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Assouline S, Wiesinger A, Spooner C, Jovanović J, Schlueter M. Validity of event-free survival as a surrogate endpoint in haematological malignancy: Review of the literature and health technology assessments. Crit Rev Oncol Hematol 2022; 175:103711. [DOI: 10.1016/j.critrevonc.2022.103711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 04/29/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022] Open
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Wang F, Xu W, Liu L, Ren X, Liu P, Zheng L, Zhang H, Zhang S, Xu Y, Guo Z. Low dose of homoharringtonine and cytarabine-based priming induction regimens for patients with de novo acute myeloid leukemia and high-risk myelodysplastic syndrome aged over 70 years. Hematology 2021; 26:1040-1045. [PMID: 34895093 DOI: 10.1080/16078454.2021.2009642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES Our objective is to retrospectively analyze the response to low dose of homoharringtonine (HHT) and cytarabine-based priming induction regimens in patients above 70 years with de novo acute myeloid leukemia (AML) and high-risk myelodysplastic syndrome (MDS). PATIENTS AND METHODS We retrospectively analyzed these very elderly newly diagnosed patients with AML and high-risk MDS, who received low dose of HHT and cytarabine-based priming induction regimens between March 2006 and September 2019. RESULTS Of the 24 patients, 11 patients (47.8%) achieved complete remission (CR) and 3 (13%) partial remission, and the overall response rate was 60.9%. The estimated median overall survival (OS) time was 12 months and the 1-year OS rate was 47.8%. Patients without CR and Charlson's Comorbidity Index > 2 may be the two independent prognostic factors. The median OS was significantly higher for patients with CR after induction chemotherapy than those without CR (22.93 vs. 8.5 months, p < .01). CONCLUSION Our study provides a hint of the efficacy of low dose of HHT and cytarabine-based priming induction regimens for patients aged over 70 years with de novo AML and high-risk MDS should be further studied.
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Affiliation(s)
- Fang Wang
- Department of Hematology/Oncology, First Hospital of Tsinghua University, Beijing, People's Republic of China
| | - Wenyan Xu
- Department of Hematology/Oncology, First Hospital of Tsinghua University, Beijing, People's Republic of China
| | - Li Liu
- Department of Hematology/Oncology, First Hospital of Tsinghua University, Beijing, People's Republic of China
| | - Xiuhong Ren
- Department of Hematology/Oncology, First Hospital of Tsinghua University, Beijing, People's Republic of China
| | - Pingping Liu
- Department of Hematology/Oncology, First Hospital of Tsinghua University, Beijing, People's Republic of China
| | - Li Zheng
- Department of Hematology/Oncology, First Hospital of Tsinghua University, Beijing, People's Republic of China
| | - Hao Zhang
- Department of Hematology/Oncology, First Hospital of Tsinghua University, Beijing, People's Republic of China
| | - Songsong Zhang
- Department of Hematology/Oncology, First Hospital of Tsinghua University, Beijing, People's Republic of China
| | - Yaru Xu
- Department of Hematology/Oncology, First Hospital of Tsinghua University, Beijing, People's Republic of China
| | - Zhenxing Guo
- Department of Hematology/Oncology, First Hospital of Tsinghua University, Beijing, People's Republic of China
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Cladribine Combined with Low-Dose Cytarabine as Frontline Treatment for Unfit Elderly Acute Myeloid Leukemia Patients: Results from a Prospective Multicenter Study of Polish Adult Leukemia Group (PALG). Cancers (Basel) 2021; 13:cancers13164189. [PMID: 34439342 PMCID: PMC8391610 DOI: 10.3390/cancers13164189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/13/2021] [Accepted: 08/17/2021] [Indexed: 01/13/2023] Open
Abstract
Simple Summary Treatment of acute myeloid leukemia (AML) in elderly patients unfit for intensive chemotherapy (IC) is a challenge in clinical practice. Here we prospectively evaluated a novel low-intensity regimen consisting of low-dose cytarabine combined with cladribine (LD-AC+cladribine) for remission induction followed by LD-AC alone in the maintenance phase as the frontline treatment for elderly AML patients ineligible for IC. We included a cohort of 117 elderly patients in poor performance status or with significant comorbidities. High-risk or intermediate-risk cytogenetics were observed in almost 90% of patients. Treatment with LD-AC+cladribine led to the objective response rate of 54% and the median overall survival of 17.3 months in the responders group. The toxicity profile was predictable and infectious complications were the most common non-hematological adverse events. In conclusion, we found LD-AC+cladribine as a beneficial therapeutic option with an acceptable safety profile in the difficult-to-treat population of elderly AML patient ineligible for IC. Abstract Acute myeloid leukemia (AML) in older unfit patients is a therapeutic challenge for clinical hematologists. We evaluated the efficacy and safety of a novel low-intensity regimen consisting of low-dose cytarabine and cladribine (LD-AC+cladribine) in first-line treatment of elderly (≥60 years) AML patients not eligible for intensive chemotherapy (IC) who had either the Eastern Cooperative Oncology Group performance status (ECOG PS) ≥2 or the hematopoietic cell transplantation comorbidity index (HCT-CI) score ≥3. The induction phase included two cycles of LD-AC+cladribine. Patients who achieved at least partial remission (PR) received maintenance treatment with LD-AC alone. Overall, 117 patients with a median age of 70 years were enrolled. Adverse cytogenetics, ECOG PS ≥2 and HCT-CI score ≥3 was observed in 43.5%, 60%, and 58% of patients, respectively. The response rate (≥PR) was 54% (complete remission [CR], 32%; CR with incomplete hematologic recovery [CRi], 5%). A median overall survival (OS) was 21 and 8.8 months in CR/CRi and PR group, respectively. Advanced age (≥75 years) and adverse cytogenetics had a negative impact on OS. The 56-day mortality rate was 20.5%. In conclusion, LD-AC+cladribine is a beneficial therapeutic option with a predictable safety profile in elderly AML patients not eligible for IC.
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Cortes JE, Candoni A, Clark RE, Leber B, Montesinos P, Vyas P, Zeidan AM, Heuser M. Selection and management of older patients with acute myeloid leukemia treated with glasdegib plus low-dose cytarabine: expert panel review. Leuk Lymphoma 2020; 61:3287-3305. [DOI: 10.1080/10428194.2020.1817445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Jorge E. Cortes
- Division of Hematology and SCT, Georgia Cancer Center, Augusta, GA, USA
| | - Anna Candoni
- University Hospital of Udine-ASUFC, Udine, Italy
| | - Richard E. Clark
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Brian Leber
- Division of Hematology and Thromboembolism, Department of Medicine, McMaster University Medical Centre, Hamilton, Canada
| | - Pau Montesinos
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
| | - Paresh Vyas
- Weatherall Institute of Molecular Medicine, Oxford, UK
- National Institute of Health Research Oxford, Biomedical Research Centre, Oxford, UK
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Benchmarking treatment effects for patients over 70 with acute myeloid leukemia: A systematic review and meta-analysis. J Geriatr Oncol 2020; 11:1293-1308. [PMID: 32665186 DOI: 10.1016/j.jgo.2020.06.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/20/2020] [Accepted: 06/15/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVES The majority of patients with acute myeloid leukemia (AML) are aged 70 and over. However, there is uncertainty about how and whether older patients with AML should receive cytotoxic treatment. MATERIALS AND METHODS Medline and Cochrane library search was performed for studies in newly diagnosed AML which enrolled at least 20 patients per arm (for randomized controlled trials), or 50 patients (for non-randomized studies) over the age of 70. References were hand searched for additional eligible studies. Study investigators were contacted to maximize relevant data. Dual independent data extraction was done using standardized data collection forms. Data was collected on study and treatment characteristics, baseline patient information, and outcomes. Study methodological quality was assessed. The primary outcome was 1 year overall survival (OS). Impact of treatment [intensive chemotherapy (INT), low-dose chemotherapy (LOW), hypomethylating agents (HMA), or best supportive care (BSC)], cytogenetics, performance status, and comorbidity were assessed. RESULTS The search produced 11,846 references of which 38 randomized controlled trials and 30 non-randomized studies met inclusion criteria, representing 13,381 patients, with a worldwide distribution. One-year OS with INT was 37% (31-42%), with LOW 11% (6-18%), with HMA 35% (18-54%) and with BSC 17%(13-21%). Two-year OS was 22% (18-26%), 11% (7-15%), 22% (16-28%), 6% (2-12%), respectively. We present subgroup data based on the studies including cytogenetics, performance status, and comorbidity. Formal direct comparisons with adjustment for all prognostic factors were not possible. CONCLUSIONS In this largest to date series of AML patients aged 70 and older, we provide benchmarks for treatment efficacy and effectiveness that may be used for decision analysis models and for the future development of clinical trials focusing on these patients.
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Singh A, Myklebust NN, Furevik SMV, Haugse R, Herfindal L. Immunoliposomes in Acute Myeloid Leukaemia Therapy: An Overview of Possible Targets and Obstacles. Curr Med Chem 2019; 26:5278-5292. [PMID: 31099318 DOI: 10.2174/0929867326666190517114450] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 12/30/2022]
Abstract
Acute Myeloid Leukaemia (AML) is the neoplastic transformation of Hematopoietic Stem Cells (HSC) and relapsed disease is a major challenge in the treatment. Despite technological advances in the field of medicine and our heightened knowledge regarding the pathogenesis of AML, the initial therapy of "7+3" Cytarabine and Daunorubicin has remained mainly unchanged since 1973. AML is a disease of the elderly, and increased morbidity in this patient group does not allow the full use of the treatment and drug-resistant relapse is common. Nanocarriers are drug-delivery systems that can be used to transport drugs to the bone marrow and target Leukemic Stem Cells (LSC), conferring less side-effects compared to the free-drug alternative. Nanocarriers also can be used to favour the transport of drugs that otherwise would not have been used clinically due to toxicity and poor efficacy. Liposomes are a type of nanocarrier that can be used as a dedicated drug delivery system, which can also have active ligands on the surface in order to interact with antigens on the target cells or tissues. In addition to using small molecules, it is possible to attach antibodies to the liposome surface, generating so-called immunoliposomes. By using immunoliposomes as a drug-delivery system, it is possible to minimize the toxic side effects caused by the chemotherapeutic drug on healthy organs, and at the same time direct the drugs towards the remaining AML blasts and stem cells. This article aims to explore the possibilities of using immunoliposomes as a drug carrier in AML therapy. Emphasis will be on possible target molecules on the AML cells, leukaemic stem cells, as well as bone marrow constituents relevant to AML therapy. Further, some conditions and precautions that must be met for immunoliposomes to be used in AML therapy will be discussed.
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Affiliation(s)
- Aditi Singh
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Sarah Marie Vie Furevik
- Hospital pharmacies enterprise, Western Norway, Bergen, Norway.,Centre for Pharmacy, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Ragnhild Haugse
- Hospital pharmacies enterprise, Western Norway, Bergen, Norway.,Centre for Pharmacy, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Lars Herfindal
- Centre for Pharmacy, Department of Clinical Science, University of Bergen, Bergen, Norway
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Effectiveness and Safety of Therapeutic Regimens for Elderly Patients With Acute Myeloid Leukemia: A Systematic Literature Review. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:e303-e314. [DOI: 10.1016/j.clml.2018.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/02/2018] [Accepted: 05/02/2018] [Indexed: 01/25/2023]
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Zhou WD, Wang X, Sun XZ, Hu J, Zhang RR, Hong Z. Actein induces apoptosis in leukemia cells through suppressing RhoA/ROCK1 signaling pathway. Int J Oncol 2017; 51:1831-1841. [DOI: 10.3892/ijo.2017.4150] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 06/23/2017] [Indexed: 11/06/2022] Open
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Butrym A, Rybka J, Baczyńska D, Poręba R, Mazur G, Kuliczkowski K. Expression of microRNA-181 determines response to treatment with azacitidine and predicts survival in elderly patients with acute myeloid leukaemia. Oncol Lett 2016; 12:2296-2300. [PMID: 27698792 PMCID: PMC5038519 DOI: 10.3892/ol.2016.4970] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 06/02/2016] [Indexed: 11/20/2022] Open
Abstract
MicroRNAs (miRs) are small non-coding RNAs that play important roles in cell differentiation and survival. Abnormal expression of miRs has been demonstrated in numerous types of cancer, including acute myeloid leukaemia (AML). The aim of the present study was to evaluate miR-181 expression at diagnosis and following the completion of chemotherapy in AML patients, with regard to clinical response and outcome, particularly in patients treated with azacitidine. miR-181 expression was analysed using reverse transcription-quantitative polymerase chain reaction in 95 bone marrow specimens from newly diagnosed AML patients and in 20 healthy subjects for comparison. The results revealed upregulated miR-181 expression in the total cohort of AML patients, which was correlated with longer survival. However, in a subset of older AML patients treated with azacitidine, low miR-181 expression at diagnosis was a predictor for complete remission and prolonged survival. The findings indicated that miR-181 has an important role in AML and determines response to azacitidine treatment in older AML patients.
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Affiliation(s)
- Aleksandra Butrym
- Department of Haematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw 50-367, Poland; Department of Physiology, Wroclaw Medical University, Wroclaw 50-367, Poland
| | - Justyna Rybka
- Department of Haematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw 50-367, Poland
| | - Dagmara Baczyńska
- Department of Forensic Medicine, Molecular Techniques Unit, Wroclaw Medical University, Wroclaw 50-345, Poland
| | - Rafał Poręba
- Department of Internal and Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw 50-556, Poland
| | - Grzegorz Mazur
- Department of Internal and Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw 50-556, Poland
| | - Kazimierz Kuliczkowski
- Department of Haematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw 50-367, Poland
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