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Creutzig U, Zimmermann M, Lehrnbecher T, Graf N, Hermann J, Niemeyer CM, Reiter A, Ritter J, Dworzak M, Stary J, Reinhardt D. Less toxicity by optimizing chemotherapy, but not by addition of granulocyte colony-stimulating factor in children and adolescents with acute myeloid leukemia: results of AML-BFM 98. J Clin Oncol 2006; 24:4499-506. [PMID: 16983120 DOI: 10.1200/jco.2006.06.5037] [Citation(s) in RCA: 145] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To improve prognosis in children with acute myeloid leukemia (AML) by randomized comparisons of (1) two short consolidation cycles versus the Berlin-Frankfurt-Muenster (BFM) -type biphasic 6-week consolidation and (2) the prophylactic administration of granulocyte colony-stimulating factor (G-CSF) versus no G-CSF. Further, therapy for standard risk patients was intensified by addition of a second induction, HAM (high-dose cytarabine and mitoxantrone). PATIENTS AND METHODS Four hundred seventy-three patients younger than 18 years with de novo AML were enrolled in trial AML-BFM 98. Patients received five courses of intensive chemotherapy, cranial irradiation, and 1-year maintenance therapy. RESULTS Four hundred eighteen patients (88%) achieved remission. Compared with trial AML-BFM 93, early deaths decreased from 7.4 to 3.2% (P = .005), and 5-year overall survival increased from 58% to 62% (log-rank P = .03). Both types of consolidation therapy led to similar outcome (event-free survival, 51% v 50%), but in the two-cycle arm, treatment duration was shorter (median duration, 15 days), and treatment related mortality was lower (five v nine patients). G-CSF shortened neutropenia, but did not reduce the rate of severe infections. Intensification of induction therapy did not improve prognosis of standard-risk patients (event-free survival, 62% v 67%). CONCLUSION Overall results were improved by neither the administration of G-CSF nor by cycle therapy; however, the latter was easier to perform. Compared with study AML-BFM 93, therapy intensification with HAM in standard-risk patients did not result in improved prognosis. Future treatment designs have to balance intensification of treatment with higher toxicity, improve supportive care, and to consider alternative treatment strategies.
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Affiliation(s)
- Ursula Creutzig
- Department of Hematology/Oncology, University Children's Hospital, Muenster, Germany.
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Yi HR, Han DK, Baek HJ, Kim YO, Kim SJ, Song ES, Kook H, Hwang TJ. Hematopoietic Stem Cell Transplantation in Pediatric Acute Myelogenous Leukemia: Relevance of the Stem Cell Source to the Transplant Outcome. THE KOREAN JOURNAL OF HEMATOLOGY 2005. [DOI: 10.5045/kjh.2005.40.4.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Hye Ryoung Yi
- Department of Pediatrics, Chonnam National University Medical School, Blood & Marrow Transplantation Center, Chonnam National University Hwasun Hospital, Gwangju, Korea
| | - Dong Kyun Han
- Department of Pediatrics, Chonnam National University Medical School, Blood & Marrow Transplantation Center, Chonnam National University Hwasun Hospital, Gwangju, Korea
| | - Hee Jo Baek
- Department of Pediatrics, Chonnam National University Medical School, Blood & Marrow Transplantation Center, Chonnam National University Hwasun Hospital, Gwangju, Korea
| | - Young Ok Kim
- Department of Pediatrics, Chonnam National University Medical School, Blood & Marrow Transplantation Center, Chonnam National University Hwasun Hospital, Gwangju, Korea
| | - Seok Joo Kim
- Department of Pediatrics, Chonnam National University Medical School, Blood & Marrow Transplantation Center, Chonnam National University Hwasun Hospital, Gwangju, Korea
| | - Eun Song Song
- Department of Pediatrics, Chonnam National University Medical School, Blood & Marrow Transplantation Center, Chonnam National University Hwasun Hospital, Gwangju, Korea
| | - Hoon Kook
- Department of Pediatrics, Chonnam National University Medical School, Blood & Marrow Transplantation Center, Chonnam National University Hwasun Hospital, Gwangju, Korea
| | - Tai Ju Hwang
- Department of Pediatrics, Chonnam National University Medical School, Blood & Marrow Transplantation Center, Chonnam National University Hwasun Hospital, Gwangju, Korea
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Johnston DL, Meshinchi S, Opheim KE, Pallavicini MG, Feusner J, Woods WG, Lange BJ, Radich JP, Bernstein ID. Progenitor cell involvement is predictive of response to induction chemotherapy in paediatric acute myeloid leukaemia. Br J Haematol 2003; 123:431-5. [PMID: 14617001 DOI: 10.1046/j.1365-2141.2003.04633.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In acute myeloid leukaemia (AML), involvement of early progenitor cells may predict poor response to induction chemotherapy. We evaluated the involvement of early progenitor cells in two AML subtypes with a favourable prognosis [t(8;21) and t(15;17)], and a subtype with poor prognosis (monosomy 7). CD34+CD33- cells were isolated by fluorescence-activated cell sorting, grown in liquid medium followed by culture in semi-solid medium, and the colonies that were formed were analysed for the identifiable genetic markers. Two of 136 colonies from six t(8;21) AML patients expressed the AML1-ETO transcript, and all six patients achieved remission after induction. None of 192 colonies from five t(15;17) AML patients expressed the RARalpha-PML transcript and all achieved remission. In contrast, in three of 10 cases of monosomy 7 AML, colonies were positive for monosomy 7, and all three patients failed to enter remission. However, five of six evaluable patients with colonies negative for monosomy 7 entered remission. These data support the hypothesis that leukaemic involvement of early progenitor cells affects the response to induction chemotherapy.
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MESH Headings
- Acute Disease
- Child
- Chromosome Aberrations
- Chromosomes, Human, Pair 15
- Chromosomes, Human, Pair 17
- Chromosomes, Human, Pair 21
- Chromosomes, Human, Pair 7
- Chromosomes, Human, Pair 8
- Core Binding Factor Alpha 2 Subunit
- Gene Rearrangement
- Genetic Markers
- Humans
- In Situ Hybridization, Fluorescence
- Leukemia, Myeloid/drug therapy
- Leukemia, Myeloid/genetics
- Monosomy
- Neoplasm Proteins/genetics
- Oncogene Proteins, Fusion/genetics
- Prognosis
- RUNX1 Translocation Partner 1 Protein
- Remission Induction
- Reverse Transcriptase Polymerase Chain Reaction
- Stem Cells
- Transcription Factors/genetics
- Translocation, Genetic
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Abstract
In vitro studies that showed RA could cause growth arrest and differentiation of myelogenous leukemia and neuroblastoma led to clinical trials of retinoids in APL and neuroblastoma that increased survival for both of those diseases. In the case of APL, ATRA has been the drug of choice, and preclinical and clinical data support direct combinations of ATRA with cytotoxic chemotherapy. For neuroblastoma, a phase I study defined a dose of 13-cis-RA, which was tolerable in patients after myeloablative therapy, and a phase III trial that showed postconsolidation therapy with 13-cis-RA improved EFS for patients with high-risk neuroblastoma. Preclinical studies in neuroblastoma indicate that ATRA or 13-cis-RA can antagonize cytotoxic chemotherapy and radiation, so use of 13-cis-RA in neuroblastoma is limited to maintenance after completion of cytotoxic chemotherapy and radiation. A limitation on the antitumor benefit of ATRA in APL is the marked decrease in drug levels that occurs during therapy as a result of induction of drug metabolism, resulting in a shorter drug half-life and decreased plasma levels. Although early studies sought to overcome the pharmacologic limitations of ATRA therapy in APL, the demonstration that ATO is active against APL in RA-refractory patients has led to a focus on studies employing ATO. Use of 13-cis-RA in neuroblastoma has avoided the decreased plasma levels seen with ATRA. It is likely that recurrent disease seen during or after 13-cis-RA therapy in neuroblastoma is due to tumor cell resistance to retinoid-mediated differentiation induction. Studies in neuroblastoma cell lines resistant to 13-cis-RA and ATRA have shown that they can be sensitive, and in some cases collaterally hypersensitive, to the cytotoxic retinoid fenretinide. Fenretinide induces tumor cell cytotoxicity rather than differentiation, acts independently from RA receptors, and in initial phase I trials has been well tolerated. Clinical trials of fenretinide, alone and in combination with ceramide modulators, are in development.
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Affiliation(s)
- C P Reynolds
- Developmental Therapeutics Section, Division of Hematology-Oncology, Children's Hospital of Los Angeles, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.
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Martinez-Climent JA, García-Conde J. Chromosomal rearrangements in childhood acute myeloid leukemia and myelodysplastic syndromes. J Pediatr Hematol Oncol 1999; 21:91-102. [PMID: 10206454 DOI: 10.1097/00043426-199903000-00004] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Recurrent chromosomal abnormalities present in the malignant cells of children with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) often correlate closely with specific clinical and biologic characteristics of the disease. Certain unique cytogenetic rearrangements are associated with distinct morphologic leukemic subtypes. These rearrangements should be detectable in most children with AML and MDS with the use of complementary molecular techniques such as fluorescence in situ hybridization (FISH), Southern blotting, and polymerase chain reaction. Apart from the diagnostic assessment, cytogenetic findings sometimes predict clinical outcome and thus also serve as prognostic parameters, which may affect the therapeutic decision. Alternative classifications of AML that take into account the genetic information are being proposed. Cytogenetic and molecular analyses may allow clinicians to more appropriately direct types of treatment. Abnormal fusion transcripts and chimeric proteins derived from karyotypic abnormalities now are being also targeted by novel therapeutic approaches.
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MESH Headings
- Acute Disease
- Adolescent
- Biomarkers, Tumor/genetics
- Child
- Child, Preschool
- Chromosome Aberrations
- Chromosome Deletion
- Chromosomes, Human/genetics
- Chromosomes, Human/ultrastructure
- Female
- Humans
- Infant
- Leukemia, Myeloid/classification
- Leukemia, Myeloid/genetics
- Leukemia, Myeloid/mortality
- Male
- Myelodysplastic Syndromes/genetics
- Myelodysplastic Syndromes/mortality
- Neoplasms, Second Primary/genetics
- Neoplasms, Second Primary/mortality
- Oncogene Proteins, Fusion/genetics
- Oncogenes
- Patient Care Planning
- Polyploidy
- Prognosis
- Translocation, Genetic
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Affiliation(s)
- J A Martinez-Climent
- Department of Hematology and Oncology, Hospital Clinico Universitario, University of Valencia, Spain
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Li X, Lopez-Guisa JM, Ninan N, Weiner EJ, Rauscher FJ, Marmorstein R. Overexpression, purification, characterization, and crystallization of the BTB/POZ domain from the PLZF oncoprotein. J Biol Chem 1997; 272:27324-9. [PMID: 9341182 DOI: 10.1074/jbc.272.43.27324] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The BTB/POZ domain defines a conserved region of about 120 residues and has been found in over 40 proteins to date. It is located predominantly at the N terminus of Zn-finger DNA-binding proteins, where it may function as a repression domain, and less frequently in actin-binding and poxvirus-encoded proteins, where it may function as a protein-protein interaction interface. A prototypic human BTB/POZ protein, PLZF (promyelocytic leukemia zinc finger) is fused to RARalpha (retinoic acid receptor alpha) in a subset of acute promyelocytic leukemias (APLs), where it acts as a potent oncogene. The exact role of the BTB/POZ domain in protein-protein interactions and/or transcriptional regulation is unknown. We have overexpressed, purified, characterized, and crystallized the BTB/POZ domain from PLZF (PLZF-BTB/POZ). Gel filtration, dynamic light scattering, and equilibrium sedimentation experiments show that PLZF-BTB/POZ forms a homodimer with a Kd below 200 nM. Differential scanning calorimetry and equilibrium denaturation experiments are consistent with the PLZF-BTB/POZ dimer undergoing a two-state unfolding transition with a Tm of 70.4 degrees C, and a DeltaG of 12.8 +/- 0.4 kcal/mol. Circular dichroism shows that the PLZF-BTB/POZ dimer has significant secondary structure including about 45% helix and 20% beta-sheet. We have prepared crystals of the PLZF-BTB/POZ that are suitable for a high resolution structure determination using x-ray crystallography. The crystals form in the space group I222 or I212121 with a = 38.8, b = 77.7, and c = 85.3 A and contain 1 protein subunit per asymmetric unit with approximately 40% solvent. Our data support the hypothesis that the BTB/POZ domain mediates a functionally relevant dimerization function in vivo. The crystal structure of the PLZF-BTB/POZ domain will provide a paradigm for understanding the structural basis underlying BTB/POZ domain function.
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Affiliation(s)
- X Li
- The Wistar Institute, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
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Abstract
Acute myelogenous leukemia (AML) accounts for about 20% of the acute leukemias seen in children. In contrast to childhood acute lymphoblastic leukemia (ALL), there has only been a modest improvement in the cure rate of children with AML during the past two decades. Approximately 40% of children treated with chemotherapy alone are long-term survivors. The outcome is somewhat better for those children who are given bone marrow transplants from histocompatible sibling donors early in the first remission. During the last decade, however, new insights into the molecular basis of AML has increased our understanding of the pathogenesis and biology of this group of leukemias and are beginning to provide us with new therapeutic strategies.
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Affiliation(s)
- D H Ebb
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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Abstract
Chromosome abnormalities of childhood acute myeloblastic leukaemia, observed at least in 70-80% of cases, are presently recognized as important parameters for diagnostic, prognostic and follow-up purposes. These abnormalities are numerical, structural or both numerical and structural. They are also classified in "primary" abnormalities, usually more or less related with one subtype of leukaemia, and "secondary" abnormalities thought to appear in a second time. Chromosome abnormalities of childhood acute myeloblastic leukaemia (AML) are not basically qualitatively different from those of adult AML. The main difference lies in the incidence of the various types of abnormalities, and these differences appear to be more marked for age extremes such as infants and elderly patients. In total, 3 common abnormalities are more frequently observed in childhood than in adult AML; t(8;21) in AML-M2, monosomy 7 in AML-M4, der(11q) in AML-M5. In addition, molecular rearrangements associated with chromosomal abnormalities are dependent on the type of rearrangement and not on age. As in adult AML, the prognostic value of chromosome abnormalities has been diversely evaluated; some anomalies seem to be related to a shorter survival than others independent of the various therapeutic protocols used. In the present work, chromosome abnormalities of childhood AML have been reviewed according to cytologic subtypes as well as to some clinical settings. Special attention has been paid to abnormalities frequently or exclusively encountered in children.
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Affiliation(s)
- T Leblanc
- Hématologie Pédiatrique, Hôpital Saint-Louis, Paris, France
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Sackmann-Muriel F, Zubizarreta P, Felice MS, Chantada G, Cygler AM, Gallego M, Rossi J. Results of treatment with an intensive induction regimen using idarubicin in combination with cytarabine and etoposide in children with acute myeloblastic leukemia. Leuk Res 1996; 20:973-81. [PMID: 9009256 DOI: 10.1016/s0145-2126(96)00071-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We report results achieved in our institution with a study opened in July 1990 (similar to the German AML-BFM-87 in which daunorubicin was replaced by idarubicin in the induction phase and cranial preventive radiotherapy was omitted) and closed in December 1994, for the treatment of newly diagnosed acute myeloblastic leukemia (AML), without prior malignancies except for myelodysplasia. This evaluation included 68 patients, whose mean age was 6 years (range: 1 month-16 years). Thirty-nine were boys and 29 were girls. Complete remission rate was 80.9% (55/68), death on induction rate was 14.7% and induction failure rate was 4.4%. At median follow up of 38 months (range: 12-66 months), the 4-year event-free survival (EFS) estimate was 0.428 (S.E.: 0.062), event-free interval (EFI) estimate was 0.529 (S.E.: 0.07) and overall survival (OS) estimate was 0.44 (S.E.: 0.071). We conclude that idarubicin in combination with cytarabine and etoposide is a highly effective regimen for induction in children with AML. Although preventive cranial irradiation was not delivered, we have observed only one combined CNS relapse. Finally, we corroborate that in this setting two definite risk groups may be identified in children with AML.
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Affiliation(s)
- F Sackmann-Muriel
- Department of Hematology/Oncology and Immunology, Hospital de Pediatría SAMIC, Buenos Aires, Argentina
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