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Kockerols C, Valk PJM, Dulucq S, Nicolini FE, Mahon FX, Atallah E, Mauro MJ, Radich JP, Bernardi S, Russo D, Farina M, Mori S, Gambacorti-Passerini C, Civettini I, Lu L, Yeung D, Branford S, Colafigli G, Breccia M, Hogenbirk P, van Rosmalen J, Cornelissen JJ, Westerweel PE. BCR::ABL1 digital PCR for treatment-free remission prediction in chronic myeloid leukemia patients: An individual participant data meta-analysis. Am J Hematol 2024. [PMID: 38769689 DOI: 10.1002/ajh.27359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 04/27/2024] [Accepted: 04/30/2024] [Indexed: 05/22/2024]
Affiliation(s)
- Camille Kockerols
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Peter J M Valk
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Stéphanie Dulucq
- Laboratory of Hematology, Hôpital Haut Lévêque, University hospital of Bordeaux, Pessac, France
| | | | - François-Xavier Mahon
- Department of Hematology, Institut Bergonié, Bordeaux, France
- INSERM Unit BRIC 1312, Bordeaux University, Bordeaux, France
| | - Ehab Atallah
- Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Michael J Mauro
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jerald P Radich
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Simona Bernardi
- Department of Clinical and Experimental Sciences, Hematology 2 and Bone Marrow Transplant Center, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Domenico Russo
- Department of Clinical and Experimental Sciences, Hematology 2 and Bone Marrow Transplant Center, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Mirko Farina
- Department of Clinical and Experimental Sciences, Hematology 2 and Bone Marrow Transplant Center, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Silvia Mori
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Carlo Gambacorti-Passerini
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
- Department of Hematology, S. Gerardo Hospital, Monza, Italy
| | - Ivan Civettini
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
- Department of Hematology, S. Gerardo Hospital, Monza, Italy
| | - Liu Lu
- South Australia Health and Medical Research Institute, University of Adelaide Medical School and Precision Cancer Medicine Theme, Adelaide, Australia
| | - David Yeung
- South Australia Health and Medical Research Institute, University of Adelaide Medical School and Precision Cancer Medicine Theme, Adelaide, Australia
| | - Susan Branford
- Department of Genetics and Molecular Pathology, Centre for Cancer Biology, SA Pathology, Adelaide, Australia
- Clinical and Health Sciences, University of South Australia, Adelaide, Australia
- School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Gioia Colafigli
- Department of Translational and Precision Medicine, Az. Policlinico Umberto I-Sapienza University, Rome, Italy
| | - Massimo Breccia
- Department of Translational and Precision Medicine, Az. Policlinico Umberto I-Sapienza University, Rome, Italy
| | - Pauline Hogenbirk
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jan J Cornelissen
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Peter E Westerweel
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
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2
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Hompland I, Boye K, Wiedswang AM, Papakonstantinou A, Røsok B, Joensuu H, Bruland Ø. Discontinuation of imatinib in patients with oligometastatic gastrointestinal stromal tumour who are in complete radiological remission: a prospective multicentre phase II study. Acta Oncol 2024; 63:288-293. [PMID: 38712513 DOI: 10.2340/1651-226x.2024.39851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/16/2024] [Indexed: 05/08/2024]
Abstract
INTRODUCTION Metastatic gastrointestinal stromal tumour (GIST) is considered incurable, and life-long treatment with tyrosine kinase inhibitors is recommended. We investigated whether selected patients with metastatic GIST may remain in durable remission despite imatinib discontinuation. PATIENTS In this 1-group, prospective, multicentre phase II trial selected patients with oligometastatic (≤3 metastases) GIST discontinued imatinib treatment. Eligible patients had been treated with imatinib >5 years without progression and had no radiologically detectable metastases after metastasectomy, radiofrequency ablation (RFA) or complete response to imatinib. The primary endpoint was progression-free survival (PFS) 3-years after stopping imatinib. Overall survival (OS) and quality of life (QoL) were secondary endpoints. RESULTS The trial closed prematurely due to slow accrual. Between January 5, 2017, and June 5, 2019, 13 patients were enrolled, of whom 12 discontinued imatinib. The median follow-up time was 55 months (range, 36 to 69) after study entry. Five (42%) of the 12 eligible patients remained progression free, and seven (58%) progressed with a median time to progression 10 months. Median PFS was 23 months and the estimated 3-year PFS 41%. Six of the seven patients who progressed restarted imatinib, and all six responded. Three-year OS was 100%, and all patients were alive at the time of the study analysis. QoL measured 5 and 11 months after discontinuation of imatinib demonstrated improvement compared to the baseline. INTERPRETATION A substantial proportion of selected patients with oligometastatic GIST treated with imatinib and metastasis surgery/RFA may remain disease-free for ≥3 years with improved QoL after stopping of imatinib.
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Affiliation(s)
- Ivar Hompland
- Department of Oncology, Oslo University Hospital, Oslo, Norway.
| | - Kjetil Boye
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | | | - Andri Papakonstantinou
- Department of Breast Cancer, Endocrine Tumors and Sarcoma, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - Bård Røsok
- Department of Hepato-Pancreatic-Biliary Surgery, Oslo University Hospital, Oslo, Norway
| | - Heikki Joensuu
- Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Øyvind Bruland
- Department of Oncology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Bourne G, Bhatia R, Jamy O. Treatment-Free Remission in Chronic Myeloid Leukemia. J Clin Med 2024; 13:2567. [PMID: 38731096 PMCID: PMC11084227 DOI: 10.3390/jcm13092567] [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: 04/06/2024] [Revised: 04/23/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
With the discovery of tyrosine kinase inhibitors (TKIs), overall survival in patients with chronic myeloid leukemia (CML) now approaches that of the general population. While these TKIs have proven to be lifesaving, remaining on them lifelong creates both physical and financial burdens for patients. Recently, multiple trials have begun looking into the efficacy of trialing patients off these TKIs to see if they can sustain treatment-free remission (TFR). TFR eligibility is currently limited to a small population of patients with both robust and sustained responses to TKIs. Currently, for those who attempt a trial of TFR, the average success rates are promising, with anywhere from 38 to 54% of patients experiencing sustained TFR. For those who fail to maintain sustained TFR, safety results to date are reassuring, with almost all patients successfully responding to the re-initiation of TKIs, with death and disease progression being very rare complications. Moving forward, research is being conducted to more accurately risk stratify patients at diagnosis and pair them with optimized upfront treatment regimens aimed at increasing candidacy for the trial of TFR.
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Affiliation(s)
| | | | - Omer Jamy
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
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Wu A, Liu X, Fruhstorfer C, Jiang X. Clinical Insights into Structure, Regulation, and Targeting of ABL Kinases in Human Leukemia. Int J Mol Sci 2024; 25:3307. [PMID: 38542279 PMCID: PMC10970269 DOI: 10.3390/ijms25063307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 04/09/2024] Open
Abstract
Chronic myeloid leukemia is a multistep, multi-lineage myeloproliferative disease that originates from a translocation event between chromosome 9 and chromosome 22 within the hematopoietic stem cell compartment. The resultant fusion protein BCR::ABL1 is a constitutively active tyrosine kinase that can phosphorylate multiple downstream signaling molecules to promote cellular survival and inhibit apoptosis. Currently, tyrosine kinase inhibitors (TKIs), which impair ABL1 kinase activity by preventing ATP entry, are widely used as a successful therapeutic in CML treatment. However, disease relapses and the emergence of resistant clones have become a critical issue for CML therapeutics. Two main reasons behind the persisting obstacles to treatment are the acquired mutations in the ABL1 kinase domain and the presence of quiescent CML leukemia stem cells (LSCs) in the bone marrow, both of which can confer resistance to TKI therapy. In this article, we systemically review the structural and molecular properties of the critical domains of BCR::ABL1 and how understanding the essential role of BCR::ABL1 kinase activity has provided a solid foundation for the successful development of molecularly targeted therapy in CML. Comparison of responses and resistance to multiple BCR::ABL1 TKIs in clinical studies and current combination treatment strategies are also extensively discussed in this article.
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MESH Headings
- Humans
- Drug Resistance, Neoplasm/genetics
- Fusion Proteins, bcr-abl
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/metabolism
- Protein Kinase Inhibitors/pharmacology
- Protein Kinase Inhibitors/therapeutic use
- Signal Transduction
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Affiliation(s)
- Andrew Wu
- Collings Stevens Chronic Leukemia Research Laboratory, Terry Fox Laboratory, British Columbia Cancer Research Institute, Vancouver, BC V5Z 1L3, Canada; (A.W.); (X.L.)
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Xiaohu Liu
- Collings Stevens Chronic Leukemia Research Laboratory, Terry Fox Laboratory, British Columbia Cancer Research Institute, Vancouver, BC V5Z 1L3, Canada; (A.W.); (X.L.)
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Clark Fruhstorfer
- Collings Stevens Chronic Leukemia Research Laboratory, Terry Fox Laboratory, British Columbia Cancer Research Institute, Vancouver, BC V5Z 1L3, Canada; (A.W.); (X.L.)
| | - Xiaoyan Jiang
- Collings Stevens Chronic Leukemia Research Laboratory, Terry Fox Laboratory, British Columbia Cancer Research Institute, Vancouver, BC V5Z 1L3, Canada; (A.W.); (X.L.)
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
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Zhang Z, Zhou X, Zhou X, Cheng Z, Hu Y. Exploration of treatment-free remission in CML, based on molecular monitoring. Cancer Med 2023; 13:e6849. [PMID: 38133525 PMCID: PMC10807643 DOI: 10.1002/cam4.6849] [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: 09/26/2023] [Revised: 11/28/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Typical chronic myelogenous leukemia (CML) is a myeloproliferative neoplasm caused by t(9; 22)(q34; q11) translocation. This chromosomal translocation forms the BCR::ABL1 fusion gene. The tyrosine kinase encoded by the BCR::ABL1 is considered to be the main pathogenic diver. BCR::ABL1 is not only a therapeutic target, but also a monitoring target. Monitoring of BCR::ABL1 reveals the progression of the disease and guides the next treatment. Now for CML, the target of treatment has been focused on treatment-free remission (TFR). METHODS We conducted a literature review of current developments of treatment-free remission and molecular monitoring methods. RESULTS More effective and sensitive CML monitoring methods such as digital droplet PCR (ddPCR) and next generation sequencing (NGS) have further studied the measurable residual disease (MRD) and clonal heterogeneity, which provides strong support for the exploration of TFR. We discussed some of the factors that may be related to TFR outcomes at the molecular level, along with some monitoring strategies. CONCLUSION Currently, predictive indicators for treatment-free remission outcomes and recurrence are lacking in clinical practice. In future, treatment-free remission research should focus on combining the clinical indicators with molecular monitoring and biological markers to personalize patient conditions and guide clinicians to develop individualized treatment plans, so that more patients with CML can achieve safer and stabler treatment-free remission.
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Affiliation(s)
| | | | - Xin Zhou
- Wuhan Union HospitalWuhanHubeiChina
| | | | - Yu Hu
- Wuhan Union HospitalWuhanHubeiChina
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Hoosen S, Mackraj I, Rapiti N. The Success of Treatment Free Remission in Chronic Myeloid Leukaemia in Clinical Practice: A Single-Centre Retrospective Experience from South Africa. Adv Hematol 2023; 2023:2004135. [PMID: 37547186 PMCID: PMC10403330 DOI: 10.1155/2023/2004135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 07/07/2023] [Accepted: 07/15/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Chronic myeloid leukaemia (CML) management has evolved from a disease once considered to be incurable just over 2 decades ago to that of one of a "functional cure" as defined by the sustained molecular response on stopping tyrosine kinase inhibitor(TKI) therapy. The next goal of CML management has been treatment-free remission (TFR). The past 4 years have seen much international data on TFR attempts in CML in clinical practice. However, Africa as a continent has lagged behind the rest of the world, in keeping up with the latest trends in CML management, and so this study aims to address this gap by assessing the outcome of TFR in CML in a single centre in South Africa (SA). Methods We conducted a retrospective cohort study in 12 CML patients in the chronic phase to assess the success of TKI discontinuation. The patients were treated in King Edward VIII Hospital (KEH), a tertiary, academic hospital in KwaZulu-Natal, South Africa, and the study period was from June 2020 to May 2022. Patients included had to have been on TKI therapy for a minimum of 5 years and achieved a deep molecular response (DMR) for a minimum period of 3 years. Results The overall TFR cohort showed a success rate of 75% at a median follow-up of 12 months. All patients who failed TFR, defined as a loss of major molecular remission (MMR), failed within 6 months of stopping TKI therapy. All patients who failed TFR regained DMR after retreatment with TKI, with no disease progression reported. The only factor influencing the success of TFR was the total period of TKI therapy. Conclusion Despite our study having a small cohort of patients, this study demonstrated that TFR in CML is an attainable goal, even in a resource-limited setting.
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Affiliation(s)
- Siddeeq Hoosen
- University of KwaZulu-Natal, School of Laboratory Medicine and Health Sciences, Durban, South Africa
- National Health Laboratory Service, IALCH, Department of Haematology, Durban, South Africa
- King Edward VIII Hospital, Department of Clinical Haematology, Durban, South Africa
| | - Irene Mackraj
- University of KwaZulu-Natal, School of Laboratory Medicine and Health Sciences, Durban, South Africa
| | - Nadine Rapiti
- University of KwaZulu-Natal, School of Laboratory Medicine and Health Sciences, Durban, South Africa
- National Health Laboratory Service, IALCH, Department of Haematology, Durban, South Africa
- King Edward VIII Hospital, Department of Clinical Haematology, Durban, South Africa
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Marin AM, Wosniaki DK, Sanchuki HBS, Munhoz EC, Nardin JM, Soares GS, Espinace DC, de Holanda Farias JS, Veroneze B, Becker LF, Costa GL, Beltrame OC, de Oliveira JC, Cambri G, Zanette DL, Aoki MN. Molecular BCR::ABL1 Quantification and ABL1 Mutation Detection as Essential Tools for the Clinical Management of Chronic Myeloid Leukemia Patients: Results from a Brazilian Single-Center Study. Int J Mol Sci 2023; 24:10118. [PMID: 37373266 DOI: 10.3390/ijms241210118] [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: 04/27/2023] [Revised: 05/23/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Chronic myeloid leukemia (CML) is a well-characterized oncological disease in which virtually all patients possess a translocation (9;22) that generates the tyrosine kinase BCR::ABL1 protein. This translocation represents one of the milestones in molecular oncology in terms of both diagnostic and prognostic evaluations. The molecular detection of the BCR::ABL1 transcription is a required factor for CML diagnosis, and its molecular quantification is essential for assessing treatment options and clinical approaches. In the CML molecular context, point mutations on the ABL1 gene are also a challenge for clinical guidelines because several mutations are responsible for tyrosine kinase inhibitor resistance, indicating that a change may be necessary in the treatment protocol. So far, the European LeukemiaNet and the National Comprehensive Cancer Network (NCCN) have presented international guidelines on CML molecular approaches, especially those related to BCR::ABL1 expression. In this study, we show almost three years' worth of data regarding the clinical treatment of CML patients at the Erasto Gaertner Hospital, Curitiba, Brazil. These data primarily comprise 155 patients and 532 clinical samples. BCR::ABL1 quantification by a duplex-one-step RT-qPCR and ABL1 mutations detection were conducted. Furthermore, digital PCR for both BCR::ABL1 expression and ABL1 mutations were conducted in a sub-cohort. This manuscript describes and discusses the clinical importance and relevance of molecular biology testing in Brazilian CML patients, demonstrating its cost-effectiveness.
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Affiliation(s)
- Anelis Maria Marin
- Laboratory for Applied Science and Technology in Health, Carlos Chagas Institute, Oswaldo Cruz Foundation (Fiocruz), Curitiba 81350-010, Brazil
| | - Denise Kusma Wosniaki
- Laboratory for Applied Science and Technology in Health, Carlos Chagas Institute, Oswaldo Cruz Foundation (Fiocruz), Curitiba 81350-010, Brazil
| | - Heloisa Bruna Soligo Sanchuki
- Laboratory for Applied Science and Technology in Health, Carlos Chagas Institute, Oswaldo Cruz Foundation (Fiocruz), Curitiba 81350-010, Brazil
| | | | | | - Gabriela Silva Soares
- Laboratory for Applied Science and Technology in Health, Carlos Chagas Institute, Oswaldo Cruz Foundation (Fiocruz), Curitiba 81350-010, Brazil
| | - Dhienifer Caroline Espinace
- Laboratory for Applied Science and Technology in Health, Carlos Chagas Institute, Oswaldo Cruz Foundation (Fiocruz), Curitiba 81350-010, Brazil
| | | | | | | | | | | | | | - Geison Cambri
- Instituto de Biologia Molecular do Paraná (IBMP), Curitiba 81350-010, Brazil
| | - Dalila Luciola Zanette
- Laboratory for Applied Science and Technology in Health, Carlos Chagas Institute, Oswaldo Cruz Foundation (Fiocruz), Curitiba 81350-010, Brazil
| | - Mateus Nóbrega Aoki
- Laboratory for Applied Science and Technology in Health, Carlos Chagas Institute, Oswaldo Cruz Foundation (Fiocruz), Curitiba 81350-010, Brazil
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8
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Dulucq S, Rigal-Huguet F, Nicolini FE, Cony-Makhoul P, Escoffre-Barbe M, Gardembas M, Legros L, Rousselot P, Liu J, Rea D, De Mas V, Hayette S, Raynaud S, Lacoste-Roussillon C, Robbesyn F, Klein E, Morisset S, Mahon FX, Etienne G. Efficacy and safety of nilotinib in chronic myeloid leukaemia patients who failed to achieve a treatment-free remission period after imatinib discontinuation: Results of the French Nilo post-STIM study. Br J Haematol 2023. [PMID: 37004981 DOI: 10.1111/bjh.18796] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 03/17/2023] [Accepted: 03/24/2023] [Indexed: 04/04/2023]
Abstract
Molecular recurrence (MRec) occurs in about half of all patients with chronic myeloid leukaemia (CML) who discontinue tyrosine kinase inhibitors (TKI) in sustained deep molecular response. A second TKI discontinuation has been attempted in some patients who regain the discontinuation criteria after resuming treatment. Nilotinib treatment affords faster and deeper molecular responses than imatinib as first-line therapy. We prospectively evaluated the efficacy and safety of nilotinib (300 mg twice daily) in chronic-phase CML patients who experienced MRec, after imatinib discontinuation and analysed the probability of TFR after a new attempt in patients treated for 2 years with sustained MR4.5 for at least 1 year. A total of 31 patients were included in the study between 2013 and 2018. Seven (23%) patients experienced serious adverse events after a median of 2 months of nilotinib treatment leading to discontinuation of treatment. One patient was excluded from the study for convenience. Among the 23 patients treated for 2 years with nilotinib, 22 maintained their molecular response for at least 1 year (median: 22 months) and stopped nilotinib. The TFR rates at 24 and 48 months after nilotinib discontinuation were 59.1% (95% confidence interval [CI]: 41.7%-83.7%) and 42.1% (95% CI: 25%-71%) respectively (NCT #01774630).
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Affiliation(s)
- Stéphanie Dulucq
- Laboratory of Hematology, University Hospital of Bordeaux, Hôpital Haut Lévêque, Pessac, France
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
| | - Françoise Rigal-Huguet
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Hematology Department, Institut Universitaire du Cancer, CHU de Toulouse, Toulouse, France
| | - Franck E Nicolini
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- INSERM U590, Centre de Recherche de Cancérologie de Lyon, Centre Léon Bérard, Lyon, France
- Hematology Department, Centre Léon Bérard, Lyon, France
| | - Pascale Cony-Makhoul
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Hematology Department, Centre Hospitalier Annecy-Genevois, Metz-Tessy, Pringy, France
| | - Martine Escoffre-Barbe
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Hematology Department, CHU de Pontchaillou, Rennes, France
| | - Martine Gardembas
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Hematology Department, CHU, Angers, France
| | - Laurence Legros
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Hematology Department, AP-HP, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Philippe Rousselot
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Hematology Department, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Jixing Liu
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Hematology & Oncology Department, Centre Hospitalier de Valence, Valence, France
| | - Delphine Rea
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Adult Hematology Department, Hôpital Saint Louis, Paris, France
| | - Véronique De Mas
- Laboratory of Hematology, Institut Universitaire du Cancer, CHU de Toulouse, Toulouse, France
| | - Sandrine Hayette
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Laboratory of Hematology, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Sophie Raynaud
- Laboratory of Hematology, University Hospital of Nice, Nice, France
| | - Caroline Lacoste-Roussillon
- Clinical Research and Innovation Department, Safety and Vigilance Unit, Bordeaux University Hospital, Bordeaux, France
| | - Fanny Robbesyn
- Laboratory of Hematology, University Hospital of Bordeaux, Hôpital Haut Lévêque, Pessac, France
| | - Emilie Klein
- Laboratory of Hematology, University Hospital of Bordeaux, Hôpital Haut Lévêque, Pessac, France
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
| | - Stéphane Morisset
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- INSERM U590, Centre de Recherche de Cancérologie de Lyon, Centre Léon Bérard, Lyon, France
| | - François-Xavier Mahon
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Hematology Department, Institut Bergonié, Bordeaux, France
- Hematology Department, CHU Bordeaux, Pessac, France
| | - Gabriel Etienne
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Hematology Department, Institut Bergonié, Bordeaux, France
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9
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Janssen L, Hopman MTE, Swaans GJA, Allard NAE, Boss M, Lobeek D, Gotthardt M, Schirris TJJ, Blijlevens NMA, Timmers S. Impact of tyrosine kinase inhibitors on glucose control and insulin regulation in patients with chronic myeloid leukemia. Am J Physiol Endocrinol Metab 2023; 324:E209-E216. [PMID: 36696600 DOI: 10.1152/ajpendo.00163.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Treatment with tyrosine kinase inhibitors (TKIs), especially nilotinib, often results in hyperglycemia, which may further increase cardiovascular disease risk in patients with chronic myeloid leukemia (CML). The mechanism underlying the TKI-induced glucose dysregulation is not clear. TKIs are suggested to affect insulin secretion but also insulin sensitivity of peripheral tissue has been proposed to play a role in the pathogenesis of TKI-induced hyperglycemia. Here, we aimed to assess whether skeletal muscle glucose uptake and insulin responses are altered in nondiabetic patients with CML receiving TKI treatment. After a glycogen-depleted exercise bout, an intravenous glucose bolus (0.3 g/kg body weight) was administered to monitor 2-h glucose tolerance and insulin response in 14 patients with CML receiving nilotinib, 14 patients with CML receiving imatinib, and 14 non-CML age- and gender-matched controls. A dynamic [18F]-FDG PET scan during a hyperinsulinemic-euglycemic clamp was performed in a subgroup of 12 male patients with CML to assess m. quadriceps glucose uptake. We showed that patients with CML treated with nilotinib have an increased insulin response to intravenous glucose administration after muscle glycogen-depleted exercise. Despite the increased insulin response to glucose administration in patients with CML receiving nilotinib, glucose disappearance rates were significantly slower in nilotinib-treated patients when compared with controls in the first 15 min after glucose administration. Although [18F]-FDG uptake in m. quadriceps was not different, patients receiving nilotinib showed a trend toward decreased glucose infusion rates during euglycemic clamping when compared with patients receiving imatinib. Together, these findings indicate disturbed skeletal muscle glucose handling in patients with CML receiving nilotinib therapy.NEW & NOTEWORTHY In this study, we have shown that non-diabetic patients with CML receiving nilotinib therapy show early signs of disturbed skeletal muscle glucose handling, which was not observed in imatinib-treated patients. These observations in nilotinib users may reflect decreased muscle insulin sensitivity, which could serve as a potential target to counteract glycemic dysregulation, and is of clinical importance since these patients have an increased cardiovascular disease risk.
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Affiliation(s)
- Lando Janssen
- Radboud Institute for Health Sciences, Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maria T E Hopman
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Greetje J A Swaans
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Neeltje A E Allard
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marti Boss
- Radboud Institute for Health Sciences, Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Daphne Lobeek
- Radboud Institute for Health Sciences, Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Martin Gotthardt
- Radboud Institute for Health Sciences, Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tom J J Schirris
- Radboud Institute for Molecular Life Sciences, Department of Pharmacology and Toxicology, Radboud Centre for Mitochondrial Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicole M A Blijlevens
- Radboud Institute for Health Sciences, Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Silvie Timmers
- Human and Animal Physiology, Wageningen University, Wageningen, The Netherlands
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10
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Roy L, Chomel JC, Guilhot J, Guerci-Bresler A, Escoffre-Barbe M, Giraudier S, Charbonnier A, Dubruille V, Huguet F, Johnson-Ansah H, Lenain P, Ame S, Etienne G, Nicolini FE, Rea D, Cony-Makhoul P, Courby S, Ianotto JC, Legros L, Machet A, Coiteux V, Hermet E, Cayssials E, Bouchet S, Mahon FX, Rousselot P, Guilhot F. Dasatinib plus Peg-Interferon alpha 2b combination in newly diagnosed chronic phase chronic myeloid leukaemia: Results of a multicenter phase 2 study (DASA-PegIFN study). Br J Haematol 2023; 200:175-186. [PMID: 36214090 DOI: 10.1111/bjh.18486] [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: 05/13/2022] [Revised: 09/04/2022] [Accepted: 09/16/2022] [Indexed: 01/14/2023]
Abstract
Superior rates of deep molecular response (DMR) have been reported with the combination of tyrosine kinase inhibitors and pegylated-interferon-alpha (Peg-IFN) in patients with newly diagnosed chronic phase-chronic myeloid leukaemia (CP-CML). In this setting, this study investigated the efficacy and safety of dasatinib combined to Peg-IFN-α2b (Dasa-PegIFN, NCT01872442). A total of 79 patients (age ≤65 years) started dasatinib; 61 were eligible for Peg-IFNα-2b add-on therapy at month 3 for a maximum 21-months duration. Dasatinib was continued thereafter. The primary endpoint was the cumulative rate of molecular response 4.5 log (MR4.5 ) by 12 months. The results are reported for the 5-year duration of the study. Grade 3 neutropenia was frequent with the combination but did not induce severe infection (one of grade 3). Other adverse events were generally low grade (4% of grade 3-4) and expected. Seventy-nine per cent and 61% of patients continued the Peg-IFN until months 12 and 24, respectively. Overall, at these time points, MR4.5 rates were 25% and 38%, respectively. Thereafter, 32% and 46% of patients achieved a sustained (≥2 years) MR4.5 or MR4 , respectively. This work established the feasibility and high rates of achievement of early and sustained DMR (a prerequisite for treatment-free-remission) with dasatinib and Peg-IFNα-2b combination as initial therapy.
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Affiliation(s)
- Lydia Roy
- Hôpital Universitaire Henri Mondor, APHP, Faculté de Santé, UPEC, Service d'Hématologie Clinique, Créteil, France
| | | | | | | | | | - Stéphane Giraudier
- Hôpital Saint-Louis, APHP et INSERM Université de Paris, Service de biologie cellulaire, Paris, France
| | - Aude Charbonnier
- Institut Paoli-Calmettes, Service d'Hématologie Clinique, Marseille, France
| | | | - Françoise Huguet
- Service d'Hématologie Clinique, CHU Toulouse, I.U.C.T.O, Toulouse, France
| | | | - Pascal Lenain
- Centre Henri Becquerel, Service d'Hématologie Clinique, Rouen, France
| | - Shanti Ame
- CHU Strasbourg, Service d'Hématologie Clinique, Strasbourg, France
| | - Gabriel Etienne
- Institut Bergonié, Service d'Hématologie Clinique, Bordeaux, France
| | - Franck E Nicolini
- Centre Léon Bérard, Service d'Hématologie Clinique & INSERM U1052 CRC, Lyon, France
| | - Delphine Rea
- Hôpital St Louis, APHP, Service d'Hématologie Clinique, Paris, France
| | | | - Stéphane Courby
- CHU Grenoble Service d'Hématologie Clinique, Grenoble, France
| | | | - Laurence Legros
- Hôpital Paul Brousse, AP-HP, Service d'Hématologie Clinique, INSERM UMRS-MD1197, Villejuif, France
| | - Antoine Machet
- Hôpital Bretonneau, CHRU Tours Service d'Hématologie Clinique, Tours, France
| | - Valérie Coiteux
- Hôpital Claude Huriez, CHRU Lille Service d'Hématologie Clinique, Lille, France
| | - Eric Hermet
- CHU d'Estaing, Clermont-Ferrand, Service d'Hématologie Clinique, Clermont-Ferrand, France
| | - Emilie Cayssials
- INSERM CIC 1402, CHU Poitiers, Poitiers, France.,CHU de Poitiers, Service d'Hématologie Clinique, Poitiers, France
| | - Stéphane Bouchet
- Hôpital Pellegrin, CHU Bordeaux, Laboratoire de pharmacologie, Bordeaux, France
| | | | - Philippe Rousselot
- Centre Hospitalier de Versailles, Université Paris Saclay UMR 1184, Service d'Hématologie Clinique, Le Chesnay, France
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- French CML group (Fi-LMC), Centre Léon Bérard, Lyon, France
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11
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Dulucq S, Nicolini FE, Rea D, Cony-Makhoul P, Charbonnier A, Escoffre-Barbe M, Coiteux V, Lenain P, Rigal-Huguet F, Liu J, Guerci-Bresler A, Legros L, Ianotto JC, Gardembas M, Turlure P, Dubruille V, Rousselot P, Martiniuc J, Jardel H, Johnson-Ansah H, Joly B, Henni T, Cayssials E, Zunic P, Berger MG, Villemagne B, Robbesyn F, Morisset S, Mahon FX, Etienne G. Kinetics of early and late molecular recurrences after first-line imatinib cessation in chronic myeloid leukemia: updated results from the STIM2 trial. Haematologica 2022; 107:2859-2869. [PMID: 35615931 PMCID: PMC9713567 DOI: 10.3324/haematol.2022.280811] [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: 02/08/2022] [Indexed: 12/14/2022] Open
Abstract
Discontinuation of tyrosine kinase inhibitors in chronic phase chronic myeloid leukemia is feasible in clinical practice based on recently published international recommendations. Nevertheless, factors predictive of molecular recurrence have not been fully elucidated and long-term follow-up of patients enrolled in clinical studies are required in order to update knowledge on discontinuation attempts particularly in terms of the safety and durability of treatment-free remission (TFR). In the current study, we updated results from the STIM2 study in the light of the consensual criterion of molecular recurrence reported in different international recommendations. Among the 199 patients included in the perprotocol study, 108 patients lost a major molecular response. With a median follow-up of 40.8 months (5.5-111 months), the probability of treatment-free remission was 43.4% [36.3-50.4] at 5 years, 40.9% [32.8-47.3] at 7 years and 34.5% [25.6- 43.3] at 9 years. Molecular recurrence occurred between 0 to 6 months, 6 to 24 months and after 24 months in 75 patients (69%), 15 patients (14%) and 18 patients (17%), respectively. Notably, the kinetics of molecular recurrence differed significantly between these three subgroups with a median time from loss of MR4 (BCR::ABL1 IS≤0.01%) to loss of major molecular response of 1, 7 and 22 months, respectively. Predictive factors of molecular recurrence differed according to the time of occurrence of the molecular recurrence. Durations of imatinib treatment and deep molecular response as well as BCR::ABL1/ABL1 levels at cessation of tyrosine kinase inhibitor treatment, as quantified by reverse transcriptase droplet digital polymerase chain reaction, are involved in molecular recurrence occurring up to 24 months but not beyond. (ClinicalTrial. gov Identifier NCT#0134373).
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Affiliation(s)
- Stéphanie Dulucq
- Laboratory of Hematology, University Hospital of Bordeaux, Hôpital Haut Lévêque, Pessac,Groupe Fi-LMC, Centre Léon Bérard, Lyon,S. Dulucq
| | - Franck E. Nicolini
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,INSERM U1052, Centre de Recherche de Cancérologie de Lyon, Centre Léon Bérard, Lyon,Hematology Department, Centre Léon Bérard, Lyon
| | - Delphine Rea
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Adult Hematology Department, Hôpital Saint Louis, Paris
| | - Pascale Cony-Makhoul
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department & Clinical Investigation Center, Centre Hospitalier Annecy-Genevois, Metz-Tessy, Pringy
| | - Aude Charbonnier
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Institut Paoli-Calmettes, Marseilles
| | - Martine Escoffre-Barbe
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, CHU de Pontchaillou, Rennes
| | - Valérie Coiteux
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, CHU Huriez, Lille
| | - Pascal Lenain
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Institut Henri Becquerel, Rouen
| | - Françoise Rigal-Huguet
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Institut Universitaire du Cancer, CHU de Toulouse, Toulouse
| | - Jixing Liu
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology & Oncology Department, Centre Hospitalier de Valence, Valence
| | - Agnès Guerci-Bresler
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, CHRU Brabois, Nancy
| | - Laurence Legros
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Hôpital Bicêtre, Le Kremlin-Bicêtre
| | | | - Martine Gardembas
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, CHU, Angers
| | - Pascal Turlure
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, CHU Dupuytren, Limoges
| | - Viviane Dubruille
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Hôtel Dieu, Nantes
| | - Philippe Rousselot
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Centre Hospitalier de Versailles, Le Chesnay
| | - Juliana Martiniuc
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Centre Hospitalier de Saint Brieuc, Saint Brieuc
| | - Henry Jardel
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Centre Hospitalier de Bretagne, Vannes
| | - Hyacinthe Johnson-Ansah
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Institute of Normandy, CHU de la Côte de Nacre, Caën
| | - Bertrand Joly
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, CH Sud Francilien, Corbeil-Essonne
| | - Tawfiq Henni
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, CHR La Réunion
| | - Emilie Cayssials
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, CHU de Poitiers, Poitiers
| | - Patricia Zunic
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Centre Hospitalier, Saint Pierre de La Réunion
| | - Marc G. Berger
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology (Biology) Department, CHU Estaing, Clermont-Ferrand
| | - Bruno Villemagne
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Internal Medicine and Onco-hematology Department, La Roche sur Yon and
| | - Fanny Robbesyn
- Laboratory of Hematology, University Hospital of Bordeaux, Hôpital Haut Lévêque, Pessac
| | - Stephane Morisset
- INSERM U1052, Centre de Recherche de Cancérologie de Lyon, Centre Léon Bérard, Lyon
| | - François-Xavier Mahon
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Institut Bergonié, Bordeaux, France,F-XM and GE contributed equally as co-senior authors
| | - Gabriel Etienne
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Institut Bergonié, Bordeaux, France,F-XM and GE contributed equally as co-senior authors
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12
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Abstract
Purpose of Review Treatment-free remission (TFR) is considered one of the main goals of therapy in patients with CML. Our goal in this paper is to review the current data on TFR, and discuss future directions. Recent Findings Multiple studies have demonstrated that attempting a treatment-free remission is safe and effective in a select group of patients. More recent data suggested that undetectable BCR-ABL1 by digital PCR prior to discontinuation is highly predictive of successful TFR. However, some patients have a successful TFR with no evidence of clinical disease despite persistent detectable BCR-ABL1. Some recent studies have shed some more light on possible mechanisms for this phenomena. Some possible mechanisms include immune mechanism, BCR-ABL1 detected in the lymphoid component only, or stem cell exhaustion. Summary TFR should be discussed with patients with CML. Patients who achieve a sustained deep molecular response may be eligible to attempt TFR, however, setting expectations that overall only 20% of patients with newly diagnosed CML will achieve a successful TFR. The importance of compliance to treatment early on cannot be overemphasized. Further studies using other drugs to get patients to a deeper remission in order to be eligible for TFR attempt, or attempting a second TFR in patients who had disease recurrence after first TFR attempt, are currently underway.
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13
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Why chronic myeloid leukaemia cannot be cured by tyrosine kinase-inhibitors. Leukemia 2021; 35:2199-2204. [PMID: 34002028 DOI: 10.1038/s41375-021-01272-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/24/2021] [Accepted: 04/28/2021] [Indexed: 01/29/2023]
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14
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Etienne G, Faberes C, Bauduer F, Adiko D, Lifermann F, Dagada C, Lenoir C, Schmitt A, Klein E, Fort MP, Bijou F, Turcq B, Robbesyn F, Durrieu F, Versmée L, Madene S, Moldovan M, Katsahian S, Charles-Nelson A, Lascaux A, Mahon FX, Dulucq S. Relevance of treatment-free remission recommendations in chronic phase chronic leukemia patients treated with frontline tyrosine kinase inhibitors. Cancer Med 2021; 10:3635-3645. [PMID: 33988316 PMCID: PMC8178499 DOI: 10.1002/cam4.3921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/30/2021] [Accepted: 04/05/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Tyrosine kinase inhibitors (TKI) can be safely discontinued in chronic phase chronic myeloid leukemia (CP-CML) patients who had achieved a sustained deep molecular response. Based on the results of discontinuation trials, recommendations regarding patient selection for a treatment-free remission (TFR) attempt had been proposed. The aims of this study were to evaluate the rate of patients eligible for TKI discontinuation and molecular recurrence-free survival (MRFS) after stop according to recommendations. METHODS Over a 10-year period, newly diagnosed CP-CML patients and treated with first-line TKI in the nine French participating centers were included. Eligibility to treatment discontinuation and MRFS were analyzed and compared according to selection criteria defined by recommendations and first-line treatments. RESULTS From January 2006 to December 2015, 398 patients were considered. Among them, 73% and 27% of patients received imatinib or either second or third generation tyrosine kinase inhibitors as frontline treatment, respectively. Considering the selection criteria defined by recommendations, up to 55% of the patients were selected as optimal candidates for treatment discontinuation. Overall 95/398 (24%) discontinued treatment. MRFS was 51.8% [95% CI 41.41-62.19] at 2 years and 43.8% [31.45-56.15] at 5 years. Patients receiving frontline second-generation TKI and fulfilling the eligibility criteria suggested by recommendations had the lowest probability of molecular relapse after TKI stop when compare to others. CONCLUSION One third of CP-CML patients treated with TKI frontline fulfilled the selection criteria suggested by European LeukemiaNet TFR recommendations. Meeting selection criteria and second-generation TKI frontline were associated with the highest MRFS.
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Affiliation(s)
- Gabriel Etienne
- Département d'Hématologie, Institut Bergonié, Bordeaux, France.,Institut National de la Santé et de la Recherche Médicale, U1218 ACTION, Université de Bordeaux, Bordeaux, France.,Groupe France Intergroupe des Leucémies Myéloïdes Chroniques, Hôpital Haut-Lévêque, Pessac, France
| | - Carole Faberes
- Département d'Hématologie, Institut Bergonié, Bordeaux, France
| | - Fréderic Bauduer
- Groupe France Intergroupe des Leucémies Myéloïdes Chroniques, Hôpital Haut-Lévêque, Pessac, France.,Service d'Hématologie, Centre Hospitalier Côte Basque, Bayonne, France.,Collège des Sciences de la Santé, Université de Bordeaux, Bordeaux, France
| | - Didier Adiko
- Groupe France Intergroupe des Leucémies Myéloïdes Chroniques, Hôpital Haut-Lévêque, Pessac, France.,Service d'Hématologie, Centre Hospitalier de Libourne, Libourne, France
| | - François Lifermann
- Service de Médecine Interne, Centre Hospitalier de Dax-Côte d'Argent, Dax, France
| | - Corinne Dagada
- Service d'Oncologie-Hématologie, Centre Hospitalier de Pau, Pau, France
| | - Caroline Lenoir
- Service d'Hémato-Oncologie Radiothérapie, Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
| | - Anna Schmitt
- Département d'Hématologie, Institut Bergonié, Bordeaux, France
| | - Emilie Klein
- Laboratoire d'Hématologie, Hôpital Haut Lévêque Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | | | - Fontanet Bijou
- Département d'Hématologie, Institut Bergonié, Bordeaux, France
| | - Beatrice Turcq
- Institut National de la Santé et de la Recherche Médicale, U1218 ACTION, Université de Bordeaux, Bordeaux, France.,Groupe France Intergroupe des Leucémies Myéloïdes Chroniques, Hôpital Haut-Lévêque, Pessac, France.,Centre National de la Recherche Scientifiue, SNC 5010, Bordeaux, France
| | - Fanny Robbesyn
- Laboratoire d'Hématologie, Hôpital Haut Lévêque Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | | | - Laura Versmée
- Département d'Hématologie, Institut Bergonié, Bordeaux, France
| | - Samia Madene
- Service de Médecine Interne et Hématologie, Centre Hospitalier Intercommunal Mont-de-Marsan - Pays des Sources, Mont de Marsan, France
| | - Marius Moldovan
- Hôpital de jour Hématologie-Oncologie, Centre Hospitalier de Périgueux, Périgueux, France
| | - Sandrine Katsahian
- Unité de Recherche Clinique et Centre Investigation Clinique-Epidémiologie, Hôpitaux Universitaires Paris-Ouest Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université Paris 5 Institut National de la Santé et de la Recherche Médicale, Centre de Recherche des Cordeliers, Equipe 22, Paris, France
| | - Anais Charles-Nelson
- Unité de Recherche Clinique et Centre Investigation Clinique-Epidémiologie, Hôpitaux Universitaires Paris-Ouest Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.,INSERM, Centre d'Investigation Clinique 1418, Module Epidémiologie Clinique, Paris, France
| | - Axelle Lascaux
- Service Des Maladies du Sang, Hôpital Haut Lévêque Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - François-Xavier Mahon
- Département d'Hématologie, Institut Bergonié, Bordeaux, France.,Institut National de la Santé et de la Recherche Médicale, U1218 ACTION, Université de Bordeaux, Bordeaux, France.,Groupe France Intergroupe des Leucémies Myéloïdes Chroniques, Hôpital Haut-Lévêque, Pessac, France
| | - Stéphanie Dulucq
- Groupe France Intergroupe des Leucémies Myéloïdes Chroniques, Hôpital Haut-Lévêque, Pessac, France.,Laboratoire d'Hématologie, Hôpital Haut Lévêque Centre Hospitalier Universitaire de Bordeaux, Pessac, France
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15
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Astrugue C, Bénard A, Bosco-Levy P, Dulucq S, Rouyer M, Lassalle R, Hayes N, Mahon FX. Budget Impact of Tyrosine Kinase Inhibitor Discontinuation in Chronic Myeloid Leukemia With Sustained Deep Molecular Response. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:683-690. [PMID: 33933237 DOI: 10.1016/j.jval.2020.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 11/02/2020] [Accepted: 11/17/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Tyrosine kinase inhibitors (TKIs) account for the vast majority of healthcare expenditure on patients with chronic myeloid leukemia (CML), and it has been demonstrated that TKI discontinuation in patients in long-term deep molecular remission (DMR) is safe and improves quality of life. Our objective was to estimate the budget impact of TKI discontinuation in CML patients in long-term DMR from the perspective of the French healthcare system. METHODS This analysis was conducted over a 5-year time horizon using a Markov model with cycles of 6 months. Transition probabilities were estimated through systematic reviews and meta-analyses. Costs were estimated from the French National Claims Database. Monte Carlo simulations were performed to take into account the uncertainty surrounding model parameters. Sensitivity analyses were carried out by varying the size of the target population and the cost of TKIs. RESULTS Over a 5-year period and for a target population of 100 patients each year eligible and agreeing to stop TKI, the TKI discontinuation strategy would save €25.5 million (95% confidence interval -39.3 to 70.0). In this model, the probability that TKI discontinuation would be more expensive than TKI continuation was 12.0%. In sensitivity analyses, mean savings ranged from €14.9 million to €62.9 million. CONCLUSIONS This study provides transparent, reproducible, and interpretable results for healthcare professionals and policy makers. Our results clearly show that innovative healthcare strategies can benefit both the healthcare system and patients. Savings from generalizing TKI discontinuation in CML patients in sustained DMR should yield health gains for other patients.
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Affiliation(s)
- Cyril Astrugue
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, team EMOS, Bordeaux, France
| | - Antoine Bénard
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, team EMOS, Bordeaux, France; CHU de Bordeaux, Pôle de santé publique, Service d'information médicale, Bordeaux, France
| | | | | | - Magali Rouyer
- Bordeaux PharmacoEpi, University of Bordeaux, Bordeaux, France
| | - Régis Lassalle
- Bordeaux PharmacoEpi, University of Bordeaux, Bordeaux, France
| | - Nathalie Hayes
- CHU de Bordeaux, Direction de la Recherche Clinique et de l'Innovation, Bordeaux, France
| | - François-Xavier Mahon
- CHU de Bordeaux, Laboratoire d'hématologie, Bordeaux, France; Institut Bergonie, Cancer Center Bordeaux, University of Bordeaux, France.
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16
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Cerveira N, Bizarro S, Teixeira MR, Mariz JM. When to Stop TKIs in Patients with Chronic Myeloid Leukemia and How to Follow Them Subsequently. Curr Treat Options Oncol 2021; 22:49. [PMID: 33866455 DOI: 10.1007/s11864-021-00851-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2021] [Indexed: 11/28/2022]
Abstract
OPINION STATEMENT ABL1 tyrosine kinase inhibitors (TKI) have dramatically improved the outcome for CML (chronic myeloid leukemia) patients. When TKI therapy is addressed appropriately, it can lead to an optimal molecular response in the majority of CML patients and a life expectancy that approaches that of the general population. However, lifelong TKI therapy may have consequences, including chronic, mostly low-grade, adverse events that can substantially impact patients' quality of life, adherence to therapy and, consequently, success of treatment. In the last few years, several groups have demonstrated that approximately 50% of chronic phase CML patients (CP-CML) who have achieved a stable deep molecular response (DMR) can stop therapy without suffering molecular relapse. Nowadays, treatment-free remission (TFR) has a significant role in the management of CML and should be considered in selected motivated patients that fulfill well-defined requirements to maximize the probability of successful discontinuation of TKI therapy.
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Affiliation(s)
- Nuno Cerveira
- Serviço de Genética, Instituto Português de Oncologia do Porto, Rua Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal.
| | - Susana Bizarro
- Serviço de Genética, Instituto Português de Oncologia do Porto, Rua Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal
| | - Manuel R Teixeira
- Serviço de Genética, Instituto Português de Oncologia do Porto, Rua Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal.,Instituto de Ciências Biomédicas, Universidade do Porto, Porto, Portugal
| | - José M Mariz
- Serviço de Hematologia, Instituto Português de Oncologia do Porto, Porto, Portugal
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17
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Highly sensitive fluorescence biosensing of BCR-ABL1 fusion gene based on exponential transcription-triggered hemin catalysis. Talanta 2021; 224:121967. [PMID: 33379130 DOI: 10.1016/j.talanta.2020.121967] [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: 09/23/2020] [Revised: 11/15/2020] [Accepted: 11/30/2020] [Indexed: 11/21/2022]
Abstract
Simple, sensitive and specific detection of the transcription level of BCR-ABL1 mRNA possesses vital clinical significance in diagnosis and treatment of chronic myeloid leukemia (CML). In this study, an innovative fluorescence biosensing methodology has been developed for sensitive and specific detection of BCR-ABL1 mRNA by integrating high-efficiency of exponential transcription and superior catalytic performance of DNA-grafted hemin. Exponential transcription was triggered by BCR-ABL1 mRNA to produce plenty of RNA products. They can specifically hybridize with circular dual-labeled hemin (DLH) probe to dissociate the intramolecular hemin dimmers into highly active hemin monomers for catalyzing fluorescence substrate tyramine. This exponential transcription-triggered hemin catalysis (ET-HC) strategy showed highly sensitive and specific for BCR-ABL1 detection with a limit of detection at 0.5 aM and a good linear range from 2 aM to 200 fM. This method was successfully applied to directly detect as low as 0.001% e13a2 transcript isoforms from complex genomic RNA extraction. Compared with clinical routine, the overall process is a thermostatic reaction and eliminates additional reverse transcription operation. Therefore, the developed ET-HC strategy might provide a promising alternative tool for precise diagnosis and personalized treatment of CML.
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18
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Seguro FS, Maciel FVR, Santos FM, Abdo ANR, Pereira TDM, Nardinelli L, Rocha V, Bendit I. MR 4log and low levels of NK cells are associated with higher molecular relapse after imatinib discontinuation: Results of a prospective trial. Leuk Res 2021; 101:106516. [PMID: 33517185 DOI: 10.1016/j.leukres.2021.106516] [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: 12/02/2020] [Revised: 01/14/2021] [Accepted: 01/18/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Treatment-free survival (TFS) in chronic myeloid leukemia (CML) is a new goal. This prospective study aims to evaluate imatinib discontinuation's feasibility and safety in patients with deep molecular response MR4 (BCR-ABL1 < 0.01 % IS). METHODS Study was approved by the ethical committee and registered at Clinicaltrials.gov (NCT03239886). Incluision criteria were: age ≥ 18y, chronic phase, first-line imatinib for 36 months, MR4 for 12 months, no previous transplant or resistance. Imatinib was resumed when two samples confirmed the loss of MMR. The primary endpoint was molecular recurrence-free survival (MRFS) at 24 months. Lymphocyte subpopulations were counted in peripheral blood before discontinuation. RESULTS 31 patients were included from Dec/2016 until Oct/2017. Median age was 54years, 58 % male, 58 % low Sokal, 65 % b3a2 transcripts, and 61 % were in MR4.5. Imatinib therapy's median time was 9.7y (3-14.9 y), median time of MR4 was 6.9y (1.6-10.3y). MRFS at 24 months was 55 % (95 % CI 39-75). Thirteen patients relapsed, 46 % after six months of discontinuation, and all patients recovered MMR. Median time to recover MMR was one month. MR4.5 was the only factor associated with MRFS. NK cells proportion at baseline was lower in patients with only MR4 who relapsed after discontinuation. CONCLUSION With a median duration of sustained MR4 above five years, as recommended by most TKI discontinuation guidelines, the TFS was similar to previous studies. Only MR4.5 was associated with lower risk of relapse. Further studies are needed to evaluate whether patients with only MR4 and low NK cell levels are suitable for discontinuation.
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Affiliation(s)
- Fernanda S Seguro
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Instituto do Câncer do Estado de São Paulo, Sao Paulo, SP, Brazil.
| | | | | | - André N R Abdo
- Instituto do Câncer do Estado de São Paulo, Sao Paulo, SP, Brazil
| | | | - Luciana Nardinelli
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Vanderson Rocha
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Israel Bendit
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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19
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Richter J, Lübking A, Söderlund S, Lotfi K, Markevärn B, Själander A, Stenke L, Deneberg S, Ahlstrand E, Myhr-Eriksson K, Panayiotidis P, Gedde-Dahl T, Žáčková D, Mayer J, Olsson-Strömberg U, Mahon FX, Saussele S, Hjorth-Hansen H, Koskenvesa P. Molecular status 36 months after TKI discontinuation in CML is highly predictive for subsequent loss of MMR-final report from AFTER-SKI. Leukemia 2021; 35:2416-2418. [PMID: 33589755 PMCID: PMC8324471 DOI: 10.1038/s41375-021-01173-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/11/2021] [Accepted: 01/28/2021] [Indexed: 01/29/2023]
Affiliation(s)
- Johan Richter
- grid.411843.b0000 0004 0623 9987Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Anna Lübking
- grid.411843.b0000 0004 0623 9987Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Stina Söderlund
- grid.412354.50000 0001 2351 3333Department of Medical Sciences, University of Uppsala and Section of Hematology, Uppsala University Hospital, Uppsala, Sweden
| | - Kourosh Lotfi
- grid.411384.b0000 0000 9309 6304Department of Hematology, University Hospital, Linköping, Sweden
| | - Berit Markevärn
- grid.412215.10000 0004 0623 991XDepartment of Hematology, University Hospital, Umeå, Sweden
| | - Anders Själander
- grid.12650.300000 0001 1034 3451Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Leif Stenke
- grid.24381.3c0000 0000 9241 5705Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Stefan Deneberg
- grid.24381.3c0000 0000 9241 5705Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Erik Ahlstrand
- grid.15895.300000 0001 0738 8966Department of Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Kristina Myhr-Eriksson
- grid.416723.50000 0004 0626 5317Department of Hematology, Sunderby Hospital, Luleå, Sweden
| | - Panayiotis Panayiotidis
- grid.5216.00000 0001 2155 0800First Department of Propedeutic Medicine, Laikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Tobias Gedde-Dahl
- grid.55325.340000 0004 0389 8485Oslo University Hospital, Oslo, Norway
| | - Daniela Žáčková
- grid.412554.30000 0004 0609 2751Department of Internal Medicine Hematology and Oncology, University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Jiří Mayer
- grid.412554.30000 0004 0609 2751Department of Internal Medicine Hematology and Oncology, University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Ulla Olsson-Strömberg
- grid.412354.50000 0001 2351 3333Department of Medical Sciences, University of Uppsala and Section of Hematology, Uppsala University Hospital, Uppsala, Sweden
| | - Francois-Xavier Mahon
- grid.412041.20000 0001 2106 639XLaboratoire Hématopoïèse Leucémique et cible thérapeutique, INSERM U876, Université Victor Ségalen Bordeaux 2, Bordeaux, France
| | - Susanne Saussele
- grid.7700.00000 0001 2190 4373Medizinische Universitätsklinik Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - Henrik Hjorth-Hansen
- grid.52522.320000 0004 0627 3560Department of Hematology, St Olavs Hospital, Trondheim, Norway
| | - Perttu Koskenvesa
- grid.15485.3d0000 0000 9950 5666Hematology Research Unit Helsinki, Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
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20
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Chow EJ, Doody DR, Wilkes JJ, Becker LK, Chennupati S, Morin PE, Winestone LE, Henk HJ, Lyman GH. Adverse events among chronic myelogenous leukemia patients treated with tyrosine kinase inhibitors: a real-world analysis of health plan enrollees. Leuk Lymphoma 2020; 62:1203-1210. [PMID: 33283555 DOI: 10.1080/10428194.2020.1855340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
With tyrosine kinase inhibitor (TKI) therapy, chronic myelogenous leukemia (CML) is now a chronic disease. CML patients treated with TKIs (n = 1200) were identified from the OptumLabs® Data Warehouse (de-identified claims and electronic health records) between 2000 and 2016 and compared with a non-cancer cohort (n = 7635). The 5-year cumulative incidence of all organ system outcomes was significantly greater for the TKI versus non-cancer group. In the first year, compared with imatinib, later generation TKIs were associated with primary infections (hazard ratios [HR] 1.43, 95% CI 1.02-2.00), circulatory events (HR 1.15, 95% CI 1.01-1.31), and skin issues (HR 1.43, 95% CI 1.13-1.80); musculoskeletal and nervous system/sensory issues were less common (HRs 0.83-0.84, p < 0.05). Increased risk of infections, cardiopulmonary and skin issues associated with later generation TKIs persisted in subsequent years. In this real-world population, TKI therapy was associated with a high burden of adverse events. Later generation TKIs may have greater toxicity than imatinib.
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Affiliation(s)
- Eric J Chow
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, WA, USA.,OptumLabs Visiting Fellow, Cambridge, MA, USA
| | - David R Doody
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Jennifer J Wilkes
- Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, WA, USA
| | | | - Shasank Chennupati
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Lena E Winestone
- Department of Pediatrics, University of California, San Francisco, Benioff Children's Hospital, San Francisco, CA, USA
| | | | - Gary H Lyman
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
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21
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Dragani M, Rege Cambrin G, Berchialla P, Dogliotti I, Rosti G, Castagnetti F, Capodanno I, Martino B, Cerrano M, Ferrero D, Gambacorti-Passerini C, Crugnola M, Elena C, Breccia M, Iurlo A, Cattaneo D, Galimberti S, Gozzini A, Bocchia M, Lunghi F, Cedrone M, Sgherza N, Luciano L, Russo S, Santoro M, Giai V, Caocci G, Levato L, Abruzzese E, Sora F, Saglio G, Fava C. A Retrospective Analysis about Frequency of Monitoring in Italian Chronic Myeloid Leukemia Patients after Discontinuation. J Clin Med 2020; 9:jcm9113692. [PMID: 33213044 PMCID: PMC7698481 DOI: 10.3390/jcm9113692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 01/26/2023] Open
Abstract
Successful discontinuation of tyrosine kinase inhibitors has been achieved in patients with chronic-phase chronic myeloid leukemia (CML). Careful molecular monitoring after discontinuation warrants safe and prompt resumption of therapy. We retrospectively evaluated how molecular monitoring has been conducted in Italy in a cohort of patients who discontinued tyrosine kinase inhibitor (TKI) treatment per clinical practice. The outcome of these patients has recently been reported-281 chronic-phase CML patients were included in this subanalysis. Median follow-up since discontinuation was 2 years. Overall, 2203 analyses were performed, 17.9% in the first three months and 38.4% in the first six months. Eighty-six patients lost major molecular response (MMR) in a mean time of 5.7 months-65 pts (75.6%) during the first six months. We evaluated the number of patients who would experience a delay in diagnosis of MMR loss if a three-month monitoring schedule was adopted. In the first 6 months, 19 pts (29.2%) would have a one-month delay, 26 (40%) a 2-month delay. Very few patients would experience a delay in the following months. A less intense frequency of monitoring, particularly after the first 6 months off treatment, would not have affected the success of treatment-free remission (TFR) nor put patients at risk of progression.
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Affiliation(s)
- Matteo Dragani
- Department of Clinical and Biological Sciences, University of Turin, 10043 Orbassano, Italy; (G.R.C.); (P.B.); (G.S.); (C.F.)
- Correspondence: ; Tel.: +39-011-902-6709
| | - Giovanna Rege Cambrin
- Department of Clinical and Biological Sciences, University of Turin, 10043 Orbassano, Italy; (G.R.C.); (P.B.); (G.S.); (C.F.)
| | - Paola Berchialla
- Department of Clinical and Biological Sciences, University of Turin, 10043 Orbassano, Italy; (G.R.C.); (P.B.); (G.S.); (C.F.)
| | - Irene Dogliotti
- Hematology Unit, Department of Biotechnology and Health Sciences, University of Turin, 10126 Turin, Italy; (I.D.); (M.C.); (D.F.)
| | - Gianantonio Rosti
- Institute of Hematology “L. e A. Seràgnoli”, University of Bologna, 40138 Bologna, Italy; (G.R.); (F.C.)
| | - Fausto Castagnetti
- Institute of Hematology “L. e A. Seràgnoli”, University of Bologna, 40138 Bologna, Italy; (G.R.); (F.C.)
| | - Isabella Capodanno
- Hematology Unit, Azienda Unità Sanitaria Locale-IRCCS, 42123 Reggio Emilia, Italy;
| | - Bruno Martino
- Hematology Unit, Grande Ospedale Metropolitano “Bianchi-Melacrino-Morelli”, 89124 Reggio Calabria, Italy;
| | - Marco Cerrano
- Hematology Unit, Department of Biotechnology and Health Sciences, University of Turin, 10126 Turin, Italy; (I.D.); (M.C.); (D.F.)
| | - Dario Ferrero
- Hematology Unit, Department of Biotechnology and Health Sciences, University of Turin, 10126 Turin, Italy; (I.D.); (M.C.); (D.F.)
| | | | - Monica Crugnola
- Division of Hematology, Azienda Ospedaliero-Universitaria di Parma, 43126 Parma, Italy;
| | - Chiara Elena
- Department of Hematology Oncology, Foundation IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy;
| | - Massimo Breccia
- Department of Translational and Precision Medicine, Sapienza University, 00161 Rome, Italy;
| | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.I.); (D.C.)
| | - Daniele Cattaneo
- Hematology Division, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.I.); (D.C.)
| | - Sara Galimberti
- Hematology Department, University of Pisa, 56126 Pisa, Italy;
| | - Antonella Gozzini
- Hematology Division, Policlinico Careggi di Firenze, 50139 Firenze, Italy;
| | - Monica Bocchia
- Hematology Unit, University of Siena, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy;
| | - Francesca Lunghi
- Hematology and Bone Marrow Transplant Unit, San Raffaele Scientific Institute IRCCS, 20132 Milano, Italy;
| | - Michele Cedrone
- Hematology Division, Az. Ospedaliera San Giovanni Addolorata, 00184 Rome, Italy;
| | - Nicola Sgherza
- Division of Hematology, IRCCS Ospedale Casa Sollievo Sofferenza, 71043 San Giovanni Rotondo, Italy;
| | - Luigia Luciano
- Hematology Unit, “Federico II” Hospital, University of Naples, 80131 Napoli, Italy;
| | - Sabina Russo
- Department of Internal Medicine, AOU Policlinico di Messina, 98124 Messina, Italy;
| | - Marco Santoro
- Hematology Unit, University of Palermo, 90127 Palermo, Italy;
| | - Valentina Giai
- Hematology Unit, Antonio e Biagio e Cesare Arrigo Hospital, 15121 Alessandria, Italy;
| | - Giovanni Caocci
- Hematology Unit, Department of Medical Sciences, University of Cagliari, 09121 Cagliari, Italy;
| | - Luciano Levato
- Department Hematology-Oncology, Azienda Ospedaliera Pugliese-Ciaccio, 88100 Catanzaro, Italy;
| | - Elisabetta Abruzzese
- Hematology Unit, S. Eugenio Hospital, Tor Vergata University, 00144 Rome, Italy;
| | - Federica Sora
- Hematology Unit, Fondazione Policlinico Universitario Gemelli IRCCS, 00168 Rome, Italy;
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences, University of Turin, 10043 Orbassano, Italy; (G.R.C.); (P.B.); (G.S.); (C.F.)
| | - Carmen Fava
- Department of Clinical and Biological Sciences, University of Turin, 10043 Orbassano, Italy; (G.R.C.); (P.B.); (G.S.); (C.F.)
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22
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Etienne G, Dulucq S, Bauduer F, Adiko D, Lifermann F, Dagada C, Lenoir C, Schmitt A, Klein E, Madene S, Fort MP, Bijou F, Moldovan M, Turcq B, Robbesyn F, Durrieu F, Versmée L, Katsahian S, Faberes C, Lascaux A, Mahon FX. Incidences of Deep Molecular Responses and Treatment-Free Remission in de Novo CP-CML Patients. Cancers (Basel) 2020; 12:cancers12092521. [PMID: 32899879 PMCID: PMC7565328 DOI: 10.3390/cancers12092521] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 08/26/2020] [Accepted: 08/29/2020] [Indexed: 12/20/2022] Open
Abstract
Simple Summary Tyrosine kinase inhibitors (TKI) can be safely discontinued in chronic myeloid leukemia patients. Achieving a sustained deep molecular response (DMR) before stop is recommended. Currently, the proportion of patients who achieve a sustained DMR remains to be determined. Based on the follow-up of 398 patients over a ten-years period, we evaluate that 46% of them have achieved a sustained DMR. Gender, BCR-ABL1 transcript type, and disease risk scores were significantly associated with the probability of achieving a DMR. 95/398 (24%) patients stopped TKI with a probability of maintaining molecular reponse without TKI resumption of 47% at 48 months after stop. In this study, TKI duration before stop and second (nilotinib, dasatinib, bosutinib) generation frontline TKI compared to imatinib were significantly associated with a lower risk of molecular relapse after stop in patients who have achieved a sustained DMR. Abstract Background: Tyrosine Kinase Inhibitors (TKIs) discontinuation in patients who had achieved a deep molecular response (DMR) offer now the opportunity of prolonged treatment-free remission (TFR). Patients and Methods: Aims of this study were to evaluate the proportion of de novo chronic-phase chronic myeloid leukemia (CP-CML) patients who achieved a sustained DMR and to identify predictive factors of DMR and molecular recurrence-free survival (MRFS) after TKI discontinuation. Results: Over a period of 10 years, 398 CP-CML patients treated with first-line TKIs were included. Median age at diagnosis was 61 years, 291 (73%) and 107 (27%) patients were treated with frontline imatinib (IMA) or second- or third-generation TKIs (2–3G TKI), respectively. With a median follow-up of seven years (range, 0.6 to 13.8 years), 182 (46%) patients achieved a sustained DMR at least 24 months. Gender, BCR-ABL1 transcript type, and Sokal and ELTS risk scores were significantly associated with a higher probability of sustained DMR while TKI first-line (IMA vs. 2–3G TKI) was not. We estimate that 28% of CML-CP would have been an optimal candidate for TKI discontinuation according to recent recommendations. Finally, 95 (24%) patients have entered in a TFR program. MRFS rates at 12 and 48 months were 55.1% (95% CI, 44.3% to 65.9%) and 46.9% (95% CI, 34.9% to 58.9%), respectively. In multivariate analyses, first-line 2–3G TKIs compared to IMA and TKI duration were the most significant factors of MRFS. Conclusions: Our results suggest that frontline TKIs have a significant impact on TFR in patients who fulfill the selection criteria for TKI discontinuation.
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Affiliation(s)
- Gabriel Etienne
- Service d’Hématologie, Institut Bergonié, 33076 Bordeaux, France; (A.S.); (M.-P.F.); (F.B.); (F.D.); (L.V.); (C.F.); (F.-X.M.)
- Institut National de la Santé et de la Recherche Médicale, U1218 ACTION, Université de Bordeaux, 33000 Bordeaux, France; (S.D.); (E.K.); (B.T.)
- Groupe France Intergroupe des Leucémies Myéloïdes Chroniques, Hôpital Haut-Lévêque, 33600 Pessac, France;
- Correspondence: ; Tel.: +33-5633-3300; Fax: +33-547-306-060
| | - Stéphanie Dulucq
- Institut National de la Santé et de la Recherche Médicale, U1218 ACTION, Université de Bordeaux, 33000 Bordeaux, France; (S.D.); (E.K.); (B.T.)
- Groupe France Intergroupe des Leucémies Myéloïdes Chroniques, Hôpital Haut-Lévêque, 33600 Pessac, France;
- Laboratoire d’Hématologie, Hôpital Haut Lévêque Centre Hospitalier Universitaire de Bordeaux, 33600 Pessac, France;
| | - Fréderic Bauduer
- Groupe France Intergroupe des Leucémies Myéloïdes Chroniques, Hôpital Haut-Lévêque, 33600 Pessac, France;
- Service d’Hématologie, Centre Hospitalier Côte Basque, 64100 Bayonne, France
- Collège des Sciences de la Santé, Université de Bordeaux, 33000 Bordeaux, France
| | - Didier Adiko
- Service d’Hématologie, Centre Hospitalier de Libourne, 33500 Libourne, France;
| | - François Lifermann
- Service de Médecine Interne, Centre Hospitalier de Dax-Côte d’Argent, 40107 Dax, France;
| | - Corinne Dagada
- Service d’Oncologie-Hématologie, Centre Hospitalier de Pau, 64000 Pau, France;
| | - Caroline Lenoir
- Service d’Hémato-Oncologie Radiothérapie, Polyclinique Bordeaux Nord Aquitaine, 33000 Bordeaux, France;
| | - Anna Schmitt
- Service d’Hématologie, Institut Bergonié, 33076 Bordeaux, France; (A.S.); (M.-P.F.); (F.B.); (F.D.); (L.V.); (C.F.); (F.-X.M.)
| | - Emilie Klein
- Institut National de la Santé et de la Recherche Médicale, U1218 ACTION, Université de Bordeaux, 33000 Bordeaux, France; (S.D.); (E.K.); (B.T.)
- Laboratoire d’Hématologie, Hôpital Haut Lévêque Centre Hospitalier Universitaire de Bordeaux, 33600 Pessac, France;
| | - Samia Madene
- Service de Médecine Interne et Hématologie, Centre Hospitalier Intercommunal Mont-de-Marsan—Pays des Sources, 40024 Mont de Marsan, France;
| | - Marie-Pierre Fort
- Service d’Hématologie, Institut Bergonié, 33076 Bordeaux, France; (A.S.); (M.-P.F.); (F.B.); (F.D.); (L.V.); (C.F.); (F.-X.M.)
| | - Fontanet Bijou
- Service d’Hématologie, Institut Bergonié, 33076 Bordeaux, France; (A.S.); (M.-P.F.); (F.B.); (F.D.); (L.V.); (C.F.); (F.-X.M.)
| | - Marius Moldovan
- Service d’Hématologie-Oncologie, Centre Hospitalier de Périgueux, 24000 Périgueux, France;
| | - Beatrice Turcq
- Institut National de la Santé et de la Recherche Médicale, U1218 ACTION, Université de Bordeaux, 33000 Bordeaux, France; (S.D.); (E.K.); (B.T.)
- Centre National de la Recherche Scientifique, SNC 5010, 33000 Bordeaux, France
| | - Fanny Robbesyn
- Laboratoire d’Hématologie, Hôpital Haut Lévêque Centre Hospitalier Universitaire de Bordeaux, 33600 Pessac, France;
| | - Françoise Durrieu
- Service d’Hématologie, Institut Bergonié, 33076 Bordeaux, France; (A.S.); (M.-P.F.); (F.B.); (F.D.); (L.V.); (C.F.); (F.-X.M.)
| | - Laura Versmée
- Service d’Hématologie, Institut Bergonié, 33076 Bordeaux, France; (A.S.); (M.-P.F.); (F.B.); (F.D.); (L.V.); (C.F.); (F.-X.M.)
- Massachusetts General Hospital, Boston, MA 02114, USA
| | - Sandrine Katsahian
- Unité de Recherche Clinique et Centre Investigation Clinique-Epidémiologie, Hôpitaux Universitaires Paris-Ouest Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris 5 Institut National de la Santé et de la Recherche Médicale, Centre de Recherche des Cordeliers, Equipe 22, 75006 Paris, France;
| | - Carole Faberes
- Service d’Hématologie, Institut Bergonié, 33076 Bordeaux, France; (A.S.); (M.-P.F.); (F.B.); (F.D.); (L.V.); (C.F.); (F.-X.M.)
| | - Axelle Lascaux
- Service des maladies du sang, Hôpital Haut Lévêque Centre Hospitalier Universitaire de Bordeaux, 33600 Pessac, France;
| | - François-Xavier Mahon
- Service d’Hématologie, Institut Bergonié, 33076 Bordeaux, France; (A.S.); (M.-P.F.); (F.B.); (F.D.); (L.V.); (C.F.); (F.-X.M.)
- Institut National de la Santé et de la Recherche Médicale, U1218 ACTION, Université de Bordeaux, 33000 Bordeaux, France; (S.D.); (E.K.); (B.T.)
- Groupe France Intergroupe des Leucémies Myéloïdes Chroniques, Hôpital Haut-Lévêque, 33600 Pessac, France;
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