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Rohweder R, de Oliveira Schmalfuss T, Dos Santos Borniger D, Ferreira CZ, Zanardini MK, Lopes GPTF, Barbosa CP, Moreira TD, Schuler-Faccini L, Sanseverino MTV, da Silva AA, Abeche AM, Vianna FSL, Fraga LR. Caffeine intake during pregnancy and adverse outcomes: An integrative review. Reprod Toxicol 2024; 123:108518. [PMID: 38042437 DOI: 10.1016/j.reprotox.2023.108518] [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: 08/24/2023] [Revised: 11/08/2023] [Accepted: 11/28/2023] [Indexed: 12/04/2023]
Abstract
Caffeine intake during pregnancy is common. Caffeine crosses the placenta, raising concerns about its possible deleterious effects on the developing embryo/fetus. Studies on this subject show conflicting results, and still there is no consensus on the recommended dose of caffeine during pregnancy. We performed an integrative review with studies from six databases, using broad MESH terms to allow the identification of publications that addressed the outcomes of caffeine use during pregnancy, with no date limit for publications, in English and Portuguese language. The research returned 16,192 articles. After removing duplicates, screening by title, abstract and full-text, we evaluated 257 and included 59 articles. We found association between caffeine intake and pregnancy loss, low birth weight, cardiac and genital anomalies, higher body mass, and neurodevelopmental and neurobehavioral outcomes. The effects were often dose dependent. No association with prematurity has been demonstrated, but one study showed a small reduction in gestational age with increasing doses of caffeine intake. Defining a safe dose for caffeine intake during pregnancy is a challenging task due to the heterogeneity in study designs and results, as well as the difficulty of reliably assessing the amount of caffeine consumed. In some studies, exposures below the recommended level of caffeine intake during pregnancy (200 mg/day), as suggested by the guidelines, were associated with pregnancy loss, low birth weight, cardiac and genital anomalies, higher body mass, and neurodevelopmental and neurobehavioral outcomes. Well-designed studies with reliable quantification of caffeine intake are needed to assess the safety of low doses during pregnancy.
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Affiliation(s)
- Ricardo Rohweder
- Sistema Nacional de Informação sobre Agentes Teratogênicos (SIAT), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Pós-Graduação em Genética e Biologia Molecular, Instituto de Biociências, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Thanyse de Oliveira Schmalfuss
- Programa de Monitoramento de Defeitos Congênitos do Hospital de Clínicas de Porto Alegre (PMDC-HCPA), Porto Alegre, Brazil
| | - Diessy Dos Santos Borniger
- Sistema Nacional de Informação sobre Agentes Teratogênicos (SIAT), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Carolina Zanfir Ferreira
- Sistema Nacional de Informação sobre Agentes Teratogênicos (SIAT), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Marcos Kobren Zanardini
- Sistema Nacional de Informação sobre Agentes Teratogênicos (SIAT), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Guilherme Paulon Torrano Ferreira Lopes
- Sistema Nacional de Informação sobre Agentes Teratogênicos (SIAT), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Camila Pocharski Barbosa
- Sistema Nacional de Informação sobre Agentes Teratogênicos (SIAT), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Taiane Dornelles Moreira
- Sistema Nacional de Informação sobre Agentes Teratogênicos (SIAT), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Lavinia Schuler-Faccini
- Sistema Nacional de Informação sobre Agentes Teratogênicos (SIAT), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Pós-Graduação em Genética e Biologia Molecular, Instituto de Biociências, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Departamento de Genética, Instituto de Biociências, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Maria Teresa Vieira Sanseverino
- Sistema Nacional de Informação sobre Agentes Teratogênicos (SIAT), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Pós-Graduação em Genética e Biologia Molecular, Instituto de Biociências, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Monitoramento de Defeitos Congênitos do Hospital de Clínicas de Porto Alegre (PMDC-HCPA), Porto Alegre, Brazil; Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - André Anjos da Silva
- Sistema Nacional de Informação sobre Agentes Teratogênicos (SIAT), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Pós-Graduação em Ciências Médicas - Universidade do Vale do Taquari - UNIVATES, Lajeado, Brazil; Universidade do Vale do Rio dos Sinos - UNISINOS, São Leopoldo, Brazil
| | - Alberto Mantovani Abeche
- Sistema Nacional de Informação sobre Agentes Teratogênicos (SIAT), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Fernanda Sales Luiz Vianna
- Sistema Nacional de Informação sobre Agentes Teratogênicos (SIAT), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Pós-Graduação em Genética e Biologia Molecular, Instituto de Biociências, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Departamento de Genética, Instituto de Biociências, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Lucas Rosa Fraga
- Sistema Nacional de Informação sobre Agentes Teratogênicos (SIAT), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Departamento de Ciências Morfológicas, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Pós-Graduação em Medicina - Ciências Médicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
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2
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Gray ZH, Chakraborty D, Duttweiler RR, Alekbaeva GD, Murphy SE, Chetal K, Ji F, Ferman BI, Honer MA, Wang Z, Myers C, Sun R, Kaniskan HÜ, Toma MM, Bondarenko EA, Santoro JN, Miranda C, Dillingham ME, Tang R, Gozani O, Jin J, Skorski T, Duy C, Lee H, Sadreyev RI, Whetstine JR. Epigenetic balance ensures mechanistic control of MLL amplification and rearrangement. Cell 2023; 186:4528-4545.e18. [PMID: 37788669 PMCID: PMC10591855 DOI: 10.1016/j.cell.2023.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 06/01/2023] [Accepted: 09/08/2023] [Indexed: 10/05/2023]
Abstract
MLL/KMT2A amplifications and translocations are prevalent in infant, adult, and therapy-induced leukemia. However, the molecular contributor(s) to these alterations are unclear. Here, we demonstrate that histone H3 lysine 9 mono- and di-methylation (H3K9me1/2) balance at the MLL/KMT2A locus regulates these amplifications and rearrangements. This balance is controlled by the crosstalk between lysine demethylase KDM3B and methyltransferase G9a/EHMT2. KDM3B depletion increases H3K9me1/2 levels and reduces CTCF occupancy at the MLL/KMT2A locus, in turn promoting amplification and rearrangements. Depleting CTCF is also sufficient to generate these focal alterations. Furthermore, the chemotherapy doxorubicin (Dox), which associates with therapy-induced leukemia and promotes MLL/KMT2A amplifications and rearrangements, suppresses KDM3B and CTCF protein levels. KDM3B and CTCF overexpression rescues Dox-induced MLL/KMT2A alterations. G9a inhibition in human cells or mice also suppresses MLL/KMT2A events accompanying Dox treatment. Therefore, MLL/KMT2A amplifications and rearrangements are controlled by epigenetic regulators that are tractable drug targets, which has clinical implications.
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Affiliation(s)
- Zach H Gray
- Cancer Epigenetics Institute, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; Nuclear Dynamics and Cancer Program, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; Institute for Cancer Research, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - Damayanti Chakraborty
- Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Charlestown, MA 02129, USA
| | - Reuben R Duttweiler
- Cancer Epigenetics Institute, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; Nuclear Dynamics and Cancer Program, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; Institute for Cancer Research, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Charlestown, MA 02129, USA
| | - Gulnaz D Alekbaeva
- Cancer Epigenetics Institute, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; Nuclear Dynamics and Cancer Program, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; Institute for Cancer Research, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - Sedona E Murphy
- Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Charlestown, MA 02129, USA
| | - Kashish Chetal
- Department of Molecular Biology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Fei Ji
- Department of Molecular Biology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Benjamin I Ferman
- Cancer Epigenetics Institute, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; Nuclear Dynamics and Cancer Program, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; Institute for Cancer Research, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - Madison A Honer
- Cancer Epigenetics Institute, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; Nuclear Dynamics and Cancer Program, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; Institute for Cancer Research, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - Zhentian Wang
- Department of Biology, Stanford University, Stanford, CA 94305, USA
| | - Cynthia Myers
- Institute for Cancer Research, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - Renhong Sun
- Mount Sinai Center for Therapeutics Discovery, Departments of Pharmacological Sciences and Oncological Sciences, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - H Ümit Kaniskan
- Mount Sinai Center for Therapeutics Discovery, Departments of Pharmacological Sciences and Oncological Sciences, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Monika Maria Toma
- Nuclear Dynamics and Cancer Program, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; Fels Cancer Institute for Personalized Medicine, Temple University School of Medicine, 3420 N. Broad Street, MRB 548, Philadelphia, PA 19140, USA
| | - Elena A Bondarenko
- Cancer Epigenetics Institute, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; Nuclear Dynamics and Cancer Program, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; Institute for Cancer Research, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - John N Santoro
- Cancer Epigenetics Institute, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; Nuclear Dynamics and Cancer Program, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; Institute for Cancer Research, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - Christopher Miranda
- Cancer Epigenetics Institute, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; Nuclear Dynamics and Cancer Program, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; Institute for Cancer Research, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - Megan E Dillingham
- Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Charlestown, MA 02129, USA
| | - Ran Tang
- Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Charlestown, MA 02129, USA; School of Life Science and Technology, Harbin Institute of Technology, 150000 Harbin, China
| | - Or Gozani
- Department of Biology, Stanford University, Stanford, CA 94305, USA
| | - Jian Jin
- Mount Sinai Center for Therapeutics Discovery, Departments of Pharmacological Sciences and Oncological Sciences, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Tomasz Skorski
- Nuclear Dynamics and Cancer Program, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; Fels Cancer Institute for Personalized Medicine, Temple University School of Medicine, 3420 N. Broad Street, MRB 548, Philadelphia, PA 19140, USA
| | - Cihangir Duy
- Cancer Epigenetics Institute, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; Nuclear Dynamics and Cancer Program, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; Institute for Cancer Research, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - Hayan Lee
- Cancer Epigenetics Institute, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; Nuclear Dynamics and Cancer Program, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; Institute for Cancer Research, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - Ruslan I Sadreyev
- Department of Molecular Biology, Massachusetts General Hospital, Boston, MA 02114, USA; Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Johnathan R Whetstine
- Cancer Epigenetics Institute, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; Nuclear Dynamics and Cancer Program, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; Institute for Cancer Research, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Charlestown, MA 02129, USA.
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3
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Geyer MB, Shaffer BC, Bhatnagar B, Mims AS, Klein V, Dilip D, Glass JL, Lozanski G, Hassoun H, Landau H, Zhang Y, Xiao W, Roshal M, Park JH. Lenalidomide-associated B-cell ALL: clinical and pathologic correlates and sensitivity to lenalidomide withdrawal. Blood Adv 2023; 7:3087-3098. [PMID: 36827680 PMCID: PMC10362546 DOI: 10.1182/bloodadvances.2022009212] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/31/2023] [Accepted: 02/16/2023] [Indexed: 02/26/2023] Open
Abstract
Lenalidomide is an effective component of induction and maintenance therapy for multiple myeloma, though with a risk of secondary malignancies, including acute lymphoblastic leukemia (ALL). In contrast to therapy-related myeloid neoplasia, lenalidomide-associated lymphoblastic neoplasia remains poorly characterized. We conducted a dual institution retrospective study of 32 ALL cases that arose after lenalidomide maintenance (all B-lineage, 31/32 BCR::ABL-negative). B-cell ALL (B-ALL) was diagnosed at median 54 months (range, 5-119) after first exposure to lenalidomide and after median 42 months of cumulative lenalidomide exposure (range, 2-114). High incidence of TP53 mutations (9/19 evaluable cases) and low hypodiploidy (8/26 patients) were identified. Despite median age of 65 years and poor-risk B-ALL features observed in the cohort, rates of complete response (CR) or CR with incomplete hematologic recovery were high (25/28 patients receiving treatment). Median event-free survival was 35.4 months among treated patients (not reached among those undergoing allogeneic hematopoietic cell transplantation [HCT]). Sixteen patients remain alive without evidence of B-ALL after HCT or extended maintenance therapy. We also describe regression of B-ALL or immature B-cell populations with B-ALL immunophenotype after lenalidomide discontinuation in 5 patients, suggesting lenalidomide may drive leukemic progression even after initiation of lymphoblastic neoplasia and that lenalidomide withdrawal alone may be an appropriate first-line intervention in selected patients. Monitoring for early B-ALL-like proliferations may offer opportunities for lenalidomide withdrawal to prevent progression. Established combination chemotherapy regimens, newer surface antigen-targeted approaches, and allogeneic HCT are effective in many patients with lenalidomide-associated B-ALL and should be offered to medically fit patients.
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Affiliation(s)
- Mark B. Geyer
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Cell Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Brian C. Shaffer
- Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bhavana Bhatnagar
- Section of Hematology/Oncology, Department of Medicine, West Virginia University, West Virginia University Cancer Institute, Morgantown, WV
| | - Alice S. Mims
- Acute Leukemia Program, The Ohio State University, The James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Victoria Klein
- Acute Leukemia Program, The Ohio State University, The James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Deepika Dilip
- Center for Epigenetics Research, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jacob L. Glass
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gerard Lozanski
- Department of Pathology, The Ohio State University, The James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Hani Hassoun
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Heather Landau
- Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yanming Zhang
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Wenbin Xiao
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mikhail Roshal
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jae H. Park
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Cell Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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Lomov NA, Viushkov VS, Rubtsov MA. Mechanisms of Secondary Leukemia Development Caused by Treatment with DNA Topoisomerase Inhibitors. BIOCHEMISTRY. BIOKHIMIIA 2023; 88:892-911. [PMID: 37751862 DOI: 10.1134/s0006297923070040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/14/2023] [Accepted: 04/20/2023] [Indexed: 09/28/2023]
Abstract
Leukemia is a blood cancer originating in the blood and bone marrow. Therapy-related leukemia is associated with prior chemotherapy. Although cancer therapy with DNA topoisomerase II inhibitors is one of the most effective cancer treatments, its side effects include development of secondary leukemia characterized by the chromosomal rearrangements affecting AML1 or MLL genes. Recurrent chromosomal translocations in the therapy-related leukemia differ from chromosomal rearrangements associated with other neoplasias. Here, we reviewed the factors that drive chromosomal translocations induced by cancer treatment with DNA topoisomerase II inhibitors, such as mobility of ends of double-strand DNA breaks formed before the translocation and gain of function of fusion proteins generated as a result of translocation.
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Affiliation(s)
- Nikolai A Lomov
- Department of Molecular Biology, Faculty of Biology, Lomonosov Moscow State University, Moscow, 119234, Russia.
| | - Vladimir S Viushkov
- Department of Molecular Biology, Faculty of Biology, Lomonosov Moscow State University, Moscow, 119234, Russia
| | - Mikhail A Rubtsov
- Department of Molecular Biology, Faculty of Biology, Lomonosov Moscow State University, Moscow, 119234, Russia
- Department of Biochemistry, Center for Industrial Technologies and Entrepreneurship Sechenov First Moscow State Medical University (Sechenov University), Moscow, 119435, Russia
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Cooling L, Kelley J, Sexton E, Anand S, Hoffmann S. A secondary CD34+ acute lymphoblastic leukemia unmasked and mobilized by G-CSF in an autologous stem cell donor with testicular cancer. Transfusion 2023; 63:684-689. [PMID: 36762622 DOI: 10.1111/trf.17269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 12/26/2022] [Indexed: 02/11/2023]
Abstract
BACKGROUND Late complications of chemotherapy include treatment-related secondary leukemias. We describe an unusual case of a new treatment-related acute lymphoblastic leukemia (t-ALL) that was unmasked and mobilized by G-CSF during autologous hematopoietic progenitor cell collection (HPCC) in a young man with testicular cancer. METHODS Electronic chart review of the patient medical history and pertinent laboratory findings. Patient CD34 and blast results were compared to 4249 autologous and 437 allogeneic HPCC performed between 2004 and 2022. In autologous donors, the %blast and %CD34 were compared by linear regression and paired t-test using commercial software. RESULTS The patient was a 21-year-old male with relapsed testicular cancer referred for G-CSF cytokine-only mobilization and autologous HPCC. His pre-mobilization WBC count and differential were normal. On the day of HPCC, his WBC = 37.9 K/mcL with 12% blasts and 9.75% circulating CD34+ cells. The patient was admitted 9 days after HPCC with a normal WBC count and 15% blasts. He was diagnosed with a pro-B t-ALL bearing an t(4:11)(q21:q23) translocation and KMT2A-AF4 rearrangement. Upon review, this patient had the highest %CD34 among 4686 HPCC and was the only donor with %CD34 > 1% after a cytokine-only mobilization. CONCLUSION We report a case of t-ALL that mimicked CD34+ HPC and was mobilized by high-dose G-CSF. Up to 70% of secondary leukemias bear 11q23/KMT2A rearrangements, which occur at the multipotent stem cell stage and can result in myeloid and lymphoid leukemias. Donors who have received past chemotherapy, especially with topoisomerase II inhibitors, are at increased risk for 11q23/KMT2A leukemias.
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Affiliation(s)
- Laura Cooling
- Department of Pathology, University of Michigan Hospitals, Ann Arbor, Michigan, USA
| | - Justin Kelley
- Department of Pathology, University of Michigan Hospitals, Ann Arbor, Michigan, USA
| | - Edison Sexton
- Department of Pathology, University of Michigan Hospitals, Ann Arbor, Michigan, USA
| | - Sarah Anand
- Department of Bone Marrow Transplantation, University of Michigan Hospitals, Ann Arbor, Michigan, USA
| | - Sandra Hoffmann
- Department of Pathology, University of Michigan Hospitals, Ann Arbor, Michigan, USA
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Zhang X, Zhang Y, Wang J, Yang J, Yu S, Yin M, Li S, Yang J. Acute Lymphoblastic Leukemia Developing in a Patient with 46, XY Pure Gonadal Dysgenesis (Swyer Syndrome) with Malignant Gonadal Germ Cell Tumor: A Case Report and Literature Review. Curr Oncol 2022; 29:9753-9759. [PMID: 36547180 PMCID: PMC9776710 DOI: 10.3390/curroncol29120766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/01/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
A female phenotype with strip-like gonads, 46, XY pure gonadal dysgenesis (PGD) has a high tendency to develop into gonadal germ cell tumors. We described one patient with 46, XY PGD, who had a gonadal mixed germ cell tumor (GCT) and acute lymphoblastic leukemia (ALL). This is a unique case because two malignancies developed and relapsed in one person with chromosome abnormality, and the patient is the youngest reported so far. There is an association between her GCT and ALL, as the two malignancies may share a common clonal origin and the NRAS mutation likely plays a role in tumor genesis. We organized MDT to formulate a suitable plan of treatment. We completed the surgery and full cycles of chemotherapy for GCT and controlled ALL by chemotherapy and bone marrow transplantation. However, unfortunately, the young life finally ended following a rare transplant rejection. We concluded that ALL likely shares common clonal origin with GCT and that gene mutations may play a role in neoplasia, which requires further exploration. In the face of such complex conditions, we need to balance the treatment of both diseases to prolong survival and improve the patients' quality of life.
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Affiliation(s)
- Xinyue Zhang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing 100730, China
| | - Ying Zhang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing 100730, China
| | - Jinhui Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing 100730, China
| | - Jie Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing 100730, China
| | - Shuangni Yu
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Min Yin
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing 100730, China
| | - Sijian Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing 100730, China
| | - Jiaxin Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing 100730, China
- Correspondence: ; Tel.: +86-010-69156204
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7
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Recurrent Translocations in Topoisomerase Inhibitor-Related Leukemia Are Determined by the Features of DNA Breaks Rather Than by the Proximity of the Translocating Genes. Int J Mol Sci 2022; 23:ijms23179824. [PMID: 36077220 PMCID: PMC9456246 DOI: 10.3390/ijms23179824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/09/2022] [Accepted: 08/21/2022] [Indexed: 11/25/2022] Open
Abstract
Topoisomerase inhibitors are widely used in cancer chemotherapy. However, one of the potential long-term adverse effects of such therapy is acute leukemia. A key feature of such therapy-induced acute myeloid leukemia (t-AML) is recurrent chromosomal translocations involving AML1 (RUNX1) or MLL (KMT2A) genes. The formation of chromosomal translocation depends on the spatial proximity of translocation partners and the mobility of the DNA ends. It is unclear which of these two factors might be decisive for recurrent t-AML translocations. Here, we used fluorescence in situ hybridization (FISH) and chromosome conformation capture followed by sequencing (4C-seq) to investigate double-strand DNA break formation and the mobility of broken ends upon etoposide treatment, as well as contacts between translocation partner genes. We detected the separation of the parts of the broken AML1 gene, as well as the increased mobility of these separated parts. 4C-seq analysis showed no evident contacts of AML1 and MLL with loci, implicated in recurrent t-AML translocations, either before or after etoposide treatment. We suggest that separation of the break ends and their increased non-targeted mobility—but not spatial predisposition of the rearrangement partners—plays a major role in the formation of these translocations.
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8
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Wang C, Shen Y, Zhang Y, Guo F, Li Q, Zhang H, Han X, Zhao H, Yang Z. Metachronous Multiple Primary Carcinoma With Acute Promyelocytic Leukemia: 2 Cases Report and Literature Review. Front Oncol 2022; 12:893319. [PMID: 35756676 PMCID: PMC9214198 DOI: 10.3389/fonc.2022.893319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/17/2022] [Indexed: 11/24/2022] Open
Abstract
The co-occurrence of multiple primary cancers with hematological malignancies is uncommon, and acute promyelocytic leukemia (APL) with MPC is even rarer, with only a few cases reported in the literature. Herein, we introduce the diagnosis and treatment of 2 cases of MPC complicated with APL in our hospital and review the relevant literature. Both patients were primary solid tumor patients and were treated with surgery and chemotherapy, and had stable disease (SD). However, more than 1 year after the primary tumor was diagnosed, clinical symptoms were found and APL was diagnosed. Both patients received standard remission-induction therapy, but unfortunately died in the short term due to hemorrhagic complications. In conclusion, treatment of hematological neoplasms, especially acute leukemia combined with multiple primary cancers, is challenging. The prognostic factors and survival analysis of MPC patients with combined APL still need further clinical research and analysis.
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Affiliation(s)
- Cong Wang
- Department of Hematology, Wuwei Tumor Hospital, Wuwei, China
| | - Yamei Shen
- Wuwei Institute of Hematology, Wuwei, China
| | - Yuxia Zhang
- Department of Hematology, Wuwei Tumor Hospital, Wuwei, China
| | - Fahui Guo
- Wuwei Institute of Hematology, Wuwei, China
| | - Qian Li
- Department of Hematology, Wuwei Tumor Hospital, Wuwei, China
| | - Huahua Zhang
- Department of Hematology, Wuwei Tumor Hospital, Wuwei, China
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9
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Therapeutic implications of menin inhibition in acute leukemias. Leukemia 2021; 35:2482-2495. [PMID: 34131281 DOI: 10.1038/s41375-021-01309-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/19/2021] [Accepted: 05/24/2021] [Indexed: 01/31/2023]
Abstract
Menin inhibitors are novel targeted agents currently in clinical development for the treatment of genetically defined subsets of acute leukemia. Menin has a tumor suppressor function in endocrine glands. Germline mutations in the gene encoding menin cause the multiple endocrine neoplasia type 1 (MEN1) syndrome, a hereditary condition associated with tumors of the endocrine glands. However, menin is also critical for leukemogenesis in subsets driven by rearrangement of the Lysine Methyltransferase 2A (KMT2A) gene, previously known as mixed-lineage leukemia (MLL), which encodes an epigenetic modifier. These seemingly opposing functions of menin can be explained by its various roles in gene regulation. Therefore, leukemias with rearrangement of KMT2A are predicted to respond to menin inhibition with early clinical data validating this proof-of-concept. These leukemias affect infants, children and adults, and lead to adverse outcomes with current standard therapies. Recent studies have identified novel targets in acute leukemia that are susceptible to menin inhibition, such as mutated Nucleophosmin 1 (NPM1), the most common genetic alteration in adult acute myeloid leukemia (AML). In addition to these alterations, other leukemia subsets with similar transcriptional dependency could be targeted through menin inhibition. This led to rationally designed clinical studies, investigating small-molecule oral menin inhibitors in relapsed acute leukemias with promising early results. Herein, we discuss the physiologic and malignant biology of menin, the mechanisms of leukemia in these susceptible subsets, and future therapeutic strategies using these inhibitors in acute leukemia.
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10
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Etiology of Acute Leukemia: A Review. Cancers (Basel) 2021; 13:cancers13092256. [PMID: 34066700 PMCID: PMC8125807 DOI: 10.3390/cancers13092256] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/30/2021] [Accepted: 05/05/2021] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Acute leukemias are some of the most common cancers affecting all age groups. Despite a significant improvement made in the treatment of acute leukemias, their cause remains unknown. A number of genetic and environmental factors for the development of acute leukemias have been proposed, but none have been proven. Undoubtedly, genetics have a major role in the development of these diseases. The effects of a variety of environmental factors, occupations and hobbies have been explored. A recent “two-hit” theory” for the development of acute lymphoblastic leukemia has been proposed. This combines genetic factors and exposure to infections for the development of this disease. Several genetic factors are suggested. Most recently, for the infection portion, exposure to a virus containing Aspergillus Flavus has been proposed. This review summarizes what is currently known about the factors that are proposed for the development of acute leukemias. Abstract Acute leukemias constitute some of the most common malignant disorders. Despite significant progress made in the treatment of these disorders, their etiology remains unknown. A large and diverse group of genetic and environmental variables have been proposed. The role of a variety of factors, including pre-existing and acquired genetic mutations, exposure to radiation and various chemicals during preconception, pregnancy and throughout life, have been explored. The effects of inherited genetic variations and disorders, pre-existing diseases, infectious agents, hobbies, occupations, prior treatments, and a host of other factors have been proposed, but none is universally applicable to all cases. Variation in the incidence and prognosis based on the age, sex, race, type of the disease, geographic area of residence and other factors are intriguing but remain unexplained. Advances in genomic profiling, including genome-wide gene expression, DNA copy number and single nucleotide polymorphism (SNP) genotype, may shed some light on the role of genetics in these disparities. Separate two-hit hypotheses for the development of acute myeloblastic and lymphoblastic leukemia have been proposed. The latter combines genetics and infection factors resulting in leukemogenesis. A number of pre- and post-natal environmental conditions and exposure to infections, including a mycovirus infected Aspergillus flavus, have been suggested. The exact nature, timing, sequence of the events and mechanisms resulting in the occurrence of leukemia requires further investigations. This review summarizes some of the above factors in acute lymphoblastic and myeloblastic leukemias and the direction for future research on the etiology of these disorders.
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Wang H, Mejia MC, Gonzalez SJ, Zoorob RJ, Chai W, Du XL. Cancer incidence and survival trends among infants in the United States from 1975 to 2014. Pediatr Blood Cancer 2021; 68:e28917. [PMID: 33470510 DOI: 10.1002/pbc.28917] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 12/10/2020] [Accepted: 01/07/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cancer among infants (<1 year old) has unique epidemiologic, clinical, and genetic characteristics compared with cancer in older children. Nonetheless, data on secular trends in infant cancer incidence and survival in the United States is sparse. METHODS Population-based data from nine areas of the Surveillance Epidemiology and End Results (SEER) were used to estimate the incidence, average annual percentage change (APC) for trends, and survival of malignant neoplasm among infants from 1975 to 2014. Data were stratified by gender, race, registry, and cancer type. RESULTS There were 3437 new infant cancer cases with an overall incidence of 23.6/100 000. Neuroblastoma was the most common infant malignancy (6.5/100 000), followed by leukemia (3.8/100 000), and brain and central nervous system tumors (3.3/100 000). The incidence rate increased significantly from 1975 to 2014 (APC 0.68; 95% CI 0.30-1.06; P < .05). Variations in overall incidence rates were uneven across SEER registry geographic areas, with the lowest rates among both males and females in New Mexico. Relative to other racial distribution, infant cancer rates were highest among Whites. The relative survival rates improved over time for all tumors except for renal, sarcomas, and germ cells and were not significantly different by gender or race. CONCLUSIONS Cancer incidence among infants increased over time largely driven by leukemia, germ cell, and sarcoma mainly among male infants. The overall survival for infant cancer has improved over the past 40 years, especially since 1990 for hepatic tumors, lymphoma, and leukemia. Further research is needed to explore the potential impacts of genetic, environmental, and perinatal factors for possible explanations for these increased cancer incidence trends.
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Affiliation(s)
- Haijun Wang
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Maria Carmenza Mejia
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Sandra J Gonzalez
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Roger J Zoorob
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Weiwen Chai
- Department of Nutrition and Health Sciences, University of Nebraska-Lincoln, Lincoln, Nebraska
| | - Xianglin L Du
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Houston, Texas
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12
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Madsen CN, Henriksen TB, Ramlau-Hansen CH, Parner ET, Olsen J, Bech BH. Coffee intake during pregnancy and childhood acute leukemia - A cohort study. Cancer Epidemiol 2020; 67:101747. [PMID: 32526645 DOI: 10.1016/j.canep.2020.101747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/09/2020] [Accepted: 05/26/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To estimate a possible association between coffee intake during pregnancy and risk of childhood acute leukemia by using a cohort design. METHODS We included data from two birth cohorts; the Danish National Birth Cohort and the Aarhus Birth Cohort. Recruitment of 141,216 eligible pregnancies occurred from 1 August 1989 to 31 December 2012. Information on maternal prenatal coffee intake and covariates was collected in early second trimester of pregnancy. Information on childhood AL diagnosed in offspring was obtained from the Danish National Patient Register. We used competing risk time-to-event regression analysis, using the pseudo-observation method to estimate risk ratio (RR) with no coffee intake during pregnancy considered the reference group. RESULTS In total 96 children were diagnosed with AL, hereof 73 with acute lymphoblastic leukemia (ALL). Coffee intake of 0.5-3 cups/day during pregnancy was not associated with a higher risk of childhood AL; aRR = 0.89, 95 % confidence interval (CI): 0.48, 1.65, however, an intake of >3 cups/day resulted in aRR = 1.37, 95 % CI: 0.56, 3.32. Only including ALL as outcome we found similar results; aRR = 0.80, 95 % CI: 0.37-1.74 and aRR = 1.46 95 % CI: 0.52-4.09, respectively. CONCLUSION We found no significant association between maternal coffee intake and risk of childhood AL but the number of cases was limited. The confidence limits does not exclude that a high prenatal coffee intake may increase the risk of childhood AL and larger studies based on prospective data are needed.
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Affiliation(s)
- Carina Nkoyo Madsen
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Denmark
| | - Tine Brink Henriksen
- Perinatal Epidemiology Research Unit, Aarhus University, Denmark; Department of Pediatrics, Aarhus University Hospital, Denmark
| | | | - Erik Thorlund Parner
- Department of Public Health, Research Unit for Biostatistic, Aarhus University, Denmark
| | - Jørn Olsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
| | - Bodil Hammer Bech
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Denmark.
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Inv(11)(q21q23); KMT2A-MAML2, a Recurrent Genetic Abnormality in T-Cell Therapy-related Acute Lymphoblastic Leukemia. J Pediatr Hematol Oncol 2020; 42:e258-e261. [PMID: 31343482 DOI: 10.1097/mph.0000000000001572] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
T-cell therapy-related acute lymphoblastic leukemia (T-t-ALL) is a rare condition associated with previous cytotoxic therapy for another disease. Here we report T-t-ALL with inv(11)(q21q23), which involves KMT2A and MAML2, a transcriptional coactivator of NOTCH proteins, that occurred after chemotherapy for Philadelphia chromosome-positive B-cell acute lymphoblastic leukemia. This case describes the youngest patient with T-t-ALL harboring inv(11)(q21q23) and is the first independent report following an initial series also occurring in children. Our results lend further support to the observation that the KMT2A-MAML2 fusion gene resulting from inv(11)(q21q23) is likely a recurrent cytogenetic abnormality in T-t-ALL and appears to be associated with pediatric cases.
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14
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Kitdumrongthum S, Reabroi S, Suksen K, Tuchinda P, Munyoo B, Mahalapbutr P, Rungrotmongkol T, Ounjai P, Chairoungdua A. Inhibition of topoisomerase IIα and induction of DNA damage in cholangiocarcinoma cells by altholactone and its halogenated benzoate derivatives. Biomed Pharmacother 2020; 127:110149. [PMID: 32344256 DOI: 10.1016/j.biopha.2020.110149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 04/01/2020] [Accepted: 04/04/2020] [Indexed: 01/02/2023] Open
Abstract
Topoisomerase IIα enzyme (Topo IIα) plays a critical function in DNA replication process and is considered to be a promising target of anti-cancer drugs. In the present study, we reported that the altholactone derivatives modified by adding a halogenated benzoate group showed greater inhibitory activity on Topo IIα enzyme in cell-free system concomitant with cytotoxicity against the CCA cell lines (KKU-M055 and KKU-M213) than those of the parent altholactone. However, the cytotoxic activities of four halogenated benzoate altholactone derivatives including iodo-, fluoro-, chloro-, and bromobenzoate derivatives (compound 1, 2, 3, and 4, respectively) were of equal potency. The fluorobenzoate derivative (compound 2) was chosen for investigating the underlying mechanism in CCA cells. Compound 2 arrested CCA cell cycle at sub G1 phase and induced apoptotic cell death. It markedly inhibited Topo IIα protein expression in both KKU-M055 and KKU-M213 cells, which was accompanied by DNA double-strand breaks demonstrated by an increase in phosphorylated H2A.X protein. Interestingly, KKU-M055 cells, which express higher Topo IIα mRNA compared to KKU-M213 cells, showed greater sensitivity to the compound, indicating the selectivity of the compound to Topo IIα enzyme. By computational docking analysis, the binding affinity of altholactone (-52.5 kcal/mol) and compound 2 (-56.7 kcal/mol) were similar to that of the Topo II poison salvicine (-53.7 kcal/mol). The aromatic moiety of both altholactones embedded in a hydrophobic pocket of Topo II ATPase domain. In addition, compound 2 induced the formation of linear DNA in Topo II-mediated cleavage assay. Collectively, our results demonstrate that the addition of fluorobenzoyl group to altholactone enhances potency and selectivity to inhibit type IIα topoisomerases. Atholactone and fluorobenzoate derivative act as Topo II cleavage complexes stabilizing compounds or Topo II poisons preferentially through binding at ATPase domain of Topo IIα, leading to DNA double-strand breaks and apoptosis induction. Such activity of 3-fluorobenzoate derivative of altholactone should be further explored for the development of an anti-cancer drug for CCA.
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Affiliation(s)
- Sarunya Kitdumrongthum
- Toxicology Graduate Program, Faculty of Science, Mahidol University, Bangkok, Thailand; Excellent Center for Drug Discovery (ECDD), Mahidol University, Bangkok, Thailand
| | - Somrudee Reabroi
- Department of Pharmacology, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Kanoknetr Suksen
- Department of Physiology, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Patoomratana Tuchinda
- Excellent Center for Drug Discovery (ECDD), Mahidol University, Bangkok, Thailand; Department of Chemistry, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Bamroong Munyoo
- Excellent Center for Drug Discovery (ECDD), Mahidol University, Bangkok, Thailand; Department of Chemistry, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Panupong Mahalapbutr
- Structural and Computational Biology Research Unit, Department of Biochemistry, Faculty of Science, Chulalongkorn University, Bangkok, Thailand
| | - Thanyada Rungrotmongkol
- Structural and Computational Biology Research Unit, Department of Biochemistry, Faculty of Science, Chulalongkorn University, Bangkok, Thailand; Program in Bioinformatics and Computational Biology, Graduate School, Chulalongkorn University, Bangkok, Thailand
| | - Puey Ounjai
- Department of Biology, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Arthit Chairoungdua
- Toxicology Graduate Program, Faculty of Science, Mahidol University, Bangkok, Thailand; Excellent Center for Drug Discovery (ECDD), Mahidol University, Bangkok, Thailand; Department of Physiology, Faculty of Science, Mahidol University, Bangkok, Thailand.
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15
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Murphy BR, Roth M, Kolb EA, Alonzo T, Gerbing R, Wells RJ. Development of acute lymphoblastic leukemia following treatment for acute myeloid leukemia in children with Down syndrome: A case report and retrospective review of Children's Oncology Group acute myeloid leukemia trials. Pediatr Blood Cancer 2019; 66:e27700. [PMID: 30908863 PMCID: PMC6941434 DOI: 10.1002/pbc.27700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/05/2019] [Accepted: 02/22/2019] [Indexed: 11/09/2022]
Abstract
Children with Down syndrome have a 150-fold increased risk of developing acute myeloid leukemia (AML) and 20-fold increased risk of developing acute lymphoblastic leukemia (ALL). Although the risk of developing AML and ALL is significantly increased in children with Down syndrome, the development of both malignancies in the same patient is very rare. We describe a patient with Down syndrome who developed ALL 6 years after being diagnosed with AML. We performed a literature review and Children's Oncology Group query and discovered eight published cases and five cases of ALL following AML in pediatric patients with Down syndrome, as well as six cases of ALL following AML in non-Down syndrome patients. There was a similar cumulative incidence of ALL after treatment for AML in the Down syndrome and non-Down syndrome populations. Overall survival in patients with Down syndrome who developed ALL after treatment for AML was comparable to overall survival for patients with Down syndrome with de novo ALL with an average follow-up of 7 years after ALL diagnosis. Clinical data collected were used to discuss whether this phenomenon represents a secondary leukemia, second primary cancer, or mixed-lineage leukemia.
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Affiliation(s)
- Brianna R. Murphy
- University of Texas M. D. Anderson Children’s Cancer Hospital, Houston, Texas
| | - Michael Roth
- University of Texas M. D. Anderson Children’s Cancer Hospital, Houston, Texas
| | - E. Anders Kolb
- Nemours/Alfred I DuPont Hospital for Children, Wilmington, Delaware
| | - Todd Alonzo
- University of Southern California Keck School of Medicine, Los Angeles, California
| | | | - Robert J. Wells
- University of Texas M. D. Anderson Children’s Cancer Hospital, Houston, Texas
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Gaut D, Bejjani A, Sasine J, Schiller G. B-cell acute lymphoblastic leukemia as a secondary malignancy following diffuse large B-cell lymphoma. Hematol Rep 2019; 11:8100. [PMID: 31285810 PMCID: PMC6589539 DOI: 10.4081/hr.2019.8100] [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] [Received: 03/02/2019] [Accepted: 05/13/2019] [Indexed: 11/23/2022] Open
Abstract
Secondary acute lymphoblastic leukemia (ALL) is a rare disease that has not been well characterized compared with secondary myelodysplastic syndrome or secondary acute myeloid leukemia. We present a report of two patients who developed ALL following complete remission of diffuse large B-cell lymphoma (DLBCL). The first case is more consistent with a therapy- related ALL as a PCR analysis of bone marrow aspirate revealed a distinct clone and the mixed-lineage leukemia gene rearrangement, commonly associated with exposure to topoisomerase II inhibitors. The second case is more consistent with clonal evolution given positive MYC and BCL2 fusion signals in the original diagnosis of DLBCL and the secondary ALL.
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Affiliation(s)
| | - Anthony Bejjani
- Division of Hematology/Oncology, David Geffen School of Medicine, University of California Los Angeles, CA, USA
| | - Joshua Sasine
- Division of Hematology/Oncology, David Geffen School of Medicine, University of California Los Angeles, CA, USA
| | - Gary Schiller
- Division of Hematology/Oncology, David Geffen School of Medicine, University of California Los Angeles, CA, USA
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17
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Jabagi MJ, Vey N, Goncalves A, Le Tri T, Zureik M, Dray-Spira R. Evaluation of the Incidence of Hematologic Malignant Neoplasms Among Breast Cancer Survivors in France. JAMA Netw Open 2019; 2:e187147. [PMID: 30657534 PMCID: PMC6484549 DOI: 10.1001/jamanetworkopen.2018.7147] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Breast cancer survivors are at an increased risk of developing certain types of hematologic malignant neoplasm after diagnosis. OBJECTIVE To estimate the incidence of various types of hematologic malignant neoplasm in breast cancer survivors, both in absolute terms and in association with the general population. DESIGN, SETTING, AND PARTICIPANTS This nationwide cohort study conducted in France used data from the French National Health Data System, a database that contains all of French residents' health-related expenses. All French women aged 20 to 85 years with an incident breast cancer diagnosis between July 1, 2006, and December 31, 2015, were included (n = 439 704) and followed up until hematologic malignant neoplasm occurrence, death, loss of follow-up, or December 31, 2016, whichever came first. Comparisons were made with all French women in the general population who were registered in the French general health insurance program each year from January 1, 2007, and December 31, 2016. Data analysis was performed from January 23, 2018, to May 25, 2018. MAIN OUTCOMES AND MEASURES Main outcomes were incident hematologic malignant neoplasm cases occurring at least 6 months after breast cancer diagnosis. The various types of hematologic malignant neoplasm considered were acute myeloid leukemia (AML), myelodysplastic syndrome (MDS), myeloproliferative neoplasms (MPNs), multiple myeloma (MM), Hodgkin lymphoma or non-Hodgkin lymphoma (HL/NHL), and acute lymphoblastic leukemia or lymphocytic lymphoma (ALL/LL). Incidence of these various types was estimated among breast cancer survivors and compared with the incidence in women in the general population. RESULTS The 439 704 women in the study had a median (interquartile range [IQR]) age of 59 (50-69) years and were followed up for a median (IQR) duration of 5 (2.8-7.5) years. Overall, 3046 cases of hematologic malignant neoplasm occurred: 509 cases (16.7%) of AML (crude incidence rate [CIR] per 100 000 person-years, 24.5; 95% CI, 22.4-26.8), 832 cases (27.3%) of MDS (CIR, 40.1; 95% CI, 37.4-42.9), and 267 cases (8.8%) of MPN (CIR, 12.8; 95% CI, 11.4-14.5). Lymphoid neoplasm cases included 420 cases (13.8%) of MM (CIR, 20.3; 95% CI, 18.4-22.3), 912 cases (29.9%) of HL/NHL (CIR, 44.4; 95% CI, 41.1-50.0), and 106 cases (3.5%) of ALL/LL (CIR, 5.1; 95% CI, 4.2-6.2). Compared with the general population, breast cancer survivors had statistically significantly higher incidence of AML (standardized incidence rate ratio [SIRR], 2.8; 95% CI, 2.5-3.2) and MDS (SIRR, 5.0; 95% CI, 4.4-5.7) and, to a lesser extent, MM (SIRR, 1.5; 95% CI, 1.3-1.7]) and ALL/LL (SIRR, 2.0; 95% CI, 1.3-3.0). CONCLUSIONS AND RELEVANCE The finding that AML and MDS still occur among breast cancer survivors today, and that ALL/LL and MM may also be of concern, merits the continuous monitoring of hematologic malignant neoplasms and the thorough investigations into their underlying mechanisms.
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Affiliation(s)
- Marie Joelle Jabagi
- University of Paris Sud, Paris-Saclay University, Paris, France
- Health Product Epidemiology Department, French National Agency for Medicines and Health Products Safety, Saint-Denis, France
| | - Norbert Vey
- Aix-Marseille University, CNRS, Inserm, Institut Paoli-Calmettes, Hematology Department, CRCM, Marseille, France
| | - Anthony Goncalves
- Aix-Marseille University, CNRS, Inserm, Institut Paoli-Calmettes, Medical Oncology Department, CRCM, Marseille, France
| | - Thien Le Tri
- Health Product Epidemiology Department, French National Agency for Medicines and Health Products Safety, Saint-Denis, France
| | - Mahmoud Zureik
- Health Product Epidemiology Department, French National Agency for Medicines and Health Products Safety, Saint-Denis, France
- Versailles Saint-Quentin-en-Yvelines University, Montigny-Le-Bretonneux, AP-HP Hôpital Sainte Perine Hospital, Paris, France
| | - Rosemary Dray-Spira
- Health Product Epidemiology Department, French National Agency for Medicines and Health Products Safety, Saint-Denis, France
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18
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Ferraro F, Gao F, Stockerl-Goldstein K, Westervelt P, DiPersio JF, Ghobadi A. Secondary acute lymphoblastic leukemia, a retrospective analysis from Washington University and meta-analysis of published data. Leuk Res 2018; 72:86-91. [PMID: 30114560 DOI: 10.1016/j.leukres.2018.07.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 07/30/2018] [Accepted: 07/30/2018] [Indexed: 11/25/2022]
Abstract
Secondary acute lymphoblastic leukemia (s-ALL) is rare and poorly defined and data regarding outcomes post-transplant are lacking. Here, we report a detailed analysis of s-ALL at our Institution. Among 211 eligible patients with ALL from 2006 to 2017, 30 (14%) were defined as s-ALL and the remaining as primary ALL (p-ALL). s-ALL patients were older and had higher incidence of adverse risk factors. Overall response (OR) after induction was not different between s-ALL and p-ALL (79% versus 90% respectively, p = 0.106). S-ALL group had a higher risk of relapse (RFS) and death (RFS HR = 1.93, 95% CI 1.2-3.12, p = 0.007. OS HR: =1.95, 95% CI 1.18-3.23, p = 0.01). In multivariate analysis, the adverse effect of s-ALL on RFS and OS was no longer significant, however a pooled meta-analysis of our and published data indicated that s-ALL is an independent risk factor for lower OS (HR: 1.30, 95% CI: 1.11-1.52, p < 0.01). Myeloablative allogeneic transplantation in s-ALL was associated with lower rates of relapse and higher transplant related mortality without improvement in OS. These data indicate that s-ALL status should be considered for risk- stratification of newly diagnosed ALL. The optimal conditioning regimen for s-ALL patients undergoing allogeneic stem cell transplantation needs to be evaluated in a larger study.
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Affiliation(s)
- Francesca Ferraro
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Feng Gao
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Keith Stockerl-Goldstein
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Peter Westervelt
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - John F DiPersio
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Armin Ghobadi
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO, 63110, USA.
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Arber DA, Borowitz MJ, Cessna M, Etzell J, Foucar K, Hasserjian RP, Rizzo JD, Theil K, Wang SA, Smith AT, Rumble RB, Thomas NE, Vardiman JW. Initial Diagnostic Workup of Acute Leukemia: Guideline From the College of American Pathologists and the American Society of Hematology. Arch Pathol Lab Med 2017; 141:1342-1393. [PMID: 28225303 DOI: 10.5858/arpa.2016-0504-cp] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT - A complete diagnosis of acute leukemia requires knowledge of clinical information combined with morphologic evaluation, immunophenotyping and karyotype analysis, and often, molecular genetic testing. Although many aspects of the workup for acute leukemia are well accepted, few guidelines have addressed the different aspects of the diagnostic evaluation of samples from patients suspected to have acute leukemia. OBJECTIVE - To develop a guideline for treating physicians and pathologists involved in the diagnostic and prognostic evaluation of new acute leukemia samples, including acute lymphoblastic leukemia, acute myeloid leukemia, and acute leukemias of ambiguous lineage. DESIGN - The College of American Pathologists and the American Society of Hematology convened a panel of experts in hematology and hematopathology to develop recommendations. A systematic evidence review was conducted to address 6 key questions. Recommendations were derived from strength of evidence, feedback received during the public comment period, and expert panel consensus. RESULTS - Twenty-seven guideline statements were established, which ranged from recommendations on what clinical and laboratory information should be available as part of the diagnostic and prognostic evaluation of acute leukemia samples to what types of testing should be performed routinely, with recommendations on where such testing should be performed and how the results should be reported. CONCLUSIONS - The guideline provides a framework for the multiple steps, including laboratory testing, in the evaluation of acute leukemia samples. Some aspects of the guideline, especially molecular genetic testing in acute leukemia, are rapidly changing with new supportive literature, which will require on-going updates for the guideline to remain relevant.
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Rosenberg AS, Brunson A, Paulus JK, Tuscano J, Wun T, Keegan THM, Jonas BA. Secondary acute lymphoblastic leukemia is a distinct clinical entity with prognostic significance. Blood Cancer J 2017; 7:e605. [PMID: 28885611 PMCID: PMC5709750 DOI: 10.1038/bcj.2017.81] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 07/20/2017] [Indexed: 01/21/2023] Open
Abstract
The effect of prior malignancy on the risk of developing, and prognosis of, acute lymphoblastic leukemia (ALL) is unknown. This observational study utilized the California Cancer Registry to estimate the risk of developing ALL after a prior malignancy using standardized incidence ratios (SIRs, 95% confidence intervals). ALL occurring after a malignancy with an SIR>1 (increased-risk (IR) malignancies) was considered secondary ALL (s-ALL). Adjusted hazard ratios (aHRs, 95% confidence intervals) compared the effect of s-ALL with de novo ALL on overall survival. A total of 14 481 patients with ALL were identified (1988–2012) and 382 (3%) had a known prior malignancy. Any prior malignancy predisposed patients to developing ALL: SIR 1.62 (1.45–1.79). Hematologic malignancies (SIR 5.57, 4.38–6.98) and IR-solid tumors (SIR 2.11, 1.73–2.54) increased the risk of developing ALL. s-ALL increased the risk of death compared with de novo ALL (aHR 1.38 (1.16–1.63)) and this effect was more pronounced among younger patients (age<40 years: aHR 4.80 (3.15–7.30); age⩾40 years: aHR 1.40 (1.16–1.69)) (interaction P<0.001). This population-based study demonstrates that s-ALL is a distinct entity that occurs after specific malignancies and carries a poor prognosis compared with de novo ALL, particularly among patients <40 years of age.
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Affiliation(s)
- A S Rosenberg
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology Oncology, University of California Davis School of Medicine, Sacramento, CA, USA.,University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - A Brunson
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology Oncology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - J K Paulus
- Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - J Tuscano
- University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA.,VA Northern California Health Care System, Sacramento, CA, USA
| | - T Wun
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology Oncology, University of California Davis School of Medicine, Sacramento, CA, USA.,University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA.,VA Northern California Health Care System, Sacramento, CA, USA
| | - T H M Keegan
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology Oncology, University of California Davis School of Medicine, Sacramento, CA, USA.,University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - B A Jonas
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology Oncology, University of California Davis School of Medicine, Sacramento, CA, USA.,University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA.,VA Northern California Health Care System, Sacramento, CA, USA
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Winters AC, Bernt KM. MLL-Rearranged Leukemias-An Update on Science and Clinical Approaches. Front Pediatr 2017; 5:4. [PMID: 28232907 PMCID: PMC5299633 DOI: 10.3389/fped.2017.00004] [Citation(s) in RCA: 249] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 01/09/2017] [Indexed: 12/18/2022] Open
Abstract
The mixed-lineage leukemia 1 (MLL1) gene (now renamed Lysine [K]-specific MethylTransferase 2A or KMT2A) on chromosome 11q23 is disrupted in a unique group of acute leukemias. More than 80 different partner genes in these fusions have been described, although the majority of leukemias result from MLL1 fusions with one of about six common partner genes. Approximately 10% of all leukemias harbor MLL1 translocations. Of these, two patient populations comprise the majority of cases: patients younger than 1 year of age at diagnosis (primarily acute lymphoblastic leukemias) and young- to-middle-aged adults (primarily acute myeloid leukemias). A much rarer subgroup of patients with MLL1 rearrangements develop leukemia that is attributable to prior treatment with certain chemotherapeutic agents-so-called therapy-related leukemias. In general, outcomes for all of these patients remain poor when compared to patients with non-MLL1 rearranged leukemias. In this review, we will discuss the normal biological roles of MLL1 and its fusion partners, how these roles are hypothesized to be dysregulated in the context of MLL1 rearrangements, and the clinical manifestations of this group of leukemias. We will go on to discuss the progress in clinical management and promising new avenues of research, which may lead to more effective targeted therapies for affected patients.
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Affiliation(s)
- Amanda C Winters
- Division of Pediatric Hematology/Oncology/BMT, University of Colorado School of Medicine and Children's Hospital Colorado , Aurora, CO , USA
| | - Kathrin M Bernt
- Division of Pediatric Hematology/Oncology/BMT, University of Colorado School of Medicine and Children's Hospital Colorado , Aurora, CO , USA
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22
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Parekh V, Peker D. Clinicopathologic and cytogenetic characterization of therapy-related acute T lymphoblastic leukemia in adult population. Leuk Lymphoma 2015; 57:1460-2. [PMID: 26585442 DOI: 10.3109/10428194.2015.1083564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Vishwas Parekh
- a Department of Pathology , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Deniz Peker
- a Department of Pathology , University of Alabama at Birmingham , Birmingham , AL , USA
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23
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Attia SM, Ahmad SF, Saquib Q, Harisa GI, Al-Khedhairy AA, Bakheet SA. Dexrazoxane mitigates epirubicin-induced genotoxicity in mice bone marrow cells. Mutagenesis 2015; 31:137-45. [DOI: 10.1093/mutage/gev065] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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24
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Loghavi S, Kutok JL, Jorgensen JL. B-acute lymphoblastic leukemia/lymphoblastic lymphoma. Am J Clin Pathol 2015; 144:393-410. [PMID: 26276770 DOI: 10.1309/ajcpan7bh5dnywzb] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES This session of the 2013 Society of Hematopathology/European Association for Haematopathology Workshop was dedicated to B-acute lymphoblastic leukemia (B-ALL)/lymphoblastic lymphoma (LBL) with recurrent translocations and not otherwise specified. METHODS In this review, we summarize the cases discussed during the workshop, review the pertinent and most recent literature on the respective topics, and provide a few key points that may aid in the workup of patients with B-ALL/LBL. RESULTS Many of the submitted cases showed interesting diagnostic, immunophenotypic, or clinical aspects of B-ALL with BCR/ABL1, MLL-associated, and other recurrent chromosomal abnormalities. Several cases showed rare aberrancies such as coexistent IGH/BCL2 and MYC rearrangements and raised issues in classification. Other cases had unusual clinical presentations, including B-ALL with hypereosinophilia and therapy-related B-ALL. Several cases highlighted the role of flow cytometry immunophenotyping in distinguishing benign B-cell precursors from aberrant lymphoblasts, and other cases raised questions regarding the clinical importance of myeloperoxidase positivity in acute lymphoblastic leukemia. CONCLUSIONS The complexity and spectrum of cases presented in this review highlight the importance of clinicopathologic correlation and the value of ancillary studies in the classification and workup of patients with B-ALL/LBL.
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Affiliation(s)
- Sanam Loghavi
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston; and
| | | | - Jeffrey L. Jorgensen
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston; and
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25
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Matnani R, Parekh V, Borate U, Brazelton J, Reddy V, Peker D. Therapy-related B-lymphoblastic leukemia associated with Philadelphia chromosome and MLL rearrangement: Single institution experience and the review of the literature. Pathol Int 2015; 65:536-40. [PMID: 26259760 DOI: 10.1111/pin.12337] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 07/09/2015] [Indexed: 11/26/2022]
Abstract
Therapy related acute lymphoblastic leukemia (t-ALL) of B cell origin is rare and constitutes approximately 2% of all ALL. Previously compiled data on the complete cytogenetic analysis of 48 t-B-ALL cases suggested that MLL rearrangement at 11q23 gene locus is the most common abnormality. Philadelphia chromosome (Ph) and a normal karyotype were reported as the second and third most common karyotypes, respectively. We investigated cytogenetic karyotypes of six t-B-ALL cases with a pre-B cell immunophenotype. Ph + t-B-ALL was noted in four of six patients previously treated with radiation and/or chemotherapy. In addition, one case demonstrated MLL rearrangement at 11q23 locus while one case demonstrated normal cytogenetic karyotype. Five of the six t-B-ALL patients had persistent leukemia following initiation of chemotherapy for secondary leukemia with survival ranging from 10 to 21 months. To our knowledge, only fourteen patients with Ph + t-B-ALL have been described in the literature. In the current study, three of four cases with Ph + t-B-ALL were associated with treated breast carcinoma while one patient was treated for Hodgkin lymphoma. All four patients had undergone radiation therapy. The results may indicate a plausible association between Ph+t-B-ALL and prior radiation exposure.
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Affiliation(s)
- Rahul Matnani
- Department of Pathology, Division of Hematology & Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Vishwas Parekh
- Department of Pathology, Division of Hematology & Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Uma Borate
- Department of Medicine, Division of Hematology & Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jason Brazelton
- Department of Pathology, Division of Hematology & Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Vishnu Reddy
- Department of Pathology, Division of Hematology & Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Deniz Peker
- Department of Pathology, Division of Hematology & Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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26
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Inhibition of Bcl-2 or IAP proteins does not provoke mutations in surviving cells. Mutat Res 2015; 777:23-32. [PMID: 25916945 DOI: 10.1016/j.mrfmmm.2015.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 03/31/2015] [Accepted: 04/07/2015] [Indexed: 11/21/2022]
Abstract
Chemotherapy and radiotherapy can cause permanent damage to the genomes of surviving cells, provoking severe side effects such as second malignancies in some cancer survivors. Drugs that mimic the activity of death ligands, or antagonise pro-survival proteins of the Bcl-2 or IAP families have yielded encouraging results in animal experiments and early phase clinical trials. Because these agents directly engage apoptosis pathways, rather than damaging DNA to indirectly provoke tumour cell death, we reasoned that they may offer another important advantage over conventional therapies: minimisation or elimination of side effects such as second cancers that result from mutation of surviving normal cells. Disappointingly, however, we previously found that concentrations of death receptor agonists like TRAIL that would be present in vivo in clinical settings provoked DNA damage in surviving cells. In this study, we used cell line model systems to investigate the mutagenic capacity of drugs from two other classes of direct apoptosis-inducing agents: the BH3-mimetic ABT-737 and the IAP antagonists LCL161 and AT-406. Encouragingly, our data suggest that IAP antagonists possess negligible genotoxic activity. Doses of ABT-737 that were required to damage DNA stimulated Bax/Bak-independent signalling and exceeded concentrations detected in the plasma of animals treated with this drug. These findings provide hope that cancer patients treated by BH3-mimetics or IAP antagonists may avoid mutation-related illnesses that afflict some cancer survivors treated with conventional DNA-damaging anti-cancer therapies.
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27
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Kelleher N, Gallardo D, González-Campos J, Hernández-Rivas JM, Montesinos P, Sarrá J, Gil C, Barba P, Guàrdia R, Brunet S, Bernal T, Martínez MP, Abella E, Bermúdez A, Sánchez-Delgado M, Antònia C, Gayoso J, Calbacho M, Ribera JM. Incidence, clinical and biological characteristics and outcome of secondary acute lymphoblastic leukemia after solid organ or hematologic malignancy. Leuk Lymphoma 2015; 57:86-91. [PMID: 25860236 DOI: 10.3109/10428194.2015.1040013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Acute lymphoblastic leukemia (ALL) following solid organ or hematologic malignancy (secondary ALL, s-ALL) is not well characterized. We analyzed the characteristics and outcome of patients with s-ALL and compared them with those of patients with de novo- ALL. Of 448 patients, 24 (5%) had previous neoplasia. Sixteen patients had received previous cytotoxic therapy (therapy-associated ALL, t-ALL), and eight had not (antecedent-malignancy ALL, am-ALL). Except for more advanced age in patients with s-ALL, no statistically significant differences were observed in WBC count, CNS involvement, immunophenotype or cytogenetics between the groups, nor in complete remission (t-ALL: 94%; am-ALL: 75%; de novo-ALL: 85%), 3-year remission duration (58%; 50%; 72%), overall survival (71%; 38%; 60%) or event-free survival (53%, 38%; 53%). Our study did not show poor clinical or cytogenetic features or inferior outcome in ALL patients with antecedent neoplastic disease, irrespective of the type of treatment received for the neoplasia.
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Affiliation(s)
- Nicholas Kelleher
- a Hematology Department of Institut Català d'Oncologia-Hospital Doctor Josep Trueta , Girona , Spain
| | - David Gallardo
- a Hematology Department of Institut Català d'Oncologia-Hospital Doctor Josep Trueta , Girona , Spain
| | - José González-Campos
- c Hematology Department of Hospital Universitario Virgen del Rocío , Sevilla , Spain
| | - Jesús M Hernández-Rivas
- d Hematology Department of Hospital Universitario de Salamanca & IBSAL , IBCC, Centro de Investigación del Cáncer, Universidad de Salamanca-CSIC Salamanca , Spain
| | - Pau Montesinos
- e Hematology Department of Hospital Universitario y Politécnico La Fe , Valencia , Spain
| | - Josep Sarrá
- f Hematology Department of Institut Català d'Oncologia-Hospital Duran i Reynals , L'Hospitalet de Llobregat , Spain
| | - Cristina Gil
- g Hematology Department of Hospital General Universitario de Alicante , Alicante , Spain
| | - Pere Barba
- h Hematology Department of Hospital Vall d'Hebron , Barcelona , Spain
| | - Ramon Guàrdia
- a Hematology Department of Institut Català d'Oncologia-Hospital Doctor Josep Trueta , Girona , Spain
| | - Salut Brunet
- i Hematology Department of Hospital de Sant Pau , Barcelona , Spain
| | - Teresa Bernal
- j Hematology Department of Hospital Central de Asturias , Oviedo , Spain
| | | | - Eugènia Abella
- l Hematology Department of Hospital del Mar , Barcelona , Spain
| | - Arantxa Bermúdez
- m Hematology Department of Hospital Marqués de Valdecilla , Santander , Spain
| | | | - Cladera Antònia
- o Hematology Department of Hospital Son Llàtzer , Palma de Mallorca , Spain
| | - Jorge Gayoso
- p Hematology Department of Hospital General Universitario Gregorio Marañón IiGSM , Madrid , Spain
| | - María Calbacho
- q Hematology Department of Hospital Ramón y Cajal , Madrid , Spain
| | - Josep-Maria Ribera
- b Hematology Department of Institut Català d'Oncologia-Hospital Germans Trias i Pujol . Jose Carreras Research Institute , Badalona , Universitat Autònoma de Barcelona, Spain
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Ganzel C, Devlin S, Douer D, Rowe JM, Stein EM, Tallman MS. Secondary acute lymphoblastic leukaemia is constitutional and probably not related to prior therapy. Br J Haematol 2015; 170:50-5. [PMID: 25823602 DOI: 10.1111/bjh.13386] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 02/04/2015] [Indexed: 01/21/2023]
Abstract
Very little is known about secondary acute lymphoblastic leukaemia (s-ALL). This retrospective analysis studied a cohort of s-ALL patients treated at a single centre between 1994 and 2013, while comparing therapy-associated ALL (t-ALL) and antecedent malignancy ALL (am-ALL) patients. Thirty-two patients with s-ALL were identified. The overall incidence was 9.4% among ALL adults while T-cell s-ALL was rare (12% of s-ALLs). The median time interval between two malignant diagnoses was 5.3 years (range: 0.1-28). In contrast to previous reports, most of the s-ALLs were CD10 + and without KMT2A (MLL) abnormalities. The overall survival (OS) rates of the entire cohort at 12 and 24 months from ALL diagnosis was 49% and 25%, respectively. Most patients (n = 23, 72%) received prior chemo-/radio-therapy for their first malignancy (t-ALL) and only 9 (28%) did not (am-ALL). No significant difference was found in the incidence of B-/T- lineage ALL, extramedullary disease, blood count, and the rate of Philadelphia-positive ALL, nor in the rates of complete remission (P = 0.55) and OS (P = 0.97). This similarity, together with high incidence of family malignancy in both groups, raise the possibility that s-ALL patients may have an inherent predisposition to malignancies and a history of previous therapy may be of lesser importance in the pathogenesis of s-ALL.
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Affiliation(s)
- Chezi Ganzel
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Shaare Zedek Medical Centre, Jerusalem, Israel
| | - Sean Devlin
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Dan Douer
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Eytan M Stein
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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29
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Bang JI, Lee ES, Kim TS, Kim SK. Unexpected Second Primary Malignancies Detected by F-18 FDG PET/CT During Follow-up for Primary Malignancy: Two Case Reports. Nucl Med Mol Imaging 2014; 49:65-8. [PMID: 25767625 DOI: 10.1007/s13139-014-0302-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 10/13/2014] [Accepted: 10/15/2014] [Indexed: 10/24/2022] Open
Abstract
As the survival rate of cancer patients has increased over the last few decades, the risk of cancer survivors developing second primary malignancies has gained attention. We report two rare cases of second primary hematologic malignancy detected by (18)F-fluorodeoxyglucose (F-18 FDG) positron emission tomography/computed tomography (PET/CT) during follow-up for primary solid malignancies. Acute lymphoblastic leukemia developed in a breast cancer patient and non-Hodgkin lymphoma in an anal cancer patient. F-18 FDG PET/CT findings led to the diagnosis of unexpected second primary hematologic malignancy in cancer survivors in these two cases.
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Affiliation(s)
- Ji-In Bang
- Department of Nuclear Medicine, Research Institute and Hospital, National Cancer Center, Korea, 323 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi 410-769 Republic of Korea
| | - Eun Seong Lee
- Department of Nuclear Medicine, Research Institute and Hospital, National Cancer Center, Korea, 323 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi 410-769 Republic of Korea
| | - Tae-Sung Kim
- Department of Nuclear Medicine, Research Institute and Hospital, National Cancer Center, Korea, 323 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi 410-769 Republic of Korea
| | - Seok-Ki Kim
- Department of Nuclear Medicine, Research Institute and Hospital, National Cancer Center, Korea, 323 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi 410-769 Republic of Korea
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MLL partner genes in secondary acute lymphoblastic leukemia: report of a new partner PRRC1 and review of the literature. Leuk Res 2014; 38:1316-9. [PMID: 25205603 DOI: 10.1016/j.leukres.2014.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 08/17/2014] [Accepted: 08/18/2014] [Indexed: 11/23/2022]
Abstract
Secondary acute lymphoblastic leukemia (sALL) following chemotherapy and/or radiotherapy of previous malignancies represents 2-10% of all cases of ALL. A 72-year-old female patient was diagnosed with acute lymphoblastic leukemia following chemotherapy for a diffuse large B cell lymphoma. Banding cytogenetics showed a t(t(5;11)(q23-31;q23) in 20 of the 21 metaphases examined and fluorescent in situ hybridization confirmed rearrangement of MLL. Long distance inverse-polymerase chain reaction revealed an in-frame fusion between 5'MLL and 3'PRRC1. Sixty-five cases of sALL associated with 11q23/MLL rearrangement, including 47 with a t(4;11)(q21;q23), were retrieved from the literature. Drug regimen used to treat the primary neoplasm was available for 54 patients; 52 had received a topoisomerase II inhibitor, known to induce MLL rearrangement.
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31
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Lymphohematopoietic cancers induced by chemicals and other agents and their implications for risk evaluation: An overview. MUTATION RESEARCH-REVIEWS IN MUTATION RESEARCH 2014; 761:40-64. [PMID: 24731989 DOI: 10.1016/j.mrrev.2014.04.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 04/02/2014] [Accepted: 04/03/2014] [Indexed: 12/13/2022]
Abstract
Lymphohematopoietic neoplasia are one of the most common types of cancer induced by therapeutic and environmental agents. Of the more than 100 human carcinogens identified by the International Agency for Research on Cancer, approximately 25% induce leukemias or lymphomas. The objective of this review is to provide an introduction into the origins and mechanisms underlying lymphohematopoietic cancers induced by xenobiotics in humans with an emphasis on acute myeloid leukemia, and discuss the implications of this information for risk assessment. Among the agents causing lymphohematopoietic cancers, a number of patterns were observed. Most physical and chemical leukemia-inducing agents such as the therapeutic alkylating agents, topoisomerase II inhibitors, and ionizing radiation induce mainly acute myeloid leukemia through DNA-damaging mechanisms that result in either gene or chromosomal mutations. In contrast, biological agents and a few immunosuppressive chemicals induce primarily lymphoid neoplasms through mechanisms that involve alterations in immune response. Among the environmental agents examined, benzene was clearly associated with acute myeloid leukemia in humans, with increasing but still limited evidence for an association with lymphoid neoplasms. Ethylene oxide and 1,3-butadiene were linked primarily to lymphoid cancers. Although the association between formaldehyde and leukemia remains controversial, several recent evaluations have indicated a potential link between formaldehyde and acute myeloid leukemia. The four environmental agents examined in detail were all genotoxic, inducing gene mutations, chromosomal alterations, and/or micronuclei in vivo. Although it is clear that rapid progress has been made in recent years in our understanding of leukemogenesis, many questions remain for future research regarding chemically induced leukemias and lymphomas, including the mechanisms by which the environmental agents reviewed here induce these diseases and the risks associated with exposures to such agents.
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Pendleton M, Lindsey RH, Felix CA, Grimwade D, Osheroff N. Topoisomerase II and leukemia. Ann N Y Acad Sci 2014; 1310:98-110. [PMID: 24495080 DOI: 10.1111/nyas.12358] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Type II topoisomerases are essential enzymes that modulate DNA under- and overwinding, knotting, and tangling. Beyond their critical physiological functions, these enzymes are the targets for some of the most widely prescribed anticancer drugs (topoisomerase II poisons) in clinical use. Topoisomerase II poisons kill cells by increasing levels of covalent enzyme-cleaved DNA complexes that are normal reaction intermediates. Drugs such as etoposide, doxorubicin, and mitoxantrone are frontline therapies for a variety of solid tumors and hematological malignancies. Unfortunately, their use also is associated with the development of specific leukemias. Regimens that include etoposide or doxorubicin are linked to the occurrence of acute myeloid leukemias that feature rearrangements at chromosomal band 11q23. Similar rearrangements are seen in infant leukemias and are associated with gestational diets that are high in naturally occurring topoisomerase II-active compounds. Finally, regimens that include mitoxantrone and epirubicin are linked to acute promyelocytic leukemias that feature t(15;17) rearrangements. The first part of this article will focus on type II topoisomerases and describe the mechanism of enzyme and drug action. The second part will discuss how topoisomerase II poisons trigger chromosomal breaks that lead to leukemia and potential approaches for dissociating the actions of drugs from their leukemogenic potential.
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Affiliation(s)
- Maryjean Pendleton
- Department of Biochemistry, Vanderbilt University School of Medicine, Nashville, Tennessee
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33
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Gómez-Herreros F, Romero-Granados R, Zeng Z, Álvarez-Quilón A, Quintero C, Ju L, Umans L, Vermeire L, Huylebroeck D, Caldecott KW, Cortés-Ledesma F. TDP2-dependent non-homologous end-joining protects against topoisomerase II-induced DNA breaks and genome instability in cells and in vivo. PLoS Genet 2013; 9:e1003226. [PMID: 23505375 PMCID: PMC3592926 DOI: 10.1371/journal.pgen.1003226] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 11/21/2012] [Indexed: 01/03/2023] Open
Abstract
Anticancer topoisomerase "poisons" exploit the break-and-rejoining mechanism of topoisomerase II (TOP2) to generate TOP2-linked DNA double-strand breaks (DSBs). This characteristic underlies the clinical efficacy of TOP2 poisons, but is also implicated in chromosomal translocations and genome instability associated with secondary, treatment-related, haematological malignancy. Despite this relevance for cancer therapy, the mechanistic aspects governing repair of TOP2-induced DSBs and the physiological consequences that absent or aberrant repair can have are still poorly understood. To address these deficits, we employed cells and mice lacking tyrosyl DNA phosphodiesterase 2 (TDP2), an enzyme that hydrolyses 5'-phosphotyrosyl bonds at TOP2-associated DSBs, and studied their response to TOP2 poisons. Our results demonstrate that TDP2 functions in non-homologous end-joining (NHEJ) and liberates DSB termini that are competent for ligation. Moreover, we show that the absence of TDP2 in cells impairs not only the capacity to repair TOP2-induced DSBs but also the accuracy of the process, thus compromising genome integrity. Most importantly, we find this TDP2-dependent NHEJ mechanism to be physiologically relevant, as Tdp2-deleted mice are sensitive to TOP2-induced damage, displaying marked lymphoid toxicity, severe intestinal damage, and increased genome instability in the bone marrow. Collectively, our data reveal TDP2-mediated error-free NHEJ as an efficient and accurate mechanism to repair TOP2-induced DSBs. Given the widespread use of TOP2 poisons in cancer chemotherapy, this raises the possibility of TDP2 being an important etiological factor in the response of tumours to this type of agent and in the development of treatment-related malignancy.
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Affiliation(s)
| | - Rocío Romero-Granados
- Centro Andaluz de Biología Molecular y Medicina Regenerativa (CABIMER), CSIC–Universidad de Sevilla (Departamento de Genética), Sevilla, Spain
| | - Zhihong Zeng
- Genome Damage and Stability Centre, University of Sussex, Falmer, United Kingdom
| | - Alejandro Álvarez-Quilón
- Centro Andaluz de Biología Molecular y Medicina Regenerativa (CABIMER), CSIC–Universidad de Sevilla (Departamento de Genética), Sevilla, Spain
| | - Cristina Quintero
- Centro Andaluz de Biología Molecular y Medicina Regenerativa (CABIMER), CSIC–Universidad de Sevilla (Departamento de Genética), Sevilla, Spain
| | - Limei Ju
- Genome Damage and Stability Centre, University of Sussex, Falmer, United Kingdom
| | - Lieve Umans
- Laboratory of Molecular Biology (Celgen), Department of Development and Regeneration, University of Leuven, Leuven, Belgium
| | - Liesbeth Vermeire
- Laboratory of Molecular Biology (Celgen), Department of Development and Regeneration, University of Leuven, Leuven, Belgium
| | - Danny Huylebroeck
- Laboratory of Molecular Biology (Celgen), Department of Development and Regeneration, University of Leuven, Leuven, Belgium
| | - Keith W. Caldecott
- Genome Damage and Stability Centre, University of Sussex, Falmer, United Kingdom
- * E-mail: (KWC); (FC-L)
| | - Felipe Cortés-Ledesma
- Centro Andaluz de Biología Molecular y Medicina Regenerativa (CABIMER), CSIC–Universidad de Sevilla (Departamento de Genética), Sevilla, Spain
- * E-mail: (KWC); (FC-L)
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Koontz MZ, Horning SJ, Balise R, Greenberg PL, Rosenberg SA, Hoppe RT, Advani RH. Risk of therapy-related secondary leukemia in Hodgkin lymphoma: the Stanford University experience over three generations of clinical trials. J Clin Oncol 2013; 31:592-8. [PMID: 23295809 DOI: 10.1200/jco.2012.44.5791] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To assess therapy-related acute myeloid leukemia/myelodysplastic syndrome (t-AML/MDS) risk in patients treated for Hodgkin lymphoma (HL) on successive generations of Stanford clinical trials. PATIENTS AND METHODS Patients with HL treated at Stanford with at least 5 years of follow-up after completing therapy were identified from our database. Records were reviewed for outcome and development of t-AML/MDS. RESULTS Seven hundred fifty-four patients treated from 1974 to 2003 were identified. Therapy varied across studies. Radiotherapy evolved from extended fields (S and C studies) to involved fields (G studies). Primary chemotherapy was mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) or procarbazine, mechlorethamine, and vinblastine (PAVe) in S studies; MOPP, PAVe, vinblastine, bleomycin, and methotrexate (VBM), or doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) in C studies; and VbM (reduced dose of bleomycin compared with VBM) or mechlorethamine, doxorubicin, vinblastine, vincristine, bleomycin, etoposide, and prednisone (Stanford V) in G studies. Cumulative exposure to alkylating agent (AA) was notably lower in the G studies compared with the S and C studies, with a 75% to 83% lower dose of nitrogen mustard in addition to omission of procarbazine and melphalan. Twenty-four (3.2%) of 754 patients developed t-AML/MDS, 15 after primary chemotherapy and nine after salvage chemotherapy for relapsed HL. The incidence of t-AML/MDS was significantly lower in the G studies (0.3%) compared with the S (5.7%) or C (5.2%) studies (P < .001). Additionally, in the G studies, no t-AML/MDS was noted after primary therapy, and the only patient who developed t-AML/MDS did so after second-line therapy. CONCLUSION Our data demonstrate the relationship between the cumulative AA dose and t-AML/MDS. Limiting the dose of AA and decreased need for secondary treatments have significantly reduced the incidence of t-AML/MDS, which was extremely rare in the G studies (Stanford V era).
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Affiliation(s)
- Michael Zach Koontz
- Stanford University Medical Center, 875 Blake Wilbur Dr, CC-2338, Stanford, CA 94305, USA
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Racke F, Cole C, Walker A, Jones J, Heerema NA. Therapy-related pro-B cell acute lymphoblastic leukemia: report of two patients with MLL amplification. Cancer Genet 2012; 205:653-6. [PMID: 23238285 DOI: 10.1016/j.cancergen.2012.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 10/29/2012] [Accepted: 11/03/2012] [Indexed: 11/30/2022]
Abstract
Improvements in chemotherapy and medical support of patients treated with chemotherapy and radiation have led to an ever-increasing number of cancer survivors. Unfortunately, a small fraction of these patients develop secondary hematologic malignancies as a consequence of their exposure to genotoxic anti-cancer regimens. Most of these are myeloid malignancies, therapy-related acute myeloid leukemia (t-AML) or myelodysplasia (t-MDS); however, a small but growing body of literature exists, which describes therapy-related acute lymphoblastic leukemias (t-ALL). Nearly all these cases are reportedly associated with translocations involving chromosome 11q23, the site of the MLL gene. We herein report two cases of ALL occurring after chemotherapy for other malignancies that showed complex karyotypic abnormalities and distinct MLL amplification by fluorescence in situ hybridization analysis. Immunophenotypic analysis showed that both cases expressed a pro-B cell (CD10-) phenotype with aberrant myeloid antigen expression. Although MLL amplification has been reported in therapy-related myeloid disease, to our knowledge this is the first report of MLL amplification occurring in therapy-related B cell ALL.
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Affiliation(s)
- Frederick Racke
- Comprehensive Cancer Center, Department of Pathology, Wexner Medical Center at The Ohio State University, Columbus, OH, USA
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36
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Tang G, Zuo Z, Thomas DA, Lin P, Liu D, Hu Y, Kantarjian HM, Bueso-Ramos C, Medeiros LJ, Wang SA. Precursor B-acute lymphoblastic leukemia occurring in patients with a history of prior malignancies: is it therapy-related? Haematologica 2011; 97:919-25. [PMID: 22207681 DOI: 10.3324/haematol.2011.057752] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Precursor B-acute lymphoblastic leukemia occurring in patients with a history of malignancies is uncommon, and this condition is not well understood. DESIGN AND METHODS A retrospective review of 457 adults with precursor B-acute lymphoblastic leukemia treated at our hospital identified 44 (9.6%) patients with prior malignancies. The clinical and genetic characteristics of this group of patients was compared with those of their counterparts with de novo disease and the relationship with prior chemoradiation therapy was assessed. RESULTS Thirty of 44(6.2%) patients received cytotoxic therapies, whereas 14 patients did not. The former group showed a significantly shorter interval from prior malignancy to onset of precursor B-acute lymphoblastic leukemia (36 versus 144 months; P = 0.002). Compared with 413 de novo cases, the frequencies of t(4;11)(q21;q23) (P<0.001) and hypodiploidy (P = 0.009) with loss of chromosome 5, 7 or 17 were significantly higher in patients who received topoisomerase II inhibitor and/or alkylating agents. By contrast, Philadelphia-positive and normal karyotype were more frequent in patients who either did not receive chemotherapy or received only local radiation or nucleoside analogs. Patients with precursor B-acute lymphoblastic leukemia following prior malignancies and chemoradiation were older, had a lower complete remission rate and showed an inferior survival in univariate, but not multivariate analysis. CONCLUSIONS The data support the interpretation that therapy-related precursor B-acute lymphoblastic leukemia does occur. In particular, cases associated with t(4;11)(q21;q23) or hypodiploidy with -5, -7, -17 are likely to be therapy-related and have a poor prognosis. The inferior outcome of these patients may be attributable to the high-risk cytogenetic abnormalities that are found in this group of patients.
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Affiliation(s)
- Guilin Tang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Roy SK, Eastmond DA. Bimolane induces multiple types of chromosomal aberrations in human lymphocytes in vitro. Mutat Res 2011; 726:181-7. [PMID: 21944901 DOI: 10.1016/j.mrgentox.2011.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 09/09/2011] [Accepted: 09/10/2011] [Indexed: 10/25/2022]
Abstract
Bimolane has been commonly used in China for the treatment of psoriasis and various types of cancer. Patients treated with bimolane have been reported to have an increased risk of developing therapy-related leukemias. Although bimolane has been identified as a human leukemia-inducing agent, little is known about its genotoxic effects, and a systematic study of the types of chromosomal alterations induced by this compound has not been performed. In this study, a combination of immunochemical, molecular and conventional cytogenetic techniques has been used to study the chromosomal alterations induced by bimolane in cultured human lymphocytes. Immunochemical staining with the CREST antibody indicated that bimolane induces micronuclei (MN) originating primarily from chromosome breakage. Interestingly fluorescence in situ hybridization (FISH) with differentially labeled chromosomes 1 and 9 centromeric probes indicated that bimolane also caused non-disjunction and polyploidy. Consistent with this, an expedited analysis of Giemsa-stained metaphase chromosomes in bimolane-treated lymphocytes revealed a high frequency of polyploidy/hyperdiploidy as well as dicentric chromosomes, and premature centromeric division (PCD). In addition, bimolane was also found to produce binucleated cells, possibly through an interference with normal functioning of intermediate filaments. As a follow-up to these studies, three different types of commercially available bimolane formulations obtained from different Chinese manufacturers were also evaluated. The effects seen with the formulated bimolane were similar to those seen with the synthesized compound. Our studies indicate that bimolane effectively induces a variety of cellular and chromosomal changes in cultured lymphocytes and that similar alterations occurring in bone marrow stem cells could contribute to the development of the secondary cancers seen in bimolane-treated patients.
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Affiliation(s)
- Shambhu K Roy
- Department of Cell Biology & Neuroscience, University of California, Riverside, CA 92521, USA
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38
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Yoo BJ, Nam MH, Sung HJ, Lim CS, Lee CK, Cho YJ, Lee KN, Yoon SY. A case of therapy-related acute lymphoblastic leukemia with t(11;19)(q23;p13.3) and MLL/MLLT1 gene rearrangement. Korean J Lab Med 2011; 31:13-7. [PMID: 21239865 PMCID: PMC3111038 DOI: 10.3343/kjlm.2011.31.1.13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Therapy-related ALL (t-ALL) is a rare secondary leukemia that develops after chemotherapy and/or radiotherapy for primary malignancies. Chromosomal 11q23 abnormalities are the most common karyotypic alterations in t-ALL. The t(11;19)(q23;p13) aberration is extremely rare and has not been confirmed at the molecular genetic level. Here, we report a case of t-ALL with t(11;19)(q23;p13.3) and MLL-MLLT1 (alias ENL) gene rearrangement confirmed by cytogenetic analysis, multiplex reverse transcription-PCR (multiplex RT-PCR), and DNA sequencing in a patient who had undergone treatment for breast cancer. A 40-yr-old woman developed acute leukemia 15 months after undergoing 6 cycles of adjuvant chemotherapy (doxorubicin 60 mg/m2 and cyclophosphamide 600 mg/m2), radiation therapy (dose, 5,900 cGy), and anticancer endocrine therapy with tamoxifen. The complete blood cell counts and bone marrow examination showed increased blasts and the blasts showed B lineage immunophenotype (positive for CD19, CD34, and cytoplasmic CD79a). Cytogenetic analysis revealed the karyotype 47,XX,+X,t(11;19)(q23;p13.3)[4]/46,XX[16]. FISH analyses, multiplex RT-PCR, and DNA sequencing confirmed the MLL-MLLT1 gene rearrangement. The patient underwent induction chemotherapy with fractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (Hyper-CVAD) and achieved complete remission. Subsequently, she underwent consolidation chemotherapy, but died of brain ischemia in the pons and the region of the middle cerebral artery. To our knowledge, this is the first case report of t-ALL with t(11;19)(q23;p13.3) and the MLL-MLLT1 gene rearrangement.
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Affiliation(s)
- Byong-Joon Yoo
- Department of Laboratory Medicine, Korea University College of Medicine, Seoul, Korea
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Wiseman DH. Donor cell leukemia: a review. Biol Blood Marrow Transplant 2010; 17:771-89. [PMID: 20951819 DOI: 10.1016/j.bbmt.2010.10.010] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 10/08/2010] [Indexed: 10/18/2022]
Abstract
Relapse of acute leukemia following hematopoietic stem cell transplantation (HSCT) usually represents return of an original disease clone, having evaded eradication by pretransplant chemo-/radiotherapy, conditioning, or posttransplant graft-versus-leukemia (GVL) effect. Rarely, acute leukemia can develop de novo in engrafted cells of donor origin. Donor cell leukemia (DCL) was first recognized in 1971, but for many years, the paucity of reported cases suggested it to be a rare phenomenon. However, in recent years, an upsurge in reported cases (in parallel with advances in molecular chimerism monitoring) suggest that it may be significantly more common than previously appreciated; emerging evidence suggests that DCL might represent up to 5% of all posttransplant leukemia "relapses." Recognition of DCL is important for several reasons. Donor-derivation of the leukemic clone has implications when selecting appropriate therapy, because seeking to enhance an allogeneic GVL effect would intuitively not have the same role as in standard recipient-derived relapses. There are also broader implications for donor selection and workup, particularly given the growing popularity of nonmyeloblative HSCT and corresponding rising age of the potential donor pool. Identification of DCL raises potential concerns over future health of the donor, posing ethical dilemmas regarding responsibilities toward donor notification (particularly in the context of cord blood transplantation). The entity of DCL is also of research interest, because it might provide a unique human model for studying the mechanisms of leukemogenesis in vivo. This review presents and collates all reported cases of DCL, and discusses the various strategies, controversies, and pitfalls when investigating origin of posttransplant relapse. Putative etiologic factors and mechanisms are proposed, and attempts made to address the difficult ethical questions posed by discovery of donor-derived malignancy within a HSCT recipient.
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Affiliation(s)
- Daniel H Wiseman
- Haematology Department, Manchester Royal Infirmary, Manchester, United Kingdom.
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40
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Shamsian BS, Gharib A, Rezaei N, Esfahani SA, Alavi S, Goudarzipour K, Arzanian MT. Development of secondary T-cell acute lymphoblastic leukemia in a child with hemophagocytic lymphohistiocytosis. Pediatr Blood Cancer 2010; 55:725-6. [PMID: 20589661 DOI: 10.1002/pbc.22578] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a severe life-threatening disorder, characterized by hyperactivation of macrophages. A 12-year-old female was referred to our center; the diagnosis of HLH was made for the patient and immunosuppressive regimen was started. After a 2-year follow-up, the patient developed secondary T-cell acute lymphoblastic leukemia (T-ALL), confirmed by flow cytometric studies. Treatment was started based on T-ALL protocol, but the patient died because of relapse and sepsis. This case highlights the issue of secondary malignancy following HLH and demonstrates the need for continued follow-up in such patients.
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Affiliation(s)
- Bibi Shahin Shamsian
- Department of Pediatric Hematology-Oncology, Mofid Children's Hospital, Shahid Beheshti Medical University, Tehran, Iran.
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Montesinos P, González JD, González J, Rayón C, de Lisa E, Amigo ML, Ossenkoppele GJ, Peñarrubia MJ, Pérez-Encinas M, Bergua J, Debén G, Sayas MJ, de la Serna J, Ribera JM, Bueno J, Milone G, Rivas C, Brunet S, Löwenberg B, Sanz M. Therapy-Related Myeloid Neoplasms in Patients With Acute Promyelocytic Leukemia Treated With All-Trans-Retinoic Acid and Anthracycline-Based Chemotherapy. J Clin Oncol 2010; 28:3872-9. [DOI: 10.1200/jco.2010.29.2268] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose We analyzed the incidence, risk factors, and outcome of therapy-related myeloid neoplasms (t-MNs) in patients with acute promyelocytic leukemia (APL) in first complete remission (CR). Patients and Methods From 1996 to 2008, 1,025 patients with APL were enrolled onto three sequential trials (LPA96, LPA99, and LPA2005) of the Programa Español para el Tratamiento de Enfermedades Hematológicas and received induction and consolidation therapy with all-trans-retinoic acid (ATRA) and anthracycline-based chemotherapy. Results Seventeen of 918 patients who achieved CR developed t-MN (10 with < 20% and seven with ≥ 20% of bone marrow blasts) after a median of 43 months from CR. Partial and complete deletions of chromosomes 5 and 7 (nine patients) and 11q23 rearrangements (three patients) were the most common cytogenetic abnormalities. Overall, the 6-year cumulative incidence of t-MN was 2.2%, whereas in low-, intermediate-, and high-risk patients, the 6-year incidence was 5.2%, 2.1%, and 0%, respectively. Multivariate analysis identified age more than 35 years and lower relapse risk score as independent prognostic factors for t-MN. The median overall survival time after t-MN was 10 months. Conclusion t-MN is a relatively infrequent, long-term, and severe complication after first-line treatment for APL with ATRA and anthracycline-based regimens. Therapeutic strategies to reduce the incidence of t-MN are warranted.
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Affiliation(s)
- Pau Montesinos
- From the Hospital Universitario La Fe; Hospital Doctor Peset, Valencia; Hospital Insular, Las Palmas; Hospital Universitario Virgen del Rocío, Sevilla; Hospital Central de Asturias, Oviedo; Hospital General, Murcia; Hospital Río Hortega, Valladolid; Hospital Clínico Universitario, Santiago de Compostela; Hospital San Pedro de Alcántara, Cáceres; Hospital Juan Canalejo, A Coruña; Hospital 12 de Octubre, Madrid; Hospital Germans Tries i Pujol; Hospital Universitario Valle d′Hebron; Hospital Sant Pau,
| | - José D. González
- From the Hospital Universitario La Fe; Hospital Doctor Peset, Valencia; Hospital Insular, Las Palmas; Hospital Universitario Virgen del Rocío, Sevilla; Hospital Central de Asturias, Oviedo; Hospital General, Murcia; Hospital Río Hortega, Valladolid; Hospital Clínico Universitario, Santiago de Compostela; Hospital San Pedro de Alcántara, Cáceres; Hospital Juan Canalejo, A Coruña; Hospital 12 de Octubre, Madrid; Hospital Germans Tries i Pujol; Hospital Universitario Valle d′Hebron; Hospital Sant Pau,
| | - José González
- From the Hospital Universitario La Fe; Hospital Doctor Peset, Valencia; Hospital Insular, Las Palmas; Hospital Universitario Virgen del Rocío, Sevilla; Hospital Central de Asturias, Oviedo; Hospital General, Murcia; Hospital Río Hortega, Valladolid; Hospital Clínico Universitario, Santiago de Compostela; Hospital San Pedro de Alcántara, Cáceres; Hospital Juan Canalejo, A Coruña; Hospital 12 de Octubre, Madrid; Hospital Germans Tries i Pujol; Hospital Universitario Valle d′Hebron; Hospital Sant Pau,
| | - Chelo Rayón
- From the Hospital Universitario La Fe; Hospital Doctor Peset, Valencia; Hospital Insular, Las Palmas; Hospital Universitario Virgen del Rocío, Sevilla; Hospital Central de Asturias, Oviedo; Hospital General, Murcia; Hospital Río Hortega, Valladolid; Hospital Clínico Universitario, Santiago de Compostela; Hospital San Pedro de Alcántara, Cáceres; Hospital Juan Canalejo, A Coruña; Hospital 12 de Octubre, Madrid; Hospital Germans Tries i Pujol; Hospital Universitario Valle d′Hebron; Hospital Sant Pau,
| | - Elena de Lisa
- From the Hospital Universitario La Fe; Hospital Doctor Peset, Valencia; Hospital Insular, Las Palmas; Hospital Universitario Virgen del Rocío, Sevilla; Hospital Central de Asturias, Oviedo; Hospital General, Murcia; Hospital Río Hortega, Valladolid; Hospital Clínico Universitario, Santiago de Compostela; Hospital San Pedro de Alcántara, Cáceres; Hospital Juan Canalejo, A Coruña; Hospital 12 de Octubre, Madrid; Hospital Germans Tries i Pujol; Hospital Universitario Valle d′Hebron; Hospital Sant Pau,
| | - Maria L. Amigo
- From the Hospital Universitario La Fe; Hospital Doctor Peset, Valencia; Hospital Insular, Las Palmas; Hospital Universitario Virgen del Rocío, Sevilla; Hospital Central de Asturias, Oviedo; Hospital General, Murcia; Hospital Río Hortega, Valladolid; Hospital Clínico Universitario, Santiago de Compostela; Hospital San Pedro de Alcántara, Cáceres; Hospital Juan Canalejo, A Coruña; Hospital 12 de Octubre, Madrid; Hospital Germans Tries i Pujol; Hospital Universitario Valle d′Hebron; Hospital Sant Pau,
| | - Gert J. Ossenkoppele
- From the Hospital Universitario La Fe; Hospital Doctor Peset, Valencia; Hospital Insular, Las Palmas; Hospital Universitario Virgen del Rocío, Sevilla; Hospital Central de Asturias, Oviedo; Hospital General, Murcia; Hospital Río Hortega, Valladolid; Hospital Clínico Universitario, Santiago de Compostela; Hospital San Pedro de Alcántara, Cáceres; Hospital Juan Canalejo, A Coruña; Hospital 12 de Octubre, Madrid; Hospital Germans Tries i Pujol; Hospital Universitario Valle d′Hebron; Hospital Sant Pau,
| | - María J. Peñarrubia
- From the Hospital Universitario La Fe; Hospital Doctor Peset, Valencia; Hospital Insular, Las Palmas; Hospital Universitario Virgen del Rocío, Sevilla; Hospital Central de Asturias, Oviedo; Hospital General, Murcia; Hospital Río Hortega, Valladolid; Hospital Clínico Universitario, Santiago de Compostela; Hospital San Pedro de Alcántara, Cáceres; Hospital Juan Canalejo, A Coruña; Hospital 12 de Octubre, Madrid; Hospital Germans Tries i Pujol; Hospital Universitario Valle d′Hebron; Hospital Sant Pau,
| | - Manuel Pérez-Encinas
- From the Hospital Universitario La Fe; Hospital Doctor Peset, Valencia; Hospital Insular, Las Palmas; Hospital Universitario Virgen del Rocío, Sevilla; Hospital Central de Asturias, Oviedo; Hospital General, Murcia; Hospital Río Hortega, Valladolid; Hospital Clínico Universitario, Santiago de Compostela; Hospital San Pedro de Alcántara, Cáceres; Hospital Juan Canalejo, A Coruña; Hospital 12 de Octubre, Madrid; Hospital Germans Tries i Pujol; Hospital Universitario Valle d′Hebron; Hospital Sant Pau,
| | - Juan Bergua
- From the Hospital Universitario La Fe; Hospital Doctor Peset, Valencia; Hospital Insular, Las Palmas; Hospital Universitario Virgen del Rocío, Sevilla; Hospital Central de Asturias, Oviedo; Hospital General, Murcia; Hospital Río Hortega, Valladolid; Hospital Clínico Universitario, Santiago de Compostela; Hospital San Pedro de Alcántara, Cáceres; Hospital Juan Canalejo, A Coruña; Hospital 12 de Octubre, Madrid; Hospital Germans Tries i Pujol; Hospital Universitario Valle d′Hebron; Hospital Sant Pau,
| | - Guillermo Debén
- From the Hospital Universitario La Fe; Hospital Doctor Peset, Valencia; Hospital Insular, Las Palmas; Hospital Universitario Virgen del Rocío, Sevilla; Hospital Central de Asturias, Oviedo; Hospital General, Murcia; Hospital Río Hortega, Valladolid; Hospital Clínico Universitario, Santiago de Compostela; Hospital San Pedro de Alcántara, Cáceres; Hospital Juan Canalejo, A Coruña; Hospital 12 de Octubre, Madrid; Hospital Germans Tries i Pujol; Hospital Universitario Valle d′Hebron; Hospital Sant Pau,
| | - María J. Sayas
- From the Hospital Universitario La Fe; Hospital Doctor Peset, Valencia; Hospital Insular, Las Palmas; Hospital Universitario Virgen del Rocío, Sevilla; Hospital Central de Asturias, Oviedo; Hospital General, Murcia; Hospital Río Hortega, Valladolid; Hospital Clínico Universitario, Santiago de Compostela; Hospital San Pedro de Alcántara, Cáceres; Hospital Juan Canalejo, A Coruña; Hospital 12 de Octubre, Madrid; Hospital Germans Tries i Pujol; Hospital Universitario Valle d′Hebron; Hospital Sant Pau,
| | - Javier de la Serna
- From the Hospital Universitario La Fe; Hospital Doctor Peset, Valencia; Hospital Insular, Las Palmas; Hospital Universitario Virgen del Rocío, Sevilla; Hospital Central de Asturias, Oviedo; Hospital General, Murcia; Hospital Río Hortega, Valladolid; Hospital Clínico Universitario, Santiago de Compostela; Hospital San Pedro de Alcántara, Cáceres; Hospital Juan Canalejo, A Coruña; Hospital 12 de Octubre, Madrid; Hospital Germans Tries i Pujol; Hospital Universitario Valle d′Hebron; Hospital Sant Pau,
| | - Josep M. Ribera
- From the Hospital Universitario La Fe; Hospital Doctor Peset, Valencia; Hospital Insular, Las Palmas; Hospital Universitario Virgen del Rocío, Sevilla; Hospital Central de Asturias, Oviedo; Hospital General, Murcia; Hospital Río Hortega, Valladolid; Hospital Clínico Universitario, Santiago de Compostela; Hospital San Pedro de Alcántara, Cáceres; Hospital Juan Canalejo, A Coruña; Hospital 12 de Octubre, Madrid; Hospital Germans Tries i Pujol; Hospital Universitario Valle d′Hebron; Hospital Sant Pau,
| | - Javier Bueno
- From the Hospital Universitario La Fe; Hospital Doctor Peset, Valencia; Hospital Insular, Las Palmas; Hospital Universitario Virgen del Rocío, Sevilla; Hospital Central de Asturias, Oviedo; Hospital General, Murcia; Hospital Río Hortega, Valladolid; Hospital Clínico Universitario, Santiago de Compostela; Hospital San Pedro de Alcántara, Cáceres; Hospital Juan Canalejo, A Coruña; Hospital 12 de Octubre, Madrid; Hospital Germans Tries i Pujol; Hospital Universitario Valle d′Hebron; Hospital Sant Pau,
| | - Gustavo Milone
- From the Hospital Universitario La Fe; Hospital Doctor Peset, Valencia; Hospital Insular, Las Palmas; Hospital Universitario Virgen del Rocío, Sevilla; Hospital Central de Asturias, Oviedo; Hospital General, Murcia; Hospital Río Hortega, Valladolid; Hospital Clínico Universitario, Santiago de Compostela; Hospital San Pedro de Alcántara, Cáceres; Hospital Juan Canalejo, A Coruña; Hospital 12 de Octubre, Madrid; Hospital Germans Tries i Pujol; Hospital Universitario Valle d′Hebron; Hospital Sant Pau,
| | - Concha Rivas
- From the Hospital Universitario La Fe; Hospital Doctor Peset, Valencia; Hospital Insular, Las Palmas; Hospital Universitario Virgen del Rocío, Sevilla; Hospital Central de Asturias, Oviedo; Hospital General, Murcia; Hospital Río Hortega, Valladolid; Hospital Clínico Universitario, Santiago de Compostela; Hospital San Pedro de Alcántara, Cáceres; Hospital Juan Canalejo, A Coruña; Hospital 12 de Octubre, Madrid; Hospital Germans Tries i Pujol; Hospital Universitario Valle d′Hebron; Hospital Sant Pau,
| | - Salut Brunet
- From the Hospital Universitario La Fe; Hospital Doctor Peset, Valencia; Hospital Insular, Las Palmas; Hospital Universitario Virgen del Rocío, Sevilla; Hospital Central de Asturias, Oviedo; Hospital General, Murcia; Hospital Río Hortega, Valladolid; Hospital Clínico Universitario, Santiago de Compostela; Hospital San Pedro de Alcántara, Cáceres; Hospital Juan Canalejo, A Coruña; Hospital 12 de Octubre, Madrid; Hospital Germans Tries i Pujol; Hospital Universitario Valle d′Hebron; Hospital Sant Pau,
| | - Bob Löwenberg
- From the Hospital Universitario La Fe; Hospital Doctor Peset, Valencia; Hospital Insular, Las Palmas; Hospital Universitario Virgen del Rocío, Sevilla; Hospital Central de Asturias, Oviedo; Hospital General, Murcia; Hospital Río Hortega, Valladolid; Hospital Clínico Universitario, Santiago de Compostela; Hospital San Pedro de Alcántara, Cáceres; Hospital Juan Canalejo, A Coruña; Hospital 12 de Octubre, Madrid; Hospital Germans Tries i Pujol; Hospital Universitario Valle d′Hebron; Hospital Sant Pau,
| | - Miguel Sanz
- From the Hospital Universitario La Fe; Hospital Doctor Peset, Valencia; Hospital Insular, Las Palmas; Hospital Universitario Virgen del Rocío, Sevilla; Hospital Central de Asturias, Oviedo; Hospital General, Murcia; Hospital Río Hortega, Valladolid; Hospital Clínico Universitario, Santiago de Compostela; Hospital San Pedro de Alcántara, Cáceres; Hospital Juan Canalejo, A Coruña; Hospital 12 de Octubre, Madrid; Hospital Germans Tries i Pujol; Hospital Universitario Valle d′Hebron; Hospital Sant Pau,
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Cho J, Hur M, Moon HW, Yun YM, Lee CH, Lee HG. A case of therapy-related ALL with MLL gene rearrangement following treatment of breast cancer. Korean J Lab Med 2010; 30:255-9. [PMID: 20603585 DOI: 10.3343/kjlm.2010.30.3.255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
ALL with MLL gene rearrangement secondary to chemotherapy has been rarely reported. We report a case of therapy-related ALL (t-ALL) with MLL gene rearrangement in a patient who had undergone treatment for breast cancer. A 60-yr-old woman with breast cancer underwent breast-conserving surgery followed by 6 cycles of adjuvant chemotherapy (cyclophosphamide, epirubicin, and fluorouracil) and radiation therapy (dose, 5,040 cGy to the left breast and a 1,000 cGy boost to the tumor bed). A follow-up examination performed 14 months after the chemotherapy revealed no evidence of breast malignancy. However, the patient's complete blood cell count indicated acute leukemia: white blood cell count, 174.1 x 10(9)/L with 88% blasts; Hb level, 12.5 g/dL; and platelet count, 103.0 x 10(9)/L. Examination of the bone marrow aspirate smear revealed a high percentage of blasts (85.1% of all nucleated cells); the blasts showed a pro-B immunophenotype and were positive for CD19, CD79a, HLA-DR, CD34, and terminal deoxynucleotidyl transferase (TdT). Cytogenetic and FISH analyses revealed t(4;11)(q21;q23) and MLL gene rearrangement, respectively. The patient received induction chemotherapy with cyclophosphamide, vincristine, doxorubicin, and dexamethasone and achieved complete remission. Following consolidation chemotherapy, she underwent allogenic peripheral blood stem cell transplantation and has been clinically stable. To our knowledge, this is the first reported case of t-ALL with MLL gene rearrangement following treatment of breast cancer in Korea.
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Affiliation(s)
- Jinhee Cho
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea
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Mimura N, Tsujimura H, Ise M, Sakai C, Takagi T, Nagata M, Kumagai K. Therapy-related leukemia following chemoradiotherapy for esophageal cancer. Eur J Haematol 2010; 85:353-7. [PMID: 20546022 DOI: 10.1111/j.1600-0609.2010.01487.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chemoradiotherapy has improved the outcome of patients with esophageal cancer. Although a sufficiently long-time survival has resulted in the increase of several treatment-related late toxicities, little is still known about the incidence of secondary malignancies. In our hospital, 348 patients with esophageal cancer received chemotherapy consisting of nedaplatin and 5-fluorouracil and concurrent irradiation. Median and average follow-up durations were 8 and 21 months (1-92), respectively. Four patients developed leukemia after 19-48 months of follow-up. Two patients were diagnosed with overt leukemia from myelodysplastic syndrome presenting a complex karyotype, including the deletion of chromosome 5 or 7. Notably, one patient showed an additional chromosomal abnormality with t(9;22)(q34;q11). Other patients developed acute myeloid leukemia with t(9;22)(q34;q11) and Burkitt leukemia with t(8;14)(q24;q32). All patients eventually succumbed to leukemia. Platinum and fluorouracil have shown relatively lower risks for secondary malignancies in comparison with alkylating agents and topoisomerase II inhibitors. Especially, nedaplatin has never been described to introduce secondary neoplasms. Our report supports the idea that the concurrent administration of radiotherapy with these agents affects the risk of leukemia. Interestingly, rare balanced chromosomal abnormalities were observed in the present cases, thus providing new insights into the leukemogenesis of therapy-related leukemia.
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Affiliation(s)
- Naoya Mimura
- Division of Hematology-Oncology Division of Gastroenterological Surgery, Chiba Cancer Center, Chiba, Japan
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Secondary hematological malignancies following breast cancer treatment. Oncol Rev 2010. [DOI: 10.1007/s12156-010-0037-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Chen W, Wang E, Lu Y, Gaal KK, Huang Q. Therapy-related acute lymphoblastic leukemia without 11q23 abnormality: report of six cases and a literature review. Am J Clin Pathol 2010; 133:75-82. [PMID: 20023261 DOI: 10.1309/ajcpywc6aqc7bavj] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Therapy-related acute lymphoblastic leukemia (t-ALL) is a rare secondary leukemia following chemotherapy and/or radiotherapy for primary malignancies. Chromosomal 11q23 abnormality, frequently detected in therapy-related acute myeloid leukemia, is the most common cytogenetic alteration in t-ALL. However, t-ALL cases without 11q23 abnormality have been rarely described. We describe 6 adults with secondary t-ALL without 11q23 abnormalities following various treatment regimens for primary malignancies. We also reviewed 48 t-ALL cases, with complete chromosomal karyotyping, reported in the literature from 1992 to 2007. In the 48 cases, an 11q23 abnormality involving the MLL gene locus was the predominant chromosomal aberration (32 [67%]), followed by t(9;22) (6 [13%]) and a normal karyotype (4 [8%]). Compared with t-ALL cases with an 11q23 abnormality, cases without an 11q23 abnormality had a relatively longer latency period (median, 36 vs 19 months) and a different primary malignancy spectrum. No major difference was observed between groups in regard to age, sex, or receipt of a topoisomerase II inhibitor. The t(8;14)(q11.2;q32), a rare, nonrandom, balanced chromosomal translocation differing from the more common translocation involving c-MYC on chromosome 8q24, was seen in 1 adult t-ALL case, which may suggest another possible pathogenesis of this disease.
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46
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Cole M, Strair R. Acute Myelogenous Leukemia and Myelodysplasia Secondary to Breast Cancer Treatment: Case Studies and Literature Review. Am J Med Sci 2010; 339:36-40. [DOI: 10.1097/maj.0b013e3181bedb74] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Millot F, Brizard F, Sorel N, Preudhomme C, Cividin M, Guilhot F, Brizard A. Therapy-related acute lymphoblastic leukemia with MLL rearrangement following treatment of Burkitt's leukemia. Leuk Lymphoma 2009; 46:925-7. [PMID: 16019540 DOI: 10.1080/10428190500052248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The occurrence of therapy-related acute lymphoblastic leukemia (ALL) is rare and, to our knowledge, is not reported in patients treated for Burkitt's leukemia. We report on a child with ALL with translocation t(4;11)(q21;q23) involving the MLL gene, 13 months after chemotherapy for Burkitt's leukemia. This present observation indicates that caution should be exercised in using high cumulative doses of DNA topoisomerase II inhibitors in such patients.
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Affiliation(s)
- Frederic Millot
- Service d'Oncologie Hématologique et de Thérapie Cellulaire, Universitary Hospital, Poitiers, France.
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Kushner BH, Kramer K, Modak S, Qin LX, Yataghena K, Jhanwar SC, Cheung NKV. Reduced risk of secondary leukemia with fewer cycles of dose-intensive induction chemotherapy in patients with neuroblastoma. Pediatr Blood Cancer 2009; 53:17-22. [PMID: 19148951 PMCID: PMC4079040 DOI: 10.1002/pbc.21931] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND We report a prospective study of secondary leukemia (SL)/myelodysplastic syndrome (MDS) in neuroblastoma (NB) patients treated with > or =5 cycles of dose-intensive chemotherapy. PROCEDURE NB patients received induction with high-dose cyclophosphamide (4,200 mg/m(2))-doxorubicin (75 mg/m(2))-vincristine (cycles 1, 2, 4, 6, 8), and high-dose cisplatin (200 mg/m(2))-etoposide (600 mg/m(2)) (cycles 3, 5, 7). Bone marrow was examined every 1-3 months for > or =36 months, with inclusion of extensive chromosomal studies 1-3 months post-induction and 1-2x/year thereafter. RESULTS One hundred eight four patients received 5 (n = 76), 6 (n = 45), 7 (n = 59), or 8 (n = 4) cycles. Eight patients developed SL/MDS (only one each in the 5- and 6-cycle groups), at 12-50 months, including two cases detected in surveillance studies. Among 108 patients who received > or =6 cycles, the 5-year cumulative incidence was 7.1% (95% CI: 2%, 12.2%), versus 0% among 54 patients who received 5 cycles without maintenance oral etoposide. Five-year cumulative incidences were 1.46%, 2.28%, and 8.47% among patients in the 5-, 6-, and 7-cycle groups, with fewer cycles having a significantly lower risk (P = 0.048). There was no significant association of risk with potentially leukemogenic consolidative treatments (targeted radiotherapy, myeloablative therapy, and oral etoposide). CONCLUSIONS Reducing the number of dose-intensive cycles significantly decreases the risk of SL/MDS, yielding 5-year rates matching the low range (0.4-2.2%) reported for moderate-dose combination chemotherapy regimens used against other pediatric solid tumors.
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Affiliation(s)
- Brian H. Kushner
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065. Tel: 212-639-6793. Fax: 212-717-3239.
| | - Kim Kramer
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065. Tel: 212-639-6410. Fax: 212-717-3239.
| | - Shakeel Modak
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065. Tel: 212-639-7623. Fax: 212-717-3695.
| | - Li-Xuan Qin
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, E. 63 Street, New York, NY 10065, Tel: 646-735-8116; Fax: 646-735-0010;
| | - Karima Yataghena
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065. Tel: 212-639-6140. Fax: 212-717-3492.
| | - Suresh C. Jhanwar
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065. Tel: 212-639-8895. Fax: 212-794-5830.
| | - Nai-Kong V. Cheung
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065. Tel: 646-888-2313. Fax: 212-744-2245.
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Therapy-related acute lymphoblastic leukemia with t(9;22)(q34;q11.2):a case study and review of the literature. ACTA ACUST UNITED AC 2009; 191:51-4. [DOI: 10.1016/j.cancergencyto.2009.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Revised: 01/14/2009] [Accepted: 01/26/2009] [Indexed: 11/17/2022]
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50
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Lee CH, Chou TC, Su TL, Yu J, Shao LE, Yu AL. BO-0742, a derivative of AHMA and N-mustard, has selective toxicity to drug sensitive and drug resistant leukemia cells and solid tumors. Cancer Lett 2008; 276:204-11. [PMID: 19108949 DOI: 10.1016/j.canlet.2008.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Revised: 11/05/2008] [Accepted: 11/07/2008] [Indexed: 11/25/2022]
Abstract
This is a preclinical study of BO-0742, a derivative of 3-(9-acridinylamino)-5-hydroxymethyl-aniline (AHMA) and N-mustard, as an anti-cancer agent. MTS assays revealed a broad spectrum of anti-cancer activities in vitro, with the greatest cytotoxicity against leukemia and neuroblastoma including those with drug resistant characteristics, and a good therapeutic index with leukemia being 10-40 times more sensitive to BO-0742 than hematopoietic progenitors. Administration of BO-0742 at an optimal dose schedule based on its pharmacokinetics significantly suppressed the growth of xenografts of human breast and ovarian cancers in mice. Thus, BO-0742 is a potent anti-cancer agent worthy of further clinical development.
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Affiliation(s)
- Chien-Hsin Lee
- Cellular and Molecular Medicine, Genomics Research Center, 128 Academia Sinica, Section 2, Taipei, Taiwan
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