1
|
Calvo C, Ronceray L, Dhédin N, Buechner J, Troeger A, Dalle JH. Haematopoietic Stem Cell Transplantation in Adolescents and Young Adults With Acute Lymphoblastic Leukaemia: Special Considerations and Challenges. Front Pediatr 2021; 9:796426. [PMID: 35087777 PMCID: PMC8787274 DOI: 10.3389/fped.2021.796426] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 12/02/2021] [Indexed: 12/17/2022] Open
Abstract
Adolescents and young adults (AYAs) represent a challenging group of acute lymphoblastic leukaemia (ALL) patients with specific needs. While there is growing evidence from comparative studies that this age group profits from intensified paediatric-based chemotherapy, the impact and optimal implementation of haematopoietic stem cell transplantation (HSCT) in the overall treatment strategy is less clear. Over recent years, improved survival rates after myeloablative allogeneic HSCT for ALL have been reported similarly for AYAs and children despite differences in transplantation practise. Still, AYAs appear to have inferior outcomes and an increased risk of treatment-related morbidity and mortality in comparison with children. To further improve HSCT outcomes and reduce toxicities in AYAs, accurate stratification and evaluation of additional or alternative targeted treatment options are crucial, based on specific molecular and immunological characterisation of ALL and minimal residual disease (MRD) assessment during therapy. Age-specific factors such as increased acute toxicities and poorer adherence to treatment as well as late sequelae might influence treatment decisions. In addition, educational, social, work, emotional, and sexual aspects during this very crucial period of life need to be considered. In this review, we summarise the key findings of recent studies on treatment approach and outcomes in this vulnerable patient group after HSCT, turning our attention to the different approaches applied in paediatric and adult centres. We focus on the specific needs of AYAs with ALL regarding social aspects and supportive care to handle complications as well as fertility issues. Finally, we comment on potential areas of future research and concisely debate the capacity of currently available immunotherapies to reduce toxicity and further improve survival in this challenging patient group.
Collapse
Affiliation(s)
- Charlotte Calvo
- Pediatric Hematology and Immunology Department, Robert Debré Academic Hospital, GHU APHP Nord - Université de Paris, Paris, France
| | - Leila Ronceray
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Nathalie Dhédin
- Hematology for Adolescents and Young Adults, Saint-Louis Academic Hospital GHU APHP Nord - Université de Paris, Paris, France
| | - Jochen Buechner
- Department of Pediatric Hematology and Oncology, Oslo University Hospital, Oslo, Norway
| | - Anja Troeger
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Hospital of Regensburg, Regensburg, Germany
| | - Jean-Hugues Dalle
- Pediatric Hematology and Immunology Department, Robert Debré Academic Hospital, GHU APHP Nord - Université de Paris, Paris, France
| |
Collapse
|
2
|
Mendivil-Perez M, Velez-Pardo C, David-Yepes GE, Fox JE, Jimenez-Del-Rio M. TPEN exerts selective anti-leukemic efficacy in ex vivo drug-resistant childhood acute leukemia. Biometals 2020; 34:49-66. [PMID: 33098492 DOI: 10.1007/s10534-020-00262-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 10/19/2020] [Indexed: 12/14/2022]
Abstract
Despite some advances in the treatment of acute lymphoblastic (ALL) and myeloid leukemia (AML) in recent years, there is still a prominent percentage of pediatric patients with a reduced overall prognosis. Therefore, other therapeutic approaches are needed to treat those patients. In the present study, we report that the metal chelator TPEN affected ΔΨm and DNA content in isolated CD34+ refractory cells from bone marrow ALL (n = 7; B-cell, n = 4; T-cell, n = 3) and AML (n = 3) pediatric patients. Furthermore, TPEN induced oxidation of hydrogen peroxide (H2O2) sensor protein DJ-1, induced up-regulation of BH3-only pro-apoptotic protein PUMA, transcription factor p53 and activated the executor protease CASPASE-3 as apoptosis markers, and reduced the reactivity of the cellular proliferating marker Ki-67 in all acute leukemic groups, and reduced the phosphorylation of c-ABL protein signal in an AML case. Remarkably, bone marrow cells from non-leukemic patients' cells (n = 2) displayed neither loss of ΔΨm nor loss of DNA content when exposed to TPEN. We conclude that TPEN selectively induces apoptosis in acute leukemic cells via reactive oxygen species (ROS) signaling mechanism. Understanding the pathways of TPEN-induced cell death may provide insight into more effective therapeutic ROS-inducing anticancer agents.
Collapse
Affiliation(s)
- Miguel Mendivil-Perez
- Neuroscience Research Group, Faculty of Medicine, Medical Research Institute, University of Antioquia (UdeA), SIU Medellin, Calle 70 No. 52-21, and Calle 62 # 52-59, Building 1, Room 412, Medellin, Colombia
| | - Carlos Velez-Pardo
- Neuroscience Research Group, Faculty of Medicine, Medical Research Institute, University of Antioquia (UdeA), SIU Medellin, Calle 70 No. 52-21, and Calle 62 # 52-59, Building 1, Room 412, Medellin, Colombia
| | - Gloria E David-Yepes
- Children's Hospital San Vicente Foundation, Pediatric Hemato-Oncology Unit, Calle 64 # 51 D-154, Medellin, Colombia
| | - Javier E Fox
- Children's Hospital San Vicente Foundation, Pediatric Hemato-Oncology Unit, Calle 64 # 51 D-154, Medellin, Colombia
| | - Marlene Jimenez-Del-Rio
- Neuroscience Research Group, Faculty of Medicine, Medical Research Institute, University of Antioquia (UdeA), SIU Medellin, Calle 70 No. 52-21, and Calle 62 # 52-59, Building 1, Room 412, Medellin, Colombia.
| |
Collapse
|
3
|
Dalle JH, Balduzzi A, Bader P, Pieczonka A, Yaniv I, Lankester A, Bierings M, Yesilipek A, Sedlacek P, Ifversen M, Svec P, Toporski J, Gungor T, Wachowiak J, Glogova E, Poetschger U, Peters C. The impact of donor type on the outcome of pediatric patients with very high risk acute lymphoblastic leukemia. A study of the ALL SCT 2003 BFM-SG and 2007-BFM-International SG. Bone Marrow Transplant 2021; 56:257-66. [PMID: 32753706 DOI: 10.1038/s41409-020-01014-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 07/01/2020] [Accepted: 07/24/2020] [Indexed: 01/01/2023]
Abstract
Allogeneic HSCT represents the only potentially curative treatment for very high risk (VHR) ALL. Two consecutive international prospective studies, ALL-SCT-(I)BFM 2003 and 2007 were conducted in 1150 pediatric patients. 569 presented with VHR disease leading to any kind of HSCT. All patients >2 year old were transplanted after TBI-based MAC. The median follow-up was 5 years. 463 patients were transplanted from matched donor (MD) and 106 from mismatched donor (MMD). 214 were in CR1. Stem cell source was unmanipulated BM for 330 patients, unmanipulated PBSC for 135, ex vivo T-cell depleted PBSC for 62 and cord-blood for 26. There were more advanced disease, more ex vivo T-cell depletion, and more chemotherapy based conditioning regimen for patients transplanted from MMD as compared to those transplanted from MSD or MD. Median follow up (reversed Kaplan Meier estimator) was 4.99 years, median follow up of survivals was 4.88, range (0.01–11.72) years. The 4-year CI of extensive cGvHD was 13 ± 2% and 17 ± 4% (p = NS) for the patients transplanted from MD and MMD, respectively. 4-year EFS was statistically better for patients transplanted from MD (60 ± 2% vs. 42 ± 5%, p < 0.001) for the whole cohort. This difference does not exist if considering separately patients treated in the most recent study. There was no difference in 4-year CI of relapse. The 4-year NRM was lower for patients transplanted from MD (9 ± 1% vs. 23 ± 4%, p < 0.001). In multivariate analysis, donor-type appears as a negative risk-factor for OS, EFS, and NRM. This paper demonstrates the impact of donor type on overall results of allogeneic stem cell transplantation for very-high risk pediatric acute lymphoblastic leukemia with worse results when using MMD stem cell source.
Collapse
|
4
|
Fuster JL, Molinos-Quintana A, Fuentes C, Fernández JM, Velasco P, Pascual T, Rives S, Dapena JL, Sisinni L, López-Godino O, Palomo P, Villa-Alcázar M, Bautista F, González-Vicent M, López-Duarte M, García-Morín M, Ramos-Elbal E, Ramírez M. Blinatumomab and inotuzumab for B cell precursor acute lymphoblastic leukaemia in children: a retrospective study from the Leukemia Working Group of the Spanish Society of Pediatric Hematology and Oncology (SEHOP). Br J Haematol 2020; 190:764-771. [PMID: 32314348 DOI: 10.1111/bjh.16647] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 03/16/2020] [Indexed: 12/13/2022]
Abstract
Blinatumomab and inotuzumab ozogamycin represent promising alternatives to conventional chemotherapy in acute lymphoblastic leukaemia (ALL). We analysed data from 29 children with ALL treated under compassionate use with blinatumomab, inotuzumab or both. The complete remission (CR) rate in a heavily pretreated population with overt relapse was 47·6%. At earlier stages (first/second CR), both antibodies represented a useful tool to reduce minimal residual disease, and/or avoid further toxic chemotherapy until stem cell transplantation. Six patients developed grade 3 reversible non-haematological toxicity. The 12-month overall survival and event-free survival rates were 50·8 ± 26·4% and 38·9 ± 25·3% with blinatumomab, 45·8 ± 26% and 27·5 ± 25% with inotuzumab.
Collapse
Affiliation(s)
- José L Fuster
- Pediatric Oncology and Haematology Department, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - Agueda Molinos-Quintana
- Department of Hematology, Pediatric Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (IBIS/CISC), Sevilla, Spain
| | - Carolina Fuentes
- Pediatric Oncology and Haematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - José M Fernández
- Pediatric Oncology and Haematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Pablo Velasco
- Pediatric Oncology and Haematology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Toñi Pascual
- Pediatric Hematology Unit, Hematology Department, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Susana Rives
- Hematology Department, Hospital San Joan de Déu, Institut de Reserca Sant Joan de Déu, Barcelona, Spain
| | - José L Dapena
- Hematology Department, Hospital San Joan de Déu, Institut de Reserca Sant Joan de Déu, Barcelona, Spain
| | - Luisa Sisinni
- Pediatric Hematology, Oncology and Hematopoietic Stem Cell Transplantation Unit, Santa Creu i Sant Pau Hospital, Barcelona, Spain
| | - Oriana López-Godino
- Hematology and Oncology Department, Centro Regional de Hemodonación, Hospital Universitario Morales Meseguer, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERER, Murcia, Spain
| | - Pilar Palomo
- Pediatric Hematology Unit, Hematology Department., Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Marta Villa-Alcázar
- Hematology and Oncology Department, Hospital Universitario HM Montepríncipe, HM/CIOCC, Madrid, Spain
| | - Francisco Bautista
- Pediatric Oncology, Haematology and Stem Cell Transplantation Department, Hospital Niño Jesús, Madrid, Spain
| | - Marta González-Vicent
- Pediatric Oncology, Haematology and Stem Cell Transplantation Department, Hospital Niño Jesús, Madrid, Spain
| | - Mónica López-Duarte
- Pediatric Hematology Unit, Hematology Department, Hospital de Valdecilla, Santander, Spain
| | - Marina García-Morín
- Pediatric Oncology and Haematology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Eduardo Ramos-Elbal
- Pediatric Oncology and Haematology Department, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - Manuel Ramírez
- Pediatric Oncology, Haematology and Stem Cell Transplantation Department, Hospital Niño Jesús, Madrid, Spain
| | | |
Collapse
|