
| | - Luisa Verga
- Unità di Ematologia, Ospedale San Gerardo, Università di Milano, Monza, Italy
| | - Anna Candoni
- Clinica di Ematologia, Università di Udine, Udine, Italy
| | - Chiara Cattaneo
- Divisione di Ematologia, Spedali Civili di Brescia, Brescia, Italy
| | - Gianpaolo Nadali
- UOC Ematologia, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Maria Enza Mitra
- Divisione di Ematologia e TMO, Policlinico di Palermo, Palermo, Italy
| | - Valentina Mancini
- Divisione di Ematologia e Centro Trapianti Midollo, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Annamaria Nosari
- Divisione di Ematologia e Centro Trapianti Midollo, Ospedale Niguarda Ca' Granda, Milan, Italy
| | | | - Mario Delia
- Sezione di Ematologia, Università di Bari, Bari, Italy
| | - Sergio Storti
- Divisione di Ematologia, Università Cattolica del S. Cuore, Campobasso, Italy
| | - Antonio Spadea
- Ematologia, Istituti Fisioterapici Ospitalieri, Rome, Italy
| | | | | | - Marco Sanna
- Istituto di Ematologia, Università di Cagliari, Cagliari, Italy
| | - Adriana Vacca
- Istituto di Ematologia, Università di Cagliari, Cagliari, Italy
| | | | - Leonardo Potenza
- Sezione di Ematologia, Dipartimento di Scienze Mediche Materno Infantili e dell'Adulto, Università degli Studi di Modena e Reggio Emilia, Modena, Italy
| | - Prassede Salutari
- Dipartimento di Ematologia Clinica, Ospedale Spirito Santo, Pescara, Italy
| | - Carlo Castagnola
- Dipartimento Onco-Ematologico, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Rosa Fanci
- Unità Operativa di Ematologia, Università di Firenze, Firenze, Italy
| | - Anna Chierichini
- Divisione di Ematologia, Ospedale S. Giovanni Addolorata, Rome, Italy
| | - Lorella Melillo
- Divisione di Ematologia, IRCCS Casa Sollievo della Sofferenza, S. Giovanni Rotondo, Napoli, Italy
| | - Marco Picardi
- Divisione di Ematologia, Università Federico II di Napoli, Napoli, Italy
| | - Luca Facchini
- Divisione di Ematologia, Arciospedale S. Maria Nuova, Reggio Emilia, Italy
| | - Bruno Martino
- Divisione di Ematologia, Azienda Ospedaliera BMM, Reggio Calabria, Italy
| | - Roberta Di Blasi
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Monica Cesarini
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Nicola Vianelli
- Istituto di Ematologia ed Oncologia Clinica, Ospedale S. Orsola-Malpighi, Università di Bologna, Bologna, Italy
| | - Morena Caira
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Federica Lessi
- Ematologia ed Immunologia Clinica, Dipartimento di Medicina, Università di Padova, Padova, Italy
| | | | | | | | | | - Franco Aversa
- Sezione di Ematologia, Università di Parma, Parma, Italy
| | - Alessandro Busca
- Dipartimento di Ematologia, Ospedale S.Giovanni Battista, Torino, Italy
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Castagnola E, Mikulska M, Viscoli C. Prophylaxis and Empirical Therapy of Infection in Cancer Patients. MANDELL, DOUGLAS, AND BENNETT'S PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES 2015. [PMCID: PMC7173426 DOI: 10.1016/b978-1-4557-4801-3.00310-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Cellot S, Johnston D, Dix D, Ethier MC, Gillmeister B, Mitchell D, Yanofsky R, Lewis V, Portwine C, Price V, Zelcer S, Silva M, Bowes L, Michon B, Stobart K, Brossard J, Beyene J, Sung L. Infections in pediatric acute promyelocytic leukemia: from the Canadian infections in acute myeloid leukemia research group. BMC Cancer 2013; 13:276. [PMID: 23735034 PMCID: PMC3679857 DOI: 10.1186/1471-2407-13-276] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 05/29/2013] [Indexed: 12/02/2022] Open
Abstract
Background It is not known whether children with acute promyelocytic leukemia (APL) have an infection risk similar to non- APL acute myeloid leukemia. The objective was to describe infectious risk in children with newly diagnosed APL and to describe factors associated with these infections. Methods We conducted a retrospective, population-based cohort study that included children ≤ 18 years of age with de novo APL treated at 15 Canadian centers. Thirty-three children with APL were included; 78.8% were treated with APL -specific protocols. Results Bacterial sterile site infection occurred in 12 (36.4%) and fungal sterile site infection occurred in 2 (6.1%) children. Of the 127 chemotherapy courses, 101 (79.5%) were classified as intensive and among these, the proportion in which a sterile site microbiologically documented infection occurred was 14/101 (13.9%). There was one infection-related death. Conclusions One third of children with APL experienced at least one sterile site bacterial infection throughout treatment and 14% of intensive chemotherapy courses were associated with a microbiologically documented sterile site infection. Infection rates in pediatric APL may be lower compared to non- APL acute myeloid leukemia although these children may still benefit from aggressive supportive care during intensive chemotherapy.
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22
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Moresco G, Martinello F, Souza LC. [Acute renal failure in patient treated with ATRA and amphotericin B: case report]. ACTA ACUST UNITED AC 2011; 33:276-81. [PMID: 21789447 DOI: 10.1590/s0101-28002011000200025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Accepted: 03/29/2011] [Indexed: 11/21/2022]
Abstract
This is a report of the case of a patient with acute promyelocytic leukemia treated with all trans-retinoic acid (ATRA), who had suspected all-trans retinoic acid syndrome (ATRA syndrome). The nonspecific febrile leukopenia observed justified the association with antimicrobial and antifungal therapy. Signs and symptoms contributed to the suspicion of ATRA syndrome, and renal function was impaired by the combination with antifungal agents. The decrease in renal function observed initially contributed to the suspicion of ATRA syndrome and was aggravated by antifungals. Thus, the use of ATRA was discontinued. Eight days after the pneumonia characterization, the possibility of ATRA syndrome was dismissed. In this context, ATR's nephrotoxicity and the synergic adverse effect by the use of nephrotoxic antifungal agents were discussed, particularly amphotericin B, as well as the importance of differential diagnosis between ATRA syndrome and infectious diseases.
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Abstract
Mucosal barrier injury (MBI), also known as mucositis, is the result of the cytotoxic effects of many treatments given for hematological malignancies (HMs) and represents a major source of potentially devastating clinical complications and negative consequences afflicting the patient's management, such as a longer hospitalization, the need of analgesic and total parenteral nutrition use, and increased costs. The available measures for the prevention and treatment of MBI have been substantially limited to the control of pain, infection, bleeding and nutrition. However, in the last decade, a better insight into the complex pathogenesis of MBI has led to the development of novel therapeutic options, such as palifermin, which has been one of the major breakthroughs in the management of this condition, potentially allowing a targeted approach to MBI. Nevertheless, and despite these significant advances, MBI still remains a significant clinical problem in the management of HM and an important burden of sufferance for afflicted patients.
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Affiliation(s)
- Pasquale Niscola
- Hematology Unit, S. Eugenio Hospital, Piazzale dell'Umanesimo 10, Rome, Italy.
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24
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Castagnola E, Rossi MR, Cesaro S, Livadiotti S, Giacchino M, Zanazzo G, Fioredda F, Beretta C, Ciocchello F, Carli M, Putti MC, Pansini V, Berger M, Licciardello M, Farina S, Caviglia I, Haupt R. Incidence of bacteremias and invasive mycoses in children with acute non-lymphoblastic leukemia: results from a multi-center Italian study. Pediatr Blood Cancer 2010; 55:1103-7. [PMID: 20680968 DOI: 10.1002/pbc.22750] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Data on the epidemiology of bacteremias and invasive fungal diseases (IFD) in children with acute myeloid leukemia (AML) are scarce. DESIGN AND METHODS In a multi-center, retrospective study, we analyzed proportion, rate per 1,000 person-days at risk, and cumulative risk of bacteremias and IFD in children with AML. RESULTS Between January 1998 and December 2005, 240 children were treated for AML at 8 Italian Centers, for a total of 521 treatment courses and 63,232 person-days at risk. Bacteremia was observed in 32% of treatment courses and IFD was seen in 10% (P < 0.0001), with rates of 2.62 and 0.84, respectively (P < 0.001). There was a significantly higher frequency of IFD during relapse treatment: proportion 15% versus 9% (P = 0.05), rate 2.10 versus 0.64 (P = 0.008) and cumulative risk 32% versus 12% (P = 0.007), while there were no differences in the proportion, rate and cumulative risk of bacteremia during front-line or relapse treatment. The epidemiology of bacteremias and IFD was different during front-line therapy for M3 as compared to other types of AML, but the differences were not statistically significant. CONCLUSIONS Severe infectious complications are frequent during the treatment of pediatric AML, especially during relapse treatment, and bacteremias are more frequent than IFD.
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Affiliation(s)
- Elio Castagnola
- Department Of Hematology and Oncology, G. Gaslini Children's Hospital, Genoa, Italy.
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25
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Castagnola E, Fontana V, Caviglia I, Caruso S, Faraci M, Fioredda F, Garre ML, Moroni C, Conte M, Losurdo G, Scuderi F, Bandettini R, Toma P, Viscoli C, Haupt R. A Prospective Study on the Epidemiology of Febrile Episodes during Chemotherapy-Induced Neutropenia in Children with Cancer or after Hemopoietic Stem Cell Transplantation. Clin Infect Dis 2007; 45:1296-304. [DOI: 10.1086/522533] [Citation(s) in RCA: 181] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Accepted: 07/21/2007] [Indexed: 11/03/2022] Open
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26
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Brunet AS, Ploton C, Galambrun C, Pondarré C, Pages MP, Bleyzac N, Freydière AM, Barbé G, Bertrand Y. Low incidence of sepsis due to viridans streptococci in a ten-year retrospective study of pediatric acute myeloid leukemia. Pediatr Blood Cancer 2006; 47:765-72. [PMID: 16333838 DOI: 10.1002/pbc.20706] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Infections remain an important cause of morbidity and mortality in children with acute myeloid leukemia (AML), and particularly viridans group streptococci (VGS) sepsis. The present study, conducted between 1993 and 2003 in children with AML, sought to assess the frequency and characteristics of infectious complications (ICs), the incidence of VGS sepsis, the interest of preventive decontamination, and a possible cytarabine dose-effect on the occurrence of ICs. METHODS Medical charts of 78 children treated according to the EORTC 58921 clinical trial were analyzed retrospectively. Patients were isolated in laminar air flow rooms, received non-absorbable gut decontamination, gum decontamination with vancomycin mouthwash, and trimethoprim-sulfamethoxasole. ICs were categorized as microbiologically documented infections (MDI), clinically documented infections (CDI), or fever of unknown origin (FUO). RESULTS Overall, 268 ICs occurred: 57.5% FUO, 8.5% CDI, and 34% MDI. Bloodstream infections occurred in 58 febrile episodes: Gram-positive bacteria represented 83% of the pathogens including 66.1% Staphylococcus species and 8.5% Streptococcus species (6.8% VGS), Gram-negative bacteria represented 13.5% of the pathogens and yeasts 3.5%. Five patients died of infection (6.4%). None died from bacterial infection and no case of VGS sepsis required intensive care. Invasive fungal infection was proven in four patients. Number of ICs was significantly different according to gum and gut decontamination status, and according to the cytarabine dose during the first intensification. No resistant strains were detected in spite of the use of local antibiotics. CONCLUSION The low rate of VGS and enterobacteriaceae sepsis was probably due to the effective decontamination. Our supportive care strategy could potentially help enhance overall survival in children with AML.
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Affiliation(s)
- A S Brunet
- Clinical Hematology and Bone Marrow Transplantation Department, Debrousse Hospital, Hospices Civils de Lyon, Lyon, France
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27
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Castagnola E, Caviglia I, Pistorio A, Fioredda F, Micalizzi C, Viscoli C, Haupt R. Bloodstream infections and invasive mycoses in children undergoing acute leukaemia treatment: A 13-year experience at a single Italian institution. Eur J Cancer 2005; 41:1439-45. [PMID: 15963894 DOI: 10.1016/j.ejca.2005.03.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2004] [Revised: 02/25/2005] [Accepted: 03/03/2005] [Indexed: 11/23/2022]
Abstract
The incidence rate (IR) of bloodstream infections (BI) and invasive mycoses (IM) during chemotherapy for paediatric acute lymphoblastic (ALL) or non-lymphoblastic leukaemias (AnLL) was evaluated for 153 BI and 22 IM diagnosed during 143,668 patient-days at risk from January 1988 to December 2000. IR, the number of episodes/100 days at risk, was 0.315 for AnLL and 0.092 for ALL (P < 0.001) with significant changes reflecting the intensity of anti-ALL chemotherapy. IR was 0.097 for first-line less intensive, 0.136 during first-line intensive, 0.261 during second-line therapy (P < 0.001), and 0.021 during maintenance. During intensive chemotherapy, the IR for BI was 0.134 in ALL with 0.087 for first-line less intensive therapy, 0.110 for first-line intensive, 0.230 for second-line intensive therapy (P < 0.001) and 0.274 in AnLL (P = 0.001). IR was 0.021 in ALL and 0.048 in AnLL (P = 0.034) for IM. In conclusion, there is a correlation between intensity of chemotherapy and rate of infections in paediatric acute leukaemias.
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Affiliation(s)
- Elio Castagnola
- Infectious Diseases Unit, Department of Hematology/Oncology, G. Gaslini Children's Hospital, Genoa, Italy.
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28
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Sham RL, Tallman MS. Treatment of acute promyelocytic leukemia in the very elderly: case report and review of the literature. Leuk Res 2004; 28:1347-50. [PMID: 15475077 DOI: 10.1016/j.leukres.2004.04.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2004] [Accepted: 04/05/2004] [Indexed: 10/26/2022]
Abstract
Acute promyelocytic leukemia (APL) is the most curable subtype of AML yet it is not known to what extent newer therapies will succeed in the very elderly. Conventional chemotherapeutic induction regimens are usually too toxic for older patients, however, all trans-retinoic acid (ATRA) and arsenic trioxide (ATO) may be useful therapeutic options if used judiciously. This case series describes three octogenarians with APL all treated with ATRA and achieved complete remissions. The last patient received ATO at the time of first relapse and achieved a second remission. To our knowledge, this is the first report of successful use of ATO for induction in an octogenarian with APL.
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Affiliation(s)
- Ronald L Sham
- Hematology/Oncology Unit, Rochester General Hospital, 1425 Portland Ave., Rochester, NY 14621, USA.
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29
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Weisman LE. Coagulase-negative staphylococcal disease: emerging therapies for the neonatal and pediatric patient. Curr Opin Infect Dis 2004; 17:237-41. [PMID: 15166827 DOI: 10.1097/00001432-200406000-00011] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Due to the high frequency, significant clinical impact, and cost of coagulase-negative staphylococcal infections, a great deal of effort continues in the investigation of the epidemiology, prevention, and treatment of coagulase-negative staphylococcal infection in the neonate and infant. RECENT FINDINGS Pediatric oncology and burn patients appear to be high-risk groups for coagulase-negative staphylococcal infections. Coagulase-negative staphylococcus appears to be the major pathogen world-wide, and associated with significant morbidity and mortality in neonatal intensive care units, in pediatric intensive care units, and following ophthalmologic surgery. A screened human polyclonal antibody and a humanized chimeric monoclonal antibody are both under investigation (in phase II-III clinical trials) for prevention of coagulase-negative staphylococcal infections in high-risk neonates. Resistance of coagulase-negative staphylococcus to antibiotics appears to be increasing. Should neonates with sepsis and central catheters have their catheters removed immediately or only when the infection is persistent? Arbekacin and linezolid are two new antibiotics that appear to be effective in the treatment of coagulase-negative staphylococcal infections, but their precise role has not yet been identified. SUMMARY This article summarizes the significant clinical reports about coagulase-negative staphylococcal infections since December 2002.
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Affiliation(s)
- Leonard E Weisman
- Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030, USA.
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