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Martínez-Cuadrón D, Megías-Vericat JE, Gil C, Bernal T, Tormo M, Martínez-Sánchez P, Rodríguez-Medina C, Serrano J, Herrera P, Simón JAP, Sayas MJ, Bergua J, Lavilla-Rubira E, Amigo ML, Benavente C, Lorenzo JLL, Pérez-Encinas MM, Vidriales MB, Colorado M, De Rueda B, García-Boyero R, Marini S, García-Suárez J, López-Pavía M, Gómez-Roncero MI, Noriega V, López A, Labrador J, Cabello A, Sossa C, Algarra L, Stevenazzi M, Solana-Altabella A, Boluda B, Montesinos P. Outcomes after intensive chemotherapy for secondary and myeloid-related changes acute myeloid leukemia patients aged 60 to 75 years old: a retrospective analysis from the PETHEMA registry. Haematologica 2024; 109:115-128. [PMID: 37199127 PMCID: PMC10772508 DOI: 10.3324/haematol.2022.282506] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 01/16/2023] [Accepted: 05/08/2023] [Indexed: 05/19/2023] Open
Abstract
Treatment options for patients with secondary acute myeloid leukemia (sAML) and AML with myeloid-related changes (AMLMRC) aged 60 to 75 years are scarce and unsuitable. A pivotal trial showed that CPX-351 improved complete remission with/without incomplete recovery (CR/CRi) and overall survival (OS) as compared with standard "3+7" regimens. We retrospectively analyze outcomes of 765 patients with sAML and AML-MRC aged 60 to 75 years treated with intensive chemotherapy, reported to the PETHEMA registry before CPX-351 became available. The CR/CRi rate was 48%, median OS was 7.6 months (95% confidence interval [CI]: 6.7-8.5) and event-free survival (EFS) 2.7 months (95% CI: 2-3.3), without differences between intensive chemotherapy regimens and AML type. Multivariate analyses identified age ≥70 years, Eastern Cooperative Oncology Group performance status ≥1 as independent adverse prognostic factors for CR/CRi and OS, while favorable/intermediate cytogenetic risk and NPM1 were favorable prognostic factors. Patients receiving allogeneic stem cell transplant (HSCT), autologous HSCT, and those who completed more consolidation cycles showed improved OS. This large study suggests that classical intensive chemotherapy could lead to similar CR/CRi rates with slightly shorter median OS than CPX-351.
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Affiliation(s)
- David Martínez-Cuadrón
- Hospital Universitari i Politècnic La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid.
| | - Juan E Megías-Vericat
- Servicio de Farmacia, Área del Medicamento. Hospital Universitari i Politècnic La Fe, Valencia
| | - Cristina Gil
- Hospital General Universitario de Alicante, Alicante
| | - Teresa Bernal
- Hospital Universitario Central de Asturias, Asturias, Instituto Universitario de Oncología del Principado de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, IUOPA, ISPA
| | - Mar Tormo
- Hospital Clínico Universitario, INCLIVA Biomedical Research Institute, Valencia
| | | | | | | | | | - José A Pérez Simón
- Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS / CISC), Universidad de Sevilla, Sevilla
| | | | | | | | | | | | | | | | | | | | | | | | - Sandra Marini
- Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra
| | | | | | | | | | | | | | - Ana Cabello
- Hospital Universitario Nuestra Señora de Candelaria, Tenerife
| | - Claudia Sossa
- FOSCAL, Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga, Bucaramanga
| | | | | | | | - Blanca Boluda
- Hospital Universitari i Politècnic La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia
| | - Pau Montesinos
- Hospital Universitari i Politècnic La Fe, Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid
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Moreno AF, Lavín-Alconero L, de Ugarriza PL, Blanco LS, Hernández SC, Burgués JMB, de Miguel MI, Huerta AJG, Zarzuela MP, Boluda B, Humala K, Calabuig ML, Amigo ML, Casas MC, Del Mar García-Saiz M, Verdugo AF, Domínguez JF, Bernal T. FOVOCIP study: a multicenter randomized trial of fosfomycin versus ciprofloxacin for febrile neutropenia in hematologic patients-efficacy and microbiologic safety. Trials 2023; 24:694. [PMID: 37891616 PMCID: PMC10612155 DOI: 10.1186/s13063-023-07702-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Multidrug-resistant Gram-negative bacterial (MRGNB) infections represent a major public health threat. Cancer patients and, among them, hematological patients are most vulnerable to these infections. Gut colonization by MRGNB is a common phenomenon occurring during hospitalization and chemotherapy exposure. In the neutropenic phase that occurs after chemotherapy, MRGNB translocation occurs increasing patient's mortality. Fluoroquinolone prophylaxis with ciprofloxacin or levofloxacin efficacy is now being questioned due to the increase of incidence in MRGNB. METHODS A phase III randomized, controlled, clinical trial, open-label parallel-group with a 1:1 ratio, aimed to demonstrate the non-inferiority of oral fosfomycin versus oral ciprofloxacin for febrile neutropenia prevention in patients with acute leukemia (AL) or hematopoietic cell transplant (HSC) receptors. Weekly surveillance cultures are planned to detect gut colonization. Changes in fecal microbiome at the beginning and end of prophylaxis will also be analyzed. DISCUSSION This trial will provide evidence of the efficacy of an alternative drug to ciprofloxacin for febrile neutropenia prevention in high-risk hematological patients. The battery of planned microbiological studies will allow us to evaluate prospectively the microbiological safety of both pharmacological strategies in terms of the selection of MRGNB occurring in each arm. In addition, valuable information on the way in which each drug changes the fecal microbiome of the patients throughout the treatment will be generated. TRIAL REGISTRATION Clinical trials NCT05311254, Registered on 5 April 2022, https://clinicaltrials.gov/ct2/show/NCT05311254?term=FOVOCIP&cntry=ES&draw=2&rank=1 . PROTOCOL VERSION 3.0, dated 20 May 2022.
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Affiliation(s)
- Ainhoa Fernández Moreno
- Hematology Department, University Hospital Central of Asturias, Avenida Roma, 33011, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias, Avenida Roma, 33011, Oviedo, Spain
- Instituto Universitario de Oncología del Principado de Asturias, C/ Fernando Bongera, 33006, Oviedo, Spain
| | - Lucía Lavín-Alconero
- Clinical Trials Agency Valdecilla-IDIVAL, Marqués de Valdecilla University Hospital, Av. Valdecilla, 25, 39008, Santander, Cantabria, Spain
- Department of Clinical Pharmacology, Marqués de, Valdecilla University Hospital, Av. Valdecilla, 25, 39008, Santander, Cantabria, Spain
| | - Paula López de Ugarriza
- Hematology Department, University Hospital Central of Asturias, Avenida Roma, 33011, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias, Avenida Roma, 33011, Oviedo, Spain
- Instituto Universitario de Oncología del Principado de Asturias, C/ Fernando Bongera, 33006, Oviedo, Spain
| | - Laura Solán Blanco
- Hematology Department, Fundación Jiménez Díaz, Av. Reyes Católicos, 28040, Madrid, Spain
| | - Sara Cáceres Hernández
- Hematology Department, San Pedro Alcántara Hospital, C/Pablo Naranjo Porras, 10003, Cáceres, Spain
| | | | | | | | - Marta Polo Zarzuela
- Hematology Department, University Clinic Hospital San Carlos, C/Prof. Martín Lagos, 28040, Madrid, Spain
| | - Blanca Boluda
- Hematology Department, Instituto de Investigación, University Hospital La Fe, Avinguda Fernando Abril Martorell, 46026, Valencia, Spain
| | - Karem Humala
- Hematology Department, University Hospital La Paz, Paseo de La Castellana, 28046, Madrid, Spain
| | - Maria Luisa Calabuig
- Hematology Department, University Clinic Hospital of Valencia, Av Blasco Ibañez, 46010, Valencia, Spain
| | - Maria Luz Amigo
- Hematology Department, University Hospital Morales Messeguer, C/Marqués de los Vélez, 30008, Murcia, Spain
| | - Marián Cuesta Casas
- Hematology Department, University Hospital Carlos Haya, Av Carlos Haya, 29010, Malaga, Spain
| | - María Del Mar García-Saiz
- Clinical Trials Agency Valdecilla-IDIVAL, Marqués de Valdecilla University Hospital, Av. Valdecilla, 25, 39008, Santander, Cantabria, Spain
- Department of Clinical Pharmacology, Marqués de, Valdecilla University Hospital, Av. Valdecilla, 25, 39008, Santander, Cantabria, Spain
| | - Ana Fernández Verdugo
- Microbiology Department, University Hospital Central of Asturias, Avenida Roma, 33011, Oviedo, Spain
| | - Javier Fernández Domínguez
- Clinical Trials Agency Valdecilla-IDIVAL, Marqués de Valdecilla University Hospital, Av. Valdecilla, 25, 39008, Santander, Cantabria, Spain
- Microbiology Department, University Hospital Central of Asturias, Avenida Roma, 33011, Oviedo, Spain
- CIBER_Enfermedades Respiratorias ISCIII, Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain
| | - Teresa Bernal
- Instituto Universitario de Oncología del Principado de Asturias, C/ Fernando Bongera, 33006, Oviedo, Spain.
- Clinical Trials Agency Valdecilla-IDIVAL, Marqués de Valdecilla University Hospital, Av. Valdecilla, 25, 39008, Santander, Cantabria, Spain.
- Department of Clinical Pharmacology, Marqués de, Valdecilla University Hospital, Av. Valdecilla, 25, 39008, Santander, Cantabria, Spain.
- CIBER_Enfermedades Respiratorias ISCIII, Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain.
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3
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Sargas C, Ayala R, Larráyoz MJ, Chillón MC, Rodriguez-Arboli E, Bilbao C, Prados de la Torre E, Martínez-Cuadrón D, Rodríguez-Veiga R, Boluda B, Gil C, Bernal T, Bergua J, Algarra L, Tormo M, Martínez-Sánchez P, Soria E, Serrano J, Alonso-Dominguez JM, García R, Amigo ML, Herrera-Puente P, Sayas MJ, Lavilla-Rubira E, Martínez-López J, Calasanz MJ, García-Sanz R, Pérez-Simón JA, Gómez Casares MT, Sánchez-García J, Barragán E, Montesinos P. Comparison of the 2022 and 2017 European LeukemiaNet risk classifications in a real-life cohort of the PETHEMA group. Blood Cancer J 2023; 13:77. [PMID: 37173322 PMCID: PMC10182047 DOI: 10.1038/s41408-023-00835-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/24/2023] [Accepted: 04/11/2023] [Indexed: 05/15/2023] Open
Abstract
Next-Generation Sequencing is needed for the accurate genetic risk stratification of acute myeloid leukemia according to European LeukemiaNet (ELN) guidelines. We validated and compared the 2022 ELN risk classification in a real-life cohort of 546 intensively and 379 non-intensively treated patients. Among fit patients, those aged ≥65 years old showed worse OS than younger regardless risk classification. Compared with the 2017 classification, 14.5% of fit patients changed the risk with the 2022 classification, increasing the high-risk group from 44.3% to 51.8%. 3.7% and 0.9% FLT3-ITD mutated patients were removed from the favorable and adverse 2017 categories respectively to 2022 intermediate risk group. We suggest that midostaurin therapy could be a predictor for 3 years OS (85.2% with vs. 54.8% without midostaurin, P = 0.04). Forty-seven (8.6%) patients from the 2017 intermediate group were assigned to the 2022 adverse-risk group as they harbored myelodysplasia (MDS)-related mutations. Patients with one MDS-related mutation did not reach median OS, while patients with ≥2 mutations had 13.6 months median OS (P = 0.002). Patients with TP53 ± complex karyotype or inv(3) had a dismal prognosis (7.1 months median OS). We validate the prognostic utility of the 2022 ELN classification in a real-life setting providing supportive evidences to improve risk stratification guidelines.
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Affiliation(s)
- Claudia Sargas
- Grupo Acreditado de Investigación en Hematología, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | - Rosa Ayala
- Hospital Universitario 12 de Octubre, CNIO, Complutense University, Madrid, Spain
| | | | - María C Chillón
- Servicio de Hematología, Hospital Universitario de Salamanca (HUS/IBSAL), CIBERONC, Centro de Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Eduardo Rodriguez-Arboli
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (IBIS/CSIC), Universidad de Sevilla, Sevilla, Spain
| | - Cristina Bilbao
- Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | | | - David Martínez-Cuadrón
- Servicio de Hematología, Grupo Acreditado de Investigación en Hematología, Hospital Universitario y Politécnico La Fe, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | - Rebeca Rodríguez-Veiga
- Servicio de Hematología, Grupo Acreditado de Investigación en Hematología, Hospital Universitario y Politécnico La Fe, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | - Blanca Boluda
- Servicio de Hematología, Grupo Acreditado de Investigación en Hematología, Hospital Universitario y Politécnico La Fe, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | - Cristina Gil
- Hospital General Universitario de Alicante, Alicante, Spain
| | - Teresa Bernal
- Hospital Universitario Central de Asturias, Instituto Universitario (IUOPA), Instituto de investigación del Principado de Asturias (ISPA), Oviedo, Spain
| | - Juan Bergua
- Hospital Universitario San Pedro de Alcántara, Cáceres, Spain
| | | | - Mar Tormo
- Hospital Clínico Universitario-INCLIVA, Valencia, Spain
| | | | - Elena Soria
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (IBIS/CSIC), Universidad de Sevilla, Sevilla, Spain
| | - Josefina Serrano
- IMIBIC, Hematology, Hospital Universitario Reina Sofía, UCO, Córdoba, Spain
| | | | | | | | | | | | | | | | | | - Ramón García-Sanz
- Servicio de Hematología, Hospital Universitario de Salamanca (HUS/IBSAL), CIBERONC, Centro de Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca, Spain
| | - José A Pérez-Simón
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (IBIS/CSIC), Universidad de Sevilla, Sevilla, Spain
| | - María T Gómez Casares
- Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | | | - Eva Barragán
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
- Servicio Análisis Clínicos, Grupo Acreditado de Investigación en Hematología, Hospital Universitario y Politécnico La Fe, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | - Pau Montesinos
- Servicio de Hematología, Grupo Acreditado de Investigación en Hematología, Hospital Universitario y Politécnico La Fe, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain.
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain.
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Boluda B, Solana-Altabella A, Cano I, Martínez-Cuadrón D, Acuña-Cruz E, Torres-Miñana L, Rodríguez-Veiga R, Navarro-Vicente I, Martínez-Campuzano D, García-Ruiz R, Lloret P, Asensi P, Osa-Sáez A, Aguero J, Rodríguez-Serrano M, Buendía-Fuentes F, Megías-Vericat JE, Martín-Herreros B, Barragán E, Sargas C, Salas M, Wooddell M, Dharmani C, Sanz MA, De la Rubia J, Montesinos P. Incidence and Risk Factors for Development of Cardiac Toxicity in Adult Patients with Newly Diagnosed Acute Myeloid Leukemia. Cancers (Basel) 2023; 15:2267. [PMID: 37190195 PMCID: PMC10136564 DOI: 10.3390/cancers15082267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/03/2023] [Accepted: 04/06/2023] [Indexed: 05/17/2023] Open
Abstract
The incidence of cardiac morbimortality in acute myeloid leukemia (AML) is not well known. We aim to estimate the cumulative incidence (CI) of cardiac events in AML patients and to identify risk factors for their occurrence. Among 571 newly diagnosed AML patients, 26 (4.6%) developed fatal cardiac events, and among 525 treated patients, 19 (3.6%) experienced fatal cardiac events (CI: 2% at 6 months; 6.7% at 9 years). Prior heart disease was associated with the development of fatal cardiac events (hazard ratio (HR) = 6.9). The CI of non-fatal cardiac events was 43.7% at 6 months and 56.9% at 9 years. Age ≥ 65 (HR = 2.2), relevant cardiac antecedents (HR = 1.4), and non-intensive chemotherapy (HR = 1.8) were associated with non-fatal cardiac events. The 9-year CI of grade 1-2 QTcF prolongation was 11.2%, grade 3 was 2.7%, and no patient had grade 4-5 events. The 9-year CI of grade 1-2 cardiac failure was 1.3%, grade 3-4 was 15%, and grade 5 was 2.1%; of grade 1-2, arrhythmia was 1.9%, grade 3-4 was 9.1%, and grade 5 was 1%. Among 285 intensive therapy patients, median overall survival decreased in those experiencing grade 3-4 cardiac events (p < 0.001). We observed a high incidence of cardiac toxicity associated with significant mortality in AML.
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Affiliation(s)
- Blanca Boluda
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (I.N.-V.)
- Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain
| | - Antonio Solana-Altabella
- Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain
- Pharmacy Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Isabel Cano
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (I.N.-V.)
- Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain
| | - David Martínez-Cuadrón
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (I.N.-V.)
- Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain
- CIBERONC, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Evelyn Acuña-Cruz
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (I.N.-V.)
- Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain
| | - Laura Torres-Miñana
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (I.N.-V.)
- Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain
| | - Rebeca Rodríguez-Veiga
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (I.N.-V.)
- Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain
| | - Irene Navarro-Vicente
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (I.N.-V.)
- Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain
| | - David Martínez-Campuzano
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (I.N.-V.)
| | - Raquel García-Ruiz
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (I.N.-V.)
| | - Pilar Lloret
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (I.N.-V.)
| | - Pedro Asensi
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (I.N.-V.)
| | - Ana Osa-Sáez
- Cardiology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Jaume Aguero
- Cardiology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | | | | | | | - Beatriz Martín-Herreros
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (I.N.-V.)
- Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain
| | - Eva Barragán
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (I.N.-V.)
- Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain
- CIBERONC, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Claudia Sargas
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (I.N.-V.)
- Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain
| | - Maribel Salas
- Daiichi Sankyo, Inc., Basking Ridge, NJ 07920, USA
- Center for Real-World Effectiveness and Safety of Therapeutics (CREST), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | | | | | - Miguel A. Sanz
- Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain
- CIBERONC, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Javier De la Rubia
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (I.N.-V.)
- Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain
- CIBERONC, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Internal Medicine, School of Medicine and Dentistry, Catholic University of Valencia, 46001 Valencia, Spain
| | - Pau Montesinos
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (I.N.-V.)
- Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain
- CIBERONC, Instituto de Salud Carlos III, 28029 Madrid, Spain
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5
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Sargas C, Ayala R, Larráyoz MJ, Chillón MC, Carrillo-Cruz E, Bilbao-Sieyro C, Prados de la Torre E, Martínez-Cuadrón D, Rodríguez-Veiga R, Boluda B, Gil C, Bernal T, Bergua JM, Algarra L, Tormo M, Martínez-Sánchez P, Soria E, Serrano J, Alonso-Domínguez JM, García-Boyero R, Amigo ML, Herrera-Puente P, Sayas MJ, Lavilla-Rubira E, Martínez-López J, Calasanz MJ, García-Sanz R, Pérez-Simón JA, Gómez-Casares MT, Sánchez-García J, Barragán E, Montesinos P. Molecular Landscape and Validation of New Genomic Classification in 2668 Adult AML Patients: Real Life Data from the PETHEMA Registry. Cancers (Basel) 2023; 15:cancers15020438. [PMID: 36672386 PMCID: PMC9856266 DOI: 10.3390/cancers15020438] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/30/2022] [Accepted: 01/07/2023] [Indexed: 01/12/2023] Open
Abstract
Next-Generation Sequencing (NGS) implementation to perform accurate diagnosis in acute myeloid leukemia (AML) represents a major challenge for molecular laboratories in terms of specialization, standardization, costs and logistical support. In this context, the PETHEMA cooperative group has established the first nationwide diagnostic network of seven reference laboratories to provide standardized NGS studies for AML patients. Cross-validation (CV) rounds are regularly performed to ensure the quality of NGS studies and to keep updated clinically relevant genes recommended for NGS study. The molecular characterization of 2856 samples (1631 derived from the NGS-AML project; NCT03311815) with standardized NGS of consensus genes (ABL1, ASXL1, BRAF, CALR, CBL, CEBPA, CSF3R, DNMT3A, ETV6, EZH2, FLT3, GATA2, HRAS, IDH1, IDH2, JAK2, KIT, KRAS, MPL, NPM1, NRAS, PTPN11, RUNX1, SETBP1, SF3B1, SRSF2, TET2, TP53, U2AF1 and WT1) showed 97% of patients having at least one mutation. The mutational profile was highly variable according to moment of disease, age and sex, and several co-occurring and exclusion relations were detected. Molecular testing based on NGS allowed accurate diagnosis and reliable prognosis stratification of 954 AML patients according to new genomic classification proposed by Tazi et al. Novel molecular subgroups, such as mutated WT1 and mutations in at least two myelodysplasia-related genes, have been associated with an adverse prognosis in our cohort. In this way, the PETHEMA cooperative group efficiently provides an extensive molecular characterization for AML diagnosis and risk stratification, ensuring technical quality and equity in access to NGS studies.
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Affiliation(s)
- Claudia Sargas
- Grupo Acreditado de Investigación en Hematología, Instituto de Investigación Sanitaria La Fe (IIS La Fe), 46026 Valencia, Spain
| | - Rosa Ayala
- Hospital Universitario 12 de Octubre, National Cancer Research Center, Complutense University, 28041 Madrid, Spain
| | - María José Larráyoz
- CIMA LAB Diagnostics, Departamento de Bioquímica y Genética, Universidad de Navarra, 31008 Pamplona, Spain
| | - María Carmen Chillón
- Servicio de Hematología, Hospital Universitario de Salamanca (HUS/IBSAL), CIBERONC, Centro de Investigación del Cáncer–IBMCC (USAL–CSIC), 37007 Salamanca, Spain
| | - Estrella Carrillo-Cruz
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (IBIS/CSIC/CIBERONC), Universidad de Sevilla, 41013 Sevilla, Spain
| | - Cristina Bilbao-Sieyro
- Hospital Universitario de Gran Canaria Dr. Negrín, 35010 Las Palmas de Gran Canaria, Spain
| | - Esther Prados de la Torre
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba (UCO), 14004 Córdoba, Spain
| | - David Martínez-Cuadrón
- Servicio de Hematología, Grupo Acreditado de Investigación en Hematología, Hospital Universitario y Politécnico La Fe, Instituto de Investigación Sanitaria La Fe (IIS La Fe), 46026 Valencia, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto de Investigación Sanitaria La Fe (IIS La Fe), 46026 Valencia, Spain
| | - Rebeca Rodríguez-Veiga
- Servicio de Hematología, Grupo Acreditado de Investigación en Hematología, Hospital Universitario y Politécnico La Fe, Instituto de Investigación Sanitaria La Fe (IIS La Fe), 46026 Valencia, Spain
| | - Blanca Boluda
- Servicio de Hematología, Grupo Acreditado de Investigación en Hematología, Hospital Universitario y Politécnico La Fe, Instituto de Investigación Sanitaria La Fe (IIS La Fe), 46026 Valencia, Spain
| | - Cristina Gil
- Hospital General Universitario de Alicante, 03010 Alicante, Spain
| | - Teresa Bernal
- Hospital Universitario Central de Asturias, Instituto Universitario (IUOPA), Instituto de Investigación del Principado de Asturias (ISPA), 33011 Oviedo, Spain
| | | | - Lorenzo Algarra
- Hospital Universitario General de Albacete, 02006 Albacete, Spain
| | - Mar Tormo
- Hospital Clínico Universitario–INCLIVA, 46010 Valencia, Spain
| | - Pilar Martínez-Sánchez
- Hospital Universitario 12 de Octubre, National Cancer Research Center, Complutense University, 28041 Madrid, Spain
| | - Elena Soria
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (IBIS/CSIC/CIBERONC), Universidad de Sevilla, 41013 Sevilla, Spain
| | - Josefina Serrano
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba (UCO), 14004 Córdoba, Spain
| | | | | | - María Luz Amigo
- Hospital Universitario Morales Messeguer, 30008 Murcia, Spain
| | | | | | | | - Joaquín Martínez-López
- Hospital Universitario 12 de Octubre, National Cancer Research Center, Complutense University, 28041 Madrid, Spain
| | - María José Calasanz
- CIMA LAB Diagnostics, Departamento de Bioquímica y Genética, Universidad de Navarra, 31008 Pamplona, Spain
| | - Ramón García-Sanz
- Servicio de Hematología, Hospital Universitario de Salamanca (HUS/IBSAL), CIBERONC, Centro de Investigación del Cáncer–IBMCC (USAL–CSIC), 37007 Salamanca, Spain
| | - José Antonio Pérez-Simón
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (IBIS/CSIC/CIBERONC), Universidad de Sevilla, 41013 Sevilla, Spain
| | | | - Joaquín Sánchez-García
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba (UCO), 14004 Córdoba, Spain
| | - Eva Barragán
- Hospital General Universitario de Alicante, 03010 Alicante, Spain
- Servicio Análisis Clínicos, Grupo Acreditado de Investigación en Hematología, Hospital Universitario y Politécnico La Fe, Instituto de Investigación Sanitaria La Fe (IIS La Fe), 46026 Valencia, Spain
- Correspondence: ; Tel.: +34-961-244589
| | - Pau Montesinos
- Servicio de Hematología, Grupo Acreditado de Investigación en Hematología, Hospital Universitario y Politécnico La Fe, Instituto de Investigación Sanitaria La Fe (IIS La Fe), 46026 Valencia, Spain
- Hospital General Universitario de Alicante, 03010 Alicante, Spain
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6
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Ayala R, Carreño-Tarragona G, Barragán E, Boluda B, Larráyoz MJ, Chillón MC, Carrillo-Cruz E, Bilbao C, Sánchez-García J, Bernal T, Martinez-Cuadron D, Gil C, Serrano J, Rodriguez-Medina C, Bergua J, Pérez-Simón JA, Calbacho M, Alonso-Domínguez JM, Labrador J, Tormo M, Amigo ML, Herrera-Puente P, Rapado I, Sargas C, Vazquez I, Calasanz MJ, Gomez-Casares T, García-Sanz R, Sanz MA, Martínez-López J, Montesinos P. Impact of FLT3-ITD Mutation Status and Its Ratio in a Cohort of 2901 Patients Undergoing Upfront Intensive Chemotherapy: A PETHEMA Registry Study. Cancers (Basel) 2022; 14:cancers14235799. [PMID: 36497281 PMCID: PMC9737662 DOI: 10.3390/cancers14235799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/04/2022] [Accepted: 11/21/2022] [Indexed: 11/26/2022] Open
Abstract
FLT3−ITD results in a poor prognosis in terms of overall survival (OS) and relapse-free survival (RFS) in acute myeloid leukemia (AML). However, the prognostic usefulness of the allelic ratio (AR) to select post-remission therapy remains controversial. Our study focuses on the prognostic impact of FLT3−ITD and its ratio in a series of 2901 adult patients treated intensively in the pre-FLT3 inhibitor era and reported in the PETHEMA registry. A total of 579 of these patients (20%) harbored FLT3−ITD mutations. In multivariate analyses, patients with an FLT3−ITD allele ratio (AR) of >0.5 showed a lower complete remission (CR rate) and OS (HR 1.47, p = 0.009), while AR > 0.8 was associated with poorer RFS (HR 2.1; p < 0.001). Among NPM1/FLT3−ITD-mutated patients, median OS gradually decreased according to FLT3−ITD status and ratio (34.3 months FLT3−ITD-negative, 25.3 months up to 0.25, 14.5 months up to 0.5, and 10 months ≥ 0.5, p < 0.001). Post-remission allogeneic transplant (allo-HSCT) resulted in better OS and RFS as compared to auto-HSCT in NPM1/FLT3−ITD-mutated AML regardless of pre-established AR cutoff (≤0.5 vs. >0.5). Using the maximally selected log-rank statistics, we established an optimal cutoff of FLT3−ITD AR of 0.44 for OS, and 0.8 for RFS. We analyzed the OS and RFS according to FLT3−ITD status in all patients, and we found that the group of FLT3−ITD-positive patients with AR < 0.44 had similar 5-year OS after allo-HSCT or auto-HSCT (52% and 41%, respectively, p = 0.86), but worse RFS after auto-HSCT (p = 0.01). Among patients with FLT3−ITD AR > 0.44, allo-HSCT was superior to auto-HSCT in terms of OS and RFS. This study provides more evidence for a better characterization of patients with AML harboring FLT3−ITD mutations.
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Affiliation(s)
- Rosa Ayala
- Hematology Department, Hospital Universitario 12 de Octubre, i+12, CNIO, CIBERONC, Complutense University, 28041 Madrid, Spain
| | - Gonzalo Carreño-Tarragona
- Hematology Department, Hospital Universitario 12 de Octubre, i+12, CNIO, CIBERONC, Complutense University, 28041 Madrid, Spain
| | - Eva Barragán
- Molecular Biology Unit, Hospital Universitari i Politécnic-IIS La Fe, 46026 Valencia, Spain
| | - Blanca Boluda
- Hematology Department, Hospital Universitari i Politécnic-IIS La Fe, CIBERONC, 46026 Valencia, Spain
| | | | - María Carmen Chillón
- Hospital Universitario de Salamanca (HUS/IBSAL), CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), 37007 Salamanca, Spain
| | - Estrella Carrillo-Cruz
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (IBIS/CSIC/CIBERONC), Universidad de Sevilla, 41120 Sevilla, Spain
| | - Cristina Bilbao
- Hospital Universitario de Gran Canaria Dr. Negrín, 35002 Las Palmas de Gran Canaria, Spain
| | | | - Teresa Bernal
- Hospital Universitario Central de Asturias, Instituto de Investigación del Principado de Asturias (ISPA), 33011 Oviedo, Spain
| | - David Martinez-Cuadron
- Hematology Department, Hospital Universitari i Politécnic-IIS La Fe, CIBERONC, 46026 Valencia, Spain
| | - Cristina Gil
- Hospital General Universitario de Alicante, 03010 Alicante, Spain
| | - Josefina Serrano
- IMIBIC, Hematology, Hospital Universitario Reina Sofía, UCO, 14004 Córdoba, Spain
| | | | - Juan Bergua
- Hospital Universitario San Pedro de Alcántara, 10001 Cáceres, Spain
| | - José A. Pérez-Simón
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (IBIS/CSIC/CIBERONC), Universidad de Sevilla, 41120 Sevilla, Spain
| | - María Calbacho
- Hematology Department, Hospital Universitario 12 de Octubre, i+12, CNIO, CIBERONC, Complutense University, 28041 Madrid, Spain
| | | | - Jorge Labrador
- Research Unit, Hematology Department, Hospital Universitario de Burgos, Universidad Isabel I, 09006 Burgos, Spain
| | - Mar Tormo
- Hematology Department, Hospital Clínico Universitario-INCLIVA, 46026 Valencia, Spain
| | - Maria Luz Amigo
- Hospital Universitario Morales Messeguer, 30008 Murcia, Spain
| | | | - Inmaculada Rapado
- Hematology Department, Hospital Universitario 12 de Octubre, i+12, CNIO, CIBERONC, Complutense University, 28041 Madrid, Spain
| | - Claudia Sargas
- Molecular Biology Unit, Hospital Universitari i Politécnic-IIS La Fe, 46026 Valencia, Spain
| | - Iria Vazquez
- CIMA LAB Diagnostics, Universidad de Navarra, 31008 Pamplona, Spain
| | | | - Teresa Gomez-Casares
- Hospital Universitario de Gran Canaria Dr. Negrín, 35002 Las Palmas de Gran Canaria, Spain
| | - Ramón García-Sanz
- Hospital Universitario de Salamanca (HUS/IBSAL), CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), 37007 Salamanca, Spain
| | - Miguel A. Sanz
- Hematology Department, Hospital Universitari i Politécnic-IIS La Fe, CIBERONC, 46026 Valencia, Spain
| | - Joaquín Martínez-López
- Hematology Department, Hospital Universitario 12 de Octubre, i+12, CNIO, CIBERONC, Complutense University, 28041 Madrid, Spain
- Correspondence: (J.M.-L.); (P.M.); Tel.: +34-917-792-788 (J.M.-L.); +34-961-244-925 (P.M.); Fax: +34-961-246-201 (P.M.)
| | - Pau Montesinos
- Hematology Department, Hospital Universitari i Politécnic-IIS La Fe, CIBERONC, 46026 Valencia, Spain
- Correspondence: (J.M.-L.); (P.M.); Tel.: +34-917-792-788 (J.M.-L.); +34-961-244-925 (P.M.); Fax: +34-961-246-201 (P.M.)
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Martínez-Cuadrón D, Serrano J, Mariz J, Gil C, Tormo M, Martínez-Sánchez P, Rodríguez-Arbolí E, García-Boyero R, Rodríguez-Medina C, Martínez-Chamorro C, Polo M, Bergua J, Aguiar E, Amigo ML, Herrera P, Alonso-Domínguez JM, Bernal T, Espadana A, Sayas MJ, Algarra L, Vidriales MB, Vasconcelos G, Vives S, Pérez-Encinas MM, López A, Noriega V, García-Fortes M, Chillón MC, Rodríguez-Gutiérrez JI, Calasanz MJ, Labrador J, López JA, Boluda B, Rodríguez-Veiga R, Martínez-López J, Barragán E, Sanz MA, Montesinos P. Characteristics and Outcomes of Adult Patients in the PETHEMA Registry with Relapsed or Refractory FLT3-ITD Mutation-Positive Acute Myeloid Leukemia. Cancers (Basel) 2022; 14:cancers14112817. [PMID: 35681796 PMCID: PMC9179309 DOI: 10.3390/cancers14112817] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 03/23/2022] [Revised: 05/26/2022] [Accepted: 05/31/2022] [Indexed: 02/01/2023] Open
Abstract
This retrospective study investigated outcomes of 404 patients with relapsed/refractory (R/R) FMS-like tyrosine kinase 3 (FLT3)-internal tandem duplication (ITD) acute myeloid leukemia (AML) enrolled in the PETHEMA registry, pre-approval of tyrosine kinase inhibitors. Most patients (63%) had received first-line intensive therapy with 3 + 7. Subsequently, patients received salvage with intensive therapy (n = 261), non-intensive therapy (n = 63) or supportive care only (n = 80). Active salvage therapy (i.e., intensive or non-intensive therapy) resulted in a complete remission (CR) or CR without hematological recovery (CRi) rate of 42%. More patients achieved a CR/CRi with intensive (48%) compared with non-intensive (19%) salvage therapy (p < 0.001). In the overall population, median overall survival (OS) was 5.5 months; 1- and 5-year OS rates were 25% and 7%. OS was significantly (p < 0.001) prolonged with intensive or non-intensive salvage therapy compared with supportive therapy, and in those achieving CR/CRi versus no responders. Of 280 evaluable patients, 61 (22%) had an allogeneic stem-cell transplant after they had achieved CR/CRi. In conclusion, in this large cohort study, salvage treatment approaches for patients with FLT3-ITD mutated R/R AML were heterogeneous. Median OS was poor with both non-intensive and intensive salvage therapy, with best long-term outcomes obtained in patients who achieved CR/CRi and subsequently underwent allogeneic stem-cell transplant.
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Affiliation(s)
- David Martínez-Cuadrón
- Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (B.B.); (R.R.-V.); (E.B.); (M.A.S.); (P.M.)
- Correspondence: ; Tel.: +34-96-1244925
| | - Josefina Serrano
- Hospital Universitario Reina Sofía and Instituto Maimónides de Investigación Biomédica Córdoba (IMIBIC), 14004 Córdoba, Spain;
| | - José Mariz
- IPO (Istituto Portugues Oncologia), 4200-072 Porto, Portugal;
| | - Cristina Gil
- Hospital General Universitario de Alicante, 03010 Alicante, Spain;
| | - Mar Tormo
- Hospital Clínico Universitario, INCLIVA Biomedical Research Institute, 46010 Valencia, Spain;
| | - Pilar Martínez-Sánchez
- Hospital Universitario 12 de Octubre, Complutense University, i+12, CNIO, 28041 Madrid, Spain; (P.M.-S.); (J.M.-L.)
| | | | | | | | | | - Marta Polo
- Hospital Clínico San Carlos, 28040 Madrid, Spain;
| | - Juan Bergua
- Hospital San Pedro Alcántara, 10003 Cáceres, Spain;
| | | | - María L. Amigo
- Hospital General Universitario Morales Meseguer, 30008 Murcia, Spain;
| | - Pilar Herrera
- Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain;
| | | | - Teresa Bernal
- Hospital Universitario Central de Asturias, 33011 Asturias, Spain;
| | - Ana Espadana
- Hospital de Coimbra, 3400-091 Coimbra, Portugal;
| | - María J. Sayas
- Hospital Universitario Doctor Peset, 46017 Valencia, Spain;
| | - Lorenzo Algarra
- Hospital General Universitario de Albacete, 02006 Albacete, Spain;
| | - María B. Vidriales
- Department of Hematology, University Hospital of Salamanca (HUS/IBSAL), CIBERONC and Cancer Research Institute of Salamanca-IBMCC (USAL-CSIC), 37007 Salamanca, Spain; (M.B.V.); (M.C.C.)
| | | | - Susana Vives
- ICO-Hospital Germans Trias i Pujol, Badalona, José Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, 08916 Barcelona, Spain;
| | | | | | - Víctor Noriega
- Complejo Hospitalario Universitario A Coruña, 15006 La Coruna, Spain;
| | | | - María C. Chillón
- Department of Hematology, University Hospital of Salamanca (HUS/IBSAL), CIBERONC and Cancer Research Institute of Salamanca-IBMCC (USAL-CSIC), 37007 Salamanca, Spain; (M.B.V.); (M.C.C.)
| | | | | | | | - Juan A. López
- Complejo Hospitalario Ciudad de Jaén, 23007 Jaén, Spain;
| | - Blanca Boluda
- Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (B.B.); (R.R.-V.); (E.B.); (M.A.S.); (P.M.)
| | - Rebeca Rodríguez-Veiga
- Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (B.B.); (R.R.-V.); (E.B.); (M.A.S.); (P.M.)
| | - Joaquín Martínez-López
- Hospital Universitario 12 de Octubre, Complutense University, i+12, CNIO, 28041 Madrid, Spain; (P.M.-S.); (J.M.-L.)
| | - Eva Barragán
- Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (B.B.); (R.R.-V.); (E.B.); (M.A.S.); (P.M.)
| | - Miguel A. Sanz
- Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (B.B.); (R.R.-V.); (E.B.); (M.A.S.); (P.M.)
| | - Pau Montesinos
- Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (B.B.); (R.R.-V.); (E.B.); (M.A.S.); (P.M.)
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8
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Solana-Altabella A, Megías-Vericat JE, Ballesta-López O, Boluda B, Cano I, Acuña-Cruz E, Rodríguez-Veiga R, Torres-Miñana L, Sargas C, Sanz MÁ, Borrell-García C, López-Briz E, Poveda-Andrés JL, De la Rubia J, Montesinos P, Martínez-Cuadrón D. Healthcare Resource Utilization among Patients between 60-75 Years with Secondary Acute Myeloid Leukemia Receiving Intensive Chemotherapy Induction: A Spanish Retrospective Observational Study. Cancers (Basel) 2022; 14:cancers14081921. [PMID: 35454828 PMCID: PMC9032151 DOI: 10.3390/cancers14081921] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 03/11/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary Studies addressing the economic costs and burden of secondary acute myeloid leukemia (sAML) are scarce in the literature. We analyzed this topic in a real-life population of sAML patients between 60–75 years receiving intensive chemotherapy induction. In elderly patients with sAML and intensive regimens, it entails an increase in costs and a longer hospital stay. In these specific patients, almost a third of the time is spent hospitalized after the diagnosis of sAML. There are no studies with this type of population and diagnosis, which gives added value to the results obtained. Pharmacoeconomic studies in patients with AML are being carried out due to the need to evaluate the cost-effectiveness of new oral drugs, therapeutic schemes with higher costs than previous treatments. Abstract Background: Information regarding the impact on healthcare systems of secondary acute myeloid leukemia (sAML) is scarce. Methods: A retrospective review of medical charts identified patients aged 60–75 years with sAML between 2010 and 2019. Patient information was collected from diagnosis to death or last follow-up. Outpatient resource use, reimbursement, frequency and duration of hospitalization, and transfusion burden were assessed. Forty-six patients with a median age of 64 years were included. Anthracycline plus cytarabine regimens were the most common induction treatment (39 patients, 85%). The ratio of the total days hospitalized between the total follow-up was 29%, with a sum of 204 hospitalizations (average four/patient; average duration 21 days). The total average reimbursement was EUR 90,008 per patient, with the majority (EUR 77,827) related to hospital admissions (EUR 17,403/hospitalization). Most hospitalizations (163, mean 22 days) occurred in the period before the first allogeneic hematopoietic stem cell transplant (alloHSCT), costing EUR 59,698 per patient and EUR 15,857 per hospitalization. The period after alloHSCT (in only 10 patients) had 41 hospitalizations (mean 21 days), and a mean reimbursement cost of EUR 99,542 per patient and EUR 24,278 per hospitalization. In conclusion, there is a high consumption of economic and healthcare resources in elderly patients with sAML receiving active treatments in Spain.
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Affiliation(s)
- Antonio Solana-Altabella
- Pharmacy Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (A.S.-A.); (J.E.M.-V.); (O.B.-L.); (C.B.-G.); (E.L.-B.); (J.L.P.-A.)
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
| | - Juan Eduardo Megías-Vericat
- Pharmacy Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (A.S.-A.); (J.E.M.-V.); (O.B.-L.); (C.B.-G.); (E.L.-B.); (J.L.P.-A.)
| | - Octavio Ballesta-López
- Pharmacy Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (A.S.-A.); (J.E.M.-V.); (O.B.-L.); (C.B.-G.); (E.L.-B.); (J.L.P.-A.)
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
| | - Blanca Boluda
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Isabel Cano
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Evelyn Acuña-Cruz
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Rebeca Rodríguez-Veiga
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Laura Torres-Miñana
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Claudia Sargas
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Miguel Á. Sanz
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Carmela Borrell-García
- Pharmacy Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (A.S.-A.); (J.E.M.-V.); (O.B.-L.); (C.B.-G.); (E.L.-B.); (J.L.P.-A.)
| | - Eduardo López-Briz
- Pharmacy Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (A.S.-A.); (J.E.M.-V.); (O.B.-L.); (C.B.-G.); (E.L.-B.); (J.L.P.-A.)
| | - José Luis Poveda-Andrés
- Pharmacy Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (A.S.-A.); (J.E.M.-V.); (O.B.-L.); (C.B.-G.); (E.L.-B.); (J.L.P.-A.)
| | - Javier De la Rubia
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
- School of Medicine and Dentistry, Catholic University of Valencia, 46010 Valencia, Spain
| | - Pau Montesinos
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - David Martínez-Cuadrón
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
- Correspondence: ; Tel.: +34-96-1244000 (ext. 4119661)
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9
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Megías-Vericat JE, Martínez-Cuadrón D, Herrero MJ, Rodríguez-Veiga R, Solana-Altabella A, Boluda B, Ballesta-López O, Cano I, Acuña-Cruz E, Cervera J, Poveda JL, Sanz MÁ, Aliño SF, Montesinos P. Influence of polymorphisms in anthracyclines metabolism genes in the standard induction chemotherapy of acute myeloid leukemia. Pharmacogenet Genomics 2021; 31:133-139. [PMID: 33675324 DOI: 10.1097/fpc.0000000000000431] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Genetic variability in anthracycline metabolism could modify the response and safety of acute myeloid leukemia (AML) induction. METHODS Polymorphisms in genes that encodes enzymes of anthracyclines metabolic pathway (CBR3: rs1056892, rs8133052, NQO1: rs1800566, NQO2: rs1143684, NOS3: rs1799983, rs2070744) were evaluated in 225 adult de novo AML patients. RESULTS The variant CBR3 rs8133052 was associated with lower hepatotoxicity (P = 0.028). Wild-type genotype of NQO2 rs1143684 was related to higher complete remission (P = 0.014), and the variant allele with greater gastrointestinal toxicity (P = 0.024). However, the variant genotype of NQO1 rs1800566 was associated with mucositis (P = 0.018), but heterozygous genotype showed less gastrointestinal toxicity (P = 0.028) and thrombocytopenia (P = 0.009). Protective effects against nephrotoxicity and thrombocytopenia were reported with variant NOS3 rs1799983 (P = 0.006, P = 0.014), whereas carriers of NOS3 rs2070744 showed higher hepatotoxicity and thrombocytopenia (P = 0.017, P = 0.013). CONCLUSIONS This study supports the influence of genetic variability of idarubicin metabolizing could be critical in predicting anthracycline-induced toxicities.
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Affiliation(s)
- Juan Eduardo Megías-Vericat
- Grupo de Farmacogenética, Instituto Investigación Sanitaria La Fe and Área del Medicamento
- Servicio de Farmacia, Área del Medicamento
| | - David Martínez-Cuadrón
- Servicio de Hematología y Hemoterapia, Hospital Universitari i Politècnic La Fe. Av. Fernando Abril Martorell, Valencia
- CIBERONC, Instituto Carlos III, Madrid
| | - María José Herrero
- Grupo de Farmacogenética, Instituto Investigación Sanitaria La Fe and Área del Medicamento
- Departamento Farmacología, Facultad de Medicina, Universidad de Valencia, Av. Blasco Ibáñez 15
| | - Rebeca Rodríguez-Veiga
- Servicio de Hematología y Hemoterapia, Hospital Universitari i Politècnic La Fe. Av. Fernando Abril Martorell, Valencia
- CIBERONC, Instituto Carlos III, Madrid
| | | | - Blanca Boluda
- Servicio de Hematología y Hemoterapia, Hospital Universitari i Politècnic La Fe. Av. Fernando Abril Martorell, Valencia
- CIBERONC, Instituto Carlos III, Madrid
| | | | - Isabel Cano
- Servicio de Hematología y Hemoterapia, Hospital Universitari i Politècnic La Fe. Av. Fernando Abril Martorell, Valencia
- CIBERONC, Instituto Carlos III, Madrid
| | - Evelyn Acuña-Cruz
- Servicio de Hematología y Hemoterapia, Hospital Universitari i Politècnic La Fe. Av. Fernando Abril Martorell, Valencia
- CIBERONC, Instituto Carlos III, Madrid
| | - José Cervera
- Servicio de Hematología y Hemoterapia, Hospital Universitari i Politècnic La Fe. Av. Fernando Abril Martorell, Valencia
- CIBERONC, Instituto Carlos III, Madrid
| | | | - Miguel Ángel Sanz
- Servicio de Hematología y Hemoterapia, Hospital Universitari i Politècnic La Fe. Av. Fernando Abril Martorell, Valencia
- CIBERONC, Instituto Carlos III, Madrid
| | - Salvador F Aliño
- Grupo de Farmacogenética, Instituto Investigación Sanitaria La Fe and Área del Medicamento
- Departamento Farmacología, Facultad de Medicina, Universidad de Valencia, Av. Blasco Ibáñez 15
- Unidad de Farmacología Clínica, Área del Medicamento, Hospital Universitari I Politècnic La Fe, Av. Fernando Abril Martorell, Valencia, Spain
| | - Pau Montesinos
- Servicio de Hematología y Hemoterapia, Hospital Universitari i Politècnic La Fe. Av. Fernando Abril Martorell, Valencia
- CIBERONC, Instituto Carlos III, Madrid
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10
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Boluda B, Martínez-Cuadrón D, Algarra L, Cano I, Sayas MJ, Acuña-Cruz E, Blanco A, Marco-Ayala J, DeLapuerta R, Díaz-González Á, Tormo M, Rodríguez-Veiga R, García R, Piñana JL, López-Pavía M, Barragán E, Amigo ML, Sargas C, López A, Solana-Altabella A, Gil C, Megías-Vericat JE, Sanz MA, Montesinos P. Evolving patterns of care and outcomes in relapsed/refractory FLT3 mutated acute myeloid leukemia adult patients. Leuk Lymphoma 2021; 62:2727-2736. [PMID: 34121593 DOI: 10.1080/10428194.2021.1938031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/21/2022]
Abstract
We have analyzed treatment patterns and outcomes of relapsed/refractory(R/R) FLT3mut AML adult patients registered in our institutional data base between 1998 and 2018. Overall, 147 patients were evaluable: 34 from 1998 to 2009, 113 from 2010 to 2018. Salvage treatments were intensive chemotherapy (n = 25, 74%), and supportive care (n = 9, 26%) in the 1998-2009 period, and intensive chemotherapy (n = 63, 56%), hypomethylating agent (n = 7, 6%), low-dose cytarabine-based (n = 8, 7%), clinical trial (n = 16, 14%) and supportive care (n = 19, 17%) in the 2010-2018 period. Complete remission (CR) or with incomplete recovery (CRi) rate was 44%, 49% among patients treated intensively (vs 30% with non-intensive p = 0.005). Median overall survival since first R/R was 5.8 months, and 16.3 months in subjects receiving an allo-HSCT in CR/CRi after first salvage (vs 3.8 in the remaining patients p < 0.0001). Clinical outcomes of R/R FLT3mut AML remain unsatisfactory. Inclusion in clinical trials and expanding options could lead to improved outcomes.
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Affiliation(s)
- Blanca Boluda
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - David Martínez-Cuadrón
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Lorenzo Algarra
- Hematology Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Isabel Cano
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - María J Sayas
- Hematology Department, Hospital Doctor Peset, Valencia, Spain
| | - Evelyn Acuña-Cruz
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Albert Blanco
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Javier Marco-Ayala
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Rosalía DeLapuerta
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Álvaro Díaz-González
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Mar Tormo
- Hematology Department, Hospital Clínico Universitario, Valencia, Spain
| | - Rebeca Rodríguez-Veiga
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Raimundo García
- Hematology Department, Hospital General Castellón, Castellón, Spain
| | - José L Piñana
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - María López-Pavía
- Hematology Department, Hospital General Universitario, Valencia, Spain
| | - Eva Barragán
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - María L Amigo
- Hematology Department, Hospital Morales Meseguer, Murcia, Spain
| | - Claudia Sargas
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Aurelio López
- Hematology Department, Hospital Arnau de Vilanova, Valencia, Spain
| | - Antonio Solana-Altabella
- Instituto de Investigación Sanitaria La Fe, Valencia, Spain.,Pharmacy Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Cristina Gil
- Hematology Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - Juan Eduardo Megías-Vericat
- Instituto de Investigación Sanitaria La Fe, Valencia, Spain.,Pharmacy Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Miguel A Sanz
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Pau Montesinos
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Instituto de Investigación Sanitaria La Fe, Valencia, Spain
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11
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Boluda B, Solana-Altabella A, Cano I, Acuña-Cruz E, Rodríguez-Veiga R, Ballesta-López O, Megías-Vericat JE, Martínez-Cuadrón D, Gómez I, Solves P, Lorenzo I, Piñana JL, Sanz J, Guerreiro M, Montoro Gómez J, Díaz-González A, Marco J, Blanco A, Sanz MÁ, Montesinos P. Extracorporeal photopheresis vs standard therapies for steroid-refractory chronic graft-vs-host disease: Pharmacoeconomic assessment of hospital resource use in Spain. J Clin Apher 2021; 36:612-620. [PMID: 33964038 PMCID: PMC8453768 DOI: 10.1002/jca.21901] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 12/21/2020] [Revised: 02/24/2021] [Accepted: 04/09/2021] [Indexed: 11/11/2022]
Abstract
Background This study assessed pharmacoeconomic costs associated with extracorporeal photopheresis (ECP) compared with other available second‐line therapies for chronic graft‐vs‐host disease (cGvHD) in a tertiary Spanish institution. Methods Patients (≥18 years) diagnosed with steroid‐refractory cGvHD were eligible. Data were collected retrospectively from index date until 1 year or relapse. Patients were distributed in two cohorts (ECP vs non‐ECP), matched by age (≤ or > 40), hematopoietic stem cell transplant (HLA‐identical sibling donor or other) and number of previous immunosuppressive lines (1, 2, or ≥ 3). Costs were assigned using the 2016 diagnosis‐related group (DRG) system: DRG 579 (€22 383) overnight stay due to major complication (ie, sepsis, pneumonia, parenteral nutrition, or respiratory failure), and DRG 875 (€5154) if no major complication. The primary endpoint was healthcare resource utilization per patient. Results Forty patients (n = 20 per cohort) were included. Median age was 49, and 37.5% were female. Mean total cost per patient was €25 319 (95% CI: €17 049–€33 590) across the two cohorts, with a slightly lower mean cost per ECP‐treated patient (€23 120) compared with the non‐ECP cohort (€27 519; P = .597). Twenty‐seven inpatient hospitalizations occurred among ECP‐treated patients, vs 33 in the non‐ECP cohort. Day hospital and external consultations were more frequent in the ECP cohort. However, fewer inpatient admissions included DRG 579 compared with the non‐ECP cohort (44% vs 58%). Inpatient length of stay was slightly shorter in the ECP cohort (30 vs 49 days; P = .298). Conclusions ECP treatment may yield economic savings in Spain through resource savings and moving costs toward outpatient care.
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Affiliation(s)
- Blanca Boluda
- Haematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Antonio Solana-Altabella
- Pharmacy Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Hematology Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Isabel Cano
- Haematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Hematology Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Evelyn Acuña-Cruz
- Haematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Rebeca Rodríguez-Veiga
- Haematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Hematology Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Octavio Ballesta-López
- Pharmacy Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Hematology Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | | | - David Martínez-Cuadrón
- Haematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Hematology Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Ines Gómez
- Haematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Pilar Solves
- Haematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Ignacio Lorenzo
- Haematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Jose Luis Piñana
- Haematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Hematology Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Jaime Sanz
- Haematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Hematology Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Manuel Guerreiro
- Haematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Juan Montoro Gómez
- Haematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Alvaro Díaz-González
- Haematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Javier Marco
- Haematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Albert Blanco
- Haematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Miguel Á Sanz
- Haematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Hematology Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Pau Montesinos
- Haematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Hematology Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
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12
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Martínez Sánchez MP, Megías-Vericat JE, Rodríguez-Veiga R, Vives S, Bergua JM, Torrent A, Suárez-Varela S, Boluda B, Martínez-López J, Cano-Ferri I, Acuña-Cruz E, Torres-Miñana L, Martín-Herreros B, Serrano A, Sempere A, Barragán E, Sargas C, Sanz M, Martínez-Cuadrón D, Montesinos P. A phase I trial of selinexor plus FLAG-Ida for the treatment of refractory/relapsed adult acute myeloid leukemia patients. Ann Hematol 2021; 100:1497-1508. [PMID: 33914097 DOI: 10.1007/s00277-021-04542-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 03/12/2021] [Accepted: 04/19/2021] [Indexed: 11/25/2022]
Abstract
Prognosis for relapsed or refractory (R/R) acute myeloid leukemia (AML) despite salvage therapy is dismal. This phase I dose-escalation trial assessed the safety and preliminary clinical activity of selinexor, an oral exportin-1 (XPO1) inhibitor, in combination with FLAG-Ida in younger R/R AML patients. The aim was to find the recommended phase 2 dose (RP2D) and maximum tolerated dose (MTD). Fourteen patients were included, and selinexor dosage was 60 mg (3 patients), 80 mg (3 patients), and 100 mg (7 patients) weekly. No dose-limiting toxicities were reported. Grade ≥3 non-hematologic adverse events (AEs) occurred in 78.6% of patients. Two patients were non MTD evaluable due to early death, and overall, 3 out of 14 patients (21.4%) had fatal AEs. Five out of 12 (42%) response and MTD evaluable patients achieved a complete remission (CR; n=4) or CR with incomplete hematologic recovery (CRi, n=1), and 4 patients (33%) subsequently underwent allogeneic transplantation. The median overall survival (OS) and event-free survival (EFS) were 6.0 (range 0.9-19.3) and 1.1 months (range 0.7-19.3), respectively. Using selinexor 100 mg/weekly, CR/CRi rate of 66.7%, OS 13.6 months (range, 1.6-19.3), and EFS 10.6 months (range, 0.9-19.3). At last follow-up, 3 patients were alive. Selinexor 100 mg/weekly with FLAG-Ida combination in R/R AML showed acceptable tolerability and efficacy, establishing the RP2D of this regimen in future clinical trials. ClinicalTrials.gov Identifier: NCT03661515.
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Affiliation(s)
- María P Martínez Sánchez
- Servicio de Hematología y Hemoterapia, Hospital Universitario 12 de Octubre, UCM, CNIO, CIBERONC, Madrid, Spain
| | | | - Rebeca Rodríguez-Veiga
- Servicio de Hematología y Hemoterapia, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Susana Vives
- Servicio de Hematología y Hemoterapia, ICO-Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Juan Miguel Bergua
- Servicio de Hematología y Hemoterapia, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - Anna Torrent
- Servicio de Hematología y Hemoterapia, ICO-Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Sara Suárez-Varela
- Servicio de Hematología y Hemoterapia, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - Blanca Boluda
- Servicio de Hematología y Hemoterapia, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Joaquín Martínez-López
- Servicio de Hematología y Hemoterapia, Hospital Universitario 12 de Octubre, UCM, CNIO, CIBERONC, Madrid, Spain
| | - Isabel Cano-Ferri
- Servicio de Hematología y Hemoterapia, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Evelyn Acuña-Cruz
- Servicio de Hematología y Hemoterapia, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Laura Torres-Miñana
- Servicio de Hematología y Hemoterapia, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Beatriz Martín-Herreros
- Grupo de investigación en Hematología, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain
| | - Alfons Serrano
- Servicio de Hematología y Hemoterapia, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Amparo Sempere
- Servicio de Hematología y Hemoterapia, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Eva Barragán
- Servicio de Hematología y Hemoterapia, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Claudia Sargas
- Servicio de Hematología y Hemoterapia, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Miguel Sanz
- Servicio de Hematología y Hemoterapia, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - David Martínez-Cuadrón
- Servicio de Hematología y Hemoterapia, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Pau Montesinos
- Servicio de Hematología y Hemoterapia, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
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13
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Solana-Altabella A, Boluda B, Rodríguez-Veiga R, Cano I, Acuña-Cruz E, Blanco A, Marco-Ayala J, de la Puerta R, Díaz-González Á, Piñana JL, Sanz J, Sempere A, Cervera J, Barragán E, Sargas C, Ballesta-López O, Megías-Vericat JE, Martínez-Cuadrón D, Sanz MÁ, Montesinos P. Healthcare resource utilization in adult patients with relapsed/refractory FLT3 mutated acute myeloid leukemia: A retrospective chart review from Spain. Eur J Haematol 2021; 106:724-733. [PMID: 33609315 DOI: 10.1111/ejh.13604] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 02/13/2021] [Accepted: 02/18/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Information regarding impact on healthcare systems of relapsed or refractory (R/R) FLT3 mutated (FLT3mut) acute myeloid leukemia (AML) is scarce. OBJECTIVE To assess the time and reimbursement associated with hospitalizations of patients with R/R FLT3mut AML in a tertiary Spanish hospital. METHODS Retrospective review of medical charts identified patients aged ≥ 18 years with R/R FLT3mut AML between 1998 and 2018. Data were collected from the date of first diagnosis of R/R FLT3mut AML (index) until death or loss to follow-up. The primary end point was duration and frequency of hospitalization, use of outpatient resources and transfusion burden. Reimbursement associated with hospitalizations (including associated chemotherapy) was also assessed. RESULTS Thirty-eight patients were eligible for inclusion. Their median age was 52 years, and 30 (79%) received intensive salvage chemotherapy; FLAG-IDA-based regimens were the most frequent (24 patients, 63%). Overall, there were 150 hospitalizations (mean 3.9/patient; mean duration 21 days). Patients spent a mean of 24% of the study period in hospital. Total mean reimbursement was €108 293 per patient; the majority (€89 834) attributable to inpatient stays (€22 576 /hospitalization). During chemotherapy period (prior to first alloHSCT), there were 73 hospitalizations (mean duration 22 days); mean reimbursement was €19 776 per hospitalization and €49 819 per patient. AlloHSCT (n = 16) involved 77 hospitalizations (mean duration 21 days), mean reimbursement €25 231/hospitalization and €131 515 per patient. CONCLUSION Data from this study suggest that there is a substantial healthcare resource utilization and cost burden on R/R FLT3mut AML patients in Spain receiving active treatments.
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Affiliation(s)
- Antonio Solana-Altabella
- Pharmacy Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain
| | - Blanca Boluda
- Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain.,Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Rebeca Rodríguez-Veiga
- Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain.,Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Isabel Cano
- Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain.,Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Evelyn Acuña-Cruz
- Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain.,Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Albert Blanco
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Javier Marco-Ayala
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Rosalía de la Puerta
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Álvaro Díaz-González
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - José L Piñana
- Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain.,Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Jaime Sanz
- Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain.,Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Amparo Sempere
- Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain.,Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - José Cervera
- Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain.,Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Eva Barragán
- Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain.,Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Claudia Sargas
- Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain.,Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Octavio Ballesta-López
- Pharmacy Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain
| | - Juan Eduardo Megías-Vericat
- Pharmacy Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain
| | - David Martínez-Cuadrón
- Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain.,Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Miguel Á Sanz
- Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain.,Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Pau Montesinos
- Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain.,Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
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14
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Megías-Vericat JE, Martínez-Cuadrón D, Herrero MJ, Rodríguez-Veiga R, Solana-Altabella A, Boluda B, Ballesta-López O, Cano I, Acuña-Cruz E, Cervera J, Poveda JL, Sanz M, Aliño SF, Montesinos P. Impact of combinations of single-nucleotide polymorphisms of anthracycline transporter genes upon the efficacy and toxicity of induction chemotherapy in acute myeloid leukemia. Leuk Lymphoma 2020; 62:659-668. [PMID: 33135528 DOI: 10.1080/10428194.2020.1839650] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Anthracycline uptake could be affected by influx and efflux transporters in acute myeloid leukemia (AML). Combinations of single-nucleotide polymorphisms (SNPs) of wild-type genotype of influx transporters (SLC22A16, SLCO1B1) and homozygous variant genotypes of ABC polymorphisms (ABCB1, ABCC1, ABCC2, ABCG2) were evaluated in 225 adult de novo AML patients. No differences in complete remission were reported, but higher induction death was observed with combinations of SLCO1B1 rs4149056 and ABCB1 (triple variant haplotype, rs1128503), previously associated with ABCB1 and SLCO1B1 SNPs. Several combinations of SLCO1B1 and SLC22A16 with ABCB1 SNPs were associated with higher toxicities, including nephrotoxicity and hepatotoxicity, neutropenia, previously related to ABCB1, and a novel correlation with mucositis. Combination of SLC22A16 rs714368 and ABCG2 rs2231142 was related to cardiac toxicity, reproducing previous correlations with ABCG2. This study shows the impact of transporter polymorphisms in AML chemotherapy safety. Further prospective studies with larger populations are needed to validate these associations.
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Affiliation(s)
- Juan Eduardo Megías-Vericat
- Grupo de Farmacogenética, Instituto Investigación Sanitaria La Fe and Área del Medicamento, Hospital Universitari i Politècnic, Valencia, Spain.,Servicio de Farmacia, Área del Medicamento. Hospital Universitari i Politècnic, Valencia, Spain
| | - David Martínez-Cuadrón
- Servicio de Hematología y Hemoterapia. Hospital Universitari i Politècnic, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - María José Herrero
- Grupo de Farmacogenética, Instituto Investigación Sanitaria La Fe and Área del Medicamento, Hospital Universitari i Politècnic, Valencia, Spain.,Departamento Farmacología, Facultad de Medicina, Universidad de Valencia, Valencia, Spain
| | - Rebeca Rodríguez-Veiga
- Servicio de Hematología y Hemoterapia. Hospital Universitari i Politècnic, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | | | - Blanca Boluda
- Servicio de Hematología y Hemoterapia. Hospital Universitari i Politècnic, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Octavio Ballesta-López
- Servicio de Farmacia, Área del Medicamento. Hospital Universitari i Politècnic, Valencia, Spain
| | - Isabel Cano
- Servicio de Hematología y Hemoterapia. Hospital Universitari i Politècnic, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Evelyn Acuña-Cruz
- Servicio de Hematología y Hemoterapia. Hospital Universitari i Politècnic, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - José Cervera
- Servicio de Hematología y Hemoterapia. Hospital Universitari i Politècnic, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - José Luis Poveda
- Servicio de Farmacia, Área del Medicamento. Hospital Universitari i Politècnic, Valencia, Spain
| | - MiguelÁngel Sanz
- Servicio de Hematología y Hemoterapia. Hospital Universitari i Politècnic, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Salvador F Aliño
- Grupo de Farmacogenética, Instituto Investigación Sanitaria La Fe and Área del Medicamento, Hospital Universitari i Politècnic, Valencia, Spain.,Departamento Farmacología, Facultad de Medicina, Universidad de Valencia, Valencia, Spain.,Unidad de Farmacología Clínica, Área del Medicamento. Hospital Universitari I Politècnic, Valencia, Spain
| | - Pau Montesinos
- Servicio de Hematología y Hemoterapia. Hospital Universitari i Politècnic, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
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15
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Sitges M, Boluda B, Garrido A, Morgades M, Granada I, Barragan E, Arnan M, Serrano J, Tormo M, Miguel Bergua J, Colorado M, Salamero O, Esteve J, Benavente C, Pérez-Encinas M, Coll R, Martí-Tutusaus JM, Brunet S, Sierra J, Ángel Sanz M, Montesinos P, Ribera JM, Vives S. Acute myeloid leukemia with inv(3)(q21.3q26.2)/t(3;3)(q21.3;q26.2): Study of 61 patients treated with intensive protocols. Eur J Haematol 2020; 105:138-147. [PMID: 32243655 DOI: 10.1111/ejh.13417] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 02/23/2020] [Accepted: 03/17/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Inv(3)(q21.3q26.2)/t(3;3)(q21.3;q26.2) is a rare poor prognosis cytogenetic abnormality present in acute myeloid leukemia (AML) and other myeloid neoplasms. OBJECTIVE The aim of this study was to evaluate the outcome of a cohort of 61 patients with newly diagnosed AML with inv(3)/t(3;3) treated with homogeneous intensive chemotherapy protocols conducted by the Spanish PETHEMA and CETLAM cooperative groups between 1999 and 2017. METHODS In this retrospective study the main clinical and biologic parameters were collected. The complete response (CR) rate, the cumulative incidence of relapse (CIR) and the overall survival (OS) were calculated. An analysis of prognostic factors for survival was performed. RESULTS Sixty-one patients received induction and only 18 (29%) achieved CR (median age, 46 years). Allogeneic hematopoietic stem cell transplantation (alloHSCT) was performed in 36 patients (59%), 15 with active disease. One- and 4-year CIR were 52% and 56%. One- and 4-year OS probabilities were 41% and 13%. By multivariate analysis monosomal karyotype (MK) was associated with poorer OS (HR 2.0, P = .017). CONCLUSION Inv(3)/t(3;3) AML is a poor prognosis entity with low response to standard chemotherapy and to alloHSCT because of frequent and early relapse. MK was associated with a poorer prognosis. Improved therapeutic strategies are clearly needed.
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Affiliation(s)
- Marta Sitges
- Hematology Departments of ICO-Hospital Germans Trias i Pujol, Josep Carreras Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain.,ICO-Hospital Universitari Doctor Josep Trueta, Girona, Spain
| | - Blanca Boluda
- Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Ana Garrido
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Mireia Morgades
- Hematology Departments of ICO-Hospital Germans Trias i Pujol, Josep Carreras Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Isabel Granada
- Hematology Departments of ICO-Hospital Germans Trias i Pujol, Josep Carreras Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Eva Barragan
- Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Montserrat Arnan
- ICO-Hospital Duran i Reynals, IDIBELL, L'Hospitalet de Llobregat, Llobregat, Spain
| | | | - Mar Tormo
- Hospital Clínico Universitario, Valencia, Spain
| | | | | | - Olga Salamero
- Hospital Universitari Vall d'Hebron/VHIO, Barcelona, Spain
| | | | | | | | - Rosa Coll
- ICO-Hospital Universitari Doctor Josep Trueta, Girona, Spain
| | | | - Salut Brunet
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jorge Sierra
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Pau Montesinos
- Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Josep-Maria Ribera
- Hematology Departments of ICO-Hospital Germans Trias i Pujol, Josep Carreras Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Susana Vives
- Hematology Departments of ICO-Hospital Germans Trias i Pujol, Josep Carreras Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
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16
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Shallis RM, Stahl M, Wei W, Montesinos P, Lengline E, Neukirchen J, Bhatt VR, Sekeres MA, Fathi AT, Konig H, Luger S, Khan I, Roboz GJ, Cluzeau T, Martínez-Cuadron D, Raffoux E, Germing U, Umakanthan JM, Mukhereje S, Brunner AM, Miller A, McMahon CM, Ritchie EK, Rodríguez-Veiga R, Itzykson R, Boluda B, Rabian F, Tormo M, Acuña-Cruz E, Rabinovich E, Yoo B, Cano I, Podoltsev NA, Bewersdorf JP, Gore S, Zeidan AM. Patterns of care and clinical outcomes of patients with newly diagnosed acute myeloid leukemia presenting with hyperleukocytosis who do not receive intensive chemotherapy. Leuk Lymphoma 2020; 61:1220-1225. [PMID: 32100599 DOI: 10.1080/10428194.2020.1728753] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Rory M Shallis
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT, USA
| | - Maximilian Stahl
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT, USA
| | - Wei Wei
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | | | - Etienne Lengline
- Hematology Department, Saint-Louis Hospital AP-HP, Paris, France
| | - Judith Neukirchen
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Vijaya R Bhatt
- Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Amir T Fathi
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Heiko Konig
- Indiana University Simon Cancer Center, Indianapolis, IN, USA
| | - Selina Luger
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Irum Khan
- University of Illinois Cancer Center, Chicago, IL, USA
| | - Gail J Roboz
- Weill Cornell Medicine, The New York Presbyterian Hospital, New York, NY, USA
| | - Thomas Cluzeau
- CHU of Nice, Hematology Department, Cote d'Azur University, Nice, France
| | | | - Emmanuel Raffoux
- Hematology Department, Saint-Louis Hospital AP-HP, Paris, France
| | - Ulrich Germing
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | | | | | - Andrew M Brunner
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Adam Miller
- Indiana University Simon Cancer Center, Indianapolis, IN, USA
| | | | - Ellen K Ritchie
- Weill Cornell Medicine, The New York Presbyterian Hospital, New York, NY, USA
| | | | - Raphaël Itzykson
- Hematology Department, Saint-Louis Hospital AP-HP, Paris, France
| | | | - Florence Rabian
- CIBERONC, Instituto Carlos III, Madrid, Spain.,Hematology Department, Saint-Louis Hospital AP-HP, Paris, France
| | - Mar Tormo
- University Clinical Hospital, INCLIVA, Valencia, Spain
| | | | | | - Brendan Yoo
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Isabel Cano
- CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Nikolai A Podoltsev
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT, USA
| | - Jan Philipp Bewersdorf
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT, USA
| | - Steven Gore
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT, USA
| | - Amer M Zeidan
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT, USA
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17
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Onecha E, Ruiz-Heredia Y, Martínez-Cuadrón D, Barragán E, Martinez-Sanchez P, Linares M, Rapado I, Perez-Oteyza J, Magro E, Herrera P, Rojas JL, Gorrochategui J, Villoria J, Boluda B, Sargas C, Ballesteros J, Montesinos P, Martínez-López J, Ayala R. Improving the prediction of acute myeloid leukaemia outcomes by complementing mutational profiling with ex vivo chemosensitivity. Br J Haematol 2020; 189:672-683. [PMID: 32068246 DOI: 10.1111/bjh.16432] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 09/02/2019] [Revised: 10/31/2019] [Accepted: 11/01/2019] [Indexed: 02/06/2023]
Abstract
Refractoriness to induction therapy and relapse after complete remission are the leading causes of death in patients with acute myeloid leukaemia (AML). This study focussed on the prediction of response to standard induction therapy and outcome of patients with AML using a combined strategy of mutational profiling by next-generation sequencing (NGS, n = 190) and ex vivo PharmaFlow testing (n = 74) for the 10 most widely used drugs for AML induction therapy, in a cohort of adult patients uniformly treated according to Spanish PETHEMA guidelines. We identified an adverse mutational profile (EZH2, KMT2A, U2AF1 and/or TP53 mutations) that carries a greater risk of death [hazard ratio (HR): 3·29, P < 0·0001]. A high correlation was found between the ex vivo PharmaFlow results and clinical induction response (69%). Clinical correlation analysis showed that the pattern of multiresistance revealed by ex vivo PharmaFlow identified patients with a high risk of death (HR: 2·58). Patients with mutation status also ran a high risk (HR 4·19), and the risk was increased further in patients with both adverse profiles (HR 4·82). We have developed a new score based on NGS and ex vivo drug testing for AML patients that improves upon current prognostic risk stratification and allows clinicians to tailor treatments to minimise drug resistance.
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Affiliation(s)
- Esther Onecha
- Hematology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.,Hematological Malignancies Clinical Research Unit, CNIO, Madrid, Spain
| | - Yanira Ruiz-Heredia
- Hematological Malignancies Clinical Research Unit, CNIO, Madrid, Spain.,Vivia Biotech, Tres Cantos, Madrid, Spain
| | - David Martínez-Cuadrón
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Madrid, Spain
| | - Eva Barragán
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Madrid, Spain
| | - Pilar Martinez-Sanchez
- Hematology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.,Hematological Malignancies Clinical Research Unit, CNIO, Madrid, Spain.,Complutense University, Madrid, Spain
| | - María Linares
- Hematology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.,Hematological Malignancies Clinical Research Unit, CNIO, Madrid, Spain.,Complutense University, Madrid, Spain
| | - Inmaculada Rapado
- Hematology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.,Hematological Malignancies Clinical Research Unit, CNIO, Madrid, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Jaime Perez-Oteyza
- Hematology Department, Hospital Universitario Sanchinarro, Madrid, Spain
| | - Elena Magro
- Hematology Department, Hospital Universitario Principe de Asturias, Madrid, Spain
| | - Pilar Herrera
- Hematology Department, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | | | | | | | - Blanca Boluda
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Madrid, Spain
| | - Claudia Sargas
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Madrid, Spain
| | | | - Pau Montesinos
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Madrid, Spain
| | - Joaquín Martínez-López
- Hematology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.,Hematological Malignancies Clinical Research Unit, CNIO, Madrid, Spain.,Complutense University, Madrid, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Rosa Ayala
- Hematology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.,Hematological Malignancies Clinical Research Unit, CNIO, Madrid, Spain.,Complutense University, Madrid, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
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18
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Boluda B, Rodríguez-Veiga R, Martínez-Cuadrón D, Lorenzo I, Sanz J, Regadera A, Sempere A, Senent L, Cervera JV, Solves P, Reitan J, Gea S, Sanz MA, Montesinos P. Time and Cost of Hospitalisation for Salvage Therapy in Adults with Philadelphia Chromosome-Negative B Cell Precursor Relapsed or Refractory Acute Lymphoblastic Leukaemia in Spain. Pharmacoecon Open 2019; 3:229-235. [PMID: 30324566 PMCID: PMC6533337 DOI: 10.1007/s41669-018-0098-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Philadelphia chromosome-negative (Ph-) relapsed or refractory (R/R) B-cell precursor acute lymphoblastic leukaemia (ALL) is rare, and information on its impact on healthcare systems is scarce. OBJECTIVE To quantify the time and reimbursement associated with hospitalisations of patients with R/R ALL in a Spanish hospital. METHODS Retrospective review of medical charts identified patients aged ≥ 18 years with Ph- R/R ALL hospitalised between 1998 and 2014. Data were collected from the date of first diagnosis of R/R ALL (index) until death or loss to follow-up. The primary endpoint was the proportion of time hospitalised during chemotherapy. Reimbursement associated with hospitalisations (including associated chemotherapy) was also assessed. RESULTS Thirty-two patients were eligible for inclusion. Their median age was 41 years, and 50% had a first remission duration of ≤ 1 year; 34% had undergone allogeneic haematological stem-cell transplantation (alloHSCT). Overall, 31 patients had received intensive salvage chemotherapy, during which there were 42 hospitalisations (mean 1.4/patient; mean duration 26 days). Patients spent a mean of 71% of the chemotherapy period in hospital. Total mean reimbursement was €26,417 per patient, almost all (€25,723) attributable to inpatient stays (€18,986/hospitalisation). From the index date to death or loss to follow-up (excluding alloHSCT-related hospitalisations), there were 80 hospitalisations (mean duration 24 days); mean reimbursement was €16,692 per hospitalisation and €41,730 per patient. AlloHSCT (n = 8) involved 18 hospitalisations (mean reimbursement €39,782/hospitalisation; €89,510/patient). CONCLUSION Data from this sample of patients suggest that hospitalisations in R/R ALL are lengthy and associated with high costs in Spain.
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Affiliation(s)
- Blanca Boluda
- Haematology Department, Hospital Universitari i Politècnic La Fe, Avinguda de Fern ando Abril Martorell, 106, 46026, Valencia, Spain
| | - Rebeca Rodríguez-Veiga
- Haematology Department, Hospital Universitari i Politècnic La Fe, Avinguda de Fern ando Abril Martorell, 106, 46026, Valencia, Spain
| | - David Martínez-Cuadrón
- Haematology Department, Hospital Universitari i Politècnic La Fe, Avinguda de Fern ando Abril Martorell, 106, 46026, Valencia, Spain
- CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Ignacio Lorenzo
- Haematology Department, Hospital Universitari i Politècnic La Fe, Avinguda de Fern ando Abril Martorell, 106, 46026, Valencia, Spain
| | - Jaime Sanz
- Haematology Department, Hospital Universitari i Politècnic La Fe, Avinguda de Fern ando Abril Martorell, 106, 46026, Valencia, Spain
- CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Ana Regadera
- Haematology Department, Hospital Universitari i Politècnic La Fe, Avinguda de Fern ando Abril Martorell, 106, 46026, Valencia, Spain
| | - Amparo Sempere
- Haematology Department, Hospital Universitari i Politècnic La Fe, Avinguda de Fern ando Abril Martorell, 106, 46026, Valencia, Spain
- CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Leonor Senent
- Haematology Department, Hospital Universitari i Politècnic La Fe, Avinguda de Fern ando Abril Martorell, 106, 46026, Valencia, Spain
| | - Jose Vicente Cervera
- Haematology Department, Hospital Universitari i Politècnic La Fe, Avinguda de Fern ando Abril Martorell, 106, 46026, Valencia, Spain
- CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Pilar Solves
- Haematology Department, Hospital Universitari i Politècnic La Fe, Avinguda de Fern ando Abril Martorell, 106, 46026, Valencia, Spain
- CIBERONC, Instituto Carlos III, Madrid, Spain
| | | | | | - Miguel Angel Sanz
- Haematology Department, Hospital Universitari i Politècnic La Fe, Avinguda de Fern ando Abril Martorell, 106, 46026, Valencia, Spain
- CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Pau Montesinos
- Haematology Department, Hospital Universitari i Politècnic La Fe, Avinguda de Fern ando Abril Martorell, 106, 46026, Valencia, Spain.
- CIBERONC, Instituto Carlos III, Madrid, Spain.
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19
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Rodríguez-Veiga R, Montesinos P, García E, Boluda B, Rojas R, Serrano J, Martínez-Cuadrón D, Martín C, Sanz J, Tabares S, Piñana JL, Lorenzo I, Montoro J, Salavert M, Pemán J, Jarque I, Solves P, Sanz GF, Torres A, Sanz MA. Validation of a multivariable prediction model for post-engraftment invasive fungal disease in 465 adult allogeneic hematopoietic stem cell transplant recipients. Mycoses 2019; 62:418-427. [PMID: 30633829 DOI: 10.1111/myc.12891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 07/05/2018] [Revised: 12/28/2018] [Accepted: 01/04/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Recently, we reported a simple prognostic score for post-engraftment invasive fungal disease (IFD) obtained in 404 adult allogeneic hematopoietic stem cell transplant (alloSCT) (training cohort). OBJECTIVES We aim to validate this score in an external cohort assessing the 1-year cumulative incidence (CI) of post-engraftment IFD. Additionally, we analyse the type of IFD and incidence of IFD according to type of prophylaxis. PATIENTS/METHODS We included 465 consecutive adult recipients surviving >40 days who engrafted and were discharged without prior IFD (median age 45 years, range, 14-69). RESULTS Patients classified as low-risk, 139; intermediate-risk, 162; and high-risk, 164 (35% vs 27% in the training cohort, P = 0.03). The CI of probable/proven IFD in the validation cohort was 8% vs 11% in the training cohort (P = 0.006). The only voriconazole prophylaxis used in the training cohort was 100 mg/12 h, 65% vs 27% in the validation cohort, but 38% received 200 mg/12 h. Thus, the validation cohort showed a lower CI of IFD (P = 0.009). The post-engraftment IFD score was validated, showing a CI of IFD for low-, intermediate- and high-risk of 3%, 6% and 14%, respectively (P < 0.001). CONCLUSION To our knowledge, this is the first prognostic index to predict the occurrence of post-engraftment IFD after alloSCT that has been validated in an external cohort.
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Affiliation(s)
| | - Pau Montesinos
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Estefanía García
- Department of Hematology, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Blanca Boluda
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - Rafael Rojas
- Department of Hematology, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Josefina Serrano
- Department of Hematology, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - David Martínez-Cuadrón
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Carmen Martín
- Department of Hematology, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Jaime Sanz
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Salvador Tabares
- Department of Hematology, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - José L Piñana
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - Ignacio Lorenzo
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - Juan Montoro
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - Miguel Salavert
- Department of Infectious Diseases, Hospital Universitari i Politècnic La Fe, València, Spain
| | - Javier Pemán
- Department of Microbiology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - Isidro Jarque
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Pilar Solves
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Guillermo F Sanz
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Antonio Torres
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain.,Asociación Medicina e Investigación (A.M.I.), Córdoba, Spain
| | - Miguel A Sanz
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
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20
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Alonso CM, Llop M, Sargas C, Pedrola L, Panadero J, Hervás D, Cervera J, Such E, Ibáñez M, Ayala R, Martínez-López J, Onecha E, de Juan I, Palanca S, Martínez-Cuadrón D, Rodríguez-Veiga R, Boluda B, Montesinos P, Sanz G, Sanz MA, Barragán E. Clinical Utility of a Next-Generation Sequencing Panel for Acute Myeloid Leukemia Diagnostics. J Mol Diagn 2019; 21:228-240. [DOI: 10.1016/j.jmoldx.2018.09.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 09/06/2018] [Accepted: 09/20/2018] [Indexed: 10/27/2022] Open
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21
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Labrador J, Luño E, Vellenga E, Brunet S, González-Campos J, Chillón MC, Holowiecka A, Esteve J, Bergua J, González-Sanmiguel JD, Gil C, Tormo M, Salamero O, Manso F, Fernández I, de laSerna J, Moreno MJ, Pérez-Encinas M, Krsnik I, Ribera JM, Cervera J, Calasanz MJ, Boluda B, Sobas M, Lowenberg B, Sanz MA, Montesinos P. Clinical significance of complex karyotype at diagnosis in pediatric and adult patients with de novo acute promyelocytic leukemia treated with ATRA and chemotherapy. Leuk Lymphoma 2018; 60:1146-1155. [PMID: 30526152 DOI: 10.1080/10428194.2018.1522438] [Citation(s) in RCA: 10] [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] [Indexed: 11/12/2022]
Abstract
Although additional cytogenetic abnormalities (ACA) do not affect the prognosis of patients with t(15;17) acute promyelocytic leukemia (APL), the role of a complex karyotype (CK) is yet to be clarified. We aimed to investigate the relationship of CK with relapse incidence in 1559 consecutive APL patients enrolled in three consecutive trials. Treatment consisted of AIDA induction followed by risk-adapted consolidation. A CK (CK) was defined as the presence of ≥2 ACA, and a very CK (CK+) as ≥3 ACA. Eighty-nine patients (8%) had a CK, of whom 41 (4%) had CK+. The 5-year cumulative incidence of relapse (CIR) in patients with CK was 18%, and 12% in those with <2 ACA (p=.09). Among patients with CK+, the 5-year CIR was 27% vs 12% (p=.003), retaining the statistical significance in multivariate analysis. This study shows an increased risk of relapse among APL patients with CK + treated with ATRA plus chemotherapy front-line regimens.
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Affiliation(s)
| | - Elisa Luño
- b Department of Hematology , Hospital Universitario Central de Asturias , Oviedo , Spain
| | - Edo Vellenga
- c University Medical Center Groningen , University of Groningen , Groningen , The Netherlands
| | - Salut Brunet
- d Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes , Universitat Autònoma de Barcelona , Barcelona , Spain
| | | | - Maria C Chillón
- f University Hospital of Salamanca-Instituto de Investigación Biomédica de Salamanca , Salamanca , Spain.,g CIBERONC, Instituto Carlos III , Madrid , Spain
| | - Aleksandra Holowiecka
- h Department of Haematology and BMT , Silesian Medical University , Katowice , Poland
| | | | - Juan Bergua
- j Hospital San Pedro de Alcántara , Cáceres , Spain
| | | | - Cristina Gil
- l Hospital General de Alicante , Alicante , Spain
| | - Mar Tormo
- m Hospital Clínico Universitario de Valencia , Valencia , Spain
| | - Olga Salamero
- n Hospital Universitario Vall d´Hebron , Barcelona , Spain
| | | | | | | | | | | | | | - Josep-Maria Ribera
- u ICO-Hospital Universitari Germans Trias i Pujol, Josep Carreras Leukemia Research Institute , Universitat Autònoma de Barcelona , Barcelona , Spain
| | - Jose Cervera
- v Hematology Department , Hospital Universitari i Politécnic La Fe , Valencia , Spain
| | - María J Calasanz
- g CIBERONC, Instituto Carlos III , Madrid , Spain.,w CIMA Lab Diagnostics , Pamplona , Spain.,x University of Navarra , Pamplona , Spain
| | - Blanca Boluda
- g CIBERONC, Instituto Carlos III , Madrid , Spain.,v Hematology Department , Hospital Universitari i Politécnic La Fe , Valencia , Spain
| | - Marta Sobas
- y Department of Haematology, Blood Neoplasms and Bone Marrow Transplantation , Wroclaw Medical University , Wroclaw , Poland
| | - Bob Lowenberg
- z Erasmus University Medical Center , Rotterdam , The Netherlands
| | - Miguel A Sanz
- g CIBERONC, Instituto Carlos III , Madrid , Spain.,v Hematology Department , Hospital Universitari i Politécnic La Fe , Valencia , Spain.,aa Department of Medicine , University of Valencia , Valencia , Spain
| | - Pau Montesinos
- g CIBERONC, Instituto Carlos III , Madrid , Spain.,v Hematology Department , Hospital Universitari i Politécnic La Fe , Valencia , Spain
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22
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Sobas M, Montesinos P, Boluda B, Bernal T, Vellenga E, Nomdedeu J, González-Campos J, Chillón M, Holowiecka A, Esteve J, Bergua J, González-Sanmiguel JD, Gil-Cortes C, Tormo M, Salamero O, Manso F, Fernández I, de la Serna J, Moreno MJ, Pérez-Encinas M, Krsnik I, Ribera JM, Escoda L, Lowenberg B, Sanz MA. An analysis of the impact of CD56 expression in de novo acute promyelocytic leukemia patients treated with upfront all-trans retinoic acid and anthracycline-based regimens. Leuk Lymphoma 2018; 60:1030-1035. [PMID: 30322324 DOI: 10.1080/10428194.2018.1516875] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Out of 956, there were 95 (10%) CD56+ APL patients treated with PETHEMA ATRA and chemotherapy. CD56+ expression was associated with high WBC, BCR3 isoform, and co-expression of CD2, CD34, CD7, HLA-DR, CD15, and CD117 antigens. CD56+ vs CD56- APL presented higher induction death rate (16% vs 8%, p = .02) and 5-years cumulative incidence of relapse (33% versus 10%, p = .006), irrespectively of the Sanz score (low-risk 47% versus 5%, p < .001; intermediate 23% versus 7%, p < .001; and high-risk 42% versus 21%, p = .007). In the multivariate analysis, CD56 + (p < .0001), higher relapse-risk score (p = .001), and male gender (p = .05) retained the independent predictive value. CD56+ APL also showed a greater risk of CNS relapse (6% versus 1%, p < .001) and lower 5-year OS (75% versus 83%, p = .003). The AIDA-based LPA2012 trial, with an intensified consolidation schedule for CD56+ APL, will elucidate whether an intensified consolidation schedule could mitigate the relapse rate in this setting.
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Affiliation(s)
- Marta Sobas
- a Department of Haematology , Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University , Poland
| | - Pau Montesinos
- b Department of Medicine , University Hospital La Fe in Valencia , Spain.,c CIBERONC, Carlos III Institute , Madrid , Spain
| | - Blanca Boluda
- b Department of Medicine , University Hospital La Fe in Valencia , Spain
| | - Teresa Bernal
- d Central University Hospital in Asturias , Oviedo , Spain
| | - Edo Vellenga
- e University Hospital , Groningen , The Netherlands
| | - Josep Nomdedeu
- f University Hospital de la Santa Creu i Sant Paul in Barcelona (Hospital of the Holy Cross and Saint Paul), Universitat Autònoma de Barcelona , Barcelona , Spain
| | | | - Maria Chillón
- c CIBERONC, Carlos III Institute , Madrid , Spain.,h University Hospital of Salamanca , Salamanca , Spain
| | | | | | - Juan Bergua
- k Hospital San Pedro in Alcántara , Cáceres , Spain
| | | | | | - Mar Tormo
- n University Hospital in Valencia , Spain
| | - Olga Salamero
- o University Hospital Vall d´Hebron , Barcelona , Spain
| | | | | | | | | | | | | | - Josep-Maria Ribera
- v ICO University Hospital Germans Trias i Pujol; Jose Carreras Research Institute , Badalona , Spain
| | | | - Bob Lowenberg
- x Erasmus University Medical Center , Rotterdam , The Netherlands
| | - Miguel Angel Sanz
- b Department of Medicine , University Hospital La Fe in Valencia , Spain.,c CIBERONC, Carlos III Institute , Madrid , Spain
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23
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Villalba A, Osorio J, Freiria C, Santiago M, Boluda B, Vicente AI, Sempere A, Andreu R, Gomis F, Senent L. Copper deficiency: a cause of misdiagnosis of myelodysplastic syndrome. Ann Hematol 2018; 97:1737-1738. [PMID: 29663030 DOI: 10.1007/s00277-018-3334-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 04/05/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Ana Villalba
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Avda Abril Martorell, 106, 46026, Valencia, Spain.
| | - Julieta Osorio
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Avda Abril Martorell, 106, 46026, Valencia, Spain
| | - Carmen Freiria
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Avda Abril Martorell, 106, 46026, Valencia, Spain
| | - Marta Santiago
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Avda Abril Martorell, 106, 46026, Valencia, Spain
| | - Blanca Boluda
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Avda Abril Martorell, 106, 46026, Valencia, Spain
| | - Ana I Vicente
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Avda Abril Martorell, 106, 46026, Valencia, Spain
| | - Amparo Sempere
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Avda Abril Martorell, 106, 46026, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Rafa Andreu
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Avda Abril Martorell, 106, 46026, Valencia, Spain
| | - Federico Gomis
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Avda Abril Martorell, 106, 46026, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Leonor Senent
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Avda Abril Martorell, 106, 46026, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
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24
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Martínez-Cuadrón D, Boluda B, Martínez P, Bergua J, Rodríguez-Veiga R, Esteve J, Vives S, Serrano J, Vidriales B, Salamero O, Cordón L, Sempere A, Jiménez-Ubieto A, Prieto-Delgado J, Díaz-Beyá M, Garrido A, Benavente C, Pérez-Simón JA, Moscardó F, Sanz MA, Montesinos P. Correction to: A phase I–II study of plerixafor in combination with fludarabine, idarubicin, cytarabine, and G-CSF (PLERIFLAG regimen) for the treatment of patients with the first early-relapsed or refractory acute myeloid leukemia. Ann Hematol 2018; 97:923. [DOI: 10.1007/s00277-018-3277-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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25
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Martínez-Cuadrón D, Boluda B, Martínez P, Bergua J, Rodríguez-Veiga R, Esteve J, Vives S, Serrano J, Vidriales B, Salamero O, Cordón L, Sempere A, Jiménez-Ubieto A, Prieto-Delgado J, Díaz-Beyá M, Garrido A, Benavente C, Pérez-Simón JA, Moscardó F, Sanz MA, Montesinos P. A phase I-II study of plerixafor in combination with fludarabine, idarubicin, cytarabine, and G-CSF (PLERIFLAG regimen) for the treatment of patients with the first early-relapsed or refractory acute myeloid leukemia. Ann Hematol 2018; 97:763-772. [PMID: 29392425 DOI: 10.1007/s00277-018-3229-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [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: 10/04/2017] [Accepted: 12/28/2017] [Indexed: 12/01/2022]
Abstract
Clinical outcomes of patients with acute myeloid leukemia (AML) showing the first primary refractory or early-relapsed disease remain very poor. The Programa Español de Tratamientos en Hematología (PETHEMA) group designed a phase I-II trial using FLAG-Ida (fludarabine, idarubicin, cytarabine, and G-CSF) plus high-dose intravenous plerixafor, a molecule inducing mobilization of blasts through the SDF-1α-CXCR4 axis blockade and potentially leading to chemosensitization of the leukemic cells. We aimed to establish a recommended phase 2 dose (RP2D) of plerixafor plus FLAG-Ida, as well as the efficacy and safety of this combination for early-relapsed (first complete remission (CR/CRi) < 12 months) or primary refractory AML. Between 2012 and 2015, 57 patients were enrolled, and 41 received the RP2D (median age 52 years [range, 18-64]). Among these patients, 20 (49%) achieved CR/CRi, and 3 (7%) died during induction. CR/CRi rate was 50% (13/26) among primary refractory and 47% (7/15) among early relapse. Overall, 25 patients (61%) were allografted. Median overall and disease-free survivals were 9.9 and 13 months, respectively. In summary, the combination of plerixafor plus FLAG-Ida resulted in a relatively high CR/CRi rate in adult patients with primary refractory or early relapsed AML, with an acceptable toxicity profile and induction mortality rate, bridging the majority of patients to allogeneic stem cell transplantation. ClinicalTrials.gov Identifier: NCT01435343.
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Affiliation(s)
- David Martínez-Cuadrón
- Hematology Department, Hospital Universitari i Politècnic, La Fe, Avinguda Fernando Abril Martorell, 106, 46026, València, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Blanca Boluda
- Hematology Department, Hospital Universitari i Politècnic, La Fe, Avinguda Fernando Abril Martorell, 106, 46026, València, Spain
| | | | - Juan Bergua
- Hospital San Pedro de Alcántara, Cáceres, Spain
| | - Rebeca Rodríguez-Veiga
- Hematology Department, Hospital Universitari i Politècnic, La Fe, Avinguda Fernando Abril Martorell, 106, 46026, València, Spain
| | | | - Susana Vives
- Hospital ICO-Universitari Germans Trias i Pujol, José Carreras Leukemia Research Institute, Badalona, Spain
| | | | | | - Olga Salamero
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Lourdes Cordón
- Hematology Department, Hospital Universitari i Politècnic, La Fe, Avinguda Fernando Abril Martorell, 106, 46026, València, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Amparo Sempere
- Hematology Department, Hospital Universitari i Politècnic, La Fe, Avinguda Fernando Abril Martorell, 106, 46026, València, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | | | | | | | - Ana Garrido
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - Federico Moscardó
- Hematology Department, Hospital Universitari i Politècnic, La Fe, Avinguda Fernando Abril Martorell, 106, 46026, València, Spain
| | - Miguel A Sanz
- Hematology Department, Hospital Universitari i Politècnic, La Fe, Avinguda Fernando Abril Martorell, 106, 46026, València, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain.,Department of Medicine, University of Valencia, Valencia, Spain
| | - Pau Montesinos
- Hematology Department, Hospital Universitari i Politècnic, La Fe, Avinguda Fernando Abril Martorell, 106, 46026, València, Spain. .,CIBERONC, Instituto Carlos III, Madrid, Spain.
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26
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Megías-Vericat JE, Montesinos P, Herrero MJ, Moscardó F, Bosó V, Martínez-Cuadrón D, Rojas L, Rodríguez-Veiga R, Boluda B, Sendra L, Cervera J, Poveda JL, Sanz MÁ, Aliño SF. Influence of cytarabine metabolic pathway polymorphisms in acute myeloid leukemia induction treatment. Leuk Lymphoma 2017; 58:2880-2894. [PMID: 28573946 DOI: 10.1080/10428194.2017.1323267] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 02/08/2023]
Abstract
Cytarabine is considered the most effective chemotherapeutic option in acute myeloid leukemia (AML). The impact of 10 polymorphisms in cytarabine metabolic pathway genes were evaluated in 225 adult de novo AML patients. Variant alleles of DCK rs2306744 and CDA rs602950 showed higher complete remission (p = .024, p = .045), with lower survival rates for variant alleles of CDA rs2072671 (p = .015, p = .045, p = .032), rs3215400 (p = .033) and wild-type genotype of rs602950 (p = .039, .014). Induction death (p = .033) and lower survival rates (p = .021, p = .047) were correlated to RRM1 rs9937 variant allele. In addition, variant alleles of CDA rs532545 and rs602950 were related to skin toxicity (p = .031, p = .049) and mucositis to DCK rs2306744 minor allele (p = .046). Other toxicities associated to variant alleles were hepatotoxicity to NT5C2 rs11598702 (p = .032), lung toxicity (p = .031) and thrombocytopenia to DCK rs4694362 (p = .046). This study supports the interest of cytarabine pathway polymorphisms regarding efficacy and toxicity of AML therapy in a coherent integrated manner.
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Affiliation(s)
- Juan Eduardo Megías-Vericat
- a Unidad de Farmacogenética, Instituto Investigación Sanitaria La Fe and Área del Medicamento , Hospital Universitario y Politécnico La Fe. , Valencia , Spain.,b Servicio de Farmacia, Área del Medicamento , Hospital Universitario y Politécnico La Fe Avda , Valencia , Spain
| | - Pau Montesinos
- c Servicio de Hematología y Hemoterapia , Hospital Universitario y Politécnico La Fe, Avda , Valencia , Spain
| | - María José Herrero
- a Unidad de Farmacogenética, Instituto Investigación Sanitaria La Fe and Área del Medicamento , Hospital Universitario y Politécnico La Fe. , Valencia , Spain.,d Departamento Farmacología, Facultad de Medicina , Universidad de Valencia. Avda. , Valencia , Spain
| | - Federico Moscardó
- c Servicio de Hematología y Hemoterapia , Hospital Universitario y Politécnico La Fe, Avda , Valencia , Spain
| | - Virginia Bosó
- a Unidad de Farmacogenética, Instituto Investigación Sanitaria La Fe and Área del Medicamento , Hospital Universitario y Politécnico La Fe. , Valencia , Spain.,b Servicio de Farmacia, Área del Medicamento , Hospital Universitario y Politécnico La Fe Avda , Valencia , Spain
| | - David Martínez-Cuadrón
- c Servicio de Hematología y Hemoterapia , Hospital Universitario y Politécnico La Fe, Avda , Valencia , Spain
| | - Luis Rojas
- a Unidad de Farmacogenética, Instituto Investigación Sanitaria La Fe and Área del Medicamento , Hospital Universitario y Politécnico La Fe. , Valencia , Spain.,e Department of Internal Medicine, Faculty of Medicine , Pontificia Universidad Católica de Chile , Santiago , Chile
| | - Rebeca Rodríguez-Veiga
- c Servicio de Hematología y Hemoterapia , Hospital Universitario y Politécnico La Fe, Avda , Valencia , Spain
| | - Blanca Boluda
- c Servicio de Hematología y Hemoterapia , Hospital Universitario y Politécnico La Fe, Avda , Valencia , Spain
| | - Luis Sendra
- a Unidad de Farmacogenética, Instituto Investigación Sanitaria La Fe and Área del Medicamento , Hospital Universitario y Politécnico La Fe. , Valencia , Spain.,d Departamento Farmacología, Facultad de Medicina , Universidad de Valencia. Avda. , Valencia , Spain
| | - José Cervera
- c Servicio de Hematología y Hemoterapia , Hospital Universitario y Politécnico La Fe, Avda , Valencia , Spain
| | - José Luis Poveda
- b Servicio de Farmacia, Área del Medicamento , Hospital Universitario y Politécnico La Fe Avda , Valencia , Spain
| | - Miguel Ángel Sanz
- c Servicio de Hematología y Hemoterapia , Hospital Universitario y Politécnico La Fe, Avda , Valencia , Spain
| | - Salvador F Aliño
- a Unidad de Farmacogenética, Instituto Investigación Sanitaria La Fe and Área del Medicamento , Hospital Universitario y Politécnico La Fe. , Valencia , Spain.,d Departamento Farmacología, Facultad de Medicina , Universidad de Valencia. Avda. , Valencia , Spain.,f Unidad de Farmacología Clínica, Área del Medicamento , Hospital Universitario y Politécnico La Fe. Avda , Valencia , Spain
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27
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Rodríguez-Veiga R, Igual B, Montesinos P, Tormo M, Sayas MJ, Linares M, Fernández JM, Salvador A, Maceira-González A, Estornell J, Calabuig M, Pedreño M, Roig M, Sanz J, Sanz G, Carretero C, Boluda B, Martínez-Cuadrón D, Sanz MÁ. Assessment of late cardiomyopathy by magnetic resonance imaging in patients with acute promyelocytic leukaemia treated with all-trans retinoic acid and idarubicin. Ann Hematol 2017; 96:1077-1084. [PMID: 28451804 DOI: 10.1007/s00277-017-3004-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 08/12/2016] [Accepted: 04/05/2017] [Indexed: 01/07/2023]
Abstract
Late cardiomyopathy CMP is regarded as a potential severe long-term complication after anthracycline-based regimens for acute promyelocitic leukaemia (APL). We assess by MRI the incidence and severity of clinical and subclinical long-term CMP in a cohort of adult APL patients in first complete remission with PETHEMA trials. Adult patients diagnosed with APL in first complete remission lasting ≥2 years underwent anamnesis and physical examination and were asked to perform a cardiac MRI. Clinical CMP was defined as radiographic and physical signs of heart failure accompanied by symptoms or by left ventricle ejection fraction (LVEF) <45% by MRI with or without symptoms. Subclinical CMP was defined as the following MRI abnormalities: LVEF 45-50% or late gadolinium enhancement or two or more of LVEF ≤55%, left ventricle end-diastolic volume index ≥98 ml/m2, left ventricle end-systolic volume index ≥38 ml/m2, right ventricle end-diastolic volume index ≥106 ml/m2 and regional wall motion abnormalities. Of the 82 patients enrolled in the study, median cumulative dose of anthracyclines (doxorubicin equivalence) was 650 mg/m2, and median time from APL diagnosis to the study was 87 months (range, 24-195). Seven out of 57 patients with available MRI (12%) had subclinical CMP (all of them showed late gadolinium enhancement in MRI), and none had clinical CMP. Among the 25 patients without MRI, none had CMP by chest X-ray and physical assessment. In summary, we found 12% of subclinical and no clinical late CMP assessed by MRI in APL patients treated with PETHEMA protocols. Due to the low number of patients, we must interpret our results cautiously.
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Affiliation(s)
- Rebeca Rodríguez-Veiga
- Hematology Department of the Hospital Universitario La Fe, Avda. Fernando Abril Martorell 106, CP, 46026, Valencia, Spain
| | - Begoña Igual
- Radiology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Pau Montesinos
- Hematology Department of the Hospital Universitario La Fe, Avda. Fernando Abril Martorell 106, CP, 46026, Valencia, Spain.
| | - Mar Tormo
- Hematology Department of the Hospital Clínico Universitario, Valencia, Spain
| | - Mª José Sayas
- Hematology Department of the Hospital Dr. Peset, Valencia, Spain
| | - Mariano Linares
- Hematology Department of the Hospital General, Valencia, Spain
| | | | - Antonio Salvador
- Cardiology Department of the Hospital Universitario La Fe, Valencia, Spain
| | | | - Jordi Estornell
- Radiology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Marisa Calabuig
- Hematology Department of the Hospital Clínico Universitario, Valencia, Spain
| | - María Pedreño
- Hematology Department of the Hospital Dr. Peset, Valencia, Spain
| | - Mónica Roig
- Hematology Department of the Hospital General, Valencia, Spain
| | - Jaime Sanz
- Hematology Department of the Hospital Universitario La Fe, Avda. Fernando Abril Martorell 106, CP, 46026, Valencia, Spain
| | - Guillermo Sanz
- Hematology Department of the Hospital Universitario La Fe, Avda. Fernando Abril Martorell 106, CP, 46026, Valencia, Spain
| | - Carlos Carretero
- Hematology Department of the Hospital Universitario La Fe, Avda. Fernando Abril Martorell 106, CP, 46026, Valencia, Spain
| | - Blanca Boluda
- Hematology Department of the Hospital Universitario La Fe, Avda. Fernando Abril Martorell 106, CP, 46026, Valencia, Spain
| | - David Martínez-Cuadrón
- Hematology Department of the Hospital Universitario La Fe, Avda. Fernando Abril Martorell 106, CP, 46026, Valencia, Spain
| | - Miguel Ángel Sanz
- Hematology Department of the Hospital Universitario La Fe, Avda. Fernando Abril Martorell 106, CP, 46026, Valencia, Spain
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28
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Megías-Vericat JE, Montesinos P, Herrero MJ, Moscardó F, Bosó V, Rojas L, Martínez-Cuadrón D, Hervás D, Boluda B, García-Robles A, Rodríguez-Veiga R, Martín-Cerezuela M, Cervera J, Sendra L, Sanz J, Miguel A, Lorenzo I, Poveda JL, Sanz MÁ, Aliño SF. Impact of ABC single nucleotide polymorphisms upon the efficacy and toxicity of induction chemotherapy in acute myeloid leukemia. Leuk Lymphoma 2016; 58:1197-1206. [PMID: 27701910 DOI: 10.1080/10428194.2016.1231405] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Anthracycline uptake could be affected by efflux pumps of the ABC family. The influence of 7 SNPs of ABC genes was evaluated in 225 adult de novo acute myeloid leukemia (AML) patients. After multivariate logistic regression there were no significant differences in complete remission, though induction death was associated to ABCB1 triple variant haplotype (p = .020). The ABCB1 triple variant haplotype was related to higher nephrotoxicity (p = .016), as well as this haplotype and the variant allele of ABCB1 rs1128503, rs2032582 to hepatotoxicity (p = .001; p = .049; p < .001). Furthermore, the variant allele of ABCC1 rs4148350 was related to severe hepatotoxicity (p = .044), and the variant allele of ABCG2 rs2231142 was associated to greater cardiac (p = .004) and lung toxicities (p = .038). Delayed time to neutropenia recovery was observed with ABCB1 rs2032582 variant (p = .047). This study shows the impact of ABC polymorphisms in AML chemotherapy safety. Further prospective studies with larger population are needed to validate these associations.
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Affiliation(s)
- Juan Eduardo Megías-Vericat
- a Unidad de Farmacogenética, Instituto Investigación Sanataria La Fe and Área del Medicamento, Hospital Universitario y Politécnico La Fe. Avda , Valencia , Spain.,b Servicio de Farmacia, Área del Medicamento. Hospital Universitario y Politécnico La Fe Avda , Valencia , Spain
| | - Pau Montesinos
- c Servicio de Hematología y Hemoterapia. Hospital Universitario y Politécnico La Fe. Avda , Valencia , Spain
| | - María José Herrero
- a Unidad de Farmacogenética, Instituto Investigación Sanataria La Fe and Área del Medicamento, Hospital Universitario y Politécnico La Fe. Avda , Valencia , Spain.,d Departamento Farmacología, Facultad de Medicina , Universidad de Valencia. Avda , Valencia , Spain
| | - Federico Moscardó
- c Servicio de Hematología y Hemoterapia. Hospital Universitario y Politécnico La Fe. Avda , Valencia , Spain
| | - Virginia Bosó
- a Unidad de Farmacogenética, Instituto Investigación Sanataria La Fe and Área del Medicamento, Hospital Universitario y Politécnico La Fe. Avda , Valencia , Spain.,b Servicio de Farmacia, Área del Medicamento. Hospital Universitario y Politécnico La Fe Avda , Valencia , Spain
| | - Luis Rojas
- a Unidad de Farmacogenética, Instituto Investigación Sanataria La Fe and Área del Medicamento, Hospital Universitario y Politécnico La Fe. Avda , Valencia , Spain.,e Department of Internal Medicine, Faculty of Medicine , Pontificia Universidad Católica de Chile. Avda , Santiago , Chile
| | - David Martínez-Cuadrón
- c Servicio de Hematología y Hemoterapia. Hospital Universitario y Politécnico La Fe. Avda , Valencia , Spain
| | - David Hervás
- f Unidad de Bioestadística, Instituto investigación Sanataria La Fe. Avda , Valencia , Spain
| | - Blanca Boluda
- c Servicio de Hematología y Hemoterapia. Hospital Universitario y Politécnico La Fe. Avda , Valencia , Spain
| | - Ana García-Robles
- b Servicio de Farmacia, Área del Medicamento. Hospital Universitario y Politécnico La Fe Avda , Valencia , Spain
| | - Rebeca Rodríguez-Veiga
- c Servicio de Hematología y Hemoterapia. Hospital Universitario y Politécnico La Fe. Avda , Valencia , Spain
| | - María Martín-Cerezuela
- b Servicio de Farmacia, Área del Medicamento. Hospital Universitario y Politécnico La Fe Avda , Valencia , Spain
| | - José Cervera
- c Servicio de Hematología y Hemoterapia. Hospital Universitario y Politécnico La Fe. Avda , Valencia , Spain
| | - Luis Sendra
- d Departamento Farmacología, Facultad de Medicina , Universidad de Valencia. Avda , Valencia , Spain
| | - Jaime Sanz
- c Servicio de Hematología y Hemoterapia. Hospital Universitario y Politécnico La Fe. Avda , Valencia , Spain
| | - Antonio Miguel
- d Departamento Farmacología, Facultad de Medicina , Universidad de Valencia. Avda , Valencia , Spain
| | - Ignacio Lorenzo
- c Servicio de Hematología y Hemoterapia. Hospital Universitario y Politécnico La Fe. Avda , Valencia , Spain
| | - José Luis Poveda
- b Servicio de Farmacia, Área del Medicamento. Hospital Universitario y Politécnico La Fe Avda , Valencia , Spain
| | - Miguel Ángel Sanz
- c Servicio de Hematología y Hemoterapia. Hospital Universitario y Politécnico La Fe. Avda , Valencia , Spain
| | - Salvador F Aliño
- a Unidad de Farmacogenética, Instituto Investigación Sanataria La Fe and Área del Medicamento, Hospital Universitario y Politécnico La Fe. Avda , Valencia , Spain.,d Departamento Farmacología, Facultad de Medicina , Universidad de Valencia. Avda , Valencia , Spain.,g Unidad de Farmacología Clínica, Área del Medicamento, Hospital Universitario y Politécnico La Fe. Avda , Valencia , Spain
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29
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Montesinos P, Rodríguez-Veiga R, Boluda B, Martínez-Cuadrón D, Cano I, Lancharro A, Sanz J, Arilla MJ, López-Chuliá F, Navarro I, Lorenzo I, Salavert M, Pemán J, Calvillo P, Martínez J, Carpio N, Jarque I, Sanz GF, Sanz MA. Incidence and risk factors of post-engraftment invasive fungal disease in adult allogeneic hematopoietic stem cell transplant recipients receiving oral azoles prophylaxis. Bone Marrow Transplant 2015; 50:1465-72. [PMID: 26281032 DOI: 10.1038/bmt.2015.181] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 07/01/2015] [Accepted: 07/03/2015] [Indexed: 01/24/2023]
Abstract
Studies that analyze the epidemiology and risk factors for invasive fungal disease (IFD) after engraftment in alloSCT are few in number. This single-center retrospective study included 404 alloSCT adult recipients surviving >40 days who engrafted and were discharged without prior IFD. All patients who received ⩾20 mg/day of prednisone were assigned to primary oral prophylaxis (itraconazole or low-dose voriconazole). The primary end point was the cumulative incidence (CI) of probable/proven IFD using the European Organization for Research and Treatment of Cancer and Mycoses Study Group (EORTC/MSG) criteria. The independent prognostic factors after multivariate analyses were used to construct a post-engraftment IFD risk score. The 1-year CI of IFD was 11%. The non-relapse mortality was 40% in those developing IFD and 16% in those who did not. The intent-to-treat analysis showed that 17% of patients abandoned the assigned prophylaxis. Age >40 years, ⩾1 previous SCT, pre-engraftment neutropenia >15 days, extensive chronic GVHD and CMV reactivation were independent risk factors. The post-engraftment IFD score stratified patients into low risk (0-1 factor, CI 0.7%), intermediate risk (2 factors, CI 9.9%) and high risk (3-5 factors, CI 24.7%) (P<0.0001). The antifungal prophylaxis strategy failed to prevent post-engraftment IFD in 11% of alloSCT. Our risk score could be useful to implement risk-adapted strategies using antifungal prophylaxis after engraftment.
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Affiliation(s)
- P Montesinos
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - R Rodríguez-Veiga
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - B Boluda
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - D Martínez-Cuadrón
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - I Cano
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - A Lancharro
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - J Sanz
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - M J Arilla
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - F López-Chuliá
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - I Navarro
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - I Lorenzo
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - M Salavert
- Department of Infectious Diseases, Hospital Universitari i Politècnic La Fe, València, Spain
| | - J Pemán
- Department of Microbiology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - P Calvillo
- Department of Radiology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - J Martínez
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - N Carpio
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - I Jarque
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - G F Sanz
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - M A Sanz
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain.,Departament de Medicina, Universitat de València, Valencia, Spain
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30
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Montesinos P, Rodríguez-Veiga R, Martínez-Cuadrón D, Boluda B, Navarro I, Vera B, Alonso CM, Sanz J, López-Chulia F, Martín G, Jannone R, Sanz G, Lancharro A, Cano I, Palau J, Lorenzo I, Jarque I, Salavert M, Ramírez P, Sanz MÁ. Treatment of invasive fungal disease using anidulafungin alone or in combination for hematologic patients with concomitant hepatic or renal impairment. Rev Iberoam Micol 2015; 32:185-9. [PMID: 25858598 DOI: 10.1016/j.riam.2014.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 05/07/2014] [Revised: 07/16/2014] [Accepted: 10/21/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Invasive fungal disease (IFD) treatment is challenging in hematologic patients due to drug interactions and toxicities that limit the use of the antifungal agents. AIMS To analyze retrospectively in terms of safety and potential efficacy anidulafungin therapy, alone or in combination. METHODS Our institutional guidelines recommended anidulafungin treatment in hematologic patients with suspected IFD and concomitant renal or liver impairment (to avoid drug interactions and preserve organ function). RESULTS From 2008 to 2013, 24 episodes of IFD occurring in 21 patients were classified as proven (4 cases), probable (15 cases) and possible (5 cases). Anidulafungin was administered alone (13%) or in combination (88%). Eight (33%) episodes were resolved, using monotherapy (1 out of 3, 33%) or a combined therapy (7 out of 21, 33%). Twelve cases (50%) were registered as failure (death due to IFD progression in 4 patients, and treatment change due to lack of efficacy in 8), and 4 cases (17%) were not evaluable (death unrelated to the IFD). Anidulafungin was not withdrawn in any case due to toxicity. CONCLUSIONS Anidulafungin therapy, alone or in combination, could be considered in hematologic patients with IFD and concomitant liver or renal impairment. Due to the low number of patients, we cannot draw any conclusion about efficacy.
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Affiliation(s)
- Pau Montesinos
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain.
| | | | | | - Blanca Boluda
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Inés Navarro
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Belen Vera
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Carmen M Alonso
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Jaime Sanz
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | | | - Guillermo Martín
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Rosa Jannone
- Intensive Care Unit Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Guillermo Sanz
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Aima Lancharro
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Isabel Cano
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Javier Palau
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Ignacio Lorenzo
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Isidro Jarque
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Miguel Salavert
- Infectious Diseases Unit of the Hospital Universitario La Fe, Valencia, Spain
| | - Paula Ramírez
- Intensive Care Unit Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Miguel Ángel Sanz
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
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31
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Blanes M, González JD, Lahuerta JJ, Ribas P, Lorenzo I, Boluda B, Sanz MA, de la Rubia J. Bortezomib-based induction therapy followed by intravenous busulfan–melphalan as conditioning regimen for patients with newly diagnosed multiple myeloma. Leuk Lymphoma 2014; 56:415-9. [DOI: 10.3109/10428194.2014.922182] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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32
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Moscardó F, Sanz J, Carbonell F, Sanz MA, Larrea L, Montesinos P, Lorenzo I, Vera B, Boluda B, Salazar C, Cañigral C, Planelles D, Jarque I, Solves P, Martín G, López F, de la Rubia J, Martínez J, Carpio N, Martínez-Cuadrón D, Puig N, Montoro JA, Roig R, Sanz GF. Effect of CD8⁺ cell content on umbilical cord blood transplantation in adults with hematological malignancies. Biol Blood Marrow Transplant 2014; 20:1744-50. [PMID: 25008329 DOI: 10.1016/j.bbmt.2014.06.038] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [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: 03/13/2014] [Accepted: 06/30/2014] [Indexed: 01/04/2023]
Abstract
Total nucleated (TNCs) and CD34(+) cells are considered major determinants of outcome after umbilical cord blood (UCB) transplantation but the effect of other cell subtypes present in the graft is unknown. This single-center cohort study included patients with hematological malignancies who received UCB transplantation after a myeloablative conditioning regimen. UCB units were primarily selected according to cell content, both TNCs and CD34(+) cells, and also according to the degree of HLA matching. Counts of several cell subtypes of the infused UCB unit, together with HLA disparities and other patient- and transplantation-related characteristics, were analyzed by multivariable methodology for their association with myeloid and platelet engraftment, graft-versus-host disease, nonrelapse mortality (NRM), disease-free survival (DFS), and overall survival (OS). Two hundred patients (median age, 32 years) were included in the study. In multivariable analyses, a greater number of CD8(+) cells was significantly associated with better results for myeloid (P = .001) and platelet (P = .008) engraftment, NRM (P = .02), DFS (P = .007), and OS (P = .01). CD34(+) cell content was predictive of myeloid engraftment (P < .001). This study suggests that the outcome after UCB transplantation in adults with hematological malignancies could be better when UCB grafts had a greater CD8(+) cell content.
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Affiliation(s)
- Federico Moscardó
- Hematopoietic Cell Transplantation Unit, Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
| | - Jaime Sanz
- Hematopoietic Cell Transplantation Unit, Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Miguel A Sanz
- Hematopoietic Cell Transplantation Unit, Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Luis Larrea
- Centro de Trasfusión de la Comunidad Valenciana, Valencia, Spain
| | - Pau Montesinos
- Hematopoietic Cell Transplantation Unit, Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Ignacio Lorenzo
- Hematopoietic Cell Transplantation Unit, Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Belén Vera
- Hematopoietic Cell Transplantation Unit, Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Blanca Boluda
- Hematopoietic Cell Transplantation Unit, Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Claudia Salazar
- Hematopoietic Cell Transplantation Unit, Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Carolina Cañigral
- Hematopoietic Cell Transplantation Unit, Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Isidro Jarque
- Hematopoietic Cell Transplantation Unit, Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Pilar Solves
- Hematopoietic Cell Transplantation Unit, Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Guillermo Martín
- Hematopoietic Cell Transplantation Unit, Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Francisca López
- Hematopoietic Cell Transplantation Unit, Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Javier de la Rubia
- Hematopoietic Cell Transplantation Unit, Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Jesús Martínez
- Hematopoietic Cell Transplantation Unit, Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Nelly Carpio
- Hematopoietic Cell Transplantation Unit, Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - David Martínez-Cuadrón
- Hematopoietic Cell Transplantation Unit, Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Nieves Puig
- Centro de Trasfusión de la Comunidad Valenciana, Valencia, Spain
| | - José A Montoro
- Centro de Trasfusión de la Comunidad Valenciana, Valencia, Spain
| | - Roberto Roig
- Centro de Trasfusión de la Comunidad Valenciana, Valencia, Spain
| | - Guillermo F Sanz
- Hematopoietic Cell Transplantation Unit, Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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33
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Gómez-Seguí I, Sánchez-Izquierdo D, Barragán E, Such E, Luna I, López-Pavía M, Ibáñez M, Villamón E, Alonso C, Martín I, Llop M, Dolz S, Fuster Ó, Montesinos P, Cañigral C, Boluda B, Salazar C, Cervera J, Sanz MA. Single-nucleotide polymorphism array-based karyotyping of acute promyelocytic leukemia. PLoS One 2014; 9:e100245. [PMID: 24959826 PMCID: PMC4069034 DOI: 10.1371/journal.pone.0100245] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 05/22/2014] [Indexed: 11/29/2022] Open
Abstract
Acute promyelocytic leukemia (APL) is characterized by the t(15;17)(q22;q21), but additional chromosomal abnormalities (ACA) and other rearrangements can contribute in the development of the whole leukemic phenotype. We hypothesized that some ACA not detected by conventional techniques may be informative of the onset of APL. We performed the high-resolution SNP array (SNP-A) 6.0 (Affymetrix) in 48 patients diagnosed with APL on matched diagnosis and remission sample. Forty-six abnormalities were found as an acquired event in 23 patients (48%): 22 duplications, 23 deletions and 1 Copy-Neutral Loss of Heterozygocity (CN-LOH), being a duplication of 8(q24) (23%) and a deletion of 7(q33-qter) (6%) the most frequent copy-number abnormalities (CNA). Four patients (8%) showed CNAs adjacent to the breakpoints of the translocation. We compared our results with other APL series and found that, except for dup(8q24) and del(7q33-qter), ACA were infrequent (≤3%) but most of them recurrent (70%). Interestingly, having CNA or FLT3 mutation were mutually exclusive events. Neither the number of CNA, nor any specific CNA was associated significantly with prognosis. This study has delineated recurrent abnormalities in addition to t(15;17) that may act as secondary events and could explain leukemogenesis in up to 40% of APL cases with no ACA by conventional cytogenetics.
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MESH Headings
- Adolescent
- Adult
- Aged
- Chromosome Aberrations
- Chromosomes, Human, Pair 15
- Chromosomes, Human, Pair 17
- Female
- Humans
- Karyotyping
- Leukemia, Promyelocytic, Acute/diagnosis
- Leukemia, Promyelocytic, Acute/drug therapy
- Leukemia, Promyelocytic, Acute/genetics
- Leukemia, Promyelocytic, Acute/mortality
- Loss of Heterozygosity
- Male
- Middle Aged
- Oncogene Proteins, Fusion/genetics
- Polymorphism, Single Nucleotide
- Prognosis
- Translocation, Genetic
- Young Adult
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Affiliation(s)
- Inés Gómez-Seguí
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Eva Barragán
- Laboratory of Molecular Biology, Department of Clinical Chemistry, University Hospital La Fe, Valencia, Spain
| | - Esperanza Such
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Irene Luna
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - María López-Pavía
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Mariam Ibáñez
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Eva Villamón
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Carmen Alonso
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Iván Martín
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Marta Llop
- Laboratory of Molecular Biology, Department of Clinical Chemistry, University Hospital La Fe, Valencia, Spain
| | - Sandra Dolz
- Laboratory of Molecular Biology, Department of Clinical Chemistry, University Hospital La Fe, Valencia, Spain
| | - Óscar Fuster
- Laboratory of Molecular Biology, Department of Clinical Chemistry, University Hospital La Fe, Valencia, Spain
| | - Pau Montesinos
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Carolina Cañigral
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Blanca Boluda
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Claudia Salazar
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Jose Cervera
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Genetics Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- * E-mail: (IGS); (MAS)
| | - Miguel A. Sanz
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
- * E-mail: (IGS); (MAS)
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34
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Sanz J, Arango M, Senent L, Jarque I, Montesinos P, Sempere A, Lorenzo I, Martín G, Moscardó F, Mayordomo E, Salavert M, Cañigral C, Boluda B, Salazar C, López-Hontangas JL, Sanz MA, Sanz GF. EBV-associated post-transplant lymphoproliferative disorder after umbilical cord blood transplantation in adults with hematological diseases. Bone Marrow Transplant 2013; 49:397-402. [PMID: 24292521 DOI: 10.1038/bmt.2013.190] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 09/06/2013] [Accepted: 09/30/2013] [Indexed: 11/09/2022]
Abstract
We analyzed the incidence, clinicopathological features, risk factors and prognosis of patients with EBV-associated post-transplant lymphoproliferative disorder (EBV-PTLD) in 288 adults undergoing umbilical cord blood transplantation (UCBT) at a single institution. Twelve patients developed proven EBV-PTLD at a median time of 73 days (range, 36-812). Three-year cumulative incidence (CI) of EBV-PTLD was 4.3% (95% CI: 1.9-6.7). All patients presented with extranodal involvement. Most frequently affected sites were the liver, spleen, central nervous system (CNS), Waldeyer's ring and BM in 7, 6, 4, 3 and 3 patients, respectively. One patient had polymorphic and 11 had monomorphic EBV-PTLD (7 diffuse large B-cell lymphomas not otherwise specified, 4 plasmablastic lymphomas). We confirmed donor origin and EBV infection in all histological samples. EBV-PTLD was the cause of death in 11 patients at a median time of 23 days (range, 1-84). The 3-year CI of EBV-PTLD was 12.9% (95% CI: 3.2-22.5) and 2.6% (95% CI: 0.5-4.7) for patients receiving reduced-intensity conditioning (RIC) and myeloablative conditioning, respectively (P<0.0001). In conclusion, adults with EBV-PTLD after UCBT showed frequent visceral and CNS involvement. The prognosis was poor despite routine viral monitoring and early intervention. An increased risk of EBV-PTLD was noted among recipients of RIC regimens.
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Affiliation(s)
- J Sanz
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - M Arango
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - L Senent
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - I Jarque
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - P Montesinos
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - A Sempere
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - I Lorenzo
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - G Martín
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - F Moscardó
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - E Mayordomo
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - M Salavert
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - C Cañigral
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - B Boluda
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - C Salazar
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - J L López-Hontangas
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - M A Sanz
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - G F Sanz
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
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35
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Solves P, Carpio N, Moscardo F, Bas T, Cañigral C, Salazar C, Boluda B, Sanz MA. Results of a preoperative autologous blood donation program for patients undergoing elective major spine surgery. Transfus Apher Sci 2013; 49:345-8. [PMID: 23871582 DOI: 10.1016/j.transci.2013.06.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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: 04/04/2013] [Revised: 06/12/2013] [Accepted: 06/21/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Spinal surgery has been shown to have a high blood transfusion requirement. Preoperative autologous blood donation (PABD) is a strategy to reduce the allogeneic transfusions in this subset of patients. MATERIAL AND METHODS We retrospectively reviewed transfusion outcome of patients undergoing elective major spinal surgery from 2005 to 2011, and included in the PABD program. Transfusion outcome was compared with a group of patients that did not enter in the program during the same period. RESULTS A total of 148 patients were included in the program during the analyzed period. Patients in the PABD program benefited from reduced exposure to allogeneic blood (Odds Ratio: 0.077, 95% confidence interval 0.043-0.140). However, 12.16% (n=18) of these patients received also allogeneic blood (total 40 red blood cell units). Univariate analysis showed the following parameters as significantly predictors of transfusion: inclusion in the program (p<0.000), number of levels fused (Odds Ratio: 1.143, p=0.010), and number of autologous red blood cells donated (Odds Ratio: 1.906, p<0.000). CONCLUSIONS The preoperative autologous blood donation program designed in our hospital was effective for reducing allogeneic transfusion in mostly young patients under major elective spinal surgery. However and as expected, their inclusion in the program increased the risk to be transfused.
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Affiliation(s)
- Pilar Solves
- Blood Bank, Hematology Department, Hospital Universitari I Politècnic La Fe, Valencia 46026, Spain.
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Boluda B, Mesa J, Obiols G, Simò R. Focal muscle infarction in a diabetic. Diabete Metab 1989; 15:269-70. [PMID: 2630379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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