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Lee B, Pierpont T, August A, Richards K. Monoclonal antibodies binding to different epitopes of CD20 differentially sensitize DLBCL to different classes of chemotherapy. Front Oncol 2023; 13:1159484. [PMID: 37601699 PMCID: PMC10436104 DOI: 10.3389/fonc.2023.1159484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 07/04/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Rituximab (R), an anti-CD20 monoclonal antibody (mAb) and the world's first approved antibody for oncology patients, was combined with the CHOP chemotherapy regimen and markedly improved the prognosis of all B- cell-derived lymphomas, the most common hematological malignancy worldwide. However, there is a 35% disease recurrence with no advancement in the first-line treatment since R was combined with the archetypal CHOP chemotherapy regimen nearly 30 years ago. There is evidence that R synergizes with chemotherapy, but the pharmacological interactions between R and CHOP or between newer anti-CD20 mAbs and CHOP remain largely unexplored. Methods We used in vitro models to score pharmacological interactions between R and CHOP across various lymphoma cell lines. We compared these pharmacological interactions to ofatumumab, a second-generation anti-CD20 mAb, and CHOP. Lastly, we used RNA-sequencing to characterize the transcriptional profiles induced by these two antibodies and potential molecular pathways that mediate their different effects. Results We discovered vast heterogeneity in the pharmacological interactions between R and CHOP in a way not predicted by the current clinical classification. We then discovered that R and ofatumumab differentially synergize with the cytotoxic and cytostatic capabilities of CHOP in separate distinct subsets of B-cell lymphoma cell lines, thereby expanding favorable immunochemotherapy interactions across a greater range of cell lines beyond those induced by R-CHOP. Lastly, we discovered these two mAbs differentially modulate genes enriched in the JNK and p38 MAPK family, which regulates apoptosis and proliferation. Discussion Our findings were completely unexpected because these mAbs were long considered to be biological and clinical equivalents but, in practice, may perform better than the other in a patient-specific manner. This finding may have immediate clinical significance because both immunochemotherapy combinations are already FDA-approved with no difference in toxicity across phase I, II, and III clinical trials. Therefore, this finding could inform a new precision medicine strategy to provide additional therapeutic benefit to patients with B-cell lymphoma using immunochemotherapy combinations that already meet the clinical standard of care.
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Affiliation(s)
- Brian Lee
- Department of Biochemistry and Molecular Genetics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Tim Pierpont
- Department of Microbiology and Immunology, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
| | - Avery August
- Department of Microbiology and Immunology, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
| | - Kristy Richards
- Department of Biomedical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
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Chohan KL, Siegler EL, Kenderian SS. CAR-T Cell Therapy: the Efficacy and Toxicity Balance. Curr Hematol Malig Rep 2023; 18:9-18. [PMID: 36763238 PMCID: PMC10505056 DOI: 10.1007/s11899-023-00687-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 02/11/2023]
Abstract
PURPOSE OF REVIEW Chimeric antigen receptor (CAR) T cell therapy is an immunotherapy that has resulted in tremendous progress in the treatment of patients with B cell malignancies. However, the remarkable efficacy of therapy is not without significant safety concerns. Herein, we will review the unique and potentially life-threatening toxicities associated with CAR-T cell therapy and their association with treatment efficacy. RECENT FINDINGS Currently, CAR-T cell therapy is approved for the treatment of B cell relapsed or refractory leukemia and lymphoma, and most recently, multiple myeloma (MM). In these different diseases, it has led to excellent complete and overall response rates depending on the patient population and therapy. Despite promising efficacy, CAR-T cell therapy is associated with significant side effects; the two most notable toxicities are cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). The treatment of CAR-T-induced toxicity is supportive; however, as higher-grade adverse events occur, toxicity-directed therapy with tocilizumab, an IL-6 receptor antibody, and steroids is standard practice. Overall, a careful risk-benefit balance exists between the efficacy and toxicities of therapies. The challenge lies in the underlying pathophysiology of CAR-T-related toxicity which relies upon the activation of CAR-T cells. Some degree of toxicity is expected to achieve an effective response to therapy, and certain aspects of treatment are also associated with toxicity. As progress is made in the investigation and approval of new CARs, novel toxicity-directed therapies and toxicity-limited constructs will be the focus of attention.
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Affiliation(s)
| | - Elizabeth L Siegler
- T Cell Engineering, Mayo Clinic, Rochester, MN, USA
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Saad S Kenderian
- T Cell Engineering, Mayo Clinic, Rochester, MN, USA.
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
- Department of Molecular Medicine, Mayo Clinic, Rochester, MN, USA.
- Department of Immunology, Mayo Clinic, Rochester, MN, USA.
- Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, 200 1st ST SW, Rochester, MN, 55902, USA.
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Gladbach YS, Sklarz LM, Roolf C, Beck J, Schütz E, Fuellen G, Junghanss C, Murua Escobar H, Hamed M. Molecular Characterization of the Response to Conventional Chemotherapeutics in Pro-B-ALL Cell Lines in Terms of Tumor Relapse. Genes (Basel) 2022; 13:genes13071240. [PMID: 35886023 PMCID: PMC9316692 DOI: 10.3390/genes13071240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/26/2022] [Accepted: 06/29/2022] [Indexed: 11/29/2022] Open
Abstract
Little is known about optimally applying chemotherapeutic agents in a specific temporal sequence to rapidly reduce the tumor load and to improve therapeutic efficacy. The clinical optimization of drug efficacy while reducing side effects is still restricted due to an incomplete understanding of the mode of action and related tumor relapse mechanisms on the molecular level. The molecular characterization of transcriptomic drug signatures can help to identify the affected pathways, downstream regulated genes and regulatory interactions related to tumor relapse in response to drug application. We tried to outline the dynamic regulatory reprogramming leading to tumor relapse in relapsed MLL-rearranged pro-B-cell acute lymphoblastic leukemia (B-ALL) cells in response to two first-line treatments: dexamethasone (Dexa) and cytarabine (AraC). We performed an integrative molecular analysis of whole transcriptome profiles of each treatment, specifically considering public knowledge of miRNA regulation via a network-based approach to unravel key driver genes and miRNAs that may control the relapse mechanisms accompanying each treatment. Our results gave hints to the crucial regulatory roles of genes leading to Dexa-resistance and related miRNAs linked to chemosensitivity. These genes and miRNAs should be further investigated in preclinical models to obtain more hints about relapse processes.
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Affiliation(s)
- Yvonne Saara Gladbach
- Institute for Biostatistics and Informatics in Medicine and Ageing Research (IBIMA), Rostock University Medical Center, 18057 Rostock, Germany; (Y.S.G.); (G.F.)
- Faculty of Biosciences, Heidelberg University, 69120 Heidelberg, Germany
- Division of Applied Bioinformatics, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Lisa-Madeleine Sklarz
- Clinic III—Hematology, Oncology, Palliative Medicine, Center for Internal Medicine, Rostock University Medical Center, 18057 Rostock, Germany; (L.-M.S.); (C.R.); (C.J.); (H.M.E.)
| | - Catrin Roolf
- Clinic III—Hematology, Oncology, Palliative Medicine, Center for Internal Medicine, Rostock University Medical Center, 18057 Rostock, Germany; (L.-M.S.); (C.R.); (C.J.); (H.M.E.)
| | - Julia Beck
- Chronix Biomedical GmbH, 37073 Göttingen, Germany; (J.B.); (E.S.)
| | - Ekkehard Schütz
- Chronix Biomedical GmbH, 37073 Göttingen, Germany; (J.B.); (E.S.)
| | - Georg Fuellen
- Institute for Biostatistics and Informatics in Medicine and Ageing Research (IBIMA), Rostock University Medical Center, 18057 Rostock, Germany; (Y.S.G.); (G.F.)
| | - Christian Junghanss
- Clinic III—Hematology, Oncology, Palliative Medicine, Center for Internal Medicine, Rostock University Medical Center, 18057 Rostock, Germany; (L.-M.S.); (C.R.); (C.J.); (H.M.E.)
| | - Hugo Murua Escobar
- Clinic III—Hematology, Oncology, Palliative Medicine, Center for Internal Medicine, Rostock University Medical Center, 18057 Rostock, Germany; (L.-M.S.); (C.R.); (C.J.); (H.M.E.)
- Comprehensive Cancer Center Mecklenburg-Vorpommern (CCC-MV), Campus Rostock, Rostock University Medical Center, 18057 Rostock, Germany
| | - Mohamed Hamed
- Institute for Biostatistics and Informatics in Medicine and Ageing Research (IBIMA), Rostock University Medical Center, 18057 Rostock, Germany; (Y.S.G.); (G.F.)
- Correspondence:
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Mi YC. [How I diagnose and treat adult acute lymphoblastic leukemia]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2020; 40:541-546. [PMID: 32397015 PMCID: PMC7364894 DOI: 10.3760/cma.j.issn.0253-2727.2019.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Y C Mi
- Institute of Hematology & Hospital of Blood Disease, CAMS & PUMC, Tianjin 300020, China
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Hoelzer D, Bassan R, Dombret H, Fielding A, Ribera JM, Buske C. Acute lymphoblastic leukaemia in adult patients: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2016; 27:v69-v82. [PMID: 27056999 DOI: 10.1093/annonc/mdw025] [Citation(s) in RCA: 170] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- D Hoelzer
- ONKOLOGIKUM Frankfurt am Museumsufer, Frankfurt, Germany
| | - R Bassan
- Hematology Unit, Ospedale dell'Angelo e Ospedale SS. Giovanni e Paolo, Mestre-Venezia, Italy
| | - H Dombret
- Institut Universitaire d'Hematologie Hopital St Louis, Paris, France
| | - A Fielding
- Cancer Institute, University College London, London, UK
| | - J M Ribera
- Department of Clinical Hematology, ICO-Hospital Germans Trias i Pujol, Jose Carreras Research Institute, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - C Buske
- CCC Ulm, Institut für Experimentelle Tumorforschung, Universitätsklinikum Ulm, Ulm, Germany
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Karachunsky AI, Rumyantseva YV, Lagoiko SN, Bührer C, Tallen G, Aleinikova OV, Bydanov OI, Korepanova NV, Baidun LV, Nasedkina TV, Stackelberg AV, Novichkova GA, Maschan AA, Litvinov DV, Ponomareva NI, Kondratchik KL, Mansurova EG, Fechina LG, Streneva OV, Yudina NB, Sharapova GR, Shamardina AV, Gerbek IE, Shapochnik AP, Rumyantsev AG, Henze G. [Age-related characteristics of the efficacy of different glucocorticosteroids in the therapy of acute lymphoblastic leukemia]. TERAPEVT ARKH 2015; 87:41-50. [PMID: 26390724 DOI: 10.17116/terarkh201587741-50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To determine predictors for decision-making on a differential approach to choosing glucocorticosteroids (GCS) for children and adolescents with acute lymphoblastic leukemia (ALL). SUBJECTS AND METHODS The analysis covered 1064 primary patients aged to 1 to 18 years with ALL who had been registered at the clinics of Russia and Belorussia in April 2002 to November 2006. Before induction therapy, the patients were randomized into a dexamethasone (DEXA) 6 mg/m2 group (n=539) and a methylprednisolone (MePRED) 60 mg/m2 one (n=525). RESULTS The entire group showed no statistically significant differences in survival rates between the patients receiving DEXA or MePRED. However, an analysis of age groups revealed the benefits of DEXA in children younger than 14 years (the event-free survival (EFS) was 76±2 and 71±2%, respectively (p=0.048); the overall survival (OS) was 81±2 and 77±2%, respectively (p=0.046); therapy-induced mortality was 6.4% (DEXA) andl 1.1% (MePRED) (p=0.01 4); the rate of isolated extramedullary relapses was 1.5% (DEXA) and 4.4% (MePRED) (p=0.009). At the same time, EFS and OS in 14-to-18-year-old adolescents were statistically significantly higher than in those who used MePRED (EFS, 65±6 and 52±6%, respectively (p=0.087); OS, 72±6 and 61±6%, respectively; (p=0.l 7). CONCLUSION The findings suggest that it is possible that the choice of a GCS for ALL therapy must be also based on a patient's age. There is a need for further studies of this matter in prospective randomized multicenter trials in children and adolescents.
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Affiliation(s)
- A I Karachunsky
- D. Rogachev Federal Research Clinical Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia; N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow, Russia
| | - Yu V Rumyantseva
- D. Rogachev Federal Research Clinical Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia; N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow, Russia
| | - S N Lagoiko
- D. Rogachev Federal Research Clinical Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia
| | - C Bührer
- Department of Pediatric Oncology/Hematology, Charité-Universitätsmedizin Berlin, Germany
| | - G Tallen
- Department of Pediatric Oncology/Hematology, Charité-Universitätsmedizin Berlin, Germany
| | - O V Aleinikova
- Republican Research and Practical Center for Pediatric Oncology and Hematology, Minsk, Belarus
| | - O I Bydanov
- D. Rogachev Federal Research Clinical Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia; Republican Research and Practical Center for Pediatric Oncology and Hematology, Minsk, Belarus
| | - N V Korepanova
- D. Rogachev Federal Research Clinical Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia
| | - L V Baidun
- Russian Children's Clinical Hospital, Ministry of Health of Russia, Moscow, Russia
| | - T V Nasedkina
- D. Rogachev Federal Research Clinical Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia
| | - A Von Stackelberg
- Department of Pediatric Oncology/Hematology, Charité-Universitätsmedizin Berlin, Germany
| | - G A Novichkova
- D. Rogachev Federal Research Clinical Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia; N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow, Russia
| | - A A Maschan
- D. Rogachev Federal Research Clinical Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia; N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow, Russia
| | - D V Litvinov
- D. Rogachev Federal Research Clinical Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia; N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow, Russia
| | - N I Ponomareva
- Russian Children's Clinical Hospital, Ministry of Health of Russia, Moscow, Russia
| | - K L Kondratchik
- N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow, Russia; Morozov City Children's Clinical Hospital, Moscow Healthcare Department, Moscow, Russia
| | - E G Mansurova
- N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow, Russia
| | - L G Fechina
- Regional Children's Clinical Hospital One, Yekaterinburg, Russia
| | - O V Streneva
- Regional Children's Clinical Hospital One, Yekaterinburg, Russia
| | - N B Yudina
- Voronezh Regional Children's Clinical Hospital One, Voronezh, Russia
| | - G R Sharapova
- Nizhnevartovsk District Children's Clinical Hospital, Nizhnevartovsk, Khanty-Mansi Autonomic District-Yugra, Russia
| | - A V Shamardina
- Nizhny Novgorod Regional Children's Clinical Hospital, Nizhny Novgorod, Russia
| | - I E Gerbek
- Tomsk Regional Clinical Hospital, Tomsk, Russia
| | - A P Shapochnik
- Orenburg Regional Clinical Oncology Dispensary, Orenburg, Russia
| | - A G Rumyantsev
- D. Rogachev Federal Research Clinical Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia
| | - G Henze
- Department of Pediatric Oncology/Hematology, Charité-Universitätsmedizin Berlin, Germany
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Efficacy and toxicity of dexamethasone vs methylprednisolone-long-term results in more than 1000 patients from the Russian randomized multicentric trial ALL-MB 2002. Leukemia 2015; 29:1955-8. [PMID: 25748686 DOI: 10.1038/leu.2015.63] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Girard P, Auquier P, Barlogis V, Contet A, Poiree M, Demeocq F, Berbis J, Herrmann I, Villes V, Sirvent N, Kanold J, Chastagner P, Chambost H, Plantaz D, Michel G. Symptomatic osteonecrosis in childhood leukemia survivors: prevalence, risk factors and impact on quality of life in adulthood. Haematologica 2013; 98:1089-97. [PMID: 23645686 DOI: 10.3324/haematol.2012.081265] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Corticosteroid can induce osteonecrosis in children with leukemia. Few studies have been designed to assess the influence of a wide range of cumulative steroid dose on this side effect. Prevalence, risk factors of symptomatic osteonecrosis and its impact on adults' Quality of Life were assessed in 943 patients enrolled in the French "Leucémies de l'Enfant et de l'Adolescent" (LEA) cohort of childhood leukemia survivors. During each medical visit, data on previous osteonecrosis diagnosis were retrospectively collected. Patients without a history but with suggestive symptoms were investigated with magnetic resonance imaging. The total steroid dose in equivalent of prednisone was calculated for each patient and its effect on osteonecrosis occurrence was studied in multivariate models. Cumulative incidence was 1.4% after chemotherapy alone versus 6.8% after transplantation (P<0.001). A higher cumulative steroid dose, age over ten years at diagnosis, and treatment with transplantation significantly increased the risk of osteonecrosis. A higher post-transplant steroid dose and age over ten years at time of transplantation were significant factors in the transplanted group. With patients grouped according to steroid dose quartile, cumulative incidence of osteonecrosis reached 3.8% in the chemotherapy group for a dose beyond 5835 mg/m(2) and 23.8% after transplantation for a post-transplant dose higher than 2055 mg/m(2). Mean physical composite score of Quality of Life was 44.3 in patients with osteonecrosis versus 54.8% in patients without (P<0.001). We conclude that total and post-transplant cumulative steroid dose may predict the risk of osteonecrosis, a rare late effect with a strong negative impact on physical domains of Quality of Life.
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Affiliation(s)
- Pauline Girard
- Department of Pediatric Hematology-Oncology, APHM, La Timone Hospital, Aix-Marseille University, France
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Hassan IB, Kristensen J, Alizadeh H, Bernsen R. Outcome of patients with acute lymphoblastic leukemia (ALL) following induction therapy with a modified (pulsed dexamethasone rather than continuous prednisone) UKALL XII/ECOG E2993 protocol at Tawam Hospital, United Arab Emirates (UAE). Med Oncol 2013; 30:519. [PMID: 23468219 DOI: 10.1007/s12032-013-0519-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 02/19/2013] [Indexed: 11/28/2022]
Abstract
This retrospective data analysis examined the outcome of 99 acute lymphoblastic leukemia (ALL) patients treated at Tawam Hospital between January 2000 and December 2009. Sixteen patients were treated before June 2002, and 83 patients were treated from June 2002. A modified form of UKALL XII/ECOG E2993 with pulsed dexamethasone in induction phase one (modified UKALL) was the main therapy from June 2002 (71/83). The median age was 28 years. Fifty-eight percent had pre-B ALL where 36 % of them were Philadelphia chromosome-positive (Ph+). Overall, complete remission (CR) rate was 86.7 % which was significantly inferior for patients with white blood cell count 30-100 × 10⁹/l (p = 0.009), therapy before June 2002 (p = 0.02), pregnancy (p = 0.005), CNS leukemia (p = 0.028), and unknown karyotype (p = 0.004). With a median follow-up of 11.8 months (0.49-126 months), the estimated overall survival (OS) and event-free survival (EFS) at 3 years were 50.6 and 28.7 %, respectively. OS and EFS were significantly inferior for patients not in CR after induction, age >20 years, Ph+, unknown karyotype and therapy before June 2002. In addition, CR, OS and EFS were significantly superior (p = 0.004, p < 0.001 and p = 0.001, respectively) for therapy with our modified UKALL protocol compared to Tawam protocol (main therapy before June 2002). In conclusion, the outcome of treatment for ALL at our institute is encouraging with significant improvement in the outcome of older adolescents and young adults when using high-intensity chemotherapy. This suggests that such an approach is feasible in developing countries in spite of some limitations including lack of stem cell transplantation service.
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Affiliation(s)
- Inaam B Hassan
- Department of Internal Medicine, Faculty of Medicine and Health Sciences, United Arab Emirates University, PO Box 17666, Al Ain, United Arab Emirates.
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Abstract
PURPOSE OF REVIEW This review will be focused on the advances in adult acute lymphoblastic leukemia (ALL) based on recently published articles. RECENT FINDINGS Progress in the understanding of the molecular basis of ALL has contributed to a more precise definition of risk factors. The study of minimal residual disease has re-defined the baseline prognostic factors and has opened new strategies for postremission management. The use of pediatric-inspired therapies for young adults with standard-risk ALL, the broadening of the number of patients who are eligible for allogeneic stem cell transplantation, the increasing use of targeted therapies (monoclonal antibodies, tyrosine kinase inhibitors, and new purine analogs, etc.) in early phases of the disease, together with the improvements in supportive therapy explain the increased survival of young and middle-aged adult ALL. SUMMARY These changes are improving long-term outcome, which in ongoing studies is expected to be of close to 50%, and are opening the door for future therapeutic advances.
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Hoyle J, Williams A. Should anaesthetists be giving dexamethasone to patients with malignancy? Br J Hosp Med (Lond) 2011; 72:478. [DOI: 10.12968/hmed.2011.72.8.478] [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]
Affiliation(s)
| | - Andrew Williams
- Department of Anaesthetics, Whipps Cross University Hospital London E11 1NR
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Oliansky DM, Larson RA, Weisdorf D, Dillon H, Ratko TA, Wall D, McCarthy PL, Hahn T. The role of cytotoxic therapy with hematopoietic stem cell transplantation in the treatment of adult acute lymphoblastic leukemia: update of the 2006 evidence-based review. Biol Blood Marrow Transplant 2011; 18:18-36.e6. [PMID: 21803017 DOI: 10.1016/j.bbmt.2011.07.019] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Accepted: 07/25/2011] [Indexed: 11/26/2022]
Abstract
Clinical research published since the first evidence-based review on the role of hematopoietic stem cell transplantation (SCT) in the treatment of acute lymphoblastic leukemia (ALL) in adults is presented and critically evaluated in this update. Treatment recommendations changed or modified based on new evidence include: (1) myeloablative allogeneic SCT is an appropriate treatment for adult (<35 years) ALL in first complete remission for all disease risk groups; and (2) reduced-intensity conditioning may produce similar outcomes to myeloablative regimens. Treatment recommendations unchanged or strengthened by new evidence include: (1) allogeneic SCT is recommended over chemotherapy for ALL in second complete remission or greater; (2) allogeneic is superior to autologous SCT; and (3) there are similar survival outcomes after related and unrelated allogeneic SCT. New treatment recommendations based on new evidence include: (1) in the absence of a suitable allogeneic donor, autologous SCT may be an appropriate therapy, but results in a high relapse rate; (2) it is appropriate to consider cord blood transplantation for patients with no HLA well-matched donor; and (3) imatinib therapy before and/or after SCT (for Ph+ ALL) yields significantly superior survival outcomes. Areas of needed research in the treatment of adult ALL with SCT were identified and presented in the review.
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Teuffel O, Kuster SP, Hunger SP, Conter V, Hitzler J, Ethier MC, Shah PS, Beyene J, Sung L. Dexamethasone versus prednisone for induction therapy in childhood acute lymphoblastic leukemia: a systematic review and meta-analysis. Leukemia 2011; 25:1232-8. [PMID: 21527934 DOI: 10.1038/leu.2011.84] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This systematic review and meta-analysis compared the efficacy and toxicity of dexamethasone (DEX) versus prednisone (PRED) for induction therapy in childhood acute lymphoblastic leukemia (ALL). We searched biomedical literature databases and conference proceedings for randomized controlled trials comparing DEX and PRED during induction therapy for childhood ALL. A total of eight studies were eligible for inclusion in this meta-analysis. DEX, in comparison with PRED, reduced events (that is, death from any cause, refractory or relapsed leukemia, or second malignancy; risk ratio (RR) 0.80; 95% confidence interval (CI), 0.68-0.94) and central nervous system relapse (RR 0.53; 95% CI, 0.44-0.65), but did not alter bone marrow relapse (RR 0.90; 95% CI, 0.69-1.18) or overall mortality (RR 0.91; 95% CI, 0.76-1.09). Patients receiving DEX had a higher risk of mortality during induction (RR 2.31; 95% CI, 1.46-3.66), neuro-psychiatric adverse events (RR 4.55; 95% CI, 2.45-8.46) and myopathy (RR 7.05; 95% CI, 3.00-16.58). There was no statistically significant difference in the risk of osteonecrosis, sepsis, fungal infection, diabetes or pancreatitis. DEX in induction therapy for children with ALL is more efficacious than PRED. However, DEX is also associated with more toxicity, and currently it remains unclear whether short-term superiority of DEX will also result in better overall survival.
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Affiliation(s)
- O Teuffel
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
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