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Ge S, Wang J, He Q, Zhu J, Liu P, Wang H, Zhang F. Auto-hematopoietic stem cell transplantation or chemotherapy? Meta-analysis of clinical choice for AML. Ann Hematol 2024:10.1007/s00277-024-05632-z. [PMID: 38267560 DOI: 10.1007/s00277-024-05632-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/13/2024] [Indexed: 01/26/2024]
Abstract
For patients with acute myeloid leukemia (AML) who are not candidates for allogeneic stem cell transplantation (SCT) or do not have a human leukocyte antigen (HLA)-matched donor, it is unclear whether autologous SCT (ASCT) has a better prognosis after the first complete response (CR1) compared to further chemotherapy treatment. A meta-analysis evaluating ASCT compared to further chemotherapy for AML patients in CR1 was performed. The Medline, Embase, Cochrane Controlled Trials Registry, Cochrane Library, Web of Science, and National Knowledge Infrastructure of China databases were searched for relevant literature as of May 26, 2023. Eligible studies included prospectively enrolled adults with AML and randomized first-time respondent patients who did not have a matched sibling donor. Fourteen randomized controlled trials were identified and included 4281 participants, of which 1499 patients received ASCT and 2782 underwent chemotherapy and continued follow-up. In patients with AML in CR1, a lower relapse rate was associated with ASCT compared to chemotherapy [odds ratio (OR) = 0.49, 95% confidence interval (CI) = 0.41-0.57]. Significant disease-free survival (DFS; OR = 1.37, 95% CI = 1.02-1.84) and relapse-free survival (RFS; OR = 2.78, 95% CI = 1.28-6.02) ASCT benefits were documented, and there was no difference in the overall survival (OS) when the studies were pooled (OR = 1.12, 95% CI = 0.85-1.48). The study results indicated that after the first remission, AML patients receiving autologous stem cell transplantation had higher DFS and RFS, similar OS, and lower relapse compared to patients undergoing chemotherapy treatment. This indicated that autologous stem cell transplantation may have a better prognosis.
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Affiliation(s)
- Songyu Ge
- First Clinical College, China Medical University, Shenyang, Liaoning Province, China
| | - Jining Wang
- Second Clinical College, China Medical University, Shenyang, Liaoning Province, China
| | - Qin He
- Department of Hematology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jiaqi Zhu
- Department of Hematology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Pai Liu
- Department of Hematology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Hongtao Wang
- Department of Hematology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
| | - Fan Zhang
- Department of Hematology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
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2
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Rossi G, Borlenghi E, Zappasodi P, Lussana F, Bernardi M, Basilico C, Molteni A, Lotesoriere I, Turrini M, Frigeni M, Fumagalli M, Cozzi P, Gigli F, Cattaneo C, Fracchiolla NS, Riva M, Martini G, Mancini V, Cairoli R, Todisco E. Adapting the Fitness Criteria for Non-Intensive Treatments in Older Patients with Acute Myeloid Leukemia to the Use of Venetoclax-Hypomethylating Agents Combination-Practical Considerations from the Real-Life Experience of the Hematologists of the Rete Ematologica Lombarda. Cancers (Basel) 2024; 16:386. [PMID: 38254875 PMCID: PMC10814062 DOI: 10.3390/cancers16020386] [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: 12/03/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
A retrospective survey was conducted in hematologic centres of the Rete Ematologica Lombarda (REL) on 529 older AML patients seen between 2020-2022. Compared to 2008-2016, the use of intensive chemotherapy (ICT) decreased from 40% to 18.1% and of hypomethylating agents (HMAs) from 19.5% to 13%, whereas the combination of Venetoclax/HMA, initially not available, increased from 0% to 36.7%. Objective treatment-specific fitness criteria proposed by SIE/SIES/GITMO in 2013 allow an appropriate choice between ICT and HMAs by balancing their efficacy and toxicity. Venetoclax/HMA, registered for patients unfit to ICT, has a unique toxicity profile because of prolonged granulocytopenia and increased infectious risk. Aiming at defining specific fitness criteria for the safe use of Venetoclax/HMA, a preliminary investigation was conducted among expert REL hematologists, asking for modifications of SIE/SIES/GITMO criteria they used to select candidates for Venetoclax/HMA. While opinions among experts varied, a general consensus emerged on restricting SIE/SIES/GITMO criteria for ICT-unfit patients to an age limit of 80-85, cardiac function > 40%, and absence of recurrent lung infections, bronchiectasis, or exacerbating COPD. Also, the presence of an adequate caregiver was considered mandatory. Such expert opinions may be clinically useful and may be considered when treatment-specific fitness criteria are updated to include Venetoclax/HMA.
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Affiliation(s)
- Giuseppe Rossi
- Department of Hematology, ASST Spedali Civili of Brescia, 25100 Brescia, Italy; (E.B.); (C.C.)
| | - Erika Borlenghi
- Department of Hematology, ASST Spedali Civili of Brescia, 25100 Brescia, Italy; (E.B.); (C.C.)
| | - Patrizia Zappasodi
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy; (P.Z.); (G.M.)
| | - Federico Lussana
- Department of Oncology and Hematology, University of Milan and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, 24100 Bergamo, Italy; (F.L.); (M.F.)
| | - Massimo Bernardi
- Haematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, 20132 Milano, Italy;
| | - Claudia Basilico
- Division of Hematology, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy;
| | - Alfredo Molteni
- Department of Hematology, ASST di Cremona, 26100 Cremona, Italy;
| | - Ivana Lotesoriere
- Department of Hematology, Ospedale Busto Arsizio, ASST Valle Olona, 21052 Busto Arsizio, Italy;
| | - Mauro Turrini
- Division of Hematology, Ospedale Valduce, 22100 Como, Italy; (M.T.); (E.T.)
| | - Marco Frigeni
- Department of Oncology and Hematology, University of Milan and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, 24100 Bergamo, Italy; (F.L.); (M.F.)
| | - Monica Fumagalli
- Department of Hematology, Ospedale “San Gerardo” ASST di Monza, 20900 Monza, Italy;
| | - Paola Cozzi
- Unità Complessa di Ematologia, ASST Ovest Milanese, Ospedale Civile, 20025 Legnano, Italy;
| | - Federica Gigli
- Divisione di Emato-Oncologia, European Institute of Oncology, 20122 Milano, Italy;
| | - Chiara Cattaneo
- Department of Hematology, ASST Spedali Civili of Brescia, 25100 Brescia, Italy; (E.B.); (C.C.)
| | - Nicola Stefano Fracchiolla
- UOC Oncoematologia, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico and University of Milan, 20122 Milano, Italy;
| | - Marta Riva
- Dipartimento di Ematologia ed Oncologia, Niguarda Cancer Center ASST Grande Ospedale Metropolitano, 20162 Milano, Italy; (M.R.); (V.M.); (R.C.)
| | - Gianluca Martini
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy; (P.Z.); (G.M.)
| | - Valentina Mancini
- Dipartimento di Ematologia ed Oncologia, Niguarda Cancer Center ASST Grande Ospedale Metropolitano, 20162 Milano, Italy; (M.R.); (V.M.); (R.C.)
| | - Roberto Cairoli
- Dipartimento di Ematologia ed Oncologia, Niguarda Cancer Center ASST Grande Ospedale Metropolitano, 20162 Milano, Italy; (M.R.); (V.M.); (R.C.)
| | - Elisabetta Todisco
- Division of Hematology, Ospedale Valduce, 22100 Como, Italy; (M.T.); (E.T.)
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Zeng X, Zhang L, Zhang Y, Jia S, Lin T, Zhao X, Huang X. Prevalence and prognostic value of baseline sarcopenia in hematologic malignancies: a systematic review. Front Oncol 2023; 13:1308544. [PMID: 38162495 PMCID: PMC10755879 DOI: 10.3389/fonc.2023.1308544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
Background The correlation between sarcopenia and hematological malignancy prognosis is still controversial. Design: A systematic review and meta-analysis. Objectives: To explore sarcopenia's prevalence and prognostic value in hematologic malignancies. Data sources and methods We searched Embase, MEDLINE, and Cochrane Library through Ovid SP using an appropriate search strategy on August 28, 2022, and updated the search results on January 9, 2023. Study quality was assessed using the Newcastle-Ottawa scale. The pooled prevalence of sarcopenia was calculated with a 95% confidence interval (CI). Relationships between sarcopenia and prognostic value were expressed as hazard ratio (HR) and 95% CI. HR means the probability of something undesirable, i.e., death or disease progression. Results The search identified more than 3992 studies, and 21 (3354 patients, median or mean age ranging from 36 to 78 years) were finally included. The risk of bias in the studies was low to medium. All included studies were diagnosed based on low muscle mass (LMM). Muscle mass was assessed mainly through imaging technologies, and different cut-offs were applied to determine LMM. The prevalence of sarcopenia was 44.5%, which could fluctuate by age. Subgroup analysis showed that older people had a higher sarcopenic rate than the non-elderly group. Sarcopenia resulted in an inferior prognosis [overall survival: HR 1.821, 95% CI 1.415-2.343; progression-free survival: HR 1.703, 95% CI 1.128-2.571). Conclusion Sarcopenia has a prevalence of over 30% in malignant hematologic patients and is associated with a poorer prognosis. Future studies with a standardized sarcopenia diagnostic criterion were needed to investigate sarcopenia's prevalence and prognostic effects in hematologic malignancies.
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Affiliation(s)
- Xiaofeng Zeng
- The Center of Gerontology and Geriatrics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Liying Zhang
- The Center of Gerontology and Geriatrics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Yu Zhang
- Sichuan University Library, Sichuan University, Chengdu, China
| | - Shuli Jia
- The Center of Gerontology and Geriatrics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Taiping Lin
- The Center of Gerontology and Geriatrics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Xuman Zhao
- The Center of Gerontology and Geriatrics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoli Huang
- The Center of Gerontology and Geriatrics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
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Weng G, Huang J, He X, Xue T, Yang L, Zhang Y, Yu G, Sun Z, Lin D, Deng L, Liang X, Xiao J, Zhang H, Guo Z, Jin H, Liu Q, Du X. Hypomethylating agents plus modified priming regimens compared with venetoclax-based regimens based on molecular characteristics for newly diagnosed patients with acute myeloid leukemia: a multi-center cohort study. Ann Hematol 2023; 102:3369-3381. [PMID: 37723307 DOI: 10.1007/s00277-023-05452-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/08/2023] [Indexed: 09/20/2023]
Abstract
Venetoclax (VEN)-based regimens are the standard of care for elderly or unfit patients with newly diagnosed (ND) acute myeloid leukemia (AML). Some single-arm studies have implied that hypomethylating agents (HMAs) plus priming regimens may potentially provide an alternative therapeutic approach, owing to encouraging efficacy seen. However, no comparative data exists yet regarding these two treatment approaches. In this retrospective multi-center cohort study, we enrolled 294 ND AML patients, allocating 167 to the HMA + priming group and 127 to the VEN-based group. Treatment response and overall survival (OS) were compared between groups. Molecular subgroup analyses were also conducted. With a median of two cycles for HMA + priming group, the overall response (ORR) was 65.3%, including 55.1% complete remission (CR), 9.6% CR with incomplete hematologic recovery (CRi) and 0.6% morphologic leukemia-free state (MLFS). With a median of two cycles for VEN-based group, the ORR was 70.9%, including 46.5% CR, 18.9% CRi, and 5.5% MLFS. Response differences (ORR or CR/CRi) between groups were not significant (p > 0.05). With a median follow-up of 10.1 months, median OSs were similar between groups (20.9 vs 16.3 months, p = 0.41). However, VEN regimens demonstrated superior CR/CRi for patients with mutations in FLT3, IDH1/2, and NPM1 compared to HMA + priming (80.0% vs 35.0%, p = 0.01; 90.9% vs 65.5%, p = 0.02; 90.9% and 65.5%, p = 0.02, respectively). In conclusion, HMAs plus modified priming regimens might be a potential alternative therapeutic approach for patients with ND AML, but VEN-based regimens presented predominance in specific molecular subgroups. Molecular characteristics contribute to guiding choice of treatment.
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Affiliation(s)
- Guangyang Weng
- Department of Hematology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Jingya Huang
- Shenzhen Blood Center, Shenzhen, Guangdong, China
| | - Xin He
- Department of Hematology, Zhongshan City People's Hospital, Zhongshan, China
| | - Tingting Xue
- Department of Hematology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Linlin Yang
- Department of Hematology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Yu Zhang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Guopan Yu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhiqiang Sun
- Department of Hematology, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Dongjun Lin
- Department of Hematology, the Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China
| | - Lan Deng
- Department of Hematology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinquan Liang
- Department of Hematology, The First People's Hospital of Chenzhou, Chenzhou, China
| | - Jie Xiao
- Department of Hematology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Hongyu Zhang
- Department of Hematology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Ziwen Guo
- Department of Hematology, Zhongshan City People's Hospital, Zhongshan, China
| | - Hua Jin
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qifa Liu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| | - Xin Du
- Department of Hematology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China.
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5
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Gaál L, Ruff E, Wiedemann Á, Svorenj S, Szita VR, Tóth AD, Masszi A, Horváth L, Szombath G, Nagy Z, Várkonyi J, Benedek S, Farkas P, Bödör C, Masszi T, Varga G. [How did the survival of acute myeloid leukemia change over the last ten years in our unit?]. Orv Hetil 2023; 164:1787-1794. [PMID: 37952177 DOI: 10.1556/650.2023.32901] [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: 07/27/2023] [Accepted: 09/03/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION Acute myeloid leukemia (AML) is a hematological malignancy with high mortality rate. The treatment is especially challenging in patients older than 65 years, which is the large majority of those. For patients unfit for intensive chemotherapy regimens, only palliative cytoreduction and basic supportive care used to be the options in our unit. However, from 2018, the azacitidine-venetoclax combination has been a new therapeutic alternative. This treatment resulted in marked survival benefit in clinical trials, however, its impact on the daily clinical practice and the entire patient population is unclear. OBJECTIVE Our goal was to evaluate how the application of azacitidine-venetoclax changed the treatment and survival of AML patients in our practice. METHOD We retrospectively analyzed the available clinical data of all AML patients treated consecutively between January 1, 2011 and December 31, 2021 at the 3rd Department of Internal Medicine (from 2020 onward called Department of Internal Medicine and Hematology), examining their treatment depending on the time period of therapy (2011-2017 and 2018-2021). Patients with acute promyelocytic leukemia were excluded. RESULTS 423 patients were diagnosed during this period. The number of cases showed a marked increase: in the first 7 years of our study, 184 patients were diagnosed, while this rose to 239 during the subsequent 4 years. The median age of patients was 67.6 years, with more than 60% of patients aged over 65. An improving trend can be observed in the overall survival: between 2011 and 2017, the median overall survival was 4.8 ± 0.9 months, while between 2018 and 2021, it was 8.3 ± 1.4 months (p = 0.051). Moreover, in the case of patients over 65 there was a significant overall survival improvement: 3.1 ± 0.5 vs. 4.9 ± 0.6 months (p = 0,01). The main factor behind this improvement could be that a large proportion of over 65 patients previously only fit for supportive care could now be treated with azacitidine-venetoclax: the percentage of actively treated patients grew from 57.1% to 75.3% in the second period. CONCLUSION The survival of patients unfit for curative therapy and older than 65 showed a steady increase which can be attributed to the introduction of new therapeutic alternatives. Orv Hetil. 2023; 164(45): 1787-1794.
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Affiliation(s)
- Lilla Gaál
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar Budapest Magyarország
| | - Eszter Ruff
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar Budapest Magyarország
| | - Ádám Wiedemann
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Belgyógyászati és Hematológiai Klinika Budapest, Szentkirályi u. 46., 1088 Magyarország
| | - Szabolcs Svorenj
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Belgyógyászati és Hematológiai Klinika Budapest, Szentkirályi u. 46., 1088 Magyarország
| | - Virág Réka Szita
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Belgyógyászati és Hematológiai Klinika Budapest, Szentkirályi u. 46., 1088 Magyarország
| | - András Dávid Tóth
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Belgyógyászati és Hematológiai Klinika Budapest, Szentkirályi u. 46., 1088 Magyarország
| | - András Masszi
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Belgyógyászati és Hematológiai Klinika Budapest, Szentkirályi u. 46., 1088 Magyarország
| | - Laura Horváth
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Belgyógyászati és Hematológiai Klinika Budapest, Szentkirályi u. 46., 1088 Magyarország
| | - Gergely Szombath
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Belgyógyászati és Hematológiai Klinika Budapest, Szentkirályi u. 46., 1088 Magyarország
| | - Zsolt Nagy
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Belgyógyászati és Hematológiai Klinika Budapest, Szentkirályi u. 46., 1088 Magyarország
| | - Judit Várkonyi
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Belgyógyászati és Hematológiai Klinika Budapest, Szentkirályi u. 46., 1088 Magyarország
| | - Szabolcs Benedek
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Belgyógyászati és Hematológiai Klinika Budapest, Szentkirályi u. 46., 1088 Magyarország
| | - Péter Farkas
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Belgyógyászati és Hematológiai Klinika Budapest, Szentkirályi u. 46., 1088 Magyarország
| | - Csaba Bödör
- 3 Semmelweis Egyetem, Általános Orvostudományi Kar, Patológiai és Kísérleti Rákkutató Intézet Budapest Magyarország
| | - Tamás Masszi
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Belgyógyászati és Hematológiai Klinika Budapest, Szentkirályi u. 46., 1088 Magyarország
| | - Gergely Varga
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Belgyógyászati és Hematológiai Klinika Budapest, Szentkirályi u. 46., 1088 Magyarország
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Brunner AM, Huggar D, Copher R, Zhou ZY, Zichlin ML, Anderson A, Downes N, McBride A. Economic burden during remission and after relapse among older patients with newly diagnosed acute myeloid leukemia without hematopoietic stem cell transplant: A retrospective study using the SEER-Medicare database. Leuk Res 2023; 132:107353. [PMID: 37562330 DOI: 10.1016/j.leukres.2023.107353] [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: 12/21/2022] [Revised: 06/13/2023] [Accepted: 07/08/2023] [Indexed: 08/12/2023]
Abstract
Acute myeloid leukemia (AML) is associated with a substantial clinical and economic burden. This study characterized the magnitude of this burden following initial treatment with standard or less intensive therapies (hypomethylating agents [HMAs]) and throughout different treatment phases post-remission. The Surveillance, Epidemiology, and End Results (SEER) cancer registry (2007-2016) linked with Medicare beneficiary claims (2007-2015) was analyzed. Patients were ≥ 65 years old with AML who initiated chemotherapy or HMAs and achieved remission. Outcomes included baseline characteristics, treatment patterns, clinical outcomes, healthcare resource utilization (HRU), and costs (2019 United States dollar). Economic impacts were stratified by treatment phase (initial treatment, early post-remission, late post-remission, and post-relapse). Early and late post-remission were defined as treatment initiated ≤ 60 days and > 60 days following initial treatment, respectively. A subgroup analysis of patients receiving only HMAs as initial treatment was also conducted. Overall, 530 patients were included (mean age: 74.1 years; 53.6 % male). In the overall analysis, 68.1 % of patients received post-remission treatment; 31.9% had no post-remission treatment. Mean monthly per patient healthcare costs by treatment phase were $45,747 (initial treatment), $30,248 (early post-remission), $23,173 (late post-remission), and $37,736 (post-relapse), driven predominantly by inpatient visits. The HMA subgroup analysis comprised 71 patients (mean age: 78.8 years; 50.7 % male); mean monthly per patient healthcare costs were highest post-relapse. The economic burden of AML among older patients is substantial across all treatment phases. AML treatments that induce and prolong remission may reduce HRU and the economic burden of disease.
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7
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Wu YH, Xiao HY, Quan RC, Tang XD, Liu WY, Lyu Y, Chen Z, Liu C, Hu XM. Comparing Arsenic-Containing Qinghuang Powder and Low-Intensity Chemotherapy in Elderly Patients with Acute Myeloid Leukemia. Chin J Integr Med 2023; 29:832-837. [PMID: 37222831 DOI: 10.1007/s11655-023-3603-6] [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] [Accepted: 02/27/2023] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To compare the clinical effect of arsenic-containing Qinghuang Powder (QHP) and low-intensity chemotherapy (LIC) in treatment of elderly acute myeloid leukemia (eAML) patients. METHODS Clinical data of 80 eAML patients treated at Xiyuan Hospital of China Academy of Chinese Medical Sciences from January 2015 to December 2020 were retrospectively analyzed. The treatment scheme was designed by real world study according to patients' preference, and patients were divided into a QHP group (35 cases) and a LIC group (45 cases). The median overall survival (mOS), 1-, 2-, and 3-year OS rates, and incidence of adverse events were compared between the two groups. RESULTS The mOS of 80 patients was 11 months, and the 1-, 2-, and 3-year OS rates were 45.51%, 17.96%, and 11.05%, respectively. The QHP and LIC groups demonstrated no significant difference in mOS (12 months vs. 10 months), 1- (48.57% vs. 39.65%), 2- (11.43% vs. 20.04%), and 3-year OS rates (5.71% vs. 13.27%, all P>0.05). Moreover, the related factors of mOS demonstrated no significant difference in patients with age>75 years (11 months vs. 8 months), secondary AML (11 months vs. 8 months), poor genetic prognosis (9 months vs. 7 months), Eastern Cooperative Oncology Group performance status score ⩾ 3 (10 months vs. 7 months) and hematopoietic stem cell transplant comorbidity index ⩾ 4 (11 months vs. 7 months) between the QHP and LIC groups (all P>0.05). However, the incidence of myelosuppression was significantly lower in the QHP group than that in the LIC group (28.57% vs. 73.33%, P<0.01). CONCLUSIONS QHP and LIC had similar survival rates in eAML patients, but QHP had a lower myelosuppression incidence. Hence, QHP can be an alternative for eAML patients who do not tolerate LIC.
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Affiliation(s)
- Yu-He Wu
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
- Graduate School, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Hai-Yan Xiao
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Ri-Cheng Quan
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Xu-Dong Tang
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Wei-Yi Liu
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Yan Lyu
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Zhuo Chen
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Chi Liu
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Xiao-Mei Hu
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China.
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Oliva EN, Candoni A, Salutari P, Palumbo GA, Reda G, Iannì G, Tripepi G, Cuzzola M, Capelli D, Mammì C, Alati C, Cannatà MC, Niscola P, Serio B, Musto P, Vigna E, Volpe A, Melillo LMA, Arcadi MT, Mannina D, Zannier ME, Latagliata R. Azacitidine Post-Remission Therapy for Elderly Patients with AML: A Randomized Phase-3 Trial (QoLESS AZA-AMLE). Cancers (Basel) 2023; 15:cancers15092441. [PMID: 37173908 PMCID: PMC10177242 DOI: 10.3390/cancers15092441] [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: 03/01/2023] [Revised: 04/11/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
This phase-3 randomized multicenter trial evaluated the efficacy of subcutaneous azacitidine (AZA) post-remission therapy vs. best supportive care (BSC) in elderly acute myeloid leukemia (AML) patients. The primary endpoint was the difference in disease-free survival (DFS) from complete remission (CR) to relapse/death. Patients with newly diagnosed AML aged ≥61 years received two courses of induction chemotherapy ("3+7" daunorubicin and cytarabine) followed by consolidation (cytarabine). At CR, 54 patients were randomized (1:1) to receive BSC (N = 27) or AZA (N = 27) at a dose of 50 mg/m2 for 7 days every 28 days and the dose increased after the 1st cycle to 75 mg/m2 for a further 5 cycles, followed by cycles every 56 days for 4.5 years. At 2 years, median DFS was 6.0 (95% CI: 0.2-11.7) months for patients receiving BSC vs. 10.8 months (95% CI: 1.9-19.6, p = 0.20) months for AZA. At 5 years, DFS was 6.0 (95% CI: 0.2-11.7) months in the BSC arm vs. 10.8 (95% CI: 1.9-19.6, p = 0.23) months in the AZA arm. Significant benefit was afforded by AZA on DFS at 2 and 5 years in patients aged >68 years (HR = 0.34, 95% CI: 0.13-0.90, p = 0.030 and HR = 0.37, 95% CI: 0.15-0.93, p = 0.034, respectively). No deaths occurred prior to leukemic relapse. Neutropenia was the most frequent adverse event. There were no differences in patient-reported outcome measures between study arms. In conclusion, AZA post-remission therapy was found to provide benefit in AML patients aged >68 years.
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Affiliation(s)
- Esther Natalie Oliva
- U.O.C. Ematologia, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, 89124 Reggio di Calabria, Italy
| | - Anna Candoni
- Divisione Ematologia, P.O. Santa Maria della Misericordia, A.S.U.F.C di Udine, 33100 Udine, Italy
| | - Prassede Salutari
- Dipartimento Oncologico-Ematologico Ospedale Civile Spirito Santo Pescara, 65124 Pescara, Italy
| | - Giuseppe A Palumbo
- Dipartimento di Scienze Mediche Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", University of Catania, 95123 Catania, Italy
| | - Gianluigi Reda
- UOC Ematologia Università degli Studi di Milano, IRCCS Ospedale Maggiore Policlinico Milano, 20133 Milano, Italy
| | - Giuseppe Iannì
- Dielnet SRL, CRO Reggio Calabria, 89124 Reggio Calabria, Italy
| | - Giovanni Tripepi
- IFC-CNR Institute of Clinical Physiology Reggio Calabria, 89124 Reggio Calabria, Italy
| | - Maria Cuzzola
- UOSD Tipizzazione Tissutale, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, 89124 Reggio di Calabria, Italy
| | - Debora Capelli
- Clinica di Ematologia Azienda Ospedaliera Universitaria, Ospedali Riuniti di Ancona, 60126 Ancona, Italy
| | - Corrado Mammì
- UOSD Medical Genetics, Great Metropolitan Hospital, 89124 Reggio Calabria, Italy
| | - Caterina Alati
- U.O.C. Ematologia, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, 89124 Reggio di Calabria, Italy
| | | | | | - Bianca Serio
- Dipartimento di Oncoematologia, AOU San Giovanni di Dio e Ruggi D'Aragona, 84125 Salerno, Italy
| | - Pellegrino Musto
- Department of Precision and Translational Medicine with Ionian Area, "Aldo Moro" University School of Medicine, 70121 Bari, Italy
- Unit of Hematology and Stem Cell Transplantation, AOUC Policlinico, 70124 Bari, Italy
| | - Ernesto Vigna
- U.O. di Ematologia, Ospedale L'Annunziata, 87100 Cosenza, Italy
| | - Antonio Volpe
- U.O. di Ematologia, Azienda Ospedaliera San Giuseppe Moscato, 83100 Avellino, Italy
| | - Lorella Maria Antonia Melillo
- U.O.C. Ematologia e Trapianto di Cellule Staminali Emopoietiche, Policlinico Foggia Ospedaliero-Universitario, 71122 Foggia, Italy
| | - Maria Teresa Arcadi
- U.O. Farmacia, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, 89124 Reggio di Calabria, Italy
| | - Donato Mannina
- U.O.C. di Ematologia, Azienda Ospedaliera Papardo, 98158 Messina, Italy
| | - Maria Elena Zannier
- Divisione Ematologia, P.O. Santa Maria della Misericordia, A.S.U.F.C di Udine, 33100 Udine, Italy
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9
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Venditti A, Cairoli R, Caira M, Finsinger P, Finocchiaro F, Neri B, De Benedittis D, Rossi G, Ferrara F. Assessing eligibility for treatment in acute myeloid leukemia in 2023. Expert Rev Hematol 2023; 16:181-190. [PMID: 36876439 DOI: 10.1080/17474086.2023.2185603] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
INTRODUCTION Age has historically been considered the main criterion to determine eligibility for intensive chemotherapy in patients with acute myeloid leukemia (AML), but age alone can no longer be considered an absolute indicator in determining which patients should be defined as unfit. Assessment of fitness for a given treatment today serves an important role in tailoring therapeutic options. AREAS COVERED This review examines the main options used in real life to define eligibility for intensive and nonintensive chemotherapy in patients with AML, with a main focus on the Italian SIE/SIES/GITMO Consensus Criteria. Other published real-life experiences are also reviewed, analyzing the correlation between these criteria and short-term mortality, and thus expected outcomes. EXPERT OPINION Assessment of fitness is mandatory at diagnosis to tailor treatment to the greatest degree possible, evaluating the patient's individual profile. This is especially relevant when considering the availability of newer, less toxic therapeutic regimens, which have shown promising results in patients with AML who are older or considered unfit for intensive treatment. Fitness assessment is now a fundamental part of AML management and a critical step that can potentially influence outcomes and not just predict them.
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Affiliation(s)
- Adriano Venditti
- Ematologia, Dipartimento di Biomedicina e Prevenzione, Università di Roma "Tor Vergata", Rome, Italy
| | - Roberto Cairoli
- Dipartimento Ematologia, Oncologia e Medicina Molecolare, ASST Grande Ospedale Metropolitano Niguarda-Milano, Milan, Italy
| | - Morena Caira
- Medical Department, AbbVie srl, Campoverde di Aprilia, Latina, Italy
| | - Paola Finsinger
- Medical Department, AbbVie srl, Campoverde di Aprilia, Latina, Italy
| | - Fabio Finocchiaro
- Medical Department, AbbVie srl, Campoverde di Aprilia, Latina, Italy
| | - Benedetta Neri
- Medical Department, AbbVie srl, Campoverde di Aprilia, Latina, Italy
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10
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Babakhanlou R, Ravandi-Kashani F. Non-intensive acute myeloid leukemia therapies for older patients. Expert Rev Hematol 2023; 16:171-180. [PMID: 36864772 DOI: 10.1080/17474086.2023.2184342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
INTRODUCTION Acute myeloid leukemia (AML) is an aggressive disease predominantly affecting the elderly population. The elderly population represents a challenging group to treat and the prognosis is generally poor with significantly worse treatment outcomes compared to the younger population. While the goal of treatment for younger fit patients is cure and includes intensive chemotherapy and stem cell transplantation, these strategies are not always feasible for elderly unfit patients due to increased frailty, co-morbidities, and, subsequently, an increased risk of treatment-related toxicity and mortality. AREAS COVERED This review will discuss both patient- and disease-related factors, outline prognostication models and summarize current treatment options, including intensive and less intensive treatment strategies and novel agents. EXPERT OPINION Although recent years have seen major advances in the development of low-intensity therapies, there is still a lack of consensus on the optimal treatment for this patient group. Because of the heterogeneity of the disease, personalizing the treatment strategy is important and curative-oriented approaches should be selected wisely, rather than following a rigid hierarchical algorithm.
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Affiliation(s)
- Rodrick Babakhanlou
- Department of Leukemia, the University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Farhad Ravandi-Kashani
- Department of Leukemia, the University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
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11
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Health-Related Quality of Life Outcomes in Older Hematopoietic Cell Transplantation Survivors. Transplant Cell Ther 2023; 29:202.e1-202.e8. [PMID: 36427784 PMCID: PMC10165614 DOI: 10.1016/j.jtct.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 11/25/2022]
Abstract
The use of hematopoietic cell transplantation (HCT) has been increasing in older patients. However, the levels if distress, psychosocial functioning, and health-related quality of life (HRQOL) among older HCT survivors remains largely unknown. In this secondary analysis using data from 2 randomized controlled trials, we analyzed baseline Cancer and Treatment Distress (CTXD) and Confidence In Survivorship Information (CSI) surveys of HCT survivors who were age ≥60 years at the time of transplantation and alive and disease-free ≥1 year post-autologous or -allogeneic HCT. We analyzed associations of these parameters with the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores of the 12-Item Short Form Survey (SF-12) and a healthcare adherence (HCA) scale, after adjusting for transplantation and patient demographic factors. A total of 567 patients were included. The median patient age at HCT was 65 years, and 68% of the patients underwent autologous HCT. The median CTXD score was .7 (mild), and the greatest distress was reported in the "health burden" subscale. The median CSI score was 1.4 (moderate-high), with the lowest confidence reported in the "late effects" subscale. We found negative Spearman correlations between CTXD score and SF-12 PCS (P = -.59) and MCS (P = -.54) and positive Spearman correlations between CSI score and SF-12 PCS (P = .23) and MCS (P = .30). The median HCA scale score was high at .8. Male sex, autologous HCT, increased distress level, and worse CSI score were associated with lower use of preventive care. Older survivors experienced a low level of distress and moderate-high level of CSI at ≥1 year post-HCT. As lower distress and higher CSI were associated with improved HRQOL and optimized preventive HCA, CTXD/CSI measures can be used to individualize the care of older adult HCT survivors.
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12
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Mendoza-Urbano DM, Tello-Cajiao ME, Rosales J, Ahumada FE, Parra-Lara LG, Arrieta E. Survival in Elderly Patients Diagnosed With Acute Myeloid Leukemia: A Hospital-Based Study. J Hematol 2023; 12:7-15. [PMID: 36895293 PMCID: PMC9990714 DOI: 10.14740/jh1055] [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: 09/16/2022] [Accepted: 11/18/2022] [Indexed: 03/11/2023] Open
Abstract
Background Acute myeloid leukemia (AML) is a hematological neoplasm that is more frequent in elderly patients. The objective of this study was to evaluate elderly patients' survival with de novo AML and acute myeloid leukemia myelodysplasia-related (AML-MR), treated with intensive and less-intensive chemotherapy and supportive care. Methods A retrospective cohort study was conducted in Fundacion Valle del Lili (Cali, Colombia), between 2013 and 2019. We included patients ≥ 60 years old diagnosed with AML. The statistical analysis considered the leukemia type (de novo vs. myelodysplasia-related) and treatment (intensive chemotherapy regimen, less-intensive chemotherapy regimen, and without chemotherapy). Survival analysis was performed using Kaplan-Meier method and Cox regression models. Results A total of 53 patients were included (31 de novo and 22 AML-MR). Intensive chemotherapy regimens were more frequent in patients with de novo leukemia (54.8%), and 77.3% of patients with AML-MR received less-intensive regimens. Survival was higher in the chemotherapy group (P = 0.006), but with no difference between chemotherapy modalities. Additionally, patients without chemotherapy were 10 times more likely to die than those who received any regimen, independent of age, sex, Eastern Cooperative Oncology performance status, and Charlson comorbidity index (adjusted hazard ratio (HR) = 11.6, 95% confidence interval (CI) 3.47 - 38.8). Conclusions Elderly patients with AML had longer survival time when receiving chemotherapy, regardless of the type of regimen.
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Affiliation(s)
| | | | - Joaquin Rosales
- Servicio de Hemato-Oncologia, Departamento de Medicina Interna, Fundacion Valle del Lili, Cali, Colombia
| | - Fabian Emiliano Ahumada
- Servicio de Hemato-Oncologia, Departamento de Medicina Interna, Fundacion Valle del Lili, Cali, Colombia
| | - Luis Gabriel Parra-Lara
- Centro de Investigaciones Clinicas (CIC), Fundacion Valle del Lili, Cali, Colombia.,Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - Elizabeth Arrieta
- Servicio de Hemato-Oncologia, Departamento de Medicina Interna, Fundacion Valle del Lili, Cali, Colombia
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13
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"Losing the Brakes"-Suppressed Inhibitors Triggering Uncontrolled Wnt/ ß-Catenin Signaling May Provide a Potential Therapeutic Target in Elderly Acute Myeloid Leukemia. Curr Issues Mol Biol 2023; 45:604-613. [PMID: 36661526 PMCID: PMC9858232 DOI: 10.3390/cimb45010040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/25/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
Dysregulated Wnt/β-catenin signal transduction is implicated in initiation, propagation, and poor prognosis in AML. Epigenetic inactivation is central to Wnt/β-catenin hyperactivity, and Wnt/β-catenin inhibitors are being investigated as targeted therapy. Dysregulated Wnt/β-catenin signaling has also been linked to accelerated aging. Since AML is a disease of old age (>60 yrs), we hypothesized age-related differential activity of Wnt/β-catenin signaling in AML patients. We probed Wnt/β-catenin expression in a series of AML in the elderly (>60 yrs) and compared it to a cohort of pediatric AML (<18 yrs). RNA from diagnostic bone marrow biopsies (n = 101) were evaluated for key Wnt/β-catenin molecule expression utilizing the NanoString platform. Differential expression of significance was defined as >2.5-fold difference (p < 0.01). A total of 36 pediatric AML (<18 yrs) and 36 elderly AML (>60 yrs) were identified in this cohort. Normal bone marrows (n = 10) were employed as controls. Wnt/β-catenin target genes (MYC, MYB, and RUNX1) showed upregulation, while Wnt/β-catenin inhibitors (CXXR, DKK1-4, SFRP1-4, SOST, and WIFI) were suppressed in elderly AML compared to pediatric AML and controls. Our data denote that suppressed inhibitor expression (through mutation or hypermethylation) is an additional contributing factor in Wnt/β-catenin hyperactivity in elderly AML, thus supporting Wnt/β-catenin inhibitors as potential targeted therapy.
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14
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Lalayanni C, Demosthenous C, Iskas M, Kelaidi C, Papathanasiou M, Syrigou A, Athanasiadou A, Papalexandri A, Batsis I, Vardi A, Polychronopoulou S, Sakellari I. Adolescents and young adults (AYA) with acute myeloid leukemia (AML): real-world long-term results and age-specific outcomes. Leuk Lymphoma 2022; 63:3128-3137. [PMID: 36002396 DOI: 10.1080/10428194.2022.2113527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Opposing acute lymphoblastic leukemia, sparse data about AYAs with acute myeloid leukemia (AML) is available. Overall, 125 AYAs (age 10-35 years) treated during the last two decades were evaluated and compared to 385 older patients. CBF leukemia was more frequent in AYAs (21.6% vs. 8%, p < 0.001); however, many presented high-risk features. AYAs showed improved complete remission rate (CR, 80% vs. 65%, p = 0.01), lower cumulative incidence of relapse and TRM and longer survival (5 year-OS 53% vs. 24%, p < 0.0001), observed mainly in intermediate-risk karyotype. Adolescents displayed even better outcomes (5 year-OS 69%). AlloHCT in CR1 was beneficial for nonadolescent AYAs (5 year-OS 66.7% vs. 44.4% without HCT, p = 0.04). Among 50 APL patients, 19 AYAs experienced better outcomes than older, mainly attributed to reduced treatment-related mortality (TRM, 5% vs. 19%, p = 0.1). We observed an important (>10%) survival gain for AYAs during the last decade. However, AYAs have still unmet needs to obtain optimal cure rates.
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Affiliation(s)
- Chrysavgi Lalayanni
- Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | | | - Michail Iskas
- Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - Charikleia Kelaidi
- Department of Pediatric Hematology and Oncology Aghia, Sophia Children's Hospital, Athens, Greece
| | - Maria Papathanasiou
- Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - Antonia Syrigou
- Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | | | | | - Ioannis Batsis
- Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - Anna Vardi
- Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - Sophia Polychronopoulou
- Department of Pediatric Hematology and Oncology Aghia, Sophia Children's Hospital, Athens, Greece
| | - Ioanna Sakellari
- Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
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15
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Villar S, Ariceta B, Agirre X, Urribarri AD, Ayala R, Martínez-Cuadrón D, Bergua JM, Vives S, Algarra L, Tormo M, Martínez P, Serrano J, Simoes C, Herrera P, Calasanz MJ, Alfonso-Piérola A, Paiva B, Martínez-López J, San Miguel JF, Prósper F, Montesinos P. The transcriptomic landscape of elderly acute myeloid leukemia identifies B7H3 and BANP as a favorable signature in high-risk patients. Front Oncol 2022; 12:1054458. [PMID: 36505804 PMCID: PMC9729799 DOI: 10.3389/fonc.2022.1054458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/02/2022] [Indexed: 11/25/2022] Open
Abstract
Acute myeloid leukemia (AML) in the elderly remains a clinical challenge, with a five-year overall survival rate below 10%. The current ELN 2017 genetic risk classification considers cytogenetic and mutational characteristics to stratify fit AML patients into different prognostic groups. However, this classification is not validated for elderly patients treated with a non-intensive approach, and its performance may be suboptimal in this context. Indeed, the transcriptomic landscape of AML in the elderly has been less explored and it might help stratify this group of patients. In the current study, we analyzed the transcriptome of 224 AML patients > 65 years-old at diagnosis treated in the Spanish PETHEMA-FLUGAZA clinical trial in order to identify new prognostic biomarkers in this population. We identified a specific transcriptomic signature for high-risk patients with mutated TP53 or complex karyotype, revealing that low expression of B7H3 gene with high expression of BANP gene identifies a subset of high-risk AML patients surviving more than 12 months. This result was further validated in the BEAT AML cohort. This unique signature highlights the potential of transcriptomics to identify prognostic biomarkers in in elderly AML.
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Affiliation(s)
- Sara Villar
- Servicio de Hematología y Terapia Celular, Clínica Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra (IDISNA), Pamplona, Spain,CIBERONC Centro de Investigación Biomédica en Red de Cáncer, Pamplona, Spain
| | - Beñat Ariceta
- CIBERONC Centro de Investigación Biomédica en Red de Cáncer, Pamplona, Spain,Centro de Investigación Médica Aplicada (CIMA) LAB Diagnostics, Universidad de Navarra, Pamplona, Spain,Program of Hematology-Oncology, CIMA, Universidad de Navarra, Pamplona, Spain
| | - Xabier Agirre
- CIBERONC Centro de Investigación Biomédica en Red de Cáncer, Pamplona, Spain,Program of Hematology-Oncology, CIMA, Universidad de Navarra, Pamplona, Spain
| | | | - Rosa Ayala
- Hospital Universitario 12 de octubre, Madrid, Spain
| | | | | | - Susana Vives
- ICO Badalona- Hospital Germans Trias i Pujol, Badalona, Spain
| | | | - Mar Tormo
- Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | - Josefina Serrano
- Hospital Universitario Reina Sofía, Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Catia Simoes
- Program of Hematology-Oncology, CIMA, Universidad de Navarra, Pamplona, Spain
| | | | - Maria José Calasanz
- CIBERONC Centro de Investigación Biomédica en Red de Cáncer, Pamplona, Spain,Centro de Investigación Médica Aplicada (CIMA) LAB Diagnostics, Universidad de Navarra, Pamplona, Spain
| | - Ana Alfonso-Piérola
- Servicio de Hematología y Terapia Celular, Clínica Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra (IDISNA), Pamplona, Spain,CIBERONC Centro de Investigación Biomédica en Red de Cáncer, Pamplona, Spain
| | - Bruno Paiva
- Servicio de Hematología y Terapia Celular, Clínica Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra (IDISNA), Pamplona, Spain,CIBERONC Centro de Investigación Biomédica en Red de Cáncer, Pamplona, Spain,Centro de Investigación Médica Aplicada (CIMA) LAB Diagnostics, Universidad de Navarra, Pamplona, Spain
| | | | - Jesús F. San Miguel
- Servicio de Hematología y Terapia Celular, Clínica Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra (IDISNA), Pamplona, Spain,CIBERONC Centro de Investigación Biomédica en Red de Cáncer, Pamplona, Spain
| | - Felipe Prósper
- Servicio de Hematología y Terapia Celular, Clínica Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra (IDISNA), Pamplona, Spain,CIBERONC Centro de Investigación Biomédica en Red de Cáncer, Pamplona, Spain,*Correspondence: Felipe Prósper, ; Pau Montesinos,
| | - Pau Montesinos
- Hospital Universitario y Politécnico la Fe, Valencia, Spain,*Correspondence: Felipe Prósper, ; Pau Montesinos,
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16
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Zhang M, Ge Y, Xu S, Fang X, Meng J, Yu L, Wang C, Liu J, Wen T, Yang Y, Wang C, Xu H. Nanomicelles co-loading CXCR4 antagonist and doxorubicin combat the refractory acute myeloid leukemia. Pharmacol Res 2022; 185:106503. [DOI: 10.1016/j.phrs.2022.106503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/27/2022] [Accepted: 10/09/2022] [Indexed: 10/31/2022]
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17
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Chen Y, Cao J, Ye Y, Luo L, Zheng X, Yang X, Zheng Z, Zheng J, Yang T, Hu J. Hypomethylating agents combined with low-dose chemotherapy for elderly patients with acute myeloid leukaemia unfit for intensive chemotherapy: a real-world clinical experience. J Chemother 2022:1-8. [PMID: 35881409 DOI: 10.1080/1120009x.2022.2097433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
This study aimed to assess the efficacy and safety of hypomethylating agent (HMA)-based regimens in the treatment of older adult patients with acute myeloid leukaemia (AML), unfit for standard induction chemotherapy. Treatment outcomes and prognostic factors of 140 older adult patients with AML who were unfit for intensive chemotherapy and were treated with HMA-based therapies were retrospectively analysed. The median age of the group was 70 years, and poor-risk cytogenetics and secondary/treatment-related AML (s/t-AML) accounted for 45.6% and 34.3% of these patients, respectively. The overall response rate was 48.6%, and 40.1% for patients who achieved complete remission (CR) or CR with incomplete blood count recovery. The median overall survival (OS) was 10.4 months, and the 1-, 2-, and 5-year OS rates were 42.6%, 19.9%, and 4.9%, respectively. Early mortality accounted for 4.3% of all cases, and infection occurred in 87.1% of all patients during induction therapy. Patients who received HMA and low-dose chemotherapy presented with significantly superior response and long-term survival rates compared to those who received HMA alone. They also showed comparable outcomes to those treated with the azacitidine plus venetoclax protocol. Low-dose chemotherapy in combination with decitabine or azacitidine showed a similar response rate and prognosis. Age ≥ 75years and a white blood cell (WBC) count ≥ 10 × 109 cells/L were identified as independent adverse prognostic factors for OS, while poor-risk cytogenetics, percentage of bone marrow blasts, and s/tAML had no significant impact on OS when patients were treated with HMA-based regimens. In conclusion, HMA combined with low-dose chemotherapy was effective and safe in older adults with AML who were unfit for intensive chemotherapy, and no difference was observed between decitabine and azacitidine.
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Affiliation(s)
| | - Jing Cao
- Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fuzhou, China
| | - Yaozhen Ye
- Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fuzhou, China
| | - Luting Luo
- Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fuzhou, China
| | - Xiaoyun Zheng
- Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fuzhou, China
| | - Xiaozhu Yang
- Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fuzhou, China
| | - Zhihong Zheng
- Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fuzhou, China
| | - Jing Zheng
- Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fuzhou, China
| | - Ting Yang
- Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fuzhou, China
| | - Jianda Hu
- Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fuzhou, China
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The Global Burden of Leukemia and Its Attributable Factors in 204 Countries and Territories: Findings from the Global Burden of Disease 2019 Study and Projections to 2030. JOURNAL OF ONCOLOGY 2022; 2022:1612702. [PMID: 35509847 PMCID: PMC9061017 DOI: 10.1155/2022/1612702] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/09/2022] [Accepted: 04/08/2022] [Indexed: 01/01/2023]
Abstract
Background. Leukemia is a common malignancy that has four main subtypes and is a threat to human health. Understanding the epidemiological status of leukemia and its four main subtypes globally is important for allocating appropriate resources, guiding clinical practice, and furthering scientific research. Methods. Average annual percentage changes (AAPCs) were calculated to estimate the change trends of age-standardized rates (ASRs) from 1990 to 2019 in 204 countries and territories. The risk factors for leukemia death and disability-adjusted life-year (DALY) were also analyzed. In addition, the future trends in ASRs were projected through 2030. Results. The total number of incident cases, deaths, and DALYs from leukemia in 2019 was 0.64, 0.33, and 11.66 million, respectively. Decreasing trends in age-standardized incidence rate (ASIR), the age-standardized death rate (ASDR), and age-standardized DALY rate were detected on a global level while increasing trends in ASIR were detected in the high-sociodemographic index (SDI) regions. The leukemia burden was heavier in males than in females. By cause, acute myeloid leukemia (AML), chronic myeloid leukemia (CML), and chronic lymphocytic leukemia (CLL) were more likely to impose a burden on the elderly, while acute lymphoblastic leukemia (ALL) showed a greater impact in the younger population. A significant positive correlation was observed between SDI and AAPC in ASIR, while SDI was negatively correlated with AAPCs in both ASDR and age-standardized DALY rate. Smoking remained the most significant risk factor associated with leukemia-related death and DALY, especially in males. Similar deaths and DALYs were caused by smoking and high body mass index (BMI) in females. Future projections through 2030 estimated that ASIR and ASDR will continue to increase, while the DALY rate is predicted to decline. Conclusions. Patterns and trends of leukemia burden are correlated with SDI. The estimated contributions to leukemia deaths indicate that timely measures are needed to reduce smoking and obesity.
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Pinto-Merino Á, Labrador J, Zubiaur P, Alcaraz R, Herrero MJ, Montesinos P, Abad-Santos F, Saiz-Rodríguez M. Role of Pharmacogenetics in the Treatment of Acute Myeloid Leukemia: Systematic Review and Future Perspectives. Pharmaceutics 2022; 14:pharmaceutics14030559. [PMID: 35335935 PMCID: PMC8954545 DOI: 10.3390/pharmaceutics14030559] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/16/2022] [Accepted: 02/28/2022] [Indexed: 12/12/2022] Open
Abstract
Acute myeloid leukemia (AML) is a heterogeneous disease characterized by remarkable toxicity and great variability in response to treatment. Plenteous pharmacogenetic studies have already been published for classical therapies, such as cytarabine or anthracyclines, but such studies remain scarce for newer drugs. There is evidence of the relevance of polymorphisms in response to treatment, although most studies have limitations in terms of cohort size or standardization of results. The different responses associated with genetic variability include both increased drug efficacy and toxicity and decreased response or resistance to treatment. A broad pharmacogenetic understanding may be useful in the design of dosing strategies and treatment guidelines. The aim of this study is to perform a review of the available publications and evidence related to the pharmacogenetics of AML, compiling those studies that may be useful in optimizing drug administration.
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Affiliation(s)
| | - Jorge Labrador
- Research Unit, Fundación Burgos por la Investigación de la Salud (FBIS), Hospital Universitario de Burgos, 09006 Burgos, Spain; (J.L.); (R.A.)
- Haematology Department, Hospital Universitario de Burgos, 09006 Burgos, Spain
- Facultad de Ciencias de la Salud, Universidad Isabel I, 09003 Burgos, Spain
| | - Pablo Zubiaur
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain; (P.Z.); (F.A.-S.)
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa (IP), Universidad Autónoma de Madrid (UAM), 28006 Madrid, Spain
| | - Raquel Alcaraz
- Research Unit, Fundación Burgos por la Investigación de la Salud (FBIS), Hospital Universitario de Burgos, 09006 Burgos, Spain; (J.L.); (R.A.)
| | - María José Herrero
- Pharmacogenetics Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain;
| | - Pau Montesinos
- Haematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain;
| | - Francisco Abad-Santos
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain; (P.Z.); (F.A.-S.)
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa (IP), Universidad Autónoma de Madrid (UAM), 28006 Madrid, Spain
| | - Miriam Saiz-Rodríguez
- Department of Health Sciences, University of Burgos, 09001 Burgos, Spain;
- Research Unit, Fundación Burgos por la Investigación de la Salud (FBIS), Hospital Universitario de Burgos, 09006 Burgos, Spain; (J.L.); (R.A.)
- Correspondence: ; Tel.: +34-947-281-800 (ext. 36078)
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Oral Hygiene Considerations in Adult Patients with Leukemia during a Cycle of Chemotherapy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19010479. [PMID: 35010738 PMCID: PMC8744976 DOI: 10.3390/ijerph19010479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/22/2021] [Accepted: 12/31/2021] [Indexed: 01/02/2023]
Abstract
The oral cavity is the place where the first symptoms of systemic diseases may appear. Leukemia is the malignancy of the hematopoietic system in which abnormal leukocytes are produced in the bone marrow and these cells spread to the peripheral blood. It is classified clinically on the basis of the duration and nature of the disease (acute or chronic), the type of cell involved (myeloid, lymphoid, or monocytes), and a rise in the number of abnormal cells in the blood. The study aimed to assess and compare the oral hygiene and periodontium status based on the indices in leukemic patients before and after one cycle of chemotherapy and whether the therapy had an impact on the change of these parameters. Dental indices used in clinical diagnostics were calculated: API (approximal plaque index), SBI (sulcus bleeding index), and CPI (community periodontal index). The research project was conducted at the Clinic of Hematooncology and Bone Marrow Transplantation of the Independent Public Clinical Hospital No. 1 in Lublin. The target population consisted of 102 adults with leukemia who were over 18 years of age. The time since diagnosis of the disease ranged from 1 to 10 years. The data were evaluated in the Statistica 12 software with the respective tests. In the majority of patients, both before and after chemotherapy, improper oral hygiene and severe generalized periodontitis were confirmed. The cycle of chemotherapy that was used did not correlate with the change of patients' oral hygiene and periodontium state. Unsatisfactory oral hygiene and periodontal health has to be addressed with urgent dental treatment to avoid systemic complications in leukemic patients.
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21
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Naji A, Ali K, Mohammad H, Alwan A. Serum hepcidin levels related to interlukin-6 in patients with acute myeloid leukemia before and after treatment. IRAQI JOURNAL OF HEMATOLOGY 2022. [DOI: 10.4103/ijh.ijh_16_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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Janerin Induces Cell Cycle Arrest at the G2/M Phase and Promotes Apoptosis Involving the MAPK Pathway in THP-1, Leukemic Cell Line. Molecules 2021; 26:molecules26247555. [PMID: 34946628 PMCID: PMC8705386 DOI: 10.3390/molecules26247555] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/08/2021] [Accepted: 12/08/2021] [Indexed: 12/02/2022] Open
Abstract
Janerin is a cytotoxic sesquiterpene lactone that has been isolated and characterized from different species of the Centaurea genus. In this study, janerin was isolated form Centaurothamnus maximus, and its cytotoxic molecular mechanism was studied in THP-1 human leukemic cells. Janerin inhibited the proliferation of THP-1 cells in a dose-dependent manner. Janerin caused the cell cycle arrest at the G2/M phase by decreasing the CDK1/Cyclin-B complex. Subsequently, we found that janerin promoted THP-1 cell death through apoptosis as indicated by flow cytometry. Moreover, apoptosis induction was confirmed by the upregulation of Bax, cleaved PARP-1, and cleaved caspase 3 and the downregulation of an anti-apoptotic Bcl-2 biomarker. In addition, immunoblotting indicated a dose dependent upregulation of P38-MAPK and ERK1/2 phosphorylation during janerin treatment. In conclusion, we have demonstrated for the first time that janerin may be capable of inducing cell cycle arrest and apoptosis through the MAPK pathway, which would be one of the mechanisms underlying its anticancer activity. As a result, janerin has the potential to be used as a therapeutic agent for leukemia.
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23
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Xu LF, Shi L, Zhang SS, Ding PS, Ma F, Song KD, Qiang P, Chang WJ, Dai YY, Mei YD, Ma XL. LukS-PV Induces Apoptosis via the SET8-H4K20me1-PIK3CB Axis in Human Acute Myeloid Leukemia Cells. Front Oncol 2021; 11:718791. [PMID: 34745943 PMCID: PMC8565356 DOI: 10.3389/fonc.2021.718791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/22/2021] [Indexed: 12/30/2022] Open
Abstract
Evidence suggests that histone modification disorders are involved in leukemia pathogenesis. We previously reported that LukS-PV, a component of Panton-Valentine leukocidin (PVL), has antileukemia activities that can induce differentiation, increase apoptosis, and inhibit proliferation of acute myeloid leukemia (AML) cells. Furthermore, LukS-PV inhibited hepatoma progression by regulating histone deacetylation, speculating that LukS-PV may exert antileukemia activity by targeting histone modification regulators. In this study, the results showed that LukS-PV induced apoptosis by downregulating the methyltransferase SET8 and its target histone H4 monomethylated at Lys 20 (H4K20me1). Furthermore, chromatin immunoprecipitation sequencing and polymerase chain reaction identified the kinase PIK3CB as a downstream target gene for apoptosis mediated by SET8/H4K20me1. Finally, our results indicated that LukS-PV induced apoptosis via the PIK3CB-AKT-FOXO1 signaling pathway by targeting SET8. This study indicates that SET8 downregulation is one of the mechanisms by which LukS-PV induces apoptosis in AML cells, suggesting that SET8 may be a potential therapeutic target for AML. Furthermore, LukS-PV may be a drug candidate for the treatment of AML that targets epigenetic modifications.
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Affiliation(s)
- Liang Fei Xu
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Lan Shi
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Shan Shan Zhang
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Peng Sheng Ding
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Fan Ma
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Kai Di Song
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Ping Qiang
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Wen Jiao Chang
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Yuan Yuan Dai
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Yi De Mei
- University of Science and Technology of China, School of Life Sciences and Medicine, USTC Life Sciences, Hefei, China
| | - Xiao Ling Ma
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.,University of Science and Technology of China, School of Life Sciences and Medicine, USTC Life Sciences, Hefei, China
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Divergent leukaemia subclones as cellular models for testing vulnerabilities associated with gains in chromosomes 7, 8 or 18. Sci Rep 2021; 11:21145. [PMID: 34707142 PMCID: PMC8551338 DOI: 10.1038/s41598-021-00623-w] [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: 07/09/2021] [Accepted: 10/08/2021] [Indexed: 11/24/2022] Open
Abstract
Haematopoietic malignancies are frequently characterized by karyotypic abnormalities. The development of targeted drugs has been pioneered with compounds against gene products of fusion genes caused by chromosomal translocations. While polysomies are equally frequent as translocations, for many of them we are lacking therapeutic approaches aimed at synthetic lethality. Here, we report two new cell lines, named MBU-7 and MBU-8, that differ in complete trisomy of chromosome18, a partial trisomy of chromosome 7 and a tetrasomy of the p-arm of chromosome 8, but otherwise share the same mutational pattern and complex karyotype. Both cell lines are divergent clones of U-937 cells and have the morphology and immunoprofile of monocytic cells. The distinct karyotypic differences between MBU-7 and MBU-8 are associated with a difference in the specific response to nucleoside analogues. Taken together, we propose the MBU-7 and MBU-8 cell lines described here as suitable in vitro models for screening and testing vulnerabilities that are associated with the disease-relevant polysomies of chromosome 7, 8 and 18.
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25
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Li S, Ji Y, Peng Y, Kota V, Kim C. Patient characteristics, treatment patterns, and mortality in elderly patients newly diagnosed with acute myeloid leukemia meeting ineligibility criteria for high intensity chemotherapy. Leuk Lymphoma 2021; 63:131-141. [PMID: 34643153 DOI: 10.1080/10428194.2021.1973669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
To describe patient characteristics, treatment patterns, and survival among elderly patients (≥66 years) newly diagnosed with acute myeloid leukemia (AML) meeting ≥1 ineligibility criteria for high-intensity chemotherapy (HIC; i.e. age >75 years, cardiac disease/prior anthracycline therapy, or secondary AML), we analyzed 2007-2017 100% Medicare hematologic cancer data. Patients were stratified based on whether they received HIC or low-intensity chemotherapy (LIC) or best supportive care (BSC) within 60 days after AML diagnosis. Of 4,152 patients, 43.2% received chemotherapy, 33.8% BSC, and 23.1% no therapy. Among chemotherapy-treated patients, HIC was more common than LIC (58.8 vs 41.2%), despite targeting patients meeting ≥1 ineligibility criteria for HIC. Poor overall survival was observed for patients receiving chemotherapy and BSC (median overall survival [interquartile range]: HIC, 1.9 [0.8, 6.6] months; LIC, 3.8 [1.4, 9.3] months; BSC, 1.0 [0.4, 2.5] months). Results highlight the need for additional effective and tolerable treatments for this population.
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Affiliation(s)
- Shuling Li
- Chronic Disease Research Group (CDRG), Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Yuanyuan Ji
- Chronic Disease Research Group (CDRG), Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Yi Peng
- Chronic Disease Research Group (CDRG), Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | | | - Christopher Kim
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
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26
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Liu X, Shi H, Shen J, Li Y, Yan W, Sun Y, Liao A, Tan Y, Yang W, Wang H. Dual Growth Factor (rhTPO + G-CSF) and Chemotherapy Combination Regimen for Elderly Patients with Acute Myeloid Leukemia: A Phase II Single-Arm Multicenter Study. Int J Gen Med 2021; 14:6093-6099. [PMID: 34611424 PMCID: PMC8485918 DOI: 10.2147/ijgm.s323699] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/20/2021] [Indexed: 12/03/2022] Open
Abstract
Acute myeloid leukemia (AML) is a disease affecting older adults, although optimal strategies for treating such patients remain unclear. This prospective phase II, open-label, multicenter study was designed to assess the efficacy and safety of two hematologic growth factors, recombinant human thrombopoietin (rhTPO) and granulocyte colony-stimulating factor (G-CSF), in combination with decitabine, cytarabine, and aclarubicin (D-CTAG regimen) to treat older adults with newly diagnosed AML (Identifier: NCT04168138). The above agents were administered as follows: decitabine (15 mg/m2 daily, days 1–5); low-dose cytarabine (10 mg/m2 q12 h, days 3–9); rhTPO (15,000 U daily, days 2, 4, 6, 8, 10–24 or until >50×109/L platelets); aclarubicin (14 mg/m2 daily, days 3–6); and G-CSF (300 μg daily, days 2–9). We concurrently monitored historic controls treated with decitabine followed by cytarabine, aclarubicin, and G-CSF (D-CAG) only. After the first D-CTAG cycle, the overall response rate (ORR) was 84.2% (16/19), including 13 (73.7%) complete remissions (CRs) and three (15.8%) partial remissions. This CR rate surpassed that of the D-CAG treatment (p < 0.05). Median overall survival (OS) time in the D-CTAG group was 20.2 months (range, 4–31 months), compared with 14 months in the D-CAG group, and 1-year OS was 78%. The proportion of those experiencing grade III–IV thrombocytopenia was significantly lower for D-CTAG (57.9%) than for D-CAG (88.4%; p < 0.05). Ultimately, the curative effect of adding rhTPO was not inferior to that of D-CAG, and D-CTAG proved safer for elderly patients, especially in terms of hematologic toxicity. A prospective phase III randomized study is warranted to confirm these observations.
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Affiliation(s)
- Xiaoyu Liu
- Haematology Department of Shengjing Hospital, China Medical University, Shenyang, Liaoning, 110004, People's Republic of China
| | - Hua Shi
- Haematology Department of Sun Yat-sen Memorial Hospital, Sun Yat-sen University Shen Shan Central Hospital, Guangzhou, People's Republic of China
| | - Jing Shen
- Haematology Department of Shengjing Hospital, China Medical University, Shenyang, Liaoning, 110004, People's Republic of China
| | - Yang Li
- Haematology Department of Shengjing Hospital, China Medical University, Shenyang, Liaoning, 110004, People's Republic of China
| | - Wei Yan
- Haematology Department of Shengjing Hospital, China Medical University, Shenyang, Liaoning, 110004, People's Republic of China
| | - Ying Sun
- Haematology Department of Shengjing Hospital, China Medical University, Shenyang, Liaoning, 110004, People's Republic of China
| | - Aijun Liao
- Haematology Department of Shengjing Hospital, China Medical University, Shenyang, Liaoning, 110004, People's Republic of China
| | - Yehui Tan
- Haematology Department of The First Hospital of Jilin University, Changchun, Jilin, People's Republic of China
| | - Wei Yang
- Haematology Department of Shengjing Hospital, China Medical University, Shenyang, Liaoning, 110004, People's Republic of China
| | - Huihan Wang
- Haematology Department of Shengjing Hospital, China Medical University, Shenyang, Liaoning, 110004, People's Republic of China
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Lai B, Mu Q, Zhang Y, Chen Y, Yan X, Ouyang G. Outcomes of newly diagnosed acute myeloid leukemia with myelodysplasia related changes and elderly acute myeloid leukemia following decitabine therapy in combination with priming regimen. ACTA ACUST UNITED AC 2021; 26:751-757. [PMID: 34555298 DOI: 10.1080/16078454.2021.1975947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This study investigates efficacy of decitabine and priming regimen in treating newly diagnosed acute myeloid leukemia with myelodysplasia related changes (AML-MRC) and elderly AML. METHODS Totally 69 newly diagnosed AML-MRC and elderly AML treated with decitabine and priming regimen were enrolled. The effects of clinical characteristics, gene mutations and karyotype on remission rate and overall survival were investigated, as well as the effects of allogeneic hematopoietic stem cell transplantation on survival after remission. RESULTS There were 39 and 10 cases achieving complete remission (CR) and partial remission (PR), respectively, with CR rate of 56.5% and overall response (OR) rate of 71%. Moreover, 15 cases had no response (NR), with NR rate of 21.7%. There were 5 cases of death within 4 weeks after treatment, with early mortality rate of 7.2%. The factors of peripheral white blood cell count, bone marrow blast proportion, doubling of platelets after treatment, and co-mutation of three or more myeloid genes, significantly affected CR and OR rates, while age significantly affected OR rate. TP53 mutation and platelets not doubling after treatment were independent prognostic factors affecting overall survival. CONCLUSION Combination of decitabine and priming regimen is effective in treating newly diagnosed AML-MRC and elderly AML.
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Affiliation(s)
- Binbin Lai
- Department of Hematology, Ningbo First Hospital, Ningbo, Zhejiang, People's Republic of China
| | - Qitian Mu
- Laboratory of Stem Cell Transplantation, Ningbo First Hospital, Ningbo, Zhejiang, People's Republic of China
| | - YanLi Zhang
- Department of Hematology, Ningbo First Hospital, Ningbo, Zhejiang, People's Republic of China
| | - Ying Chen
- Laboratory of Stem Cell Transplantation, Ningbo First Hospital, Ningbo, Zhejiang, People's Republic of China
| | - Xiao Yan
- Department of Hematology, Ningbo First Hospital, Ningbo, Zhejiang, People's Republic of China
| | - Guifang Ouyang
- Department of Hematology, Ningbo First Hospital, Ningbo, Zhejiang, People's Republic of China
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A slow-go prognosis for older patients with newly diagnosed AML. Blood 2021; 138:501-502. [PMID: 34410354 DOI: 10.1182/blood.2021012456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/14/2021] [Indexed: 11/20/2022] Open
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Oliva EN, Ronnebaum SM, Zaidi O, Patel DA, Nehme SA, Chen C, Almeida AM. A systematic literature review of disease burden and clinical efficacy for patients with relapsed or refractory acute myeloid leukemia. AMERICAN JOURNAL OF BLOOD RESEARCH 2021; 11:325-360. [PMID: 34540343 PMCID: PMC8446831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/12/2021] [Indexed: 06/13/2023]
Abstract
Acute myeloid leukemia (AML) is a rapidly progressive hematological malignancy that is difficult to cure. The prognosis is poor and treatment options are limited in case of relapse. A comprehensive assessment of current disease burden and the clinical efficacy of non-intensive therapies in this population are lacking. We conducted two systematic literature reviews (SLRs). The first SLR (disease burden) included observational studies reporting the incidence and economic and humanistic burden of relapsed/refractory (RR) AML. The second SLR (clinical efficacy) included clinical trials (phase II or later) reporting remission rates (complete remission [CR] or CR with incomplete hematologic recovery [CRi]) and median overall survival (mOS) in patients with RR AML or patients with de novo AML who are ineligible for intensive chemotherapy. For both SLRs, MEDLINE®/Embase® were searched from January 1, 2008 to January 31, 2020. Clinical trial registries were also searched for the clinical efficacy SLR. After screening, two independent reviewers determined the eligibility for inclusion in the SLRs based on full-text articles. The disease burden SLR identified 130 observational studies. The median cumulative incidence of relapse was 29.4% after stem cell transplant and 46.8% after induction chemotherapy. Total per-patient-per-month costs were $28,148-$29,322; costs and health care resource use were typically higher for RR versus non-RR patients. Patients with RR AML had worse health-related quality of life (HRQoL) scores than patients with de novo AML across multiple instruments, and lower health utility values versus other AML health states (i.e. newly diagnosed, remission, consolidation, and maintenance therapy). The clinical efficacy SLR identified 50 trials (66 total trial arms). CR/CRi rates and mOS have remained relatively stable and low over the last 2 decades. Across all arms, the median rate of CR/CRi was 18.3% and mOS was 6.2 months. In conclusion, a substantial proportion of patients with AML will develop RR AML, which is associated with significant humanistic and economic burden. Existing treatments offer limited efficacy, highlighting the need for more effective non-intensive treatment options.
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Lazarevic VL. Acute myeloid leukaemia in patients we judge as being older and/or unfit. J Intern Med 2021; 290:279-293. [PMID: 33780573 DOI: 10.1111/joim.13293] [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: 01/01/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 11/29/2022]
Abstract
The definition of older age in AML is arbitrary. In the context of the clinical studies, it starts with age ≥60 or ≥65 years and in recent years ≥70 or 75, depending on the selection of the studied population. In clinical practice, with older age, we often mean that the patient is unfit for intensive chemotherapy. Higher age overlaps with categories such as worse performance status, unfitness, comorbidities, poor-risk cytogenetics, adverse mutation patterns, age-related clonal haematopoiesis and specific disease ontogeny. Intensive induction therapy can result in prolonged overall survival, at least in a subset of elderly patients aged up to 75 years despite the reluctance of some physicians and patients to use treatment regimens perceived as toxic. Venetoclax and azacitidine combination is the new standard of comparison for persons unfit for intensive therapy. New oral hypomethylating agent CC-486 as maintenance therapy led to a prolonged overall survival in a randomized trial of patients ≥55 years of age who were in first complete remission, but not eligible for allogeneic stem cell transplantation. Any therapy is better than no therapy, but a substantial proportion of older patients still receive only palliative care. Making a decision for AML diagnosed in older age should be individualized and shared through the dialog with the patient and relatives or cohabitants, considering medical issues and social factors including personal goals. Although we are witnesses of the advances in basic research and therapy, we are still a very long way from curing older patients with AML.
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Affiliation(s)
- V Lj Lazarevic
- From the, Department of Hematology, Oncology and Radiation Physics, Stem Cell Center, Skåne University Hospital, Lund University, Lund, Sweden
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31
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Apel A, Moshe Y, Ofran Y, Gural A, Wolach O, Ganzel C, Canaani J, Zektser M, Duek A, Stemer G, Hellman I, Basood M, Frisch A, Leibovitch C, Koren‐Michowitz M. Venetoclax combinations induce high response rates in newly diagnosed acute myeloid leukemia patients ineligible for intensive chemotherapy in routine practice. Am J Hematol 2021; 96:790-795. [PMID: 33836555 DOI: 10.1002/ajh.26190] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 12/19/2022]
Abstract
Combinations of the BCL-2 inhibitor, venetoclax, with either hypomethylating agents (HMA) or low dose cytarabine (LDAC), have shown promising results in clinical trials of AML patients unfit for intensive therapy. We report on the efficacy and safety of venetoclax combinations in AML patients treated outside of clinical trials. Complete remission (CR) + CR with incomplete count recovery (CRi) were achieved in 61% of patients, with similar CR+CRi rates in with secondary AML, and in patients who were previously treated with HMA (61% and 43%, respectively). Relapse occurred in 25% of patients, with a median event-free survival (EFS) of 11.7 months (95% CI, 10.09-13.35) in responding patients. At a median follow up of 8.7 months, the median overall survival (OS) was 9.8 months (95% CI 6.42-13.3) in the entire cohort. In multivariate analysis adverse karyotype was the only negative predictor of CR/CRi (p = .03), while both ECOG performance status (PS) and adverse karyotype were significantly associated with shorter OS (p = .023 and .038, respectively). Median OS was higher in patients achieving CR/CRi and in patients proceeding to allogeneic stem cell transplantation (allo-SCT). Treatment was well tolerated, with side effects similar to those described in the randomized clinical trials. Tumor lysis syndrome (TLS) occurred in 12% of patients. Our data support the efficacy and safety of venetoclax combinations in newly diagnosed AML patients not eligible for intensive therapy. According to our data, secondary AML patients could benefit from venetoclax combinations similarly to de-novo AML patients, and allo-SCT could be offered to selected patients achieving CR/CRi.
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Affiliation(s)
- Arie Apel
- Department of Hematology, Shamir Medical Center (formerly Assaf Harofe Medical Center), Zerifin, Israel, Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Yakir Moshe
- Department of Hematology and Bone Marrow Transplantation Tel‐Aviv Sourasky Medical Center Tel Aviv Israel
| | - Yishai Ofran
- Department of Hematology and Bone Marrow Transplantation Rambam Health Care Campus Haifa Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology Haifa Israel
| | - Alexander Gural
- Leukemia Service, Department of Hematology Hasassah‐Hebrew‐University Medical Center Jerusalem Israel
| | - Ofir Wolach
- Institute of Hematology Davidoff Cancer Center, Belinson Hospital, Rabin Medical Center Petach Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Chezi Ganzel
- Department of Hematology Shaare Zedek Medical Center Jerusalem Israel
- Faculty of Medicine Hebrew University of Jerusalem Jerusalem Israel
| | - Jonathan Canaani
- Hematology Division, Chaim Sheba Medical Center Tel Aviv University Tel Aviv Israel
| | - Miri Zektser
- Institute of Hematology, Faculty of Health Science Soroka University Medical Center Beersheba Israel
| | - Adrian Duek
- Hematology Department Assuta Medical Center Ashdod Israel
| | - Galia Stemer
- Hematology Unit Haemek Medical Center Afula Israel
| | - Ilana Hellman
- Hematology Unit Meir Medical Center Kfar Saba Israel
| | - May Basood
- Department of Hematology and Bone Marrow Transplantation Tel‐Aviv Sourasky Medical Center Tel Aviv Israel
| | - Avraham Frisch
- Department of Hematology and Bone Marrow Transplantation Rambam Health Care Campus Haifa Israel
| | - Chiya Leibovitch
- Institute of Hematology Davidoff Cancer Center, Belinson Hospital, Rabin Medical Center Petach Tikva Israel
| | - Maya Koren‐Michowitz
- Department of Hematology, Shamir Medical Center (formerly Assaf Harofe Medical Center), Zerifin, Israel, Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
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Wang W, Liu J, Chen K, Wang J, Dong Q, Xie J, Yuan Y. Vitamin D promotes autophagy in AML cells by inhibiting miR-17-5p-induced Beclin-1 overexpression. Mol Cell Biochem 2021; 476:3951-3962. [PMID: 34185245 DOI: 10.1007/s11010-021-04208-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 06/14/2021] [Indexed: 11/24/2022]
Abstract
MicroRNA (miR)-17-5p has been investigated in many diseases as a regulator of disease progression and is highly expressed in acute myeloid leukemia (AML). However, potential mechanisms underlying the function of miR-17-5p in AML need more elucidation. MiR-17-5p expression was augmented, while 25(OH)D3 and Beclin-1 levels were decreased in AML patients with the highest risk for disease progression. MiR-17-5p, 25(OH)D3 and Beclin-1 were determined to be clinically important in AML based on ROC curve analysis. Higher miR-17-5p expression as well as lower 25(OH)D3 and Beclin-1 expression were relevant with poor prognosis in AML. In addition, miR-17-5p was negatively correlated with and bound to BECN1. Vitamin D was found to diminish cell proliferation and enhance autophagy. Finally, through rescue assays, miR-17-5p facilitated the ability of cell proliferation, inhibited autophagy and apoptosis by modulating Beclin-1 in HL-60 cells following the treatment of 4 μM vitamin D. Vitamin D promoted autophagy in AML cells by modulating miR-17-5p and Beclin-1.
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Affiliation(s)
- Weijia Wang
- Department of Laboratory Diagnosis, Zhongshan People's Hospital, No. 2, Sunwen East Road, Zhongshan City, 528403, Guangdong, China
| | - Jing Liu
- Ethics Committee, Zhongshan People's Hospital, Zhongshan City, 528403, Guangdong, China
| | - Kang Chen
- Department of Laboratory Diagnosis, Zhongshan People's Hospital, No. 2, Sunwen East Road, Zhongshan City, 528403, Guangdong, China
| | - Juan Wang
- Department of Laboratory Diagnosis, Zhongshan People's Hospital, No. 2, Sunwen East Road, Zhongshan City, 528403, Guangdong, China
| | - Qian Dong
- Department of Laboratory Diagnosis, Zhongshan People's Hospital, No. 2, Sunwen East Road, Zhongshan City, 528403, Guangdong, China
| | - Jinye Xie
- Department of Laboratory Diagnosis, Zhongshan People's Hospital, No. 2, Sunwen East Road, Zhongshan City, 528403, Guangdong, China
| | - Yong Yuan
- Department of Laboratory Diagnosis, Zhongshan People's Hospital, No. 2, Sunwen East Road, Zhongshan City, 528403, Guangdong, China.
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Zhu H, Yang B, Liu J, Wang B, Wu Y, Zheng Z, Ling Y. A novel treatment regimen of granulocyte colony-stimulating factor combined with ultra-low-dose decitabine and low-dose cytarabine in older patients with acute myeloid leukemia and myelodysplastic syndromes. Ther Adv Hematol 2021; 12:20406207211009334. [PMID: 33995987 PMCID: PMC8111530 DOI: 10.1177/20406207211009334] [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: 11/03/2020] [Accepted: 03/21/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Older patients with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) unfit for intensive chemotherapy are emergent for suitable treatment strategies. Hypomethylating agents and low-dose cytarabine have generated relevant benefits in the hematological malignancies over recent decades. We evaluated the efficacy and safety of the novel treatment regimen consisting of ultra-low-dose decitabine and low-dose cytarabine, with granulocyte colony-stimulating factor (G-CSF) in this population of patients. Methods and materials: Patients aged more than 60 years with newly diagnosed AML/MDS were enrolled to receive therapy combined of 300 µg subcutaneously per day for priming, decitabine 5.15–7.62 mg/m2/d intravenously and cytarabine 15 mg/m2/d twice a day subcutaneously and G-CSF for consecutive 10 days every 28 days. The study enrolled 28 patients unfit for standard intensive chemotherapy. The median age of patients was 68 years (range 60–83 years) and 20 (71.4%) patients harbored AML. The primary outcome was to evaluate overall response rate. Results: Overall, this novel ultra-low-dose treatment regimen was well tolerated, with 0% of both 4- and 8-week mortality occurrence. Objective response rate (CR + CRi + PR in AML and CR + mCR + PR in MDS) was 57.1% after the first treatment course. Responses of hematologic improvement (HI) aspect were achieved in 18 of 28 (64.3%) patients, 11 (39.3%), 12 (42.9%), and eight patients (28.6%) achieved HI-E, HI-P, HI-N, respectively. Conclusions: Untreated elderly with AML/MDS were well tolerated and benefited from this novel ultra-low-dose treatment regimen.
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Affiliation(s)
- Huan Zhu
- Department of Hematology, The Third Affiliated Hospital of Soochow University, The First People's Hospital of Changzhou, Changzhou, Jiangsu, China
| | - Bin Yang
- The Third Affiliated Hospital of Soochow University, The First People's Hospital of Changzhou, Changzhou, Jiangsu, China
| | - Jia Liu
- The Third Affiliated Hospital of Soochow University, The First People's Hospital of Changzhou, Changzhou, Jiangsu, China
| | - Biao Wang
- The Third Affiliated Hospital of Soochow University, The First People's Hospital of Changzhou, Changzhou, Jiangsu, China
| | - Yicun Wu
- The Third Affiliated Hospital of Soochow University, The First People's Hospital of Changzhou, Changzhou, Jiangsu, China
| | - Zhuojun Zheng
- The Third Affiliated Hospital of Soochow University, The First People's Hospital of Changzhou, Changzhou, Jiangsu, China
| | - Yun Ling
- Department of Hematology, The Third Affiliated Hospital of Soochow University, The First People's Hospital of Changzhou, Juqian Road 185, Changzhou, Jiangsu 213000, China
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Maiti A, Qiao W, Sasaki K, Ravandi F, Kadia TM, Jabbour EJ, Daver NG, Borthakur G, Garcia‐Manero G, Pierce SA, Montalbano KS, Pemmaraju N, Naqvi K, Ohanian M, Short NJ, Alvarado Y, Takahashi K, Yilmaz M, Jain N, Kornblau SM, Andreeff M, Bose P, Ferrajoli A, Issa GC, Masarova L, Thompson PA, Rausch CR, Ning J, Kantarjian HM, DiNardo CD, Konopleva MY. Venetoclax with decitabine vs intensive chemotherapy in acute myeloid leukemia: A propensity score matched analysis stratified by risk of treatment-related mortality. Am J Hematol 2021; 96:282-291. [PMID: 33264443 DOI: 10.1002/ajh.26061] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/23/2020] [Accepted: 11/29/2020] [Indexed: 12/11/2022]
Abstract
Hypomethylating agents (HMA) with venetoclax is a new standard for older/unfit patients with acute myeloid leukemia (AML). However, it is unknown how HMA with venetoclax compare to intensive chemotherapy (IC) in patients who are "fit" or "unfit" for IC. We compared outcomes of older patients with newly diagnosed AML receiving 10-day decitabine with venetoclax (DEC10-VEN) vs IC. DEC10-VEN consisted of daily venetoclax with decitabine 20 mg/m2 for 10 days for induction and decitabine for 5 days as consolidation. The IC cohort received regimens containing cytarabine ≥1 g/m2 /d. A validated treatment-related mortality score (TRMS) was used to classify patients at high-risk or low-risk for TRM with IC. Propensity scores were used to match patients to minimize bias. Median age of the DEC10-VEN cohort (n = 85) was 72 years (range 63-89) and 28% patients were at high-risk of TRM with IC. The comparator IC group (n = 85) matched closely in terms of baseline characteristics. DEC10-VEN was associated with significantly higher CR/CRi compared to IC (81% vs 52%, P < .001), and lower rate of relapse (34% vs 56%, P = .01), 30-day mortality (1% vs 24%, P < .01), and longer overall survival (OS; 12.4 vs 4.5 months, HR = 0.48, 95%CI 0.29-0.79, P < .01). In patients at both at high-risk and low-risk of TRM, DEC10-VEN showed significantly higher CR/CRi, lower 30-day mortality, and longer OS compared to IC. Patients at both high-risk and low-risk of TRM had comparable outcomes with DEC10-VEN. In conclusion, DEC10-VEN offers better outcomes compared to intensive chemotherapy in older patients with newly diagnosed AML, particularly in those at high-risk of TRM.
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Affiliation(s)
- Abhishek Maiti
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
- Division of Cancer Medicine The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Wei Qiao
- Department of Biostatistics The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Koji Sasaki
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Farhad Ravandi
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Tapan M. Kadia
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Elias J. Jabbour
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Naval G. Daver
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Gautam Borthakur
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | | | - Sherry A. Pierce
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Kathryn S. Montalbano
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Naveen Pemmaraju
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Kiran Naqvi
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Maro Ohanian
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Nicholas J. Short
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Yesid Alvarado
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Koichi Takahashi
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Musa Yilmaz
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Nitin Jain
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Steven M. Kornblau
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Michael Andreeff
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Prithviraj Bose
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Alessandra Ferrajoli
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Ghayas C. Issa
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Lucia Masarova
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Philip A. Thompson
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Caitlin R. Rausch
- Division of Pharmacy The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Jing Ning
- Division of Pharmacy The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Hagop M. Kantarjian
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Courtney D. DiNardo
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Marina Y. Konopleva
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
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Zhang Y, Luo T, Ding X, Chang Y, Liu C, Zhang Y, Hao S, Yin Q, Jiang B. Inhibition of mitochondrial complex III induces differentiation in acute myeloid leukemia. Biochem Biophys Res Commun 2021; 547:162-168. [PMID: 33610916 DOI: 10.1016/j.bbrc.2021.02.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/06/2021] [Indexed: 10/22/2022]
Abstract
Although acute myeloid leukemia (AML) is a highly heterogeneous disease with diverse genetic subsets, one hallmark of AML blasts is myeloid differentiation blockade. Extensive evidence has indicated that differentiation induction therapy represents a promising treatment strategy. Here, we identified that the pharmacological inhibition of the mitochondrial electron transport chain (ETC) complex III by antimycin A inhibits proliferation and promotes cellular differentiation of AML cells. Mechanistically, we showed that the inhibition of dihydroorotate dehydrogenase (DHODH), a rate-limiting enzyme in de novo pyrimidine biosynthesis, is involved in antimycin A-induced differentiation. The activity of antimycin A could be reversed by supplement of excessive amounts of exogenous uridine as well as orotic acid, the product of DHODH. Furthermore, we also found that complex III inhibition exerts a synergistic effect in differentiation induction combined with DHODH inhibitor brequinar as well as with the pyrimidine salvage pathway inhibitor dipyridamole. Collectively, our study uncovered the link between mitochondrial complex III and AML differentiation and may provide further insight into the potential application of mitochondrial complex III inhibitor as a mono or combination treatment in differentiation therapy of AML.
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Affiliation(s)
- Youping Zhang
- Department of Hematology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Ting Luo
- School of Pharmacy, East China University of Science and Technology, 130 Meilong Road, Shanghai, 200237, China
| | - Xinyu Ding
- Shanghai Institute for Advanced Immunochemical Studies, ShanghaiTech University, 393 Middle Huaxia Road, Shanghai, 201210, China
| | - YungTing Chang
- Department of Pharmacy, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Chuanxu Liu
- Department of Hematology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Yongqiang Zhang
- School of Pharmacy, East China University of Science and Technology, 130 Meilong Road, Shanghai, 200237, China
| | - Siguo Hao
- Department of Hematology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China.
| | - Qianqian Yin
- Shanghai Institute for Advanced Immunochemical Studies, ShanghaiTech University, 393 Middle Huaxia Road, Shanghai, 201210, China.
| | - Biao Jiang
- Shanghai Institute for Advanced Immunochemical Studies, ShanghaiTech University, 393 Middle Huaxia Road, Shanghai, 201210, China; CAS Key Laboratory of Synthetic Chemistry of Natural Substances, Shanghai Institute of Organic Chemistry, Chinese Academy of Sciences, 345 Lingling Road, Shanghai 200032, China.
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Biological characteristics of aging in human acute myeloid leukemia cells: the possible importance of aldehyde dehydrogenase, the cytoskeleton and altered transcriptional regulation. Aging (Albany NY) 2020; 12:24734-24777. [PMID: 33349623 PMCID: PMC7803495 DOI: 10.18632/aging.202361] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/20/2020] [Indexed: 12/19/2022]
Abstract
Patients with acute myeloid leukemia (AML) have a median age of 65-70 years at diagnosis. Elderly patients have more chemoresistant disease, and this is partly due to decreased frequencies of favorable and increased frequencies of adverse genetic abnormalities. However, aging-dependent differences may also contribute. We therefore compared AML cell proteomic and phosphoproteomic profiles for (i) elderly low-risk and younger low-risk patients with favorable genetic abnormalities; and (ii) high-risk patients with adverse genetic abnormalities and a higher median age against all low-risk patients with lower median age. Elderly low-risk and younger low-risk patients showed mainly phosphoproteomic differences especially involving transcriptional regulators and cytoskeleton. When comparing high-risk and low-risk patients both proteomic and phosphoproteomic studies showed differences involving cytoskeleton and immunoregulation but also transcriptional regulation and cell division. The age-associated prognostic impact of cyclin-dependent kinases was dependent on the cellular context. The protein level of the adverse prognostic biomarker mitochondrial aldehyde dehydrogenase (ALDH2) showed a similar significant upregulation both in elderly low-risk and elderly high-risk patients. Our results suggest that molecular mechanisms associated with cellular aging influence chemoresistance of AML cells, and especially the cytoskeleton function may then influence cellular hallmarks of aging, e.g. mitosis, polarity, intracellular transport and adhesion.
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Mao J, Gao W, Xue L, Zhao L, Miao L, Jia T, Zhu Y, Wang Y, Meng L, Wang J. The prognostic factors and efficacy of induction chemotherapy in elderly patients with acute myeloid leukemia. AMERICAN JOURNAL OF BLOOD RESEARCH 2020; 10:320-329. [PMID: 33489440 PMCID: PMC7811900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/09/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Acute myeloid leukemia (AML) is the most common form of hematological malignancy in adults. We aimed to investigate the efficacy of different treatment measures and prognostic factors for elderly patients with AML. METHODS The clinical data of 65 newly diagnosed elderly patients with AML were retrospectively analyzed. Among them, 45 patients received induction chemotherapy including standard cytarabine regimen (n = 21) and low dose cytarabine regimen (n = 24), and 20 patients received palliative treatment. The efficacy and prognosis were compared between the groups. RESULTS There were no statistical differences in complete remission, overall survival and the 6-month disease-free survival rates between standard cytarabine group and low dose cytarabine group (P = 0.675, P = 0.775, P = 0.751, respectively). Significant difference in median overall survival and overall survival rate were detected (P < 0.001, P = 0.031, respectively), but no significant difference in early death rate (P = 0.238) was found between induction chemotherapy group and palliative treatment group. Multivariate analysis showed that the white blood cells count ≥ 100.0 × 109/L was associated with early death. CONCLUSIONS The induction chemotherapy did not increase the early mortality. The low dose cytarabine regimen can be used as the first-line choice for elderly acute myeloid leukemia patients who are not suitable for intensive chemotherapy.
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Affiliation(s)
- Jianping Mao
- Department of Hematology, The First People’s Hospital of Lianyungang City, The Affiliated Lianyungang Hospital of Xuzhou Medical University, The Affiliated Hospital of Kangda College of Nanjing Medical University, Lianyungang Clinical College of Nanjing Medical UniversityLianyungang, China
| | - Wenliang Gao
- Department of Internal Medicine, The Second Children and Women’s Health Care of Jinan CityJinan, China
| | - Lianguo Xue
- Department of Hematology, The First People’s Hospital of Lianyungang City, The Affiliated Lianyungang Hospital of Xuzhou Medical University, The Affiliated Hospital of Kangda College of Nanjing Medical University, Lianyungang Clinical College of Nanjing Medical UniversityLianyungang, China
| | - Lidong Zhao
- Department of Hematology, The First People’s Hospital of Lianyungang City, The Affiliated Lianyungang Hospital of Xuzhou Medical University, The Affiliated Hospital of Kangda College of Nanjing Medical University, Lianyungang Clinical College of Nanjing Medical UniversityLianyungang, China
| | - Lei Miao
- Department of Hematology, The First People’s Hospital of Lianyungang City, The Affiliated Lianyungang Hospital of Xuzhou Medical University, The Affiliated Hospital of Kangda College of Nanjing Medical University, Lianyungang Clinical College of Nanjing Medical UniversityLianyungang, China
| | - Tao Jia
- Department of Hematology, The First People’s Hospital of Lianyungang City, The Affiliated Lianyungang Hospital of Xuzhou Medical University, The Affiliated Hospital of Kangda College of Nanjing Medical University, Lianyungang Clinical College of Nanjing Medical UniversityLianyungang, China
| | - Yuanxin Zhu
- Department of Hematology, The First People’s Hospital of Lianyungang City, The Affiliated Lianyungang Hospital of Xuzhou Medical University, The Affiliated Hospital of Kangda College of Nanjing Medical University, Lianyungang Clinical College of Nanjing Medical UniversityLianyungang, China
| | - Ying Wang
- Department of Hematology, The First People’s Hospital of Lianyungang City, The Affiliated Lianyungang Hospital of Xuzhou Medical University, The Affiliated Hospital of Kangda College of Nanjing Medical University, Lianyungang Clinical College of Nanjing Medical UniversityLianyungang, China
| | - Lijuan Meng
- Department of Geriatric Oncology, The First Affiliated Hospital with Nanjing Medical UniversityNanjing, China
| | - Juan Wang
- Department of Pediatrics, The First People’s Hospital of Lianyungang CityLianyungang, China
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Koenig K, Mims A, Levis MJ, Horowitz MM. The Changing Landscape of Treatment in Acute Myeloid Leukemia. Am Soc Clin Oncol Educ Book 2020; 40:1-12. [PMID: 32239961 DOI: 10.1200/edbk_279129] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The treatment of acute myeloid leukemia is evolving, with increased understanding of molecular pathogenesis allowing better risk stratification and development of new therapies. Tests to identify and drugs to target specific molecular abnormalities are improving remission rates and prolonging survival in patients with high-risk disease. Allogeneic hematopoietic stem cell transplantation remains an important curative therapy, with advances in donor availability and approaches to reduce transplant-related mortality making it applicable in many more patients. Considerations in identifying appropriate patients for targeted therapy and transplantation are presented.
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Affiliation(s)
- Kristin Koenig
- Division of Hematology, Department of Medicine, The Ohio State University and The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Alice Mims
- Division of Hematology, Department of Medicine, The Ohio State University and The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Mark J Levis
- Hematologic Malignancies and Bone Marrow Transplant Program, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Mary M Horowitz
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
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Wang Y, Guo T, Liu Q, Xie X. CircRAD18 Accelerates the Progression of Acute Myeloid Leukemia by Modulation of miR-206/PRKACB Axis. Cancer Manag Res 2020; 12:10887-10896. [PMID: 33154668 PMCID: PMC7608482 DOI: 10.2147/cmar.s277432] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/04/2020] [Indexed: 12/27/2022] Open
Abstract
Background Circular RNAs (circRNAs) play a crucial role in tumorigenesis. However, the effects of circRNAs on acute myeloid leukemia (AML) remain largely unexplored. We explored the function of circRAD18 in AML development. Methods QRT-PCR was performed for the levels of circRAD18, RAD18, microRNA-206 (miR-206) and protein kinase CAMP-activated catalytic subunit beta (PRKACB). Cell Counting Kit-8 (CCK-8) assay and colony formation assay were utilized for cell proliferation. Flow cytometry analysis was carried out to analyze cell apoptosis and cell cycle process. Transwell assay was manipulated for cell migration and invasion. Western blot assay was conducted for protein levels. Dual-luciferase reporter assay was adopted to verify the interaction between miR-206 and circRAD18 or PRKACB. Results CircRAD18 level was increased in AML patients’ blood specimens and AML cell lines compared to normal controls. CircRAD18 knockdown impeded the proliferation, migration and invasion and facilitated the apoptosis and cell cycle arrest in AML cells. Moreover, circRAD18 was identified as a sponge for miR-206, and circRAD18 knockdown-mediated effect on AML cell progression was reversed by miR-206 suppression. Additionally, PRKACB was the target gene of miR-206. MiR-206 overexpression suppressed the malignant behaviors of AML cells, while PRKACB elevation restored the effects. Conclusion CircRAD18 aggravated the malignancy of AML cells through reducing miR-206 expression and elevating PRKACB expression, indicating circRAD18 might be a therapeutic target for AML.
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Affiliation(s)
- Yanyan Wang
- Shanghai Institute of Hematology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Te Guo
- German Cancer Research Center, Heidelberg 69120, Germany
| | - Quan Liu
- German Cancer Research Center, Heidelberg 69120, Germany
| | - Xianfei Xie
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
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Bittencourt MC, Ciurea SO. Recent Advances in Allogeneic Hematopoietic Stem Cell Transplantation for Acute Myeloid Leukemia. Biol Blood Marrow Transplant 2020; 26:e215-e221. [DOI: 10.1016/j.bbmt.2020.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/25/2020] [Accepted: 06/07/2020] [Indexed: 12/12/2022]
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Sharplin K, Wee LYA, Singhal D, Edwards S, Danner S, Lewis I, Thomas D, Wei A, Yong ASM, Hiwase DK. Outcomes and health care utilization of older patients with acute myeloid leukemia. J Geriatr Oncol 2020; 12:243-249. [PMID: 32713804 DOI: 10.1016/j.jgo.2020.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 04/27/2020] [Accepted: 07/06/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The incidence of acute myeloid leukemia (AML) in older patients is increasing, but practice guidelines balancing quality-of-life, time outside of hospital and overall survival (OS) are not established. METHODS We conducted a retrospective analysis comparing time outside hospital, OS and end-of-life care in AML patients ≥60 years treated with intensive chemotherapy (IC), hypomethylating agents (HMA) and best supportive care (BSC) in a tertiary hospital. RESULTS Of 201 patients diagnosed between 2005 and 2015, 54% received IC while 14% and 32% were treated with HMA and BSC respectively. Median OS was significantly higher in patients treated with IC and HMA compared with BSC (11.5 versus 16.2 versus 1.3 months; p < .0001). Median number of hospital admissions for the entire cohort was 3 (1-17) and patients spent <50% of their life after the diagnosis in the hospital setting. Compared to BSC, IC (HR 0.27, p < .0001) and HMA therapy (HR 0.16, p < .0001) were associated with the lower likelihood of spending at least 25% of survival time in hospital. Although 66% patients were referred to palliative care, the interval between referral to death was 24 (1-971) days and 46% patients died in the hospital. CONCLUSION Older patients with AML, irrespective of treatment, require intensive health care resources, are more likely to die in hospital and less likely to use hospice services. Older AML patients treated with disease modifying therapy survive longer than those receiving BSC, and spend >50% of survival time outside the hospital. These data are informative for counselling older patients with AML.
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Affiliation(s)
- Kirsty Sharplin
- Haematology, Royal Adelaide Hospital, Port Road, Adelaide, Australia
| | - Li Yan A Wee
- Haematology, Royal Adelaide Hospital, Port Road, Adelaide, Australia; Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Deepak Singhal
- Haematology, Royal Adelaide Hospital, Port Road, Adelaide, Australia; School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
| | - Suzanne Edwards
- School of Public Health, University of Adelaide, Adelaide, Australia
| | - Silke Danner
- Haematology, Royal Adelaide Hospital, Port Road, Adelaide, Australia
| | - Ian Lewis
- School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
| | - Daniel Thomas
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Andrew Wei
- Department of Clinical Hematology, Alfred Hospital and Monash University, Melbourne, Australia
| | - Agnes S M Yong
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, Australia; School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
| | - Devendra K Hiwase
- Haematology, Royal Adelaide Hospital, Port Road, Adelaide, Australia; Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, Australia; School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia.
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Jensen P, Carlet M, Schlenk RF, Weber A, Kress J, Brunner I, Słabicki M, Grill G, Weisemann S, Cheng YY, Jeremias I, Scholl C, Fröhling S. Requirement for LIM kinases in acute myeloid leukemia. Leukemia 2020; 34:3173-3185. [PMID: 32591645 DOI: 10.1038/s41375-020-0943-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 06/10/2020] [Accepted: 06/17/2020] [Indexed: 02/08/2023]
Abstract
Acute myeloid leukemia (AML) is an aggressive disease for which only few targeted therapies are available. Using high-throughput RNA interference (RNAi) screening in AML cell lines, we identified LIM kinase 1 (LIMK1) as a potential novel target for AML treatment. High LIMK1 expression was significantly correlated with shorter survival of AML patients and coincided with FLT3 mutations, KMT2A rearrangements, and elevated HOX gene expression. RNAi- and CRISPR-Cas9-mediated suppression as well as pharmacologic inhibition of LIMK1 and its close homolog LIMK2 reduced colony formation and decreased proliferation due to slowed cell-cycle progression of KMT2A-rearranged AML cell lines and patient-derived xenograft (PDX) samples. This was accompanied by morphologic changes indicative of myeloid differentiation. Transcriptome analysis showed upregulation of several tumor suppressor genes as well as downregulation of HOXA9 targets and mitosis-associated genes in response to LIMK1 suppression, providing a potential mechanistic basis for the anti-leukemic phenotype. Finally, we observed a reciprocal regulation between LIM kinases (LIMK) and CDK6, a kinase known to be involved in the differentiation block of KMT2A-rearranged AML, and addition of the CDK6 inhibitor palbociclib further enhanced the anti-proliferative effect of LIMK inhibition. Together, these data suggest that LIMK are promising targets for AML therapy.
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Affiliation(s)
- Patrizia Jensen
- Division of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Biosciences, Heidelberg University, Heidelberg, Germany
| | - Michela Carlet
- Research Unit Apoptosis in Hematopoietic Stem Cells, Helmholtz Center Munich, German Center for Environmental Health, Munich, Germany
| | - Richard F Schlenk
- Clinical Trials Center, National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg University Hospital and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Andrea Weber
- Division of Applied Functional Genomics, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany
| | - Jana Kress
- Division of Applied Functional Genomics, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany
| | - Ines Brunner
- Division of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Mikołaj Słabicki
- Division of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Gregor Grill
- Division of Applied Functional Genomics, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany
| | - Simon Weisemann
- Division of Applied Functional Genomics, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany
| | - Ya-Yun Cheng
- Division of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Biosciences, Heidelberg University, Heidelberg, Germany
| | - Irmela Jeremias
- Research Unit Apoptosis in Hematopoietic Stem Cells, Helmholtz Center Munich, German Center for Environmental Health, Munich, Germany.,Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians University Munich, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Claudia Scholl
- Division of Applied Functional Genomics, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany. .,German Cancer Consortium (DKTK), Core Center Heidelberg, Heidelberg, Germany.
| | - Stefan Fröhling
- Division of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany. .,German Cancer Consortium (DKTK), Core Center Heidelberg, Heidelberg, Germany.
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Yi M, Li A, Zhou L, Chu Q, Song Y, Wu K. The global burden and attributable risk factor analysis of acute myeloid leukemia in 195 countries and territories from 1990 to 2017: estimates based on the global burden of disease study 2017. J Hematol Oncol 2020; 13:72. [PMID: 32513227 PMCID: PMC7282046 DOI: 10.1186/s13045-020-00908-z] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/28/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Acute myeloid leukemia (AML) is a common leukemia subtype and has a poor prognosis. The risk of AML is highly related to age. In the context of population aging, a comprehensive report presenting epidemiological trends of AML is evaluable for policy-marker to allocate healthy resources. METHODS This study was based on the Global Burden of Disease 2017 database. We analyzed the change trends of incidence rate, death rate, and disability-adjusted life year (DALY) rate by calculating the corresponding estimated annual percentage change (EAPC) values. Besides, we investigated the influence of social development degree on AML's epidemiological trends and potential risk factors for AML-related mortality. RESULTS From 1990 to 2017, the incidence of AML gradually increased in the globe. Males and elder people had a higher possibility to develop AML. Developed countries tended to have higher age-standardized incidence rate and death rate than developing regions. Smoking, high body mass index, occupational exposure to benzene, and formaldehyde were the main risk factors for AML-related mortality. Notably, the contribution ratio of exposure to carcinogens was significantly increased in the low social-demographic index (SDI) region than in the high SDI region. CONCLUSION Generally, the burden of AML became heavier during the past 28 years which might need more health resources to resolve this population aging-associated problem. In the present stage, developed countries with high SDI had the most AML incidences and deaths. At the same time, developing countries with middle- or low-middle SDI also need to take actions to relieve rapidly increased AML burden.
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Affiliation(s)
- Ming Yi
- Department of Oncology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Anping Li
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Linghui Zhou
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Qian Chu
- Department of Oncology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yongping Song
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Kongming Wu
- Department of Oncology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China. .,The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China.
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Xiang X, Li L, Bo P, Kuang T, Liu S, Xie X, Guo S, Fu X, Zhang Y. 7‑Difluoromethyl‑5,4'‑dimethoxygenistein exerts anti‑angiogenic effects on acute promyelocytic leukemia HL‑60 cells by inhibiting the TLR4/NF‑κB signaling pathway. Mol Med Rep 2020; 21:2251-2259. [PMID: 32186776 PMCID: PMC7115195 DOI: 10.3892/mmr.2020.11029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 02/18/2020] [Indexed: 01/17/2023] Open
Abstract
Angiogenesis plays an important role in the development and metastasis of tumors, and anti-angiogenesis agents are used to treat tumors. For example, the acute promyelocytic leukemia (APL) may be treated with arsenic trioxide. Angiogenesis in APL is a multi-step dynamic equilibrium process coordinated by various angiogenic stimulators and inhibitors, which play key roles in the occurrence, progression and chemosensitivity of this disease. Our research group previously synthesized 7-difluoromethyl-5,4′-dimethoxygenistein (DFMG), and found that it inhibits angiogenesis during atherosclerotic plaque formation. In the present study, the effect and mechanism of DFMG in angiogenesis induced by APL HL-60 cells was investigated using a chick embryo chorioallantoic membrane model and Matrigel tubule formation assays. The results obtained revealed an anti-angiogenesis effect of DFMG towards HL-60 cells. When the Toll-like receptor 4/nuclear factor-κB (TLR4/NF-κB) signaling pathway was inhibited, the anti-angiogenic effect of DFMG was further enhanced. However, when the TLR4/NF-κB signaling pathway was activated, the anti-angiogenic effect of DFMG was attenuated. These results demonstrated that DFMG inhibits angiogenesis induced by APL HL-60 cells, and provides insights into the mechanism by which DFMG inhibits the TLR4/NF-κB signaling pathway. In conclusion, in the present study, the anti-angiogenesis effect of DFMG on APL has been reported, and the mechanism by which DFMG induced the anti-angiogenesis effect was explored. These findings have provided a potential new drug candidate for the treatment of patients with APL.
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Affiliation(s)
- Xueping Xiang
- Department of Internal Medicine, Medical College of Hunan Normal University, Changsha, Hunan 410013, P.R. China
| | - Lesai Li
- Department of Gynecologic Oncology, Hunan Cancer Hospital, Changsha, Hunan 410013, P.R. China
| | - Pingjuan Bo
- Department of Internal Medicine, Medical College of Hunan Normal University, Changsha, Hunan 410013, P.R. China
| | - Ting Kuang
- Department of Gynecologic Oncology, Hunan Cancer Hospital, Changsha, Hunan 410013, P.R. China
| | - Sujuan Liu
- Department of Internal Medicine, Medical College of Hunan Normal University, Changsha, Hunan 410013, P.R. China
| | - Xiaolin Xie
- Department of Internal Medicine, Medical College of Hunan Normal University, Changsha, Hunan 410013, P.R. China
| | - Sihui Guo
- Department of Internal Medicine, Medical College of Hunan Normal University, Changsha, Hunan 410013, P.R. China
| | - Xiaohua Fu
- Department of Internal Medicine, Medical College of Hunan Normal University, Changsha, Hunan 410013, P.R. China
| | - Yong Zhang
- Department of Internal Medicine, Medical College of Hunan Normal University, Changsha, Hunan 410013, P.R. China
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Palmieri R, Paterno G, De Bellis E, Mercante L, Buzzatti E, Esposito F, Del Principe MI, Maurillo L, Buccisano F, Venditti A. Therapeutic Choice in Older Patients with Acute Myeloid Leukemia: A Matter of Fitness. Cancers (Basel) 2020; 12:cancers12010120. [PMID: 31906489 PMCID: PMC7016986 DOI: 10.3390/cancers12010120] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 12/19/2019] [Accepted: 12/31/2019] [Indexed: 01/17/2023] Open
Abstract
Acute myeloid leukemia (AML), with an incidence increasing with age, is the most common acute leukemia in adults. Concurrent comorbidities, mild to severe organ dysfunctions, and low performance status (PS) are frequently found in older patients at the onset, conditioning treatment choice and crucially influencing the outcome. Although anthracyclines plus cytarabine-based chemotherapy, also called “7 + 3” regimen, remains the standard of care in young adults, its use in patients older than 65 years should be reserved to selected cases because of higher incidence of toxicity. These adverse features of AML in the elderly underline the importance of a careful patient assessment at diagnosis as a critical tool in the decision-making process of treatment choice. In this review, we will describe selected recently approved drugs as well as examine prognostic algorithms that may be helpful to assign treatment in elderly patients properly.
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Affiliation(s)
- Raffaele Palmieri
- Hematology, Department of Biomedicine and Prevention, University Tor Vergata, 00133 Rome, Italy; (R.P.); (G.P.); (E.D.B.); (L.M.); (E.B.); (F.E.); (M.I.D.P.); (F.B.)
- Fondazione Policlinico Tor Vergata, 00133 Rome, Italy;
| | - Giovangiacinto Paterno
- Hematology, Department of Biomedicine and Prevention, University Tor Vergata, 00133 Rome, Italy; (R.P.); (G.P.); (E.D.B.); (L.M.); (E.B.); (F.E.); (M.I.D.P.); (F.B.)
- Fondazione Policlinico Tor Vergata, 00133 Rome, Italy;
| | - Eleonora De Bellis
- Hematology, Department of Biomedicine and Prevention, University Tor Vergata, 00133 Rome, Italy; (R.P.); (G.P.); (E.D.B.); (L.M.); (E.B.); (F.E.); (M.I.D.P.); (F.B.)
- Fondazione Policlinico Tor Vergata, 00133 Rome, Italy;
| | - Lisa Mercante
- Hematology, Department of Biomedicine and Prevention, University Tor Vergata, 00133 Rome, Italy; (R.P.); (G.P.); (E.D.B.); (L.M.); (E.B.); (F.E.); (M.I.D.P.); (F.B.)
- Fondazione Policlinico Tor Vergata, 00133 Rome, Italy;
| | - Elisa Buzzatti
- Hematology, Department of Biomedicine and Prevention, University Tor Vergata, 00133 Rome, Italy; (R.P.); (G.P.); (E.D.B.); (L.M.); (E.B.); (F.E.); (M.I.D.P.); (F.B.)
- Fondazione Policlinico Tor Vergata, 00133 Rome, Italy;
| | - Fabiana Esposito
- Hematology, Department of Biomedicine and Prevention, University Tor Vergata, 00133 Rome, Italy; (R.P.); (G.P.); (E.D.B.); (L.M.); (E.B.); (F.E.); (M.I.D.P.); (F.B.)
- Fondazione Policlinico Tor Vergata, 00133 Rome, Italy;
| | - Maria Ilaria Del Principe
- Hematology, Department of Biomedicine and Prevention, University Tor Vergata, 00133 Rome, Italy; (R.P.); (G.P.); (E.D.B.); (L.M.); (E.B.); (F.E.); (M.I.D.P.); (F.B.)
- Fondazione Policlinico Tor Vergata, 00133 Rome, Italy;
| | - Luca Maurillo
- Fondazione Policlinico Tor Vergata, 00133 Rome, Italy;
| | - Francesco Buccisano
- Hematology, Department of Biomedicine and Prevention, University Tor Vergata, 00133 Rome, Italy; (R.P.); (G.P.); (E.D.B.); (L.M.); (E.B.); (F.E.); (M.I.D.P.); (F.B.)
- Fondazione Policlinico Tor Vergata, 00133 Rome, Italy;
| | - Adriano Venditti
- Hematology, Department of Biomedicine and Prevention, University Tor Vergata, 00133 Rome, Italy; (R.P.); (G.P.); (E.D.B.); (L.M.); (E.B.); (F.E.); (M.I.D.P.); (F.B.)
- Fondazione Policlinico Tor Vergata, 00133 Rome, Italy;
- Correspondence: ; Tel.: +39-0620903226
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Fan T, Quan RC, Liu WY, Xiao HY, Tang XD, Liu C, Li L, Lv Y, Wang HZ, Xu YG, Guo XQ, Hu XM. Arsenic-Containing Qinghuang Powder () is an Alternative Treatment for Elderly Acute Myeloid Leukemia Patients Refusing Low-Intensity Chemotherapy. Chin J Integr Med 2019; 26:339-344. [PMID: 31848890 DOI: 10.1007/s11655-019-3050-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyze the overall survival (OS) of elderly acute myeloid leukemia (AML) patients treated with oral arsenic-containing Qinghuang Powder (, QHP) or low-intensity chemotherapy (LIC). METHODS Forty-two elderly AML patients treated with intravenous or subcutaneous LIC (1 month for each course, at least 3 courses) or oral QHP (3 months for each course, at least 2 courses) were retrospectively analyzed from January 2015 to December 2017. The main endpoints of analysis were OS and 1-, 2-, 3-year OS rates of patients, respectively. And the adverse reactions induding bone marrow suppression, digestive tract discomfort and myocardia injury were observed. RESULTS Out of 42 elderly AML patients, 22 received LIC treatment and 20 received QHP treatment, according to patients' preference. There was no significant difference on OS between LIC and QHP patients (13.0 months vs. 13.5 months, >0.05). There was no significant difference on OS rates between LIC and QHP groups at 1 year (59.1% vs. 70.0%), 2 years (13.6% vs. 15%), and 3 years (4.6% vs. 5.0%, all >0.05). Furthermore, there was no significant difference of OS on prognosis stratification of performance status > 2 (12 months vs. 12 months), age> 75 year-old (12.0 months vs. 12.5 months), hematopoietic stem cell transplant comorbidity index >2 (12 months vs. 13 months), poor cytogenetics (12 months vs. 8 months), and diagnosis of secondary AML (10 months vs. 14 months) between LIC and QHP patients (>0.05). CONCLUSION QHP may be an alternative treatment for elderly AML patients refusing LIC therapy.
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Affiliation(s)
- Teng Fan
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
- Graduate School, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Ri-Cheng Quan
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Wei-Yi Liu
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Hai-Yan Xiao
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Xu-Dong Tang
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Chi Liu
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Liu Li
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Yan Lv
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Hong-Zhi Wang
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Yong-Gang Xu
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Xiao-Qing Guo
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Xiao-Mei Hu
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China.
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Feng S, Zhou L, Zhang X, Tang B, Zhu X, Liu H, Sun Z, Zheng C. Impact Of ELN Risk Stratification, Induction Chemotherapy Regimens And Hematopoietic Stem Cell Transplantation On Outcomes In Hyperleukocytic Acute Myeloid Leukemia With Initial White Blood Cell Count More Than 100 × 10 9/L. Cancer Manag Res 2019; 11:9495-9503. [PMID: 31807075 PMCID: PMC6850690 DOI: 10.2147/cmar.s225123] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 10/25/2019] [Indexed: 01/09/2023] Open
Abstract
Background Hyperleukocytic acute myeloid leukemia (AML) (initial white blood cell count≥100 × 109/L) is a clinical emergency often accompanied by leukostasis syndrome, tumor lysis syndrome (TLS), and disseminated intravascular coagulation (DIC), with a poor clinical prognosis. The aim of this study retrospectively analyzed the clinical features of hyperleukocytic AML, focusing on high-risk factors affecting prognosis, the selection of initial induction therapy, and the impact of hematopoietic stem cell transplantation (HSCT) on prognosis. Patients and methods A total of 558 AML patients at our center from January 2013 to December 2017 were diagnosed, and 52 (9.32%) patients presented with hyperleukocytosis were retrospectively reviewed. Results The 3-year overall survival (OS) rate in the 15–39 years old and 40–60 years old group was 58.8% and 25.4%, respectively; the longest survival time in patients aged >60 years was only 8 months, and the 8-month OS rate was 8.3% (p=0.002). The 3-year OS rate of the patients in the favorable risk group, intermediate risk group and high risk group, according to the 2017 ELN risk stratification, was 50%, 28.0%, and 29.5%, respectively (p=0.374). The 3-year OS rate of patients carrying CEBPA or NPM1 mutation and those with FLT3-ITD or MLL mutation was 37.5% and 30.0%, respectively (p=0.63). The 3-year OS rate of patients employing an induction regimen of a standard IA regimen was 58.4%, and of those employing a non-standard IA regimen was 22.2% (p=0.065). The 3-year OS rate of the transplantation patients reached 73.8%, while the 9-month OS rate of patients without transplantation was 11.4% (p<0.001). Conclusion This study suggest that hyperleukocytosis is an independent risk factor for AML patients, regardless of the risk stratification based on cytogenetic or molecular abnormalities. Age is the main factor influencing the prognosis of hyperleukocytic AML. The use of a standard IA regimen and HSCT can significantly improve the patient’s prognosis.
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Affiliation(s)
- Shanglong Feng
- Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, People's Republic of China
| | - Li Zhou
- Department of Hematology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China
| | - Xinhui Zhang
- Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, People's Republic of China
| | - Baolin Tang
- Department of Hematology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China
| | - Xiaoyu Zhu
- Department of Hematology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China
| | - Huilan Liu
- Department of Hematology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China
| | - Zimin Sun
- Department of Hematology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China
| | - Changcheng Zheng
- Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, People's Republic of China.,Department of Hematology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China
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Ferrara F, Lessi F, Vitagliano O, Birkenghi E, Rossi G. Current Therapeutic Results and Treatment Options for Older Patients with Relapsed Acute Myeloid Leukemia. Cancers (Basel) 2019; 11:E224. [PMID: 30769877 PMCID: PMC6406399 DOI: 10.3390/cancers11020224] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/05/2019] [Accepted: 02/10/2019] [Indexed: 11/16/2022] Open
Abstract
Considerable progress has been made in the treatment of acute myeloid leukemia (AML). However, current therapeutic results are still unsatisfactory in untreated high-risk patients and poorer in those with primary refractory or relapsed disease. In older patients, reluctance by clinicians to treat unfit patients, higher AML cell resistance related to more frequent adverse karyotype and/or precedent myelodysplastic syndrome, and preferential involvement of chemorefractory early hemopoietic precursors in the pathogenesis of the disease further account for poor prognosis, with median survival lower than six months. A general agreement exists concerning the administration of aggressive salvage therapy in young adults followed by allogeneic stem cell transplantation; on the contrary, different therapeutic approaches varying in intensity, from conventional salvage chemotherapy based on intermediate⁻high-dose cytarabine to best supportive care, are currently considered in the relapsed, older AML patient population. Either patients' characteristics or physicians' attitudes count toward the process of clinical decision making. In addition, several new drugs with clinical activity described as "promising" in uncontrolled single-arm studies failed to improve long-term outcomes when tested in larger randomized clinical trials. Recently, new agents have been approved and are expected to consistently improve the clinical outcome for selected genomic subgroups, and research is in progress in other molecular settings. While relapsed AML remains a tremendous challenge to both patients and clinicians, knowledge of the molecular pathogenesis of the disease is fast in progress, potentially leading to personalized therapy in most patients.
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Affiliation(s)
| | - Federica Lessi
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padua, 35153 Padua, Italy.
| | | | - Erika Birkenghi
- Division of Hematology, Spedali Civili, 25123 Brescia, Italy.
| | - Giuseppe Rossi
- Division of Hematology, Spedali Civili, 25123 Brescia, Italy.
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Improved Survival of Elderly-fit Patients With Acute Myeloid Leukemia Requiring Intensive Therapy: 3-Year Multicenter Analysis From TALWG. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:e509-e514. [DOI: 10.1016/j.clml.2018.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/14/2018] [Accepted: 08/01/2018] [Indexed: 11/22/2022]
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End-of-life care for older AML patients relapsing after allogeneic stem cell transplant at a dedicated cancer center. Bone Marrow Transplant 2018; 54:700-706. [PMID: 30135464 DOI: 10.1038/s41409-018-0311-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 08/06/2018] [Accepted: 08/13/2018] [Indexed: 11/08/2022]
Abstract
Older patients with acute myelogenous leukemia (AML) are at increased risk for mortality and morbidity. While allogeneic stem cell transplantation may provide cure in some patients, many still relapse after transplant and are then left with limited therapeutic options and poor survival. Moreover, the quality of the end-of-life care for these patients has not been previously reported. We describe here the end-of-life experience of a cohort of 72 older patients with AML who relapsed after first allogeneic stem cell transplant at our dedicated cancer center. Despite a median overall survival of only 4 months, we find a high level of primary palliative care delivered by transplant/leukemia physicians through goals of care discussions and/or advanced care planning and provide evidence for high-quality end-of-life care outcomes, often with concurrent disease-directed therapy. Our results compare favorably with end-of-life care outcomes reported for older AML patients, including those who did not undergo transplant. Given the poor prognosis and unique underlying vulnerabilities in this high-risk patient population, incorporating timely advanced care planning and palliative care delivery while exploring available salvage options may further improve end-of-life care outcomes.
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