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Kättström M, Uggla B, Tina E, Kimby E, Norén T, Athlin S. Improved plasmablast response after repeated pneumococcal revaccinations following primary immunization with 13-valent pneumococcal conjugate vaccine or 23-valent pneumococcal polysaccharide vaccine in patients with chronic lymphocytic leukemia. Vaccine 2023; 41:3128-3136. [PMID: 37061372 DOI: 10.1016/j.vaccine.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/26/2023] [Accepted: 04/04/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND Patients with chronic lymphocytic leukemia (CLL) show an immune dysfunction with increased risk of infections and poor response to vaccination. Streptococcus pneumoniae is a common cause of morbidity and mortality in CLL patients. In a previous randomized clinical trial, we found a superior immune response in CLL patients receiving conjugated pneumococcal vaccine compared to non-conjugated vaccine. The response to revaccination in CLL patients is scarcely studied. In this study, early humoral response to repeated revaccinations with pneumococcal vaccines was evaluated, by determination of B cell subsets and plasmablast dynamics in peripheral blood. METHOD CLL patients (n = 14) and immunocompetent controls (n = 31) were revaccinated with a 13-valent pneumococcal conjugate vaccine (PCV13) after previous primary immunization (3-6 years ago) with PCV13 or a 23-valent pneumococcal polysaccharide vaccine (PPSV23). Eight weeks after the first revaccination, all CLL patients received a second revaccination with PCV13 or PPSV23. B cell subsets including plasmablasts were analyzed in peripheral blood by flow cytometry, before and after the first and the second revaccination. RESULTS None of the CLL patients, but all controls, had detectable plasmablasts at baseline (p < 0.001). After the first revaccination with PCV13, the plasmablast proportions did not increase in CLL patients (p = 0.13), while increases were seen in controls (p < 0.001). However, after a second revaccination with PCV13 or PPSV23, plasmablasts increased compared to baseline also in CLL patients (p < 0.01). If no response was evident after first revaccination, only a second revaccination with PCV13 increased plasmablasts in contrast to PPSV23 revaccination. Patients with hypogammaglobulinemia and ongoing/previous CLL specific treatment responded poorly, also to a second revaccination. CONCLUSION In CLL patients, pneumococcal revaccination induced minor early plasmablast response compared to controls, but the response improved using a strategy of repeated doses with of conjugated T cell dependent pneumococcal vaccine.
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Affiliation(s)
- Magdalena Kättström
- Section of Hematology, Department of Medicine, Faculty of Medicine and Health, Örebro University, SE 70185 Örebro, Sweden.
| | - Bertil Uggla
- Section of Hematology, Department of Medicine, Faculty of Medicine and Health, Örebro University, SE 70185 Örebro, Sweden
| | - Elisabet Tina
- Department of Clinical Research Laboratory, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Eva Kimby
- Unit of Hematology, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Torbjörn Norén
- Department of Laboratory Medicine, Clinical Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Simon Athlin
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, SE 70185 Örebro, Sweden
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Österroos A, Maia T, Eriksson A, Jädersten M, Lazarevic V, Wennström L, Antunovic P, Cammenga J, Deneberg S, Lorenz F, Möllgård L, Uggla B, Ölander E, Aguiar E, Trigo F, Höglund M, Juliusson G, Lehmann S. A real-world based score to predict early death in acute promyelocytic leukemia. Haematologica 2022; 107:1528-1537. [PMID: 35081688 PMCID: PMC9244824 DOI: 10.3324/haematol.2021.280093] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Indexed: 11/09/2022] Open
Abstract
With increasingly effective treatments, early death (ED) has become the predominant reason for therapeutic failure in patients with acute promyelocytic leukemia (APL). To better prevent ED, patients with high-risk of ED must be identified. Our aim was to develop a score that predicts the risk of ED in a real-life setting. We used APL patients in the population-based Swedish AML Registry (n=301) and a Portuguese hospital-based registry (n=129) as training and validation cohorts, respectively. The cohorts were comparable with respect to age (median, 54 and 53 years) and ED rate (19.6% and 18.6%). The score was developed by logistic regression analyses, risk-per-quantile assessment and scoring based on ridge regression coefficients from multivariable penalized logistic regression analysis. White blood cell count, platelet count and age were selected by this approach as the most significant variables for predicting ED. The score identified low-, high- and very high-risk patients with ED risks of 4.8%, 20.2% and 50.9% respectively in the training cohort and with 6.7%, 25.0% and 36.0% as corresponding values for the validation cohort. The score identified an increased risk of ED already at sub-normal and normal white blood cell counts and, consequently, it was better at predicting ED risk than the Sanz score (AUROC 0.77 vs. 0.64). In summary, we here present an externally validated and population-based risk score to predict ED risk in a real-world setting, identifying patients with the most urgent need of aggressive ED prevention. The results also suggest that increased vigilance for ED is already necessary at sub-normal/normal white blood cell counts.
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Affiliation(s)
| | - Tânia Maia
- Department of Clinical Hematology, University Hospital Center of São João, Porto
| | - Anna Eriksson
- Department of Medical Sciences, Uppsala University, Uppsala
| | - Martin Jädersten
- Department of Hematology, Karolinska University Hospital, Stockholm
| | - Vladimir Lazarevic
- Department of Hematology, Skåne University Hospital, Lund, Sweden; Stem Cell Center, Department of Hematology, Department of Laboratory Medicine, Lund University, Lund
| | - Lovisa Wennström
- Department of Hematology, Sahlgrenska University Hospital, Gothenburg
| | - Petar Antunovic
- Department of Hematology, Linköping University Hospital, Linköping
| | - Jörg Cammenga
- Department of Hematology, Linköping University Hospital, Linköping
| | - Stefan Deneberg
- Department of Hematology, Karolinska University Hospital, Stockholm
| | - Fryderyk Lorenz
- Department of Hematology, Norrland University Hospital, Umeå
| | - Lars Möllgård
- Department of Hematology, Sahlgrenska University Hospital, Gothenburg
| | - Bertil Uggla
- Department of Medicine, Division of Hematology, Örebro University Hospital, Örebro
| | - Emma Ölander
- Department of Hematology, Sundsvall Hospital, Sundsvall
| | - Eliana Aguiar
- Department of Clinical Hematology, University Hospital Center of São João, Porto
| | - Fernanda Trigo
- Department of Clinical Hematology, University Hospital Center of São João, Porto
| | - Martin Höglund
- Department of Medical Sciences, Uppsala University, Uppsala
| | - Gunnar Juliusson
- Department of Hematology, Skåne University Hospital, Lund, Sweden; Stem Cell Center, Department of Hematology, Department of Laboratory Medicine, Lund University, Lund
| | - Sören Lehmann
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Department of Hematology, Karolinska University Hospital, Stockholm.
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Lidén M, Adrian D, Widell J, Uggla B, Thunberg P. Quantitative T2* imaging of iron overload in a non-dedicated center - Normal variation, repeatability and reader variation. Eur J Radiol Open 2021; 8:100357. [PMID: 34095355 PMCID: PMC8167145 DOI: 10.1016/j.ejro.2021.100357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/03/2021] [Accepted: 05/15/2021] [Indexed: 11/18/2022] Open
Abstract
Background Patients with transfusion dependent anemia are at risk of complications from iron overload. Quantitative T2* magnetic resonance imaging (MRI) is the best non-invasive method to assess iron deposition in the liver and heart and to guide chelation therapy. Purpose To investigate the image quality and inter-observer variations in T2* measurements of the myocardium and the liver, and to obtain the lower limit of cardiac and hepatic quantitative T2* values in patients without suspicion of iron overload. Material and methods Thirty-eight patients referred for cardiac MRI were prospectively included in the study. Three patients were referred with, and 35 without suspicion of iron overload. Quantitative T2* parametric maps were obtained on a 1.5 T MRI system in the cardiac short axis and liver axial view. Two readers independently assessed the image quality and the representative and the lowest T2* value in the myocardium and the liver. Results The normal range of representative T2* values in the myocardium and liver was 24−45 ms and 14−37 ms, respectively. None of the 35 participants (0 %, 95 % confidence interval 0–11 %) in the normal reference group demonstrated representative T2* values below previously reported lower limits in the myocardium (20 ms) or the liver (8 ms). Focal myocardial areas with T2* values near the lower normal range, 19−20 ms, were seen in two patients. The readers generally reported good image quality. Conclusion T2* imaging for assessing iron overload can be performed in a non-dedicated center with sufficient image quality.
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Affiliation(s)
- Mats Lidén
- Department of Radiology, Faculty of Medicine and Health, Örebro University, S-701 82, Sweden
- Corresponding author.
| | - David Adrian
- Department of Radiology, Örebro University Hospital, Region Örebro County, Sweden
| | - Jonas Widell
- Department of Radiology, Örebro University Hospital, Region Örebro County, Sweden
| | - Bertil Uggla
- Department of Medicine, Faculty of Medicine and Health, Örebro University, Sweden
| | - Per Thunberg
- Department of Medical Physics, Faculty of Medicine and Health, Örebro University, Sweden
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Orsmark-Pietras C, Landberg N, Lorenz F, Uggla B, Höglund M, Lehmann S, Derolf Å, Deneberg S, Antunovic P, Cammenga J, Möllgård L, Wennström L, Lilljebjörn H, Rissler M, Fioretos T, Lazarevic VL. Clinical and genomic characterization of patients diagnosed with the provisional entity acute myeloid leukemia with BCR-ABL1, a Swedish population-based study. Genes Chromosomes Cancer 2021; 60:426-433. [PMID: 33433047 DOI: 10.1002/gcc.22936] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/24/2020] [Revised: 01/07/2021] [Accepted: 01/09/2021] [Indexed: 11/09/2022] Open
Abstract
Acute myeloid leukemia (AML) with t(9;22)(q34;q11), also known as AML with BCR-ABL1, is a rare, provisional entity in the WHO 2016 classification and is considered a high-risk disease according to the European LeukemiaNet 2017 risk stratification. We here present a retrospective, population-based study of this disease entity from the Swedish Acute Leukemia Registry. By strict clinical inclusion criteria we aimed to identify genetic markers further distinguishing AML with t(9;22) as a separate entity. Twenty-five patients were identified and next-generation sequencing using a 54-gene panel was performed in 21 cases. Interestingly, no mutations were found in NPM1, FLT3, or DNMT3A, three frequently mutated genes in AML. Instead, RUNX1 was the most commonly mutated gene, with aberrations present in 38% of the cases compared to around 10% in de novo AML. Additional mutations were identified in genes involved in RNA splicing (SRSF2, SF3B1) and chromatin regulation (ASXL1, STAG2, BCOR, BCORL1). Less frequently, mutations were found in IDH2, NRAS, TET2, and TP53. The mutational landscape exhibited a similar pattern as recently described in patients with chronic myeloid leukemia (CML) in myeloid blast crisis (BC). Despite the concomitant presence of BCR-ABL1 and RUNX1 mutations in our cohort, both features of high-risk AML, the RUNX1-mutated cases showed a superior overall survival compared to RUNX1 wildtype cases. Our results suggest that the molecular characteristics of AML with t(9;22)/BCR-ABL1 and CML in myeloid BC are similar and do not support a distinction of the two disease entities based on their underlying molecular alterations.
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Affiliation(s)
| | - Niklas Landberg
- Division of Clinical Genetics, Department of Laboratory Medicine, Lund University, Lund, Sweden.,Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Fryderyk Lorenz
- Department of Oncology and Hematology, Umeå University Hospital, Umeå, Sweden
| | - Bertil Uggla
- Department of Medicine, Section of Hematology, Örebro University Hospital, Örebro, Sweden
| | - Martin Höglund
- Department of Hematology, Uppsala University Hospital, Uppsala, Sweden
| | - Sören Lehmann
- Department of Hematology, Uppsala University Hospital, Uppsala, Sweden
| | - Åsa Derolf
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Stefan Deneberg
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Petar Antunovic
- Department of Hematology, Linköping University Hospital, Linköping, Sweden
| | - Jörg Cammenga
- Department of Hematology, Linköping University Hospital, Linköping, Sweden
| | - Lars Möllgård
- Department of Hematology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lovisa Wennström
- Department of Hematology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Henrik Lilljebjörn
- Division of Clinical Genetics, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Marianne Rissler
- Division of Clinical Genetics, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Thoas Fioretos
- Division of Clinical Genetics, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Vladimir Lj Lazarevic
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
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5
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Kozlowski P, Kameran Behnam K, Uggla B, Åström M. Carfilzomib-induced hemolysis is noticeably common but rarely shows features of thrombotic microangiopathy: A retrospective study. Eur J Haematol 2020; 104:588-593. [PMID: 32115785 PMCID: PMC7318150 DOI: 10.1111/ejh.13401] [Citation(s) in RCA: 4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 11/29/2022]
Abstract
Objective Hemolysis is a sporadically reported but potentially serious side effect of the proteasome inhibitor carfilzomib. We aimed to investigate the frequency of hemolysis in an unselected cohort. Methods We performed a retrospective, single‐center study of the incidence of hemolysis in patients treated with carfilzomib, based mainly on consecutive haptoglobin levels. The patients were diagnosed with myeloma (n = 20), AL amyloidosis (n = 3), and light‐chain deposition disease (n = 1). Carfilzomib treatment was applied after a median of 3 (range: 1‐7) therapy lines. Results Haptoglobin levels were normal/increased before, generally suppressed during, and normalized after treatment with carfilzomib. Very low haptoglobin (<0.1 g/L) implying the presence of hemolysis was observed in 16 of 24 (67%) patients during carfilzomib therapy. Hemolysis was mild in 11 of 16 (69%) affected patients, whereas 5 of 16 (31%) required transfusion. Severe hemolysis was explained by thrombotic microangiopathy (TMA) in one patient who died of the complication. Mechanisms were unclear in the remaining 15 patients. Conclusions Hemolysis was surprisingly common but mostly mild during carfilzomib treatment. However, the possibility of TMA should be kept in mind in this setting. Hypothetically, non‐TMA hemolysis could be attributed to the accumulation of globin chains due to the suppression of eukaryotic translation initiation inhibition by carfilzomib.
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Affiliation(s)
- Piotr Kozlowski
- Division of Hematology, Department of Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Klodia Kameran Behnam
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Bertil Uggla
- Division of Hematology, Department of Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Maria Åström
- Division of Hematology, Department of Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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6
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Österroos A, Eriksson A, Antunovic P, Cammenga J, Deneberg S, Lazarevic V, Lorenz F, Möllgård L, Derolf ÅR, Uggla B, Wennström L, Ölander E, Höglund M, Juliusson G, Lehmann S. Real‐world data on treatment patterns and outcomes of hypomethylating therapy in patients with newly diagnosed acute myeloid leukaemia aged ≥ 60 years. Br J Haematol 2020; 189:e13-e16. [DOI: 10.1111/bjh.16410] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 12/12/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sören Lehmann
- Uppsala University Hospital UppsalaSweden
- Karolinska University Hospital Stockholm Sweden
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7
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Derolf Å, Juliusson G, Benson L, Fløisand Y, Lazarevic V, Antunovic P, Möllgård L, Lehmann S, Uggla B, Wahlin A, Höglund M, Deneberg S. Decreasing early mortality in acute myeloid leukaemia in Sweden 1997–2014: improving performance status is a major contributing factor. Br J Haematol 2019; 188:187-191. [DOI: 10.1111/bjh.16265] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Åsa Derolf
- Department of Hematology Karolinska University Hospital StockholmSweden
- Department of Internal Medicine Karolinska Institutet StockholmSweden
| | - Gunnar Juliusson
- Department of Hematology, Oncology and Radiation Physics Skåne University Hospital LundSweden
| | - Lina Benson
- Epidemiology and Regional Oncologic Center in Stockholm StockholmSweden
| | - Yngvar Fløisand
- Department of Hematology Oslo University Hospital OsloSweden
| | - Vladimir Lazarevic
- Department of Hematology, Oncology and Radiation Physics Skåne University Hospital LundSweden
| | - Petar Antunovic
- Department of Hematology Linköping University Hospital LinköpingSweden
| | - Lars Möllgård
- Department of Medicine Sahlgrenska University Hospital GöteborgSweden
| | - Sören Lehmann
- Department of Medical Sciences Unit of Haematology Uppsala University UppsalaSweden
| | - Bertil Uggla
- Department of Medicine School of Health and Medical Sciences Örebro University Hospital ÖrebroSweden
| | - Anders Wahlin
- Department of Radiation Sciences Umeå University Umeå Sweden
| | - Martin Höglund
- Department of Medical Sciences Unit of Haematology Uppsala University UppsalaSweden
| | - Stefan Deneberg
- Department of Hematology Karolinska University Hospital StockholmSweden
- Department of Internal Medicine Karolinska Institutet StockholmSweden
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Vaht K, Göransson M, Carlson K, Isaksson C, Lenhoff S, Sandstedt A, Uggla B, Winiarski J, Ljungman P, Andersson PO, Brune M. High Graft-versus-Host Disease-Free, Relapse/Rejection-Free Survival and Similar Outcome of Related and Unrelated Allogeneic Stem Cell Transplantation for Aplastic Anemia: A Nationwide Swedish Cohort Study. Biol Blood Marrow Transplant 2019; 25:1970-1974. [PMID: 31173901 DOI: 10.1016/j.bbmt.2019.05.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/26/2019] [Accepted: 05/28/2019] [Indexed: 11/19/2022]
Abstract
Allogeneic stem cell transplantation (SCT) as primary treatment for aplastic anemia (AA) is being increasingly used. Yet, age, stem cell source, and donor type are important outcome factors. We have recently performed a nationwide cohort study of all patients with AA in Sweden diagnosed from 2000 to 2011 and now present outcome data on SCT patients. In total, 68 patients underwent SCT, and 63% of them had failed immunosuppressive therapy. We found that, with a median follow-up of 109 months (range, 35 to 192 months), 5-year overall survival (OS) for all patients was 86.8%, whereas graft-versus-host disease-free, relapse/rejection-free survival (GRFS) at 5 years was 69.1%. There was no survival impact regarding the donor type or stem cell source. Patients aged ≥40 years had a higher transplant-related mortality (29.4% versus 7.8%; P = .023), which translated into a lower 5-year OS: 70.6% versus 92.2% (P = .022) and a trend of lower GRFS (52.9% versus 74.5%; P = .069). In conclusion, we found in this real-world setting that both OS and GRFS were high, but SCT for patients with AA aged ≥40 years is problematic, and clinical trials addressing this issue are warranted.
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Affiliation(s)
- Krista Vaht
- Section of Hematology and Coagulation, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Medicine, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
| | - Magnus Göransson
- Department of Pediatrics, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kristina Carlson
- Department of Hematology, Uppsala University Hospital, Uppsala, Sweden
| | - Cecilia Isaksson
- Department of Hematology, Cancer Centre, University Hospital, Umeå, Sweden
| | - Stig Lenhoff
- Department of Hematology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Anna Sandstedt
- Department of Hematology, Linköping University Hospital, Linköping, Sweden
| | - Bertil Uggla
- Section of Hematology Department of Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jacek Winiarski
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Huddinge and CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Per Ljungman
- Centre of Allogeneic Stem Cell Transplantation Unit (CAST), Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Per-Ola Andersson
- Institute of Medicine, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden; Department of Medicine, Södra Älvsborg Hospital Borås, Borås, Sweden
| | - Mats Brune
- Section of Hematology and Coagulation, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Medicine, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
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Vaht K, Göransson M, Carlson K, Isaksson C, Lenhoff S, Sandstedt A, Uggla B, Winiarski J, Ljungman P, Brune M, Andersson PO. Low response rate to ATG-based immunosuppressive therapy in very severe aplastic anaemia - A Swedish nationwide cohort study. Eur J Haematol 2018. [DOI: 10.1111/ejh.13057] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Krista Vaht
- Section of Haematology and Coagulation; Sahlgrenska University Hospital; Gothenburg Sweden
- Institute of Medicine; Sahlgrenska Academy at Gothenburg University; Gothenburg Sweden
| | - Magnus Göransson
- Department of Pediatrics; The Queen Silvia Children's Hospital; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Kristina Carlson
- Department of Haematology; Uppsala University Hospital; Uppsala Sweden
| | - Cecilia Isaksson
- Department of Haematology; Cancer Centre; University Hospital; Umeå Sweden
| | - Stig Lenhoff
- Department of Haematology; Skåne University Hospital; Lund University; Lund Sweden
| | - Anna Sandstedt
- Department of Haematology; Linköping University Hospital; Linköping Sweden
| | - Bertil Uggla
- Section of Haematology Department of Medicine; Faculty of Medicine and Health; Örebro University; Örebro Sweden
| | - Jacek Winiarski
- Astrid Lindgren Children's Hospital; Karolinska Institutet; Karolinska University Hospital and CLINTEC; Stockholm Sweden
| | - Per Ljungman
- Centre of Allogeneic Stem Cell Transplantation Unit (CAST); Department of Medicine; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - Mats Brune
- Section of Haematology and Coagulation; Sahlgrenska University Hospital; Gothenburg Sweden
- Institute of Medicine; Sahlgrenska Academy at Gothenburg University; Gothenburg Sweden
| | - Per-Ola Andersson
- Institute of Medicine; Sahlgrenska Academy at Gothenburg University; Gothenburg Sweden
- Department of Medicine; Södra Älvsborg Hospital Borås; Borås Sweden
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10
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Vaht K, Göransson M, Carlson K, Isaksson C, Lenhoff S, Sandstedt A, Uggla B, Winiarski J, Ljungman P, Brune M, Andersson PO. Incidence and outcome of acquired aplastic anemia: real-world data from patients diagnosed in Sweden from 2000-2011. Haematologica 2017; 102:1683-1690. [PMID: 28751565 PMCID: PMC5622852 DOI: 10.3324/haematol.2017.169862] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 07/19/2017] [Indexed: 12/21/2022] Open
Abstract
A plastic anemia is a rare life-threatening disease. However, since the introduction of immunosuppressive therapy and allogeneic stem cell transplantation, the outcome has improved considerably, and the 5-year survival is reported to be 70–80% in selected patient cohorts. Yet, contemporary population-based data on incidence and survival are lacking. We performed a national retrospective study to determine the incidence, treatment, and survival of patients with aplastic anemia diagnosed in Sweden from 2000–2011. Patients were included via the National Patient Registry, and diagnosed according to the Camitta criteria. In total, 257 confirmed cases were identified, with an overall incidence of 2.35 (95% CI: 2.06–2.64) cases per million inhabitants per year. Median age was 60 years (range: 2–92), and median follow up was 76 (0–193) months. Primary treatments included immunosuppressive therapy (63%), allogenic stem cell transplantation (10%), or single-agent cyclosporine/no specific therapy (27%). The 5-year survival was 90.7% in patients aged 0–18 years, 90.5% in patients aged 19–39 years, 70.7% in patients aged 40–59 years, and 38.1% in patients aged ≥60 years. Multivariate analysis showed that age (both 40–59 and ≥60 age groups), very severe aplastic anemia and single-agent cyclosporine/no specific therapy were independent risk factors for inferior survival. In conclusion, younger aplastic anemia patients experience a very good long-term survival, while that of patients ≥60 years in particular remains poor. Apparently, the challenge today is to improve the management of older aplastic anemia patients, and prospective studies to address this medical need are warranted.
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Affiliation(s)
- Krista Vaht
- Section of Hematology and Coagulation, Sahlgrenska University Hospital, Gothenburg, Sweden .,Sahlgrenska Academy at Gothenburg University, Sweden
| | - Magnus Göransson
- Department of Pediatrics, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Umeå, Sweden
| | - Kristina Carlson
- Department of Hematology, Uppsala University Hospital, Umeå, Sweden
| | - Cecilia Isaksson
- Department of Hematology, Cancer Centre, University Hospital, Umeå, Sweden
| | - Stig Lenhoff
- Department of Hematology, Skåne University Hospital, Lund University, Stockholm, Sweden
| | - Anna Sandstedt
- Department of Hematology, Linköping University Hospital, Stockholm, Sweden
| | - Bertil Uggla
- Section of Hematology Department of Medicine, Faculty of Medicine and Health, Örebro University, Stockholm, Sweden
| | - Jacek Winiarski
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Per Ljungman
- Centre of allogeneic stem cell transplantation (CAST), Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Mats Brune
- Section of Hematology and Coagulation, Sahlgrenska University Hospital, Gothenburg, Sweden.,Sahlgrenska Academy at Gothenburg University, Sweden
| | - Per-Ola Andersson
- South Älvsborg Hospital Borås, Sweden.,Sahlgrenska Academy at Gothenburg University, Sweden
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11
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Lazarevic VL, Rosso A, Juliusson G, Antunovic P, Derolf ÅR, Deneberg S, Möllgård L, Uggla B, Wennström L, Wahlin A, Höglund M, Lehmann S, Johansson B. Incidence and prognostic significance of isolated trisomies in adult acute myeloid leukemia: A population-based study from the Swedish AML registry. Eur J Haematol 2017; 98:493-500. [PMID: 28152233 DOI: 10.1111/ejh.12861] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES AND METHODS To ascertain the incidence/clinical implications of isolated autosomal trisomies in adult acute myeloid leukemia (AML), all such cases were retrieved from the Swedish AML Registry. RESULTS Of the 3179 cytogenetically informative AMLs diagnosed January 1997-May 2015, 246 (7.7%) had isolated trisomies. The frequency increased by age (2.4% at age 18-60 years vs. 23% at >60 years; P<.0001); the median age was 69 years. The five most common were +8 (4.0%), +13 (0.9%), +11 (0.8%), +21 (0.7%), and +4 (0.5%). Age and gender, types of AML and treatment, and complete remission and early death rates did not differ between the single trisomy and the intermediate risk (IR) groups or among cases with isolated gains of chromosomes 4, 8, 11, 13, or 21. The overall survival (OS) was similar in the single trisomy (median 1.6 years) and IR groups (1.7 years; P=.251). The OS differed among the most frequent isolated trisomies; the median OS was 2.5 years for +4, 1.9 years for +21, 1.5 years for +8, 1.1 years for +11, and 0.8 years for +13 (P=.013). CONCLUSION AML with single trisomies, with the exception of +13, should be grouped as IR.
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Affiliation(s)
- Vladimir Lj Lazarevic
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.,Stem Cell Center, Lund University, Lund, Sweden
| | - Aldana Rosso
- Epidemiology and Registry Center in South Sweden, Skåne University Hospital, Lund, Sweden.,Medical Radiology, Department of Translational Medicine, Lund University, Lund, Sweden
| | - Gunnar Juliusson
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.,Stem Cell Center, Lund University, Lund, Sweden
| | - Petar Antunovic
- Department of Hematology, Linköping University Hospital, Linköping, Sweden
| | - Åsa Rangert Derolf
- Department of Medicine, Division of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Stefan Deneberg
- Department of Medicine, Division of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Möllgård
- Department of Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Bertil Uggla
- Department of Medicine, School of Health and Medical Sciences, Örebro University Hospital, Örebro, Sweden
| | - Lovisa Wennström
- Department of Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Anders Wahlin
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Martin Höglund
- Department of Hematology, Academic Hospital, Uppsala, Sweden
| | - Sören Lehmann
- Department of Hematology, Academic Hospital, Uppsala, Sweden
| | - Bertil Johansson
- Department of Clinical Genetics, University and Regional Laboratories Region Skåne, Lund, Sweden.,Division of Clinical Genetics, Department of Laboratory Medicine, Lund University, Lund, Sweden
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12
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Lehmann S, Deneberg S, Antunovic P, Rangert-Derolf Å, Garelius H, Lazarevic V, Myhr-Eriksson K, Möllgård L, Uggla B, Wahlin A, Wennström L, Höglund M, Juliusson G. Early death rates remain high in high-risk APL: update from the Swedish Acute Leukemia Registry 1997-2013. Leukemia 2017; 31:1457-1459. [PMID: 28232742 DOI: 10.1038/leu.2017.71] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- S Lehmann
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,Unit of Hematology, Department of Medicine, Karolinska Institute, Huddinge, Stockholm, Sweden
| | - S Deneberg
- Unit of Hematology, Department of Medicine, Karolinska Institute, Huddinge, Stockholm, Sweden
| | - P Antunovic
- Department of Hematology, Linköping University Hospital, Linköping, Sweden
| | - Å Rangert-Derolf
- Department of Hematology, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - H Garelius
- Department of Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | - V Lazarevic
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - K Myhr-Eriksson
- Department of Medicine, School of Health and Medical Sciences, Örebro University Hospital, Örebro, Sweden
| | - L Möllgård
- Department of Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | - B Uggla
- Department of Medicine, School of Health and Medical Sciences, Örebro University Hospital, Örebro, Sweden
| | - A Wahlin
- Department of Medicine, School of Health and Medical Sciences, Örebro University Hospital, Örebro, Sweden
| | - L Wennström
- Department of Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | - M Höglund
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - G Juliusson
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
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13
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Juliusson G, Abrahamsson J, Lazarevic V, Antunovic P, Derolf Å, Garelius H, Lehmann S, Myhr-Eriksson K, Möllgård L, Uggla B, Wahlin A, Wennström L, Höglund M. Prevalence and characteristics of survivors from acute myeloid leukemia in Sweden. Leukemia 2016; 31:728-731. [PMID: 27795559 PMCID: PMC5339425 DOI: 10.1038/leu.2016.312] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- G Juliusson
- Department of Hematology and Oncology, Skåne University Hospital, Lund, Sweden.,Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - J Abrahamsson
- Department of Pediatrics, Institution for Clinical Sciences, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - V Lazarevic
- Department of Hematology and Oncology, Skåne University Hospital, Lund, Sweden.,Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - P Antunovic
- Department of Hematology, University Hospital Linköping, Linköping, Sweden
| | - Å Derolf
- Hematology Center, Karolinska University Hospital, Stockholm, Sweden
| | - H Garelius
- Department of Hematology, Sahlgrenska University Hospital Gothenburg, Gothenburg, Sweden
| | - S Lehmann
- Department of Hematology, Academic Hospital, Uppsala, Sweden
| | | | - L Möllgård
- Department of Hematology, Sahlgrenska University Hospital Gothenburg, Gothenburg, Sweden
| | - B Uggla
- School of Medical Sciences, Örebro University Hospital, Örebro, Sweden
| | - A Wahlin
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - L Wennström
- Department of Pediatrics, Institution for Clinical Sciences, Queen Silvia Children's Hospital, Gothenburg, Sweden.,Department of Hematology, Sahlgrenska University Hospital Gothenburg, Gothenburg, Sweden
| | - M Höglund
- Department of Hematology, Academic Hospital, Uppsala, Sweden
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14
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Lazarevic V, Rosso A, Juliusson G, Antunovic P, Rangert-Derolf Å, Lehmann S, Möllgård L, Uggla B, Wennström L, Wahlin A, Höglund M, Johansson B. Prognostic significance of high hyperdiploid and triploid/tetraploid adult acute myeloid leukemia. Am J Hematol 2015; 90:800-5. [PMID: 26088289 DOI: 10.1002/ajh.24091] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 06/16/2015] [Accepted: 06/17/2015] [Indexed: 11/07/2022]
Abstract
To ascertain the clinical implications of high hyperdiploid (HH; 49-65 chromosomes) and triploid/tetraploid (TT; >65 chromosomes) adult acute myeloid leukemia (AML), all such cases were retrieved from the Swedish AML Registry. Of the 3,654 cytogenetically informative cases diagnosed between January 1997 and May 2014, 68 (1.9%) were HH (n = 50)/TT (n = 18). Patients with HH/TT were older than those with intermediate risk (IR) AML (median 71 years vs. 67 years; P = 0.042) and less often had de novo AML (63% vs. 79%; P = 0.004); no such differences were observed between HH/TT and complex karyotype (CK) AML. The overall survival (OS) was similar between patients with HH/TT and CK AML (median 0.9 years vs. 0.6 years; P = 0.082), whereas OS was significantly longer (median 1.6 years; P = 0.028) for IR AML. The OS was shorter for cases with HH than with TT (median 0.6 years vs. 1.4 years; P = 0.032) and for HH/TT AMLs with adverse abnormalities (median 0.8 years vs. 1.1 years; P = 0.044). In conclusion, HH/TT AML is associated with a poor outcome, but chromosome numbers >65 and absence of adverse aberrations seem to translate into a more favorable prognosis. Thus, HH/TT AMLs are clinically heterogeneous and should not automatically be grouped as high risk.
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Affiliation(s)
- Vladimir Lazarevic
- Department of Hematology and Vascular Disease; Skåne University Hospital; Lund Sweden
- Stem Cell Center; Lund University; Lund Sweden
| | - Aldana Rosso
- Epidemiology and Registry Center in South Sweden; Skåne University Hospital; Lund Sweden
| | - Gunnar Juliusson
- Department of Hematology and Vascular Disease; Skåne University Hospital; Lund Sweden
- Stem Cell Center; Lund University; Lund Sweden
| | - Petar Antunovic
- Department of Hematology; Linköping University Hospital; Linköping Sweden
| | - Åsa Rangert-Derolf
- Department of Medicine; Division of Hematology Stockholm and Huddinge; Karolinska University Hospital, Karolinska; Sweden
| | - Sören Lehmann
- Department of Medicine; Division of Hematology Stockholm and Huddinge; Karolinska University Hospital, Karolinska; Sweden
| | - Lars Möllgård
- Department of Medicine; Sahlgrenska University Hospital; Göteborg Sweden
| | - Bertil Uggla
- Department of Medicine; School of Health and Medical Sciences; Örebro University Hospital; Örebro Sweden
| | - Lovisa Wennström
- Department of Medicine; Sahlgrenska University Hospital; Göteborg Sweden
| | - Anders Wahlin
- Department of Radiation Sciences; Umeå University; Umeå Sweden
| | - Martin Höglund
- Department of Hematology; Academic Hospital; Uppsala Sweden
| | - Bertil Johansson
- Department of Clinical Genetics; University and Regional Laboratories Region Skåne; Lund Sweden
- Department of Laboratory Medicine; Division of Clinical Genetics; Lund University; Lund Sweden
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15
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Hulegårdh E, Nilsson C, Lazarevic V, Garelius H, Antunovic P, Rangert Derolf Å, Möllgård L, Uggla B, Wennström L, Wahlin A, Höglund M, Juliusson G, Stockelberg D, Lehmann S. Characterization and prognostic features of secondary acute myeloid leukemia in a population-based setting: a report from the Swedish Acute Leukemia Registry. Am J Hematol 2015; 90:208-14. [PMID: 25421221 DOI: 10.1002/ajh.23908] [Citation(s) in RCA: 176] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 11/18/2014] [Accepted: 11/21/2014] [Indexed: 12/29/2022]
Abstract
Patients with secondary acute myeloid leukemia (AML) often escape inclusion in clinical trials and thus, population-based studies are crucial for its accurate characterization. In this first large population-based study on secondary AML, we studied AML with an antecedent hematological disease (AHD-AML) or therapy-related AML (t-AML) in the population-based Swedish Acute Leukemia Registry. The study included 3,363 adult patients of which 2,474 (73.6%) had de novo AML, 630 (18.7%) AHD-AML, and 259 (7.7%) t-AML. Secondary AML differed significantly compared to de novo AML with respect to age, gender, and cytogenetic risk. Complete remission (CR) rates were significantly lower but early death rates similar in secondary AML. In a multivariable analysis, AHD-AML (HR 1.51; 95% CI 1.26-1.79) and t-AML (1.72; 1.38-2.15) were independent risk factors for poor survival. The negative impact of AHD-AML and t-AML on survival was highly age dependent with a considerable impact in younger patients, but without independent prognostic value in the elderly. Although patients with secondary leukemia did poorly with intensive treatment, early death rates and survival were significantly worse with palliative treatment. We conclude that secondary AML in a population-based setting has a striking impact on survival in younger AML patients, whereas it lacks prognostic value among the elderly patients.
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Affiliation(s)
- Erik Hulegårdh
- Department of Medicine and Regional Tumor Registry; Sahlgrenska University Hospital; Göteborg Sweden
| | - Christer Nilsson
- Hematology Centre; Karolinska University Hospital, Huddinge, Stockholm and Regional Tumor Registry; Stockholm Sweden
| | - Vladimir Lazarevic
- Department of Hematology and Regional Tumor Registry; Skåne University Hospital and Lund University; Lund Sweden
- Swedish Acute Myeloid Leukemia Group
| | - Hege Garelius
- Department of Medicine and Regional Tumor Registry; Sahlgrenska University Hospital; Göteborg Sweden
- Swedish Acute Myeloid Leukemia Group
| | - Petar Antunovic
- Swedish Acute Myeloid Leukemia Group
- Department of Hematology and Regional Tumor Registry; Linköping University Hospital; Linköping Sweden
| | - Åsa Rangert Derolf
- Swedish Acute Myeloid Leukemia Group
- Center of Hematology and Regional Tumor Registry; Karolinska University Hospital; Solna Stockholm Sweden
| | - Lars Möllgård
- Department of Medicine and Regional Tumor Registry; Sahlgrenska University Hospital; Göteborg Sweden
- Swedish Acute Myeloid Leukemia Group
| | - Bertil Uggla
- Swedish Acute Myeloid Leukemia Group
- Department of Medicine; Örebro University Hospital; Örebro Sweden
| | - Lovisa Wennström
- Department of Medicine and Regional Tumor Registry; Sahlgrenska University Hospital; Göteborg Sweden
- Swedish Acute Myeloid Leukemia Group
| | - Anders Wahlin
- Swedish Acute Myeloid Leukemia Group
- Department of Radiation Sciences; University of Umeå and Regional Tumor Registry, Norrland University Hospital; Umeå Sweden
| | - Martin Höglund
- Swedish Acute Myeloid Leukemia Group
- Department of Hematology and Regional Tumor Registry; Academic Hospital, Uppsala; Sweden
| | - Gunnar Juliusson
- Department of Hematology and Regional Tumor Registry; Skåne University Hospital and Lund University; Lund Sweden
- Swedish Acute Myeloid Leukemia Group
| | - Dick Stockelberg
- Department of Medicine and Regional Tumor Registry; Sahlgrenska University Hospital; Göteborg Sweden
- Swedish Acute Myeloid Leukemia Group
| | - Sören Lehmann
- Hematology Centre; Karolinska University Hospital, Huddinge, Stockholm and Regional Tumor Registry; Stockholm Sweden
- Swedish Acute Myeloid Leukemia Group
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16
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Lazarevic V, Hörstedt AS, Johansson B, Antunovic P, Billström R, Derolf Å, Lehmann S, Möllgård L, Peterson S, Stockelberg D, Uggla B, Vennström L, Wahlin A, Höglund M, Juliusson G. Failure matters: unsuccessful cytogenetics and unperformed cytogenetics are associated with a poor prognosis in a population-based series of acute myeloid leukaemia. Eur J Haematol 2014; 94:419-23. [PMID: 25200361 DOI: 10.1111/ejh.12446] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2014] [Indexed: 01/20/2023]
Abstract
Unsuccessful cytogenetics (UC) in patients with acute myeloid leukaemia (AML) treated on different SWOG trials was recently reported to be associated with increased age and dismal outcome. To ascertain whether this holds true also in unselected patients with AML, we retrieved all cytogenetic reports in cases from the population-based Swedish AML Registry. Between 1997 and 2006, 1737 patients below 80 yr of age without myelosarcoma or acute promyelocytic leukaemia received intensive treatment. The frequencies of UC and unperformed cytogenetics (UPC) were 2.1% and 20%, respectively. The early death rates differed between the cytogenetic subgroups (P = 0.006) with the highest rates in patients with UC (14%) and UPC (12%) followed by high-risk (HR) AML, intermediate risk (IR) and standard risk (SR) cases successfully karyotyped (8.6%, 5.9%, and 5.8%, respectively). The complete remission rate was lower in UC and UPC and HR compared with the other risk groups (P < 0.001). The overall five-year survival rates were 25% for UC and 22% for UPC, whereas the corresponding frequencies for SR, IR and HR AML patients without UC and UPC were 64%, 31% and 15%, respectively. In conclusion, lack of cytogenetic data translates into a poor prognosis.
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Affiliation(s)
- Vladimir Lazarevic
- Department of Hematology and Coagulation, Skåne University Hospital, Lund, Sweden; Stem Cell Center, Lund University, Lund, Sweden
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17
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Burman J, Iacobaeus E, Svenningsson A, Lycke J, Gunnarsson M, Nilsson P, Vrethem M, Fredrikson S, Martin C, Sandstedt A, Uggla B, Lenhoff S, Johansson JE, Isaksson C, Hägglund H, Carlson K, Fagius J. Autologous haematopoietic stem cell transplantation for aggressive multiple sclerosis: the Swedish experience. J Neurol Neurosurg Psychiatry 2014; 85:1116-21. [PMID: 24554104 DOI: 10.1136/jnnp-2013-307207] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Autologous haematopoietic stem cell transplantation (HSCT) is a viable option for treatment of aggressive multiple sclerosis (MS). No randomised controlled trial has been performed, and thus, experiences from systematic and sustained follow-up of treated patients constitute important information about safety and efficacy. In this observational study, we describe the characteristics and outcome of the Swedish patients treated with HSCT for MS. METHODS Neurologists from the major hospitals in Sweden filled out a follow-up form with prospectively collected data. Fifty-two patients were identified in total; 48 were included in the study and evaluated for safety and side effects; 41 patients had at least 1 year of follow-up and were further analysed for clinical and radiological outcome. In this cohort, 34 patients (83%) had relapsing-remitting MS, and mean follow-up time was 47 months. RESULTS At 5 years, relapse-free survival was 87%; MRI event-free survival 85%; expanded disability status scale (EDSS) score progression-free survival 77%; and disease-free survival (no relapses, no new MRI lesions and no EDSS progression) 68%. Presence of gadolinium-enhancing lesions prior to HSCT was associated with a favourable outcome (disease-free survival 79% vs 46%, p=0.028). There was no mortality. The most common long-term side effects were herpes zoster reactivation (15%) and thyroid disease (8.4%). CONCLUSIONS HSCT is a very effective treatment of inflammatory active MS and can be performed with a high degree of safety at experienced centres.
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Affiliation(s)
- Joachim Burman
- Department of Neuroscience, Uppsala University, Uppsala, Sweden Department of Neurology, Uppsala University Hospital, Uppsala, Sweden
| | - Ellen Iacobaeus
- Neuroimmunology Unit, Department of Clinical Neuroscience, Karolinska Institute Solna, Center for Molecular Medicine, Stockholm, Sweden
| | - Anders Svenningsson
- Department of Pharmacology and Clinical Neuroscience, Umeå University and University Hospital of Northern Sweden, Umeå, Sweden
| | - Jan Lycke
- Department of Neurology, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Martin Gunnarsson
- Department of Neurology, Örebro University Hospital, Örebro, Sweden School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Petra Nilsson
- Department of Neurology, Skåne University Hospital Lund, Lund, Sweden
| | - Magnus Vrethem
- Neurology and Clinical Neurophysiology, Faculty of Health Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden Department of Neurology and Neurophysiology, County Council of Östergötland, Linköping, Sweden
| | - Sten Fredrikson
- Department of Clinical Neuroscience, Karolinska Institute Huddinge, Stockholm, Sweden
| | - Claes Martin
- Neurology Unit, Division of Internal Medicine, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Anna Sandstedt
- Department of Hematology, Linköping University Hospital, Linköping, Sweden
| | - Bertil Uggla
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden Division of Hematology, Department of Medicine, Örebro University Hospital, Örebro, Sweden
| | - Stig Lenhoff
- Department of Hematology and Coagulation, Skåne University Hospital, Lund, Sweden
| | - Jan-Erik Johansson
- Department of Hematology and Coagulation, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Hans Hägglund
- Division of Hematology, Department of Medical Science, Uppsala University Hospital, Uppsala, Sweden
| | - Kristina Carlson
- Division of Hematology, Department of Medical Science, Uppsala University Hospital, Uppsala, Sweden
| | - Jan Fagius
- Department of Neuroscience, Uppsala University, Uppsala, Sweden Department of Neurology, Uppsala University Hospital, Uppsala, Sweden
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18
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Mulligan SP, Karlsson K, Strömberg M, Jønsson V, Gill D, Hammerström J, Hertzberg M, McLennan R, Uggla B, Norman J, Wallvik J, Sundström G, Johansson H, Brandberg Y, Liliemark J, Juliusson G. Cladribine prolongs progression-free survival and time to second treatment compared to fludarabine and high-dose chlorambucil in chronic lymphocytic leukemia. Leuk Lymphoma 2014; 55:2769-77. [PMID: 24524339 DOI: 10.3109/10428194.2014.893306] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We conducted a randomized phase III trial to compare the efficacy and safety of two purine analogs, cladribine and fludarabine, with high-dose chlorambucil, in patients with previously untreated chronic lymphocytic leukemia (CLL). Between 1997 and 2004, 223 patients with CLL were randomly assigned to cladribine, fludarabine or chlorambucil, for six cycles of therapy with frequent health-related quality of life assessments. There was no statistical difference for the primary endpoint of overall response with cladribine (70%), fludarabine (67%) and chlorambucil (59%), or complete remission (12%, 7% and 8%), respectively. However, the median progression-free survival (25, 10, 9 months) and median time to second treatment (40, 22, 21 months) were superior with cladribine. There was no significant difference in overall survival (96, 82 and 91 months), nor in toxicity or HRQoL assessments. Monotherapy with cladribine gives superior PFS and longer response duration than fludarabine and chlorambucil as first-line treatment of CLL.
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Affiliation(s)
- Stephen P Mulligan
- Department of Haematology, Royal North Shore Hospital , Sydney , Australia
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19
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Lehmann S, Bykov VJ, Ali D, Andrén O, Cherif H, Tidefelt U, Uggla B, Yachnin J, Juliusson G, Moshfegh A, Paul C, Wiman KG, Andersson PO. Targeting p53 in Vivo: A First-in-Human Study With p53-Targeting Compound APR-246 in Refractory Hematologic Malignancies and Prostate Cancer. J Clin Oncol 2012; 30:3633-9. [DOI: 10.1200/jco.2011.40.7783] [Citation(s) in RCA: 306] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose APR-246 (PRIMA-1MET) is a novel drug that restores transcriptional activity of unfolded wild-type or mutant p53. The main aims of this first-in-human trial were to determine maximum-tolerated dose (MTD), safety, dose-limiting toxicities (DLTs), and pharmacokinetics (PK) of APR-246. Patients and Methods APR-246 was administered as a 2-hour intravenous infusion once per day for 4 consecutive days in 22 patients with hematologic malignancies and prostate cancer. Acute myeloid leukemia (AML; n = 7) and prostate cancer (n = 7) were the most frequent diagnoses. Starting dose was 2 mg/kg with dose escalations up to 90 mg/kg. Results MTD was defined as 60 mg/kg. The drug was well tolerated, and the most common adverse effects were fatigue, dizziness, headache, and confusion. DLTs were increased ALT/AST (n = 1), dizziness, confusion, and sensory disturbances (n = 2). PK showed little interindividual variation and were neither dose nor time dependent; terminal half-life was 4 to 5 hours. Tumor cells showed cell cycle arrest, increased apoptosis, and upregulation of p53 target genes in several patients. Global gene expression analysis revealed changes in genes regulating proliferation and cell death. One patient with AML who had a p53 core domain mutation showed a reduction of blast percentage from 46% to 26% in the bone marrow, and one patient with non-Hodgkin's lymphoma with a p53 splice site mutation showed a minor response. Conclusion We conclude that APR-246 is safe at predicted therapeutic plasma levels, shows a favorable pharmacokinetic profile, and can induce p53-dependent biologic effects in tumor cells in vivo.
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Affiliation(s)
- Sören Lehmann
- Sören Lehmann, Dina Ali, and Christer Paul, Karolinska University Hospital, Huddinge; Vladimir J.N. Bykov, Ali Moshfegh, and Klas G. Wiman, Karolinska Institutet, Stockholm; Ove Andrén, Örebro University; Ulf Tidefelt and Bertil Uggla, Örebro University Hospital, Örebro; Honar Cherif and Jeffrey Yachnin, Uppsala University Hospital, Uppsala; Gunnar Juliusson, Skåne University Hospital, Lund; and Per-Ola Andersson, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Vladimir J.N. Bykov
- Sören Lehmann, Dina Ali, and Christer Paul, Karolinska University Hospital, Huddinge; Vladimir J.N. Bykov, Ali Moshfegh, and Klas G. Wiman, Karolinska Institutet, Stockholm; Ove Andrén, Örebro University; Ulf Tidefelt and Bertil Uggla, Örebro University Hospital, Örebro; Honar Cherif and Jeffrey Yachnin, Uppsala University Hospital, Uppsala; Gunnar Juliusson, Skåne University Hospital, Lund; and Per-Ola Andersson, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Dina Ali
- Sören Lehmann, Dina Ali, and Christer Paul, Karolinska University Hospital, Huddinge; Vladimir J.N. Bykov, Ali Moshfegh, and Klas G. Wiman, Karolinska Institutet, Stockholm; Ove Andrén, Örebro University; Ulf Tidefelt and Bertil Uggla, Örebro University Hospital, Örebro; Honar Cherif and Jeffrey Yachnin, Uppsala University Hospital, Uppsala; Gunnar Juliusson, Skåne University Hospital, Lund; and Per-Ola Andersson, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ove Andrén
- Sören Lehmann, Dina Ali, and Christer Paul, Karolinska University Hospital, Huddinge; Vladimir J.N. Bykov, Ali Moshfegh, and Klas G. Wiman, Karolinska Institutet, Stockholm; Ove Andrén, Örebro University; Ulf Tidefelt and Bertil Uggla, Örebro University Hospital, Örebro; Honar Cherif and Jeffrey Yachnin, Uppsala University Hospital, Uppsala; Gunnar Juliusson, Skåne University Hospital, Lund; and Per-Ola Andersson, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Honar Cherif
- Sören Lehmann, Dina Ali, and Christer Paul, Karolinska University Hospital, Huddinge; Vladimir J.N. Bykov, Ali Moshfegh, and Klas G. Wiman, Karolinska Institutet, Stockholm; Ove Andrén, Örebro University; Ulf Tidefelt and Bertil Uggla, Örebro University Hospital, Örebro; Honar Cherif and Jeffrey Yachnin, Uppsala University Hospital, Uppsala; Gunnar Juliusson, Skåne University Hospital, Lund; and Per-Ola Andersson, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ulf Tidefelt
- Sören Lehmann, Dina Ali, and Christer Paul, Karolinska University Hospital, Huddinge; Vladimir J.N. Bykov, Ali Moshfegh, and Klas G. Wiman, Karolinska Institutet, Stockholm; Ove Andrén, Örebro University; Ulf Tidefelt and Bertil Uggla, Örebro University Hospital, Örebro; Honar Cherif and Jeffrey Yachnin, Uppsala University Hospital, Uppsala; Gunnar Juliusson, Skåne University Hospital, Lund; and Per-Ola Andersson, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bertil Uggla
- Sören Lehmann, Dina Ali, and Christer Paul, Karolinska University Hospital, Huddinge; Vladimir J.N. Bykov, Ali Moshfegh, and Klas G. Wiman, Karolinska Institutet, Stockholm; Ove Andrén, Örebro University; Ulf Tidefelt and Bertil Uggla, Örebro University Hospital, Örebro; Honar Cherif and Jeffrey Yachnin, Uppsala University Hospital, Uppsala; Gunnar Juliusson, Skåne University Hospital, Lund; and Per-Ola Andersson, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jeffrey Yachnin
- Sören Lehmann, Dina Ali, and Christer Paul, Karolinska University Hospital, Huddinge; Vladimir J.N. Bykov, Ali Moshfegh, and Klas G. Wiman, Karolinska Institutet, Stockholm; Ove Andrén, Örebro University; Ulf Tidefelt and Bertil Uggla, Örebro University Hospital, Örebro; Honar Cherif and Jeffrey Yachnin, Uppsala University Hospital, Uppsala; Gunnar Juliusson, Skåne University Hospital, Lund; and Per-Ola Andersson, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gunnar Juliusson
- Sören Lehmann, Dina Ali, and Christer Paul, Karolinska University Hospital, Huddinge; Vladimir J.N. Bykov, Ali Moshfegh, and Klas G. Wiman, Karolinska Institutet, Stockholm; Ove Andrén, Örebro University; Ulf Tidefelt and Bertil Uggla, Örebro University Hospital, Örebro; Honar Cherif and Jeffrey Yachnin, Uppsala University Hospital, Uppsala; Gunnar Juliusson, Skåne University Hospital, Lund; and Per-Ola Andersson, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ali Moshfegh
- Sören Lehmann, Dina Ali, and Christer Paul, Karolinska University Hospital, Huddinge; Vladimir J.N. Bykov, Ali Moshfegh, and Klas G. Wiman, Karolinska Institutet, Stockholm; Ove Andrén, Örebro University; Ulf Tidefelt and Bertil Uggla, Örebro University Hospital, Örebro; Honar Cherif and Jeffrey Yachnin, Uppsala University Hospital, Uppsala; Gunnar Juliusson, Skåne University Hospital, Lund; and Per-Ola Andersson, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christer Paul
- Sören Lehmann, Dina Ali, and Christer Paul, Karolinska University Hospital, Huddinge; Vladimir J.N. Bykov, Ali Moshfegh, and Klas G. Wiman, Karolinska Institutet, Stockholm; Ove Andrén, Örebro University; Ulf Tidefelt and Bertil Uggla, Örebro University Hospital, Örebro; Honar Cherif and Jeffrey Yachnin, Uppsala University Hospital, Uppsala; Gunnar Juliusson, Skåne University Hospital, Lund; and Per-Ola Andersson, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Klas G. Wiman
- Sören Lehmann, Dina Ali, and Christer Paul, Karolinska University Hospital, Huddinge; Vladimir J.N. Bykov, Ali Moshfegh, and Klas G. Wiman, Karolinska Institutet, Stockholm; Ove Andrén, Örebro University; Ulf Tidefelt and Bertil Uggla, Örebro University Hospital, Örebro; Honar Cherif and Jeffrey Yachnin, Uppsala University Hospital, Uppsala; Gunnar Juliusson, Skåne University Hospital, Lund; and Per-Ola Andersson, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Per-Ola Andersson
- Sören Lehmann, Dina Ali, and Christer Paul, Karolinska University Hospital, Huddinge; Vladimir J.N. Bykov, Ali Moshfegh, and Klas G. Wiman, Karolinska Institutet, Stockholm; Ove Andrén, Örebro University; Ulf Tidefelt and Bertil Uggla, Örebro University Hospital, Örebro; Honar Cherif and Jeffrey Yachnin, Uppsala University Hospital, Uppsala; Gunnar Juliusson, Skåne University Hospital, Lund; and Per-Ola Andersson, Sahlgrenska University Hospital, Gothenburg, Sweden
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20
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Prenkert M, Uggla B, Tidefelt U, Strid H. CRIM1 is expressed at higher levels in drug-resistant than in drug-sensitive myeloid leukemia HL60 cells. Anticancer Res 2010; 30:4157-4161. [PMID: 21036735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
AIM The aim of this study was to explore possible differences in the mRNA expression levels of CRIM1, SMAD5, BMP4 and BMP7 in sensitive (S) and multidrug-resistant (R0.5) myeloid leukemia HL60 cells. MATERIALS AND METHODS HL60S and HL60R0.5 cells were exposed to daunorubicin (DNR) or cytarabine (Ara-C). RESULTS Baseline levels of CRIM1 were found to be 15-fold higher in HL60R0.5 than in HL60S. Sixteen hours of exposure to DNR resulted in a 5.6-fold increase in CRIM1 levels in HL60S. Exposure to either DNR or Ara-C resulted in modest increases in CRIM1 levels in HL60R0.5. Similarly, baseline levels of SMAD5 and BMP4 were higher in HL60R0.5 than in HL60S cells. Analysis of the drug SMAD5-resistance marker permeability-glycoprotein (Pgp) revealed that CRIM1 and Pgp exhibit a covariance pattern of expression. CONCLUSION This study demonstrated that CRIM1 is expressed at high levels in resistant leukemia cells, indicating that CRIM1 may play a role in drug-resistance.
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MESH Headings
- ATP Binding Cassette Transporter, Subfamily B, Member 1/biosynthesis
- ATP Binding Cassette Transporter, Subfamily B, Member 1/genetics
- Bone Morphogenetic Protein 4/biosynthesis
- Bone Morphogenetic Protein 4/genetics
- Bone Morphogenetic Protein 7/biosynthesis
- Bone Morphogenetic Protein 7/genetics
- Bone Morphogenetic Protein Receptors
- Cytarabine/pharmacology
- Daunorubicin/pharmacology
- Drug Resistance, Multiple
- Drug Resistance, Neoplasm
- Fluorescent Antibody Technique
- HL-60 Cells
- Humans
- Leukemia, Myeloid/drug therapy
- Leukemia, Myeloid/genetics
- Leukemia, Myeloid/metabolism
- Membrane Proteins/biosynthesis
- Membrane Proteins/genetics
- RNA, Messenger/biosynthesis
- RNA, Messenger/genetics
- Smad5 Protein/biosynthesis
- Smad5 Protein/genetics
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Affiliation(s)
- Malin Prenkert
- School of Health and Medical Sciences, Orebro University Hospital, Orebro, Sweden.
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21
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Prenkert M, Uggla B, Tina E, Tidefelt U, Strid H. Rapid induction of P-glycoprotein mRNA and protein expression by cytarabine in HL-60 cells. Anticancer Res 2009; 29:4071-4076. [PMID: 19846953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Overexpression of P-glycoprotein (P-gp), breast cancer resistance protein (BCRP) and glutathione-S-transferase pi (GSTpi) is associated with drug resistance in acute myeloid leukemia (AML). The short-term effects of drug exposure on their expression levels were investigated. MATERIALS AND METHODS HL-60 cells and drug-resistant sublines were cultured with or without daunorubicin (DNR) and cytarabine (Ara-C). At several time-points the expression levels of P-gp, BCRP and GSTpi were determined. RESULTS After exposure to Ara-C, P-gp mRNA rapidly increased in all the cell lines. P-gp protein was detected in the sensitive cells after 8 h exposure to Ara-C. GSTpi mRNA increased in the resistant cells, but no change in BCRP mRNA was observed. Exposure to DNR revealed rapidly increased P-gp and GSTpi mRNA in the resistant cells. CONCLUSION Ara-C rapidly increases P-gp mRNA and protein expression in sensitive and resistant cells, and GSTpi mRNA in resistant cells, in vitro. This may be of clinical importance during AML induction chemotherapy.
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MESH Headings
- ATP Binding Cassette Transporter, Subfamily B, Member 1/biosynthesis
- ATP Binding Cassette Transporter, Subfamily B, Member 1/genetics
- ATP Binding Cassette Transporter, Subfamily G, Member 2
- ATP-Binding Cassette Transporters/biosynthesis
- ATP-Binding Cassette Transporters/genetics
- Antimetabolites, Antineoplastic/pharmacology
- Blotting, Western
- Cytarabine/pharmacology
- Daunorubicin/pharmacology
- Drug Resistance, Neoplasm
- Flow Cytometry
- Gene Expression Regulation, Leukemic/drug effects
- Glutathione S-Transferase pi/biosynthesis
- Glutathione S-Transferase pi/genetics
- HL-60 Cells
- Humans
- Neoplasm Proteins/biosynthesis
- Neoplasm Proteins/genetics
- RNA, Messenger/biosynthesis
- RNA, Messenger/genetics
- Reverse Transcriptase Polymerase Chain Reaction
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Affiliation(s)
- Malin Prenkert
- School of Health and Medical Sciences, Orebro University, Orebro, Sweden.
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22
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Paul E, Paul E, Uggla B, Deneberg S, Bengtzen S, Hermansson M, Dahlman I, Rosenquist R, Wiman KG, Nahi H. Low p14ARF expression inde novoacute myeloid leukemia with normal karyotype is associated with poor survival. Leuk Lymphoma 2009; 50:1512-8. [DOI: 10.1080/10428190903111914] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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23
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Uggla B, Tina E, Nahi H, Paul C, Höglund M, Sirsjö A, Tidefelt U. Topoisomerase IIα mRNA and protein expression vs. in vitro drug resistance and clinical outcome in acute leukaemia. Int J Oncol 2007. [DOI: 10.3892/ijo.31.1.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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24
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Uggla B, Tina E, Nahi H, Paul C, Höglund M, Sirsjö A, Tidefelt U. Topoisomerase IIalpha mRNA and protein expression vs. in vitro drug resistance and clinical outcome in acute leukaemia. Int J Oncol 2007; 31:153-60. [PMID: 17549416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
The objective of this study was to correlate the expression of topoisomerase (topo) IIalpha to in vitro drug sensitivity and to the clinical outcome in patients with acute leukaemia. Leukaemic cells were isolated from bone marrow or blood from 94 patients. Topo IIalpha mRNA (n=58) and protein (n=60) expression was determined by real-time RT-PCR and flow cytometry, respectively. In both groups, chemosensitivity testing by a bioluminescence ATP assay was performed to a variable extent for both topo IIalpha poisons and non-topo IIalpha targeting drugs. Topo IIalpha mRNA expression varied with relative values ranging from 0.03 to 14.20 (median 1.10). The median value for topo IIalpha protein-positive cells was 23% (range 0-99%). Cell samples from patients with a high (>median value) percentage of topo IIalpha-positive cells were significantly more sensitive to the topo IIalpha active drugs etoposide and daunorubicin, and showed a borderline value for idarubicin (p=0.08), while there was no difference for non-topo IIalpha targeting drugs. However, we did not find any significant differences in mRNA expression or the percentage of topo IIalpha-positive cells in patients who achieved complete remission after at most two induction courses compared with those who did not, nor did we find any difference in survival when patients with high mRNA expression/percentage of topo IIalpha-positive cells were compared with patients with low values. We conclude that expression of topo IIalpha, determined as percentage of topo IIalpha-positive cells, in leukaemic cells correlates to chemosensitivity in vitro against topoisomerase poisons but that it does not predict clinical outcome in acute leukaemia.
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MESH Headings
- Acute Disease
- Adult
- Aged
- Aged, 80 and over
- Antibiotics, Antineoplastic/pharmacology
- Antigens, Neoplasm/analysis
- Antigens, Neoplasm/genetics
- Antigens, Neoplasm/metabolism
- Blood Cells/drug effects
- Blood Cells/enzymology
- Bone Marrow Cells/drug effects
- Bone Marrow Cells/enzymology
- Cell Survival
- DNA Topoisomerases, Type II/analysis
- DNA Topoisomerases, Type II/genetics
- DNA Topoisomerases, Type II/metabolism
- DNA-Binding Proteins/analysis
- DNA-Binding Proteins/genetics
- DNA-Binding Proteins/metabolism
- Daunorubicin
- Drug Resistance, Neoplasm/genetics
- Etoposide/pharmacology
- Female
- Humans
- Leukemia, Myeloid/enzymology
- Leukemia, Myeloid/mortality
- Leukemia, Myeloid/pathology
- Male
- Middle Aged
- Prognosis
- RNA, Messenger/analysis
- RNA, Messenger/metabolism
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Affiliation(s)
- Bertil Uggla
- Department of Medicine, Orebro University Hospital, 701 85 Orebro, Sweden.
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25
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Broliden PA, Dahl IM, Hast R, Johansson B, Juvonen E, Kjeldsen L, Porwit-MacDonald A, Sjoo M, Tangen JM, Uggla B, Oberg G, Hellstrom-Lindberg E. Antithymocyte globulin and cyclosporine A as combination therapy for low-risk non-sideroblastic myelodysplastic syndromes. Haematologica 2006; 91:667-70. [PMID: 16670072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
The present study evaluated the combination of antithymocyte globulin (ATG) and cyclosporine A (CsA) in patients with low-risk myelodysplastic syndromes. Twenty patients (17 with refractory anemia and 3 with refractory anemia with excess blasts) received treatment with rabbit-ATG plus CsA. The overall response rate was 30% (6/20); three of the six responders had a complete response. The responses lasted 2-58 months, with two patients still being in complete remission at 42 and 58 months. Short-lasting cytogenetic remissions were achieved in two patients. ATG was poorly tolerated in patients over 70 years of age. Four out of 20 patients progressed to acute myeloid leukemia within a year. We conclude that immunosuppressive treatment may be a therapeutic option for selected patients with myelodysplastic syndrome.
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MESH Headings
- Acute Disease
- Adult
- Aged
- Aged, 80 and over
- Anemia, Refractory/drug therapy
- Anemia, Refractory/genetics
- Anemia, Refractory/therapy
- Anemia, Refractory, with Excess of Blasts/drug therapy
- Anemia, Refractory, with Excess of Blasts/genetics
- Anemia, Refractory, with Excess of Blasts/therapy
- Aneuploidy
- Antilymphocyte Serum/therapeutic use
- Atrial Fibrillation/chemically induced
- Cyclosporine/adverse effects
- Cyclosporine/therapeutic use
- Disease Progression
- Female
- Humans
- Hypotension/chemically induced
- Immunosuppressive Agents/adverse effects
- Immunosuppressive Agents/therapeutic use
- Karyotyping
- Leukemia, Myeloid/epidemiology
- Male
- Middle Aged
- Prospective Studies
- Remission Induction
- Risk
- T-Lymphocytes/immunology
- Treatment Outcome
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Affiliation(s)
- Per Anders Broliden
- Karolinska Institutet, Department of Medicine, Karolinska University, Hospital Huddinge, Stockholm, Sweden
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26
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Uggla B, Ståhl E, Wågsäter D, Paul C, Karlsson MG, Sirsjö A, Tidefelt U. BCRP mRNA expression v. clinical outcome in 40 adult AML patients. Leuk Res 2005; 29:141-6. [PMID: 15607361 DOI: 10.1016/j.leukres.2004.06.004] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2004] [Accepted: 06/04/2004] [Indexed: 10/26/2022]
Abstract
Efflux pumps are considered being mechanisms behind drug resistance in acute myeloid leukaemia (AML). A recently described efflux pump, breast cancer resistance protein (BCRP), can be expressed in AML, but its clinical importance is uncertain. In this study BCRP mRNA expression was determined in samples from 40 AML patients by real-time RT-PCR. The expression varied from negative to 76 times that of control cells. There was no difference in BCRP mRNA expression between patients responding to induction treatment and non-responders. However, in the group of responders, the 14 patients with the highest expression had significantly shorter overall survival (mean 38 months, SEM 15 months) than the 14 patients with the lowest (74 months, SEM 16 months) (P = 0.047). This suggests a possible role of BCRP in drug resistance in AML.
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MESH Headings
- ATP Binding Cassette Transporter, Subfamily G, Member 2
- ATP-Binding Cassette Transporters/genetics
- ATP-Binding Cassette Transporters/metabolism
- Adult
- Aged
- Cell Line, Tumor
- Drug Resistance, Neoplasm/physiology
- Female
- Gene Expression Regulation, Leukemic
- Humans
- Leukemia, Myeloid, Acute/blood
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/genetics
- Male
- Middle Aged
- Neoplasm Proteins/genetics
- Neoplasm Proteins/metabolism
- Predictive Value of Tests
- Prognosis
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- Reverse Transcriptase Polymerase Chain Reaction
- Survival Analysis
- Treatment Outcome
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Affiliation(s)
- Bertil Uggla
- Department of Medicine, Orebro University Hospital, 701 85 Orebro, Sweden.
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27
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Abstract
Spontaneous appearance of acquired anticoagulants is a rare phenomenon. We present two cases, where such antibodies against factor VIII were masked by warfarin therapy. The two patients were anticoagulated with warfarin due to mechanical heart valve and recurrent thromboembolic events, respectively. Different therapies against the inhibitor of factor VIII were used in the two cases. One patient received corticosteroids and high-dose gammaglobulin with temporary effect and was then effectively treated with cyclophosphamide. The other patient was successfully treated with cyclosporine. The special problems of keeping the balance between thrombosis and bleeding in this group of patients with need of anticoagulation due to mechanical heart valves or other thrombogenic factors are discussed.
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Affiliation(s)
- Bertil Uggla
- Department of Medicine, Orebro University Hospital, Orebro, Sweden.
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28
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Uggla B, Tidefelt U, Vikerfors T, Fredlund H. Activation of granulocytes in patients treated with chemotherapy. Clin Lab Haematol 2002; 24:29-31. [PMID: 11843895 DOI: 10.1046/j.1365-2257.2002.00185.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
It is well known that patients with granulocytopenia due to chemotherapy are susceptible to life-threatening infections. To determine whether or not granulocyte function is also impaired by chemotherapy, respiratory burst, CD11b and CD18 expression were analysed by flow cytometry in granulocytes from 10 patients with haematological malignancies: before and after the commencement of high-dose chemotherapy and in the recovery phase. As a comparison, the same granulocytic functions were analysed in patients treated with low-dose hydroxyurea and in healthy volunteers. The granulocytes were activated by Staphylococcus aureus and Staphylococcus epidermidis. A decreased ability to mobilize CD18 in the recovery phase was seen, but the significance of this finding must be evaluated carefully owing to the small patient number.
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Affiliation(s)
- B Uggla
- Department of Medicine, Orebro Medical Centre Hospital, Orebro, Sweden.
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29
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Uggla B, Möllgård L, Ståhl E, Mossberg LL, Karlsson MG, Paul C, Tidefelt U. Expression of topoisomerase IIalpha in the G0/G1 cell cycle phase of fresh leukemic cells. Leuk Res 2001; 25:961-6. [PMID: 11597731 DOI: 10.1016/s0145-2126(01)00062-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Topoisomerase IIalpha (topo IIalpha) is the target enzyme for several antineoplastic drugs. Correlation between low expression of topo IIalpha and drug resistance has been shown in vitro, but there is limited evidence of a correlation to initial response to treatment or to overall prognosis. Normal cells express topo IIalpha in S/G2/M phase of the cell cycle but not in G0/G1 phase. However, some data suggest that topo IIalpha could be expressed in G0/G1 phase in malignant cells. We have investigated the expression of topo IIalpha in leukemic cells from 25 patients with acute leukemia by flow cytometry, separating cells of different cell cycle phases. We demonstrated that 9/25 samples showed >50% positive cells in G0/G1, and another five samples showed >20%. This finding could possibly provide an explanation to previous difficulties in correlating topo IIalpha expression with clinical outcome. Six of eight patients, where >20% of the cells in G0/G1 were positive for topo IIalpha, entered CR, compared to one of five patients with <20% topo IIalpha positive cells in G0/G1. We suggest that topo IIalpha expression in G0/G1 in leukemic cells may be of predictive value for clinical response to cytostatic drugs.
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Affiliation(s)
- B Uggla
- Department of Medicine, Orebro Medical Center Hospital, S-70185, Orebro, Sweden.
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