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Kopmar NE, Gooley T, Curley N, Russell K, Shaw C, Schonhoff K, Lim J, Halpern AB, Walter RB, Scott BL, Appelbaum J, Hendrie PC, Estey EH, Percival MEM. Results from a phase I study of continuous infusion cladribine, high-dose cytarabine, and mitoxantrone for relapsed/refractory high-grade myeloid neoplasms. Leuk Lymphoma 2023; 64:1057-1059. [PMID: 36896478 PMCID: PMC10330652 DOI: 10.1080/10428194.2023.2185087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/15/2023] [Accepted: 02/20/2023] [Indexed: 03/11/2023]
Affiliation(s)
- Noam E Kopmar
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Ted Gooley
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Niall Curley
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Kathryn Russell
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Carole Shaw
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Kelda Schonhoff
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - John Lim
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Anna B Halpern
- Department of Medicine, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Roland B Walter
- Department of Medicine, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Laboratory Medicine & Pathology, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Bart L Scott
- Department of Medicine, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Jacob Appelbaum
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Paul C Hendrie
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Elihu H Estey
- Department of Medicine, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Mary-Elizabeth M Percival
- Department of Medicine, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
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2
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Mrózek K, Kohlschmidt J, Blachly JS, Nicolet D, Carroll AJ, Archer KJ, Mims AS, Larkin KT, Orwick S, Oakes CC, Kolitz JE, Powell BL, Blum WG, Marcucci G, Baer MR, Uy GL, Stock W, Byrd JC, Eisfeld AK. Outcome prediction by the 2022 European LeukemiaNet genetic-risk classification for adults with acute myeloid leukemia: an Alliance study. Leukemia 2023; 37:788-798. [PMID: 36823396 PMCID: PMC10079544 DOI: 10.1038/s41375-023-01846-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/03/2023] [Accepted: 02/08/2023] [Indexed: 02/25/2023]
Abstract
Recently, the European LeukemiaNet (ELN) revised its genetic-risk classification of acute myeloid leukemia (AML). We categorized 1637 adults with AML treated with cytarabine/anthracycline regimens according to the 2022 and 2017 ELN classifications. Compared with the 2017 ELN classification, 2022 favorable group decreased from 40% to 35% and adverse group increased from 37% to 41% of patients. The 2022 genetic-risk groups seemed to accurately reflect treatment outcomes in all patients and patients aged <60 years, but in patients aged ≥60 years, relapse rates, disease-free (DFS) and overall (OS) survival were not significantly different between intermediate and adverse groups. In younger African-American patients, DFS and OS did not differ between intermediate-risk and adverse-risk patients nor did DFS between favorable and intermediate groups. In Hispanic patients, DFS and OS did not differ between favorable and intermediate groups. Outcome prediction abilities of 2022 and 2017 ELN classifications were similar. Among favorable-risk patients, myelodysplasia-related mutations did not affect patients with CEBPAbZIP mutations or core-binding factor AML, but changed risk assignment of NPM1-mutated/FLT3-ITD-negative patients to intermediate. NPM1-mutated patients with adverse-risk cytogenetic abnormalities were closer prognostically to the intermediate than adverse group. Our analyses both confirm and challenge prognostic significance of some of the newly added markers.
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Grants
- UG1 CA233180 NCI NIH HHS
- U10 CA180821 NCI NIH HHS
- UG1 CA189850 NCI NIH HHS
- P30 CA033572 NCI NIH HHS
- UG1 CA233247 NCI NIH HHS
- R35 CA197734 NCI NIH HHS
- UG1 CA233339 NCI NIH HHS
- P50 CA140158 NCI NIH HHS
- UG1 CA233331 NCI NIH HHS
- U10 CA180882 NCI NIH HHS
- UG1 CA233338 NCI NIH HHS
- U24 CA196171 NCI NIH HHS
- P30 CA016058 NCI NIH HHS
- UG1 CA233327 NCI NIH HHS
- Leukemia and Lymphoma Society (Leukemia & Lymphoma Society)
- Aptevo, Daiichi Sankyo, Glycomemetics, Kartos Pharmaceuticals, Xencor and Genentech
- U.S. Department of Health & Human Services | NIH | NCI | Division of Cancer Epidemiology and Genetics, National Cancer Institute (National Cancer Institute Division of Cancer Epidemiology and Genetics)
- BLP is a consultant for Cornerstone Pharmaceuticals and reported research funding from Ambit Biosciences, Cornerstone, Genentech, Hoffman LaRoche, Jazz Pharmaceuticals, Novartis and Pfizer.
- WGB reported honoraria from Abbvie, Syndax, and AmerisourceBergen and research funding from Celyad Oncology, Nkarta, Xencor, Forma Therapeutics and Leukemia and Lymphoma Society.
- Agios Savvas Regional Cancer Hospital
- GLU is a consultant for AbbVie, Agios, Jazz, GlaxoSmithKline, Genentech, and Novartis; reported honoraria from Astellas and research funding from Macrogenics.
- JCB consults for Astellas, AstraZeneca, Novartis, Pharmacyclics, Syndax and Trillium; receives honoraria from Astellas, AstraZeneca, Novartis, Pharmacyclics, Syndax and Trillium; he is a Chairman of the Scientific Advisory Board of Vincerx Pharmaceuticals and a member of advisory committee of Newave; and is a current equity holder of Vincerx Pharmaceuticals.
- U.S. Department of Health & Human Services | NIH | National Cancer Institute (NCI)
- American Cancer Society (American Cancer Society, Inc.)
- Leukemia Research Foundation (LRF)
- Pelotonia
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Affiliation(s)
- Krzysztof Mrózek
- Clara D. Bloomfield Center for Leukemia Outcomes Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
| | - Jessica Kohlschmidt
- Clara D. Bloomfield Center for Leukemia Outcomes Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- Alliance Statistics and Data Management Center, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - James S Blachly
- The Ohio State University, Department of Internal Medicine, Columbus, OH, USA
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Deedra Nicolet
- Clara D. Bloomfield Center for Leukemia Outcomes Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- Alliance Statistics and Data Management Center, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Andrew J Carroll
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kellie J Archer
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Alice S Mims
- The Ohio State University, Department of Internal Medicine, Columbus, OH, USA
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Karilyn T Larkin
- Clara D. Bloomfield Center for Leukemia Outcomes Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University, Department of Internal Medicine, Columbus, OH, USA
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Shelley Orwick
- The Ohio State University, Department of Internal Medicine, Columbus, OH, USA
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Christopher C Oakes
- The Ohio State University, Department of Internal Medicine, Columbus, OH, USA
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Jonathan E Kolitz
- Monter Cancer Center, Hofstra Northwell School of Medicine, Lake Success, NY, USA
| | - Bayard L Powell
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | | | - Guido Marcucci
- Department of Hematological Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Maria R Baer
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
| | - Geoffrey L Uy
- Washington University School of Medicine, St. Louis, MO, USA
| | - Wendy Stock
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - John C Byrd
- Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Ann-Kathrin Eisfeld
- Clara D. Bloomfield Center for Leukemia Outcomes Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
- The Ohio State University, Department of Internal Medicine, Columbus, OH, USA.
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
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Lu CC, Li JL, Wang YF, Ko BS, Tang JL, Lee CC. A BLSTM with Attention Network for Predicting Acute Myeloid Leukemia Patient's Prognosis using Comprehensive Clinical Parameters. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:2455-2458. [PMID: 31946395 DOI: 10.1109/embc.2019.8856524] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The prognosis management is crucial for highrisk disease like Acute Myeloid Leukemia (AML) in order to support decisions of clinical treatment. However, the challenges of accurate and consistent forecasting lie in the high variability of the disease outcomes and the complexity of the multiple clinical measurements available over the course of the treatment. In order to capture the multi-dimensional and longitudinal aspect of these comprehensive clinical parameters, we utilize an attention-based bi-directional long shortterm memory (Att-BLSTM) network to predict AML patient's survival and relapse. Specifically, we gather a 10-year worth of real patient's clinical data including blood test, medication, HSCT status, and gene mutation information. Our proposed Att-BLSTM framework achieves 77.1% and 67.3% AUC in tasks of predicting the next 2-year mortality and disease relapse with these comprehensive clinical parameters, and our further analysis demonstrates that a next 0 to 3 months prediction performs equally well, i.e., 74.8% and 67% AUC for mortality and relapse respectively.
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Bezerra ED, Othus M, Shawn C, Percival ME, Gardner K, Walter RB, Becker PS, Hendrie PC, Estey EH. Independent Associations Between Glomerular Filtration Rate and Serum Bilirubin Level and Early Mortality in Acute Myeloid Leukemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:e633-e635. [PMID: 31648955 DOI: 10.1016/j.clml.2019.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 06/28/2019] [Indexed: 10/26/2022]
Affiliation(s)
| | - Megan Othus
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Carole Shawn
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Mary-Elizabeth Percival
- Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA
| | - Kelda Gardner
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Roland B Walter
- Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA
| | - Pamela S Becker
- Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA
| | - Paul C Hendrie
- Department of Medicine, University of Washington, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA
| | - Elihu H Estey
- Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA
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5
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Halpern AB, Othus M, Huebner EM, Scott BL, Hendrie PC, Percival MEM, Becker PS, Smith HA, Oehler VG, Orozco JJ, Cassaday RD, Gardner KM, Chen TL, Buckley SA, Orlowski KF, Anwar A, Estey EH, Walter RB. Phase I/II trial of cladribine, high-dose cytarabine, mitoxantrone, and G-CSF with dose-escalated mitoxantrone for relapsed/refractory acute myeloid leukemia and other high-grade myeloid neoplasms. Haematologica 2018; 104:e143-e146. [PMID: 30409798 DOI: 10.3324/haematol.2018.204792] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Anna B Halpern
- Clinical Research Division, Fred Hutchinson Cancer Research Center/University of Washington.,Department of Medicine, Division of Hematology, University of Washington
| | - Megan Othus
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center
| | - Emily M Huebner
- Clinical Research Division, Fred Hutchinson Cancer Research Center/University of Washington
| | - Bart L Scott
- Clinical Research Division, Fred Hutchinson Cancer Research Center/University of Washington.,Department of Medicine, Division of Medical Oncology, University of Washington
| | - Paul C Hendrie
- Department of Medicine, Division of Hematology, University of Washington.,Seattle Cancer Care Alliance
| | - Mary-Elizabeth M Percival
- Clinical Research Division, Fred Hutchinson Cancer Research Center/University of Washington.,Department of Medicine, Division of Hematology, University of Washington
| | - Pamela S Becker
- Clinical Research Division, Fred Hutchinson Cancer Research Center/University of Washington.,Department of Medicine, Division of Hematology, University of Washington
| | | | - Vivian G Oehler
- Clinical Research Division, Fred Hutchinson Cancer Research Center/University of Washington.,Department of Medicine, Division of Hematology, University of Washington
| | - Johnnie J Orozco
- Clinical Research Division, Fred Hutchinson Cancer Research Center/University of Washington.,Department of Medicine, Division of Hematology, University of Washington
| | - Ryan D Cassaday
- Clinical Research Division, Fred Hutchinson Cancer Research Center/University of Washington.,Department of Medicine, Division of Hematology, University of Washington
| | - Kelda M Gardner
- Department of Medicine, Division of Hematology, University of Washington
| | - Tara L Chen
- Deparment of Pharmacy Services, University of Washington
| | - Sarah A Buckley
- Hematology/Oncology Fellowship Program, University of Washington/Fred Hutchinson Cancer Research Center
| | - Kaysey F Orlowski
- Clinical Research Division, Fred Hutchinson Cancer Research Center/University of Washington
| | - Asma Anwar
- Hematology/Oncology Fellowship Program, University of Washington/Fred Hutchinson Cancer Research Center
| | - Elihu H Estey
- Clinical Research Division, Fred Hutchinson Cancer Research Center/University of Washington.,Department of Medicine, Division of Hematology, University of Washington
| | - Roland B Walter
- Clinical Research Division, Fred Hutchinson Cancer Research Center/University of Washington .,Department of Medicine, Division of Hematology, University of Washington.,Department of Epidemiology, University of Washington, Seattle, WA, USA
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6
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Delaney C, Milano F, Cicconi L, Othus M, Becker PS, Sandhu V, Nicoud I, Dahlberg A, Bernstein ID, Appelbaum FR, Estey EH. Infusion of a non-HLA-matched ex-vivo expanded cord blood progenitor cell product after intensive acute myeloid leukaemia chemotherapy: a phase 1 trial. LANCET HAEMATOLOGY 2016; 3:e330-9. [PMID: 27374466 DOI: 10.1016/s2352-3026(16)30023-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 04/05/2016] [Accepted: 04/06/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND The intensive chemotherapy regimens used to treat acute myeloid leukaemia routinely result in serious infections, largely due to prolonged neutropenia. We investigated the use of non-HLA-matched ex-vivo expanded cord blood progenitor cells to accelerate haemopoietic recovery and reduce infections after chemotherapy. METHODS We enrolled patients with a diagnosis of acute myeloid leukaemia by WHO criteria and aged 18-70 years inclusive at our institution (Fred Hutchinson Cancer Research Center) into this phase 1 trial. The primary endpoint of the study was safety of infusion of non-HLA-matched expanded cord blood progenitor cells after administration of clofarabine, cytarabine, and granulocyte-colony stimulating factor priming. The protocol is closed to accrual and analysis was performed per protocol. The trial is registered with ClinicalTrials.gov, NCT01031368. FINDINGS Between June 29, 2010, and June 26, 2012, 29 patients with acute myeloid leukaemia (19 newly diagnosed, ten relapsed or refractory) were enrolled. The most common adverse events were fever (27 [93%] of 29 patients) and infections (25 [86%] of 29 patients). We observed one case of acute infusional toxicity (attributed to an allergic reaction to dimethyl sulfoxide) in the 29 patients enrolled, who received 42 infusions of expanded progenitor cells. The following additional serious but expected adverse events were observed (each in one patient): grade 4 atrial fibrillation, grade 4 febrile neutropenia, lung infection with grade 4 absolute neutrophil count, colon infection with grade 4 absolute neutrophil count, grade 4 changed mental status, and one death from liver failure. No unexpected toxicity or graft-versus-host disease was observed. There was no evidence of in-vivo persistence of the expanded progenitor cell product in any patient beyond 14 days or induced alloimmunisation. INTERPRETATION Infusion of the expanded progenitor cell product seemed safe and might provide a promising treatment method for patients with acute myeloid leukaemia. FUNDING Biomedical Advanced Research and Development Authority in the US Department of Health and Human Services and Genzyme (Sanofi).
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Affiliation(s)
- Colleen Delaney
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Pediatrics, University of Washington, Seattle, WA, USA.
| | - Filippo Milano
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Medical Oncology, University of Washington, Seattle, WA, USA
| | - Laura Cicconi
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Megan Othus
- Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; SWOG Statistical Center, Seattle, WA, USA
| | - Pamela S Becker
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Medical Oncology, University of Washington, Seattle, WA, USA
| | - Vicky Sandhu
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Ian Nicoud
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Ann Dahlberg
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Irwin D Bernstein
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Frederick R Appelbaum
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Medical Oncology, University of Washington, Seattle, WA, USA
| | - Elihu H Estey
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Medical Oncology, University of Washington, Seattle, WA, USA
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