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Fimognari C, Turrini E, Sestili P, Calcabrini C, Carulli G, Fontanelli G, Rousseau M, Cantelli-Forti G, Hrelia P. Antileukemic activity of sulforaphane in primary blasts from patients affected by myelo- and lympho-proliferative disorders and in hypoxic conditions. PLoS One 2014; 9:e101991. [PMID: 25019218 PMCID: PMC4096754 DOI: 10.1371/journal.pone.0101991] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 06/13/2014] [Indexed: 11/18/2022] Open
Abstract
Sulforaphane is a dietary isothiocyanate found in cruciferous vegetables showing antileukemic activity. With the purpose of extending the potential clinical impact of sulforaphane in the oncological field, we investigated the antileukemic effect of sulforaphane on blasts from patients affected by different types of leukemia and, taking into account the intrinsically hypoxic nature of bone marrow, on a leukemia cell line (REH) maintained in hypoxic conditions. In particular, we tested sulforaphane on patients with chronic lymphocytic leukemia, acute myeloid leukemia, T-cell acute lymphoblastic leukemia, B-cell acute lymphoblastic leukemia, and blastic NK cell leukemia. Sulforaphane caused a dose-dependent induction of apoptosis in blasts from patients diagnosed with acute lymphoblastic or myeloid leukemia. Moreover, it was able to cause apoptosis and to inhibit proliferation in hypoxic conditions on REH cells. As to its cytotoxic mechanism, we found that sulforaphane creates an oxidative cellular environment that induces DNA damage and Bax and p53 gene activation, which in turn helps trigger apoptosis. On the whole, our results raise hopes that sulforaphane might set the stage for a novel therapeutic principle complementing our growing armature against malignancies and advocate the exploration of sulforaphane in a broader population of leukemic patients.
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Affiliation(s)
- Carmela Fimognari
- Department for Life Quality Studies, Alma Mater Studiorum-University of Bologna, Rimini, Italy
| | - Eleonora Turrini
- Department for Life Quality Studies, Alma Mater Studiorum-University of Bologna, Rimini, Italy
| | - Piero Sestili
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", Urbino, Italy
| | - Cinzia Calcabrini
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", Urbino, Italy
| | - Giovanni Carulli
- Division of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giulia Fontanelli
- Division of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Martina Rousseau
- Division of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giorgio Cantelli-Forti
- Department for Life Quality Studies, Alma Mater Studiorum-University of Bologna, Rimini, Italy
| | - Patrizia Hrelia
- Department of Pharmacy and BioTechnology, Alma Mater Studiorum-University of Bologna, Bologna, Italy
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2
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Shawi M, Chu TW, Martinez-Marignac V, Yu Y, Gryaznov SM, Johnston JB, Lees-Miller SP, Assouline SE, Autexier C, Aloyz R. Telomerase contributes to fludarabine resistance in primary human leukemic lymphocytes. PLoS One 2013; 8:e70428. [PMID: 23922990 PMCID: PMC3726637 DOI: 10.1371/journal.pone.0070428] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 06/17/2013] [Indexed: 12/17/2022] Open
Abstract
We report that Imetelstat, a telomerase inhibitor that binds to the RNA component of telomerase (hTR), can sensitize primary CLL lymphocytes to fludarabine in vitro. This effect was observed in lymphocytes from clinically resistant cases and with cytogenetic abnormalities associated with bad prognosis. Imetelstat mediated-sensitization to fludarabine was not associated with telomerase activity, but with the basal expression of Ku80. Since both Imetelstat and Ku80 bind hTR, we assessed 1) if Ku80 and Imetelstat alter each other's binding to hTR in vitro and 2) the effect of an oligonucleotide complementary to the Ku binding site in hTR (Ku oligo) on the survival of primary CLL lymphocytes exposed to fludarabine. We show that Imetelstat interferes with the binding of Ku70/80 (Ku) to hTR and that the Ku oligo can sensitize CLL lymphocytes to FLU. Our results suggest that Ku binding to hTR may contribute to fludarabine resistance in CLL lmphocytes. This is the first report highlighting the potentially broad effectiveness of Imetelstat in CLL, and the potential biological and clinical implications of a functional interaction between Ku and hTR in primary human cancer cells.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Agents/pharmacology
- Antineoplastic Agents/therapeutic use
- Catalytic Domain/drug effects
- Chromosome Deletion
- Chromosomes, Human, Pair 11
- Chromosomes, Human, Pair 17
- DNA Helicases/genetics
- DNA Helicases/metabolism
- Drug Resistance, Neoplasm/genetics
- Enzyme Activation
- Gene Expression Regulation, Leukemic/drug effects
- Histones/metabolism
- Humans
- Indoles/pharmacology
- Ku Autoantigen
- Leukemia, Lymphoid/drug therapy
- Leukemia, Lymphoid/genetics
- Leukemia, Lymphoid/metabolism
- Middle Aged
- Niacinamide/analogs & derivatives
- Niacinamide/pharmacology
- Oligonucleotides
- Phosphorylation
- Protein Binding/drug effects
- Telomerase/chemistry
- Telomerase/genetics
- Telomerase/metabolism
- Vidarabine/analogs & derivatives
- Vidarabine/pharmacology
- Vidarabine/therapeutic use
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Affiliation(s)
- May Shawi
- Department of Medicine, Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
- Department of Anatomy and Cell Biology, McGill University, Montreal, Quebec, Canada
- Bloomfield Centre for Research in Ageing, Jewish General Hospital, Montreal, Quebec, Canada
| | - Tsz Wai Chu
- Department of Medicine, Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
- Bloomfield Centre for Research in Ageing, Jewish General Hospital, Montreal, Quebec, Canada
| | - Veronica Martinez-Marignac
- Lady Davis Institute for Medical Research & Cancer Segal Center, Jewish General Hospital, Montreal, Quebec, Canada
| | - Y. Yu
- University of Calgary, Department of Biochemistry and Molecular Biology, Southern Alberta Cancer Research Institute, Calgary, Alberta, Canada
| | | | - James B. Johnston
- Manitoba Institute of Cell Biology, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Susan P. Lees-Miller
- University of Calgary, Department of Biochemistry and Molecular Biology, Southern Alberta Cancer Research Institute, Calgary, Alberta, Canada
| | - Sarit E. Assouline
- Oncology Department, McGill University, Montreal, Quebec, Canada
- Lady Davis Institute for Medical Research & Cancer Segal Center, Jewish General Hospital, Montreal, Quebec, Canada
| | - Chantal Autexier
- Department of Medicine, Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
- Department of Anatomy and Cell Biology, McGill University, Montreal, Quebec, Canada
- Bloomfield Centre for Research in Ageing, Jewish General Hospital, Montreal, Quebec, Canada
| | - Raquel Aloyz
- Department of Medicine, Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
- Oncology Department, McGill University, Montreal, Quebec, Canada
- Lady Davis Institute for Medical Research & Cancer Segal Center, Jewish General Hospital, Montreal, Quebec, Canada
- * E-mail:
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3
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Matutes E, Bosanquet AG, Wade R, Richards SM, Else M, Catovsky D. The use of individualized tumor response testing in treatment selection: second randomization results from the LRF CLL4 trial and the predictive value of the test at trial entry. Leukemia 2013; 27:507-10. [PMID: 22810506 PMCID: PMC3567236 DOI: 10.1038/leu.2012.209] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
MESH Headings
- Antineoplastic Agents/pharmacology
- Biological Assay
- Drug Monitoring
- Drug Resistance, Neoplasm
- Follow-Up Studies
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/blood
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Multicenter Studies as Topic
- Neoplasm Recurrence, Local/blood
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/mortality
- Patient Selection
- Predictive Value of Tests
- Prognosis
- Random Allocation
- Randomized Controlled Trials as Topic
- Survival Rate
- Vidarabine/analogs & derivatives
- Vidarabine/pharmacology
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Affiliation(s)
- E Matutes
- Haemato-Oncology Research Unit, The Institute of Cancer Research, Sutton, UK
| | - A G Bosanquet
- Bath Cancer Research, Royal United Hospital, Bath, UK
| | - R Wade
- Clinical Trial Service Unit, Oxford University, Oxford, UK
| | - S M Richards
- Clinical Trial Service Unit, Oxford University, Oxford, UK
| | - M Else
- Haemato-Oncology Research Unit, The Institute of Cancer Research, Sutton, UK
| | - D Catovsky
- Haemato-Oncology Research Unit, The Institute of Cancer Research, Sutton, UK
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4
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Best OG, Che Y, Singh N, Forsyth C, Christopherson RI, Mulligan SP. The Hsp90 inhibitor SNX-7081 synergizes with and restores sensitivity to fludarabine in chronic lymphocytic leukemia cells with lesions in the TP53 pathway: a potential treatment strategy for fludarabine refractory disease. Leuk Lymphoma 2012; 53:1367-75. [PMID: 22149137 DOI: 10.3109/10428194.2011.647310] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Drug resistance in chronic lymphocytic leukemia (CLL) associated with lesions in the ATM/TP53 pathway represents a major challenge in clinical management. Evidence suggests that heat shock protein-90 (Hsp90) inhibitors may represent a therapeutic option in combination with more conventional therapies. We explored the effects of combining the Hsp90 inhibitor, SNX-7081, with fludarabine in vitro against CLL cells and hematological cell lines. In seven cell lines and 23 patient samples synergy between SNX-7081 and fludarabine (2-FaraA) was apparent in the three TP53 mutated cell lines and at significantly lower concentrations in TP53 or ATM dysfunctional patient cells. In 11/13 2-FaraA-resistant patient samples, SNX-7081 reduced the 50% inhibitory concentration to within a clinically achievable range. Synergy between SNX-7081 and 2-FaraA was evident in both the cell lines and patient samples as a significant decrease in cell viability. Our data suggest that combining SNX-7081 and fludarabine may be effective in the treatment of fludarabine-refractory CLL.
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Affiliation(s)
- O Giles Best
- Northern Blood Research Centre, Kolling Institute, Royal North Shore Hospital, Sydney, Australia.
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5
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Castejón R, Yebra M, Citores MJ, Villarreal M, García-Marco JA, Vargas JA. Drug induction apoptosis assay as predictive value of chemotherapy response in patients with B-cell chronic lymphocytic leukemia. Leuk Lymphoma 2009; 50:593-603. [PMID: 19373658 DOI: 10.1080/10428190902780669] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
A large number of prognostic factors are available to help predict the course of the disease for patients with B-cell chronic lymphocytic leukemia (B-CLL). However, it is not clear the involvement of these well established prognostic factors in the clinical response of the patients with B-CLL to the chemotherapy. The possible association of the patient clinical-biological characteristics and the in vitro response to chemotherapic agents may serve to provide powerful predictive information to identify optimum treatment for patients. An apoptosis induction assay displays the patient in vitro responses to chemotherapy and the possible association with their clinical-biological characteristics. In this study, patients showed a significant better in vitro response to drugs when they were in the initial stages of the disease or with low beta(2) microglobulin serum level. Response to purine analogues was significantly higher in patients with long lymphocyte doubling time (LDT), few cells expressing CD38, normal karyotype or no p53 deletion, whereas there was no correspondence with ZAP-70 expression. Furthermore, a good correlation was shown between in vitro apoptosis induction assay and the patient clinical response to purine analogues. In conclusion, association between in vitro drug sensitivity and some of the markers considered as prognostic factors could help to develop personalised therapeutic regimens for patients with B-CLL.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Agents/pharmacology
- Apoptosis/drug effects
- B-Lymphocytes/drug effects
- B-Lymphocytes/metabolism
- B-Lymphocytes/pathology
- Chlorambucil/pharmacology
- Cladribine/pharmacology
- Female
- Flow Cytometry
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/blood
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Male
- Middle Aged
- Predictive Value of Tests
- Prognosis
- Time Factors
- Tumor Cells, Cultured
- Vidarabine/analogs & derivatives
- Vidarabine/pharmacology
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Affiliation(s)
- Raquel Castejón
- Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro, Universidad Autonoma de Madrid, Madrid, Spain.
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6
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Jun KR, Jang S, Chi HS, Lee KH, Lee JH, Choi SJ, Seo JJ, Moon HN, Im HJ, Park CJ. Relationship between In Vitro Chemosensitivity assessed with MTT Assay and Clinical Outcomes in 103 Patients with Acute Leukemia. Ann Lab Med 2007; 27:89-95. [DOI: 10.3343/kjlm.2007.27.2.89] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Kyung Ran Jun
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seongsoo Jang
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun Sook Chi
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyoo Hyung Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Je Hwan Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seong Jun Choi
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Jin Seo
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyung Nam Moon
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho Joon Im
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chan Jeoung Park
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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7
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Zhong Y, Bakke AC, Fan G, Braziel RM, Gatter KM, Leis JF, Maziarz RT, Huang JZ. Drug resistance in B-cell chronic lymphocytic leukemia: Predictable by in vitro evaluation with a multiparameter flow cytometric cytotoxicity assay. CYTOMETRY PART B-CLINICAL CYTOMETRY 2007; 72:189-95. [PMID: 17226861 DOI: 10.1002/cyto.b.20117] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients with B-cell chronic lymphocytic leukemia (B-CLL) often demonstrate variable responses to similar treatments. It would be highly desirable to develop a personalized therapeutic strategy for selection of appropriate drugs or regimens based on the drug sensitivity profiles of leukemic cells from individuals. METHODS We applied a multiparameter flow cytometric drug cytotoxicity assay to evaluate drug effects specifically on B-CLL cells from 43 individuals after leukemic cells were incubated in vitro with fludarabine, chlorambucil, cladribine, or prednisolone. RESULTS We demonstrated that different B-CLL cell populations from 43 individuals showed a marked variability in drug sensitivity. In vitro resistance to fludarabine was greatest in B-CLL cells with deletions of p53, a cytogenetic abnormality that is almost invariably associated with a poor therapeutic response clinically. CONCLUSIONS In vitro drug sensitivity profiles analyzed by a multiparameter flow cytometric cytotoxicity assay may serve as a tool to facilitate individualized selection of appropriate drugs for treatment in B-CLL. Prospective trials will be needed to validate the clinical utility of this flow cytometric cytotoxicity assay.
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Affiliation(s)
- Yanping Zhong
- Department of Pathology, Oregon Heath and Science University, Portland, Oregon 97201-3098, USA
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8
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Doğan AL, Doğan A, Canpinar H, Duzgunçinar O, Demirpençe E. Effect of fludarabine on leukocyte functions. Chemotherapy 2004; 50:283-8. [PMID: 15608444 DOI: 10.1159/000082627] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2004] [Accepted: 07/15/2004] [Indexed: 11/19/2022]
Abstract
BACKGROUND Fludarabine induces leukemic cell apoptosis and is highly efficient in chronic lymphocytic leukemia. However, fludarabine therapy causes severe leukopenia. Leukocyte myeloperoxidase (MPO) catalyzes the formation of HOCl, and this is the main microbicidal function in phagocytes. The aim of our study was to evaluate the effect of fludarabine on leukocytes, i.e. their degranulation capacity, MPO activity and HOCl production. METHODS Peripheral blood leukocytes were incubated for 48 h with fludarabine. Degranulation was measured using a flow-cytometric method. MPO activity and HOCl production were measured spectrophotometrically. RESULTS The degranulation capacity of fludarabine-treated leukocytes was significantly elevated compared to untreated controls. MPO activity and HOCl production were also increased in parallel. A possible direct activating effect of fludarabine was tested on the MPO activity of HL60 cells. Fludarabine did not affect MPO activity at concentrations ranging from 10 microM to 2 mM. CONCLUSION Fludarabine had no inhibitory effect on the microbial killing of leukocytes.
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Affiliation(s)
- A Lale Doğan
- Department of Basic Oncology, Institute of Oncology, Hacettepe University, Ankara, Turkey
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9
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Hayon T, Dvilansky A, Shpilberg O, Nathan I. Appraisal of the MTT-based assay as a useful tool for predicting drug chemosensitivity in leukemia. Leuk Lymphoma 2004; 44:1957-62. [PMID: 14738150 DOI: 10.1080/1042819031000116607] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The MTT-based assay relies upon the cellular reduction of tetrazolium salts to their intensely colored formazans. The test is easy to perform in hematological malignancies and is adaptable for high throughput of samples, although there are some minor limitations in its application resulting from metabolic interference. This class of assays are highly accurate for predicting drug resistance, whereas their predictive value for drug sensitivity depends on the type of disease and drug or drug combination used. They have been found to predict clinical response to fludarabine FLD in B-CLL and were useful for predetermining clinical potential of a single drug or drug combination in AML patients. Extensive studies with ALL patients have supported their advantage for selecting effective drug treatment of the disease. To conclude, pretreatment chemosensitivity assays may help in the selection of chemotherapeutic drugs with the greatest likelihood for clinical effectiveness, and in the exclusion of uneffective therapy. This can lead to improved disease management, response, survival and use of financial resources.
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Affiliation(s)
- Tamar Hayon
- Department of Clinical Biochemistry, Faculty of Health Sciences, Ben-Gurion University, Beer Sheva, Israel
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10
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Brajusković G, Marjanović S, Skaro-Milić A. [Effect of chlorambucil on B-lymphocytes in the peripheral blood of patients with chronic lymphocytic leukemia--study of cellular ultrastructure]. VOJNOSANIT PREGL 2003; 60:175-80. [PMID: 12852160 DOI: 10.2298/vsp0302175b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
B type Chronic Lymphocytic Leukemia (B-CLL) is a malignant disease characterized by the progressive accumulation of morphologically mature, but immunologically dysfunctional CD 5+ lymphocytes in the blood, bone marrow and lymphatic organs in the early phase of the cell cycle. B-CLL is an example of human malignancy caused by alternations in the pathways of programmed cell death--apoptosis. Recent investigations showed a probable role of apoptosis as a prognostic parameter in B-CLL patients. Since the introduction of chlorambucil in the therapy in 1952, besides all the achievements in modern oncology, chlorambucil remained the most common antineoplastic agent in the treatment of CLL. Numerous experimental studies, both in vitro and in vivo, showed the capability of antineoplastic agents to induce the process of apoptosis of neoplastically transformed cells. In this study the effect of chlorambucil on B lymphocytes was monitored in 16 samples of peripheral blood taken from B-CLL diagnosed patients. According to the investigations performed in this study by ultrastructure analysis of B-CLL cells, it was concluded that chlorambucil either induced apoptosis in B-CLL cells, or activated cell response to the stress.
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11
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In Vitro Evaluation of Fludarabine in Combination With Cyclophosphamide and/or Mitoxantrone in B-Cell Chronic Lymphocytic Leukemia. Blood 1999. [DOI: 10.1182/blood.v94.8.2836.420k35_2836_2843] [Citation(s) in RCA: 129] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
B-chronic lymphocytic leukemia (B-CLL) is characterized by the accumulation of long-lived CD5+ B lymphocytes. We have analyzed the effect in vitro of the combination of fludarabine with cyclophosphamide and/or mitoxantrone on cells from 20 B-CLL patients. Mafosfamide, the active form of cyclophosphamide in vitro, increased the cytotoxicity of fludarabine in all of the patients studied and produced a significant synergistic effect (P < .01) after 48 hours of incubation. The addition of mitoxantrone to this combination increased the cytotoxic effect in cells from 8 patients, but in the remaining 12 patients no significant increase was observed. The effect of fludarabine and mafosfamide was dose-dependent. Mafosfamide and fludarabine had a synergistic effect in inducing apoptosis of B-CLL cells as determined by DNA staining with propidium iodide and analysis of phosphatidylserine exposure. Mafosfamide significantly increased the apoptosis induced by fludarabine on CD19+ cells (P = .007), but not on CD3+ cells (P= .314). Cell viability was correlated with a decrease in Mcl-1 levels and an increase in p53 levels. These results support that fludarabine in combination with cyclophosphamide and/or mitoxantrone can be highly effective in the treatment of B-CLL.
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12
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Bosanquet AG, Johnson SA, Richards SM. Prognosis for fludarabine therapy of chronic lymphocytic leukaemia based on ex vivo drug response by DiSC assay. Br J Haematol 1999; 106:71-7. [PMID: 10444165 DOI: 10.1046/j.1365-2141.1999.01516.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The cytotoxic antimetabolite fludarabine is a widely used active agent in chronic lymphocytic leukaemia (CLL). However, cost and occasional adverse side-effects necessitate careful use. Identifying before treatment patients not likely to benefit from fludarabine could advance disease management both clinically and financially. We used the DiSC (differential staining cytotoxicity) assay, an ex vivo apoptotic drug response test, to identify the sensitivity or resistance to fludarabine of lymphocytes from B-cell CLL patients and compared the results with subsequent patient treatment, response and survival. Patients were grouped thus: those receiving fludarabine within 1 year of assay (+/- other cytotoxic drugs), and those receiving other chemotherapy (excluding fludarabine) within 1 year of assay. Fludarabine-test-resistance was found in 12/100 (12%) of untreated patients and 45/143 (31%) of previously treated patients (17/32 (53%) of patients previously treated with fludarabine). Treating fludarabine-test-resistant patients with fludarabine resulted in poor response compared with fludarabine-test-sensitive patients (7% v 69%) and short survival (median 7.9 v 41.7 months; relative risk (RR) = 14.8; P < 0.0001). 81% of fludarabine-test-resistant patients were test sensitive to other regimens. If treated with chemotherapy other than fludarabine, test-resistant patients responded better and survived substantially longer than those treated with fludarabine (RR = 2.9; P = 0.001). Not all CLL patients should receive fludarabine. Fludarabine-test-resistance by DiSC assay is a powerful independent prognostic factor. Pretreatment DiSC assay results could enable the toxic, clinical and financial costs of fludarabine treatment to be avoided in fludarabine-test-resistant patients. Disease management, response, survival and use of financial resources might be significantly improved if therapy choice in CLL patients was guided by DiSC assay.
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Affiliation(s)
- A G Bosanquet
- Bath Cancer Research Unit, School of Postgraduate Medicine, University of Bath, Royal United Hospital, Bath.
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