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Capelli D, Saraceni F, Fiorentini A, Chiarucci M, Menotti D, Poloni A, Discepoli G, Leoni P, Olivieri A. Feasibility and Outcome of a Phase II Study of Intensive Induction Chemotherapy in 91 Elderly Patients with AML Evaluated Using a Simplified Multidimensional Geriatric Assessment. Adv Ther 2020; 37:2288-2302. [PMID: 32297279 PMCID: PMC7467471 DOI: 10.1007/s12325-020-01310-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Indexed: 12/04/2022]
Abstract
Introduction We prospectively tested in a phase II study high-dose aracytin and idarubicin plus amifostine as induction regimen in 149 patients with acute myeloid leukaemia (AML) aged ≥ 60 years, evaluated by a simplified multidimensional geriatric assessment (MGA). Methods Ninety-one fully or partially fit patients (61%) were allocated to intensive chemotherapy and 58 (39%) frail patients to best supportive care (BSC). Intensively treated patients, showing early death and complete response (CR) rate respectively of 5.5% and 73.6%, received 61 consolidations, followed by autologous transplant (ASCT), stem cell transplantation (SCT) or gemtuzumab ozogamicin, depending on mobilization outcome and donor availability. Results The 8-year overall survival (OS) of these patients was 20.4%, with median duration of 11.4 months significantly superior to the 1.5 months of BSC arm (p < 0.001). Hyperleukocytosis and cytogenetics were predictors of survival with a relative risk of 1.8 in patients with poor karyotype without hyperleukocytosis (p = 0.02) and 3 in those with hyperleukocytosis (≥ 50,000/μl) (p = 0.002). Conclusion MGA allowed tailored post-consolidation in 53.8% of patients after high-dose aracytin induction, with long-term survival doubling that reported in the literature after standard-dose cytarabine regimens. Trial Registration The study was registered with the Umin Clinical Trial Registry (www.umin.ac.jp/ctr), number R000014052. Electronic Supplementary Material The online version of this article (10.1007/s12325-020-01310-4) contains supplementary material, which is available to authorized users.
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Jeha GM, Wesley T, Cataldo VD. Novel Translocation in Acute Myeloid Leukemia: Case Report and Review of Risk-Stratification and Induction Chemotherapy in Patients With Acute Myeloid Leukemia. J Hematol 2020; 9:13-17. [PMID: 32362980 PMCID: PMC7188377 DOI: 10.14740/jh605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 02/27/2020] [Indexed: 12/14/2022] Open
Abstract
Identification of chromosomal abnormalities in patients with acute myeloid leukemia (AML) has contributed substantially to our current understanding of the molecular pathogenesis underlying leukemogenesis, and risk-stratification based on molecular abnormalities both influences treatment strategies and aids in determining prognosis. While over 300 established mutations have been documented in AML, the enhanced availability of genetic analysis and the increase in awareness of uncommon chromosomal translocations have made it possible for rare, apparently unique translocations to become recognized and to ultimately gain prognostic significance. Hence, we present a case of AML with a novel, balanced 2;12 translocation involving breakpoints previously undescribed. Although the patient required second induction, first remission was ultimately achieved. While the prognostic significance of this translocation is not fully elucidated, it is our hope that documentation of this patient's presentation will help to characterize the significance of a yet undefined cytogenetic abnormality in AML.
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Affiliation(s)
- George M Jeha
- Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Tiffany Wesley
- Louisiana State University Health Sciences Center, New Orleans, LA, USA.,Louisiana State University Health Sciences Center, Baton Rouge, LA, USA
| | - Vince D Cataldo
- Louisiana State University Health Sciences Center, Baton Rouge, LA, USA.,Hematology-Oncology Clinic, Baton Rouge, LA, USA
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3
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FLT3 internal tandem duplication does not impact prognosis after haploidentical allogeneic hematopoietic stem cell transplantation in AML patients. Bone Marrow Transplant 2019; 54:1462-1470. [PMID: 30710101 DOI: 10.1038/s41409-019-0456-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 11/08/2022]
Abstract
Acute myelogenous leukemia (AML) patients with fetal liver tyrosine kinase 3 (FLT3) internal tandem duplications (ITDs) have poor prognoses if treated with chemotherapy only, primarily as they experience increased relapse rates. To determine whether this alteration also affects outcomes after haploidentical donor (HID) allogeneic hematopoietic stem cell transplantation (allo-HSCT), we compared 334 consecutive FLT3-ITD-positive vs -negative patients with AML (other than acute promyelocytic leukemia) who underwent HID-HSCT. FLT3-ITD was detected in 39 of 334 patients (11.7%). The 2-year relapse rates for FLT3-ITD-positive and -negative patients were 16% and 17%, respectively (P = 0.774). The 3-year disease-free survival (DFS) rates for FLT3-ITD-positive and -negative patients were 74% (95% confidence interval [CI]: 64-81) and 73% (95% CI: 70-81), respectively; P = 0.872); while the 3-year overall survival (OS) rates were 72% (95% CI: 67-81) and 77% (95% CI: 72-84), respectively (P = 0.862). FLT3-ITD mutation had no influence on non-relapse mortality (NRM 15% vs 14%, P = 0.463). Multivariate analyses showed that disease status at HSCT and white blood cell count at diagnosis were independent risk factors associated with relapse, DFS, and OS. In conclusion, FLT3 mutation status has no impact on outcomes after HID-HSCT in patients with AML. HID-HSCT is therefore a valid option for AML patients with FLT3-ITD mutation.
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Tzoran I, Rebibo-Sabbah A, Brenner B, Aharon A. Disease dynamics in patients with acute myeloid leukemia: new biomarkers. Exp Hematol 2015; 43:936-43. [PMID: 26232698 DOI: 10.1016/j.exphem.2015.07.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 07/15/2015] [Accepted: 07/21/2015] [Indexed: 12/14/2022]
Abstract
Acute myeloid leukemia (AML) is characterized by rapid growth of leukemic blast cells. Extracellular vesicles (EVs), shedding from various cells, express antigens, reflecting their cellular origin. The current study was designed to explore the role of circulating EVs as potential biomarkers of AML activity and predictors of thrombogenicity in patients with this malignancy. Blood samples were collected from healthy controls and patients with newly diagnosed AML at three time points: diagnosis, nadir, and remission. EV concentration, cell origin, and expression of coagulation proteins were characterized using fluorescence-activated cell sorting. EV cytokine contents were evaluated by protein array. Procoagulant activity was assessed using Factor Xa chromogenic assay. Forty-two AML patients were enrolled in the study. Total EV numbers were higher in patients in first remission compared with controls, whereas blast EV counts were higher in patients at diagnosis compared with controls and patients in remission. Blast EV levels were significantly lower in patients who achieved remission and were alive at 3-year follow up compared with their succumbed counterparts. At all three time points, percentage of endothelial EVs was higher in patients compared with controls. EV procoagulant activity was elevated at diagnosis and in remission, and, unlike controls' EVs, patients' EVs increased endothelial cell thrombogenicity. EVs of AML patients express membrane proteins of blast cells and might serve as biomarkers of leukemia dynamics and presence of minimal residual disease. Increased levels of endothelial EVs and their procoagulant activity may indicate a vascular injury associated with a hypercoagulable state in AML.
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Affiliation(s)
- Inna Tzoran
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel; Internal Medicine C, Rambam Health Care Campus, Haifa, Israel; Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
| | - Annie Rebibo-Sabbah
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel; Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Benjamin Brenner
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel; Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Anat Aharon
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel; Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
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5
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Souto Filho JTD, Loureiro MM, Pulcheri W, Morais JC, Nucci M, Portugal RD. Evaluation of bone marrow aspirates in patients with acute myeloid leukemia at day 14 of induction therapy. Diagn Pathol 2015; 10:122. [PMID: 26205005 PMCID: PMC4513973 DOI: 10.1186/s13000-015-0365-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 07/15/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Early assessment of response to chemotherapy in acute myeloid leukemia may be performed by examining bone marrow aspirate (BMA) or biopsy (BMB); a hypocellular bone marrow sample indicates adequate anti-leukemic activity. We sought to evaluate the quantitative and qualitative assessment of BMA performed on day 14 (D14) of chemotherapy, to verify the inter-observer agreement, to compare the results of BMA and BMB, and to evaluate the impact of D14 blast clearance on the overall survival (OS). METHODS A total of 107 patients who received standard induction chemotherapy and had bone marrow samples were included. BMA evaluation was performed by two observers using two methods: quantitative assessment and a qualitative (Likert) scale. ROC curves were obtained correlating the BMA quantification of blasts and the qualitative scale, by both observers, with BMB result as gold-standard. RESULTS There was a significant agreement between the two observers in both the qualitative and quantitative assessments (Kw = 0.737, p < 0.001, and rs = 0.798, p < 0.001; ICC = 0.836, p < 0.001, respectively). The areas under the curve (AUC) were 0.924 and 0.946 for observer 1 and 0.867 and 0.870 for observer 2 for assessments of the percentage of blasts and qualitative scale, respectively. The best cutoff for blast percentage in BMA was 6% and 7% for observers 1 and 2, respectively. A similar analysis for the qualitative scale showed the best cutoff as "probably infiltrated". Patients who attained higher grades of cytoreduction on D14 had better OS. CONCLUSIONS Evaluation of D14 BMA using both methods had a significant agreement with BMB and between observers, identifying a population of patients with poor outcome.
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Affiliation(s)
- João Tadeu D Souto Filho
- University Hospital, Universidade Federal do Rio de Janeiro, Rua Prof. Rodolpho Paulo Rocco, 255, Sala 4A 12, Rio de Janeiro, 22251-030, RJ, Brazil.
- Faculdade de Medicina de Campos, Campos dos Goytacazes, RJ, Brazil.
- Instituto Federal de Educação, Ciência e Tecnologia Fluminense, Campos dos Goytacazes, RJ, Brazil.
| | - Monique M Loureiro
- University Hospital, Universidade Federal do Rio de Janeiro, Rua Prof. Rodolpho Paulo Rocco, 255, Sala 4A 12, Rio de Janeiro, 22251-030, RJ, Brazil.
| | - Wolmar Pulcheri
- University Hospital, Universidade Federal do Rio de Janeiro, Rua Prof. Rodolpho Paulo Rocco, 255, Sala 4A 12, Rio de Janeiro, 22251-030, RJ, Brazil
| | - José Carlos Morais
- University Hospital, Universidade Federal do Rio de Janeiro, Rua Prof. Rodolpho Paulo Rocco, 255, Sala 4A 12, Rio de Janeiro, 22251-030, RJ, Brazil
| | - Marcio Nucci
- University Hospital, Universidade Federal do Rio de Janeiro, Rua Prof. Rodolpho Paulo Rocco, 255, Sala 4A 12, Rio de Janeiro, 22251-030, RJ, Brazil.
| | - Rodrigo D Portugal
- University Hospital, Universidade Federal do Rio de Janeiro, Rua Prof. Rodolpho Paulo Rocco, 255, Sala 4A 12, Rio de Janeiro, 22251-030, RJ, Brazil.
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Budziszewska BK, Pluta A, Sulek K, Wierzbowska A, Robak T, Giebel S, Holowiecka-Goral A, Sawicki W, Ejduk A, Patkowska E, Manko J, Gajkowska-Kulik J, Piszcz J, Mordak-Domagala M, Madry K, Holowiecki J, Kyrcz-Krzemien S, Nowakowska-Domagala M, Dmoszynska A, Calbecka M, Kloczko J, Wiktor Jędrzejczak W, Lange A, Razny M, Bilinski P, Warzocha K, Lech-Maranda E. Treatment of elderly patients with acute myeloid leukemia adjusted for performance status and presence of comorbidities: a Polish Adult Leukemia Group study. Leuk Lymphoma 2015; 56:2331-8. [PMID: 25393675 DOI: 10.3109/10428194.2014.985672] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This prospective study estimated outcomes in 509 elderly patients with acute myeloid leukemia (AML) with different treatment approaches depending on Eastern Cooperative Oncology Group (ECOG) performance status and Charlson Comorbidity Index (CCI). Patients were stratified into fit (ECOG 0-2 and CCI 0-2) or frail (ECOG>2 and/or CCI>2) groups. Fit patients with CCI 0 received intensive chemotherapy whilst reduced-intensive chemotherapy (R-IC) was given to those with CCI 1-2. Frail patients received best supportive therapy. Fit patients presented a longer overall survival (OS) than frail subjects, but 8-week mortality rates were similar. The complete response (CR) rate between fit CCI 0 and CCI 1-2 subgroups was significantly different. Both of the fit subgroups showed similar 8-week mortality rates and OS probabilities. Allocating fit patients with CCI 1-2 to R-IC enabled an increase in the group of elderly patients who could be treated with the intention of inducing remission.
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Affiliation(s)
- Bozena Katarzyna Budziszewska
- a Hematology Department, Institute of Hematology and Transfusion Medicine , Warsaw , Poland.,b Center of Postgraduate Medical Education , Warsaw , Poland
| | - Agnieszka Pluta
- c Hematology Department, Medical University of Lodz , Lodz , Poland
| | - Kazimierz Sulek
- d Hematology Department, Military Medical Institute , Warsaw , Poland
| | | | - Tadeusz Robak
- c Hematology Department, Medical University of Lodz , Lodz , Poland
| | - Sebastian Giebel
- e Department of Bone Marrow Transplantation , Comprehensive Cancer Center, M. Sklodowska-Curie Memorial Institute , Gliwice , Poland
| | | | - Waldemar Sawicki
- d Hematology Department, Military Medical Institute , Warsaw , Poland
| | - Anna Ejduk
- a Hematology Department, Institute of Hematology and Transfusion Medicine , Warsaw , Poland
| | - Elzbieta Patkowska
- a Hematology Department, Institute of Hematology and Transfusion Medicine , Warsaw , Poland.,b Center of Postgraduate Medical Education , Warsaw , Poland
| | - Joanna Manko
- f Hematology Department, Medical University of Lublin , Lublin , Poland
| | | | - Jaroslaw Piszcz
- h Hematology Department, Medical University of Bialystok , Bialystok , Poland
| | | | - Krzysztof Madry
- j Hematology and Oncology Department, Warsaw Medical University , Warsaw , Poland
| | - Jerzy Holowiecki
- e Department of Bone Marrow Transplantation , Comprehensive Cancer Center, M. Sklodowska-Curie Memorial Institute , Gliwice , Poland
| | | | | | - Anna Dmoszynska
- f Hematology Department, Medical University of Lublin , Lublin , Poland
| | | | - Janusz Kloczko
- h Hematology Department, Medical University of Bialystok , Bialystok , Poland
| | | | - Andrzej Lange
- i Lower Silesian Centrum for Cellular Transplantation , Wroclaw , Poland
| | - Malgorzata Razny
- m Hematology Department, Rydygier Memorial Hospital , Krakow , Poland
| | - Przemyslaw Bilinski
- a Hematology Department, Institute of Hematology and Transfusion Medicine , Warsaw , Poland
| | - Krzysztof Warzocha
- a Hematology Department, Institute of Hematology and Transfusion Medicine , Warsaw , Poland
| | - Ewa Lech-Maranda
- a Hematology Department, Institute of Hematology and Transfusion Medicine , Warsaw , Poland.,b Center of Postgraduate Medical Education , Warsaw , Poland
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Visani G, Malagola M, Guiducci B, Lucesole M, Loscocco F, Gabucci E, Paolini S, Piccaluga PP, Isidori A. Conditioning regimens in acute myeloid leukemia. Expert Rev Hematol 2014; 7:465-479. [PMID: 25025371 DOI: 10.1586/17474086.2014.939066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Current intensive consolidation chemotherapy for patients with acute myeloid leukemia (AML) produces median remission duration of 12-18 months, with less than 30% of patients surviving 5 years free of disease. Post-remission therapy is necessary to prevent relapse in most patients with AML; therefore, the aim of post-remission treatment is to eradicate the minimal residual disease. Nevertheless, the optimal form of treatment is still under debate. The choice among the possible approaches (intensive chemotherapy, autologous or allogeneic hematopoietic stem cell transplantation) relies on two main factors: the expected risk of relapse, as determined by biological features, and expected morbidity and mortality associated with a specific option. In this review, we focus on the different preparative regimens before autologous and allogeneic hematopoietic stem cell transplantation in patients with AML, stressing the importance of an adequate conditioning regimen as a mandatory element of a successful AML therapy, in both the allogeneic and the autologous transplant setting.
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Cairoli R, Beghini A, Turrini M, Bertani G, Nadali G, Rodeghiero F, Castagnola C, Lazzaroni F, Nichelatti M, Ferrara F, Pizzolo G, Pogliani E, Rossi G, Martinelli G, Morra E. Old and new prognostic factors in acute myeloid leukemia with deranged core-binding factor beta. Am J Hematol 2013; 88:594-600. [PMID: 23619823 DOI: 10.1002/ajh.23461] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 04/04/2013] [Accepted: 04/08/2013] [Indexed: 02/06/2023]
Abstract
Acute myeloid leukemia (AML) with deranged core-binding factor beta (CBFβ) is usually associated with a favorable prognosis with 50-70% of patients cured using contemporary treatments. We analyzed the prognostic significance of clinical features on 58 patients with CBFβ-AML aged ≤60 years. Increasing age was the only predictor for survival (P <0.001), with an optimal cut-point at 43 years. White blood cells (WBCs) at diagnosis emerged as an independent risk factor for relapse incidence (P = 0.017), with 1.1% increase of hazard for each 1.0 × 10(9) /L WBC increment. KIT mutations lacked prognostic value for survival and showed only a trend for relapse incidence (P = 0.069).
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Affiliation(s)
- Roberto Cairoli
- Division of Haematology; Niguarda Hospital; Milan Italy
- Division of Haematology; Department of Internal Medicine; Valduce Hospital; Como Italy
| | - Alessandro Beghini
- Department of Medical Biotechnology and Translational Medicine; University of Milan; Milan Italy
| | - Mauro Turrini
- Division of Haematology; Niguarda Hospital; Milan Italy
| | | | - Gianpaolo Nadali
- Department of Clinical and Experimental Medicine; University of Verona; Verona Italy
| | | | - Carlo Castagnola
- Department of Haematology Oncology; University of Pavia & Fondazione IRCCS Policlinico San Matteo; Pavia Italy
| | - Francesca Lazzaroni
- Department of Medical Biotechnology and Translational Medicine; University of Milan; Milan Italy
| | | | - Felicetto Ferrara
- Division of Haematology and Stem Cell Transplantation Unit; Cardarelli General Hospital; Naples Italy
| | - Giovanni Pizzolo
- Department of Clinical and Experimental Medicine; University of Verona; Verona Italy
| | - Enrico Pogliani
- Division of Hematology and Bone Marrow Transplantation Unit; San Gerardo University Hospital; Monza Italy
| | - Giuseppe Rossi
- Department of Haematology; Spedali Civili; Brescia Italy
| | | | - Enrica Morra
- Division of Haematology; Niguarda Hospital; Milan Italy
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Ferrara F, Barosi G, Venditti A, Angelucci E, Gobbi M, Pane F, Tosi P, Zinzani P, Tura S. Consensus-based definition of unfitness to intensive and non-intensive chemotherapy in acute myeloid leukemia: a project of SIE, SIES and GITMO group on a new tool for therapy decision making. Leukemia 2013; 27:997-9. [DOI: 10.1038/leu.2012.303] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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10
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1 0 8. Cancer Biomark 2012. [DOI: 10.1201/b14318-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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11
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Abstract
Acute myeloid leukemia (AML) is a heterogeneous disease increasing in frequency owing to an aging population. Decisions on intensive induction treatments, intensification and allografting rely on the ability to divide an apparently homogeneous group according to risk. A wide range of clinical, cytogenetic and molecular variables may be used to inform this task; here we examine those variables useful in assessing prognosis for a patient with non-acute promyelocitic AML focusing on core binding factor leukemia. In clinical practice, when counseling an individual patient with AML, a range of well-known clinical variables (age, performance status and tumor burden) and genetic variables (cytogenetic and gene mutation) must be considered to better define the prognostic risk.
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12
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Brunet S, Labopin M, Esteve J, Cornelissen J, Socié G, Iori AP, Verdonck LF, Volin L, Gratwohl A, Sierra J, Mohty M, Rocha V. Impact of FLT3 internal tandem duplication on the outcome of related and unrelated hematopoietic transplantation for adult acute myeloid leukemia in first remission: a retrospective analysis. J Clin Oncol 2012; 30:735-41. [PMID: 22291086 DOI: 10.1200/jco.2011.36.9868] [Citation(s) in RCA: 219] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Patients with acute myeloid leukemia (AML) and FLT3/internal tandem duplication (FLT3/ITD) have poor prognosis if treated with chemotherapy only. Whether this alteration also affects outcome after allogeneic hematopoietic stem-cell transplantation (HSCT) remains uncertain. PATIENTS AND METHODS We analyzed 206 patients who underwent HLA-identical sibling and matched unrelated HSCTs reported to the European Group for Blood and Marrow Transplantation with a diagnosis of AML with normal cytogenetics and data on FLT3/ITD (present: n = 120, 58%; absent: n = 86, 42%). Transplantations were performed in first complete remission (CR) after myeloablative conditioning. RESULTS Compared with FLT3/ITD-negative patients, FLT3/ITD-positive patients had higher median leukocyte count at diagnosis (59 v 21 × 10(9)/L; P < .001) and shorter interval from CR to transplantation (87 v 99 days; P = .04). Other characteristics were similar in the two groups. At 2 years, relapse incidence (RI; ± standard deviation) was higher (30% ± 5% v 16% ± 5%; P = .006) and leukemia-free survival (LFS) lower (58% ± 5% v 71% ± 6%; P = .04) in FLT3/ITD-positive compared with FLT3/ITD-negative patients. In multivariate analyses, FLT3/ITD led to increased RI (hazard ratio [HR], 3.4; 95% CI, 1.46 to 7.94; P = .005), as did older age, female sex, shorter interval between CR and transplantation, and higher number of chemotherapy courses before achieving CR. FLT3/ITD positivity was associated with decreased LFS (HR, 0.37; 95% CI, 0.19 to 0.73; P = .002), along with older age and higher number of chemotherapy courses before achieving CR. CONCLUSION FLT3/ITD adversely affected the outcome of HSCT in the same direction it does after chemotherapy; despite this, more than half of the patients harboring this mutation who received transplants were alive and leukemia free at 2 years. To further improve the results, use of FLT3 inhibitors before or after HSCT deserves investigation.
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Affiliation(s)
- Salut Brunet
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain.
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Marchesi F, Annibali O, Cerchiara E, Tirindelli MC, Avvisati G. Cytogenetic abnormalities in adult non-promyelocytic acute myeloid leukemia: A concise review. Crit Rev Oncol Hematol 2011; 80:331-46. [DOI: 10.1016/j.critrevonc.2010.11.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 10/18/2010] [Accepted: 11/09/2010] [Indexed: 12/20/2022] Open
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14
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Shi JY, Ren ZH, Jiao B, Xiao R, Yun HY, Chen B, Zhao WL, Zhu Q, Chen Z, Chen SJ. Genetic variations of DNA repair genes and their prognostic significance in patients with acute myeloid leukemia. Int J Cancer 2010; 128:233-8. [DOI: 10.1002/ijc.25318] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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15
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Ferrara F, Izzo T, Criscuolo C, Riccardi C, Celentano M, Mele G. Day 15 bone marrow driven double induction in young adult patients with acute myeloid leukemia: feasibility, toxicity, and therapeutic results. Am J Hematol 2010; 85:687-90. [PMID: 20652967 DOI: 10.1002/ajh.21791] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The strategy named double induction (DI) in acute myeloid leukemia (AML) consists of two courses of chemotherapy irrespective of the degree of cytoreduction in the bone marrow (BM) after the first course, unless severe complications prohibit its application. We describe treatment results from a series of 33 patients in whom DI was adopted only after demonstration of persistence of more than 10% blast cells at day 15 (D15) examination of BM. All patients received as induction idarubicin, cytarabine, and etoposide. As second induction, we administered the combination of fludarabine, intermediate dose cytarabine, and Granulocyte colony stimulating factor (G-CSF). The median blast count at D15 was 30 (15-90). Overall, 30 of 33 patients were judged as eligible to receive DI, reasons for exclusion being in all cases active infection in the context of severe pancytopenia. Nineteen patients (63%) had unfavorable karyotype and 11 (37%) normal karyotype; seven of these had Fms-like tyrosine kinase gene internal tandem duplication (FLT3/ITD) mutation. Overall, complete remission (CR) was achieved in 20/30 patients (67%), while eight patients (27%) were refractory and two died of infectious complications. All refractory patients had unfavorable cytogenetics. All patients achieving CR were programmed to receive allogeneic stem cell transplantation (allo-SCT), which was actually performed in 11 patients. Our study suggest that D15 driven DI represents a feasible and effective therapeutic strategy in young adult AML patients, improving therapeutic results and not compromising feasibility of allo-SCT. When compared with conventional DI, it offers the potential to avoid unnecessary toxicity in a consistent proportion of patients.
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Affiliation(s)
- Felicetto Ferrara
- Division of Hematology and Stem Cell Transplantation Unit, Cardarelli Hospital, Via Nicolò Piccinni 6, Naples, Italy.
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16
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Challenges in treating older patients with acute myeloid leukemia. JOURNAL OF ONCOLOGY 2010; 2010:943823. [PMID: 20628485 PMCID: PMC2902223 DOI: 10.1155/2010/943823] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2009] [Accepted: 03/27/2010] [Indexed: 01/24/2023]
Abstract
Whereas in younger patients diagnosed with acute myeloid leukemia (AML) treatment is straightforward and the goal is cure, the optimal treatment decision for older adults remains highly controversial. Physicians need to determine whether palliation, “something” beyond palliation, intensive therapy, or an investigational therapy is the most appropriate treatment option. This requires understanding of the biology and risk profile of the AML, clinical judgment in evaluating the functional status of the patient, communication skills in understanding the patient's wishes and social background, and medical expertise in available therapies. The physician has to accurately inform the patient about (a) the unique biological considerations of his leukemia and his prognosis; (b) the risks and benefits of all available treatment options; (c) novel therapeutic approaches and how the patient can get access to these treatments. Last but not least, he has to recommend a treatment. This paper tries to discuss each of these issues.
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Association of Human Development Index with rates and outcomes of hematopoietic stem cell transplantation for patients with acute leukemia. Blood 2010; 116:122-8. [PMID: 20395416 DOI: 10.1182/blood-2010-01-266478] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Human Development Index (HDI) is used by the United Nations Organization to measure socioeconomic achievements of countries. We evaluated the association of HDI with rates and outcomes of hematopoietic stem cell transplantation (HSCT) for patients with acute leukemia. For the analysis of HSCT rates, all adults with acute leukemia (n = 16 403) treated in 30 European countries, between 2001 and 2005, were included. Association of HDI with the outcome was analyzed for 2015 patients with acute myeloid leukemia treated with myeloablative allotransplantation. Countries were classified according to HDI quintiles. Highly significant correlation was found for HDI and the total number of HSCT per population (R = 0.78; P < .001), as well as separately for sibling HSCT (R = 0.84; P < .001), unrelated HSCT (R = 0.66; P < .001), and autologous HSCT (R = 0.43; P = .02). The probabilities of leukemia-free survival for 5 consecutive groups of countries with increasing HDI were: 56%, 59%, 63%, 58%, and 68% (P = .01). In a multivariate analysis, transplantations performed in countries belonging to the upper HDI category were associated with higher leukemia-free survival compared with the remaining ones (HR = 1.36, P = .008), which resulted mainly from reduced risk of relapse (HR = 0.72, P = .04). We conclude that, in Europe, the HDI is associated with both rates and results of HSCT for acute leukemia.
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Luger SM. Treating the elderly patient with acute myelogenous leukemia. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2010; 2010:62-69. [PMID: 21239772 DOI: 10.1182/asheducation-2010.1.62] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Decisions regarding the optimal treatment of acute myelogenous leukemia in the elderly patient requires the consideration of multiple factors. Population-based studies have demonstrated that, for all age groups, aggressive therapy results in improved survival and quality of life when compared with palliative care. The optimal induction and postremission regimen for older patients has yet to be determined. Furthermore, not all patients are candidates for such therapy. Consideration of patient and disease-related factors can help to determine the appropriateness of intensive therapy in a given patient. For those patients for whom aggressive induction therapy does not seem to be in their best interest, novel agents are being investigated that will hopefully address the issues of induction death and early relapse associated with these patient populations.
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Affiliation(s)
- Selina M Luger
- Hospital of the University of Pennsylvania, Perelman Center for Advanced Medicine, and Hematologic Malignancies and Stem Cell Transplant Program, Hematology-Oncology Division, University of Pennsylvania Medical Center, Philadelphia, PA 19104, USA.
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