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Su M, Dey A, Maddah E, Mugundu GM, Singh AP. Quantitative pharmacology of dual-targeted bicistronic CAR-T-cell therapy using multiscale mechanistic modeling. CPT Pharmacometrics Syst Pharmacol 2025; 14:229-245. [PMID: 39508140 PMCID: PMC11812944 DOI: 10.1002/psp4.13259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 09/28/2024] [Accepted: 10/07/2024] [Indexed: 11/08/2024] Open
Abstract
Despite the initial success of single-targeted chimeric-antigen receptor (CAR) T-cell therapy in hematological malignancies, its long-term effectiveness is often hindered by antigen heterogeneity and escape. As a result, there is a growing interest in cell therapies targeting multiple antigens (≥2). However, the dose-exposure-response relationship and specific factors influencing the pharmacology of dual-targeted CAR-T-cell therapy remain unclear. In this study, we have developed a multiscale cellular kinetic-pharmacodynamic (CK-PD) model using case studies from CD19/CD22 and GPRC5D/BCMA autologous CAR-Ts. Initially, an in vitro tumor-killing model characterized the impact of individual binder affinities and their contribution to overall potency across varying (1) effector: target (ET) ratios and (2) tumor-associated antigen (TAA) expressing cell lines. Subsequently, an integrated CK-PD model was developed in pediatric acute lymphoblastic leukemia (ALL) patients, which accounted for CAR-T-cell product composition and relative antigen abundance in patients' tumor burden to characterize patient-level multiphasic cellular kinetics using multiple bioanalytical assays (e.g., flow and qPCR-based readouts). Global sensitivity analysis highlighted relative antigen expression, maximum killing rate constant, and CAR-T expansion rate constant as major determinants for observed exposure of dual-targeted CAR-T-cell therapy. This modeling framework could facilitate dose-optimization and construct refinement for dual-targeted bicistronic CAR-T-cell therapies, serving as a valuable tool for both forward and reverse translation in drug development.
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Affiliation(s)
- Mei‐Chi Su
- Cell Therapy Clinical Pharmacology and Modeling, Precision and Translational Medicine, Oncology Cell Therapy and Therapeutic Area UnitTakeda PharmaceuticalsCambridgeMassachusettsUSA
- Experimental and Clinical Pharmacology, College of PharmacyUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Agnish Dey
- Cell Therapy Clinical Pharmacology and Modeling, Precision and Translational Medicine, Oncology Cell Therapy and Therapeutic Area UnitTakeda PharmaceuticalsCambridgeMassachusettsUSA
| | - Erfan Maddah
- Cell Therapy Clinical Pharmacology and Modeling, Precision and Translational Medicine, Oncology Cell Therapy and Therapeutic Area UnitTakeda PharmaceuticalsCambridgeMassachusettsUSA
| | - Ganesh M. Mugundu
- Cell Therapy Clinical Pharmacology and Modeling, Precision and Translational Medicine, Oncology Cell Therapy and Therapeutic Area UnitTakeda PharmaceuticalsCambridgeMassachusettsUSA
| | - Aman P. Singh
- Cell Therapy Clinical Pharmacology and Modeling, Precision and Translational Medicine, Oncology Cell Therapy and Therapeutic Area UnitTakeda PharmaceuticalsCambridgeMassachusettsUSA
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2
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Witek MA, Larkey NE, Bartakova A, Hupert ML, Mog S, Cronin JK, Vun J, August KJ, Soper SA. Microfluidic Affinity Selection of B-Lineage Cells from Peripheral Blood for Minimal Residual Disease Monitoring in Pediatric B-Type Acute Lymphoblastic Leukemia Patients. Int J Mol Sci 2024; 25:10619. [PMID: 39408948 PMCID: PMC11477226 DOI: 10.3390/ijms251910619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2024] [Revised: 09/28/2024] [Accepted: 09/29/2024] [Indexed: 10/20/2024] Open
Abstract
Assessment of minimal residual disease (MRD) is the most powerful predictor of outcome in B-type acute lymphoblastic leukemia (B-ALL). MRD, defined as the presence of leukemic cells in the blood or bone marrow, is used for the evaluation of therapy efficacy. We report on a microfluidic-based MRD (MF-MRD) assay that allows for frequent evaluation of blood for the presence of circulating leukemia cells (CLCs). The microfluidic chip affinity selects B-lineage cells, including CLCs using anti-CD19 antibodies poised on the wall of the microfluidic chip. Affinity-selected cells are released from the capture surface and can be subjected to immunophenotyping to enumerate the CLCs, perform fluorescence in situ hybridization (FISH), and/or molecular analysis of the CLCs' mRNA/gDNA. During longitudinal testing of 20 patients throughout induction and consolidation therapy, the MF-MRD performed 116 tests, while only 41 were completed with multiparameter flow cytometry (MFC-MRD) using a bone marrow aspirate, as standard-of-care. Overall, 57% MF-MRD tests were MRD(+) as defined by CLC numbers exceeding a threshold of 5 × 10-4%, which was determined to be the limit of quantitation. Above a threshold of 0.01%, MFC-MRD was positive in 34% of patients. The MF offered the advantage of the opportunity for efficiently processing small volumes of blood (2 mL), which is important in the care of pediatric patients, especially infants. The minimally invasive means of blood collection are of high value when treating patients whose MRD is typically tested using an invasive bone marrow biopsy. MF-MRD detection can be useful for stratification of patients into risk groups and monitoring of patient well-being after completion of treatment for early recognition of potential impending disease recurrence.
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Affiliation(s)
- Malgorzata A. Witek
- Department of Chemistry, The University of Kansas, Lawrence, KS 66047, USA;
- Center of BioModular Multiscale Systems for Precision Medicine, Lawrence, KS 66045, USA; (N.E.L.); (S.M.)
| | - Nicholas E. Larkey
- Center of BioModular Multiscale Systems for Precision Medicine, Lawrence, KS 66045, USA; (N.E.L.); (S.M.)
- Department of Cancer Biology, The University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Alena Bartakova
- Biofluidica Inc., San Diego, CA 92121, USA; (A.B.); (M.L.H.)
| | | | - Shalee Mog
- Center of BioModular Multiscale Systems for Precision Medicine, Lawrence, KS 66045, USA; (N.E.L.); (S.M.)
| | - Jami K. Cronin
- Division of Hematology/Oncology/Bone Marrow Transplant, Children’s Mercy Kansas City, Kansas City, MO 64108, USA; (J.K.C.); (J.V.)
| | - Judy Vun
- Division of Hematology/Oncology/Bone Marrow Transplant, Children’s Mercy Kansas City, Kansas City, MO 64108, USA; (J.K.C.); (J.V.)
| | - Keith J. August
- Division of Hematology/Oncology/Bone Marrow Transplant, Children’s Mercy Kansas City, Kansas City, MO 64108, USA; (J.K.C.); (J.V.)
| | - Steven A. Soper
- Department of Chemistry, The University of Kansas, Lawrence, KS 66047, USA;
- Center of BioModular Multiscale Systems for Precision Medicine, Lawrence, KS 66045, USA; (N.E.L.); (S.M.)
- Department of Cancer Biology, The University of Kansas Medical Center, Kansas City, KS 66160, USA
- Biofluidica Inc., San Diego, CA 92121, USA; (A.B.); (M.L.H.)
- Bioengineering Program, The University of Kansas, Lawrence, KS 66045, USA
- Department of Mechanical Engineering, The University of Kansas, Lawrence, KS 66045, USA
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Elsemary MT, Maritz MF, Smith LE, Warkiani ME, Thierry B. Enrichment of T-lymphocytes from leukemic blood using inertial microfluidics toward improved chimeric antigen receptor-T cell manufacturing. Cytotherapy 2024; 26:1264-1274. [PMID: 38819362 DOI: 10.1016/j.jcyt.2024.05.005] [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: 02/29/2024] [Revised: 04/30/2024] [Accepted: 05/05/2024] [Indexed: 06/01/2024]
Abstract
Chimeric antigen receptor cell therapy is a successful immunotherapy for the treatment of blood cancers. However, hurdles in their manufacturing remain including efficient isolation and purification of the T-cell starting material. Herein, we describe a one-step separation based on inertial spiral microfluidics for efficient enrichment of T-cells in B-cell acute lymphoblastic leukemia (ALL) and B-cell chronic lymphocytic leukemia patient's samples. In healthy donors used to optimize the process, the lymphocyte purity was enriched from 65% (SD ± 0.2) to 91% (SD ± 0.06) and T-cell purity was enriched from 45% (SD ± 0.1) to 73% (SD ± 0.02). Leukemic samples had higher starting B-cells compared to the healthy donor samples. Efficient enrichment and recovery of lymphocytes and T-cells were achieved in ALL samples with B-cells, monocytes and leukemic blasts depleted by 80% (SD ± 0.09), 89% (SD ± 0.1) and 74% (SD ± 0.09), respectively, and a 70% (SD ± 0.1) T-cell recovery. Chronic lymphocytic leukemia samples had lower T-cell numbers, and the separation process was less efficient compared to the ALL. This study demonstrates the use of inertial microfluidics for T-cell enrichment and depletion of B-cell blasts in ALL, suggesting its potential to address a key bottleneck of the chimeric antigen receptor-T manufacturing workflow.
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MESH Headings
- Humans
- T-Lymphocytes/immunology
- Receptors, Chimeric Antigen/immunology
- Immunotherapy, Adoptive/methods
- Microfluidics/methods
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Cell Separation/methods
- B-Lymphocytes/immunology
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/immunology
- Receptors, Antigen, T-Cell/immunology
- Receptors, Antigen, T-Cell/metabolism
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Affiliation(s)
- Mona T Elsemary
- Future Industries Institute, University of South Australia Mawson Lakes Campus, Mawson Lakes, SA, Australia
| | - Michelle F Maritz
- Future Industries Institute, University of South Australia Mawson Lakes Campus, Mawson Lakes, SA, Australia
| | - Louise E Smith
- Future Industries Institute, University of South Australia Mawson Lakes Campus, Mawson Lakes, SA, Australia
| | | | - Benjamin Thierry
- Future Industries Institute, University of South Australia Mawson Lakes Campus, Mawson Lakes, SA, Australia.
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Salem AM, Mugundu GM, Singh AP. Development of a multiscale mechanistic modeling framework integrating differential cellular kinetics of CAR T-cell subsets and immunophenotypes in cancer patients. CPT Pharmacometrics Syst Pharmacol 2023; 12:1285-1304. [PMID: 37448297 PMCID: PMC10508581 DOI: 10.1002/psp4.13009] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Chimeric antigen receptor (CAR) T-cell subsets and immunophenotypic composition of the pre-infusion product, as well as their longitudinal changes following infusion, are expected to affect CAR T-cell expansion, persistence, and clinical outcomes. Herein, we sequentially evolved our previously described cellular kinetic-pharmacodynamic (CK-PD) model to incorporate CAR T-cell product-associated attributes by utilizing published preclinical and clinical datasets from two affinity variants (FMC63 and CAT19 scFv) anti-CD19 CAR T-cells. In step 1, a unified cell-level PD model was used to simultaneously characterize the in vitro killing datasets of two CAR T-cells against CD19+ cell lines at varying effector:target ratios. In step 2, an augmented CK-PD model for anti-CD19 CAR T-cells was developed, by integrating CK dataset(s) from two bioanalytical measurements (quantitative polymerase chain reaction and flow cytometry) in patients with cancer. The model described the differential in vivo expansion properties of CAR T-cell subsets. The estimated expansion rate constant was ~1.12-fold higher for CAR+CD8+ cells in comparison to CAR+CD4+ T-cells. In step 3, the model was extended to characterize the disposition of four immunophenotypic populations of CAR T-cells, including stem-cell memory, central memory, effector memory, and effector cells. The model adequately characterized the longitudinal changes in immunophenotypes post anti-CD19 CAR T-cell infusion in pediatric patients with acute lymphocytic leukemia. Polyclonality in the pre-infusion product was identified as a categorical covariate influencing differentiation of immunophenotypes. In the future, this model could be leveraged a priori toward optimizing the composition of CAR T-cell infusion product, and further understand the CK-PD relationship in patients.
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Affiliation(s)
- Ahmed M. Salem
- Clinical Pharmacology and Modeling, Precision and Translational MedicineOncology Cell Therapy and Therapeutic Area Unit, Takeda PharmaceuticalsCambridgeMassachusettsUSA
- Center for Translational MedicineUniversity of Maryland School of PharmacyBaltimoreMarylandUSA
| | - Ganesh M. Mugundu
- Clinical Pharmacology and Modeling, Precision and Translational MedicineOncology Cell Therapy and Therapeutic Area Unit, Takeda PharmaceuticalsCambridgeMassachusettsUSA
| | - Aman P. Singh
- Clinical Pharmacology and Modeling, Precision and Translational MedicineOncology Cell Therapy and Therapeutic Area Unit, Takeda PharmaceuticalsCambridgeMassachusettsUSA
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Shibusawa M, Tanimoto T. Acute Myeloid Leukemia with Myelodysplasia Related Changes. Leukemia 2022. [DOI: 10.36255/exon-publications-leukemia-aml-mrca] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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6
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Helenius M, Vaitkeviciene G, Abrahamsson J, Jonsson ÓG, Lund B, Harila-Saari A, Vettenranta K, Mikkel S, Stanulla M, Lopez-Lopez E, Waanders E, Madsen HO, Marquart HV, Modvig S, Gupta R, Schmiegelow K, Nielsen RL. Characteristics of white blood cell count in acute lymphoblastic leukemia: A COST LEGEND phenotype-genotype study. Pediatr Blood Cancer 2022; 69:e29582. [PMID: 35316565 DOI: 10.1002/pbc.29582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/20/2021] [Accepted: 12/31/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND White blood cell count (WBC) as a measure of extramedullary leukemic cell survival is a well-known prognostic factor in acute lymphoblastic leukemia (ALL), but its biology, including impact of host genome variants, is poorly understood. METHODS We included patients treated with the Nordic Society of Paediatric Haematology and Oncology (NOPHO) ALL-2008 protocol (N = 2347, 72% were genotyped by Illumina Omni2.5exome-8-Bead chip) aged 1-45 years, diagnosed with B-cell precursor (BCP-) or T-cell ALL (T-ALL) to investigate the variation in WBC. Spline functions of WBC were fitted correcting for association with age across ALL subgroups of immunophenotypes and karyotypes. The residuals between spline WBC and actual WBC were used to identify WBC-associated germline genetic variants in a genome-wide association study (GWAS) while adjusting for age and ALL subtype associations. RESULTS We observed an overall inverse correlation between age and WBC, which was stronger for the selected patient subgroups of immunophenotype and karyotypes (ρBCP-ALL = -.17, ρT-ALL = -.19; p < 3 × 10-4 ). Spline functions fitted to age, immunophenotype, and karyotype explained WBC variation better than age alone (ρ = .43, p << 2 × 10-6 ). However, when the spline-adjusted WBC residuals were used as phenotype, no GWAS significant associations were found. Based on available annotation, the top 50 genetic variants suggested effects on signal transduction, translation initiation, cell development, and proliferation. CONCLUSION These results indicate that host genome variants do not strongly influence WBC across ALL subsets, and future studies of why some patients are more prone to hyperleukocytosis should be performed within specific ALL subsets that apply more complex analyses to capture potential germline variant interactions and impact on WBC.
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Affiliation(s)
- Marianne Helenius
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Copenhagen, Denmark.,Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Goda Vaitkeviciene
- Vilnius University Hospital Santaros Klinikos Center for Pediatric Oncology and Hematology and Vilnius University, Vilnius, Lithuania
| | - Jonas Abrahamsson
- Department of Paediatrics, Institution for Clinical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Bendik Lund
- Department of Pediatrics, St. Olavs Hospital, Trondheim, Norway
| | - Arja Harila-Saari
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Kim Vettenranta
- University of Helsinki and Children´s Hospital, University of Helsinki, Helsinki, Finland
| | - Sirje Mikkel
- Department of Hematology and Oncology, University of Tartu, Tartu, Estonia
| | - Martin Stanulla
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Elixabet Lopez-Lopez
- Department of Genetics, Physical Anthropology and Animal Physiology, Faculty of Science and Technology, University of the Basque Country (UPV/EHU), Leioa, Spain.,Pediatric Oncology Group, BioCruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Esmé Waanders
- Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Hans O Madsen
- Department of Clinical Immunology, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Hanne Vibeke Marquart
- Department of Clinical Immunology, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Signe Modvig
- Department of Clinical Immunology, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Ramneek Gupta
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Copenhagen, Denmark.,Novo Nordisk Research Centre Oxford, Oxford, UK
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Rikke Linnemann Nielsen
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Copenhagen, Denmark.,Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark.,Novo Nordisk Research Centre Oxford, Oxford, UK
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7
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Ohana Z, Serraes S, Elder C, Katusa N. Cytogenetic guided therapy using blinatumomab and inotuzumab ozogamicin in a patient with relapse/refractory acute lymphoblastic leukemia. J Oncol Pharm Pract 2022:10781552211073958. [PMID: 35043731 DOI: 10.1177/10781552211073958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Acute Lymphoblastic Leukemia (ALL) is an aggressive cancer that requires intense chemotherapy and has a high rate of recurrence. Treatments of Relapse/Refractory (R/R) B-cell ALL are limited. Blinatumomab, a bispecific T-cell engager (CD19/CD3) monocolonal antibody, and Inotuzumab Ozogamicin, an anti-CD22 antibody conjugate, are current recommended options. CASE REPORT To describe a R/R B-cell ALL patient who failed blinatumomab therapy. Subsequently she received inotuzumab ozogamicin achieving a complete response. MANAGEMENT & OUTCOME Our patient was initially treated with CALGB 10403 regimen but did not achieve a complete response. Blinatumomab was given for relapse/refractory disease however she had an incomplete response despite having 100% expression in CD19 markers. Consequently, she received inotuzumab ozogamicin attributable to 70% expression of CD22. She responded with a complete response and transitioned to a successful hematopoietic stem cell transplant. DISCUSSION There is limited clinical guidance on the preferred treatment of adult R/R B-Cell ALL. Currently, there are no randomized head-to-head trials comparing efficacy of blinatumomab and inotuzumab ozogamicin. Clinical patterns of blinatumomab resistance has been reported. Our case study remains unclear of why our patient had unsuccessful outcomes with blinatumomab regardless of having CD19 positivity of 100%. Future prospective analysis and comparative studies are needed to determine proper sequencing of these therapies.
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Affiliation(s)
- Zahava Ohana
- 219819Cleveland Clinic Florida, Weston, Florida, United States
| | | | - Christopher Elder
- 10605Florida Cancer Specialists & Research Institute LLC, Fort Myers, Florida, United States
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Deshpande NM, Gite S, Pradhan B, Kotecha K, Alamri A. Improved Otsu and Kapur approach for white blood cells segmentation based on LebTLBO optimization for the detection of Leukemia. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2022; 19:1970-2001. [PMID: 35135238 DOI: 10.3934/mbe.2022093] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The diagnosis of leukemia involves the detection of the abnormal characteristics of blood cells by a trained pathologist. Currently, this is done manually by observing the morphological characteristics of white blood cells in the microscopic images. Though there are some equipment- based and chemical-based tests available, the use and adaptation of the automated computer vision-based system is still an issue. There are certain software frameworks available in the literature; however, they are still not being adopted commercially. So there is a need for an automated and software- based framework for the detection of leukemia. In software-based detection, segmentation is the first critical stage that outputs the region of interest for further accurate diagnosis. Therefore, this paper explores an efficient and hybrid segmentation that proposes a more efficient and effective system for leukemia diagnosis. A very popular publicly available database, the acute lymphoblastic leukemia image database (ALL-IDB), is used in this research. First, the images are pre-processed and segmentation is done using Multilevel thresholding with Otsu and Kapur methods. To further optimize the segmentation performance, the Learning enthusiasm-based teaching-learning-based optimization (LebTLBO) algorithm is employed. Different metrics are used for measuring the system performance. A comparative analysis of the proposed methodology is done with existing benchmarks methods. The proposed approach has proven to be better than earlier techniques with measuring parameters of PSNR and Similarity index. The result shows a significant improvement in the performance measures with optimizing threshold algorithms and the LebTLBO technique.
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Affiliation(s)
- Nilkanth Mukund Deshpande
- Department of Electronics and Telecommunication, Lavale, Symbiosis Institute of Technology, Symbiosis International (Deemed University), Pune 412115, Maharashtra, India
- Electronics and Telecommunication, Vilad Ghat, Dr. Vithalrao Vikhe Patil College of Engineering, Ahmednagar 414111, India
| | - Shilpa Gite
- Department of Computer Science, Lavale, Symbiosis Institute of Technology, Symbiosis International (Deemed University), Pune 412115, Maharashtra, India
- Symbiosis Center for Applied Artificial Intelligence, Lavale, Symbiosis International (Deemed University), Pune 412115, Maharashtra, India
| | - Biswajeet Pradhan
- Centre for Advanced Modelling and Geospatial Information Systems, School of Civil and Environmental Engineering, Faculty of Engineering and IT, University of Technology Sydney, NSW 2007, Sydney, Australia
- Earth Observation Centre, Institute of Climate Change, Universiti Kebangsaan Malaysia, 43600 UKM, Bangi, Malaysia
| | - Ketan Kotecha
- Department of Computer Science, Lavale, Symbiosis Institute of Technology, Symbiosis International (Deemed University), Pune 412115, Maharashtra, India
- Symbiosis Center for Applied Artificial Intelligence, Lavale, Symbiosis International (Deemed University), Pune 412115, Maharashtra, India
| | - Abdullah Alamri
- Department of Geology and Geophysics, College of Science, King Saud University, Riyadh 11451, Saudi Arabia
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Alsulami HA, Alnashri MM, Bawazir AF, Alrashid LT, Dly RA, Alharbi YA, Qari MH. Prognostics and Clinical Outcomes in Patients Diagnosed With Acute Myeloid Leukemia (AML) in a Teaching Hospital. Cureus 2021; 13:e18915. [PMID: 34812301 PMCID: PMC8603085 DOI: 10.7759/cureus.18915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Acute myeloid leukemia (AML) is a heterogeneous disease. Prognosis and survival depend on several factors that determine tumor behavior and response to therapy. AML has a poor prognosis that depends on several factors: patient's age, gender, body mass index (BMI), baseline white blood cells count, and bone marrow blast (BMB) cell count at the time of diagnosis. Therefore, this study aimed to determine the prognostic role of these factors and their impact on outcomes, and how these prognostic factors may affect AML patients before and after induction chemotherapy. Methods: The study design is an observational, retrospective record review. We included records of patients diagnosed with primary and secondary AML who received chemotherapy between 2013 and 2019 at King Abdulaziz University in Jeddah, Saudi Arabia. Data were extracted from medical records, entered into an Excel sheet (Microsoft Corp., Redmond, WA), and analyzed using SPSS Statistics, version 25 (IBM Corp., Armonk, NY). Results: Forty-two AML patients who were started on chemotherapy were analyzed. The mean age at diagnosis was 35 ± 22.2 years; 52.4% were male. The ability to achieve the first remission varied according to age group; the 21-45 age group had the higher ability and survival rate of 75.0%. On the other hand, the mortality incidence was higher (at 70.0%) in both the 11-20 and the 46-70 age groups. A strong negative correlation was observed between age and survival duration after treatment (SDAT) (r = - 0.618, p = 0.004). The death incidence was increased in the BMI ranges that were under and above the normal weight range. SDAT differed significantly between the three groups in favor of the normal-weight patients (p = 0.019). We found that patients with BMB < 5 had the most deaths. There was a significant negative association between BMB and days to achieve the first remission after treatment (p = 0.033). Conclusion: Age, BMI, and BMB are considered effective prognostic factors for AML patients.
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Affiliation(s)
- Hind A Alsulami
- Hematology Department, King Abdulaziz University Hospital, Jeddah, SAU
| | - Maryam M Alnashri
- Hematology Department, King Abdulaziz University Hospital, Jeddah, SAU
| | - Alanoud F Bawazir
- Hematology Department, King Abdulaziz University Hospital, Jeddah, SAU
| | - Laila T Alrashid
- Hematology Department, King Abdulaziz University Hospital, Jeddah, SAU
| | - Raghdah A Dly
- Hematology Department, King Abdulaziz University Hospital, Jeddah, SAU
| | - Yusr A Alharbi
- Hematology Department, King Abdulaziz University Hospital, Jeddah, SAU
| | - Mohamad H Qari
- Hematology Department, King Abdulaziz University Hospital, Jeddah, SAU
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10
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Chen P, Liu Y, Zhang R, Wang H, Zhang J, Guo M, Du Z. Adaptive immunity-related gene expression profile is correlated with clinical phenotype in patients with acute myeloid leukemia. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:939. [PMID: 34350254 PMCID: PMC8263877 DOI: 10.21037/atm-21-2720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/09/2021] [Indexed: 12/21/2022]
Abstract
Background Acute myeloid leukemia (AML) is a common and lethal hematopoietic malignancy that is highly dependent on the immune microenvironment. However, light has yet to be shed on the landscape of adaptive immunity-related genes. This work aimed to uncover the novel molecular events in AML and potential therapeutic strategies for AML treatment. Methods For the current research, the transcriptional information of 732 genes that participate in adaptive immunity was collected from 173 patients with AML, and the patients were grouped into different cohorts based on the different expression patterns. The correlations between gene expression and clinical characteristics, including prognosis, were studied. Results According to the notably different expressions of adaptive immunity-related genes, the 173 patients were divided into 2 clusters and 3 subclusters. No significant differences in overall survival (OS) or progression-free survival (PFS) were detected between the clusters or subclusters. There were obvious discrepancies found in age, peripheral blood (PB) blast percentage, and French-American-British (FAB) classification between each cluster or subcluster. The patients in cluster 1 were older and more of them had M5 type; the patients in cluster 2 were younger and more of them had M2 type. Further, 81 genes were significantly correlated with age and 101 genes were significantly correlated with PB blast percentage. Comparison of the prognosis between each FAB type revealed that patients with M3 type displayed the most favorable OS and PFS. Among the differentially expressed genes (DEGs), CLEC2B expression was much lower in M2 patients than in patients with other types (P<0.001), and its high expression indicated a worse outcome (12.4 vs. 46.5 months of OS). Conclusions This study has uncovered the expression profile of adaptive immunity-related genes in AML. The different gene expression patterns are not associated with survival, but are significantly correlated the FAB types. CLEC2B expression is low in patients with M2 type and is negatively correlated with prognosis, thus revealing a potential therapeutic target for AML.
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Affiliation(s)
- Peng Chen
- Department of Hematology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yi Liu
- Department of Hematology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Rui Zhang
- Department of Hematology, People's Hospital of Cangzhou, Cangzhou, China
| | - Haitao Wang
- Department of Hematology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Juan Zhang
- Department of Hematology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Meng Guo
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Zhenlan Du
- Department of Hematology and Oncology, Faculty of Pediatrics, Chinese PLA General Hospital, Beijing, China.,Bayi Children's Hospital, Seventh Medical Center of Chinese PLA General Hospital, Beijing, China.,National Engineering Laboratory for Birth Defects Prevention and Control of Key Technology, Beijing, China.,Beijing Key Laboratory of Pediatric Organ Failure, Beijing, China
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11
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Srisurapanont K, Prakalapakorn W, Sutamworarot C, Siriraksa T, Jinapeng M, Rattanathammethee T. Pretreatment grade 4 thrombocytopenia is an independent prognostic factor in adult acute lymphoblastic leukemia: an extended analysis of a single-center retrospective study. ACTA ACUST UNITED AC 2021; 26:26-30. [PMID: 33357100 DOI: 10.1080/16078454.2020.1856512] [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: 10/22/2022]
Abstract
Objectives: Low pretreatment platelet count is negatively associated with overall survival (OS) of certain subtypes of acute lymphoblastic leukemia (ALL). However, the prognostic impact of the grade of thrombocytopenia on OS and disease-free survival (DFS) has never been explored. Methods: We conducted an extended analysis of a retrospective study. Newly diagnosed adults with ALL was enrolled in this study. The grade of thrombocytopenia was evaluated in accordance with the Common Terminology Criteria for Adverse Events (CTCAE) version 3.0. Prognostic impacts were assessed by the hazard ratios (HRs) and 95% confidence intervals (CIs) obtained from univariate and multivariate Cox proportional hazards regression analyses. Results: A total of 90 participants were included in this study. There were 18 cases with grade 4 thrombocytopenia among the 71 participants presented with thrombocytopenia of any grade. Both univariate and multivariate Cox regression analyses suggested the independent negative prognostic impact of grade 4 thrombocytopenia on both OS (HR = 4.73, 95% CI = 1.95-11.52) and DFS (HR = 9.82, 95% CI = 3.14-30.76) of adult ALL, using the cohort of patients with no thrombocytopenia as a reference. In addition, treatment regimen, cytogenetic profile, time to treatment, and platelet count were independent prognostic factors of the OS. We also found that treatment regimen, cytogenetic profile, and peripheral blood blast percentage were independent prognostic factors of the DFS. Conclusion: Grade 4 thrombocytopenia was a negative prognostic factor for both overall survival and disease-free survival of adults with acute lymphoblastic leukemia.
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Affiliation(s)
| | | | | | | | - Metapon Jinapeng
- Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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12
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Brown P, Inaba H, Annesley C, Beck J, Colace S, Dallas M, DeSantes K, Kelly K, Kitko C, Lacayo N, Larrier N, Maese L, Mahadeo K, Nanda R, Nardi V, Rodriguez V, Rossoff J, Schuettpelz L, Silverman L, Sun J, Sun W, Teachey D, Wong V, Yanik G, Johnson-Chilla A, Ogba N. Pediatric Acute Lymphoblastic Leukemia, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2021; 18:81-112. [PMID: 31910389 DOI: 10.6004/jnccn.2020.0001] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Acute lymphoblastic leukemia (ALL) is the most common pediatric malignancy. Advancements in technology that enhance our understanding of the biology of the disease, risk-adapted therapy, and enhanced supportive care have contributed to improved survival rates. However, additional clinical management is needed to improve outcomes for patients classified as high risk at presentation (eg, T-ALL, infant ALL) and who experience relapse. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for pediatric ALL provide recommendations on the workup, diagnostic evaluation, and treatment of the disease, including guidance on supportive care, hematopoietic stem cell transplantation, and pharmacogenomics. This portion of the NCCN Guidelines focuses on the frontline and relapsed/refractory management of pediatric ALL.
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Affiliation(s)
- Patrick Brown
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | - Hiroto Inaba
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | - Colleen Annesley
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | - Susan Colace
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Mari Dallas
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | - Kara Kelly
- Roswell Park Comprehensive Cancer Center
| | | | | | | | - Luke Maese
- Huntsman Cancer Institute at the University of Utah
| | - Kris Mahadeo
- The University of Texas MD Anderson Cancer Center
| | | | | | | | - Jenna Rossoff
- Ann & Robert H. Lurie Children's Hospital of Chicago
| | - Laura Schuettpelz
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | - Weili Sun
- City of Hope National Medical Center
| | - David Teachey
- Abramson Cancer Center at the University of Pennsylvania
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13
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Liquid biopsy for minimal residual disease detection in leukemia using a portable blast cell biochip. NPJ Precis Oncol 2019; 3:30. [PMID: 31815186 PMCID: PMC6889137 DOI: 10.1038/s41698-019-0102-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 10/21/2019] [Indexed: 12/11/2022] Open
Abstract
Long-term management for leukemia is challenging due to the painful and invasive procedure of bone marrow (BM) biopsy. At present, non-invasive liquid (blood) biopsy is not utilized for leukemia, due to lower counts of leukemia blast cells in the blood. Here, we described a robust system for the simultaneous detection and enrichment of rare blast cells. Enrichment of blast cells was achieved from blood with a one-step microfluidic blast cell biochip (BCB) sorting system, without specific targeting of proteins by antibodies. Non-target cells encountered a differential net force as compared to stiffer blast cells and were removed. The efficiency of the BCB promotes high detection sensitivity (1 in 106 cells) even from patients with minimal residual disease. The procedure was validated using actual blast cells from patients with various types of leukemia. Outcomes were compared to current evaluation standards, such as flow cytometry, using BM aspirates. Blast cell detection efficiency was higher in 55.6% of the patients using the BCB as compared to flow cytometry, despite the lower concentrations of blast cells in liquid biopsy. These studies promote early-stage detection and routine monitoring for minimal residual disease in patients.
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14
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Lin S, Shaik N, Martinelli G, Wagner AJ, Cortes J, Ruiz‐Garcia A. Population Pharmacokinetics of Glasdegib in Patients With Advanced Hematologic Malignancies and Solid Tumors. J Clin Pharmacol 2019; 60:605-616. [PMID: 31769065 PMCID: PMC7187372 DOI: 10.1002/jcph.1556] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 10/22/2019] [Indexed: 01/08/2023]
Abstract
Glasdegib is an inhibitor of the Hedgehog pathway recently approved in the United States for the treatment of acute myeloid leukemia. A population pharmacokinetic analysis was conducted to characterize the kinetic behavior of glasdegib and its sources of variability (covariates) by utilizing data from 269 patients with cancer treated with oral glasdegib doses ranging from 5 to 640 mg/d. Nonlinear mixed-effects modeling was conducted using NONMEM (v.7.3) and Perl-speaks NONMEM (v.4.2.0). The estimated apparent total clearance, apparent central volume of distribution, and apparent peripheral volume of distribution were 6.27 L/h, 3.32 L, and 279.2 L, respectively. Age, sex, race, and hepatic function were not significant covariates on glasdegib pharmacokinetic parameters. Baseline body weight, percentage bone marrow blasts, creatinine clearance, and use of moderate or strong cytochrome P450 3A inhibitors were statistically significant covariates on apparent total clearance; however, the magnitude of the effects was not considered clinically meaningful.
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Affiliation(s)
- Swan Lin
- Clinical PharmacologyGlobal Product DevelopmentPfizer IncSan DiegoCaliforniaUSA
| | - Naveed Shaik
- Clinical PharmacologyGlobal Product DevelopmentPfizer IncSan DiegoCaliforniaUSA
| | - Giovanni Martinelli
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST IRCCS)MeldolaItaly
| | | | - Jorge Cortes
- University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Ana Ruiz‐Garcia
- Clinical PharmacologyGlobal Product DevelopmentPfizer IncSan DiegoCaliforniaUSA
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15
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Wohl I, Zurgil N, Hakuk Y, Sobolev M, Deutsch M. Discrimination of leukemic Jurkat cells from normal lymphocytes via novo label-free cytometry based on fluctuation of image gray values. EUROPEAN BIOPHYSICS JOURNAL: EBJ 2019; 48:267-275. [PMID: 30903263 DOI: 10.1007/s00249-019-01351-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/23/2018] [Accepted: 02/20/2019] [Indexed: 11/30/2022]
Abstract
We introduce a simple, label-free cytometry technique, based on the spatio-temporal fluctuation analysis of pixel gray levels of a cell image utilizing the Gray Level Information Entropy (GLIE) function. In this study, the difference in GLIE random fluctuations and its biophysical etiology in a comparison cell model of leukemic Jurkat cells and human healthy donor lymphocytes was explored. A combination of common bright field microscopy and a unique imaging dish wherein cells are individually held untethered in a picoliter volume matrix of optical chambers was used. Random GLIE fluctuations were found to be greater in malignant Jurkat cells than in benign lymphocytes, while these fluctuations correlate with intracellular vesicle Mean Square Displacement (MSD) values and are inhibited by myosin-2 and adenosine triphosphate (ATP) inhibitors. These results suggest that the incoherent active forces acting on the cytoskeleton which cause mechanical dissipative fluctuation of the cytoskeletal and related intracellular content are the biophysical cellular mechanism behind the GLIE random fluctuation results. Analysis of the results in Jurkat cells and normal lymphocytes suggests the possible potential of this simple and automated label-free cytometry to identify malignancy, particularly in a diagnostic setup of multiple cell examination.
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Affiliation(s)
- Ishay Wohl
- The Biophysical Interdisciplinary Schottenstein Center for the Research and Technology of the Cellome, Physics Department, Bar Ilan University, 5290002, Ramat-Gan, Israel
| | - Naomi Zurgil
- The Biophysical Interdisciplinary Schottenstein Center for the Research and Technology of the Cellome, Physics Department, Bar Ilan University, 5290002, Ramat-Gan, Israel
| | - Yaron Hakuk
- The Biophysical Interdisciplinary Schottenstein Center for the Research and Technology of the Cellome, Physics Department, Bar Ilan University, 5290002, Ramat-Gan, Israel
| | - Maria Sobolev
- The Biophysical Interdisciplinary Schottenstein Center for the Research and Technology of the Cellome, Physics Department, Bar Ilan University, 5290002, Ramat-Gan, Israel
| | - Mordechai Deutsch
- The Biophysical Interdisciplinary Schottenstein Center for the Research and Technology of the Cellome, Physics Department, Bar Ilan University, 5290002, Ramat-Gan, Israel.
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16
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Benton CB, Khan M, Sallman D, Nazha A, Nogueras González GM, Piao J, Ning J, Aung F, Al Ali N, Jabbour E, Kadia TM, Borthakur G, Ravandi F, Pierce S, Steensma D, DeZern A, Roboz G, Sekeres M, Andreeff M, Kantarjian H, Komrokji RS, Garcia-Manero G. Prognosis of patients with intermediate risk IPSS-R myelodysplastic syndrome indicates variable outcomes and need for models beyond IPSS-R. Am J Hematol 2018; 93:1245-1253. [PMID: 30051599 DOI: 10.1002/ajh.25234] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/18/2018] [Accepted: 07/23/2018] [Indexed: 01/01/2023]
Abstract
The International Prognostic Scoring System-Revised (IPSS-R) is one standard for myelodysplastic syndrome (MDS) risk stratification. It divides patients into five categories including an intermediate subset (IPSS-R int-risk). Outcomes and clinical interventions for patients with IPSS-R int-risk are not well defined. We performed an analysis of outcomes of this group of patients. Out of 3167 patients, a total of 298 were identified with IPSS-R int-risk MDS and retrospectively analyzed to assess characteristics affecting outcomes. Cox proportional hazard models for overall survival (OS) were performed to identify statistically significant clinical factors that influence survival. Age of 66 years or greater, peripheral blood blasts of 2% or more, and history of red blood cell (RBC) transfusion were significantly associated with inferior survival. Based on these features, MDS patients with IPSS-R int-risk were classified into two prognostic risk groups for analysis, an int-favorable group and an int-adverse group, and had significantly divergent outcomes. Sequential prognostication was validated using two independent datasets comprising over 700 IPSS-R int-risk patients. The difference in median survival between int-favorable and int-adverse patients was 3.7 years in the test cohort, and 1.8 and 2.0 years in the two validation cohorts. These results confirm significantly variable outcomes of patients with IPSS-R int-risk and need for different prognostic systems.
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Affiliation(s)
- Christopher B. Benton
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Maliha Khan
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - David Sallman
- Department of Malignant Hematology; H. Lee Moffitt Cancer Center; Tampa Florida
| | - Aziz Nazha
- Department of Leukemia; Cleveland Clinic; Cleveland Ohio
| | | | - Jin Piao
- Department of Statistics; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Jing Ning
- Department of Statistics; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Fleur Aung
- Laboratory Medicine; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Najla Al Ali
- Department of Malignant Hematology; H. Lee Moffitt Cancer Center; Tampa Florida
| | - Elias Jabbour
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Tapan M. Kadia
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Gautam Borthakur
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Farhad Ravandi
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Sherry Pierce
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - David Steensma
- Department of Medical Oncology; Dana-Farber Cancer Institute; Boston
| | - Amy DeZern
- Sidney Kimmel Comprehensive Cancer Center; The Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Gail Roboz
- Joan and Sanford I. Weill Department of Medicine; Weill Cornell Medical; New York New York
| | | | - Michael Andreeff
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Hagop Kantarjian
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Rami S. Komrokji
- Department of Malignant Hematology; H. Lee Moffitt Cancer Center; Tampa Florida
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17
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Park SS, Kim HJ, Min KI, Min GJ, Jeon YW, Yoon JH, Yahng SA, Shin SH, Lee SE, Cho BS, Eom KS, Kim YJ, Lee S, Min CK, Cho SG, Kim DW, Lee JW, Min WS. Prognostic Prediction Model for Second Allogeneic Stem-Cell Transplantation in Patients With Relapsed Acute Myeloid Leukemia: Single-Center Report. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2018; 18:e167-e182. [PMID: 29519618 DOI: 10.1016/j.clml.2018.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/05/2018] [Accepted: 02/13/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE To identify factors affecting survival outcomes and to develop a prognostic model for second allogeneic stem-cell transplantation (allo-SCT2) for relapsed acute myeloid leukemia (AML) after the first autologous or allogeneic stem-cell transplantation. PATIENTS AND METHODS Seventy-eight consecutive adult AML patients who received allo-SCT2 were analyzed in this retrospective study. RESULTS The 4-year overall survival (OS) rate was 28.7%. In multivariate analysis, poor cytogenetic risk at diagnosis, circulating blast ≥ 20% at relapse, duration from first transplantation to relapse < 9 months, and failure to achieve morphologic complete remission after allo-SCT2 were factors associated with poor OS. A prognostic model was developed with the following score system: intermediate and poor cytogenetic risk at diagnosis (0.5 and 1 point), peripheral blast ≥ 20% at relapse (1 point), duration from the first transplantation to relapse < 9 months (1 point), and failure to achieve morphologic complete remission after allo-SCT2 (1 point). The model identified 2 subgroups according to the 4-year OS rate: 51.3% in the low-risk group (score < 2) and 2.8% in the high-risk group (score ≥ 2) (P < .001). CONCLUSION This prognostic model might be useful to make an appropriate decision for allo-SCT2 in relapsed AML after the first autologous or allogeneic stem-cell transplantation.
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Affiliation(s)
- Sung-Soo Park
- Catholic Blood and Marrow Transplantation Center, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea; Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hee-Je Kim
- Catholic Blood and Marrow Transplantation Center, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea; Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Kyoung Il Min
- Catholic Blood and Marrow Transplantation Center, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Gi June Min
- Catholic Blood and Marrow Transplantation Center, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea; Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young-Woo Jeon
- Catholic Blood and Marrow Transplantation Center, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea; Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae-Ho Yoon
- Catholic Blood and Marrow Transplantation Center, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea; Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung-Ah Yahng
- Incheon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Seung-Hwan Shin
- Yeoido St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-Eun Lee
- Catholic Blood and Marrow Transplantation Center, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea; Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Byung-Sik Cho
- Catholic Blood and Marrow Transplantation Center, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea; Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ki-Seong Eom
- Catholic Blood and Marrow Transplantation Center, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea; Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoo-Jin Kim
- Catholic Blood and Marrow Transplantation Center, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea; Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seok Lee
- Catholic Blood and Marrow Transplantation Center, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea; Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chang-Ki Min
- Catholic Blood and Marrow Transplantation Center, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea; Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seok-Goo Cho
- Catholic Blood and Marrow Transplantation Center, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Dong-Wook Kim
- Catholic Blood and Marrow Transplantation Center, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea; Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong Wook Lee
- Catholic Blood and Marrow Transplantation Center, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Woo-Sung Min
- Catholic Blood and Marrow Transplantation Center, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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18
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Davis LL, Hume KR, Stokol T. A retrospective review of acute myeloid leukaemia in 35 dogs diagnosed by a combination of morphologic findings, flow cytometric immunophenotyping and cytochemical staining results (2007-2015). Vet Comp Oncol 2017; 16:268-275. [PMID: 29239119 DOI: 10.1111/vco.12377] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 11/15/2017] [Accepted: 11/16/2017] [Indexed: 02/06/2023]
Abstract
Acute myeloid leukaemia (AML) is an uncommon, rapidly progressive neoplasm in dogs. The aim of this retrospective study was to characterize the clinical presentation, haematologic findings, diagnostic imaging results, treatment and survival time of a contemporary cohort of dogs with AML. Diagnosis was based on >20% blasts in bone marrow or blood identified as myeloid based on morphologic findings, flow cytometric immunophenotyping and cytochemical staining. Medical records of 35 dogs diagnosed with AML from 2007 to 2015 were included. Most dogs presented with inappetence (66%) and lethargy (57%) and physical examination findings of peripheral lymphadenopathy (74%) and tachypnea (62%). Common haematologic findings were quantifiable circulating blasts (85%; median blast count 35 700/μL; range: 300-276 500/μL), anaemia (median haematocrit 34%; range: 11%-52%) and thrombocytopenia (median 57 000/μL; range: 9000-252 000/μL). Bicytopenia and pancytopenia were each found in 44% of dogs. Follow-up information was available for 34 dogs. The overall median survival time from diagnosis was 19 days (range: 1-121 days). Clinical progression in some dogs was not as rapid as previously reported. Haematologic responses to various chemotherapeutics were documented in 3 dogs, with associated survival times of 62, 103 and 121 days. Dogs treated with prednisone or a combination of chemotherapy and prednisone had improved survival compared to dogs that received symptomatic care only (P < .0001). Our results show canine AML has an overlapping clinical presentation with lymphoma. The prognosis for canine AML remains extremely guarded. Further studies are needed to optimize therapeutic regimens for dogs with AML.
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Affiliation(s)
- L L Davis
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, New York
| | - K R Hume
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, New York
| | - T Stokol
- Department of Population Medicine and Diagnostic Sciences, Cornell University College of Veterinary Medicine, Ithaca, New York
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19
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Arya D, Sachithanandan SP, Ross C, Palakodeti D, Li S, Krishna S. MiRNA182 regulates percentage of myeloid and erythroid cells in chronic myeloid leukemia. Cell Death Dis 2017; 8:e2547. [PMID: 28079885 PMCID: PMC5386378 DOI: 10.1038/cddis.2016.471] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 12/12/2016] [Accepted: 12/14/2016] [Indexed: 12/20/2022]
Abstract
The deregulation of lineage control programs is often associated with the progression of haematological malignancies. The molecular regulators of lineage choices in the context of tyrosine kinase inhibitor (TKI) resistance remain poorly understood in chronic myeloid leukemia (CML). To find a potential molecular regulator contributing to lineage distribution and TKI resistance, we undertook an RNA-sequencing approach for identifying microRNAs (miRNAs). Following an unbiased screen, elevated miRNA182-5p levels were detected in Bcr-Abl-inhibited K562 cells (CML blast crisis cell line) and in a panel of CML patients. Earlier, miRNA182-5p upregulation was reported in several solid tumours and haematological malignancies. We undertook a strategy involving transient modulation and CRISPR/Cas9 (clustered regularly interspersed short palindromic repeats)-mediated knockout of the MIR182 locus in CML cells. The lineage contribution was assessed by methylcellulose colony formation assay. The transient modulation of miRNA182-5p revealed a biased phenotype. Strikingly, Δ182 cells (homozygous deletion of MIR182 locus) produced a marked shift in lineage distribution. The phenotype was rescued by ectopic expression of miRNA182-5p in Δ182 cells. A bioinformatic analysis and Hes1 modulation data suggested that Hes1 could be a putative target of miRNA182-5p. A reciprocal relationship between miRNA182-5p and Hes1 was seen in the context of TK inhibition. In conclusion, we reveal a key role for miRNA182-5p in restricting the myeloid development of leukemic cells. We propose that the Δ182 cell line will be valuable in designing experiments for next-generation pharmacological interventions.
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Affiliation(s)
- Deepak Arya
- Cellular Organization and Signalling Group, National Centre for Biological Sciences, Tata Institute of Fundamental Research, Bangalore, India
- Manipal University, Manipal, India
| | - Sasikala P Sachithanandan
- Cellular Organization and Signalling Group, National Centre for Biological Sciences, Tata Institute of Fundamental Research, Bangalore, India
| | - Cecil Ross
- Department of Medicine, St Johns Medical College and Hospitals, Bangalore, India
| | - Dasaradhi Palakodeti
- Stem Cells and Regeneration Group, Institute for Stem Cell Biology and Regenerative Medicine, Bangalore, India
| | - Shang Li
- Duke-NUS Graduate Medical School, Singapore
| | - Sudhir Krishna
- Cellular Organization and Signalling Group, National Centre for Biological Sciences, Tata Institute of Fundamental Research, Bangalore, India
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20
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Oben KZ, Gachuki BW, Alhakeem SS, McKenna MK, Liang Y, St. Clair DK, Rangnekar VM, Bondada S. Radiation Induced Apoptosis of Murine Bone Marrow Cells Is Independent of Early Growth Response 1 (EGR1). PLoS One 2017; 12:e0169767. [PMID: 28081176 PMCID: PMC5230770 DOI: 10.1371/journal.pone.0169767] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 11/14/2016] [Indexed: 12/03/2022] Open
Abstract
An understanding of how each individual 5q chromosome critical deleted region (CDR) gene contributes to malignant transformation would foster the development of much needed targeted therapies for the treatment of therapy related myeloid neoplasms (t-MNs). Early Growth Response 1 (EGR1) is a key transcriptional regulator of myeloid differentiation located within the 5q chromosome CDR that has been shown to regulate HSC (hematopoietic stem cell) quiescence as well as the master regulator of apoptosis—p53. Since resistance to apoptosis is a hallmark of malignant transformation, we investigated the role of EGR1 in apoptosis of bone marrow cells; a cell population from which myeloid malignancies arise. We evaluated radiation induced apoptosis of Egr1+/+ and Egr1-/- bone marrow cells in vitro and in vivo. EGR1 is not required for radiation induced apoptosis of murine bone marrow cells. Neither p53 mRNA (messenger RNA) nor protein expression is regulated by EGR1 in these cells. Radiation induced apoptosis of bone marrow cells by double strand DNA breaks induced p53 activation. These results suggest EGR1 dependent signaling mechanisms do not contribute to aberrant apoptosis of malignant cells in myeloid malignancies.
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Affiliation(s)
- Karine Z. Oben
- Department of Microbiology, Immunology and Molecular Genetics, University of Kentucky, Lexington, Kentucky, United States of America
| | - Beth W. Gachuki
- Department of Microbiology, Immunology and Molecular Genetics, University of Kentucky, Lexington, Kentucky, United States of America
| | - Sara S. Alhakeem
- Department of Microbiology, Immunology and Molecular Genetics, University of Kentucky, Lexington, Kentucky, United States of America
| | - Mary K. McKenna
- Department of Microbiology, Immunology and Molecular Genetics, University of Kentucky, Lexington, Kentucky, United States of America
| | - Ying Liang
- Department of Toxicology and Cancer Biology, University of Kentucky, Lexington, Kentucky, United States of America
- Department of Internal Medicine, University of Kentucky, Lexington, Kentucky, United States of America
| | - Daret K. St. Clair
- Department of Toxicology and Cancer Biology, University of Kentucky, Lexington, Kentucky, United States of America
| | - Vivek M. Rangnekar
- Department of Microbiology, Immunology and Molecular Genetics, University of Kentucky, Lexington, Kentucky, United States of America
- Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky, United States of America
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, United States of America
| | - Subbarao Bondada
- Department of Microbiology, Immunology and Molecular Genetics, University of Kentucky, Lexington, Kentucky, United States of America
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, United States of America
- * E-mail:
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Linjama T, Impola U, Niittyvuopio R, Kuittinen O, Kaare A, Rimpiläinen J, Volin L, Peräsaari J, Jaatinen T, Lauronen J, Saarinen T, Juvonen E, Partanen J, Koskela S. Conflicting HLA assignment by three different typing methods due to the apparent loss of heterozygosity in the MHC region. HLA 2016; 87:350-5. [DOI: 10.1111/tan.12770] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/26/2016] [Accepted: 02/17/2016] [Indexed: 12/30/2022]
Affiliation(s)
- T. Linjama
- Department of Research and Development; Finnish Red Cross Blood Service; Helsinki Finland
| | - U. Impola
- Department of Research and Development; Finnish Red Cross Blood Service; Helsinki Finland
| | - R. Niittyvuopio
- Comprehensive Cancer Center, Stem Cell Transplantation Unit; Helsinki University Central Hospital; Helsinki Finland
| | - O. Kuittinen
- Department of Oncology; Oulu University Hospital; Oulu Finland
| | - A. Kaare
- Department of Haematology and Bone Marrow Transplantation; Tarto University Hospital; Tarto Estonia
| | - J. Rimpiläinen
- Department of Internal Medicine; Tampere University Hospital; Tampere Finland
| | - L. Volin
- Comprehensive Cancer Center, Stem Cell Transplantation Unit; Helsinki University Central Hospital; Helsinki Finland
| | - J. Peräsaari
- Department of Research and Development; Finnish Red Cross Blood Service; Helsinki Finland
| | - T. Jaatinen
- Department of Research and Development; Finnish Red Cross Blood Service; Helsinki Finland
| | - J. Lauronen
- Department of Research and Development; Finnish Red Cross Blood Service; Helsinki Finland
| | - T. Saarinen
- Department of Research and Development; Finnish Red Cross Blood Service; Helsinki Finland
| | - E. Juvonen
- Department of Research and Development; Finnish Red Cross Blood Service; Helsinki Finland
| | - J. Partanen
- Department of Research and Development; Finnish Red Cross Blood Service; Helsinki Finland
| | - S. Koskela
- Department of Research and Development; Finnish Red Cross Blood Service; Helsinki Finland
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Von Willebrand Factor and Factor VIII levels in Egyptian children with newly diagnosed acute lymphoblastic leukemia in relation to peripheral blast cells and steroid therapy. J Pediatr Hematol Oncol 2014; 36:518-23. [PMID: 25105915 DOI: 10.1097/mph.0000000000000219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Endothelial dysfunction has been reported in children with acute lymphoblastic leukemia (ALL). The aim of this study is to assess Von Willebrand Factor antigen (VWF antigen) and Factor VIII (FVIII) in newly diagnosed ALL patients, in relation to peripheral blast (PB) cells, steroid therapy, and any prognostic potential. PROCEDURE VWF antigen and FVIII were assessed initially (D0) and at day 8 (D8) steroid therapy for 32 newly diagnosed ALL patients with and without peripheral blood blast cells. RESULTS At diagnosis, patients with PBs had a significantly higher levels of VWF antigen (102.7 ± 22.9% vs. 56.9 ± 8%, P<0.001) and FVIII (93.4 ± 15.9% vs. 6 62.6 ± 18.1%, P<0.001) than those without. Following steroid therapy, both factors decreased in those with PBs, whereas an increase above baseline was observed in those without PBs. Furthermore, there was a significant positive correlation between PBs and both VWF antigen (P<0.001) and FVIII levels (P=0.002). High-risk patients were comparable with standard-risk group in mean values of VWF antigen (P=0.234) and FVIII (P=0.891) at diagnosis. After 12 months from diagnosis, all patients without PB achieved and maintained complete remission. Those with initial PB reported relapse (12.5%) or death (4.2%) during follow-up. CONCLUSIONS Markers of endothelial dysfunction namely VWF and FVIII were related to circulating blast cells and steroids therapy through lysis of lymphoblasts results in reduction of both factors, with risk of thrombosis during induction with marked disintegration of malignant cells.
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Cheng H, Yang Y, Dai W, Tang C, Shi M, Feng G, Kang T, Su X, Zhao G. Acute leukemia presenting with blasts first found in the cerebrospinal fluid but not in the peripheral blood. J Clin Neurosci 2010; 17:1252-5. [PMID: 20605098 DOI: 10.1016/j.jocn.2010.02.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Revised: 01/19/2010] [Accepted: 02/07/2010] [Indexed: 11/28/2022]
Abstract
Acute leukemia presenting with central nervous system (CNS) signs and symptoms is uncommon and prone to be misdiagnosed. Here, we report nine patients with acute leukemia, including five patients with acute lymphoblastic leukemia (ALL) and four patients with acute myeloid leukemia (AML). These patients presented with symptoms suggestive of involvement of multiple cranial nerves, the spinal cord, and meningeal involvement. Moreover, we found that all these patients unexpectedly showed the presence of blasts in the cerebrospinal fluid (CSF) but not in the peripheral blood despite repeated examinations. Bone marrow examination confirmed the presence of acute leukemia in these patients. Seven patients died within 18months of diagnosis and two patients developed stable disease. Our findings show a novel presenting feature of acute leukemia and highlight the importance of CSF cytology in the diagnosis of acute leukemia.
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Affiliation(s)
- Haoran Cheng
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China
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Acute erythroid leukemia: a reassessment using criteria refined in the 2008 WHO classification. Blood 2009; 115:1985-92. [PMID: 20040759 DOI: 10.1182/blood-2009-09-243964] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Acute erythroid leukemia (AEL) is a rare type of acute myeloid leukemia (AML) for which diagnostic criteria have been refined in the 2008 World Health Organization (WHO) classification of AML. The relationship of AEL to myelodysplastic syndromes (MDSs) and to AML with myelodysplasia-related changes (AML-MRC) is not clearly defined. We conducted a retrospective, multi-institutional study of patients with AEL and compared them with patients with MDS or AML-MRC with erythroid hyperplasia (> or = 50% erythroid cells). Among a total of 124 patients with AEL, 32% had a history of MDS or chronic cytopenia, 32% had therapy-related disease, and 35% had de novo disease. Sixty-four percent of patients had unfavorable AML risk-group karyotypes. FLT3 and RAS mutations were infrequent, occurring in 6% and 2%, respectively. The median overall survival (OS) of all AEL patients was 8 months, comparable with that of patients with MDS or AML-MRC with erythroid hyperplasia. The OS was related to cytogenetic risk group, but not blast count or morphologic dysplasia. Our findings suggest that AEL is in the continuum of MDS and AML with erythroid hyperplasia, where karyotype rather than an arbitrary blast cutoff represents the most important prognostic factor.
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Albitar M, Potts SJ, Giles FJ, O'Brien S, Jilani I, Donahue AC, Estey EH, Kantarjian H. Proteomics-based prediction of clinical response in acute myeloid leukemia. Exp Hematol 2009; 37:784-90. [PMID: 19422784 DOI: 10.1016/j.exphem.2009.03.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2008] [Revised: 01/27/2009] [Accepted: 03/04/2009] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Response to chemotherapy is achieved in 60% to 70% of patients with acute myeloid leukemia. The ability to predict responders may help in stratifying patients and exploring different therapeutic approaches for nonresponders. Proteomics methods were used to search for predictive factors or combinations of factors. MATERIALS AND METHODS Peripheral blood plasma samples from 41 patients with confirmed acute myeloid leukemia with intermediate or poor cytogenetics were obtained prior to induction therapy for proteomic analysis. For each plasma sample, four fractions eluted from a strong anion column were applied to 3 different ProteinChip array surfaces and 12 surface-enhanced laser desorption/ionization spectra were generated. Peaks that correlated with response were identified, and decision trees incorporating these peaks along with various clinical and laboratory findings were constructed to predict response. RESULTS Multiple decision trees were constructed. One peak, when combined with age, provided strong positive prediction of responders with 83% accuracy. A second tree, which combined one peak with both cytogenetics and the percent of monocytes in peripheral blood, detected responders with 95% accuracy. A third peak was adequate to predict responders in the intermediate cytogenetic group with 86% accuracy. CONCLUSIONS Proteomic analysis should be further explored to define factors important in predicting clinical response in patients with acute myeloid leukemia.
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Affiliation(s)
- Maher Albitar
- Quest Diagnostics Nichols Institute, San Juan Capistrano, CA 92690-6130, USA.
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Albitar M, Potts SJ, Giles FJ, O'Brien S, Keating M, Thomas D, Clarke C, Jilani I, Aguilar C, Estey E, Kantarjian H. Proteomic-based prediction of clinical behavior in adult acute lymphoblastic leukemia. Cancer 2006; 106:1587-94. [PMID: 16518825 DOI: 10.1002/cncr.21770] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Response in adult acute lymphoblastic leukemia (ALL) can be achieved in a majority of patients. However, unlike pediatric ALL, recurrence is common in adult ALL, and the ability to predict at an early stage which patients are most likely to experience recurrence may help in devising new therapeutic approaches to prevent recurrence. METHODS Peripheral blood plasma from 57 patients with confirmed ALL was obtained before induction therapy for proteomic analysis. Follow-up continued for a median period of 71 weeks. For each plasma sample, 4 fractions eluted from a strong anion column were applied to 3 different ProteinChip array surfaces, and 12 surface-enhanced laser desorption/ionization (SELDI) spectra were generated. Peaks that correlated with recurrence were identified and decision trees were constructed and evaluated, using only 2 peaks per predictive tree. RESULTS The best decision trees provided strong positive prediction of recurrence, with correct predictions 84% to 92% of the time, whereas negative prediction of patients who did not experience recurrence was less robust, with 62% to 74% accuracy. Prediction of recurrence was independent of cytogenetics, bone marrow blast count, lactate dehydrogenase, beta-2-microglobulin, or surface markers. Positive prediction of L3 morphological classification was achieved in 80% of test cases. CONCLUSIONS Peripheral blood plasma is adequate to predict clinical behavior in ALL patients irrespective of the percentage of bone marrow blasts. Proteomic analysis of plasma offers a useful approach for profiling patients with ALL.
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Affiliation(s)
- Maher Albitar
- Quest Diagnostics Nichols Institute, San Juan Capistrano, CA 92690, USA.
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Current Awareness in Hematological Oncology. Hematol Oncol 2005. [DOI: 10.1002/hon.731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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