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Qiao X, van der Zanden SY, Li X, Tan M, Zhang Y, Song JY, van Gelder MA, Hamoen FL, Janssen L, Zuur CL, Pang B, van Tellingen O, Li J, Neefjes J. Diversifying the anthracycline class of anti-cancer drugs identifies aclarubicin for superior survival of acute myeloid leukemia patients. Mol Cancer 2024; 23:120. [PMID: 38831402 PMCID: PMC11149191 DOI: 10.1186/s12943-024-02034-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 05/28/2024] [Indexed: 06/05/2024] Open
Abstract
The efficacy of anthracycline-based chemotherapeutics, which include doxorubicin and its structural relatives daunorubicin and idarubicin, remains almost unmatched in oncology, despite a side effect profile including cumulative dose-dependent cardiotoxicity, therapy-related malignancies and infertility. Detoxifying anthracyclines while preserving their anti-neoplastic effects is arguably a major unmet need in modern oncology, as cardiovascular complications that limit anti-cancer treatment are a leading cause of morbidity and mortality among the 17 million cancer survivors in the U.S. In this study, we examined different clinically relevant anthracycline drugs for a series of features including mode of action (chromatin and DNA damage), bio-distribution, anti-tumor efficacy and cardiotoxicity in pre-clinical models and patients. The different anthracycline drugs have surprisingly individual efficacy and toxicity profiles. In particular, aclarubicin stands out in pre-clinical models and clinical studies, as it potently kills cancer cells, lacks cardiotoxicity, and can be safely administered even after the maximum cumulative dose of either doxorubicin or idarubicin has been reached. Retrospective analysis of aclarubicin used as second-line treatment for relapsed/refractory AML patients showed survival effects similar to its use in first line, leading to a notable 23% increase in 5-year overall survival compared to other intensive chemotherapies. Considering individual anthracyclines as distinct entities unveils new treatment options, such as the identification of aclarubicin, which significantly improves the survival outcomes of AML patients while mitigating the treatment-limiting side-effects. Building upon these findings, an international multicenter Phase III prospective study is prepared, to integrate aclarubicin into the treatment of relapsed/refractory AML patients.
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Affiliation(s)
- Xiaohang Qiao
- Division of Tumor Biology and Immunology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Sabina Y van der Zanden
- Department of Cell and Chemical Biology, ONCODE Institute, Leiden University Medical Center, Leiden, The Netherlands
| | - Xiaoyang Li
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Minkang Tan
- Department of Cell and Chemical Biology, ONCODE Institute, Leiden University Medical Center, Leiden, The Netherlands
| | - Yunxiang Zhang
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ji-Ying Song
- Division of Experimental Animal Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Merle A van Gelder
- Department of Cell and Chemical Biology, ONCODE Institute, Leiden University Medical Center, Leiden, The Netherlands
| | - Feija L Hamoen
- Department of Cell and Chemical Biology, ONCODE Institute, Leiden University Medical Center, Leiden, The Netherlands
| | - Lennert Janssen
- Department of Cell and Chemical Biology, ONCODE Institute, Leiden University Medical Center, Leiden, The Netherlands
| | - Charlotte L Zuur
- Division of Tumor Biology and Immunology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Baoxu Pang
- Department of Cell and Chemical Biology, ONCODE Institute, Leiden University Medical Center, Leiden, The Netherlands
| | - Olaf van Tellingen
- Division of Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Junmin Li
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Wuxi Branch of Ruijin Hospital, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai , 200025, China.
| | - Jacques Neefjes
- Department of Cell and Chemical Biology, ONCODE Institute, Leiden University Medical Center, Leiden, The Netherlands.
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Bahattab S, Assiri A, Alhaidan Y, Trivilegio T, AlRoshody R, Huwaizi S, Almuzzaini B, Alamro A, Abudawood M, Alehaideb Z, Matou-Nasri S. Pharmacological p38 MAPK inhibitor SB203580 enhances AML stem cell line KG1a chemosensitivity to daunorubicin by promoting late apoptosis, cell growth arrest in S-phase, and miR-328-3p upregulation. Saudi Pharm J 2024; 32:102055. [PMID: 38699598 PMCID: PMC11063648 DOI: 10.1016/j.jsps.2024.102055] [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: 02/26/2024] [Accepted: 03/27/2024] [Indexed: 05/05/2024] Open
Abstract
Acute myeloid leukaemia (AML) is characterized by uncontrolled proliferation of myeloid progenitor cells and impaired maturation, leading to immature cell accumulation in the bone marrow and bloodstream, resulting in hematopoietic dysfunction. Chemoresistance, hyperactivity of survival pathways, and miRNA alteration are major factors contributing to treatment failure and poor outcomes in AML patients. This study aimed to investigate the impact of the pharmacological p38 mitogen-activated protein kinase (MAPK) inhibitor SB203580 on the chemoresistance potential of AML stem cell line KG1a to the therapeutic drug daunorubicin (DNR). KG1a and chemosensitive leukemic HL60 cells were treated with increasing concentrations of DNR. Cell Titer-Glo®, flow cytometry, phosphokinase and protein arrays, Western blot technology, and reverse transcription-quantitative polymerase chain reaction (RT-qPCR) were employed for assessment of cell viability, half-maximal inhibitory concentration (IC50) determination, apoptotic status detection, cell cycle analysis, apoptosis-related protein and gene expression monitoring. Confocal microscopy was used to visualize caspase and mitochondrial permeability transition pore (mPTP) activities. Exposed at various incubation times, higher DNR IC50 values were determined for KG1a cells than for HL60 cells, confirming KG1a cell chemoresistance potential. Exposed to DNR, late apoptosis induction in KG1a cells was enhanced after SB203580 pretreatment, defined as the combination treatment. This enhancement was confirmed by increased cleavage of poly(ADP-ribose) polymerase, caspase-9, caspase-3, and augmented caspase-3/-7 and mPTP activities in KG1a cells upon combination treatment, compared to DNR. Using phosphokinase and apoptosis protein arrays, the combination treatment decreased survival Akt phosphorylation and anti-apoptotic Bcl-2 expression levels in KG1a cells while increasing the expression levels of the tumor suppressor p53 and cyclin-dependent kinase inhibitor p21, compared to DNR. Cell cycle analysis revealed KG1a cell growth arrest in G2/M-phase caused by DNR, while combined treatment led to cell growth arrest in S-phase, mainly associated with cyclin B1 expression levels. Remarkably, the enhanced KG1a cell sensitivity to DNR after SB203580 pretreatment was associated with an increased upregulation of miR-328-3p and slight downregulation of miR-26b-5p, compared to DNR effect. Altogether, these findings could contribute to the development of a new therapeutic strategy by targeting the p38 MAPK pathway to improve treatment outcomes in patients with refractory or relapsed AML.
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Affiliation(s)
- Sara Bahattab
- Blood and Cancer Research Department, King Abdullah International Medical Research Center (KAIMRC), King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Ministry of National Guard-Health Affairs (MNG-HA), Riyadh 11481, Saudi Arabia
- Biochemistry Department, College of Science, King Saud University, Riyadh 11451, Saudi Arabia
| | - Ali Assiri
- Blood and Cancer Research Department, King Abdullah International Medical Research Center (KAIMRC), King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Ministry of National Guard-Health Affairs (MNG-HA), Riyadh 11481, Saudi Arabia
- Department of Clinical Laboratories Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11362, Saudi Arabia
| | - Yazeid Alhaidan
- Medical Genomics Research Department, KAIMRC, KSAU-HS, MNG-HA, Riyadh 11481, Saudi Arabia
| | - Thadeo Trivilegio
- Medical Research Core Facility and Platforms, KAIMRC, KSAU-HS, MNG-HA, Riyadh 11481, Saudi Arabia
| | - Rehab AlRoshody
- Blood and Cancer Research Department, King Abdullah International Medical Research Center (KAIMRC), King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Ministry of National Guard-Health Affairs (MNG-HA), Riyadh 11481, Saudi Arabia
| | - Sarah Huwaizi
- Medical Research Core Facility and Platforms, KAIMRC, KSAU-HS, MNG-HA, Riyadh 11481, Saudi Arabia
| | - Bader Almuzzaini
- Medical Genomics Research Department, KAIMRC, KSAU-HS, MNG-HA, Riyadh 11481, Saudi Arabia
| | - Abir Alamro
- Biochemistry Department, College of Science, King Saud University, Riyadh 11451, Saudi Arabia
| | - Manal Abudawood
- Department of Clinical Laboratories Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11362, Saudi Arabia
| | - Zeyad Alehaideb
- Medical Genomics Research Department, KAIMRC, KSAU-HS, MNG-HA, Riyadh 11481, Saudi Arabia
| | - Sabine Matou-Nasri
- Blood and Cancer Research Department, King Abdullah International Medical Research Center (KAIMRC), King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Ministry of National Guard-Health Affairs (MNG-HA), Riyadh 11481, Saudi Arabia
- Biosciences Department, Faculty of the School of Systems Biology, George Mason University, Manassas, VA 20110, United States
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Tiong IS, Wall M, Bajel A, Kalro A, Fleming S, Roberts AW, Thiagarajah N, Chua CC, Latimer M, Yeung D, Marlton P, Johnston A, Enjeti A, Fong CY, Cull G, Larsen S, Kennedy G, Schwarer A, Kipp D, Ramanathan S, Verner E, Tiley C, Morris E, Hahn U, Moore J, Taper J, Purtill D, Warburton P, Stevenson W, Murphy N, Tan P, Beligaswatte A, Mutsando H, Hertzberg M, Shortt J, Szabo F, Dunne K, Wei AH. How comparable are patient outcomes in the "real-world" with populations studied in pivotal AML trials? Blood Cancer J 2024; 14:54. [PMID: 38531863 DOI: 10.1038/s41408-024-00996-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 01/21/2024] [Accepted: 01/24/2024] [Indexed: 03/28/2024] Open
Abstract
Despite an increasing desire to use historical cohorts as "synthetic" controls for new drug evaluation, limited data exist regarding the comparability of real-world outcomes to those in clinical trials. Governmental cancer data often lacks details on treatment, response, and molecular characterization of disease sub-groups. The Australasian Leukaemia and Lymphoma Group National Blood Cancer Registry (ALLG NBCR) includes source information on morphology, cytogenetics, flow cytometry, and molecular features linked to treatment received (including transplantation), response to treatment, relapse, and survival outcome. Using data from 942 AML patients enrolled between 2012-2018, we assessed age and disease-matched control and interventional populations from published randomized trials that led to the registration of midostaurin, gemtuzumab ozogamicin, CPX-351, oral azacitidine, and venetoclax. Our analyses highlight important differences in real-world outcomes compared to clinical trial populations, including variations in anthracycline type, cytarabine intensity and scheduling during consolidation, and the frequency of allogeneic hematopoietic cell transplantation in first remission. Although real-world outcomes were comparable to some published studies, notable differences were apparent in others. If historical datasets were used to assess the impact of novel therapies, this work underscores the need to assess diverse datasets to enable geographic differences in treatment outcomes to be accounted for.
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Affiliation(s)
- Ing Soo Tiong
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- The Alfred Hospital, Melbourne, VIC, Australia
- Monash University, Melbourne, VIC, Australia
| | - Meaghan Wall
- Monash University, Melbourne, VIC, Australia
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Ashish Bajel
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Royal Melbourne Hospital, Parkville, VIC, Australia
- The University of Melbourne, Melbourne, VIC, Australia
| | - Akash Kalro
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | | | - Andrew W Roberts
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Royal Melbourne Hospital, Parkville, VIC, Australia
- The University of Melbourne, Melbourne, VIC, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | | | - Chong Chyn Chua
- The Alfred Hospital, Melbourne, VIC, Australia
- Monash University, Melbourne, VIC, Australia
- The Northern Hospital, Epping, VIC, Australia
| | - Maya Latimer
- Canberra Hospital, Garran, ACT, Australia
- ACT Pathology, Garran, ACT, Australia
- Australian National University, Canberra, ACT, Australia
| | - David Yeung
- Royal Adelaide Hospital, Adelaide, SA, Australia
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Paula Marlton
- Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- University of Queensland, Brisbane, QLD, Australia
| | | | - Anoop Enjeti
- Calvary Mater Newcastle, Waratah, NSW, Australia
| | | | - Gavin Cull
- Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- PathWest Laboratory Medicine, Nedlands, WA, Australia
- University of Western Australia, Perth, WA, Australia
| | - Stephen Larsen
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Glen Kennedy
- Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | | | | | | | | | - Campbell Tiley
- Gosford Hospital, Gosford, NSW, Australia
- University of Newcastle, Callaghan, NSW, Australia
| | - Edward Morris
- Townsville University Hospital, Douglas, QLD, Australia
| | - Uwe Hahn
- Royal Adelaide Hospital, Adelaide, SA, Australia
- The Queen Elizabeth Hospital, Woodville South, SA, Australia
- SA Pathology, Adelaide, SA, Australia
| | - John Moore
- St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
| | - John Taper
- Nepean Hospital, Kingswood, NSW, Australia
| | - Duncan Purtill
- PathWest Laboratory Medicine, Nedlands, WA, Australia
- Fiona Stanley Hospital, Murdoch, WA, Australia
| | | | - William Stevenson
- Royal North Shore Hospital, St Leonards, NSW, Australia
- Northern Clinical School, University of Sydney, Sydney, NSW, Australia
| | | | - Peter Tan
- Royal Perth Hospital, Perth, WA, Australia
| | - Ashanka Beligaswatte
- Royal Adelaide Hospital, Adelaide, SA, Australia
- Flinders Medical Centre, Bedford Park, SA, Australia
- Flinders University, Bedford Park, SA, Australia
| | | | | | - Jake Shortt
- Monash University, Melbourne, VIC, Australia
- Monash Medical Centre, Clayton, VIC, Australia
| | | | - Karin Dunne
- Australasian Leukaemia and Lymphoma Group (ALLG), Melbourne, VIC, Australia
| | - Andrew H Wei
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
- Royal Melbourne Hospital, Parkville, VIC, Australia.
- The University of Melbourne, Melbourne, VIC, Australia.
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.
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Lupia T, Crisà E, Sangiorgio V, Bosio R, Stroffolini G, Staffilano E, Gregorc V, Corcione S, De Rosa FG. Presumptive pulmonary toxocariasis in a patient affected by acute myeloid leukemia and Hodgkin lymphoma: case report and review of the literature in immunocompromised hosts. LE INFEZIONI IN MEDICINA 2024; 32:103-112. [PMID: 38456027 PMCID: PMC10917563 DOI: 10.53854/liim-3201-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/26/2024] [Indexed: 03/09/2024]
Abstract
Toxocariasis is a zoonosis transmitted by the nematode Toxocara spp. Immunocompromised hosts are more susceptible than general population to bacterial, viral, fungal and parasitic infections. In this population toxocariasis may present as exacerbation or reactivation and could have severe or atypical manifestations being a diagnostic challenge for healthcare providers. We report a case of a presumptive pulmonary toxocariasis during chemotherapy in a patient affected by acute myeloid leukaemia (AML) and Hodgkin lymphoma and we summarize current evidence of pulmonary involvement in immunocompromised population with Toxocara spp infection in a narrative review. The aim of this work is also to revise the current literature on pulmonary involvement during Toxocara spp infection in immunocompromised hosts to improve knowledge on clinical presentation, treatment and outcome. A 66 years old man who had undergone to a cytarabine and idarubicin chemotherapy induction scheme for AML, complained of febrile neutropenia and dry cought. At the chest computed tomography (CT) there were multiple nodular pulmonary lesions with subpleural consolidations. The lung biopsy revealed inflammatory infiltration with diffuse small granulomas with minor eosinophil component. The laboratory analysis showed high immunoglobulin E (IgE) count with normal peripherical eosinophils, among the extended parasitological analysis, Toxocara immunoblot assay resulted positive. In the most accepted hypothesis of a polmunary toxocariasis infection, the patient was treated with a combination of albendazole plus corticosteroids for four weeks, with a positive outcome. Infection complications during chemotherapy are not uncommon, however, this is the first reported case of pulmonary toxocariasis during cytarabine and idarubicin treatment in AML. The revised literature shows male gender and younger age as possible risk factors, nevertheless the majority of cases of seropositivity for Toxocara was reported in solid organ malignancies. In this case, the suspect was mainly based on laboratory total elevated IgE, confirmed by serological, anatomo-pathological and radiological findings. Hypereosinophilia is often not present in chronic infection. In conclusion, pulmonary toxocariasis should be ruled out in patients with pulmonary involvement and high IgE titre, with or without peripheral eosinophilia, especially in those with known immunocompromised status.
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Affiliation(s)
- Tommaso Lupia
- Unit of Infectious Diseases, Cardinal Massaia, Asti, Italy
| | - Elena Crisà
- Unit of Oncology and Haematology, Candiolo Cancer Institute, Candiolo, Italy
| | - Valentina Sangiorgio
- Pathological Anatomy Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - Roberta Bosio
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Giacomo Stroffolini
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Elena Staffilano
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Vanesa Gregorc
- Unit of Oncology and Haematology, Candiolo Cancer Institute, Candiolo, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
- School of Medicine, Infectious Disease & Geographic Medicine, Tufts University, Boston, MA, USA
| | - Francesco Giuseppe De Rosa
- Unit of Infectious Diseases, Cardinal Massaia, Asti, Italy
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
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Iqbal A, Dubey M, Randhawa AS, Khanikar D, Hazarika M, Roy PS, Dutta C, Barbhuiyan S, Deka R. Improved Treatment Outcomes With Modified Induction Therapy in Acute Myeloid Leukemia (AML): A Retrospective Observational Study From a Regional Cancer Center. Cureus 2024; 16:e53303. [PMID: 38435958 PMCID: PMC10905208 DOI: 10.7759/cureus.53303] [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] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND The aggressive, genetically diverse group of malignant illnesses known as acute myeloid leukemia (AML) is characterized by clonally related myeloblast invasion of the bone marrow, blood, and other organs. The treatment regimen plays a crucial role in the management of AML, and it is associated with poor overall survival and enhanced risk of relapse. Induction therapy with a 7+3 DA regimen (daunorubicin + ara-C) has been the treatment of choice for young and fit patients. OBJECTIVE To evaluate the effect of dose modification in young and fit patients for a modified treatment regimen. METHODS This was a retrospective, observational study of AML patients to analyze the outcomes of modified induction therapy in AML patients enrolled at Dr. B. Borooah Cancer Institute, Guwahati, Assam, India, from October 2021 to March 2022. The outcomes of modified induction therapy with intensive chemotherapy (modified 7+3 DA) and low-intensity chemotherapy decitabine (10 days) and venetoclax + azacytidine (seven days) were considered after the first two cycles or 60 days, whichever was earlier. RESULTS Data from 31 patients with de-novo AML was analyzed; the median age of the patients was 41 years (range: 2-71 years), and the male-to-female ratio was 1.8. There were seven patients in the pediatric age group (2-13 years), and 19%, 65%, and 13% of patients belonged to favorable, intermediate, and high-risk groups, respectively. With regards to modified induction therapy (n=31), 20 (65%) patients received modified "7+3 DA", nine (29%) received hypomethylating agents (HMA, decitabine only), and two patients received HMA (azacitidnie) + venetoclax. Additionally, 23/31 patients completed at least two cycles of induction therapy. Overall, 60 day-induction mortality was 13%, and the complete remission (CR) and partial remission (PR) rates were 48% and 26%, respectively. In patients who received modified "7+3 DA", the CR rate was 55%. CONCLUSIONS The notable reduction in deaths due to infections observed in our study suggests that centers with limited resources for preventing neutropenic complications during induction therapies in AML patients could consider adopting this modified regimen.
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Affiliation(s)
- Asif Iqbal
- Adult Hematology, Dr. Bhubaneswar Borooah Cancer Institute, Guwahati, IND
| | - Manas Dubey
- Medical Oncology, Dr. Bhubaneswar Borooah Cancer Institute, Guwahati, IND
| | | | - Duncan Khanikar
- Medical Oncology, Dr. Bhubaneswar Borooah Cancer Institute, Guwahati, IND
| | - Munlima Hazarika
- Pediatric Oncology, Dr. Bhubaneswar Borooah Cancer Institute, Guwahati, IND
| | - Partha S Roy
- Medical Oncology, Dr. Bhubaneswar Borooah Cancer Institute, Guwahati, IND
| | - Chayanika Dutta
- Medical Oncology, Dr. Bhubaneswar Borooah Cancer Institute, Guwahati, IND
| | - Suhani Barbhuiyan
- Pediatric Oncology, Dr. Bhubaneswar Borooah Cancer Institute, Guwahati, IND
| | - Roopam Deka
- Oncopathology, Haematopathology, Dr. Bhubaneswar Borooah Cancer Institute, Guwahati, IND
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Murillo-Maldonado MA, Galván PG, Ortega IP, Morales FG, Villegas LJ, Acosta ED. Long-term experience in treatment of acute promyelocytic leukemia in Mexican children in a tertiary care hospital. Front Oncol 2023; 13:1286106. [PMID: 38023223 PMCID: PMC10661391 DOI: 10.3389/fonc.2023.1286106] [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: 08/30/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Acute promyelocytic leukemia (APL) is a rare myeloid leukemia subtype affecting adult and pediatric populations. APL constitutes 15-20% of all childhood AML in Latin America, compared to 7% in the non-Latino population. This leukemia has unique characteristics, such as its association with chromosomal translocations involving the retinoid acid receptor α (RARA) gene on chromosome 17. In addition, APL is also distinct from other AML subtypes due to its response to all-trans-retinoic acid (ATRA), which induces terminal granulocytic differentiation of blasts. Overall 5-year survival rates are generally reported to be greater than 80%. Materials and methods A study was conducted from January 2008 to December 2022 applying the IC-APL 2006 treatment protocol. This case series reports the clinical results of 22 children with APL. In all cases, the diagnosis was made by bone marrow aspiration and evaluation of the t(15:17) or t(11:17) transcripts. Results We identified 22 patients with APL, of whom 10 were female and 12 were male. Twelve patients debuted with coagulation abnormalities. The doses of anthracyclines varied according to the risk, with an average of 496.8 mgm2. The cardiological assessment was performed before and after chemotherapy, finding 2/22 patients with moderate sisto-diastolic dysfunction and one with mild pulmonary insufficiency at the end of treatment. There were 6/22 patients with complications related to ATRA treatment, the most frequent being pseudotumor cerebri. All complications were transitory and treated immediately without complications. In this series of cases, an overall survival of 90.6% and a relapse-free survival of 90.6% were recorded. The follow-up mean was 9.1 ± 3.8 years. Conclusion APL is a highly curable disease when combined with ATRA and anthracyclines. In this series of cases, good long-term results were observed with the IC-APL 2006 protocol. However, in Latin America, the availability of drugs such as arsenic trioxide as the first line of treatment is an unresolved challenge.
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Affiliation(s)
| | | | - Israel Parra Ortega
- Laboratory of Molecular Biology, Federico Gómez, Children’s Hospital of Mexico Federico Gómez, Mexico City, Mexico
| | - Félix Gaytán Morales
- Myeloid Leukemia Clinic, Federico Gómez, Children’s Hospital of Mexico, Mexico City, Mexico
- Hematopoietic Stem Cell Transplant Unit, Federico Gómez, Children’s Hospital of Mexico Federico Gómez, Mexico City, Mexico
| | - Luis Juárez Villegas
- Department of Hemato-Oncology, Federico Gómez, Children’s Hospital of Mexico Federico Gómez, Mexico City, Mexico
| | - Elisa Dorantes Acosta
- Myeloid Leukemia Clinic, Federico Gómez, Children’s Hospital of Mexico, Mexico City, Mexico
- Leukemia Cell Research Biobank, Federico, Gómez Children’s Hospital of Mexico, Mexico City, Mexico
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Yakkala PA, Penumallu NR, Shafi S, Kamal A. Prospects of Topoisomerase Inhibitors as Promising Anti-Cancer Agents. Pharmaceuticals (Basel) 2023; 16:1456. [PMID: 37895927 PMCID: PMC10609717 DOI: 10.3390/ph16101456] [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: 09/16/2023] [Revised: 10/08/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
Topoisomerases are very important enzymes that regulate DNA topology and are vital for biological actions like DNA replication, transcription, and repair. The emergence and spread of cancer has been intimately associated with topoisomerase dysregulation. Topoisomerase inhibitors have consequently become potential anti-cancer medications because of their ability to obstruct the normal function of these enzymes, which leads to DNA damage and subsequently causes cell death. This review emphasizes the importance of topoisomerase inhibitors as marketed, clinical and preclinical anti-cancer medications. In the present review, various types of topoisomerase inhibitors and their mechanisms of action have been discussed. Topoisomerase I inhibitors, which include irinotecan and topotecan, are agents that interact with the DNA-topoisomerase I complex and avert resealing of the DNA. The accretion of DNA breaks leads to the inhibition of DNA replication and cell death. On the other hand, topoisomerase II inhibitors like etoposide and teniposide, function by cleaving the DNA-topoisomerase II complex thereby effectively impeding the release of double-strand DNA breaks. Moreover, the recent advances in exploring the therapeutic efficacy, toxicity, and MDR (multidrug resistance) issues of new topoisomerase inhibitors have been reviewed in the present review.
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Affiliation(s)
- Prasanna Anjaneyulu Yakkala
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India;
| | - Naveen Reddy Penumallu
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India;
| | - Syed Shafi
- Department of Chemistry, School of Chemical and Life Sciences, Jamia Hamdard, Hamdard Nagar, New Delhi 110062, India;
| | - Ahmed Kamal
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India;
- Department of Pharmacy, Birla Institute of Technology and Science (BITS) Pilani, Hyderabad Campus, Dist. Medchal, Hyderabad 500078, India
- Telangana State Council of Science & Technology, Environment, Forests, Science & Technology Department, Hyderabad 500004, India
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Application of High-Efficiency Cell Expansion and High-Throughput Drug Sensitivity Screening for Leukemia Treatment. DISEASE MARKERS 2022; 2022:4052591. [PMID: 35845130 PMCID: PMC9277151 DOI: 10.1155/2022/4052591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 11/24/2022]
Abstract
This study is to assess the clinical value of in vitro primary cell high-efficiency expansion and high-throughput drug sensitivity screening (HEHDS) system in leukemia, and we evaluated a cohort of 121 patients with acute myeloid leukemia (AML) and 27 patients with acute lymphoblastic leukemia (ALL) using HEHDS. Bone marrow aspirates were collected from patients with leukemia. Purified leukemic cancer cells were obtained, cultured, and screened with a panel of 247 FDA-approved compounds by HEHDS technology. Ninety-six patients received HEHDS-guided therapy while 52 patients who were subjected to physician directed therapy served as controls. ALL patients who received treatment guided by HEHDS showed higher rate of complete remission (CR) than that of patients in the non-HEHDS group (90.91% vs. 56.25%). Similarly, AML patients received HEHDS-guided therapy were found to have greater CR rate, when compared with patients who received physician-directed therapy (45.88% vs. 25%). There was a significantly higher rate of CR in HEHDS-guided therapy group compared to the non-HEHDS group. The application of HEHDS could be beneficial for leukemia treatment.
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Humoral immune response to COVID-19 infection or vaccination among celiac disease patients. Cent Eur J Immunol 2022; 47:267-274. [PMID: 36817269 PMCID: PMC9896984 DOI: 10.5114/ceji.2022.118649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/22/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Celiac disease (CD) is the most common autoimmune disease (AD) of the small intestine, affecting 1-2% of the population globally. It is characterized by the serological presence of autoantibodies (Abs), tissue transglutaminase antibody (tTGA), immunoglobulin (Ig) A, and IgG. Production of antibodies against SARS-CoV-2 after infection with the virus or vaccination is not well understood, especially among CD patients. The goal of this study was to measure the IgG antibodies in Jordanian patients infected with or vaccinated against the SARS-CoV-2 virus with different types of vaccines (Pfizer- BioNTech BNT162b2, Sinopharm BBIBP-CorV or Oxford-AstraZeneca ChAdOx1-S) and compare them with the levels in non-celiac controls. IgG levels induced by different vaccines were also compared. Material and methods The data for this cross-sectional study were obtained via a survey, whereby respondents were identified through convenience sampling. The healthy controls were given Questionnaire A while CD patients completed Questionnaire B. The blood samples from all participants were tested for the COVID-19 nucleocapsid protein (NP) IgG serum levels for participants previously infected with SARS-CoV-2, and spike (S) protein (S1/S2) IgG serum levels for vaccine recipients. Results The study involved 116 individuals, 60 (51.7%) of whom were CD patients. The NP IgG serum levels in the infected and S1/S2 IgG levels in the vaccinated CD patients were significantly lower than the levels in controls (48.3 ±44.5 vs. 81.1 ±34.4 and 49 ±45.8 vs. 75.7 ±38.6, p = 0.002). Moreover, only the Pfizer vaccine induced significantly more IgG antibodies in controls compared to CD patients (88.8 ±29.1 vs. 58.3 ±45.4, p = 0.01). On the other hand, the IgG levels were significantly higher in CD patients who received the Pfizer relative to the AstraZeneca vaccine (58.3 ±45.5 vs. 13.0 ±23.6, p = 0.03). After adjusting for presence of CD, age, sex, body mass index (BMI), comorbidities, vaccine type, smoking, gluten adherence, and time since infection or vaccination, SARS-CoV-2 S1/S2 IgG Abs and/or NP IgG Abs positivity was significantly associated with CD absence and negatively with vaccine type (AstraZeneca) with the odds ratios (ORs) of 9.6 (95% CI = 1.5-59.2, p = 0.015) and 0.03 (95% CI = 0.004-0.244. p = 0.001), respectively. Conclusions We concluded that patients with CD had lower SARS-CoV-2 S1/S2 IgG Abs and NP IgG Abs levels than controls, and CD patients who received the Pfizer vaccine had higher IgG levels than patients who received the AstraZeneca vaccine. We recommend that further research be conducted to address the dynamics of the antibody responses in CD patients regarding COVID-19 infection.
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Kulkayeva GU, Kemaykin VM, Kuttymuratov AM, Burlaka ZI, Saparbay JZ, Zhakhina GT, Adusheva AA, Dosayeva SD. First report from a single center retrospective study in Kazakhstan on acute myeloid leukemia treatment outcomes. Sci Rep 2021; 11:24001. [PMID: 34907276 PMCID: PMC8671420 DOI: 10.1038/s41598-021-03559-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/03/2021] [Indexed: 11/23/2022] Open
Abstract
Acute myeloid leukemia (AML) is the most common hematological malignancy in adults. In the last decade, internationally approved AML treatment guidelines, including hematopoietic stem cell transplantation are widely used in Kazakhstan. The categorization of acute myeloid leukemia was done according to the French-American British classification. The prognosis of patients at the time of diagnosis was determined by cytogenetic tests following the guidelines of the European LeukemiaNet. The overall survival and event-free survival were analyzed using the Kaplan-Meier method, and hazard ratios were defined with Cox regression. In total, 398 patients with AML were treated in the National Research Oncology Center between 2010 and 2020. The mean age was 38.3 years. We found a correlation between ethnicity, cytogenetic group, white blood cell count, and treatment approaches with overall and event-free survival. There was a significantly longer OS in a cytogenetic group with a good prognosis compared with intermediate and poor prognosis. The median survival time in the group with a good prognosis was 43 months, 23 months in the intermediate group (p = 0.7), and 12 months in the poor prognosis group (p = 0.016). There was a significantly longer OS for the group of patients who received hematopoietic stem cell transplantation (HSCT), 52 months versus 10 months in the group who received chemotherapy only, p-value < 0.0001. Prognostic factors, such as cytogenetic group, initial WBC count, and treatment approaches are significantly associated with patient survival. Our study data were consistent with the most recent studies, available in the literature adjusted for the population in question.
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Affiliation(s)
- G U Kulkayeva
- LLP «National Research Oncology Center», Kerey and Zhanibek Khandar Street 3, 01-0000, Nur-Sultan, Kazakhstan
| | - V M Kemaykin
- Department of Oncohematology and Stem Cell Transplantation, LLP «National Research Oncology Center», Kerey and Zhanibek Khandar Street 3, 01-0000, Nur-Sultan, Kazakhstan
| | - A M Kuttymuratov
- Department of Oncohematology and Stem Cell Transplantation, LLP «National Research Oncology Center», Kerey and Zhanibek Khandar Street 3, 01-0000, Nur-Sultan, Kazakhstan
| | - Z I Burlaka
- Department of Oncohematology and Stem Cell Transplantation, LLP «National Research Oncology Center», Kerey and Zhanibek Khandar Street 3, 01-0000, Nur-Sultan, Kazakhstan
| | - J Z Saparbay
- Department of Hepatology, Gastroenterology and Organ Transplantation, LLP «National Research Oncology Center», Kerey and Zhanibek Khandar Street 3, 01-0000, Nur-Sultan, Kazakhstan.
| | - G T Zhakhina
- Department of Science, LLP «National Research Oncology Center», Kerey and Zhanibek Khandar Street 3, 01-0000, Nur-Sultan, Kazakhstan
| | - A A Adusheva
- Department of Oncohematology and Stem Cell Transplantation, LLP «National Research Oncology Center», Kerey and Zhanibek Khandar Street 3, 01-0000, Nur-Sultan, Kazakhstan
| | - S D Dosayeva
- Department of Oncohematology and Stem Cell Transplantation, LLP «National Research Oncology Center», Kerey and Zhanibek Khandar Street 3, 01-0000, Nur-Sultan, Kazakhstan
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McCurdy SR, Luger SM. Dose intensity for induction in acute myeloid leukemia: what, when, and for whom? Haematologica 2021; 106:2544-2554. [PMID: 34320781 PMCID: PMC8485660 DOI: 10.3324/haematol.2020.269134] [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: 02/11/2021] [Indexed: 11/09/2022] Open
Abstract
Intensive chemotherapy has been the backbone of the treatment of acute myeloid leukemia (AML) for decades. However, an increase in novel targeted agents, which has been brought about in part by a deeper understanding of the genetic makeup of AML, has led to remission-inducing regimens that do not require traditional cytotoxic agents. Combinations of a hypomethylating agent (HMA) and venetoclax have doubled the chance of remission for patients considered unfit for induction chemotherapy who would have traditionally been offered singleagent HMA. In fact, this regimen may rival the complete remission rate achieved with induction chemotherapy for certain populations such as the very elderly and those with secondary AML, but equivalency has yet to be established. Further advances include the addition of gemtuzumab ozogamicin and FLT3 inhibitors to induction chemotherapy, which improves survival for patients with core-binding factor and FLT3-mutated AML, respectively. Still, much work is needed to improve the outcomes of the highest-risk subgroups: frail patients and those with high-risk cytogenetics and/or TP53 mutations. Promisingly, the landscape of AML therapy is shifting dramatically and no longer is intensity, when feasible, always the best answer for AML.
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Affiliation(s)
- Shannon R McCurdy
- Division of Hematology-Oncology/Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Selina M Luger
- Division of Hematology-Oncology/Department of Medicine, University of Pennsylvania, Philadelphia, PA.
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