1
|
Gao F, Xu T, Zang F, Luo Y, Pan D. Cardiotoxicity of Anticancer Drugs: Molecular Mechanisms, Clinical Management and Innovative Treatment. Drug Des Devel Ther 2024; 18:4089-4116. [PMID: 39286288 PMCID: PMC11404500 DOI: 10.2147/dddt.s469331] [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: 04/17/2024] [Accepted: 08/05/2024] [Indexed: 09/19/2024] Open
Abstract
With the continuous refinement of therapeutic measures, the survival rate of tumor patients has been improving year by year, while cardiovascular complications related to cancer therapy have become increasingly prominent. Exploring the mechanism and prevention strategy of cancer therapy-related cardiovascular toxicity (CTR-CVT) remains one of the research hotspots in the field of Cardio-Oncology in recent years. Cardiotoxicity of anticancer drugs involves heart failure, myocarditis, hypertension, arrhythmias and vascular toxicity, mechanistically related to vascular endothelial dysfunction, ferroptosis, mitochondrial dysfunction and oxidative stress. To address the cardiotoxicity induced by different anticancer drugs, various therapeutic measures have been put in place, such as reducing the accumulation of anticancer drugs, shifting to drugs with less cardiotoxicity, using cardioprotective drugs, and early detection. Due to the very limited treatments available to ameliorate anticancer drugs-induced cardiotoxicity, a few innovations are being shifted from animal studies to human studies. Examples include mitochondrial transplantation. Mitochondrial transplantation has been proven to be effective in in vivo and in vitro experiments. Several recent studies have demonstrated that intercellular mitochondrial transfer can ameliorate doxorubicin(DOX)-induced cardiotoxicity, laying the foundation for innovative therapies in anticancer drugs-induced cardiotoxicity. In this review, we will discuss the current status of anticancer drugs-induced cardiotoxicity in terms of the pathogenesis and treatment, with a focus on mitochondrial transplantation, and we hope that this review will bring some inspiration to you.
Collapse
Affiliation(s)
- Feiyu Gao
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221004, People's Republic of China
| | - Tao Xu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221004, People's Republic of China
| | - Fangnan Zang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221004, People's Republic of China
| | - Yuanyuan Luo
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221004, People's Republic of China
| | - Defeng Pan
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221004, People's Republic of China
| |
Collapse
|
2
|
Bucelli C, Capodanno I, Miggiano MC, Cavazzini F, Crescenzi SL, Russo S, Carmosino I, Annunziata M, Sorà F, Bonifacio M, Luciano L, Caocci G, Loglisci G, Elena C, Lunghi F, Mullai R, Attolico I, Binotto G, Crisà E, Sportoletti P, Di Veroli A, Scortechini AR, Leporace AP, Maggi A, Crugnola M, Stagno F, Sancetta R, Murgano P, Rapezzi D, Luzi D, Vincelli DI, Galimberti S, Bocchia M, Fava C, Malato A, Abruzzese E, Saglio G, Specchia G, Breccia M, Iurlo A, Tiribelli M, Latagliata R. Choice of Frontline Tyrosine-Kinase Inhibitor and Early Events in Very Elderly Patients With Chronic Myeloid Leukemia in Chronic Phase: A "Campus CML" Study. Eur J Haematol 2024. [PMID: 39263855 DOI: 10.1111/ejh.14299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 08/14/2024] [Accepted: 08/16/2024] [Indexed: 09/13/2024]
Abstract
OBJECTIVES The study aimed to evaluate the utilization of frontline TKI therapy in a large cohort of elderly CP-CML patients. METHODS A retrospective analysis was conducted on 332 CP-CML patients aged 75 years or older among 1929 diagnosed from January 2012 to December 2019 followed at 36 participating Hematology Centers involved in the "Campus CML" project. RESULTS Among the patients analyzed, 85.8% received imatinib (IM) while 14.2% received second-generation TKIs (2G-TKI), 59.5% dasatinib, and 40.5% nilotinib. Most patients initiated IM at standard dose (67.3%) while 32.7% at reduced dose. A similar trend was observed with 2G-TKIs. The cumulative incidence of permanent TKI discontinuation at 12 months was 28.4%, primarily due to primary resistance (10.1%) and extra-hematologic toxicity (9.5%), with no significant difference between IM and 2G-TKI groups. Following the introduction of generic IM in Italy in 2018, IM usage increased significantly compared with 2G-TKIs. CONCLUSIONS IM was in our Centers the preferred frontline therapy for older CP-CML patients, with increasing utilization after the introduction of generic formulations. However, 2G-TKIs are still used in a substantial proportion of patients, suggesting individualized physician assessments regarding patient suitability and expectations. Further investigation is needed to assess efficacy and safety of reduced TKI doses in this patient population.
Collapse
Affiliation(s)
- C Bucelli
- Hematology Division, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - I Capodanno
- Hematology Unit, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy
| | - M C Miggiano
- Hematology Department, San Bortolo Hospital, Vicenza, Italy
| | - F Cavazzini
- Hematology Unit, University of Ferrara, Ferrara, Italy
| | | | - S Russo
- Hematology, University of Messina, Messina, Italy
| | - I Carmosino
- Hematology, Department of Translational and Precision Medicine, Policlinico Umberto I-Sapienza University, Rome, Italy
| | - M Annunziata
- Hematology Unit, Cardarelli Hospital, Naples, Italy
| | - F Sorà
- Institute of Hematology, Policlinico Universitario A. Gemelli, "Cattolica" University, Rome, Italy
| | - M Bonifacio
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - L Luciano
- Hematology, University Federico II, Naples, Italy
| | - G Caocci
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - G Loglisci
- Hematology, Vito Fazzi Hospital, Lecce, Italy
| | - C Elena
- Hematology, Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - F Lunghi
- Division of Hematology and BMT, IRCCS San Raffaele Hospital, Milan, Italy
| | - R Mullai
- Division of Hematology and BMT, Department of Medical Area, University of Udine, Udine, Italy
| | - I Attolico
- Hematology and Transplantation Unit, University of Bari, Bari, Italy
| | - G Binotto
- Department of Medicine, Hematology and Clinical Immunology, University of Padua, Padua, Italy
| | - E Crisà
- Hematology, Ospedale Maggiore, Novara, Italy
| | | | - A Di Veroli
- Hematology, Belcolle Hospital, Viterbo, Italy
| | - A R Scortechini
- Hematology Unit, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
| | - A P Leporace
- Hematology Unit Azienda Ospedaliero Universitaria Sant'Andrea, Roma, Italy
| | - A Maggi
- Hematology, San Giuseppe Moscati Hospital, Taranto, Italy
| | - M Crugnola
- Hematology, University of Parma, Parma, Italy
| | - F Stagno
- Hematology, Ferrarotto Hospital, Catania, Italy
| | - R Sancetta
- Hematology Unit, Dell'Angelo Hospital, Venezia-Mestre, Italy
| | - P Murgano
- Division of Hematology, Sant'Elia Hospital, Caltanissetta, Italy
| | - D Rapezzi
- Hematology, AO Santa Croce e Carle, Cuneo, Italy
| | - D Luzi
- Onco-Hematology Department, AO Santa Maria, Terni, Italy
| | - D I Vincelli
- Hematology, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | - S Galimberti
- Department of Clinical and Experimental Medicine, Hematology, University of Pisa, Pisa, Italy
| | - M Bocchia
- Hematology, AOU Senese, Siena, Italy
| | - C Fava
- Hematology, Mauriziano Hospital, Torino, Italy
| | - A Malato
- Hematology, Cervello Hospital, Palermo, Italy
| | - E Abruzzese
- Hematology, Sant'Eugenio Hospital, Roma, Italy
| | - G Saglio
- Department of Clinical and Biological Sciences, University of Turin, Torino, Italy
| | - G Specchia
- School of Medicine, University of Bari, Bari, Italy
| | - M Breccia
- Hematology, Department of Translational and Precision Medicine, Policlinico Umberto I-Sapienza University, Rome, Italy
| | - A Iurlo
- Hematology Division, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - M Tiribelli
- Division of Hematology and BMT, Department of Medical Area, University of Udine, Udine, Italy
| | | |
Collapse
|
3
|
Hochhaus A, Wang J, Kim DW, Kim DDH, Mayer J, Goh YT, le Coutre P, Takahashi N, Kim I, Etienne G, Andorsky D, Issa GC, Larson RA, Bombaci F, Kapoor S, McCulloch T, Malek K, Yau L, Ifrah S, Hoch M, Cortes JE, Hughes TP. Asciminib in Newly Diagnosed Chronic Myeloid Leukemia. N Engl J Med 2024; 391:885-898. [PMID: 38820078 DOI: 10.1056/nejmoa2400858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
BACKGROUND Patients with newly diagnosed chronic myeloid leukemia (CML) need long-term therapy with high efficacy and safety. Asciminib, a BCR::ABL1 inhibitor specifically targeting the ABL myristoyl pocket, may offer better efficacy and safety and fewer side effects than currently available frontline ATP-competitive tyrosine kinase inhibitors (TKIs). METHODS In a phase 3 trial, patients with newly diagnosed CML were randomly assigned in a 1:1 ratio to receive either asciminib (80 mg once daily) or an investigator-selected TKI, with randomization stratified by European Treatment and Outcome Study long-term survival score category (low, intermediate, or high risk) and by TKI selected by investigators before randomization (including imatinib and second-generation TKIs). The primary end points were major molecular response (defined as BCR::ABL1 transcript levels ≤0.1% on the International Scale [IS]) at week 48, for comparisons between asciminib and investigator-selected TKIs and between asciminib and investigator-selected TKIs in the prerandomization-selected imatinib stratum. RESULTS A total of 201 patients were assigned to receive asciminib and 204 to receive investigator-selected TKIs. The median follow-up was 16.3 months in the asciminib group and 15.7 months in the investigator-selected TKI group. A major molecular response at week 48 occurred in 67.7% of patients in the asciminib group, as compared with 49.0% in the investigator-selected TKI group (difference, 18.9 percentage points; 95% confidence interval [CI], 9.6 to 28.2; adjusted two-sided P<0.001]), and in 69.3% of patients in the asciminib group as compared with 40.2% in the imatinib group within the imatinib stratum (difference, 29.6 percentage points; 95% CI, 16.9 to 42.2; adjusted two-sided P<0.001). The percentage of patients with a major molecular response at week 48 was 66.0% with asciminib and 57.8% with TKIs in the second-generation TKI stratum (difference, 8.2 percentage points; 95% CI, -5.1 to 21.5). Adverse events of grade 3 or higher and events leading to discontinuation of the trial regimen were less frequent with asciminib (38.0% and 4.5%, respectively) than with imatinib (44.4% and 11.1%) and second-generation TKIs (54.9% and 9.8%). CONCLUSIONS In this trial comparing asciminib with investigator-selected TKIs and imatinib, asciminib showed superior efficacy and a favorable safety profile in patients with newly diagnosed chronic-phase CML. Direct comparison between asciminib and second-generation TKIs was not a primary objective. (Funded by Novartis; ASC4FIRST ClinicalTrials.gov number, NCT04971226).
Collapse
Affiliation(s)
- Andreas Hochhaus
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
| | - Jianxiang Wang
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
| | - Dong-Wook Kim
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
| | - Dennis Dong Hwan Kim
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
| | - Jiri Mayer
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
| | - Yeow-Tee Goh
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
| | - Philipp le Coutre
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
| | - Naoto Takahashi
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
| | - Inho Kim
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
| | - Gabriel Etienne
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
| | - David Andorsky
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
| | - Ghayas C Issa
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
| | - Richard A Larson
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
| | - Felice Bombaci
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
| | - Shruti Kapoor
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
| | - Tracey McCulloch
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
| | - Kamel Malek
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
| | - Lillian Yau
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
| | - Sophie Ifrah
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
| | - Matthias Hoch
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
| | - Jorge E Cortes
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
| | - Timothy P Hughes
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
| |
Collapse
|
4
|
Rozental A, Halperin E, Leibovitch C, Barzili M, Michowitz MK, Duek A, Rozovski U, Extermann M, Raanani P, Shacham-Abulafia A. CML in the very elderly: the impact of comorbidities and TKI selection in a real-life multicenter study. Ann Hematol 2024; 103:3585-3594. [PMID: 38862792 PMCID: PMC11358301 DOI: 10.1007/s00277-024-05828-3] [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: 03/01/2024] [Accepted: 05/31/2024] [Indexed: 06/13/2024]
Abstract
Tyrosine kinase inhibitors (TKIs) have greatly improved chronic myeloid leukemia (CML) treatments, with survival rates close to the general population. Yet, for the very elderly, robust data remains limited. This study focused on assessing comorbidities, treatment approaches, responses, and survival for elderly CML patients. Our study was conducted on 123 elderly (≥ 75 years) CML patients across four centers in Israel and Moffitt Cancer Center, USA. The median age at diagnosis was 79.1 years, with 44.7% being octogenarians. Comorbidities were very common; cardiovascular risk factors (60%), cardiovascular diseases (42%), with a median age-adjusted Charlson Comorbidity Index (aaCCI) of 5. Imatinib was the leading first-line therapy (69%), while the use of second-generation TKIs increased post-2010. Most patients achieved a major molecular response (MMR, 66.7%), and half achieved a deep molecular response (DMR, 50.4%). Over half (52.8%) of patients moved to second-line, and nearly a quarter (23.5%) to third-line treatments, primarily due to intolerance. Overall survival (OS) was notably longer in patients with an aaCCI score below 5, and in patients who attained DMR. Contrary to expectations, the Israeli cohort showed a shorter actual life expectancy than projected, suggesting a larger impact of CML on elderly survival. In summary, imatinib remains the main initial treatment, but second-generation TKIs are on the rise among elderly CML patients. Outcomes in elderly CML patients depend on comorbidities, TKI type, response, and age, underscoring the need for personalized therapy and additional research on TKI effectiveness and safety.
Collapse
MESH Headings
- Humans
- Aged
- Protein Kinase Inhibitors/therapeutic use
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/mortality
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/epidemiology
- Male
- Aged, 80 and over
- Female
- Comorbidity
- Israel/epidemiology
- Imatinib Mesylate/therapeutic use
- Survival Rate
- Retrospective Studies
- Treatment Outcome
Collapse
Affiliation(s)
- Alon Rozental
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Campus, Petah-Tikva, Israel
- Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
- Senior Adult Oncology Program, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Erez Halperin
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Campus, Petah-Tikva, Israel
- Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Chiya Leibovitch
- Internal Medicine B, Ashdod Hospital, Samson Assuta, Ashdod, Israel
| | - Meirav Barzili
- Hematology and Hemato-Oncology Division, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Maya Koren- Michowitz
- Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
- Shamir Medical Center, Department of Hematology, Zerifin, Israel
| | - Adrian Duek
- Hematology Department, Assuta Medical Center, Ashdod, Israel
| | - Uri Rozovski
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Campus, Petah-Tikva, Israel
- Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Martine Extermann
- Senior Adult Oncology Program, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Pia Raanani
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Campus, Petah-Tikva, Israel
- Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Adi Shacham-Abulafia
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Campus, Petah-Tikva, Israel.
- Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
| |
Collapse
|
5
|
Tan S, Baggio D, Porch K, Nerlekar N, Shortt J, Ko B. An association between Dasatinib, elevated left atrial pressure and pleural effusion. Int J Cardiol 2024; 410:132216. [PMID: 38821121 DOI: 10.1016/j.ijcard.2024.132216] [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] [Received: 12/26/2023] [Revised: 04/18/2024] [Accepted: 05/27/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Tyrosine kinase inhibitors (TKI), such as Dasatinib, are effective in the treatment of chronic myeloid leukemia (CML) but associated with development of pleural effusions (PE). The relationship between haemodynamic parameters identified on transthoracic echocardiogram (TTE) such as elevated estimated left atrial pressure (LAP), and PE development is unknown. This study aims to describe associations between Dasatinib, elevated LAP and PE. METHODS This was a retrospective study of 71 CML patients who underwent TTE during treatment with various TKIs. Descriptive analysis was performed to identify associations between TKI use, PE and elevated LAP on TTE. Multivariate logistic regression was performed to identify predictors of elevated LAP. RESULTS There were 36 patients treated with Dasatinib, 15 Nilotinib, and 20 Imatinib. Those treated with Dasatinib had higher rates of elevated LAP (44% vs 7% Nilotinib vs 10% Imatinib, p < 0.01) and PE (39% vs 7% vs 0%, p < 0.01). In the 15 patients who developed PE, 14 (93%) patients were treated with Dasatinib. Patients with PE had higher rates of elevated LAP (67% vs 16%, p < 0.01). Nineteen (26.8%) patients in the entire cohort had elevated LAP. After multivariate adjustment, Dasatinib (OR 33.50, 95% CI = 4.99-224.73, p < 0.01) and age (OR 1.12, 95% CI = 1.04-1.20, p < 0.01) were associated with elevated LAP. CONCLUSIONS Among patients with CML, there was an association between Dasatinib use, PE and elevated LAP on TTE. These findings are hypothesis generating and further studies are required to evaluate the utility of elevated LAP on TTE as a novel marker for prediction and surveillance of PE.
Collapse
Affiliation(s)
- Sean Tan
- Victorian Heart Hospital, Monash Health, Melbourne, Victoria, Australia; Victorian Heart Institute, Monash University, Melbourne, Victoria, Australia
| | - Diva Baggio
- Monash Haematology, Monash Health, Melbourne, Victoria, Australia
| | - Kylie Porch
- Monash Haematology, Monash Health, Melbourne, Victoria, Australia
| | - Nitesh Nerlekar
- Victorian Heart Hospital, Monash Health, Melbourne, Victoria, Australia; Victorian Heart Institute, Monash University, Melbourne, Victoria, Australia
| | - Jake Shortt
- Monash Haematology, Monash Health, Melbourne, Victoria, Australia; School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Brian Ko
- Victorian Heart Hospital, Monash Health, Melbourne, Victoria, Australia; Monash Cardiovascular Research Centre, Monash University, Melbourne, Victoria, Australia.
| |
Collapse
|
6
|
Belohlavkova P, Zackova D, Klamova H, Faber E, Karas M, Stejskal L, Cmunt E, Cerna O, Jeziskova I, Machova Polakova K, Zak P, Jurkova T, Chrapava M, Mayer J. Clinical efficacy and safety of first-line nilotinib or imatinib therapy in patients with chronic myeloid leukemia-Nationwide real life data. Cancer Med 2024; 13:e70158. [PMID: 39267544 PMCID: PMC11393449 DOI: 10.1002/cam4.70158] [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: 02/16/2024] [Revised: 07/31/2024] [Accepted: 08/18/2024] [Indexed: 09/17/2024] Open
Abstract
BACKGROUND To evaluate the outcomes of first-line imatinib versus nilotinib treatment for chronic myeloid leukemia in the chronic phase (CML-CP) in real-world clinical practice. METHODS A propensity score analysis was performed to eliminate imbalances between the treatment groups. In the analysis, 163 patients in the nilotinib group and 163 patients in the matched imatinib group were retrospectively evaluated. RESULTS Nilotinib-treated patients achieved complete cytogenetic response (CCyR) and major molecular response more rapidly than imatinib-treated patients. However, there was no significant difference in 5-year overall survival (OS) or progression-free survival (PFS) between the two groups (OS: 94.3% vs. 90.5%, p = 0.602; PFS: 92.9% vs. 88.0%, p = 0.614). Nilotinib-treated patients had a higher failure-free survival (FFS) and event-free survival (EFS) than imatinib-treated patients (FFS: 71.7% vs. 54.3%, p = 0.040; EFS: 71.7% vs. 53.5%, p = 0.025). CONCLUSIONS This retrospective analysis from clinical practice did not confirm any benefit of frontline nilotinib treatment for OS and PFS; however, it did demonstrate higher FFS and EFS in the nilotinib cohort.
Collapse
Affiliation(s)
- Petra Belohlavkova
- 4th Department of Internal Medicine and Haematology, University Hospital Hradec Kralove and Charles University, Prague, Czech Republic
| | - Daniela Zackova
- Department of Internal Medicine-Haematology and Oncology, University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Hana Klamova
- Institute of Haematology and Blood Transfusion, Prague, Czech Republic
| | - Edgar Faber
- Department of Haemato-oncology, University Hospital Olomouc and Palacky University, Olomouc, Czech Republic
| | - Michal Karas
- Department of Haemato-oncology, University Hospital Plzen and Charles University, Plzen, Czech Republic
| | - Lukas Stejskal
- Department of Haemato-oncology, University Hospital Ostrava and Ostrava University, Ostrava, Czech Republic
| | - Eduard Cmunt
- 1st Department of Internal Medicine-Haematology, General University Hospital and Charles University, Prague, Czech Republic
| | - Olga Cerna
- Department of Internal Medicine-Haematology, University Hospital Kralovske Vinohrady and Charles University, Prague, Czech Republic
| | - Ivana Jeziskova
- Department of Internal Medicine-Haematology and Oncology, University Hospital Brno and Masaryk University, Brno, Czech Republic
| | | | - Pavel Zak
- 4th Department of Internal Medicine and Haematology, University Hospital Hradec Kralove and Charles University, Prague, Czech Republic
| | - Tereza Jurkova
- Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - Marika Chrapava
- Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - Jiri Mayer
- Department of Internal Medicine-Haematology and Oncology, University Hospital Brno and Masaryk University, Brno, Czech Republic
- Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic
| |
Collapse
|
7
|
Stempel JM, Shallis RM, Wong R, Podoltsev NA. Challenges in management of older patients with chronic myeloid leukemia. Leuk Lymphoma 2024; 65:1219-1232. [PMID: 38652861 DOI: 10.1080/10428194.2024.2342559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/22/2024] [Accepted: 04/07/2024] [Indexed: 04/25/2024]
Abstract
Tyrosine kinase inhibitors (TKIs) have significantly improved the survival of patients with chronic myeloid leukemia (CML), however, older patients are often underrepresented in pivotal trials. Approximately 20% of older adults never start treatment and face significant barriers to accomplish favorable outcomes. The treatment goal is to improve survival, prevent progression, and preserve quality of life. This is achieved through optimizing TKI doses and employing discontinuation strategies to attain treatment-free remission (TFR), a goal increasingly pursued by older patients. Imatinib may be favored as the front-line option for older individuals due to its side effect profile and cost. Bosutinib's favorable cardiovascular tolerability makes it a suitable second-line agent, but lower-dose dasatinib may likewise be an attractive option. The prevalence of comorbidities can preclude the use of second generation TKIs in some older patients. Optimal care for older patients with CML centers on personalized treatment, close monitoring, and proactive support.
Collapse
Affiliation(s)
- Jessica M Stempel
- Section of Hematology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT, USA
| | - Rory M Shallis
- Section of Hematology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT, USA
| | - Rong Wong
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Nikolai A Podoltsev
- Section of Hematology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT, USA
| |
Collapse
|
8
|
Liu Z, Wu D, Ke C, Nian Q, Chen Y, Huang Y, Chen M. Real-World Disproportionality Analysis of the Food and Drug Administration Adverse Event Reporting System Database for Asciminib. Oncology 2024:1-13. [PMID: 39102794 DOI: 10.1159/000540542] [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: 04/04/2024] [Accepted: 07/19/2024] [Indexed: 08/07/2024]
Abstract
INTRODUCTION Asciminib is primarily utilized for treating Philadelphia chromosome-positive chronic myeloid leukemia in its chronic phase among patients harboring the T315I mutation or those who have been previously treated with at least two tyrosine kinase inhibitors. The safety profile of asciminib across a broad patient population over an extended timeframe remains unverified. This study uses a real-world pharmacovigilance database to evaluate the adverse events (AEs) linked with asciminib, providing valuable insights for clinical drug safety. METHODS Data from the FDA Adverse Event Reporting System (FAERS) database, spanning from October 2021 to December 2023, served as the basis for this analysis. The extent of disproportional events was assessed using sophisticated metrics such as the reporting odds ratio, proportional reporting ratio, information component, and empirical Bayesian geometric mean. RESULTS Within the specified period, the FAERS database documented 3,913,574 AE reports, with asciminib being associated with 966 incidents. Reactions to asciminib spanned 27 system organ categories. Utilizing four distinct analytical algorithms, 663 significant preferred terms exhibiting disproportional frequencies were identified. Notably, this investigation uncovered 26 significant AEs linked to off-label asciminib use, encompassing conditions such as gynecomastia, nephrotic syndrome, orchitis, pyelonephritis, hepatotoxicity, and pancreatitis. The median onset time for asciminib-related AEs was 52.5 days, ranging from 17 to 122.75 days. CONCLUSION The study sheds light on additional potential AEs associated with asciminib use, warranting further research to confirm these findings.
Collapse
Affiliation(s)
- Zhijing Liu
- Department of Pharmacy, Affiliated Hospital of Putian University, Pu Tian, China
| | - Dongzhi Wu
- Department of Orthopedics Institute, Fuzhou Second General Hospital, Fuzhou, China
| | - Chengjie Ke
- Department of Pharmacy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Pharmacy, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Qichun Nian
- Department of Pharmacy, Pingtan Comprehensive Experimental Area Hospital, Pingtan Comprehensive Experimental Area, Fuzhou, China
| | - Yan Chen
- Department of Pharmacy, Pingtan Comprehensive Experimental Area Hospital, Pingtan Comprehensive Experimental Area, Fuzhou, China
| | - Yaping Huang
- Department of Pharmacy, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Fuzhou, China
| | - Maohua Chen
- Department of Pharmacy, Pingtan Comprehensive Experimental Area Hospital, Pingtan Comprehensive Experimental Area, Fuzhou, China
| |
Collapse
|
9
|
Jabbour E, Kantarjian H. Chronic myeloid leukemia: 2025 update on diagnosis, therapy, and monitoring. Am J Hematol 2024. [PMID: 39093014 DOI: 10.1002/ajh.27443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/09/2024] [Accepted: 07/16/2024] [Indexed: 08/04/2024]
Abstract
DISEASE OVERVIEW Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm with an annual incidence of two cases/100 000. It accounts for approximately 15% of newly diagnosed cases of leukemia in adults. DIAGNOSIS CML is characterized by a balanced genetic translocation, t(9;22) (q34;q11.2), involving a fusion of the Abelson murine leukemia (ABL1) gene from chromosome 9q34 with the breakpoint cluster region (BCR) gene on chromosome 22q11.2. This rearrangement is known as the Philadelphia chromosome. The molecular consequence of this translocation is the generation of a BCR::ABL1 fusion oncogene, which in turn translates into a BCR::ABL1 oncoprotein. FRONTLINE THERAPY Four tyrosine kinase inhibitors (TKIs), imatinib, dasatinib, bosutinib, and nilotinib, are approved by the United States Food and Drug Administration (FDA) for first-line treatment of newly diagnosed CML in the chronic phase (CML-CP). Clinical trials with second and third-generation TKIs in frontline CML-CP therapy reported significantly deeper and faster responses but had no impact on survival prolongation, likely because of their potent efficacy and the availability of effective TKIs salvage therapies for patients who have a cytogenetic relapse with frontline TKI therapy. All four TKIs are equivalent if the aim of therapy is to improve survival. In younger patients with high-risk disease and in whom the aim of therapy is to induce a treatment-free remission status, second-generation TKIs may be favored. SALVAGE THERAPY For CML post-failure on frontline therapy, second-line options include second and third-generation TKIs. Although potent and selective, these TKIs exhibit unique pharmacological profiles and response patterns relative to different patient and disease characteristics, such as patients' comorbidities and financial status, disease stage, and BCR::ABL1 mutational status. Patients who develop the T315I "gatekeeper" mutation display resistance to all currently available TKIs except ponatinib, asciminib, and olverembatinib. Allogeneic stem cell transplantation remains an important therapeutic option for patients with CML-CP and failure (due to resistance) of at least two TKIs and for all patients in advanced-phase disease. Older patients who have a cytogenetic relapse post-failure on all TKIs can maintain long-term survival if they continue a daily most effective/least toxic TKI, with or without the addition of non-TKI anti-CML agents (hydroxyurea, omacetaxine, azacitidine, decitabine, cytarabine, and others).
Collapse
Affiliation(s)
- Elias Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hagop Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
10
|
Shin DY, Park S, Jang E, Kong JH, Won YW, Oh S, Choi Y, Kim JA, Lee SW, Mun YC, Kim H, Kim SH, Rok Do Y, Kwak JY, Kim HJ, Zang DY, Lim SN, Lee WS, Kim DW. Early dose reduction of dasatinib does not compromise clinical outcomes in patients with chronic myeloid leukemia: A comparative analysis of two prospective trials. Leuk Res 2024; 143:107542. [PMID: 38924942 DOI: 10.1016/j.leukres.2024.107542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 06/04/2024] [Accepted: 06/15/2024] [Indexed: 06/28/2024]
Abstract
Dasatinib is a potent second-generation tyrosine kinase inhibitor (TKI) used as a first-line treatment option for patients with chronic myeloid leukemia (CML). Currently, dose modification due to adverse events (AEs) is common in patients treated with dasatinib. This study compared the outcomes of two sequential prospective trials that enrolled patients with newly diagnosed chronic phase of CML (CP-CML) and initiated dasatinib at a starting dose of 100 mg daily. In the PCR-DEPTH study, CP-CML patients who started dasatinib 100 mg daily were enrolled and followed up, while in the DAS-CHANGE study, when patients achieved early molecular response with any grade of AEs were enrolled and treated with dasatinib 80 mg once daily. A total of 102 patients (PCR-DEPTH) and 90 patients (DAS-CHANGE) were compared. Although the median value of the relative dose intensity (RDI) of dasatinib was significantly higher in PCR-DEPTH than in DAS-CHANGE (99.6 % vs. 80.1 %, p <0.001), the MMR rate at 12months showed a trend toward superiority in DAS-CHANGE compared to PCR-DEPTH (77.1 % vs 65.2 %, p = 0.084). The frequencies of MR4.0 at 24 and 36 months were higher in DAS-CHANGE than in PCR-DEPTH (44.4 % vs 28.8 %, p = 0.052 and 63.6 % vs 40.3 %, p= 0.013, respectively). RDIs were not different according to the MMR, MR4.0 or MR4.5 in analyses using a pooled population. Our results suggest that early dose reduction of dasatinib does not compromise efficacy in patients achieving EMR at 3 months and could be an interventional strategy for improving long term outcomes.
Collapse
Affiliation(s)
- Dong-Yeop Shin
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sahee Park
- Hematology Department, Eulji Medical Center, Uijeongbu city, Republic of Korea; Leukemia Omics Research Institute, Eulji University, Uijeongbu city, Republic of Korea
| | - Eunjung Jang
- Hematology Department, Eulji Medical Center, Uijeongbu city, Republic of Korea; Leukemia Omics Research Institute, Eulji University, Uijeongbu city, Republic of Korea
| | - Jee Hyun Kong
- Department of Hematology-Oncology, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
| | - Young-Woong Won
- Division of Hematology and Oncology, Department of Internal Medicine, Hanyang University College of Medicine, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Sukjoong Oh
- Division of Hematology and Oncology, Department of Internal Medicine, Hanyang University College of Medicine, Hanyang University Seoul Hospital, Seoul, Republic of Korea
| | - Yunsuk Choi
- Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong-A Kim
- Department of Hematology, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Republic of Korea
| | - Se Won Lee
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Yeung-Chul Mun
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Hawk Kim
- Division of Hematology, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Sung-Hyun Kim
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Young Rok Do
- Division of Hematology-Oncology, School of Medicine, Keimyung University, Daegu, Republic of Korea
| | - Jae-Yong Kwak
- Division of Hematology-Oncology, Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Hyeoung-Joon Kim
- Department of Internal Medicine, Chonnam National University School of Medicine, Gwangju, Republic of Korea
| | - Dae Young Zang
- Department of Internal Medicine, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Sung-Nam Lim
- Department of Hematology and Oncology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Won Sik Lee
- Department of Internal Medicine, Inje University College of Medicine, Inje University Busan Paik Hospital, Busan, Republic of Korea.
| | - Dong-Wook Kim
- Hematology Department, Eulji Medical Center, Uijeongbu city, Republic of Korea; Leukemia Omics Research Institute, Eulji University, Uijeongbu city, Republic of Korea.
| |
Collapse
|
11
|
Laganà A, Scalzulli E, Bisegna ML, Carmosino I, Ielo C, Costa A, Torrieri L, Totaro M, Martelli M, Breccia M. Treatment free remission (TFR) after second-generation tyrosine kinase inhibitors (2G-TKIs) treatment in chronic myeloid leukemia (CML): from feasibility to safety. Expert Opin Drug Saf 2024; 23:969-979. [PMID: 38873693 DOI: 10.1080/14740338.2024.2368822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 06/12/2024] [Indexed: 06/15/2024]
Abstract
INTRODUCTION Chronic myeloid leukemia (CML) prevalence is currently increasing due to the great efficacy of tyrosine kinase inhibitor (TKI) therapy. Discontinuation of treatment in the long-term, owing to avoid off-target side effects or treatment-free remission (TFR), has become an additional treatment goal in CML patients who achieved a deep molecular response (DMR). Second-generation TKIs (2 G-TKIs) have a significantly higher rate of DMR than imatinib. Hence, especially in young patients with a strategy of TFR, 2 G-TKIs are becoming the most frequently used TKIs and may increase TFR attempts in the future. AREAS COVERED In this review, the main findings extrapolated from clinical trials and real-life evidence regarding 2 G-TKIs discontinuation were discussed, through broad research on Medline, Embase, and archives from EHA and ASH congresses. EXPERT OPINION Overall, TFR rate after 2 G-TKIs is ranging from 40% to 60% for selected patients with sustained DMR and it can be considered a safe procedure, that have become, nowadays, a daily practice. However, many crucial aspects regarding treatment choices, timings, as well as predictive factors, patient communication, and optimal strategies need to be better clarified to improve successful TFR rate.
Collapse
Affiliation(s)
- Alessandro Laganà
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Emilia Scalzulli
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Maria Laura Bisegna
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Ida Carmosino
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Claudia Ielo
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Alessandro Costa
- Hematology Unit, Department of Medical Sciences and Public Health, Businco Hospital, University of Cagliari, Cagliari, Italy
| | - Lorenzo Torrieri
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Matteo Totaro
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Maurizio Martelli
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Massimo Breccia
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
12
|
George B, Chan KH, Rios A. Therapeutic options for chronic myeloid leukemia following the failure of second-generation tyrosine kinase inhibitor therapy. Front Oncol 2024; 14:1446517. [PMID: 39139284 PMCID: PMC11320603 DOI: 10.3389/fonc.2024.1446517] [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: 06/10/2024] [Accepted: 07/15/2024] [Indexed: 08/15/2024] Open
Abstract
The management of chronic myeloid leukemia in the chronic phase (CML-CP) has witnessed significant advancements since the identification of a common chromosomal translocation anomaly involving chromosomes 9 and 22, which results in the formation of the Philadelphia chromosome driven by the BCR-ABL1 fusion protein. This discovery paved the way for the development of tyrosine kinase inhibitors (TKIs) that target the adenosine triphosphate (ATP) binding site of ABL1 through the BCR-ABL-1 fusion protein. Following the approval of Imatinib by the Food and Drug Administration (FDA) as the first TKI for CML treatment in 2001, the median overall survival (OS) for chronic phase CML (CML-CP) has significantly improved, approaching that of the general population. However, achieving this milestone crucially depends on reaching certain treatment response milestones. Since the introduction of imatinib, five additional TKIs have been approved for CML-CP treatment. Despite the availability of these treatments, many patients may experience treatment failure and require multiple lines of therapy due to factors such as the emergence of resistance, such as mutations in the ATP binding site of ABL, or intolerance to therapy. This review will primarily focus on exploring treatment options for patients who fail second-generation TKI therapy due to true resistance.
Collapse
Affiliation(s)
- Binsah George
- Division of Hematology/Oncology, Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | | | | |
Collapse
|
13
|
Moulik NR, Harriss-Buchan A, Saglio G, Evans N, Suttorp M. Cases of Patients Treated in Countries With Limited Resources and Discussed by Experts of the International CML Foundation (iCMLf)-Case No. 1: A Boy Presenting With Priapism and Loss of Vision. Case Rep Oncol Med 2024; 2024:5534445. [PMID: 39104564 PMCID: PMC11300043 DOI: 10.1155/2024/5534445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/03/2024] [Accepted: 04/10/2024] [Indexed: 08/07/2024] Open
Abstract
Pediatric chronic myeloid leukemia (pCML) is a rare malignancy accounting for only 2%-3% of all childhood leukemias. Due to this rarity, familiarity with pCML is limited among most pediatric practitioners, including even pediatric hemato-oncologists. In low- and middle-income countries (LMICs), limited financial resources and limited data specific to pCML represent obstacles that healthcare providers must face in diagnosing and treating this rare condition in children. The International CML Foundation (iCMLf) is improving outcomes for people with CML in these countries where resources, diagnostics, and access to medicines may be limited (https://www.cml-foundation.org/lmic-programs.html). Virtual meetings with the purpose of teaching participating pediatricians from LMICs of defined geographical regions were organised by the iCMLf in 2023. At a virtual meeting of the South Asia region, the case of a 14-year-old Indian boy was presented diagnosed with CML in a chronic phase complicated by priapism and loss of vision in his left eye due to hyperleukocytosis. Key aspects of this case are discussed in-depth from the perspective of (i) a pediatric hemato-oncologist practicing in a high-income country, (ii) a pediatric hemato-oncologist practicing in a LMIC, (iii) an adult CML hematologist, and (iv) from the iCMLf in improving the care of children with CML worldwide. Thus by discussing a multifaceted complicated case of pCML in written form as well as pointing to the pediatric module of the iCMLf Knowledge Centre will hopefully contribute to minimize existing knowledge gaps in a rare pediatric malignancy.
Collapse
Affiliation(s)
| | | | - Guiseppe Saglio
- Department of Clinical and Biological SciencesUniversity of Turin, Turin, Italy
| | - Nicola Evans
- International CML Foundation, Bexhill-on-Sea, UK
| | - Meinolf Suttorp
- Pediatric Hematology and OncologyTechnical University of Dresden, Dresden, Germany
| |
Collapse
|
14
|
Yuan J, Guo L, Ma J, Zhang H, Xiao M, Li N, Gong H, Yan M. HMGB1 as an extracellular pro-inflammatory cytokine: Implications for drug-induced organic damage. Cell Biol Toxicol 2024; 40:55. [PMID: 39008169 PMCID: PMC11249443 DOI: 10.1007/s10565-024-09893-2] [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: 02/14/2024] [Accepted: 06/18/2024] [Indexed: 07/16/2024]
Abstract
Drug-induced organic damage encompasses various intricate mechanisms, wherein HMGB1, a non-histone chromosome-binding protein, assumes a significant role as a pivotal hub gene. The regulatory functions of HMGB1 within the nucleus and extracellular milieu are interlinked. HMGB1 exerts a crucial regulatory influence on key biological processes including cell survival, inflammatory regulation, and immune response. HMGB1 can be released extracellularly from the cell during these processes, where it functions as a pro-inflammation cytokine. HMGB1 interacts with multiple cell membrane receptors, primarily Toll-like receptors (TLRs) and receptor for advanced glycation end products (RAGE), to stimulate immune cells and trigger inflammatory response. The excessive or uncontrolled HMGB1 release leads to heightened inflammatory responses and cellular demise, instigating inflammatory damage or exacerbating inflammation and cellular demise in different diseases. Therefore, a thorough review on the significance of HMGB1 in drug-induced organic damage is highly important for the advancement of pharmaceuticals, ensuring their effectiveness and safety in treating inflammation as well as immune-related diseases. In this review, we initially outline the characteristics and functions of HMGB1, emphasizing their relevance in disease pathology. Then, we comprehensively summarize the prospect of HMGB1 as a promising therapeutic target for treating drug-induced toxicity. Lastly, we discuss major challenges and propose potential avenues for advancing the development of HMGB1-based therapeutics.
Collapse
Affiliation(s)
- JianYe Yuan
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, Changsha, China
- Institute of Clinical Pharmacy, Central South University, Changsha, China
- International Research Center for Precision Medicine, Transformative Technology and Software Services, Hunan, China
- Xiangya School of Medicine, Central South University, Changsha, China
- Department of Pathology, The Eight Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Lin Guo
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, Changsha, China
- Institute of Clinical Pharmacy, Central South University, Changsha, China
- International Research Center for Precision Medicine, Transformative Technology and Software Services, Hunan, China
| | - JiaTing Ma
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, Changsha, China
- Institute of Clinical Pharmacy, Central South University, Changsha, China
- International Research Center for Precision Medicine, Transformative Technology and Software Services, Hunan, China
| | - HeJian Zhang
- Xiangya School of Medicine, Central South University, Changsha, China
| | - MingXuan Xiao
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, Changsha, China
- Institute of Clinical Pharmacy, Central South University, Changsha, China
- International Research Center for Precision Medicine, Transformative Technology and Software Services, Hunan, China
| | - Ning Li
- Xiangya School of Pharmaceutical Sciences, Central South University, Changsha, China
| | - Hui Gong
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, Changsha, China
- Institute of Clinical Pharmacy, Central South University, Changsha, China
- International Research Center for Precision Medicine, Transformative Technology and Software Services, Hunan, China
| | - Miao Yan
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, Changsha, China.
- Institute of Clinical Pharmacy, Central South University, Changsha, China.
- International Research Center for Precision Medicine, Transformative Technology and Software Services, Hunan, China.
| |
Collapse
|
15
|
Chaudhary P, Chaudhary S, Patel F, Patel S, Vaishnani T, Trivedi N, Patel D, Sonagara T, Hirapara A, Vyas K, Patel L, Kumar R, Chakraborty N, Sharma D, Suthar J, Kamdar P, Jajodia E, Ahmad F, Arora N. Validation of a novel NGS based BCR::ABL1 kinase domain mutation detection assay in Indian cohort. Sci Rep 2024; 14:15745. [PMID: 38977756 PMCID: PMC11231265 DOI: 10.1038/s41598-024-66310-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 07/01/2024] [Indexed: 07/10/2024] Open
Abstract
The efficacy and treatment outcome of a CML patient are heavily dependent on BCR::ABL1 kinase domain (KD) mutation status. Next-generation sequencing technology is a bright alternative to the previously used sanger sequencing method due to its global presence in diagnostic setups, massive parallel sequencing ability, and far better sensitivity. In the present study, we have demonstrated a new protocol for kinase domain mutation analysis using the next-generation sequencing (NGS) method using the ion torrent sequencing platform. This protocol uses RNA as the starting material, followed by nested PCR to amplify the fusion transcript, which is subsequently used as a template for NGS. Initial validation and comparison of this assay with the sanger sequencing (SS) method yielded 95.23% agreement. CML samples (n = 121) with a failure to TKI response were subjected to this newly developed NGS-based assay to detect KD mutations, from which samples were found to have mutations with a sensitivity ranging from 2.32 to 93.41%. A total of 34.71% of samples (n = 42) were found to be positive for one or more KD mutations, whereas 65.29% of samples (n = 81) were found to be negative. Nine samples out of 42 positive samples, i.e., 21.42%, were found to have compound mutations. This is one of the first studies from India, which includes more than 160 samples and is analyzed by the NGS approach for KD mutation analysis.
Collapse
Affiliation(s)
- Pooja Chaudhary
- Molecular Department, Unipath Specialty Laboratory Ltd, Ahmedabad, Gujarat, India.
| | - Spandan Chaudhary
- Molecular Department, Unipath Specialty Laboratory Ltd, Ahmedabad, Gujarat, India.
| | - Falguni Patel
- Department of Biotechnology and Microbiology, Shri M.M. Patel Institute of Science and Research, Kadi Sarva Vishwavidyalaya, Gandhinagar, Gujarat, India
| | - Shiv Patel
- Molecular Department, Unipath Specialty Laboratory Ltd, Ahmedabad, Gujarat, India
| | - Toral Vaishnani
- Molecular Department, Unipath Specialty Laboratory Ltd, Ahmedabad, Gujarat, India
| | - Nikha Trivedi
- Molecular Department, Unipath Specialty Laboratory Ltd, Ahmedabad, Gujarat, India
| | - Dhiren Patel
- Molecular Department, Unipath Specialty Laboratory Ltd, Ahmedabad, Gujarat, India
| | - Tushar Sonagara
- Molecular Department, Unipath Specialty Laboratory Ltd, Ahmedabad, Gujarat, India
| | - Ashish Hirapara
- Molecular Department, Unipath Specialty Laboratory Ltd, Ahmedabad, Gujarat, India
| | - Kavisha Vyas
- Molecular Department, Unipath Specialty Laboratory Ltd, Ahmedabad, Gujarat, India
| | - Lokesh Patel
- Molecular Department, Unipath Specialty Laboratory Ltd, Ahmedabad, Gujarat, India
| | - Raja Kumar
- Molecular Department, Unipath Specialty Laboratory Ltd, Ahmedabad, Gujarat, India
| | - Nikkan Chakraborty
- Molecular Department, Unipath Specialty Laboratory Ltd, Ahmedabad, Gujarat, India
| | - Divya Sharma
- Molecular Department, Unipath Specialty Laboratory Ltd, Ahmedabad, Gujarat, India
| | - Jigar Suthar
- Molecular Department, Unipath Specialty Laboratory Ltd, Ahmedabad, Gujarat, India
| | - Payal Kamdar
- Molecular Department, Unipath Specialty Laboratory Ltd, Ahmedabad, Gujarat, India
| | - Ekta Jajodia
- Molecular Department, Unipath Specialty Laboratory Ltd, Ahmedabad, Gujarat, India
| | - Firoz Ahmad
- Molecular Department, Unipath Specialty Laboratory Ltd, Ahmedabad, Gujarat, India
| | - Neeraj Arora
- Molecular Department, Unipath Specialty Laboratory Ltd, Ahmedabad, Gujarat, India
| |
Collapse
|
16
|
Iriyama N, Iwanaga E, Kimura Y, Watanabe N, Ishikawa M, Nakayama H, Sato E, Tabayashi T, Mitsumori T, Takaku T, Nakazato T, Tokuhira M, Fujita H, Ando M, Hatta Y, Kawaguchi T. Changes in chronic myeloid leukemia treatment modalities and outcomes after introduction of second-generation tyrosine kinase inhibitors as first-line therapy: a multi-institutional retrospective study by the CML Cooperative Study Group. Int J Hematol 2024; 120:60-70. [PMID: 38587692 DOI: 10.1007/s12185-024-03758-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 03/11/2024] [Accepted: 03/14/2024] [Indexed: 04/09/2024]
Abstract
This study investigated changes in treatment modalities and outcomes of chronic myeloid leukemia in the chronic phase (CP-CML) after the approval of second-generation tyrosine kinase inhibitors (2G-TKIs) for first-line therapy. Patients were grouped into those who underwent TKI therapy up to December 2010 (imatinib era group, n = 185) and after January 2011 (2G-TKI era group, n = 425). All patients in the imatinib era group were initially treated with imatinib, whereas patients in the 2G-TKI era group were mostly treated with dasatinib (55%) or nilotinib (36%). However, outcomes including progression-free survival, overall survival, and CML-related death (CRD) did not differ significantly between groups. When stratified by risk scores, the prognostic performance of the ELTS score was superior to that of the Sokal score. Even though both scoring systems predicted CRD in the imatinib era, only the ELTS score predicted CRD in the 2G-TKI era. Notably, the outcome of patients classified as high-risk by ELTS score was more favorable in the 2G-TKI era group than in the imatinib era group. Thus, expanding treatment options may have improved patient outcomes in CP-CML, particularly in patients classified as high-risk by ELTS score.
Collapse
Affiliation(s)
- Noriyoshi Iriyama
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Eisaku Iwanaga
- Department of Hematology, Rheumatology and Infectious Diseases, Kumamoto University Hospital, Kumamoto, Japan
| | - Yuta Kimura
- Department of Hematology, Japan Community Health Care Organization, Saitama Medical Center, Saitama, Japan
| | - Naoki Watanabe
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
| | - Maho Ishikawa
- Department of Hemato-Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Hitomi Nakayama
- Department of Hematology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Eriko Sato
- Department of Hematology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Takayuki Tabayashi
- Department of Hematology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Toru Mitsumori
- Department of Hematology, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Tomoiku Takaku
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
| | - Tomonori Nakazato
- Department of Hematology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Michihide Tokuhira
- Department of Hematology, Japan Community Health Care Organization, Saitama Medical Center, Saitama, Japan
| | - Hiroyuki Fujita
- Department of Hematology, Saiseikai Yokohama Nanbu Hospital, Yokohama, Japan
| | - Miki Ando
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
| | - Yoshihiro Hatta
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Tatsuya Kawaguchi
- Department of Hematology, Rheumatology and Infectious Diseases, Kumamoto University Hospital, Kumamoto, Japan
- Department of Medical Technology, Kumamoto Health Science University, Kumamoto, Japan
| |
Collapse
|
17
|
Abdallah AM, Hafez H, Madney Y, Ahmed S, Yassin D, Salem S, Yousry R, Abdel-Azim H, Lehmann L, Elhaddad A. Predictive value of early molecular response to tyrosine kinase inhibitors in pediatric patients with chronic myeloid leukemia. Leuk Lymphoma 2024; 65:1024-1027. [PMID: 38513148 DOI: 10.1080/10428194.2024.2331625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/12/2024] [Indexed: 03/23/2024]
MESH Headings
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Protein Kinase Inhibitors/therapeutic use
- Protein Kinase Inhibitors/adverse effects
- Child
- Adolescent
- Treatment Outcome
- Female
- Prognosis
- Male
- Child, Preschool
- Fusion Proteins, bcr-abl/genetics
- Fusion Proteins, bcr-abl/antagonists & inhibitors
- Tyrosine Kinase Inhibitors
Collapse
Affiliation(s)
- Aya M Abdallah
- Department of Pediatric Oncology, Children's Cancer Hospital Egypt (CCHE 57357), Cairo, Egypt
| | - Hanafy Hafez
- Department of Pediatric Oncology, Children's Cancer Hospital Egypt (CCHE 57357), Cairo, Egypt
- Department of Pediatric Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Youssef Madney
- Department of Pediatric Oncology, Children's Cancer Hospital Egypt (CCHE 57357), Cairo, Egypt
- Department of Pediatric Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Sonia Ahmed
- Department of Pediatric Oncology, Children's Cancer Hospital Egypt (CCHE 57357), Cairo, Egypt
- Department of Pediatric Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Dina Yassin
- Department of Clinical Pathology, Children's Cancer Hospital Egypt (CCHE 57357), Cairo, Egypt
- Department of Clinical Pathology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Sherine Salem
- Department of Clinical Pathology, Children's Cancer Hospital Egypt (CCHE 57357), Cairo, Egypt
- Department of Clinical Pathology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Rodina Yousry
- Department of Research, Children's Cancer Hospital (CCHE 57357), Cairo, Egypt
| | - Hisham Abdel-Azim
- Cancer Center, Children Hospital and Medical Center, Loma Linda University, Loma Linda, CA, USA
| | - Leslie Lehmann
- Pediatric Stem Cell Transplantation Unit, Dana Farber Cancer Institute, Boston, MA, USA
| | - Alaa Elhaddad
- Department of Pediatric Oncology, Children's Cancer Hospital Egypt (CCHE 57357), Cairo, Egypt
- Department of Pediatric Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| |
Collapse
|
18
|
Sun M, Li S, Liu Z, Ma S, Liu X, Meng Q, Zheng Y, Chen C. Efficacy and safety of flumatinib in the treatment of newly diagnosed chronic myeloid leukemia in the chronic phase: A real-world single-center retrospective study, with a focus on premature drug discontinuation. Leuk Res 2024; 142:107507. [PMID: 38692191 DOI: 10.1016/j.leukres.2024.107507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/22/2024] [Accepted: 04/25/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE To assess the real-world efficacy and safety of flumatinib as first-line and post-line treatments for chronic myeloid leukemia in the chronic phase (CML-CP). RESULTS Among 141 patients receiving flumatinib as first-line and post-line treatment, the 12-month major molecular response (MMR) rates were 69.4% and 67.6%, respectively. The median time to response was 6 and 10.5 months, respectively. In post-line treatment, the early molecular response (EMR) of flumatinib as second-line is significantly superior to that of third-line treatment (3-month EMR rate: 79.2% vs. 39.3%, P<0.001; 3-month MMR rate: 45.8% vs. 21.4%, P=0.033). Contrastively, patients who switched to flumatinib due to intolerance had significantly higher MMR rates at 3, 6, and 12 months compared to patients who switched due to inadequate response (60.6% vs. 24.2%, P=0.003; 66.7% vs. 36.0%, P=0.027; 84.2% vs. 50.0%, P=0.038). Premature drug discontinuation was observed in 28.4% of the patients. Grades 3-4 hematologic adverse events (AEs) were identified as independent risk factors for premature drug discontinuation. Patients who discontinued treatment and those who previously received only imatinib therapy had a poorer molecular response and failure-free survival. CONCLUSIONS Flumatinib demonstrates favorable efficacy and safety. Treatment discontinuation can result in a poorer molecular response and long-term prognosis.
Collapse
Affiliation(s)
- Mingshan Sun
- Qilu Hospital of Shandong University, Department of Hematology, Jinan, Shandong, China
| | - Shijie Li
- Qilu Hospital of Shandong University, Department of Hematology, Jinan, Shandong, China
| | - Zhenyi Liu
- Qilu Hospital of Shandong University, Department of Hematology, Jinan, Shandong, China
| | - Sai Ma
- Qilu Hospital of Shandong University, Department of Hematology, Jinan, Shandong, China
| | - Xiaohan Liu
- Qilu Hospital of Shandong University, Department of Hematology, Jinan, Shandong, China
| | - Qing Meng
- Qilu Hospital of Shandong University, Department of Hematology, Jinan, Shandong, China
| | - Yueyue Zheng
- Qilu Hospital of Shandong University, Department of Hematology, Jinan, Shandong, China
| | - Chunyan Chen
- Qilu Hospital of Shandong University, Department of Hematology, Jinan, Shandong, China.
| |
Collapse
|
19
|
Saydan B, Özmen D, Eşkazan AE. Is 50 mg/day the new standard dose of dasatinib in newly diagnosed patients with chronic myeloid leukemia in chronic phase? Expert Rev Hematol 2024; 17:275-277. [PMID: 38888284 DOI: 10.1080/17474086.2024.2370556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 06/17/2024] [Indexed: 06/20/2024]
Affiliation(s)
- Betül Saydan
- Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Deniz Özmen
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Ahmet Emre Eşkazan
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| |
Collapse
|
20
|
Andorsky D, Kota V, Sweet K. Exploring treatment decision-making in chronic myeloid leukemia in chronic phase. Front Oncol 2024; 14:1369246. [PMID: 39011484 PMCID: PMC11246988 DOI: 10.3389/fonc.2024.1369246] [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: 01/11/2024] [Accepted: 04/15/2024] [Indexed: 07/17/2024] Open
Abstract
The introduction of tyrosine kinase inhibitors (TKIs) has transformed the treatment of chronic myeloid leukemia (CML). Each approved TKI has its own risk-benefit profile, and patients have choices across lines of therapy. Identifying the initial and subsequent treatment that will lead to the best possible outcome for individual patients is challenging. In this review, we summarize data for each approved TKI across lines of therapy in patients with CML in chronic phase, highlighting elements of each agent's safety and efficacy profile that may impact patient selection, and provide insights into individualized treatment sequencing decision-making aimed at optimizing patient outcomes.
Collapse
Affiliation(s)
- David Andorsky
- Rocky Mountain Cancer Centers, Boulder, CO, United States
| | - Vamsi Kota
- Department of Medicine: Hematology and Oncology, Georgia Cancer Center, Augusta, GA, United States
| | - Kendra Sweet
- Department of Malignant hematology, Moffitt Cancer Center, Tampa, FL, United States
| |
Collapse
|
21
|
Pantazi D, Alivertis D, Tselepis AD. Underlying Mechanisms of Thrombosis Associated with Cancer and Anticancer Therapies. Curr Treat Options Oncol 2024; 25:897-913. [PMID: 38862694 DOI: 10.1007/s11864-024-01210-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2024] [Indexed: 06/13/2024]
Abstract
OPINION STATEMENT Cancer-associated thrombosis (CAT) has been identified as the second most prevalent cause of death after cancer itself. Moreover, the risk of thrombotic events in cancer patients increases due to anticancer drugs, such as tyrosine kinase inhibitors (TKIs). Venous thromboembolism (VTE) as well as arterial thromboembolic (ATE) events are present in CAT. Although VTE occurs more frequently, ATE events are very significant and in some cases are more dangerous than VTE. Guidelines for preventing thrombosis refer mainly VTE as well as the contribution of ATE events. Several factors are involved in thrombosis related to cancer, but the whole pathomechanism of thrombosis is not clear and may differ between patients. The activation of the coagulation system and the interaction of cancer cells with other cells including platelets, endothelial cells, monocytes, and neutrophils are promoted by a hypercoagulable state caused by cancer. We present an update on the pathomechanisms of CAT and the effect of anticancer drugs, mainly targeted therapies with a focus on TKIs. Considering the risk of bleeding associated with anticoagulation in each cancer patient, the anticoagulation strategy may involve the use of FXIa inhibitors, direct oral anticoagulants, and low-molecular-weight heparin. Further research would be valuable in developing strategies for reducing CAT.
Collapse
Affiliation(s)
- Despoina Pantazi
- Laboratory of Biochemistry, Department of Chemistry/Atherothrombosis Research Centre, University of Ioannina, 451 10, Ioannina, Epirus, Greece.
| | - Dimitrios Alivertis
- Department of Biological Applications and Technology, University of Ioannina, 451 10, Ioannina, Epirus, Greece
| | - Alexandros D Tselepis
- Laboratory of Biochemistry, Department of Chemistry/Atherothrombosis Research Centre, University of Ioannina, 451 10, Ioannina, Epirus, Greece
| |
Collapse
|
22
|
Li Y, Zhang Y, Wang J, He A, Zhang W, Cao X, Chen Y, Liu J, Zhang P, Wang J, Zhao W, Yang Y, Meng X, Chen S, Zhang L, Wang T, Wang X, Ma X. Development and validation of a nomogram to predict poor efficacy of imatinib in the treatment of newly diagnosed chronic phase chronic myeloid leukemia patients. Front Oncol 2024; 14:1418417. [PMID: 38978732 PMCID: PMC11228340 DOI: 10.3389/fonc.2024.1418417] [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: 04/16/2024] [Accepted: 06/11/2024] [Indexed: 07/10/2024] Open
Abstract
Background Imatinib is the most widely used tyrosine kinase inhibitor (TKI) in patients with newly diagnosed chronic-phase chronic myeloid leukemia(CML-CP). However, failure to achieve optimal response after imatinib administration, and subsequent switch to second-generation TKI therapy results in poor efficacy and induces drug resistance. In the present study, we developed and validated a nomogram to predict the efficacy of imatinib in the treatment of patients newly diagnosed with CML-CP in order to help clinicians truly select patients who need 2nd generation TKI during initial therapy and to supplement the risk score system. Methods We retrospectively analyzed 156 patients newly diagnosed with CML-CP who met the inclusion criteria and were treated with imatinib at the Second Affiliated Hospital of Xi'an Jiao Tong University from January 2012 to June 2022. The patients were divided into a poor-response cohort (N = 60)and an optimal-response cohort (N = 43) based on whether they achieved major molecular remission (MMR) after 12 months of imatinib treatment. Using univariate and multivariate logistic regression analyses, we developed a chronic myeloid leukemia imatinib-poor treatment (CML-IMP) prognostic model using a nomogram considering characteristics like age, sex, HBG, splenic size, and ALP. The CML-IMP model was internally validated and compared with Sokal, Euro, EUTOS, and ELTS scores. Results The area under the curve of the receiver operator characteristic curve (AUC)of 0.851 (95% CI 0.778-0.925) indicated satisfactory discriminatory ability of the nomogram. The calibration plot shows good consistency between the predicted and actual observations. The net reclassification index (NRI), continuous NRI value, and the integrated discrimination improvement (IDI) showed that the nomogram exhibited superior predictive performance compared to the Sokal, EUTOS, Euro, and ELTS scores (P < 0.05). In addition, the clinical decision curve analysis (DCA) showed that the nomogram was useful for clinical decision-making. In predicting treatment response, only Sokal and CML-IMP risk stratification can effectively predict the cumulative acquisition rates of CCyR, MMR, and DMR (P<0.05). Conclusion We constructed a nomogram that can be effectively used to predict the efficacy of imatinib in patients with newly diagnosed CML-CP based on a single center, 10-year retrospective cohort study.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Xiaorong Ma
- Department of Hematology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| |
Collapse
|
23
|
Wang X, Hou Y, Lyu Y, Zhou J, Zhang X, Hassani MA, Huang D, Zhao Z, Zhou D, Xie F, Zhang X, Yan J. LncRNA IRAIN overcomes imatinib resistance in chronic myeloid leukemia via NF-κB/CD44 pathway inhibition. iScience 2024; 27:109851. [PMID: 38784023 PMCID: PMC11112338 DOI: 10.1016/j.isci.2024.109851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/08/2024] [Accepted: 04/26/2024] [Indexed: 05/25/2024] Open
Abstract
The development of tyrosine kinase inhibitors (TKIs) has revolutionarily increased the overall survival of patients with chronic myeloid leukemia (CML). However, drug resistance remains a major obstacle. Here, we demonstrated that a BCR-ABL1-independent long non-coding RNA, IRAIN, is constitutively expressed at low levels in CML, resulting in imatinib resistance. IRAIN knockdown decreased the sensitivity of CD34+ CML blasts and cell lines to imatinib, whereas IRAIN overexpression significantly increased sensitivity. Mechanistically, IRAIN downregulates CD44, a membrane receptor favorably affecting TKI resistance, by binding to the nuclear factor kappa B subunit p65 to reduce the expression of p65 and phosphorylated p65. Therefore, the demethylating drug decitabine, which upregulates IRAIN, combined with imatinib, formed a dual therapy strategy which can be applied to CML with resistance to TKIs.
Collapse
Affiliation(s)
- Xijia Wang
- Department of Hematology, Liaoning Medical Center for Hematopoietic Stem Cell Transplantation, the Second Hospital of Dalian Medical University, Dalian 116027, China
- Liaoning Key Laboratory of Hematopoietic Stem Cell Transplantation and Translational Medicine, Blood Stem Cell Transplantation Institute, Dalian Key Laboratory of Hematology, Diamond Bay Institute of Hematology, the Second Hospital of Dalian Medical University, Dalian 116027, China
| | - Yutong Hou
- Department of Hematology, Liaoning Medical Center for Hematopoietic Stem Cell Transplantation, the Second Hospital of Dalian Medical University, Dalian 116027, China
| | - Yizhu Lyu
- Department of Hematology, Liaoning Medical Center for Hematopoietic Stem Cell Transplantation, the Second Hospital of Dalian Medical University, Dalian 116027, China
| | - Jiayin Zhou
- Department of Hematology, Liaoning Medical Center for Hematopoietic Stem Cell Transplantation, the Second Hospital of Dalian Medical University, Dalian 116027, China
- Liaoning Key Laboratory of Hematopoietic Stem Cell Transplantation and Translational Medicine, Blood Stem Cell Transplantation Institute, Dalian Key Laboratory of Hematology, Diamond Bay Institute of Hematology, the Second Hospital of Dalian Medical University, Dalian 116027, China
| | - Xin Zhang
- Department of Hematology, Liaoning Medical Center for Hematopoietic Stem Cell Transplantation, the Second Hospital of Dalian Medical University, Dalian 116027, China
- Liaoning Key Laboratory of Hematopoietic Stem Cell Transplantation and Translational Medicine, Blood Stem Cell Transplantation Institute, Dalian Key Laboratory of Hematology, Diamond Bay Institute of Hematology, the Second Hospital of Dalian Medical University, Dalian 116027, China
| | - Mohammad Arian Hassani
- Department of Hematology, Liaoning Medical Center for Hematopoietic Stem Cell Transplantation, the Second Hospital of Dalian Medical University, Dalian 116027, China
- Liaoning Key Laboratory of Hematopoietic Stem Cell Transplantation and Translational Medicine, Blood Stem Cell Transplantation Institute, Dalian Key Laboratory of Hematology, Diamond Bay Institute of Hematology, the Second Hospital of Dalian Medical University, Dalian 116027, China
| | - Dan Huang
- Department of Hematology, Liaoning Medical Center for Hematopoietic Stem Cell Transplantation, the Second Hospital of Dalian Medical University, Dalian 116027, China
- Liaoning Key Laboratory of Hematopoietic Stem Cell Transplantation and Translational Medicine, Blood Stem Cell Transplantation Institute, Dalian Key Laboratory of Hematology, Diamond Bay Institute of Hematology, the Second Hospital of Dalian Medical University, Dalian 116027, China
| | - Zhijia Zhao
- Department of Hematology, Liaoning Medical Center for Hematopoietic Stem Cell Transplantation, the Second Hospital of Dalian Medical University, Dalian 116027, China
| | - Dong Zhou
- Department of Hematology, Liaoning Medical Center for Hematopoietic Stem Cell Transplantation, the Second Hospital of Dalian Medical University, Dalian 116027, China
| | - Fang Xie
- Department of Hematology, Liaoning Medical Center for Hematopoietic Stem Cell Transplantation, the Second Hospital of Dalian Medical University, Dalian 116027, China
- Liaoning Key Laboratory of Hematopoietic Stem Cell Transplantation and Translational Medicine, Blood Stem Cell Transplantation Institute, Dalian Key Laboratory of Hematology, Diamond Bay Institute of Hematology, the Second Hospital of Dalian Medical University, Dalian 116027, China
| | - Xuehong Zhang
- Center of Genome and Personalized Medicine, Institute of Cancer Stem Cell, Dalian Medical University, Dalian, Liaoning 116044, China
| | - Jinsong Yan
- Department of Hematology, Liaoning Medical Center for Hematopoietic Stem Cell Transplantation, the Second Hospital of Dalian Medical University, Dalian 116027, China
- Liaoning Key Laboratory of Hematopoietic Stem Cell Transplantation and Translational Medicine, Blood Stem Cell Transplantation Institute, Dalian Key Laboratory of Hematology, Diamond Bay Institute of Hematology, the Second Hospital of Dalian Medical University, Dalian 116027, China
- Department of Pediatric, Pediatric Oncology and Hematology Center of the Second Hospital of Dalian Medical University, Dalian, Liaoning 116027, China
| |
Collapse
|
24
|
Gupta D, Sivaramakrishnan P, Layek A, Mishra M. Exudative pleural effusion during sunitinib treatment. BMJ Case Rep 2024; 17:e257191. [PMID: 38885996 DOI: 10.1136/bcr-2023-257191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024] Open
Abstract
Drug-induced pleural effusion is one of the rare causes of exudative pleural effusion and a high index of suspicion is necessary to lead to early diagnosis. We hereby present the case of a young male in his late 30s, known case of metastatic gastrointestinal stromal tumour on sunitinib therapy, who presented with right-sided mild pleural effusion. Diagnostic thoracentesis showed the effusion to be a monomorphic exudate with low adenosine deaminase, which was negative for malignant cells on cytopathology. A contrast-enhanced CT chest revealed an enlarged lymph node (LN) at the 4R station, cytological analysis of which was suggestive of reactive lymphoid hyperplasia. Infective workup of the LN aspirate and bronchoalveolar lavage taken from the right middle lobe was negative. After systematically excluding the usual causes of exudative pleural effusion, sunitinib was considered to be a possible cause and was, therefore, withheld. A repeat chest X-ray after 3 weeks of stopping the drug showed resolution of the pleural effusion.
Collapse
Affiliation(s)
- Deepansh Gupta
- Pulmonary Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | | | - Avishek Layek
- Pulmonary Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Mayank Mishra
- Pulmonary Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| |
Collapse
|
25
|
Li Y, Kuang P, Zhu H, Pan L, Dong T, Lin T, Chen Y, Yang Y. Successful maintenance of a sustained molecular response in CML patients receiving low-dose tyrosine kinase inhibitors. Ther Adv Hematol 2024; 15:20406207241259678. [PMID: 38883162 PMCID: PMC11179506 DOI: 10.1177/20406207241259678] [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: 03/17/2024] [Accepted: 05/20/2024] [Indexed: 06/18/2024] Open
Abstract
Background The development of tyrosine kinase inhibitor (TKI) therapy has positively impacted the survival rates of patients with chronic myeloid leukemia (CML). It is common in medical practice to adjust the dosage of TKI downward because of TKI-associated adverse events, financial burden, comorbidity, or an attempt at treatment-free remission. Objectives This investigation sought to explore the feasibility of employing a reduced dosage of TKI for treating CML. Design This was a retrospective study. Methods Patients with CML in its chronic phase who had been on a reduced dose of TKI for a minimum of 3 months for various reasons in a practical clinical environment, irrespective of molecular response, were included. Regular molecular monitoring was performed, and changes in adverse events were recorded after dose reduction. Results This research included a total of 144 participants. Upon reducing the dosage, 136 of 144 patients achieved major molecular response or deeper, and 132 of 144 achieved molecular response 4 (MR4). Following a median observation period of 16 months, the calculated 1- and 2-year survival rates free from MR4 failure were estimated to be 96.5% (95% CI: 90.8-98.7) and 90.5% (95% CI: 81.3-95.3), respectively. MR4 failure-free survival was better in patients with longer MR4 durations (⩾34 months) before dose reduction (p = 0.02). The median interval from dose reduction to MR4 loss was 15 months. Improved TKI-associated adverse events after dose reduction were observed in 61.3% of patients. Conclusion Lowering the TKI dose can effectively preserve a deep molecular response over time while relieving adverse events caused by TKIs.
Collapse
Affiliation(s)
- Yan Li
- Department of Hematology, Institute of Hematology, West China Hospital of Sichuan University, Chengdu, P.R. China
| | - Pu Kuang
- Department of Hematology, Institute of Hematology, West China Hospital of Sichuan University, Chengdu, P.R. China
| | - Huanling Zhu
- Department of Hematology, Institute of Hematology, West China Hospital of Sichuan University, Chengdu, P.R. China
| | - Ling Pan
- Department of Hematology, Institute of Hematology, West China Hospital of Sichuan University, Chengdu, P.R. China
| | - Tian Dong
- Department of Hematology, Institute of Hematology, West China Hospital of Sichuan University, Chengdu, P.R. China
| | - Ting Lin
- Department of Hematology, Institute of Hematology, West China Hospital of Sichuan University, Chengdu, P.R. China
| | - Yu Chen
- Department of Internal Medicine, Chengdu Wuhou Likang Hospital, Chengdu, P.R. China
| | - Yunfan Yang
- Department of Hematology, Institute of Hematology, West China Hospital of Sichuan University, Guoxuexiang 37, Chengdu 610041, P.R. China
| |
Collapse
|
26
|
Jain AG, Gesiotto Q, Ball S, Nodzon L, Rodriguez A, Chan O, Padron E, Kuykendall A, Komrokji R, Sallman DA, Lancet JE, Pinilla-Ibarz J, Sweet K. Incidence of pleural effusion with dasatinib and the effect of switching therapy to a different TKI in patients with chronic phase CML. Ann Hematol 2024; 103:1941-1945. [PMID: 38634915 DOI: 10.1007/s00277-024-05760-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/12/2024] [Indexed: 04/19/2024]
Abstract
Dasatinib is one of the second generation tyrosine kinase inhibitors (TKI) which is approved for the treatment of patients with chronic phase CML (CP-CML) both in the front line and in the second line setting. Pleural effusion (PE) is a unique toxicity associated with dasatinib use. Our aim was to study the incidence of pleural effusion in our cohort of patients who were treated with dasatinib for CP-CML and the safety upon TKI switch. A total of 390 patients were treated with dasatinib during their course of treatment for CP-CML. A total of 69 patients (17.6%) developed any grade of PE. About 33 (48%) patients developed CTCAE grade 2 PE, 34 (49%) grade 3 and only 1 patient developed grade 4 PE. Recurrence of PE was observed in 34 (49%) patients. While only 12 patients (17.3%) continued using dasatinib after development of PE, dasatinib was discontinued in the other 57 patients. Therapy was switched to bosutinib in 13 patients out of which 6 (46%) patients re-developed PE. While only 12.5% patients developed re-accumulation of pleural fluid in patients switched to imatinib, none of the patients switched to nilotinib re-developed PE. A change in TKI to bosutinib was associated with a 46% risk of recurrence of PE in patients who develop PE on dasatinib for the treatment of CP-CML. The incidence of recurrent PE was markedly lower in patient switched to imatinib or nilotinib.
Collapse
Affiliation(s)
- Akriti G Jain
- Taussig Cancer Institute, Cleveland Clinic, 9500 Euclid Avenue CA-60,, Cleveland, OH, 44195, USA.
| | - Quinto Gesiotto
- Hematology Oncology Fellow, Thomas Jefferson University, Philadelphia, PA, USA
| | - Somedeb Ball
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lisa Nodzon
- Division of Malignant Hematology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Amanda Rodriguez
- Division of Malignant Hematology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Onyee Chan
- Division of Malignant Hematology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Eric Padron
- Division of Malignant Hematology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Andrew Kuykendall
- Division of Malignant Hematology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Rami Komrokji
- Division of Malignant Hematology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - David A Sallman
- Division of Malignant Hematology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jeffrey E Lancet
- Division of Malignant Hematology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Javier Pinilla-Ibarz
- Division of Malignant Hematology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Kendra Sweet
- Division of Malignant Hematology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| |
Collapse
|
27
|
Rea D, Fodil S, Lengline E, Raffoux E, Cayuela JM. Tyrosine Kinase Inhibitor Discontinuation in Chronic Myeloid Leukemia: Strategies to Optimize Success and New Directions. Curr Hematol Malig Rep 2024; 19:104-110. [PMID: 38393431 DOI: 10.1007/s11899-024-00728-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE OF REVIEW The discovery that patients suffering from chronic myeloid leukemia who obtain deep and long-lasting molecular responses upon treatment with tyrosine kinase inhibitors may maintain their disease silent for many years after therapy discontinuation launched the era of treatment-free remission as a key management goal in clinical practice. The purpose of this review on treatment-free remission is to discuss clinical advances, highlight knowledge gaps, and describe areas of research. RECENT FINDINGS Patients in treatment-free remission are a minority, and it is believed that some may still retain a reservoir of leukemic stem cells; thus, whether they can be considered as truly cured is uncertain. Strengthening BCR::ABL1 inhibition increases deep molecular responses but is not sufficient to improve treatment-free remission, and we lack biomarkers to identify and specifically target residual cells with aggressive potential. Another level of complexity resides in the intra- and inter-patient clonal heterogeneity of minimal residual disease and characteristics of the bone marrow environment. Finding determinants of deep molecular responses achievement and elucidating varying biological mechanisms enabling either post-tyrosine kinase inhibitor chronic myeloid leukemia control or relapse may help develop innovative and safe therapies. In the light of the increasing prevalence of CML, targeting the residual leukemic stem cell pool is thought to be the key.
Collapse
Affiliation(s)
- Delphine Rea
- Service d'Hématologie Adulte, Hôpital Saint-Louis APHP, 75010, Paris, France.
- France Intergroupe Des Leucémies Myéloïdes Chroniques FiLMC, Paris, France.
| | - Sofiane Fodil
- Service d'Hématologie Adulte, Hôpital Saint-Louis APHP, 75010, Paris, France
| | - Etienne Lengline
- Service d'Hématologie Adulte, Hôpital Saint-Louis APHP, 75010, Paris, France
| | - Emmanuel Raffoux
- Service d'Hématologie Adulte, Hôpital Saint-Louis APHP, 75010, Paris, France
| | - Jean-Michel Cayuela
- France Intergroupe Des Leucémies Myéloïdes Chroniques FiLMC, Paris, France
- Laboratoire Central d'Hématologie, Hôpital Saint-Louis APHP, Paris, France
| |
Collapse
|
28
|
Fujita S, Kasahara H, Kato J, Koda Y, Shiroshita K, Yamaguchi K, Okayama M, Abe R, Kikuchi T, Shimizu T, Mori T, Kataoka K, Okamoto S. The Impact of Pretransplant Use of Tyrosine Kinase Inhibitors on Allogeneic Stem Cell Transplantation in Patients with Chronic Myeloid Leukemia - A Single-institution Retrospective Study. Intern Med 2024; 63:1549-1562. [PMID: 37899244 PMCID: PMC11189713 DOI: 10.2169/internalmedicine.2479-23] [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] [Received: 06/20/2023] [Accepted: 09/11/2023] [Indexed: 10/31/2023] Open
Abstract
Objective Chronic myeloid leukemia (CML) is a malignant hematological disorder, and allogeneic stem cell transplantation (allo-SCT) was its only curative treatment until the introduction of tyrosine kinase inhibitors (TKIs). Allo-SCT is still considered for CML patients who are resistant to TKIs and in an advanced phase. Currently, second- and third-generation (2/3G TKIs are typically incorporated into the first-line treatment of CML. However, the impact of 2/3G TKIs on subsequent allo-SCT remains unclear. We therefore evaluated the effect of 2/3G TKIs on allo-SCT. Methods We retrospectively evaluated the effect of pretransplant therapy with TKIs on the outcome of allo-SCT for CML using clinical data at our institution. Patients Thirty-two CML patients who received their first allo-SCT procedure at our institute from 2001 to 2020 were included. We divided the patients into three subgroups based on TKI treatment before allo-SCT. Patients receiving no TKIs, only imatinib (IM), and 2/3G TKIs were classified into the Non-TKI, IM, and 2/3G TKI groups, respectively. Results In a univariate analysis, the pretransplant use of 2/3G TKIs was significantly associated with a higher 5-year overall survival (91.7%) and relapse-free survival (75.0%) than the use of IM (37.5% and 12.5%) in patients presenting with or progressing to the advanced phase. In addition, pretransplant use of 2/3G TKIs did not increase the incidence of graft-versus-host disease (GVHD). Conclusion We demonstrated that the pretransplant use of 2/3G TKIs was safe and improved the outcome of CML patients who presented with or progressed to the advanced phase without increasing the frequency of GVHD.
Collapse
Affiliation(s)
- Shinya Fujita
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Japan
| | - Hidenori Kasahara
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Japan
- Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Japan
| | - Jun Kato
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Japan
| | - Yuya Koda
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Japan
| | - Kohei Shiroshita
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Japan
| | - Kentaro Yamaguchi
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Japan
| | - Mikio Okayama
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Japan
- Department of Hematology, Kawasaki Municipal Hospital, Japan
| | - Ryohei Abe
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Japan
- Department of Hematology, Saitama Medical University Hospital, Japan
| | - Taku Kikuchi
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Japan
| | - Takayuki Shimizu
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Japan
| | - Takehiko Mori
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Japan
- Department of Hematology, Tokyo Medical and Dental University School of Medicine, Japan
| | - Keisuke Kataoka
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Japan
- Division of Molecular Oncology, National Cancer Center Research Institute, Japan
| | - Shinichiro Okamoto
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Japan
| |
Collapse
|
29
|
Zhang X, Xu N, Yang Y, Lin H, Liu B, Du X, Liu X, Liang R, Chen C, Huang J, Zhu H, Pan L, Wang X, Li G, Liu Z, Zhang Y, Liu Z, Hu J, Liu C, Li F, Yang W, Meng L, Han Y, Lin L, Zhao Z, Tu C, Zheng C, Bai Y, Zhou Z, Chen S, Qiu H, Yang L, Sun X, Sun H, Zhou L, Liu Z, Wang D, Guo J, Pang L, Zeng Q, Suo X, Zhang W, Zheng Y, Zhang Y, Li W, Jiang Q. Comparison of the Efficacy Among Nilotinib, Dasatinib, Flumatinib and Imatinib in Newly Diagnosed Chronic-Phase Chronic Myeloid Leukemia Patients: A Real-World Multi-Center Retrospective Study. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024; 24:e257-e266. [PMID: 38461040 DOI: 10.1016/j.clml.2024.02.008] [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: 01/19/2024] [Revised: 02/10/2024] [Accepted: 02/12/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND There are limited data comprehensively comparing therapy responses and outcomes among nilotinib, dasatinib, flumatinib and imatinib for newly diagnosed chronic-phase chronic myeloid leukemia in a real-world setting. PATIENTS AND METHODS Data from patients with chronic-phase CML receiving initial a second-generation tyrosine-kinase inhibitor (2G-TKI, nilotinib, dasatinib or flumatinib) or imatinib therapy from 77 Chinese centers were retrospectively interrogated. Propensity-score matching (PSM) analyses were performed to to compare therapy responses and outcomes among these 4 TKIs. RESULTS 2,496 patients receiving initial nilotinib (n = 512), dasatinib (n = 134), flumatinib (n = 411) or imatinib (n = 1,439) therapy were retrospectively interrogated in this study. PSM analyses indicated that patients receiving initial nilotinib, dasatinib or flumatinib therapy had comparable cytogenetic and molecular responses (p = .28-.91) and survival outcomes including failure-free survival (FFS, p = .28-.43), progression-free survival (PFS, p = .19-.93) and overall survival (OS) (p values = .76-.78) but had significantly higher cumulative incidences of cytogenetic and molecular responses (all p values < .001) and higher probabilities of FFS (p < .001-.01) than those receiving imatinib therapy, despite comparable PFS (p = .18-.89) and OS (p = .23-.30). CONCLUSION Nilotinib, dasatinib and flumatinib had comparable efficacy, and significantly higher therapy responses and higher FFS rates than imatinib in newly diagnosed CML patients. However, there were no significant differences in PFS and OS among these 4 TKIs. These real-world data may provide additional evidence for routine clinical assessments to identify more appropriate therapies.
Collapse
Affiliation(s)
- Xiaoshuai Zhang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Na Xu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yunfan Yang
- Department of Hematology, Institute of Hematology, West China Hospital, Sichuan University, Sichuan, China
| | - Hai Lin
- Department of Hematology, The First Hospital of Jilin University, Jilin, China
| | - Bingcheng Liu
- National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjing, China
| | - Xin Du
- Department of Hematology, The Second People's Hospital of Shenzhen, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Xiaoli Liu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Rong Liang
- Department of Hematology, Xijing Hospital, Airforce Military Medical University, Xi'an, China
| | - Chunyan Chen
- Department of Hematology, Qilu Hospital of Shandong University, Jinan, China
| | - Jian Huang
- Department of Hematology, The First Affiliated Hospital of Zhejiang University, College of Medicine, Zhejiang University. Department of Hematology, The Fourth Affiliated Hospital of Zhejiang University, College of Medicine, Zhejiang University. Zhejiang Provincial Clinical Research Center for Haematological Disorders, Zhejiang, China
| | - Huanling Zhu
- Department of Hematology, Institute of Hematology, West China Hospital, Sichuan University, Sichuan, China
| | - Ling Pan
- Department of Hematology, Institute of Hematology, West China Hospital, Sichuan University, Sichuan, China
| | - Xiaodong Wang
- Department of Hematology, Sichuan Academy of Medical Sciences Sichuan Provincial People's Hospital, Sichuan, China
| | - Guohui Li
- Department of Hematology, Xi'an international medical center hospital, Xi'an, China
| | - Zhuogang Liu
- Department of Hematology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yanqing Zhang
- Department of Hematology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhenfang Liu
- Department of Hematology, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Jianda Hu
- Department of Hematology, Fujian Medical University Union Hospital, Fujian, China
| | - Chunshui Liu
- Department of Hematology, The First Hospital of Jilin University, Jilin, China
| | - Fei Li
- Center of Hematology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wei Yang
- Department of Hematology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Li Meng
- Department of Hematology, Tongji Hospital of Tongji Medical College, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Yanqiu Han
- Department of Hematology, The Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
| | - Li'e Lin
- Department of Hematology, Hainan General Hospital, Hainan, China
| | - Zhenyu Zhao
- Department of Hematology, Hainan General Hospital, Hainan, China
| | - Chuanqing Tu
- Department of Hematology, Shenzhen Baoan Hospital, Shenzhen University Second Affiliated Hospital, Shenzhen, China
| | - Caifeng Zheng
- Department of Hematology, Shenzhen Baoan Hospital, Shenzhen University Second Affiliated Hospital, Shenzhen, China
| | - Yanliang Bai
- Department of Hematology, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Henan, China
| | - Zeping Zhou
- Department of Hematology, The Second Hospital Affiliated to Kunming Medical University, Kunming, China
| | - Suning Chen
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Institute of Blood and Marrow Transplantation of Soochow University, Soochow, China
| | - Huiying Qiu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Institute of Blood and Marrow Transplantation of Soochow University, Soochow, China
| | - Lijie Yang
- Department of Hematology, Xi'an international medical center hospital, Xi'an, China
| | - Xiuli Sun
- Department of Hematology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Hui Sun
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Li Zhou
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zelin Liu
- Department of Hematology, Huazhong University of Science and Technology Union Shenzhen Hospital, Nanshan Hospital, Shenzhen, China
| | - Danyu Wang
- Department of Hematology, Huazhong University of Science and Technology Union Shenzhen Hospital, Nanshan Hospital, Shenzhen, China
| | - Jianxin Guo
- Department of Hematology, The Second Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Liping Pang
- Department of Hematology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Qingshu Zeng
- Department of Hematology, The First Affiliated Hospital of Anhui Medical University, Anhui, China
| | - Xiaohui Suo
- Department of Hematology, Handan Central Hospital, Handan, China
| | - Weihua Zhang
- Department of Hematology, First Hospital of Shanxi Medical University, Shanxi, China
| | - Yuanjun Zheng
- Department of Hematology, First Hospital of Shanxi Medical University, Shanxi, China
| | - Yanli Zhang
- Department of Hematology, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Henan, China..
| | - Weiming Li
- Department of Hematology, Union hospital, Tongji Medical college, Huazhong University of Science and Technology, Wuhan, China..
| | - Qian Jiang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China.; Peking University People's Hospital, Qingdao, China..
| |
Collapse
|
30
|
Kantarjian H, Branford S, Breccia M, Cortes J, Haddad FG, Hochhaus A, Hughes T, Issa GC, Jabbour E, Nicolini FE, Sasaki K, Xavier-Mahon F. Are there new relevant therapeutic endpoints in the modern era of the BCR::ABL1 tyrosine kinase inhibitors in chronic myeloid leukemia? Leukemia 2024; 38:947-950. [PMID: 38531949 DOI: 10.1038/s41375-024-02229-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 03/28/2024]
Affiliation(s)
| | - Susan Branford
- SA Pathology, Centre For Cancer Biology Australia, Adelaide, SA, Australia
| | - Massimo Breccia
- Department of Translational and Precision Medicine, Sapienza University-Rome, Rome, Italy
| | | | - Fadi G Haddad
- Leukemia Department, MD Anderson Cancer Center, Madrid, Spain
| | | | - Timothy Hughes
- South Australian Health & Medical Institute, SAHMRI, Adelaide, SA, Australia
| | - Ghayas C Issa
- Leukemia Department, MD Anderson Cancer Center, Madrid, Spain
| | - Elias Jabbour
- Leukemia Department, MD Anderson Cancer Center, Madrid, Spain
| | - Franck E Nicolini
- Hematology Department and CRCL INSERM U 1052, Centre Léon Berard, Lyon, France
| | - Koji Sasaki
- Leukemia Department, MD Anderson Cancer Center, Madrid, Spain
| | - Francois Xavier-Mahon
- Institut Bergonié or Bergonié Institute 229 cours de l'Argonne, 33076, Bordeaux, France
- INSERM U1312 Bordeaux University, Bordeaux, France
| |
Collapse
|
31
|
Franke GN, Loewe G, Reiser M, Linde H, Josting A, von der Heyde E, Platzbecker U, Weide R, Tesch H, Nusch A, Dengler J, Jentsch-Ullrich K. Spotlight on the real-world treatment of CML pts in Germany: a retrospective survey in private oncology practices. Ann Hematol 2024; 103:1569-1575. [PMID: 38472361 PMCID: PMC11009736 DOI: 10.1007/s00277-024-05702-2] [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: 11/13/2023] [Accepted: 03/05/2024] [Indexed: 03/14/2024]
Abstract
Clinical trials in chronic myeloid leukemia (CML) are usually carried out in specialized centers whereas primary care for patients (pts) with CML is mainly provided by local oncology practices. The aim of this study was to assess treatment practices in pts with CML in the setting of private oncology practices in Germany. We collected data of 819 pts with a confirmed diagnosis (dx) of CML in 2013 or later from 43 practices. At dx, 84.2% (n=690) and 9.4% (n=77) of pts were in chronic or accelerated phase, 0.7% (n=6) had a blast crisis. Molecular monitoring was provided by EUTOS certified laboratories in 87.7% of pts. Typical BCR::ABL1 transcripts were detected in 86.6% (n=709). Molecular response was assessed after 2.8, 6.0, 9.4 and 12.9 m (mean) after start of treatment. Of the pts with available data, 11.1% did not achieve early molecular response and at 18 m, 83.7% had at least a major molecular response. 288 (35.2%) of pts switched to 2nd line (2L) treatment after a mean of 21.0 months. Reasons for 2L treatment were side effects in 43.4% and suboptimal response or failure in 31.4% of pts. 106 pts went on to third line (3L) treatment. 36.8 % of pts switched to and 92.8 % of pts still on 3L treatment achieved BCR::ABL1IS ≤1% at 12 m. In conclusion, in Germany pts with CML are routinely monitored by qPCR and good responses are achieved in the majority. Treatment changes are mainly due to adverse events rather than suboptimal responses.
Collapse
Affiliation(s)
- Georg-Nikolaus Franke
- Department for Hematology, Cellular Therapies, Hemostaseology and Infectious Diseases, University of Leipzig Medical Center, Leipzig, Germany.
| | | | - Marcel Reiser
- PIOH-Zentrum Praxis Internistischer Onkologie und Hämatologie, Cologne, Germany
| | - Hartmut Linde
- MVZ für Blut- und Krebserkrankungen, Potsdam, Germany
| | - Andreas Josting
- Schwerpunktpraxis für Onkologie, Gastroenterologie, Hämatologie und Palliativmedizin, Berlin, Germany
| | | | - Uwe Platzbecker
- Department for Hematology, Cellular Therapies, Hemostaseology and Infectious Diseases, University of Leipzig Medical Center, Leipzig, Germany
| | - Rudolf Weide
- Praxis für Hämatologie und Onkologie, Koblenz, Germany
| | - Hans Tesch
- Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany
| | - Arndt Nusch
- MVZ-Onkologie Velbert/Ratingen GbR, Velbert, Germany
| | - Jolanta Dengler
- Onkologische Schwerpunktpraxis Heilbronn, Heilbronn, Germany
| | | |
Collapse
|
32
|
Wang Y, Liang ZJ, Gale RP, Liao HZ, Ma J, Gong TJ, Shao YQ, Liang Y. Chronic myeloid leukaemia: Biology and therapy. Blood Rev 2024; 65:101196. [PMID: 38604819 DOI: 10.1016/j.blre.2024.101196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 04/13/2024]
Abstract
Chronic myeloid leukaemia (CML) is caused by BCR::ABL1. Tyrosine kinase-inhibitors (TKIs) are the initial therapy. Several organizations have reported milestones to evaluate response to initial TKI-therapy and suggest when a change of TKI should be considered. Achieving treatment-free remission (TFR) is increasingly recognized as the optimal therapy goal. Which TKI is the best initial therapy for which persons and what depth and duration of molecular remission is needed to achieve TFR are controversial. In this review we discuss these issues and suggest future research directions.
Collapse
MESH Headings
- Humans
- Protein Kinase Inhibitors/therapeutic use
- Fusion Proteins, bcr-abl/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/etiology
- Remission Induction
- Biology
Collapse
Affiliation(s)
- Yun Wang
- Department of Hematologic Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Centre for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Zhi-Jian Liang
- Department of Hematologic Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Centre for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Robert Peter Gale
- Department of Hematologic Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Centre for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; Centre for Haematology, Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Hua-Ze Liao
- Department of Hematologic Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Centre for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Jun Ma
- Harbin Institute of Hematology and Oncology, Harbin First Hospital, Harbin 150010, China
| | - Tie-Jun Gong
- Harbin Institute of Hematology and Oncology, Harbin First Hospital, Harbin 150010, China.
| | - Ying-Qi Shao
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China.
| | - Yang Liang
- Department of Hematologic Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Centre for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China.
| |
Collapse
|
33
|
Tian J, Song YP, Zhang GC, Wang SF, Chu XX, Chai Y, Wang CL, He AL, Zhang F, Shen XL, Zhang WH, Yang LH, Nie DN, Wang DM, Zhu HL, Gao D, Lou SF, Zhou ZP, Su GH, Li Y, Lin JY, Shi QZ, Ouyang GF, Jing HM, Chen SJ, Li J, Mi JQ. Oral arsenic plus imatinib versus imatinib solely for newly diagnosed chronic myeloid leukemia: a randomized phase 3 trial with 5-year outcomes. J Cancer Res Clin Oncol 2024; 150:189. [PMID: 38605258 PMCID: PMC11009770 DOI: 10.1007/s00432-024-05700-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 03/13/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE The synergistic effects of combining arsenic compounds with imatinib against chronic myeloid leukemia (CML) have been established using in vitro data. We conducted a clinical trial to compare the efficacy of the arsenic realgar-indigo naturalis formula (RIF) plus imatinib with that of imatinib monotherapy in patients with newly diagnosed chronic phase CML (CP-CML). METHODS In this multicenter, randomized, double-blind, phase 3 trial, 191 outpatients with newly diagnosed CP-CML were randomly assigned to receive oral RIF plus imatinib (n = 96) or placebo plus imatinib (n = 95). The primary end point was the major molecular response (MMR) at 6 months. Secondary end points include molecular response 4 (MR4), molecular response 4.5 (MR4.5), progression-free survival (PFS), overall survival (OS), and adverse events. RESULTS The median follow-up duration was 51 months. Due to the COVID-19 pandemic, the recruitment to this study had to be terminated early, on May 28, 2020. The rates of MMR had no significant statistical difference between combination and imatinib arms at 6 months and any other time during the trial. MR4 rates were similar in both arms. However, the 12-month cumulative rates of MR4.5 in the combination and imatinib arms were 20.8% and 10.5%, respectively (p = 0.043). In core treatment since the 2-year analysis, the frequency of MR4.5 was 55.6% in the combination arm and 38.6% in the imatinib arm (p = 0.063). PFS and OS were similar at five years. The safety profiles were similar and serious adverse events were uncommon in both groups. CONCLUSION The results of imatinib plus RIF as a first-line treatment of CP-CML compared with imatinib might be more effective for achieving a deeper molecular response (Chinadrugtrials number, CTR20170221).
Collapse
Affiliation(s)
- Jie Tian
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong-Ping Song
- The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | | | | | | | - Ye Chai
- Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Chun-Ling Wang
- The Affiliated Huaian No 1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Ai-Li He
- The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Feng Zhang
- The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Xu-Liang Shen
- Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
| | - Wei-Hua Zhang
- The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Lin-Hua Yang
- The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Da-Nian Nie
- The Second Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | | | - Huan-Ling Zhu
- West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Da Gao
- The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Shi-Feng Lou
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ze-Ping Zhou
- The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Guo-Hong Su
- Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Yan Li
- The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jin-Ying Lin
- The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Qing-Zhi Shi
- The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | | | | | - Sai-Juan Chen
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Jian Li
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Jian-Qing Mi
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| |
Collapse
|
34
|
Özmen D, Alpaydın DD, Saldoğan MA, Eşkazan AE. A safety review of tyrosine kinase inhibitors for chronic myeloid leukemia. Expert Opin Drug Saf 2024; 23:411-423. [PMID: 38484148 DOI: 10.1080/14740338.2024.2331190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/07/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Since the introduction of first tyrosine kinase inhibitor (TKI) imatinib, the treatment of chronic myeloid leukemia (CML) has reached excellent survival expectancies. Long survival rates bring about issues regarding TKI safety. AREAS COVERED The aim of this review is to compare the side effects of current TKIs both in the first and later lines and outline a safety andprofile of CML treatment. Seminal studies on TKIs and other newer drugs and extended follow-up of these studies; real-life data of each drug were usedduring the course of this. PubMed was used as a search database and onlyarticles in English were included. EXPERT OPINION With longer follow-up CML patients, resistant slowgrade adverse events seem to be the major obstacle in the way of treatmentefficacy. If efficacy is the priority, vigorous treatment of side effect and administration of full dose TKI are reasonable. But when treatment goals are reached, dose modifications or alternative treatment regimens may be acceptedpossible. More studies are needed on dose modification protocols and potential benefits and safety of treatment-free remission.
Collapse
Affiliation(s)
- Deniz Özmen
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Duygu Demet Alpaydın
- Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | | | - Ahmet Emre Eşkazan
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| |
Collapse
|
35
|
Tobaiqy M, Helmi N, MacLure K, Saade S. The prevalence of hepatic and thyroid toxicity associated with imatinib treatment of chronic myeloid leukaemia: a systematic review. Int J Clin Pharm 2024; 46:368-381. [PMID: 38147280 DOI: 10.1007/s11096-023-01671-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 11/13/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Imatinib, a potent inhibitor of targeted protein tyrosine kinases, treats chronic myeloid leukaemia (CML). Data on imatinib-associated changes in hepatic and thyroid functions are limited and conflicting. AIM To report the prevalence of hepatic and thyroid toxicity associated with the use of imatinib in CML patients. METHOD Articles for the systematic review were selected from electronic databases (PubMed, CINALH, Web of Science). Readily accessible peer-reviewed full articles in English published 1st January 2000 to 18th July 2023 were included. The search terms included combinations of: imatinib, CML, liver toxicity, hepatic toxicity, thyroid toxicity. Screening of titles, abstracts, full text articles was conducted independently by two reviewers. Inclusions and exclusions were recorded following PRISMA guidelines. Detailed reasons for exclusion were recorded. Included articles were critically appraised. RESULTS Ten thousand one hundred and twenty-three CML patients were reported in the 82 included studies corresponding to 21 case reports, 2 case series, 39 clinical trials and 20 observational studies were selected. Excluding case studies/reports, 1268 (12.6%; n = 1268/10046) hepatotoxicity adverse events were reported, of which 64.7% were rated as mild grade I & II adverse events, 363 (28.6%) as severe, grade III and IV adverse events; some led to treatment discontinuation, liver transplantation and fatal consequences. Twenty (35.1%) studies reported discontinuation of imatinib treatment due to the severity of hepatic toxicity. Fourteen (8.4%, n = 14/167) thyroid dysfunction adverse events were reported. CONCLUSION High frequency of mild and severe hepatotoxicity, associated with imatinib in CML patients, was reported in the published literature. Low numbers of mild and manageable thyroid toxicity events were reported.
Collapse
Affiliation(s)
- Mansour Tobaiqy
- Department of Pharmacology, College of Medicine, University of Jeddah, Jeddah, Saudi Arabia.
| | - Nawal Helmi
- Department of Biochemistry, College of Sciences, University of Jeddah, Jeddah, Saudi Arabia
| | | | - Sylvia Saade
- Health and Sciences Department, American University of Science and Technology, Beirut, Lebanon
| |
Collapse
|
36
|
Claudiani S, Chughtai F, Khan A, Hayden C, Fernando F, Khorashad J, Orovboni V, Scandura G, Innes A, Apperley JF, Milojkovic D. Long-term outcomes after upfront second-generation tyrosine kinase inhibitors for chronic myeloid leukemia: managing intolerance and resistance. Leukemia 2024; 38:796-802. [PMID: 38424138 PMCID: PMC10997507 DOI: 10.1038/s41375-024-02187-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Abstract
Second-generation tyrosine kinase inhibitors (2GTKI) are more effective in inducing rapid molecular responses than imatinib when used first-line in patients with chronic myeloid leukemia in chronic phase (CML-CP). However, failure of first line-2GTKI (1L-2GTKI) still occurs and there is no consensus regarding subsequent management. We retrospectively analyzed the outcome of 106 CML-CP patients treated with 1L-2GTKI and with a median follow-up of 91 months. 45 patients (42.4%) switched to an alternative TKI, 28 for intolerance (26.4%) and 17 (16%) for resistance. Most patients who remained on 1L-2GTKI achieved deep molecular responses (DMR) and 15 (14.1%) are in treatment-free remission (TFR). Intolerant patients also obtained DMR, although most required multiple TKI changes and were slower to respond, particularly if treated with 2L-imatinib. Inferior outcomes were observed in resistant patients, who failed alternative 2L-2GTKI and required 3/4GTKI and/or allogeneic hematopoietic stem cell transplant (alloSCT). 7yr-OS was significantly lower for these individuals (66.1%) than for intolerant patients and those who remained on 1L-2GTKI (100% and 97.9%, respectively; p = 0.001). It is apparent that failure of 1L-2GTKI is a challenging problem in modern CML therapy. Intolerance can be effectively managed by switching to an alternative 2GTKI, but resistance requires early consideration of 3/4GTKI.
Collapse
Affiliation(s)
- Simone Claudiani
- Centre for Haematology, Department of Immunology and Inflammation, Faculty of Medicine, Imperial College London, London, UK.
- Department of Haematology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.
| | - Farhan Chughtai
- Centre for Haematology, Department of Immunology and Inflammation, Faculty of Medicine, Imperial College London, London, UK
| | - Afzal Khan
- Centre for Haematology, Department of Immunology and Inflammation, Faculty of Medicine, Imperial College London, London, UK
| | - Chloe Hayden
- Imperial Molecular Pathology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Fiona Fernando
- Centre for Haematology, Department of Immunology and Inflammation, Faculty of Medicine, Imperial College London, London, UK
- Department of Haematology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Jamshid Khorashad
- Centre for Haematology, Department of Immunology and Inflammation, Faculty of Medicine, Imperial College London, London, UK
| | - Victoria Orovboni
- Imperial Molecular Pathology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Glenda Scandura
- Centre for Haematology, Department of Immunology and Inflammation, Faculty of Medicine, Imperial College London, London, UK
| | - Andrew Innes
- Centre for Haematology, Department of Immunology and Inflammation, Faculty of Medicine, Imperial College London, London, UK
- Department of Haematology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Jane F Apperley
- Centre for Haematology, Department of Immunology and Inflammation, Faculty of Medicine, Imperial College London, London, UK
- Department of Haematology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Dragana Milojkovic
- Centre for Haematology, Department of Immunology and Inflammation, Faculty of Medicine, Imperial College London, London, UK
- Department of Haematology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| |
Collapse
|
37
|
Tungjitviboonkun S, Wachirapornpruet P, Unsuwan S. Concomitant L248V With E225V Mutation in the BCR-ABL Gene Associated With Rapid Chronic Myeloid Leukemia Lymphoid Blast Crisis. Cureus 2024; 16:e58972. [PMID: 38800235 PMCID: PMC11127122 DOI: 10.7759/cureus.58972] [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: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm characterized by the presence of the Philadelphia chromosome (Ph), resulting from the t(9;22)(q34;q11.2) translocation. Imatinib, a tyrosine kinase inhibitor (TKI), has revolutionized the treatment of CML. However, despite the initial response, some patients may progress to an advanced stage, such as a blast crisis. We report a 40-year-old female who presented with CML chronic phase (CP) taking imatinib 400 mg/day and achieved a complete hematological response (CHR) after one month of treatment. She achieved a suboptimal response in the third month (BCR-ABL positive 10.29% IS). However, five months into therapy, she developed a sudden lymphoid blast crisis with chromosomal aberrations involving chromosomes 10 and 12. Molecular analysis detected concomitant L248V with partial exon 4 deletion and E225V mutations within the BCR-ABL1 fusion gene. The patient received intensive chemotherapy and dasatinib. We report the first case of concomitant mutation of L248V with partial exon 4 deletion and E255V on BCR-ABL1 gene mutation, which contributes to a sudden precursor B-cell lymphoid blast crisis.
Collapse
|
38
|
Flygt H, Söderlund S, Richter J, Saussele S, Koskenvesa P, Stenke L, Mustjoki S, Dimitrijevic A, Stentoft J, Majeed W, Roy L, Wolf D, Dreimane A, Gjertsen BT, Gedde-Dahl T, Ahlstrand E, Markevärn B, Hjorth-Hansen H, Janssen J, Olsson-Strömberg U. Treatment-free remission after a second TKI discontinuation attempt in patients with Chronic Myeloid Leukemia re-treated with dasatinib - interim results from the DAstop2 trial. Leukemia 2024; 38:781-787. [PMID: 38278960 PMCID: PMC10997502 DOI: 10.1038/s41375-024-02145-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/25/2023] [Accepted: 01/08/2024] [Indexed: 01/28/2024]
Abstract
Tyrosine kinase inhibitor (TKI) discontinuation in chronic myeloid leukemia (CML) has become part of routine care for patients with a sustained deep molecular response (DMR). Approximately 50% experience a molecular relapse upon TKI cessation. Most of them quickly regain DMR upon TKI resumption. Whether these patients can achieve a second treatment-free remission (TFR) remains unclear. DAstop2 (ClinicalTrials.gov ID: NCT03573596) is a prospective study including patients with a failed first TFR attempt re-treated with any TKI for ≥ one year. Upon entering the study, patients received the TKI dasatinib for additional two years. Patients with sustained DMR for ≥1 year qualified for a second TKI stop. Ninety-four patients were included between Oct 2017-Dec 2021. At the time of data analysis, 62 patients had attempted a 2nd stop. After a median follow-up of 27 months from 2nd stop, TFR rates were 61, 56 and 46% at 6, 12 and 24 months respectively. No progression to advanced stage disease was seen and 87% had re-achieved MR4 within a median of 3 months from TKI re-initiation. In summary, we show that a 2nd TFR attempt after dasatinib treatment is safe, feasible and TFR rates seem in the range of those reported in trials of a first TKI stop.
Collapse
Affiliation(s)
- Hjalmar Flygt
- Department of Medical Science and Division of Hematology, Uppsala University Hospital, Uppsala, Sweden.
| | - Stina Söderlund
- Department of Medical Science and Division of Hematology, Uppsala University Hospital, Uppsala, Sweden
| | - Johan Richter
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Susanne Saussele
- Medical Clinic, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Perttu Koskenvesa
- Department of Hematology, Hematology Research Unit Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
| | - Leif Stenke
- Department of Hematology, Karolinska University Hospital and Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Satu Mustjoki
- Department of Hematology, Hematology Research Unit Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
- Translational Immunology Research Program and Department of Clinical Chemistry and Hematology, University of Helsinki, Helsinki, Finland
- ICAN Digital Precision Cancer Medicine Flagship, Helsinki, Finland
| | | | - Jesper Stentoft
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Waleed Majeed
- Department of Hemato-Oncology, Stavanger University Hospital, Stavanger, Norway
| | - Lydia Roy
- French CML group Fi-LMC, Centre Léon Bérard, Lyon, Hôpital Universitaire Henri Mondor, AP-HP, Service d'hématologie Clinique & Faculté de Santé, Université Paris Est Créteil, Créteil, France
| | - Dominik Wolf
- Department of Hematology and Oncology, Comprehensive Cancer Center Innsbruck (CCCI), Tyrolean Cancer Research Institute (TKFI), Medical University Innsbruck, Innsbruck, Austria
- Medical Clinic 3, Universitätsklinikum, Bonn, Germany
| | - Arta Dreimane
- Department of Hematology, Linköping University Hospital, Linköping, Sweden
| | - Bjørn Tore Gjertsen
- Department of Internal Medicine, Hematology Section, Haukeland University Hospital, Bergen, Norway
| | - Tobias Gedde-Dahl
- Department of Hematology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Erik Ahlstrand
- Department of Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Berit Markevärn
- Department of Hematology, Umeå University Hospital, Umeå, Sweden
| | | | - Jeroen Janssen
- Department of Hematology, Radboud University medical center, Nijmegen, The Netherlands
| | - Ulla Olsson-Strömberg
- Department of Medical Science and Division of Hematology, Uppsala University Hospital, Uppsala, Sweden
| |
Collapse
|
39
|
Chelysheva E, Apperley J, Turkina A, Yassin MA, Rea D, Nicolini FE, Barraco D, Kazakbaeva K, Saliev S, Abulafia AS, Al-Kindi S, Byrne J, Robertson HF, Cerrano M, Shmakov R, Polushkina E, de Fabritiis P, Trawinska MM, Abruzzese E. Chronic myeloid leukemia diagnosed in pregnancy: management and outcome of 87 patients reported to the European LeukemiaNet international registry. Leukemia 2024; 38:788-795. [PMID: 38388649 DOI: 10.1038/s41375-024-02183-0] [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: 11/13/2023] [Revised: 02/07/2024] [Accepted: 02/13/2024] [Indexed: 02/24/2024]
Abstract
The management of chronic myeloid leukemia (CML) diagnosed during pregnancy is a rare and challenging situation. We report the treatment and outcome of 87 cases diagnosed in chronic phase from 2001-2022 derived from the largest international observational registry, supported by the European LeukemiaNet (ELN), of 400 pregnancies in 299 CML women. Normal childbirth occurred in 76% without an increased rate of birth abnormalities or life-threatening events, including in patients untreated or treated with interferon-α and/or imatinib in 2nd-3rd trimester. The low birth weight rate of 12% was comparable to that seen in the normal population. Elective and spontaneous abortions occurred in 21% and 3%, respectively. The complete hematologic response rate before labor was 95% with imatinib and 47% with interferon only. No disease progression during pregnancy was observed, 28% of the patients switched their therapy at varying times after delivery. Treatment options balance the efficacy and safety for mother and infant: interferon-α can commence in the 1st trimester and continued throughout in cases of good disease control and tolerability. Because of limited placental crossing, selected tyrosine kinase inhibitors (imatinib and nilotinib) seem to be safe and effective options in 2nd and 3rd trimester while hydroxycarbamide offers few benefits.
Collapse
Affiliation(s)
| | - Jane Apperley
- Centre for Haematology, Imperial College London, London, UK
| | - Anna Turkina
- National Medical Research Center for Hematology, Moscow, Russian Federation
| | - Mohamed A Yassin
- Department of Medical Oncology/ Hematology Section, National Centre For Cancer Care & Research, Doha, Qatar
| | - Delphine Rea
- Service d'hématologie Adulte and FiLMC Hôpital Saint-Louis, Paris, France
| | - Franck E Nicolini
- Hematology department and INSERM 1052 CRCL, Centre Léon Bérard, Lyon, France
| | - Daniela Barraco
- Division of Hematology, University Hospital "Ospedale di Circolo e Fondazione Macchi - ASST Sette Laghi", Varese, Italy
| | - Khamida Kazakbaeva
- Republician Specilized Scientific and Practical Medical Centre of Hematology, Tashkent, Uzbekistan
| | - Sukhrob Saliev
- Republician Specilized Scientific and Practical Medical Centre of Hematology, Tashkent, Uzbekistan
| | - Adi Shacham Abulafia
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Campus, Petah-Tikva, Israel
| | - Salam Al-Kindi
- Department of Haematology, Sultan Qaboos University, Muscat, Oman
| | - Jennifer Byrne
- Centre for Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, England, UK
| | | | - Marco Cerrano
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Roman Shmakov
- FSBI «National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I.Kulakov» Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
| | - Evgenia Polushkina
- FSBI «National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I.Kulakov» Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
| | - Paolo de Fabritiis
- Hematology, S. Eugenio Hospital, Tor Vergata University, ASL Roma2, Rome, Italy
| | | | | |
Collapse
|
40
|
Veltmaat L, Cortes J. Arterio-occlusive events among patients with chronic myeloid leukemia on tyrosine kinase inhibitors. Blood 2024; 143:858-865. [PMID: 38194683 DOI: 10.1182/blood.2023022403] [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: 09/12/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 01/11/2024] Open
Abstract
ABSTRACT Tyrosine kinase inhibitors (TKIs) are standard therapy for patients with chronic myeloid leukemia. Each of these drugs has a specific profile of tyrosine kinases that they inhibit and, although all are clinically effective, they each have unique toxicity profiles. With the introduction of ponatinib, arterio-occlusive events were first noted and later found to occur with all TKIs to various extents. The recognition of this "class effect" was delayed considering ponatinib was introduced 10 years after the introduction of imatinib. The reasons for the delay in identification of this class effect are likely multifaceted. Importantly, there is an inconsistency in adverse event reporting criteria among the major clinical trials of the various TKIs, likely resulting in mixed reporting of arterio-occlusive events. Reporting events based on a frequency threshold, lack of sufficient follow-up, attempts at causality attribution, and the primary focus on molecular response may all have played an additional role. Considering the increasing rate of arterio-occlusive events over time, the termination of many trials after only 5 years prevents full assessment of the impact of these events. A comprehensive evaluation of TKI adverse effects using uniform Medical Dictionary for Regulatory Activities terms and comprehensive adjudication of these events may be helpful in better assessing the real risk for patients with each TKI. Future clinical trials should use a uniform and comprehensive approach to reporting adverse events without attempting to assign causality to the study drug.
Collapse
Affiliation(s)
| | - Jorge Cortes
- Georgia Cancer Center at Augusta University, Augusta, GA
| |
Collapse
|
41
|
Ansari AS, K C R, Morales LC, Nasrullah M, Meenakshi Sundaram DN, Kucharski C, Jiang X, Brandwein J, Uludağ H. Lipopolymer mediated siRNA delivery targeting aberrant oncogenes for effective therapy of myeloid leukemia in preclinical animal models. J Control Release 2024; 367:821-836. [PMID: 38360178 DOI: 10.1016/j.jconrel.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 02/17/2024]
Abstract
The clinical development of tyrosine kinase inhibitors (TKI) has led to great strides in improving the survival of chronic myeloid leukemia (CML) and acute myeloid leukemia (AML) patients. But even the new generation TKIs are rendered futile in the face of evolving landscape of acquired mutations leading to drug resistance, necessitating the pursuit of alternative therapeutic approaches. In contrast to exploiting proteins as targets like most conventional drugs and TKIs, RNA Interference (RNAi) exerts its therapeutic action towards disease-driving aberrant genes. To realize the potential of RNAi, the major challenge is to efficiently deliver the therapeutic mediator of RNAi, small interfering RNA (siRNA) molecules. In this study, we explored the feasibility of using aliphatic lipid (linoleic acid and lauric acid)-grafted polymers (lipopolymers) for the delivery of siRNAs against the FLT3 oncogene in AML and BCR-ABL oncogene in CML. The lipopolymer delivered siRNA potently suppressed the proliferation AML and CML cells via silencing of the targeted oncogenes. In both AML and CML subcutaneous xenografts generated in NCG mice, intravenously administered lipopolymer/siRNA complexes displayed significant inhibitory effect on tumor growth. Combining siFLT3 complexes with gilteritinib allowed for reduction of effective drug dosage, longer duration of remission, and enhanced survival after relapse, compared to gilteritinib monotherapy. Anti-leukemic activity of siBCR-ABL complexes was similar in wild-type and TKI-resistant cells, and therapeutic efficacy was confirmed in vivo through prolonged survival of the NCG hosts systemically implanted with TKI-resistant cells. These results demonstrate the preclinical efficacy of lipopolymer facilitated siRNA delivery, providing a novel therapeutic platform for myeloid leukemias.
Collapse
MESH Headings
- Humans
- Animals
- Mice
- RNA, Small Interfering
- Fusion Proteins, bcr-abl/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/genetics
- Oncogenes
- Models, Animal
- Protein Kinase Inhibitors/therapeutic use
- Protein Kinase Inhibitors/pharmacology
- Drug Resistance, Neoplasm
- Aniline Compounds
- Pyrazines
Collapse
Affiliation(s)
- Aysha S Ansari
- Department of Chemical and Materials Engineering, Faculty of Engineering, University of Alberta, Edmonton T6G 1H9, Alberta, Canada
| | - Remant K C
- Department of Chemical and Materials Engineering, Faculty of Engineering, University of Alberta, Edmonton T6G 1H9, Alberta, Canada
| | - Luis C Morales
- Department of Chemical and Materials Engineering, Faculty of Engineering, University of Alberta, Edmonton T6G 1H9, Alberta, Canada
| | - Mohammad Nasrullah
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton T6G 2H1, Alberta, Canada
| | | | - Cezary Kucharski
- Department of Chemical and Materials Engineering, Faculty of Engineering, University of Alberta, Edmonton T6G 1H9, Alberta, Canada
| | - Xiaoyan Jiang
- Department of Molecular Genetics and Terry Fox Labs, University of British Columbia, Vancouver V5Z 1L3, British Columbia, Canada
| | - Joseph Brandwein
- Division of Hematology, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton T6G 2E1, Alberta, Canada
| | - Hasan Uludağ
- Department of Chemical and Materials Engineering, Faculty of Engineering, University of Alberta, Edmonton T6G 1H9, Alberta, Canada; Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton T6G 2H1, Alberta, Canada.
| |
Collapse
|
42
|
Collins JB, Muluneh B, Profitt S. Evaluation of real-world versus clinical trial outcomes of tyrosine kinase inhibitor therapy for chronic myeloid leukemia. J Oncol Pharm Pract 2024; 30:385-396. [PMID: 38105466 PMCID: PMC10943612 DOI: 10.1177/10781552231217694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 12/19/2023]
Abstract
Tyrosine kinase inhibitors (TKIs) are the mainstay of treatment for chronic myeloid leukemia (CML). Patients enrolled in clinical trials investigating the safety and efficacy of TKIs in CML are generally younger, have fewer comorbidities, and are monitored differently than patients treated in the real world. This narrative literature review summarizes efficacy outcomes (complete cytogenetic response, major molecular response, and disease progression) and safety outcomes (duration of TKI therapy, TKI discontinuation rates, dosage changes, and frequently reported adverse events) from landmark clinical trials as well as real-world studies. Patients with CML treated with TKIs in a real-world setting may achieve different rates of specific response milestones than those treated on clinical trials. While real-world studies reported similar overall incidences of adverse events as clinical trials, real-world patients with CML were more likely to discontinue TKIs due to adverse events.
Collapse
Affiliation(s)
- James B Collins
- UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Benyam Muluneh
- UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
- UNC Lineberger Cancer Center, Chapel Hill, NC, USA
| | - Sarah Profitt
- Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
43
|
Zou H, Luo J, Guo Y, Deng L, Zeng L, Pan Y, Li P. Tyrosine phosphorylation-mediated YAP1-TFAP2A interactions coordinate transcription and trastuzumab resistance in HER2+ breast cancer. Drug Resist Updat 2024; 73:101051. [PMID: 38219531 DOI: 10.1016/j.drup.2024.101051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 12/31/2023] [Accepted: 01/05/2024] [Indexed: 01/16/2024]
Abstract
Trastuzumab resistance in HER2+ breast cancer (BC) is the major reason leading to poor prognosis of BC patients. Oncogenic gene overexpression or aberrant activation of tyrosine kinase SRC is identified to be the key modulator of trastuzumab response. However, the detailed regulatory mechanisms underlying SRC activation-associated trastuzumab resistance remain poorly understood. In the present study, we discover that SRC-mediated YAP1 tyrosine phosphorylation facilitates its interaction with transcription factor AP-2 alpha (activating enhancer binding protein 2 alpha, TFAP2A), which in turn promotes YAP1/TEAD-TFAP2A (YTT) complex-associated transcriptional outputs, thereby conferring trastuzumab resistance in HER2+ BC. Inhibition of SRC kinase activity or disruption of YTT complex sensitizes cells to trastuzumab treatment in vitro and in vivo. Additionally, we also identify YTT complex co-occupies the regulatory regions of a series of genes related to trastuzumab resistance and directly regulates their transcriptions, including EGFR, HER2, H19 and CTGF. Moreover, YTT-mediated transcriptional regulation is coordinated by SRC kinase activity. Taken together, our study reveals that SRC-mediated YTT complex formation and transcriptions are responsible for multiple mechanisms associated with trastuzumab resistance. Therefore, targeting HER2 signaling in combination with the inhibition of YTT-associated transcriptional outputs could serve as the treatment strategy to overcome trastuzumab resistance caused by SRC activation.
Collapse
Affiliation(s)
- Hailin Zou
- Scientific Research Center, The Seventh Affiliated Hospital of Sun Yat-sen University, No. 628 Zhenyuan Road, Shenzhen 518107, Guangdong, China
| | - Juan Luo
- Scientific Research Center, The Seventh Affiliated Hospital of Sun Yat-sen University, No. 628 Zhenyuan Road, Shenzhen 518107, Guangdong, China
| | - Yibo Guo
- Scientific Research Center, The Seventh Affiliated Hospital of Sun Yat-sen University, No. 628 Zhenyuan Road, Shenzhen 518107, Guangdong, China
| | - Liang Deng
- Department of General Surgery, The Seventh Affiliated Hospital of Sun Yat-sen University, No. 628 Zhenyuan Road, Shenzhen 518107, Guangdong, China
| | - Leli Zeng
- Scientific Research Center, The Seventh Affiliated Hospital of Sun Yat-sen University, No. 628 Zhenyuan Road, Shenzhen 518107, Guangdong, China
| | - Yihang Pan
- Scientific Research Center, The Seventh Affiliated Hospital of Sun Yat-sen University, No. 628 Zhenyuan Road, Shenzhen 518107, Guangdong, China; Guangdong Provincial Key Laboratory of Digestive Cancer Research, The Seventh Affiliated Hospital of Sun Yat-sen University, No. 628 Zhenyuan Road, Shenzhen 518107, Guangdong, China.
| | - Peng Li
- Scientific Research Center, The Seventh Affiliated Hospital of Sun Yat-sen University, No. 628 Zhenyuan Road, Shenzhen 518107, Guangdong, China; Guangdong Provincial Key Laboratory of Digestive Cancer Research, The Seventh Affiliated Hospital of Sun Yat-sen University, No. 628 Zhenyuan Road, Shenzhen 518107, Guangdong, China.
| |
Collapse
|
44
|
Menger JM, Sathianathen RS, Sakamoto KM, Hijiya N. BCR/ABL-Positive Chronic Myeloid Leukemia in Children: Current Treatment Approach. Curr Oncol Rep 2024; 26:250-257. [PMID: 38340217 DOI: 10.1007/s11912-024-01502-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the most updated treatment recommendations for pediatric CML, and to discuss current areas of investigation. RECENT FINDINGS There is new phase 1 data to support the safety of the non-ATP competitive tyrosine kinase inhibitor (TKI) asciminib in the pediatric cohort. Ongoing studies are investigating the role of treatment-free remission in children. Chronic phase CML in children is managed with lifelong TKI therapy; however, evidence of deeper remissions sustained with second-generation TKIs may permit shorter treatment courses. Use of more specific TKIs may mitigate some of the side effects specific to the pediatric cohort. Children with advanced phase CML should achieve a complete hematologic remission with use of a second-generation TKI prior to transplant to achieve the best outcome.
Collapse
Affiliation(s)
- Jenna M Menger
- Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, 10069, USA.
| | | | - Kathleen M Sakamoto
- Division of Hematology/Oncology, Department of Pediatrics, Stanford University, Stanford, CA, 94305, USA
| | - Nobuko Hijiya
- Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, 10069, USA
| |
Collapse
|
45
|
Klink AJ, Keating SJ, Brokars J, Feinberg B, Jabbour E. Real-World Effectiveness of Dasatinib Versus Imatinib in Newly Diagnosed Patients With Chronic Myeloid Leukemia. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024; 24:149-157. [PMID: 38135632 DOI: 10.1016/j.clml.2023.10.005] [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: 07/26/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION Limited data exist comparing dasatinib with imatinib in clinical practice. This study assessed real-world outcomes associated with first-line (1L) dasatinib or imatinib treatment of chronic myeloid leukemia (CML). PATIENTS AND METHODS This retrospective, observational, United States multisite cohort study analyzed electronic medical record data from adults with Philadelphia chromosome-positive (Ph+) CML in the chronic phase (CML-CP) after 1L dasatinib or imatinib between January 2014 and September 2018. Rates of and times to major molecular response (MMR) and deep molecular response (DMR) were assessed overall and in subgroups (low vs. intermediate/high risk, aged <65 vs. ≥65 years, low/normal vs. high body mass index [BMI]). RESULTS The dasatinib cohort (n = 309) experienced higher rates of MMR (n = 304, 79% vs. 65%, P < .001) and DMR (44% vs. 25%, P < .001) vs. the imatinib cohort with shorter median times to MMR (11.9 vs. 14.7 months, P < .001) and DMR (30.3 vs. 66.1 months, P < .001). Patients with intermediate-/high-risk disease and those aged <65 years had higher MMR and DMR rates and achieved response earlier with dasatinib (P < .01). Patients with low-risk disease treated with dasatinib had higher rates of DMR (60% vs. 32%, P = .01). Across BMI strata, rates of MMR and DMR were higher with dasatinib (P < .05). CONCLUSIONS Patients with CML-CP treated with 1L dasatinib achieved higher rates of, with shorter times to, MMR and DMR versus 1L imatinib. These clinically meaningful improvements were observed across subgroups.
Collapse
Affiliation(s)
| | | | | | | | - Elias Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
46
|
Batar P, Alizadeh H, Rokszin G, Abonyi-Toth Z, Demeter J. Comorbidities and outcomes of patients with chronic myeloid leukemia treated with tyrosine kinase inhibitors: a real-world, nationwide, retrospective study from Hungary. Pathol Oncol Res 2024; 30:1611497. [PMID: 38444749 PMCID: PMC10913892 DOI: 10.3389/pore.2024.1611497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 02/07/2024] [Indexed: 03/07/2024]
Abstract
Purpose: This study aimed to provide real-world evidence on the characteristics, treatment patterns, and outcomes of patients with chronic myeloid leukemia (CML) receiving tyrosine kinase inhibitor (TKI) treatment in Hungary between 2011 and 2019. Patients and methods: This nationwide, retrospective study included patients who were newly diagnosed with CML in Hungarian clinical practice between January 2011 and December 2019. The analysis was based on the reimbursed prescription claims for imatinib, bosutinib, dasatinib, nilotinib, or ponatinib with the ICD-10 code C9210 in a public pharmacy between January 2009 and December 2019 using data from the National Health Insurance Fund (NHIF) of Hungary. CML incidence and prevalence, TKI treatment patterns, comorbidities, and overall survival (OS) were examined. Results: Between 2011 and 2019, altogether 1,407 patients were diagnosed with CML, with an annual average of 156 patients. The number of patients newly initiating first-line TKI therapy for CML significantly increased between 2011 and 2019 (2011: n = 136 vs. 2019: n = 191; p = 0.0043). Nilotinib was typically prescribed for younger patients (≤64 years), while older patients (≥65 years) mostly received imatinib. The most common comorbidity of CML patients was hypertension, and the proportion of patients with other malignancies was relatively high in all treatment groups. 5-year OS was 77.1% during the whole study period. Patients initiating first-line TKI treatment for CML in 2015 had significantly better 4-year OS compared to those starting treatment in 2011 (82.4% vs. 73.5%, respectively, (HR 0.53 (95%CI 0.32-0.87) p = 0.0118). Conclusion: This study is the first to provide insights into the characteristics, treatment patterns, and outcomes of CML patients treated with TKIs in Hungarian clinical practice between 2011 and 2019. We found slightly lower OS rates compared to other European countries, however, there was a statistically significant improvement in 4-year OS during the study period. The management of CML was in line with international guidelines and recommendations.
Collapse
Affiliation(s)
- Peter Batar
- Department of Hematology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Hussain Alizadeh
- 1st Department of Medicine, Division of Haematology, Clinical Center, Medical School, University of Pecs, Pecs, Hungary
| | | | - Zsolt Abonyi-Toth
- RxTarget Ltd., Szolnok, Hungary
- Department of Biostatistics, University of Veterinary Medicine, Budapest, Hungary
| | - Judit Demeter
- Department of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| |
Collapse
|
47
|
Elsabagh AA, Benkhadra M, Elmakaty I, Elsayed A, Elsayed B, Elmarasi M, Abutineh M, Qasem NM, Ali E, Yassin M. Male Fertility and Fatherhood in Chronic Myeloid Leukemia: Current Understanding and Future Perspectives. Cancers (Basel) 2024; 16:791. [PMID: 38398181 PMCID: PMC10886940 DOI: 10.3390/cancers16040791] [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: 10/16/2023] [Revised: 11/08/2023] [Accepted: 11/16/2023] [Indexed: 02/25/2024] Open
Abstract
Chronic myeloid leukemia (CML), while traditionally a disease of the elderly, has recently risen in incidence among younger patients. Hence, fertility concerns have emerged considering the disease process and treatments, especially with the current scarce and conflicting recommendations. This review explores the impact of CML treatments including the first-line tyrosine kinase inhibitors (TKIs) and other treatments on male fertility in chronic myeloid leukemia (CML) patients. The aim of this review was to compile the available evidence on male fertility to ultimately tailor treatment plans for male CML patients for whom fertility and future chances for conception pose a concern. The data available on the conventional and newer TKIs to address fertility concerns were reviewed, particularly the potential long- and short-term effects. Also, the possible side effects on subsequent generations were a crucial focus point of this review to reach a more comprehensive CML management approach. We found and compared the evidence on TKIs approved to treat CML. We also reported the effects of hydroxyurea, interferon, and transplantation, which are considered second-line treatments. Our findings suggest that these drugs might have an undiscovered effect on fertility. More research with larger sample sizes and longer follow-up periods is essential to solidify our understanding of these effects.
Collapse
Affiliation(s)
- Ahmed Adel Elsabagh
- College of Medicine, Qatar University, Doha P.O. Box 2713, Qatar; (I.E.); (B.E.); (M.E.)
| | - Maria Benkhadra
- National Center for Cancer Care & Research, Hamad General Hospital, Doha P.O. Box 3050, Qatar;
| | - Ibrahim Elmakaty
- College of Medicine, Qatar University, Doha P.O. Box 2713, Qatar; (I.E.); (B.E.); (M.E.)
| | - Abdelrahman Elsayed
- College of Medicine, Qatar University, Doha P.O. Box 2713, Qatar; (I.E.); (B.E.); (M.E.)
| | - Basant Elsayed
- College of Medicine, Qatar University, Doha P.O. Box 2713, Qatar; (I.E.); (B.E.); (M.E.)
| | - Mohamed Elmarasi
- College of Medicine, Qatar University, Doha P.O. Box 2713, Qatar; (I.E.); (B.E.); (M.E.)
| | - Mohammad Abutineh
- Hematology Section, Medical Oncology, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation, Doha P.O. Box 3050, Qatar (N.M.Q.)
| | - Nabeel Mohammad Qasem
- Hematology Section, Medical Oncology, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation, Doha P.O. Box 3050, Qatar (N.M.Q.)
| | - Elrazi Ali
- One Brooklyn Health, Interfaith Medical Center, Brooklyn, NY 11213, USA;
| | - Mohamed Yassin
- Hematology Section, Medical Oncology, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation, Doha P.O. Box 3050, Qatar (N.M.Q.)
| |
Collapse
|
48
|
Marcé S, Méndez A, Xicoy B, Estrada N, Cabezón M, Sturla AL, García MR, Angona A, Amat P, Escribano Serrat S, Scalzulli E, Morgades M, Senín A, Hernández-Boluda JC, Ferrer-Marín F, Anguita E, Cortés M, Plensa E, Breccia M, García-Gutierrez V, Zamora L. e14a2 Transcript Favors Treatment-Free Remission in Chronic Myeloid Leukemia When Associated with Longer Treatment with Tyrosine Kinase Inhibitors and Sustained Deep Molecular Response. J Clin Med 2024; 13:779. [PMID: 38337473 PMCID: PMC10856594 DOI: 10.3390/jcm13030779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
e13a2 and e14a2 are the most frequent transcript types of the BCR::ABL1 fusion gene in chronic myeloid leukemia (CML). The current goal with tyrosine kinase inhibitors (TKI) is to achieve sustained deep molecular response (DMR) in order to discontinue TKI treatment and remain in the so-called treatment-free remission (TFR) phase, but biological factors associated with these goals are not well established. This study aimed to determine the effect of transcript type on TFR in patients receiving frontline treatment with imatinib (IM) or second-generation TKI (2G-TKI). Patients treated at least 119 months with IM presented less post-discontinuation relapse than those that discontinued IM before 119 months (p = 0.005). In addition, cases with the e14a2 transcript type treated at least 119 months with IM presented a better TFR (p = 0.024). On the other hand, the type of transcript did not affect the cytogenetic or molecular response in 2G-TKI treated patients; however, the use of 2G-TKI may be associated with higher and earlier DMR in patients with the e14a2 transcript.
Collapse
Affiliation(s)
- Sílvia Marcé
- Hematology Department, Myeloid Neoplasms Group, ICO Badalona-Hospital Germans Trias i Pujol, Josep Carreras Leukaemia Research Institute (IJC), 08916 Badalona, Spain; (A.M.); (B.X.); (N.E.); (M.C.); (M.M.); (L.Z.)
| | - Aleix Méndez
- Hematology Department, Myeloid Neoplasms Group, ICO Badalona-Hospital Germans Trias i Pujol, Josep Carreras Leukaemia Research Institute (IJC), 08916 Badalona, Spain; (A.M.); (B.X.); (N.E.); (M.C.); (M.M.); (L.Z.)
| | - Blanca Xicoy
- Hematology Department, Myeloid Neoplasms Group, ICO Badalona-Hospital Germans Trias i Pujol, Josep Carreras Leukaemia Research Institute (IJC), 08916 Badalona, Spain; (A.M.); (B.X.); (N.E.); (M.C.); (M.M.); (L.Z.)
| | - Natalia Estrada
- Hematology Department, Myeloid Neoplasms Group, ICO Badalona-Hospital Germans Trias i Pujol, Josep Carreras Leukaemia Research Institute (IJC), 08916 Badalona, Spain; (A.M.); (B.X.); (N.E.); (M.C.); (M.M.); (L.Z.)
| | - Marta Cabezón
- Hematology Department, Myeloid Neoplasms Group, ICO Badalona-Hospital Germans Trias i Pujol, Josep Carreras Leukaemia Research Institute (IJC), 08916 Badalona, Spain; (A.M.); (B.X.); (N.E.); (M.C.); (M.M.); (L.Z.)
| | - Antonella Luciana Sturla
- Hematology Department, ICO Hospitalet-Hospital Duran y Reynals, 08908 Barcelona, Spain; (A.L.S.); (M.R.G.); (A.S.)
| | - Miriam Ratia García
- Hematology Department, ICO Hospitalet-Hospital Duran y Reynals, 08908 Barcelona, Spain; (A.L.S.); (M.R.G.); (A.S.)
| | - Anna Angona
- Hematology Department, ICO Girona-Hospital Josep Trueta, 17007 Girona, Spain;
| | - Paula Amat
- Hematology Department, Hospital Clínico Universitario-INCLIVA de Valencia, 46010 Valencia, Spain; (P.A.); (J.C.H.-B.)
| | - Silvia Escribano Serrat
- Hematology Department, Hospital Clínico San Carlos, IML, IdISSC, Universidad Complutense de Madrid (UCM), 28040 Madrid, Spain; (S.E.S.); (E.A.)
| | - Emilia Scalzulli
- Hematology, Department of Precision and Translational Medicine, Policlinico Umberto 1, Sapienza University, 00189 Rome, Italy; (E.S.); (M.B.)
| | - Mireia Morgades
- Hematology Department, Myeloid Neoplasms Group, ICO Badalona-Hospital Germans Trias i Pujol, Josep Carreras Leukaemia Research Institute (IJC), 08916 Badalona, Spain; (A.M.); (B.X.); (N.E.); (M.C.); (M.M.); (L.Z.)
| | - Alicia Senín
- Hematology Department, ICO Hospitalet-Hospital Duran y Reynals, 08908 Barcelona, Spain; (A.L.S.); (M.R.G.); (A.S.)
| | - Juan Carlos Hernández-Boluda
- Hematology Department, Hospital Clínico Universitario-INCLIVA de Valencia, 46010 Valencia, Spain; (P.A.); (J.C.H.-B.)
| | - Francisca Ferrer-Marín
- Hematology Department, Hospital General Universitario Morales Meseguer-CIBERER, IMIB, UCAM, 30008 Múrcia, Spain;
| | - Eduardo Anguita
- Hematology Department, Hospital Clínico San Carlos, IML, IdISSC, Universidad Complutense de Madrid (UCM), 28040 Madrid, Spain; (S.E.S.); (E.A.)
| | - Montserrat Cortés
- Hematology Department, Hospital General de Granollers, 08402 Granollers, Spain;
| | - Esther Plensa
- Hematology Department, Consorci Sanitari del Maresme, Hospital de Mataró, 08301 Mataró, Spain;
| | - Massimo Breccia
- Hematology, Department of Precision and Translational Medicine, Policlinico Umberto 1, Sapienza University, 00189 Rome, Italy; (E.S.); (M.B.)
| | - Valentín García-Gutierrez
- Hematology Department, Hospital Ramón y Cajal, IRYCIS, Universidad de Alcalalá Madrid, 28801 Madrid, Spain;
| | - Lurdes Zamora
- Hematology Department, Myeloid Neoplasms Group, ICO Badalona-Hospital Germans Trias i Pujol, Josep Carreras Leukaemia Research Institute (IJC), 08916 Badalona, Spain; (A.M.); (B.X.); (N.E.); (M.C.); (M.M.); (L.Z.)
| |
Collapse
|
49
|
Huang CE, Lee KD, Chang JJ, Tzeng HE, Huang SH, Yu LHL, Chen MC. Association of Nilotinib With Cardiovascular Diseases in Patients With Chronic Myelogenous Leukemia: A National Population-Based Cohort Study. Oncologist 2024; 29:e81-e89. [PMID: 37561957 PMCID: PMC10769786 DOI: 10.1093/oncolo/oyad225] [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: 03/27/2023] [Accepted: 07/12/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Tyrosine kinase inhibitor (TKI) treatment has been identified to be a risk factor for metabolic syndrome and cardiovascular diseases (CVDs) in patients diagnosed with chronic myeloid leukemia (CML). However, the specific contribution of post-TKI metabolic syndrome and the individual TKIs, including imatinib, nilotinib, and dasatinib, contribute to the development of CVDs remains unclear. METHODS We conducted a nationwide database to investigate the incidence of post-TKI metabolic syndrome, including diabetes, hyperlipidemia, and hypertension, as well as their association with CVDs. To compare the risk of post-TKI comorbidities and CVDs among TKIs, we utilized the incidence rate ratio (IRR), and subdistribution hazard ratio (SHR) calculated from multiple Fine-Gray models. RESULTS A total of 1211 patients without diabetes, 1235 patients without hyperlipidemia, and 1074 patients without hypertension were enrolled in the study. The incidence rate of post-TKI diabetes and hyperlipidemia was the highest in patients treated with nilotinib compared to imatinib and dasatinib (IRRs ≥ 3.15, Ps ≤ .047). After adjusting for confounders, nilotinib remained a significant risk factor for post-TKI diabetes and hyperlipidemia at an SHR of 3.83 (P < .001) and 5.15 (P < .001), respectively. Regarding the occurrence of CVDs, patients treated with nilotinib were more likely to develop CVDs than those treated with imatinib in non-hyperlipidemic group (IRR = 3.21, P = .020). Pre-existing and post-TKI hyperlipidemia were found to have a stronger association with CVDs, with SHR values of 5.81 (P = .034) and 13.21 (P = .001), respectively. CONCLUSION The findings of this study indicate that nilotinib treatment is associated with increased risks of diabetes and hyperlipidemia, with hyperlipidemia being the most significant risk for CVDs. Therefore, we recommend that CML patients receiving nilotinib should undergo screening for diabetes and hyperlipidemia prior to initiating TKI treatment. Additionally, regular monitoring of lipid profiles during TKI therapy and implementing effective management strategies to control hyperlipidemia are crucial.
Collapse
Affiliation(s)
- Cih-En Huang
- Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuan-Der Lee
- Cell Therapy and Regenerative Medicine Center, Comprehensive Cancer Center, Taichung Veterans General Hospital, Taichung, Taiwan
- International Ph.D. Program for Cell Therapy and Regeneration Medicine, College of Medicine, School of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Jung-Jung Chang
- Division of Cardiology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Huey-En Tzeng
- Division of Transfusion Medicine, Department of Pathology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shih-Hao Huang
- Department of Public Health and Biostatistics Consulting Center, Chang Gung University, Taoyuan, Taiwan
| | | | - Min-Chi Chen
- Department of Public Health and Biostatistics Consulting Center, Chang Gung University, Taoyuan, Taiwan
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| |
Collapse
|
50
|
Costa A, Abruzzese E, Latagliata R, Mulas O, Carmosino I, Scalzulli E, Bisegna ML, Ielo C, Martelli M, Caocci G, Breccia M. Safety and Efficacy of TKIs in very Elderly Patients (≥75 Years) with Chronic Myeloid Leukemia. J Clin Med 2024; 13:273. [PMID: 38202280 PMCID: PMC10779829 DOI: 10.3390/jcm13010273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 12/27/2023] [Accepted: 12/30/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND While the outcomes of chronic phase chronic myeloid leukemia (CP-CML) patients aged over 65 years have been extensively evaluated in real-life experiences, limited data exist for the very elderly population (i.e., aged ≥ 75 years), especially for next-generation tyrosine kinase inhibitors (TKIs). In this retrospective study, we sought to evaluate the safety and efficacy of TKIs in this particular setting of patients. METHODS We conducted a retrospective analysis of a multicenter cohort of 123 newly diagnosed CP-CML very elderly patients. RESULTS The median age at diagnosis was 80 years (range: 75-96). In the first line, 86.1% of patients received imatinib, 7.1% dasatinib, 5.6% nilotinib, and 0.81% received bosutinib. A total of 31 patients (25.2%) switched to second-line therapy, nine patients to a third line, and one patient to a fourth line of therapy. Resistance to treatment was the primary reason for switching therapy in both the first (64.5%) and second lines (77.7%). At diagnosis, reduced doses were administered in 36.5% of patients, in 61.2% in the second line, and in all patients in subsequent lines of therapy. In the first-line setting, 71.9% of patients achieved an early molecular response (EMR, i.e., 3-month BCR::ABL1IS < 10%); at 6, 12, and 24 months, MR3 was reached by 35.7%, 55.7%, and 75.0% of patients, respectively, with 16.6%, 35.7%, and 51.7% achieving a deep molecular response (DMR) at the same time points. Treatment-free remission (TFR) was successfully attempted in 11 patients. During the follow-up period, adverse events (AEs) were observed in 78.8% of patients, including 22 cases of cardiovascular AEs. Toxicity grade ≥ 3 was more commonly observed in patients treated with standard doses of TKIs compared to reduced doses (p = 0.033). Overall, the median follow-up was 46.62 months (range: 1.8-206.2), and 43 patients died due to non-CML-related causes. Three patients died due to disease progression to advanced (n = 1) and blastic (n = 2) phases. The 5-year overall survival (OS) for the entire cohort was 71.9% (95% CI: 0.63-0.81), with no significant difference between the patients treated with standard doses of TKIs compared to those treated with reduced doses (p = 0.35). CONCLUSIONS TKIs appear to be safe and effective even in very elderly CML patients, and dose optimization strategies yield satisfactory molecular responses for adequate disease control with an improved safety profile.
Collapse
Affiliation(s)
- Alessandro Costa
- 1Hematology Unit, Businco Hospital, Department of Medical Sciences and Public Health, University of Cagliari, 09121 Cagliari, Italy; (A.C.); (O.M.); (G.C.)
| | - Elisabetta Abruzzese
- Hematology Unit, S. Eugenio Hospital, ASL Roma 2, Tor Vergata University, 00144 Rome, Italy
| | | | - Olga Mulas
- 1Hematology Unit, Businco Hospital, Department of Medical Sciences and Public Health, University of Cagliari, 09121 Cagliari, Italy; (A.C.); (O.M.); (G.C.)
| | - Ida Carmosino
- Hematology, Department of Translational and Precision Medicine, Az. Policlinico Umberto I-Sapienza University, 00185 Rome, Italy
| | - Emilia Scalzulli
- Hematology, Department of Translational and Precision Medicine, Az. Policlinico Umberto I-Sapienza University, 00185 Rome, Italy
| | - Maria Laura Bisegna
- Hematology, Department of Translational and Precision Medicine, Az. Policlinico Umberto I-Sapienza University, 00185 Rome, Italy
| | - Claudia Ielo
- Hematology, Department of Translational and Precision Medicine, Az. Policlinico Umberto I-Sapienza University, 00185 Rome, Italy
| | - Maurizio Martelli
- Hematology, Department of Translational and Precision Medicine, Az. Policlinico Umberto I-Sapienza University, 00185 Rome, Italy
| | - Giovanni Caocci
- 1Hematology Unit, Businco Hospital, Department of Medical Sciences and Public Health, University of Cagliari, 09121 Cagliari, Italy; (A.C.); (O.M.); (G.C.)
| | - Massimo Breccia
- Hematology, Department of Translational and Precision Medicine, Az. Policlinico Umberto I-Sapienza University, 00185 Rome, Italy
| |
Collapse
|