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Roy Moulik N, Harriss-Buchan A, Saglio G, Suttorp M. Challenges in Management of Pediatric Chronic Myeloid Leukemia (pCML) in the Low-Middle Income Countries (LMICs): Insights from an International CML Foundation (iCMLf) Multi-National Survey. Pediatr Hematol Oncol 2024; 41:290-295. [PMID: 38229452 DOI: 10.1080/08880018.2023.2301404] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/29/2023] [Indexed: 01/18/2024]
Abstract
Despite being a rare disease, high-income countries (HICs) have formulated guidelines for management of pediatric CML (pCML). We conducted a survey amongst 24 physicians from 22 Low-Middle Income Countries (LMICs) to gather information regarding their practice and experience in treating children with pCML. Rarity of pCML, lack of adequate expertise, and setting-adapted guidelines along with limitations in diagnostic infrastructure as well as challenges in accessing tyrosine kinase inhibitors (TKIs) were identified as major barriers in optimum management of patients. For the first time in literature, our findings provide valuable insights into the multifaceted challenges faced in managing pCML in LMICs.
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Affiliation(s)
| | | | - Giuseppe Saglio
- Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Meinolf Suttorp
- Pediatric Hemato-Oncology, Medical Faculty, Technical University of Dresden, Dresden, Germany
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2
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Elmakaty I, Saglio G, Al-Khabori M, Elsayed A, Elsayed B, Elmarasi M, Elsabagh AA, Alshurafa A, Ali E, Yassin M. The Contemporary Role of Hematopoietic Stem Cell Transplantation in the Management of Chronic Myeloid Leukemia: Is It the Same in All Settings? Cancers (Basel) 2024; 16:754. [PMID: 38398145 PMCID: PMC10886670 DOI: 10.3390/cancers16040754] [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] [Received: 10/08/2023] [Revised: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 02/25/2024] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) for chronic myeloid leukemia (CML) patients has transitioned from the standard of care to a treatment option limited to those with unsatisfactory tyrosine kinase inhibitor (TKI) responses and advanced disease stages. In recent years, the threshold for undergoing HSCT has increased. Most CML patients now have life expectancies comparable to the general population, and therefore, the goal of therapy is shifting toward achieving treatment-free remission (TFR). While TKI discontinuation trials in CML show potential for achieving TFR, relapse risk is high, affirming allogeneic HSCT as the sole curative treatment. HSCT should be incorporated into treatment algorithms from the time of diagnosis and, in some patients, evaluated as soon as possible. In this review, we will look at some of the recent advances in HSCT, as well as its indication in the era of aiming for TFR in the presence of TKIs in CML.
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Affiliation(s)
- Ibrahim Elmakaty
- College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences, University of Turin, 10124 Turin, Italy
| | | | | | - Basant Elsayed
- College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
| | - Mohamed Elmarasi
- College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
| | | | - Awni Alshurafa
- Hematology Section, Medical Oncology, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation (HMC), Doha P.O. Box 3050, Qatar
| | - Elrazi Ali
- Interfaith Medical Center, Brooklyn, NY 11213, USA
| | - Mohamed Yassin
- College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
- Hematology Section, Medical Oncology, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation (HMC), Doha P.O. Box 3050, Qatar
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3
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Hehlmann R, Saglio G. Luigi (Gino) Chieco-Bianchi: a man linking hematological and virological research. Leukemia 2024; 38:233-234. [PMID: 38057494 DOI: 10.1038/s41375-023-02087-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 10/30/2023] [Accepted: 11/10/2023] [Indexed: 12/08/2023]
Affiliation(s)
- Rüdiger Hehlmann
- Emeritus Professor of Medicine of the Heidelberg University, Mannheim, Germany
- President ELN Foundation, Weinheim, Germany
| | - Giuseppe Saglio
- Emeritus Professor of Internal Medicine and Hematology of the University of Turin, Turin, Italy.
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4
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Tiribelli M, Latagliata R, Breccia M, Capodanno I, Miggiano MC, Cavazzini F, Bucelli C, Attolico I, Crescenzi SL, Russo S, Annunziata M, Sorà F, Bonifacio M, Mulas O, Loglisci G, Maggi A, Binotto G, Crisà E, Scortechini AR, Leporace AP, Sancetta R, Murgano P, Abruzzese E, Stagno F, Rapezzi D, Luzi D, Vincelli I, Bocchia M, Fava C, Malato A, Crugnola M, Pizzuti M, Lunghi F, Galimberti S, Dalmazzo M, Fanin R, Scalzulli E, Foà R, Iurlo A, Saglio G, Specchia G. Determinants of frontline tyrosine kinase inhibitor choice for patients with chronic-phase chronic myeloid leukemia: A study from the Registro Italiano LMC and Campus CML. Cancer 2023; 129:2637-2644. [PMID: 37354090 DOI: 10.1002/cncr.34923] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Imatinib, dasatinib, and nilotinib are tyrosine kinase inhibitors (TKIs) approved in Italy for frontline treatment of chronic-phase chronic myeloid leukemia (CP-CML). The choice of TKI is based on a combined evaluation of the patient's and the disease characteristics. The aim of this study was to analyze the use of frontline TKI therapy in an unselected cohort of Italian patients with CP-CML to correlate the choice with the patient's features. METHODS A total of 1967 patients with CP-CML diagnosed between 2012 and 2019 at 36 centers throughout Italy were retrospectively evaluated; 1089 patients (55.4%) received imatinib and 878 patients (44.6%) received a second-generation (2G) TKI. RESULTS Second-generation TKIs were chosen for most patients aged <45 years (69.2%), whereas imatinib was used in 76.7% of patients aged >65 years (p < .001). There was a predominant use of imatinib in intermediate/high European long-term survival risk patients (60.0%/66.0% vs. 49.7% in low-risk patients) and a limited use of 2G-TKIs in patients with comorbidities such as hypertension, diabetes, chronic obstructive pulmonary disease, previous neoplasms, ischemic heart disease, or stroke and in those with >3 concomitant drugs. We observed a greater use of imatinib (61.1%) in patients diagnosed in 2018-2019 compared to 2012-2017 (53.2%; p = .002). In multivariable analysis, factors correlated with imatinib use were age > 65 years, spleen size, the presence of comorbidities, and ≥3 concomitant medications. CONCLUSIONS This observational study of almost 2000 cases of CML shows that imatinib is the frontline drug of choice in 55% of Italian patients with CP-CML, with 2G-TKIs prevalently used in younger patients and in those with no concomitant clinical conditions. Introduction of the generic formulation in 2018 seems to have fostered imatinib use.
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Affiliation(s)
- Mario Tiribelli
- Division of Hematology and Bone Marrow Transplant, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
- Department of Medical Area, University of Udine, Udine, Italy
| | | | - Massimo Breccia
- Hematology, Department of Precision and Translational Medicine, "Sapienza" University, Rome, Italy
| | - Isabella Capodanno
- Hematology Unit, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy
| | | | | | - Cristina Bucelli
- Division of Hematology, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Immacolata Attolico
- Hematology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | | | - Sabina Russo
- Hematology, University of Messina, Messina, Italy
| | | | - Federica Sorà
- Institute of Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, and Department of Radiological and Hematological Sciences, Cattolica University, Rome, Italy
| | | | - Olga Mulas
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | | | - Gianni Binotto
- Hematology and Clinical Immunology, Department of Medicine, University of Padua, Padua, Italy
| | - Elena Crisà
- Hematology, Ospedale Maggiore della Carità di Novara, University of Eastern Piedmont, Novara, Italy
| | | | | | | | - Pamela Murgano
- Division of Hematology, Sant'Elia Hospital, Caltanissetta, Italy
| | | | - Fabio Stagno
- Hematology Section and Bone Marrow Transplant Unit, Rodolico Hospital, Azienda Ospedaliero Universitaria Policlinico "Rodolico-San Marco", Catania, Italy
| | - Davide Rapezzi
- Hematology, Azienda Ospedaliera Santa Croce e Carle, Cuneo, Italy
| | - Debora Luzi
- Onco-Hematology Department, Azienda Ospedaliera Santa Maria, Terni, Italy
| | - Iolanda Vincelli
- Hematology, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | - Monica Bocchia
- Hematology, Azienda Ospedaliero Universitaria Senese, Siena, Italy
| | - Carmen Fava
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | | | - Monica Crugnola
- Hematology and Stem Cell Transplant Unit, Azienda Ospedaliero Universitaria, Parma, Italy
| | | | | | | | - Matteo Dalmazzo
- Division of Hematology and Internal Medicine, "San Luigi Gonzaga" University Hospital, Turin, Italy
| | - Renato Fanin
- Division of Hematology and Bone Marrow Transplant, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
- Department of Medical Area, University of Udine, Udine, Italy
| | - Emilia Scalzulli
- Hematology, Department of Precision and Translational Medicine, "Sapienza" University, Rome, Italy
| | - Robin Foà
- Hematology, Department of Precision and Translational Medicine, "Sapienza" University, Rome, Italy
| | - Alessandra Iurlo
- Division of Hematology, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Giorgina Specchia
- Hematology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
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5
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Breccia M, Saglio G. Interferon in chronic myeloid leukaemia: Is it useful for treatment-free remission? Br J Haematol 2023; 202:1087-1088. [PMID: 37537862 DOI: 10.1111/bjh.19013] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 07/20/2023] [Accepted: 07/22/2023] [Indexed: 08/05/2023]
Abstract
The role of IFNα in chronic myeloid leukaemia patients who have achieved a deep molecular response (DMR) is still unknown. The study reported by Irani et al., which shows the prospective biological effects of the drug in combination with a second-generation tyrosine kinase inhibitor, pave the way for further clinical studies aimed at increasing the rate of DMR for a possible successful discontinuation. Commentary on: Irani et al. Immune modulation in chronic myeloid leukaemia patients treated with nilotinib and interferon-alpha. Br J Haematol 2023;202:1127-1136.
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Affiliation(s)
- Massimo Breccia
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
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6
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Radich JP, Wall M, Branford S, Campbell CD, Chaturvedi S, DeAngelo DJ, Deininger M, Guinney J, Hochhaus A, Hughes TP, Kantarjian HM, Larson RA, Li S, Maegawa R, Mishra K, Obourn V, Pinilla-Ibarz J, Purkayastha D, Sadek I, Saglio G, Shrestha A, White BS, Druker BJ. Molecular response in newly diagnosed chronic-phase chronic myeloid leukemia: prediction modeling and pathway analysis. Haematologica 2023. [PMID: 36727397 DOI: 10.3324/haematol.2022.281878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Indexed: 02/03/2023] Open
Abstract
Tyrosine kinase inhibitor therapy revolutionized chronic myeloid leukemia treatment and showed how targeted therapy and molecular monitoring could be used to substantially improve survival outcomes. We used chronic myeloid leukemia as a model to understand a critical question: Why do some patients have an excellent response to therapy, while others have a poor response? We studied gene expression in whole blood samples from 112 patients from a large phase 3 randomized trial, dichotomizing cases into good responders (BCR::ABL1 ≤10% International Scale by 3 and 6 months and ≤0.1% by 12 months) and poor responders (failure to meet these criteria). Predictive models based on gene expression demonstrated the best performance (area under the curve [SD], 0.76 [0.07]). All of the top 20 pathways overexpressed in good responders involved immune regulation, a finding validated in an independent data set. This study emphasizes the importance of pretreatment adaptive immune response in treatment efficacy and suggests biological pathways that can be targeted to improve response.
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Affiliation(s)
| | | | | | | | | | | | - Michael Deininger
- Huntsman Cancer Institute, The University of Utah, Salt Lake City, UT
| | | | | | - Timothy P Hughes
- South Australian Health and Medical Research Institute and University of Adelaide, Adelaide
| | | | | | - Sai Li
- Novartis Pharmaceuticals Corporation, Basel, Basel-Stadt
| | | | | | - Vanessa Obourn
- Novartis Institutes for Biomedical Research, Cambridge, MA
| | | | | | - Islam Sadek
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | | | - Alok Shrestha
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | | | - Brian J Druker
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR
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7
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Iurlo A, Cattaneo D, Consonni D, Castagnetti F, Miggiano MC, Binotto G, Bonifacio M, Rege-Cambrin G, Tiribelli M, Lunghi F, Gozzini A, Pregno P, Abruzzese E, Capodanno I, Bucelli C, Pizzuti M, Artuso S, Iezza M, Scalzulli E, La Barba G, Maggi A, Russo S, Elena C, Scortechini AR, Tafuri A, Latagliata R, Caocci G, Bocchia M, Galimberti S, Luciano L, Fava C, Foà R, Saglio G, Rosti G, Breccia M. Treatment discontinuation following low-dose TKIs in 248 chronic myeloid leukemia patients: Updated results from a campus CML real-life study. Front Pharmacol 2023; 14:1154377. [PMID: 37033642 PMCID: PMC10076530 DOI: 10.3389/fphar.2023.1154377] [Citation(s) in RCA: 2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/14/2023] [Indexed: 04/11/2023] Open
Abstract
TKIs long-term treatment in CML may lead to persistent adverse events (AEs) that can promote relevant morbidity and mortality. Consequently, TKIs dose reduction is often used to prevent AEs. However, data on its impact on successful treatment-free remission (TFR) are quite scarce. We conducted a retrospective study on the outcome of CML subjects who discontinued low-dose TKIs from 54 Italian hematology centers participating in the Campus CML network. Overall, 1.785 of 5.108 (35.0%) regularly followed CML patients were treated with low-dose TKIs, more frequently due to relevant comorbidities or AEs (1.288, 72.2%). TFR was attempted in 248 (13.9%) subjects, all but three while in deep molecular response (DMR). After a median follow-up of 24.9 months, 172 (69.4%) patients were still in TFR. TFR outcome was not influenced by gender, Sokal/ELTS risk scores, prior interferon, number and last type of TKI used prior to treatment cessation, DMR degree, reason for dose reduction or median TKIs duration. Conversely, TFR probability was significantly better in the absence of resistance to any prior TKI. In addition, patients with a longer DMR duration before TKI discontinuation (i.e., >6.8 years) and those with an e14a2 BCR::ABL1 transcript type showed a trend towards prolonged TFR. It should also be emphasized that only 30.6% of our cases suffered from molecular relapse, less than reported during full-dose TKI treatment. The use of low-dose TKIs does not appear to affect the likelihood of achieving a DMR and thus trying a treatment withdrawal, but might even promote the TFR rate.
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Affiliation(s)
- A. Iurlo
- Hematology Division, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- *Correspondence: A. Iurlo,
| | - D. Cattaneo
- Hematology Division, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - D. Consonni
- Epidemiology Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - F. Castagnetti
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology “L. and A. Seràgnoli”, University of Bologna, “S. Orsola-Malpighi” Hospital, Bologna, Italy
| | - M. C. Miggiano
- Division of Hematology, San Bortolo Hospital, Vicenza, Italy
| | - G. Binotto
- Department of Medicine, Hematology and Clinical Immunology, Padua School of Medicine, Padua, Italy
| | - M. Bonifacio
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - G. Rege-Cambrin
- Division of Internal Medicine and Hematology, San Luigi Gonzaga Hospital, Turin, Italy
| | - M. Tiribelli
- Division of Hematology and BMT—Udine Hopsital, ASUFC and Department of Medicine—University of Udine, Udine, Italy
| | - F. Lunghi
- Division of Hematology and BMT, IRCCS San Raffaele Hospital, Milan, Italy
| | - A. Gozzini
- Division of Hematology, AOU Careggi, Firenze, Italy
| | - P. Pregno
- Division of Hematology, AOU Città della Salute e della Scienza, Torino, Italy
| | - E. Abruzzese
- Hematology Division, Sant’Eugenio Hospital, Rome, Italy
| | - I. Capodanno
- Division of Hematology, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - C. Bucelli
- Hematology Division, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M. Pizzuti
- Hematology Unit, Ospedale Potenza, Potenza, Italy
| | - S. Artuso
- Hematology Division, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M. Iezza
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology “L. and A. Seràgnoli”, University of Bologna, “S. Orsola-Malpighi” Hospital, Bologna, Italy
| | - E. Scalzulli
- Division of Hematology, Department of Precision and Translational, Policlinico Umberto 1, Sapienza University, Rome, Italy
| | - G. La Barba
- Hematology Unit, Azienda USL di Pescara, Pescara, Italy
| | - A. Maggi
- Division of Hematology, Hospital “S. G. Moscati”, Taranto, Italy
| | - S. Russo
- Division of Hematology, Dipartimento di Patologia Umana dell''Adulto e dell'Età Evolutiva, Policlinico G. Martino, University of Messina, Messina, Italy
| | - C. Elena
- UOC Ematologia 1, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - A. R. Scortechini
- Division of Hematology, Department of Molecular and Clinical Sciences, Polytechnic University of Marche, Ancona, Italy
| | - A. Tafuri
- Division of Hematology, Azienda Ospedaliera Universitaria Sant'Andrea, Rome, Italy
| | - R. Latagliata
- Division of Hematology, Belcolle Hospital, Viterbo, Italy
| | - G. Caocci
- Department of Medical Sciences and Public Health, University of Cagliari, Businco Hospital, Cagliari, Italy
| | - M. Bocchia
- Hematology Unit, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | - S. Galimberti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - L. Luciano
- Division of Hematology, Department of Clinical Medicine and Surgery, Federico II University, Napoli, Italy
| | - C. Fava
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - R. Foà
- Division of Hematology, Department of Precision and Translational, Policlinico Umberto 1, Sapienza University, Rome, Italy
| | - G. Saglio
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - G. Rosti
- Scientific Direction, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - M. Breccia
- Division of Hematology, Department of Precision and Translational, Policlinico Umberto 1, Sapienza University, Rome, Italy
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8
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Marchionni L, Lobo FP, Kostadinov R, Serra A, Besso FG, Deaglio S, Stratta P, Berrino M, Zanettini C, Imada EL, Omar MN, Gaidano G, Bruno B, Saglio G, Amoroso A. Donor-derived acute myeloid leukemia in solid organ transplantation. Am J Transplant 2022; 22:3111-3119. [PMID: 35979657 PMCID: PMC9897593 DOI: 10.1111/ajt.17174] [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: 01/13/2022] [Revised: 08/03/2022] [Accepted: 08/12/2022] [Indexed: 02/05/2023]
Abstract
We report the transmission of acute myeloid leukemia (AML) undetected at donation from a deceased organ donor to two kidneys and one liver recipients. We reviewed the medical records, and performed molecular analyses and whole exome sequencing (WES) to ascertain AML donor origin and its molecular evolution. The liver recipient was diagnosed 11 months after transplantation and died from complications 2 months later. The two kidney recipients (R1 and R2) were diagnosed 19 and 20 months after transplantation and both received treatment for leukemia. R1 died of complications 11 months after diagnosis, while R2 went into complete remission for 44 months, before relapsing. R2 died 10 months later of complications from allogenic bone marrow transplantation. Microsatellite analysis demonstrated donor chimerism in circulating cells from both kidney recipients. Targeted molecular analyses and medical records revealed NPM1 mutation present in the donor and recipients, while FLT3 was mutated only in R1. These findings were confirmed by WES, which revealed additional founder and clonal mutations, and HLA genomic loss in R2. In conclusion, we report the first in-depth genomic analysis of AML transmission following solid organ transplantation, revealing distinct clonal evolution, and providing a potential molecular explanation for tumor escape.
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Affiliation(s)
- Luigi Marchionni
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Francisco Pereira Lobo
- Department of Genetics, Ecology and Evolution, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Rumen Kostadinov
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anna Serra
- Department of Clinical and Biological Sciences, University of Turin, Torino, Italy
| | - Federico Genzano Besso
- Immunogenetics and Transplant Biology Service, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Silvia Deaglio
- Immunogenetics and Transplant Biology Service, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
- Department of Medical Sciences, University of Turin, Torino, Italy
| | - Piero Stratta
- Department of Clinical and Experimental Medicine, University of Eastern Piedmont, Novara, Italy
| | - Monica Berrino
- Immunogenetics and Transplant Biology Service, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Claudio Zanettini
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Eddie Luidy Imada
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Mohamed N. Omar
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Gianluca Gaidano
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Benedetto Bruno
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Italy
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences, University of Turin, Torino, Italy
| | - Antonio Amoroso
- Immunogenetics and Transplant Biology Service, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
- Department of Medical Sciences, University of Turin, Torino, Italy
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9
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Sainas S, Giorgis M, Circosta P, Poli G, Alberti M, Passoni A, Gaidano V, Pippione AC, Vitale N, Bonanni D, Rolando B, Cignetti A, Ramondetti C, Lanno A, Ferraris DM, Canepa B, Buccinnà B, Piccinini M, Rizzi M, Saglio G, Al-Karadaghi S, Boschi D, Miggiano R, Tuccinardi T, Lolli ML. Targeting Acute Myelogenous Leukemia Using Potent Human Dihydroorotate Dehydrogenase Inhibitors Based on the 2-Hydroxypyrazolo[1,5- a]pyridine Scaffold: SAR of the Aryloxyaryl Moiety. J Med Chem 2022; 65:12701-12724. [PMID: 36162075 PMCID: PMC9574863 DOI: 10.1021/acs.jmedchem.2c00496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Indexed: 11/28/2022]
Abstract
In recent years, human dihydroorotate dehydrogenase inhibitors have been associated with acute myelogenous leukemia as well as studied as potent host targeting antivirals. Starting from MEDS433 (IC50 1.2 nM), we kept improving the structure-activity relationship of this class of compounds characterized by 2-hydroxypyrazolo[1,5-a]pyridine scaffold. Using an in silico/crystallography supported design, we identified compound 4 (IC50 7.2 nM), characterized by the presence of a decorated aryloxyaryl moiety that replaced the biphenyl scaffold, with potent inhibition and pro-differentiating abilities on AML THP1 cells (EC50 74 nM), superior to those of brequinar (EC50 249 nM) and boosted when in combination with dipyridamole. Finally, compound 4 has an extremely low cytotoxicity on non-AML cells as well as MEDS433; it has shown a significant antileukemic activity in vivo in a xenograft mouse model of AML.
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Affiliation(s)
- Stefano Sainas
- Department
of Drug Science and Technology, University
of Turin, Via P. Giuria 9, Turin 10125, Italy
| | - Marta Giorgis
- Department
of Drug Science and Technology, University
of Turin, Via P. Giuria 9, Turin 10125, Italy
| | - Paola Circosta
- Department
of Clinical and Biological Sciences, University
of Turin, Regione Gonzole 10, Orbassano, Turin 10043, Italy
- Molecular
Biotechnology Center, University of Turin, Via Nizza 52, Turin 10126, Italy
| | - Giulio Poli
- Department
of Pharmacy, University of Pisa, Via Bonanno 6, Pisa 56126, Italy
| | - Marta Alberti
- Department
of Pharmaceutical Sciences, University of
Piemonte Orientale, Via
G. Bovio 6, Novara 28100, Italy
| | - Alice Passoni
- Laboratory
of Mass Spectrometry, Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, Milan 20156, Italy
| | - Valentina Gaidano
- Division
of Hematology and Cell Therapy, AO Ordine
Mauriziano, Largo Filippo
Turati, 62, Turin 10128, Italy
| | - Agnese C. Pippione
- Department
of Drug Science and Technology, University
of Turin, Via P. Giuria 9, Turin 10125, Italy
| | - Nicoletta Vitale
- Department
of Molecular Biotechnology and Health Sciences, University of Turin, Via Nizza 52, Turin 10126, Italy
| | - Davide Bonanni
- Department
of Drug Science and Technology, University
of Turin, Via P. Giuria 9, Turin 10125, Italy
- Life
Science Department, University of Modena, Via Università 4, Modena 41121, Italy
| | - Barbara Rolando
- Department
of Drug Science and Technology, University
of Turin, Via P. Giuria 9, Turin 10125, Italy
| | - Alessandro Cignetti
- Division
of Hematology and Cell Therapy, AO Ordine
Mauriziano, Largo Filippo
Turati, 62, Turin 10128, Italy
| | - Cristina Ramondetti
- Department
of Oncology, University of Turin, Via Michelangelo 27/B, Turin 10125, Italy
| | - Alessia Lanno
- Laboratory
of Mass Spectrometry, Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, Milan 20156, Italy
| | - Davide M. Ferraris
- Department
of Pharmaceutical Sciences, University of
Piemonte Orientale, Via
G. Bovio 6, Novara 28100, Italy
| | - Barbara Canepa
- GEM FORLAB, Via Ing.
Comotto 36, Caluso, Turin, 10014, Italy
| | - Barbara Buccinnà
- Department
of Oncology, University of Turin, Via Michelangelo 27/B, Turin 10125, Italy
| | - Marco Piccinini
- Department
of Oncology, University of Turin, Via Michelangelo 27/B, Turin 10125, Italy
| | - Menico Rizzi
- Department
of Pharmaceutical Sciences, University of
Piemonte Orientale, Via
G. Bovio 6, Novara 28100, Italy
| | - Giuseppe Saglio
- Department
of Clinical and Biological Sciences, University
of Turin, Regione Gonzole 10, Orbassano, Turin 10043, Italy
- Division
of Hematology and Cell Therapy, AO Ordine
Mauriziano, Largo Filippo
Turati, 62, Turin 10128, Italy
| | - Salam Al-Karadaghi
- Department
of Biochemistry and Structural Biology, Lund University, Naturvetarvägen
14, Box 124, Lund 221 00, Sweden
| | - Donatella Boschi
- Department
of Drug Science and Technology, University
of Turin, Via P. Giuria 9, Turin 10125, Italy
| | - Riccardo Miggiano
- Department
of Pharmaceutical Sciences, University of
Piemonte Orientale, Via
G. Bovio 6, Novara 28100, Italy
| | - Tiziano Tuccinardi
- Molecular
Biotechnology Center, University of Turin, Via Nizza 52, Turin 10126, Italy
| | - Marco L. Lolli
- Department
of Drug Science and Technology, University
of Turin, Via P. Giuria 9, Turin 10125, Italy
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10
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Saglio G. EXABS-113-CML Assessment and Management of TKI Related AOE's in CML. Clin Lymphoma Myeloma Leuk 2022; 22 Suppl 2:S14. [PMID: 36163712 DOI: 10.1016/s2152-2650(22)00645-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Giuseppe Saglio
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
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11
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Gugliotta G, Castagnetti F, Breccia M, Levato L, Intermesoli T, D'Adda M, Salvucci M, Stagno F, Rege-Cambrin G, Tiribelli M, Martino B, Bocchia M, Cedrone M, Trabacchi E, Cavazzini F, Porretto F, Sorà F, Simula MP, Albano F, Soverini S, Foà R, Pane F, Cavo M, Saglio G, Baccarani M, Rosti G. Treatment-free remission in chronic myeloid leukemia patients treated front-line with nilotinib: 10-year follow-up of the GIMEMA CML 0307 study. Haematologica 2022; 107:2356-2364. [PMID: 35385922 PMCID: PMC9521223 DOI: 10.3324/haematol.2021.280175] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Indexed: 11/09/2022] Open
Abstract
We report the final analysis, with a 10-year follow-up, of the phase II study GIMEMA CML 0307 (NCT00481052), which enrolled 73 adult patients (median age 51 years, range 18-83) with newly diagnosed chronic-phase (CP)-chronic myeloid leukemia (CML) to investigate the efficacy and the toxicity of front-line treatment with nilotinib (NIL). The initial dose was 400 mg twice daily; the dose was reduced to 300 mg twice daily as soon as this dose was approved and registered. The 10-year overall survival and progression-free survival were 94.5%. At the last contact, 36 (49.3%) patients were continuing NIL (22 patients at 300 mg twice daily, 14 at lower doses), 18 (24.7%) patients were in treatment-free remission (TFR), 14 (19.2%) were receiving other tyrosinekinase inhibitors and 4 (5.5%) patients have died. The rates of major (MMR) and deep (MR4) molecular responses by 10 years were 96% and 83%, respectively. The median time to MMR and MR4 were 6 and 18 months, respectively. After a median duration of NIL treatment of 88 months, 24 (32.9%) patients discontinued NIL while in stable deep molecular response. In these patients, the 2-years estimated treatment-free survival was 72.6%. The overall TFR rate, calculated on all enrolled patients, was 24.7% (18/73 patients). Seventeen patients (23.3%), at a median age of 69 years, had at least one arterial obstructive event. In conclusion, the use of NIL front-line in CP-CML can induce a stable TFR in a relevant number of patients, although cardiovascular toxicity remains of concern.
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Affiliation(s)
- Gabriele Gugliotta
- Istituto di Ematologia Seragnoli, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna
| | - Fausto Castagnetti
- Istituto di Ematologia Seragnoli, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna
| | - Massimo Breccia
- Hematology, Department of Translational and Precision Medicine, Policlinico Umberto I, Sapienza University, Rome
| | - Luciano Levato
- Unità di Ematologia, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro
| | | | | | | | - Fabio Stagno
- Hematology Section and BMT Unit, Rodolico Hospital, AOU Policlinico Rodolico - San Marco, Catania
| | - Giovanna Rege-Cambrin
- Unità di Medicina Interna, Ospedale San Luigi Gonzaga, Università di Torino, Orbassano
| | - Mario Tiribelli
- Clinica Ematologica, Dipartimento di Area Medica, Azienda Sanitaria Universitaria Friuli Centrale, Udine
| | - Bruno Martino
- Unità di Ematologia, Grande Ospedale Metropolitano-G.O.M. Bianchi-Melacrino-Morelli, Reggio Calabria
| | - Monica Bocchia
- Hematology Unit, Azienda Ospedaliero-Universitaria Senese, Siena University, Siena
| | | | - Elena Trabacchi
- Unità di Ematologia, Ospedale Guglielmo da Saliceto, Piacenza
| | | | | | - Federica Sorà
- Unità di Ematologia, Fondazione Policlinico Universitario A Gemelli IRCSS, Università Cattolica, Roma
| | - Maria Pina Simula
- Ematologia e Centro Trapianti Midollo Osseo, Ospedale Oncologico Businco, Cagliari
| | - Francesco Albano
- Hematology and Stem Cell Transplantation Unit, Department of Emergency and Organ Transplantation (D.E.T.O.), Aldo Moro University, Bari
| | - Simona Soverini
- Istituto di Ematologia Seragnoli, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, Policlinico Umberto I, Sapienza University, Rome
| | | | - Michele Cavo
- Istituto di Ematologia Seragnoli, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna
| | - Giuseppe Saglio
- Divisione Universitaria di Ematologia e Terapie Cellulari, A.O. Ordine Mauriziano, Turin
| | | | - Gianantonio Rosti
- IRCSS - Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola (FC)
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12
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Iurlo A, Cattaneo D, Artuso S, Consonni D, Abruzzese E, Binotto G, Bocchia M, Bonifacio M, Castagnetti F, Galimberti S, Gozzini A, Iezza M, Latagliata R, Luciano L, Maggi A, Miggiano MC, Pregno P, Rege-Cambrin G, Russo S, Scortechini AR, Tafuri A, Tiribelli M, Fava C, Rosti G, Foa R, Breccia M, Saglio G. Treatment-Free Remission in Chronic Myeloid Leukemia Patients Treated With Low-Dose TKIs: A Feasible Option Also in the Real-Life. A Campus CML Study. Front Oncol 2022; 12:839915. [PMID: 35311109 PMCID: PMC8927081 DOI: 10.3389/fonc.2022.839915] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 12/20/2021] [Accepted: 02/14/2022] [Indexed: 01/06/2023] Open
Abstract
Treatment-free remission (TFR) has become a primary therapeutic goal in CML and is also considered feasible by international guidelines. TKIs dose reduction is often used in real-life practice to reduce adverse events, although its impact on TFR is still a matter of debate. This study aimed to explore the attitude of Italian hematologists towards prescribing TKIs at reduced doses and its impact on TFR. In September 2020, a questionnaire was sent to 54 hematology centers in Italy participating to the Campus CML network. For each patient, data on the main disease characteristics were collected. Most of the hematologists involved (64.4%) believed that low-dose TKIs should not influence TFR. Indeed, this approach was offered to 194 patients. At the time of TFR, all but 3 patients had already achieved a DMR, with a median duration of 61.0 months. After a median follow-up of 29.2 months, 138 (71.1%) patients were still in TFR. Interestingly, TFR outcome was not impaired by any of the variables examined, including sex, risk scores, BCR-ABL1 transcript types, previous interferon, type and number of TKIs used before treatment cessation, degree of DMR or median duration of TKIs therapy. On the contrary, TFR was significantly better after dose reduction due to AEs; furthermore, patients with a longer DMR duration showed a trend towards prolonged TFR. This survey indicates that low-dose TKI treatment is an important reality. While one third of Italian hematologists still had some uncertainties on TFR feasibility after using reduced doses of TKIs outside of clinical trials, TFR has often been considered a safe option even in patients treated with low-dose TKIs in the real-life setting. It should be noted that only 28.9% of our cases had a molecular recurrence, less than reported during standard dose treatment. Consequently, TFR is not impaired using low-dose TKIs.
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Affiliation(s)
- Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniele Cattaneo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Silvia Artuso
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Dario Consonni
- Epidemiology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Gianni Binotto
- Department of Medicine, Hematology and Clinical Immunology, Padua School of Medicine, Padua, Italy
| | - Monica Bocchia
- Hematology Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | | | - Fausto Castagnetti
- Institute of Hematology "L. and A. Seràgnoli", Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, "S. Orsola-Malpighi" Hospital, Bologna, Italy
| | - Sara Galimberti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Miriam Iezza
- Institute of Hematology "L. and A. Seràgnoli", Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, "S. Orsola-Malpighi" Hospital, Bologna, Italy
| | | | - Luigiana Luciano
- Division of Hematology, Department of Clinical Medicine and Surgery, Federico II University, Napoli, Italy
| | | | | | - Patrizia Pregno
- Division of Hematology, AOU Città della Salute e della Scienza, Torino, Italy
| | - Giovanna Rege-Cambrin
- Division of Internal Medicine and Hematology, San Luigi Gonzaga Hospital, Turin, Italy
| | - Sabina Russo
- Division of Hematology, Dipartimento di Patologia Umana dell'Adulto e dell'Età Evolutiva, Policlinico G. Martino, University of Messina, Messina, Italy
| | - Anna Rita Scortechini
- Division of Hematology, Department of Molecular and Clinical Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Agostino Tafuri
- Division of Hematology, Azienda Ospedaliera Universitaria Sant'Andrea, Rome, Italy
| | - Mario Tiribelli
- Division of Hematology and BMT, Department of Medical and Morphological Research, University of Udine, Udine, Italy
| | - Carmen Fava
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Gianantonio Rosti
- Scientific Direction, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Robin Foa
- Division of Hematology, Department of Precision and Translational, Policlinico Umberto 1, Sapienza University, Rome, Italy
| | - Massimo Breccia
- Division of Hematology, Department of Precision and Translational, Policlinico Umberto 1, Sapienza University, Rome, Italy
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
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13
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Saglio G, Rosti G, Hehlmann R, Hochhaus A, Gale RP. Prof. Michele Baccarani. August 16, 1942 to December 20, 2021: a gifted life in haematology. Leukemia 2022. [PMCID: PMC8979815 DOI: 10.1038/s41375-022-01525-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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14
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Petiti J, Itri F, Signorino E, Frolli A, Fava C, Armenio M, Marini S, Giugliano E, Lo Iacono M, Saglio G, Cilloni D. Detection of SF3B1 p.Lys700Glu Mutation by PNA-PCR Clamping in Myelodysplastic Syndromes and Myeloproliferative Neoplasms. J Clin Med 2022; 11:jcm11051267. [PMID: 35268357 PMCID: PMC8911290 DOI: 10.3390/jcm11051267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/08/2022] [Accepted: 02/23/2022] [Indexed: 01/25/2023] Open
Abstract
Mutations in SF3B1 are found in 20% of myelodysplastic syndromes and 5–10% of myeloproliferative neoplasms, where they are considered important for diagnosis and therapy decisions. Sanger sequencing and NGS are the currently available methods to identify SF3B1 mutations, but both are time-consuming and expensive techniques that are not practicable in most small-/medium-sized laboratories. To identify the most frequent SF3B1 mutation, p.Lys700Glu, we developed a novel fast and cheap assay based on PNA-PCR clamping. After setting the optimal PCR conditions, the limit of detection of PNA-PCR clamping was evaluated, and the method allowed up to 0.1% of mutated SF3B1 to be identified. Successively, PNA-PCR clamping and Sanger sequencing were used to blind test 90 DNA from patients affected by myelodysplastic syndromes and myeloproliferative neoplasms for the SF3B1 p.Lys700Glu mutation. PNA-PCR clamping and Sanger sequencing congruently identified 75 negative and 13 positive patients. Two patients identified as positive by PNA-PCR clamping were missed by Sanger analysis. The discordant samples were analyzed by NGS, which confirmed the PNA-PCR clamping result, indicating that these samples contained the SF3B1 p.Lys700Glu mutation. This approach could easily increase the characterization of myelodysplastic syndromes and myeloproliferative neoplasms in small-/medium-sized laboratories, and guide patients towards more appropriate therapy.
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Affiliation(s)
- Jessica Petiti
- Department of Clinical and Biological Sciences, University of Turin, 10043 Orbassano, Italy; (F.I.); (E.S.); (A.F.); (C.F.); (G.S.); (D.C.)
- Correspondence: (J.P.); (M.L.I.); Tel.: +39-011-670-5480 (J.P.); +39-011-670-5489 (M.L.I.)
| | - Federico Itri
- Department of Clinical and Biological Sciences, University of Turin, 10043 Orbassano, Italy; (F.I.); (E.S.); (A.F.); (C.F.); (G.S.); (D.C.)
| | - Elisabetta Signorino
- Department of Clinical and Biological Sciences, University of Turin, 10043 Orbassano, Italy; (F.I.); (E.S.); (A.F.); (C.F.); (G.S.); (D.C.)
| | - Antonio Frolli
- Department of Clinical and Biological Sciences, University of Turin, 10043 Orbassano, Italy; (F.I.); (E.S.); (A.F.); (C.F.); (G.S.); (D.C.)
| | - Carmen Fava
- Department of Clinical and Biological Sciences, University of Turin, 10043 Orbassano, Italy; (F.I.); (E.S.); (A.F.); (C.F.); (G.S.); (D.C.)
| | - Marco Armenio
- Department of Molecular Biotechnology and Health Sciences, University of Turin, 10126 Turin, Italy;
| | - Silvia Marini
- Division of Internal Medicine and Hematology, San Luigi Gonzaga Hospital, 10043 Orbassano, Italy; (S.M.); (E.G.)
| | - Emilia Giugliano
- Division of Internal Medicine and Hematology, San Luigi Gonzaga Hospital, 10043 Orbassano, Italy; (S.M.); (E.G.)
| | - Marco Lo Iacono
- Department of Clinical and Biological Sciences, University of Turin, 10043 Orbassano, Italy; (F.I.); (E.S.); (A.F.); (C.F.); (G.S.); (D.C.)
- Correspondence: (J.P.); (M.L.I.); Tel.: +39-011-670-5480 (J.P.); +39-011-670-5489 (M.L.I.)
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences, University of Turin, 10043 Orbassano, Italy; (F.I.); (E.S.); (A.F.); (C.F.); (G.S.); (D.C.)
| | - Daniela Cilloni
- Department of Clinical and Biological Sciences, University of Turin, 10043 Orbassano, Italy; (F.I.); (E.S.); (A.F.); (C.F.); (G.S.); (D.C.)
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15
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Houshmand M, Kazemi A, Anjam Najmedini A, Ali MS, Gaidano V, Cignetti A, Fava C, Cilloni D, Saglio G, Circosta P. Shedding Light on Targeting Chronic Myeloid Leukemia Stem Cells. J Clin Med 2021; 10:jcm10245805. [PMID: 34945101 PMCID: PMC8708315 DOI: 10.3390/jcm10245805] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 12/06/2021] [Indexed: 12/12/2022] Open
Abstract
Chronic myeloid leukemia stem cells (CML LSCs) are a rare and quiescent population that are resistant to tyrosine kinase inhibitors (TKI). When TKI therapy is discontinued in CML patients in deep, sustained and apparently stable molecular remission, these cells in approximately half of the cases restart to grow, resuming the leukemic process. The elimination of these TKI resistant leukemic stem cells is therefore an essential step in increasing the percentage of those patients who can reach a successful long-term treatment free remission (TFR). The understanding of the biology of the LSCs and the identification of the differences, phenotypic and/or metabolic, that could eventually allow them to be distinguished from the normal hematopoietic stem cells (HSCs) are therefore important steps in designing strategies to target LSCs in a rather selective way, sparing the normal counterparts.
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Affiliation(s)
- Mohammad Houshmand
- Department of Clinical Biological Sciences, University of Turin, San Luigi University Hospital, 10043 Turin, Italy; (M.H.); (M.S.A.); (C.F.); (D.C.); (P.C.)
| | - Alireza Kazemi
- Department of Hematology and Blood Banking, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran 1971653313, Iran; (A.K.); (A.A.N.)
| | - Ali Anjam Najmedini
- Department of Hematology and Blood Banking, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran 1971653313, Iran; (A.K.); (A.A.N.)
| | - Muhammad Shahzad Ali
- Department of Clinical Biological Sciences, University of Turin, San Luigi University Hospital, 10043 Turin, Italy; (M.H.); (M.S.A.); (C.F.); (D.C.); (P.C.)
| | - Valentina Gaidano
- Division of Hematology, A.O. SS Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy;
| | - Alessandro Cignetti
- Division of Hematology and Cell Therapy, A.O. Ordine Mauriziano, 10128 Turin, Italy;
| | - Carmen Fava
- Department of Clinical Biological Sciences, University of Turin, San Luigi University Hospital, 10043 Turin, Italy; (M.H.); (M.S.A.); (C.F.); (D.C.); (P.C.)
| | - Daniela Cilloni
- Department of Clinical Biological Sciences, University of Turin, San Luigi University Hospital, 10043 Turin, Italy; (M.H.); (M.S.A.); (C.F.); (D.C.); (P.C.)
| | - Giuseppe Saglio
- Department of Clinical Biological Sciences, University of Turin, San Luigi University Hospital, 10043 Turin, Italy; (M.H.); (M.S.A.); (C.F.); (D.C.); (P.C.)
- Correspondence:
| | - Paola Circosta
- Department of Clinical Biological Sciences, University of Turin, San Luigi University Hospital, 10043 Turin, Italy; (M.H.); (M.S.A.); (C.F.); (D.C.); (P.C.)
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16
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Breccia M, Abruzzese E, Accurso V, Attolico I, Barulli S, Bergamaschi M, Binotto G, Bocchia M, Bonifacio M, Caocci G, Capodanno I, Castagnetti F, Cavazzini F, Crisà E, Crugnola M, Stella De Candia M, Elena C, Fava C, Galimberti S, Gozzini A, Gugliotta G, Intermesoli T, Iurlo A, La Barba G, Latagliata R, Leonetti Crescenzi S, Levato L, Loglisci G, Lucchesi A, Luciano L, Lunghi F, Luzi D, Malato A, Cristina Miggiano M, Pizzuti M, Pregno P, Rapezzi D, Rege-Cambrin G, Rosti G, Russo S, Sancetta R, Rita Scortechini A, Sorà F, Sportoletti P, Stagno F, Tafuri A, Tiribelli M, Foà R, Saglio G. COVID-19 infection in chronic myeloid leukaemia after one year of the pandemic in Italy. A Campus CML report. Br J Haematol 2021; 196:559-565. [PMID: 34636033 PMCID: PMC8652631 DOI: 10.1111/bjh.17890] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 07/11/2021] [Revised: 09/21/2021] [Accepted: 09/27/2021] [Indexed: 11/30/2022]
Abstract
Limited information is available on the impact of the COVID-19 pandemic on the management of chronic myeloid leukaemia (CML). The Campus CML network collected retrospective information on 8 665 CML patients followed at 46 centres throughout Italy during the pandemic between February 2020 and January 2021. Within this cohort, we recorded 217 SARS-CoV-2-positive patients (2·5%). Most patients (57%) were diagnosed as having SARS-CoV-2 infection during the second peak of the pandemic (September 2020 to January 2021). The majority (35%) was aged between 50 and 65 years with a male prevalence (73%). Fifty-six percent of patients presented concomitant comorbidities. The median time from CML diagnosis to SARS-CoV-2 infection was six years (three months to 18 years). Twenty-one patients (9·6%) required hospitalization without the need of respiratory assistance, 18 (8·2%) were hospitalized for respiratory assistance, 8 (3·6%) were admitted to an intensive care unit, while 170 (78%) were only quarantined. Twenty-three percent of patients discontinued tyrosine kinase inhibitor (TKI) therapy during the infection. Twelve patients died due to COVID-19 with a mortality rate of 5·5% in the positive cohort and of 0·13% in the whole cohort. We could also document sequelae caused by the SARS-CoV-2 infection and an impact of the pandemic on the overall management of CML patients.
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Affiliation(s)
- Massimo Breccia
- Department of Translational and Precision Medicine, Sapienza University, Roma, Italy
| | | | - Vincenzo Accurso
- UO di Ematologia con Trapianto, AU Policlinico Paolo Giaccone, Palermo, Italy
| | - Immacolata Attolico
- UO Ematologia con Trapianto, Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Sara Barulli
- Divisione di Ematologia di Muraglia, CTMO Ospedale San Salvatore, Pesaro, Italy
| | | | - Gianni Binotto
- Ematologia ed Immunologia Clinica, Università degli Studi di Padova, Padova, Italy
| | - Monica Bocchia
- U.O.C. Ematologia e Trapianti, A.O. Senese - Policlinico 'Le Scotte', Siena, Italy
| | - Massimiliano Bonifacio
- Divisione di Ematologia, Istituti Ospitalieri di Verona, Policlinico G.B. Rossi, Verona, Italy
| | | | | | - Fausto Castagnetti
- Istituto di Ematologia 'Lorenzo e A. Seragnoli', Policlinico S. Orsola-Malpighi, Bologna, Italy
| | | | - Elena Crisà
- S.C.D.U. Ematologia - DIMECS e Dipartimento Oncologico, Università del Piemonte Orientale Amedeo Avogadro, Novara, Italy
| | | | | | - Chiara Elena
- Ematologia, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Carmen Fava
- A.S.O. Ordine Mauriziano, P.O. Umberto I, Struttura Complessa a Direzione Universitaria-Ematologia e Terapie Cellulari, Torino, Italy
| | - Sara Galimberti
- Ematologia, Università di Pisa - Azienda Ospedaliera Pisana, Pisa, Italy
| | - Antonella Gozzini
- Unità di Ricerca e di Malattie del Sangue, Ematologia San Luca Vecchio, Firenze, Italy
| | - Gabriele Gugliotta
- Istituto di Ematologia 'Lorenzo e A. Seragnoli', Policlinico S. Orsola-Malpighi, Bologna, Italy
| | | | - Alessandra Iurlo
- UOC Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | | | | | | | | | - Alessandro Lucchesi
- Ematologia, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) 'Dino Amadori', Meldola, Italy
| | - Luigiana Luciano
- Ematologia, Azienda Ospedaliera Universitaria - Università degli Studi di Napoli 'Federico II', Napoli, Italy
| | | | - Debora Luzi
- Ematologia, A.O. Santa Maria - Terni S.C Oncoematologia, Terni, Italy
| | | | | | | | - Patrizia Pregno
- Dipartimento di Oncologia ed Ematologia S.C. Ematologia 2, A.O. Città della Salute e della Scienza di Torino S. G. Battista, Torino, Italy
| | | | - Giovanna Rege-Cambrin
- Dipartimento di Scienze Cliniche e Biologiche, Ospedale S. Luigi Gonzaga-Medicina Interna 2, Orbassano, Italy
| | - Gianantonio Rosti
- Ematologia, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) 'Dino Amadori', Meldola, Italy
| | - Sabina Russo
- Dipartimento di Medicina Interna, Azienda Ospedaliera Universitaria - Policlinico G. Martino, Messina, Italy
| | | | | | - Federica Sorà
- Ematologia, Policlinico Gemelli - Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - Fabio Stagno
- Hematology Section and BMT Unit, AOU Policlinico 'Rodolico-San Marco', Catania, Italy
| | | | - Mario Tiribelli
- Clinica Ematologica-Centro Trapianti e Terapie cellulari, Azienda Ospedaliero-Universitaria, Udine, Italy
| | - Robin Foà
- Department of Translational and Precision Medicine, Sapienza University, Roma, Italy
| | - Giuseppe Saglio
- A.S.O. Ordine Mauriziano, Struttura Complessa a Direzione Universitaria-Ematologia e Terapie Cellulari-, P.O. Umberto I, Torino, Italy
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17
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Specchia G, Pregno P, Breccia M, Castagnetti F, Monagheddu C, Bonifacio M, Tiribelli M, Stagno F, Caocci G, Martino B, Luciano L, Pizzuti M, Gozzini A, Scortechini AR, Albano F, Bergamaschi M, Capodanno I, Patriarca A, Fava C, Rege-Cambrin G, Sorà F, Galimberti S, Bocchia M, Binotto G, Reddiconto G, DiTonno P, Maggi A, Sanpaolo G, De Candia MS, Giai V, Abruzzese E, Miggiano MC, La Barba G, Pietrantuono G, Guella A, Levato L, Mulas O, Saccona F, Rosti G, Musto P, Di Raimondo F, Pane F, Baccarani M, Saglio G, Ciccone G. Prognostic Factors for Overall Survival In Chronic Myeloid Leukemia Patients: A Multicentric Cohort Study by the Italian CML GIMEMA Network. Front Oncol 2021; 11:739171. [PMID: 34513714 PMCID: PMC8427308 DOI: 10.3389/fonc.2021.739171] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 08/06/2021] [Indexed: 11/13/2022] Open
Abstract
An observational prospective study was conducted by the CML Italian network to analyze the role of baseline patient characteristics and first line treatments on overall survival and CML-related mortality in 1206 newly diagnosed CML patients, 608 treated with imatinib (IMA) and 598 with 2nd generation tyrosine kinase inhibitors (2GTKI). IMA-treated patients were much older (median age 69 years, IQR 58-77) than the 2GTKI group (52, IQR 41-63) and had more comorbidities. Estimated 4-year overall survival of the entire cohort was 89% (95%CI 85.9-91.4). Overall, 73 patients (6.1%) died: 17 (2.8%) in the 2GTKI vs 56 (9.2%) in the IMA cohort (adjusted HR=0.50; 95% CI=0.26-0.94), but no differences were detected for CML-related mortality (10 (1.7%) vs 11 (1.8%) in the 2GTKIs vs IMA cohort (sHR=1.61; 0.52-4.96). The ELTS score was associated to CML mortality (high risk vs low, HR=9.67; 95%CI 2.94-31.74; p<0.001), while age (per year, HR=1.03; 95%CI 1.00-1.06; p=0.064), CCI (4-5 vs 2, HR=5.22; 95%CI 2.56-10.65; p<0.001), ELTS score (high risk vs low, HR=3.11; 95%CI 1.52-6.35, p=0.002) and 2GTKI vs IMA (HR=0.26; 95%CI 0.10-0.65, p=0.004) were associated to an increased risk of non-related CML mortality. The ELTS score showed a better discriminant ability than the Sokal score in all comparisons.
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Affiliation(s)
- Giorgina Specchia
- Former Full Professor of Hematology- University of Bari Aldo Moro" Bari GIMEMA WP CML, Bari, Italy
| | - Patrizia Pregno
- Haematology Unit, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Massimo Breccia
- Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Roma, Italy
| | - Fausto Castagnetti
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Chiara Monagheddu
- Clinical Epidemiology Unit and CPO Piemonte, Città della Salute e della Scienza, Torino, Italy
| | | | - Mario Tiribelli
- Division of Hematology and BMT, Department of Medical Area, University of Udine, Udine, Italy
| | - Fabio Stagno
- Division of Hematology and Bone Marrow Transplant, Azienda Ospedaliera-Universitaria (AOU) Policlinico-V. Emanuele, Catania, Italy
| | - Giovanni Caocci
- Department of Medical Sciences and Public Health, Businco Hospital, University of Cagliari, Cagliari, Italy
| | - Bruno Martino
- Haematology Unit, Azienda Ospedaliera "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Luigiana Luciano
- Haematology Unit "Federico II", University of Naples, Naples, Italy
| | - Michele Pizzuti
- Department of Hematology, "San Carlo" Regional Hospital, Potenza, Italy
| | - Antonella Gozzini
- Haematology Unit, AOU Careggi, University of Florence, Florence, Italy
| | - Anna Rita Scortechini
- Division of Hematology, Department of Molecular and Clinical Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Francesco Albano
- Department of Emergency and Transplantation, Hematology Section, University of Bari Medical School, Bari, Italy
| | | | - Isabella Capodanno
- Department of Hematology, Azienda UNITà SANITARIA LOCALE (USL)-IRCCS di Reggio Emilia, Viale Risorgimento, Reggio Emilia, Italy
| | - Andrea Patriarca
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Carmen Fava
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | | | - Federica Sorà
- Institute of Hematology, Università Cattolica Sacro Cuore, Rome, Italy
| | - Sara Galimberti
- Department of Clinical and Experimental Medicine, Unità Operativa (UO) Haematology, AOU Pisana, Pisa, Italy
| | - Monica Bocchia
- Haematology Unit, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | | | - Giovanni Reddiconto
- Department of Ematologia, Lecce Ematologia Ospedale Vito Fazzi, Lecce, Italy
| | - Paolo DiTonno
- Haematology Unit, National Cancer Center, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | | | - Grazia Sanpaolo
- Department of Hematology and Stem Cell Transplantation Unit, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | | | - Valentina Giai
- Haematology Unit, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Elisabetta Abruzzese
- Hemoglobinopathies Unit, Hematology Department, S. Eugenio Hospital (ASL Roma 2), Rome, Italy
| | | | - Gaetano La Barba
- Department of Hematology, "Spirito Santo" Hospital, Pescara, Italy
| | - Giuseppe Pietrantuono
- Hematology Oncology, IRCCS Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture, Italy
| | - Anna Guella
- Hematology Unit, Santa Chiara Hospital, Trento, Italy
| | - Luciano Levato
- Haematology Unit, A. Pugliese Hospital, Azienda Ospedaliera Pugliese Ciaccio, Catanzaro, Italy
| | - Olga Mulas
- Department of Medical Sciences and Public Health, Businco Hospital, University of Cagliari, Cagliari, Italy
| | - Fabio Saccona
- Clinical Epidemiology Unit and CPO Piemonte, Città della Salute e della Scienza, Torino, Italy
| | - Gianantonio Rosti
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Pellegrino Musto
- Department of Emergency and Transplantation, Hematology Section, University of Bari Medical School, Bari, Italy
| | - Francesco Di Raimondo
- Division of Hematology and Bone Marrow Transplant, Azienda Ospedaliera-Universitaria (AOU) Policlinico-V. Emanuele, Catania, Italy
| | - Fabrizio Pane
- Haematology Unit "Federico II", University of Naples, Naples, Italy
| | - Michele Baccarani
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Giovannino Ciccone
- Clinical Epidemiology Unit and CPO Piemonte, Città della Salute e della Scienza, Torino, Italy
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18
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Vannucchi AM, Mortara A, D’Alessio A, Morelli M, Tedeschi A, Festuccia MB, Monforte AD, Capochiani E, Selleri C, Simonetti F, Saracino A, Rapezzi D, Badagliacca MR, Falasca K, Molteni A, Palazzolo R, Schettino G, Bocchia M, Turrini M, Ascierto PA, Zuurman M, Paley C, Coco P, Saglio G. JAK Inhibition with Ruxolitinib in Patients with COVID-19 and Severe Pneumonia: Multicenter Clinical Experience from a Compassionate Use Program in Italy. J Clin Med 2021; 10:jcm10163752. [PMID: 34442045 PMCID: PMC8397012 DOI: 10.3390/jcm10163752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/10/2021] [Accepted: 08/20/2021] [Indexed: 12/15/2022] Open
Abstract
Jak inhibitors are potent anti-inflammatory drugs that have the potential to dampen the hyperactive inflammatory response associated with severe COVID-19. We reviewed the clinical outcomes of 218 patients with COVID-19 hospitalized for severe pneumonia and treated with ruxolitinib through a compassionate use program. Data on the duration of treatment; outcomes at 4, 7, 14, and 28 days; oxygen support requirements; clinical status; and laboratory parameters were retrospectively collected. Overall, according to the physician evaluation, 66.5% of patients showed improvement at follow-up; of these, 83.5% showed improvement by day 7. Oxygen support status also showed improvement, and by day 7, 21.6% of patients were on ambient air, compared with 1.4% at baseline, which increased to 48.2% by day 28. Significant decreases in C-reactive protein and increases in the lymphocyte total count were already observed by day 4, which seemed to correlate with a positive outcome. At the end of the observation period, 87.2% of patients were alive. No unexpected safety findings were observed, and grade 3/4 adverse events were reported in 6.9% of patients.
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Affiliation(s)
- Alessandro Maria Vannucchi
- Center Research Innovation of Myeloproliferative Neoplasms (CRIMM), SOD Hematology, University of Florence and AOU Careggi, 50134 Florence, Italy;
| | - Andrea Mortara
- Department of Clinical Cardiology, Policlinico di Monza, 28100 Monza, Italy;
| | - Andrea D’Alessio
- COVID Medical Department, Policlinico S. Marco, Gruppo San Donato University and Research Hospital, 24040 Zingonia, Italy;
| | - Mara Morelli
- Novartis Farma SpA, 21040 Origgio, Italy; (M.M.); (M.Z.); (P.C.)
| | - Alberto Tedeschi
- U.O.C. Medicina Generale, Ospedale Bolognini, ASST Bergamo Est, 24068 Seriate, Italy;
| | | | | | - Enrico Capochiani
- UOC Ematologia, Azienda USL Toscana Nord Ovest, 57124 Livorno, Italy;
| | - Carmine Selleri
- Hematology, Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy;
| | | | - Annalisa Saracino
- Clinica Malattie Infettive, Dip. Scienze Biomediche ed Oncologia Umana, Università degli Studi di Bari, 70124 Bari, Italy;
| | - Davide Rapezzi
- S.C. Ematologia Ospedale S. Croce e Carle, 12100 Cuneo, Italy;
| | - Maria Rita Badagliacca
- UOS UFA UOC Farmacia Ospedaliera Distretto Ospedaliero CL1-P.O.S. Elia, Azienda Sanitaria Provinciale di Caltanissetta, 93100 Caltanissetta, Italy;
| | - Katia Falasca
- Clinic of Infectious Diseases, Department of Medicine and Science of Aging, University G. d’Annunzio, Chieti-Pescara, 66100 Chieti, Italy;
| | | | | | | | - Monica Bocchia
- Hematology Unit, University of Siena, Azienda Ospedaliero Universitaria Senese, 53100 Siena, Italy;
| | - Mauro Turrini
- Division of Hematology, Department of Medicine, Valduce Hospital, 22100 Como, Italy;
| | - Paolo A. Ascierto
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale per lo Studio e la Cura dei Tumori IRCCS Fondazione G. Pascale, 80131 Naples, Italy;
| | - Mike Zuurman
- Novartis Farma SpA, 21040 Origgio, Italy; (M.M.); (M.Z.); (P.C.)
- Novartis Pharma BV, 1101 Amsterdam, The Netherlands
| | | | - Paola Coco
- Novartis Farma SpA, 21040 Origgio, Italy; (M.M.); (M.Z.); (P.C.)
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences of the University of Turin, San Luigi University Hospital, 10143 Orbassano, Italy
- Correspondence:
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19
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Mughal TI, Psaila B, DeAngelo DJ, Saglio G, Van Etten RA, Radich JP. Interrogating the molecular genetics of chronic myeloproliferative malignancies for personalized management in 2021. Haematologica 2021; 106:1787-1793. [PMID: 33657787 PMCID: PMC8252942 DOI: 10.3324/haematol.2020.267252] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 01/13/2021] [Indexed: 12/15/2022] Open
Affiliation(s)
- Tariq I Mughal
- Tufts University Medical Center, Boston, MA, USA; University of Buckingham Medical School, Buckingham.
| | - Bethan Psaila
- MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford
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20
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Kantarjian HM, Hughes TP, Larson RA, Kim DW, Issaragrisil S, le Coutre P, Etienne G, Boquimpani C, Pasquini R, Clark RE, Dubruille V, Flinn IW, Kyrcz-Krzemien S, Medras E, Zanichelli M, Bendit I, Cacciatore S, Titorenko K, Aimone P, Saglio G, Hochhaus A. Correction to: Long-term outcomes with frontline nilotinib versus imatinib in newly diagnosed chronic myeloid leukemia in chronic phase: ENESTnd 10-year analysis. Leukemia 2021; 35:2142-2143. [PMID: 34108614 DOI: 10.1038/s41375-021-01306-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Timothy P Hughes
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,University of Adelaide, Adelaide, SA, Australia
| | - Richard A Larson
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | - Dong-Wook Kim
- Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | | | | | | | - Carla Boquimpani
- Hemorio, Institute of Hematology, Rio de Janeiro, Brazil.,Oncoclínica Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ricardo Pasquini
- Universidade Federal do Paraná, Hospital de Clinicas, Curitiba, Paraná, Brazil
| | - Richard E Clark
- Royal Liverpool University Hospital, Liverpool, United Kingdom
| | | | - Ian W Flinn
- Sarah Cannon Research Institute, Nashville, TN, USA
| | - Slawomira Kyrcz-Krzemien
- Department of Hematology and Bone Marrow Transplantation, Medical University of Silesia, Katowice, Poland
| | - Ewa Medras
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Maria Zanichelli
- Instituto de Tratamento do Câncer Infantil, Instituto da Criança, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil
| | - Israel Bendit
- Laboratory of Medical Investigation in Pathogenesis and Targeted Therapy in Onco-Immuno-Hematology (LIM-31), Department of Hematology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Ksenia Titorenko
- Novartis Pharmaceuticals Corporation, Moscow, Russian Federation
| | | | - Giuseppe Saglio
- Division of Internal Medicine and Hematology, University of Turin, Turin, Italy
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21
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Breccia M, Pregno P, Castagnetti F, Bonifacio M, Tiribelli M, Gozzini A, Scortechini AR, Luciano L, Martino B, Stagno F, Caocci G, La Barba G, Pizzuti M, Ciccone G, Saglio G, Specchia G. Eutos long-term survival score discriminates different Sokal score categories in chronic myeloid leukemia patients, showing better survival prediction. Analysis of the GIMEMA CML observational study. Leukemia 2021; 35:1814-1816. [PMID: 34002030 DOI: 10.1038/s41375-021-01292-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/21/2021] [Accepted: 05/07/2021] [Indexed: 12/30/2022]
Affiliation(s)
- Massimo Breccia
- Department of Translational and Precision Medicine, Az. Policlinico Umberto I-Sapienza University, Rome, Italy.
| | - Patrizia Pregno
- Hematology Unit, Az Ospedaliero Universitaria Città' della Salute e della Scienza, Torino, Italy
| | - Fausto Castagnetti
- Institute of Hematology "L. and A. Seràgnoli", Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, "S. Orsola-Malpighi" Hospital, Bologna, Italy
| | | | - Mario Tiribelli
- Division of Hematology and BMT, Department of Medical Area, University of Udine, Udine, Italy
| | - Antonella Gozzini
- Hematology Unit, AOU Careggi, University of Florence, Florence, Italy
| | - Anna Rita Scortechini
- Division of Hematology, Azienda Ospedaliero Universitaria Ospedali Riuniti Ancona, Ancona, Italy
| | - Luigiana Luciano
- Hematology Unit, Federico II University of Naples, Napoli, Italy
| | - Bruno Martino
- Hematology Unit, A.O. Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Fabio Stagno
- Hematology Section, Ferrarotto Hospital, Catania, Italy
| | - Giovanni Caocci
- Department of Medical Sciences and Public Health, University of Cagliari, Businco Hospital, Cagliari, Italy
| | - Gaetano La Barba
- Department of Hematology, "Spirito Santo" Hospital, Pescara, Italy
| | | | - Giovannino Ciccone
- Unit of Clinical Epidemiology, CPO Piemonte, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Giuseppe Saglio
- Divisione Universitaria di Ematologia e Terapie Cellulari, A.O. Ordine Mauriziano, Turin, Italy
| | - Giorgina Specchia
- Hematology Section, Department of Emergency and Transplantation - GIMEMA WP CML, University of Bari Aldo Moro, Bari, Italy
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22
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Sainas S, Giorgis M, Circosta P, Gaidano V, Bonanni D, Pippione AC, Bagnati R, Passoni A, Qiu Y, Cojocaru CF, Canepa B, Bona A, Rolando B, Mishina M, Ramondetti C, Buccinnà B, Piccinini M, Houshmand M, Cignetti A, Giraudo E, Al-Karadaghi S, Boschi D, Saglio G, Lolli ML. Targeting Acute Myelogenous Leukemia Using Potent Human Dihydroorotate Dehydrogenase Inhibitors Based on the 2-Hydroxypyrazolo[1,5- a]pyridine Scaffold: SAR of the Biphenyl Moiety. J Med Chem 2021; 64:5404-5428. [PMID: 33844533 PMCID: PMC8279415 DOI: 10.1021/acs.jmedchem.0c01549] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Indexed: 02/08/2023]
Abstract
The connection with acute myelogenous leukemia (AML) of dihydroorotate dehydrogenase (hDHODH), a key enzyme in pyrimidine biosynthesis, has attracted significant interest from pharma as a possible AML therapeutic target. We recently discovered compound 1, a potent hDHODH inhibitor (IC50 = 1.2 nM), able to induce myeloid differentiation in AML cell lines (THP1) in the low nM range (EC50 = 32.8 nM) superior to brequinar's phase I/II clinical trial (EC50 = 265 nM). Herein, we investigate the 1 drug-like properties observing good metabolic stability and no toxic profile when administered at doses of 10 and 25 mg/kg every 3 days for 5 weeks (Balb/c mice). Moreover, in order to identify a backup compound, we investigate the SAR of this class of compounds. Inside the series, 17 is characterized by higher potency in inducing myeloid differentiation (EC50 = 17.3 nM), strong proapoptotic properties (EC50 = 20.2 nM), and low cytotoxicity toward non-AML cells (EC30(Jurkat) > 100 μM).
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Affiliation(s)
- Stefano Sainas
- Department
of Drug Science and Technology, University
of Turin, Via P. Giuria 9, Turin 10125, Italy
| | - Marta Giorgis
- Department
of Drug Science and Technology, University
of Turin, Via P. Giuria 9, Turin 10125, Italy
| | - Paola Circosta
- Department
of Clinical and Biological Sciences, University
of Turin, Regione Gonzole 10, Orbassano, Turin 10043, Italy
- Molecular
Biotechnology Center, University of Turin, Via Nizza 52, Turin 10126, Italy
| | - Valentina Gaidano
- Department
of Clinical and Biological Sciences, University
of Turin, Regione Gonzole 10, Orbassano, Turin 10043, Italy
- Division
of Hematology, AO SS Antonio e Biagio e
Cesare Arrigo, Via Venezia
16, Alessandria 15121, Italy
| | - Davide Bonanni
- Department
of Drug Science and Technology, University
of Turin, Via P. Giuria 9, Turin 10125, Italy
| | - Agnese C. Pippione
- Department
of Drug Science and Technology, University
of Turin, Via P. Giuria 9, Turin 10125, Italy
| | - Renzo Bagnati
- Department
of Environmental Health Sciences, Istituto
di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, Milano 20156, Italy
| | - Alice Passoni
- Department
of Environmental Health Sciences, Istituto
di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, Milano 20156, Italy
| | - Yaqi Qiu
- Laboratory
of Tumor Microenvironment, Candiolo Cancer
Institute, FPO, IRCCS, Candiolo, Strada Provinciale, 142-KM 3.95, Candiolo, Turin 10060, Italy
- Higher
Education Mega Center, Institutes for Life Sciences, South China University of Technology, Guangzhou 510641, China
| | - Carina Florina Cojocaru
- Laboratory
of Tumor Microenvironment, Candiolo Cancer
Institute, FPO, IRCCS, Candiolo, Strada Provinciale, 142-KM 3.95, Candiolo, Turin 10060, Italy
| | - Barbara Canepa
- Gem
Forlab srl, Via Ribes,
5, Colleretto Giacosa, Turin 10010, Italy
| | - Alessandro Bona
- Gem
Chimica srl, Via Maestri
del Lavoro, 25, Busca, Cuneo 12022, Italy
| | - Barbara Rolando
- Department
of Drug Science and Technology, University
of Turin, Via P. Giuria 9, Turin 10125, Italy
| | - Mariia Mishina
- Department
of Drug Science and Technology, University
of Turin, Via P. Giuria 9, Turin 10125, Italy
| | - Cristina Ramondetti
- Department
of Oncology, University of Turin, Via Michelangelo 27/B, Turin 10125, Italy
| | - Barbara Buccinnà
- Department
of Oncology, University of Turin, Via Michelangelo 27/B, Turin 10125, Italy
| | - Marco Piccinini
- Department
of Oncology, University of Turin, Via Michelangelo 27/B, Turin 10125, Italy
| | - Mohammad Houshmand
- Department
of Clinical and Biological Sciences, University
of Turin, Regione Gonzole 10, Orbassano, Turin 10043, Italy
- Molecular
Biotechnology Center, University of Turin, Via Nizza 52, Turin 10126, Italy
| | - Alessandro Cignetti
- Division
of Hematology and Cell Therapy, AO Ordine
Mauriziano, Largo Filippo Turati, 62, Turin 10128, Italy
| | - Enrico Giraudo
- Department
of Drug Science and Technology, University
of Turin, Via P. Giuria 9, Turin 10125, Italy
- Laboratory
of Tumor Microenvironment, Candiolo Cancer
Institute, FPO, IRCCS, Candiolo, Strada Provinciale, 142-KM 3.95, Candiolo, Turin 10060, Italy
| | - Salam Al-Karadaghi
- Department
of Biochemistry and Structural Biology, Lund University, Naturvetarvägen 14, Box 124, Lund 221 00, Sweden
| | - Donatella Boschi
- Department
of Drug Science and Technology, University
of Turin, Via P. Giuria 9, Turin 10125, Italy
| | - Giuseppe Saglio
- Department
of Clinical and Biological Sciences, University
of Turin, Regione Gonzole 10, Orbassano, Turin 10043, Italy
- Division
of Hematology and Cell Therapy, AO Ordine
Mauriziano, Largo Filippo Turati, 62, Turin 10128, Italy
| | - Marco L. Lolli
- Department
of Drug Science and Technology, University
of Turin, Via P. Giuria 9, Turin 10125, Italy
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23
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Castagnetti F, Pane F, Rosti G, Saglio G, Breccia M. Dosing Strategies for Improving the Risk-Benefit Profile of Ponatinib in Patients With Chronic Myeloid Leukemia in Chronic Phase. Front Oncol 2021; 11:642005. [PMID: 33796468 PMCID: PMC8009177 DOI: 10.3389/fonc.2021.642005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 01/29/2021] [Indexed: 01/01/2023] Open
Abstract
The treatment of chronic myeloid leukemia (CML) has been advanced by the development of small-molecule tyrosine kinase inhibitors (TKIs), which target the fusion protein BCR-ABL1 expressed by the Philadelphia chromosome. Ponatinib is a 3rd generation TKI that binds BCR-ABL1 with high affinity and inhibits most BCR-ABL1 mutants, including the T315I mutation. The approved starting dose of ponatinib is 45 mg once daily (full dose), however, the need for a full dose, especially in patients with dose adjustments due to tolerability problems, remains undemonstrated. Lower starting doses of ponatinib (30 mg or 15 mg once daily) for patients “with lesser degrees of resistance or multiple intolerances, especially those with an increased cardiovascular risk profile” has been recommended by the 2020 European LeukemiaNet. However, the available literature and guidance on the use of ponatinib at low dosage are limited. The objective of this paper is to describe how we select ponatinib dosage for CML patients in chronic phase in our clinical practice based on the available evidence and our clinical experience. We propose dosing regimens for the optimal starting dose for six generic cases of CML patients in chronic phase eligible for the switch to ponatinib and provide an algorithm to guide ponatinib dosing during treatment.
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Affiliation(s)
- Fausto Castagnetti
- Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Fabrizio Pane
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Napoli, Italy
| | - Gianantonio Rosti
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Giuseppe Saglio
- Division of Hematology & Internal Medicine, Department of Clinical & Biological Sciences of the University of Turin, 'San Luigi Gonzaga' University Hospital, Orbassano, Italy
| | - Massimo Breccia
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
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Radich JP, Hochhaus A, Masszi T, Hellmann A, Stentoft J, Casares MTG, García-Gutiérrez JV, Conneally E, le Coutre PD, Gattermann N, Martino B, Saussele S, Giles FJ, Ross DM, Aimone P, Li S, Titorenko K, Saglio G. Treatment-free remission following frontline nilotinib in patients with chronic phase chronic myeloid leukemia: 5-year update of the ENESTfreedom trial. Leukemia 2021; 35:1344-1355. [PMID: 33707652 PMCID: PMC8102196 DOI: 10.1038/s41375-021-01205-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/01/2021] [Accepted: 02/18/2021] [Indexed: 02/03/2023]
Abstract
The ENESTfreedom trial assessed the feasibility of treatment-free remission (TFR) in patients with chronic myeloid leukemia in chronic phase (CML-CP) following frontline nilotinib treatment. Results for long-term outcomes after a 5-year follow-up are presented herein. Patients who had received ≥2 years of frontline nilotinib therapy and achieved MR4.5 underwent a 1-year nilotinib treatment consolidation phase before attempting TFR. At the 5-year data cut-off, 81/190 patients entering the TFR phase (42.6%) were still in TFR, with 76 (40.0%) in MR4.5. Patients who lost major molecular response (MMR) entered a treatment re-initiation phase; 90/91 patients entering this phase (98.9%) regained MMR and 84/91 patients (92.3%) regained MR4.5. The Kaplan–Meier estimated treatment-free survival rate at 5 years was 48.2%. No disease progression or CML-related deaths were reported. Whereas the incidence of adverse events (AEs) declined from 96 weeks following the start of TFR, an increase in AE frequency was observed for patients in the treatment re-initiation phase. Low Sokal risk score, BCR-ABL1IS levels at 48 weeks of TFR and stable MR4.5 response for the first year of TFR were associated with higher TFR rates. Overall, these results support the efficacy and safety of attempting TFR following upfront nilotinib therapy of >3 years in patients with CML-CP.
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Affiliation(s)
- Jerald P Radich
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Andreas Hochhaus
- Abteilung Hämatologie/Onkologie, Universitätsklinikum Jena, Jena, Germany
| | | | | | | | | | | | | | | | | | - Bruno Martino
- Azienda Ospedaliera Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | - Susanne Saussele
- III. Med. Klinik, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | | | - David M Ross
- Division of Haematology, SA Pathology, Royal Adelaide Hospital, Adelaide, Australia
| | | | - Sai Li
- Novartis Pharma AG, Basel, Switzerland
| | - Ksenia Titorenko
- Novartis Pharmaceuticals Corporation, Moscow, Russian Federation
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25
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Ramadan S, Ceparano G, Cignetti A, Sammassimo S, Bagnardi V, Pagan E, Gottardi D, Fiori S, Passerini R, Radice T, Saglio G, Tarella C. Prognostic Impact of Baseline Immunologic Profile in Aggressive B-cell non-Hodgkin's Lymphomas. Mediterr J Hematol Infect Dis 2021; 13:e2021018. [PMID: 33747399 PMCID: PMC7938923 DOI: 10.4084/mjhid.2021.018] [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: 10/26/2020] [Accepted: 02/06/2021] [Indexed: 12/02/2022] Open
Abstract
Host immune homeostasis as an independent prognostic indicator has been inadequately evaluated in aggressive non-Hodgkin's lymphomas (NHL). The present study addresses the prognostic significance in aggressive NHLs of the immunologic profile evaluated by pretreatment serum levels of immunoglobulins (Ig) and lymphocyte-monocyte ratio (LMR). In this series of 90 patients with aggressive lymphoma, the median level for IgG was 1,024mg/dl (range 436-2236), and for LMR was 2.2 (range 0.2-13.8). CR rate was higher with IgG levels ≥1,024mg/dL (91% vs 77% p=0.059). LMR ≤ 2.2 was associated with lower 1-year PFS (73% vs. 92%, p 0.016). Patients with good/very good R-IPI showed a reduced PFS if IgG or LMR was low, while patients with poor R-IPI did better if LMR or IgG levels were high. We combined both parameters with the R-IPI and produced a four-risk prognostic score showing one-year PFS of 95% (95% CI 68%-99%), 100% (95% CI 100%-100%), 73% (95% CI 52%-86%), and 59% (95% CI 31%-79%), in patients with zero, one, two and three risk factors, respectively. The results indicate for the first time the value of baseline serum Ig levels in the prognostic assessment of aggressive lymphoma.
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Affiliation(s)
- Safaa Ramadan
- Division of Onco-Hematoncology, European Institute of Oncology, IRCCS, Milano, Italy
- NCI-Cairo University, Egypt, Cairo, Egypt
| | - Giusy Ceparano
- Division of Onco-Hematoncology, European Institute of Oncology, IRCCS, Milano, Italy
| | - Alessandro Cignetti
- Divisione Universitaria di Ematologia e Terapie Cellulari, A.O. Ordine Mauriziano, Torino, Italy
| | - Simona Sammassimo
- Division of Onco-Hematoncology, European Institute of Oncology, IRCCS, Milano, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milano, Italy
| | - Eleonora Pagan
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milano, Italy
| | - Daniela Gottardi
- Divisione Universitaria di Ematologia e Terapie Cellulari, A.O. Ordine Mauriziano, Torino, Italy
| | - Stefano Fiori
- Haemolymphopathology Unit, European Institute of Oncology IRCCS, Milan, Italy
| | - Rita Passerini
- Divisione di Medicina di Laboratorio, European Institute of Oncology, Milano, Italy
| | - Tommaso Radice
- Division of Onco-Hematoncology, European Institute of Oncology, IRCCS, Milano, Italy
| | - Giuseppe Saglio
- Divisione Universitaria di Ematologia e Terapie Cellulari, A.O. Ordine Mauriziano, Torino, Italy
| | - Corrado Tarella
- Division of Onco-Hematoncology, European Institute of Oncology, IRCCS, Milano, Italy
- Dipartimento Universitario di Scienze della Salute (DISS), Università di Milano, Italy
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26
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Gaidano V, Houshmand M, Vitale N, Carrà G, Morotti A, Tenace V, Rapelli S, Sainas S, Pippione AC, Giorgis M, Boschi D, Lolli ML, Cilloni D, Cignetti A, Saglio G, Circosta P. The Synergism between DHODH Inhibitors and Dipyridamole Leads to Metabolic Lethality in Acute Myeloid Leukemia. Cancers (Basel) 2021; 13:1003. [PMID: 33670894 PMCID: PMC7957697 DOI: 10.3390/cancers13051003] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/15/2021] [Accepted: 02/22/2021] [Indexed: 12/20/2022] Open
Abstract
Dihydroorotate Dehydrogenase (DHODH) is a key enzyme of the de novo pyrimidine biosynthesis, whose inhibition can induce differentiation and apoptosis in acute myeloid leukemia (AML). DHODH inhibitors had shown promising in vitro and in vivo activity on solid tumors, but their effectiveness was not confirmed in clinical trials, probably because cancer cells exploited the pyrimidine salvage pathway to survive. Here, we investigated the antileukemic activity of MEDS433, the DHODH inhibitor developed by our group, against AML. Learning from previous failures, we mimicked human conditions (performing experiments in the presence of physiological uridine plasma levels) and looked for synergic combinations to boost apoptosis, including classical antileukemic drugs and dipyridamole, a blocker of the pyrimidine salvage pathway. MEDS433 induced apoptosis in multiple AML cell lines, not only as a consequence of differentiation, but also directly. Its combination with antileukemic agents further increased the apoptotic rate, but when experiments were performed in the presence of physiological uridine concentrations, results were less impressive. Conversely, the combination of MEDS433 with dipyridamole induced metabolic lethality and differentiation in all AML cell lines; this extraordinary synergism was confirmed on AML primary cells with different genetic backgrounds and was unaffected by physiological uridine concentrations, predicting in human activity.
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Affiliation(s)
- Valentina Gaidano
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, 10043 Turin, Italy; (M.H.); (G.C.); (A.M.); (D.C.); (G.S.); (P.C.)
- Division of Hematology, A.O. SS Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Mohammad Houshmand
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, 10043 Turin, Italy; (M.H.); (G.C.); (A.M.); (D.C.); (G.S.); (P.C.)
- Molecular Biotechnology Center, University of Turin, 10126 Turin, Italy;
| | - Nicoletta Vitale
- Molecular Biotechnology Center, University of Turin, 10126 Turin, Italy;
- Department of Medical Sciences, University of Turin, 10124 Turin, Italy
| | - Giovanna Carrà
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, 10043 Turin, Italy; (M.H.); (G.C.); (A.M.); (D.C.); (G.S.); (P.C.)
- Molecular Biotechnology Center, University of Turin, 10126 Turin, Italy;
| | - Alessandro Morotti
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, 10043 Turin, Italy; (M.H.); (G.C.); (A.M.); (D.C.); (G.S.); (P.C.)
| | - Valerio Tenace
- Department of Electrical and Computer Engineering, University of Utah, Salt Lake City, UT 84112, USA;
| | - Stefania Rapelli
- Department of Life Sciences and System Biology, University of Turin, 10124 Turin, Italy;
| | - Stefano Sainas
- Department of Drug Science and Technology, University of Turin, 10124 Turin, Italy; (S.S.); (A.C.P.); (M.G.); (D.B.); (M.L.L.)
| | - Agnese Chiara Pippione
- Department of Drug Science and Technology, University of Turin, 10124 Turin, Italy; (S.S.); (A.C.P.); (M.G.); (D.B.); (M.L.L.)
| | - Marta Giorgis
- Department of Drug Science and Technology, University of Turin, 10124 Turin, Italy; (S.S.); (A.C.P.); (M.G.); (D.B.); (M.L.L.)
| | - Donatella Boschi
- Department of Drug Science and Technology, University of Turin, 10124 Turin, Italy; (S.S.); (A.C.P.); (M.G.); (D.B.); (M.L.L.)
| | - Marco Lucio Lolli
- Department of Drug Science and Technology, University of Turin, 10124 Turin, Italy; (S.S.); (A.C.P.); (M.G.); (D.B.); (M.L.L.)
| | - Daniela Cilloni
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, 10043 Turin, Italy; (M.H.); (G.C.); (A.M.); (D.C.); (G.S.); (P.C.)
- University Division of Hematology and Cell Therapy, A.O. Ordine Mauriziano, University of Turin, 10128 Turin, Italy;
| | - Alessandro Cignetti
- University Division of Hematology and Cell Therapy, A.O. Ordine Mauriziano, University of Turin, 10128 Turin, Italy;
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, 10043 Turin, Italy; (M.H.); (G.C.); (A.M.); (D.C.); (G.S.); (P.C.)
- University Division of Hematology and Cell Therapy, A.O. Ordine Mauriziano, University of Turin, 10128 Turin, Italy;
| | - Paola Circosta
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, 10043 Turin, Italy; (M.H.); (G.C.); (A.M.); (D.C.); (G.S.); (P.C.)
- Molecular Biotechnology Center, University of Turin, 10126 Turin, Italy;
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27
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Ali MS, Panuzzo C, Calabrese C, Maglione A, Piazza R, Cilloni D, Saglio G, Pergolizzi B, Bracco E. The Giant HECT E3 Ubiquitin Ligase HERC1 Is Aberrantly Expressed in Myeloid Related Disorders and It Is a Novel BCR-ABL1 Binding Partner. Cancers (Basel) 2021; 13:cancers13020341. [PMID: 33477751 PMCID: PMC7832311 DOI: 10.3390/cancers13020341] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 12/13/2022] Open
Abstract
Simple Summary The pathological role/s of the HERC family members has recently been initiated to be explored in few solid tumors and the assessment of their transcript amount reveals that they might act as effective prognostic factors. However, evidence concerning the non-solid tumors, and especially myeloid related neoplasms, is currently lacking. In the present article for the first time we provide original data for a clear and well-defined association between the gene expression level of a giant HERC E3 ubiquitin ligase family member, HERC1, and some myeloid related disorders, namely Acute Myeloid Leukemia, Myeloproliferative neoplasms and Chronic Myeloid Leukemia. Furthermore, our findings unveil that the HERC1 protein physically interacts, likely forming a very large supramolecular complex, and it is a putative BCR-ABL1 tyrosine kinase substrate. We hope that this work will contribute to the advance of our understanding of the roles played by the giant HERCs in myeloid related neoplasms. Abstract HERC E3 subfamily members are parts of the E3 ubiquitin ligases and key players for a wide range of cellular functions. Though the involvement of the Ubiquitin Proteasome System in blood disorders has been broadly studied, so far the role of large HERCs in this context remains unexplored. In the present study we examined the expression of the large HECT E3 Ubiquitin Ligase, HERC1, in blood disorders. Our findings revealed that HERC1 gene expression was severely downregulated both in acute and in chronic myelogenous leukemia at diagnosis, while it is restored after complete remission achievement. Instead, in Philadelphia the negative myeloproliferative neoplasm HERC1 level was peculiarly controlled, being very low in Primary Myelofibrosis and significantly upregulated in those Essential Thrombocytemia specimens harboring the mutation in the calreticulin gene. Remarkably, in CML cells HERC1 mRNA level was associated with the BCR-ABL1 kinase activity and the HERC1 protein physically interacted with BCR-ABL1. Furthermore, we found that HERC1 was directly tyrosine phosphorylated by the ABL kinase. Overall and for the first time, we provide original evidence on the potential tumor-suppressing or -promoting properties, depending on the context, of HERC1 in myeloid related blood disorders.
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Affiliation(s)
- Muhammad Shahzad Ali
- Department of Clinical and Biological Science, Medical School, University of Torino, 10043 Orbassano, Italy; (M.S.A.); (C.P.); (C.C.); (A.M.); (D.C.); (G.S.)
| | - Cristina Panuzzo
- Department of Clinical and Biological Science, Medical School, University of Torino, 10043 Orbassano, Italy; (M.S.A.); (C.P.); (C.C.); (A.M.); (D.C.); (G.S.)
| | - Chiara Calabrese
- Department of Clinical and Biological Science, Medical School, University of Torino, 10043 Orbassano, Italy; (M.S.A.); (C.P.); (C.C.); (A.M.); (D.C.); (G.S.)
| | - Alessandro Maglione
- Department of Clinical and Biological Science, Medical School, University of Torino, 10043 Orbassano, Italy; (M.S.A.); (C.P.); (C.C.); (A.M.); (D.C.); (G.S.)
| | - Rocco Piazza
- Department of Health Sciences, University of Milano-Bicocca, 20900 Monza, Italy;
| | - Daniela Cilloni
- Department of Clinical and Biological Science, Medical School, University of Torino, 10043 Orbassano, Italy; (M.S.A.); (C.P.); (C.C.); (A.M.); (D.C.); (G.S.)
| | - Giuseppe Saglio
- Department of Clinical and Biological Science, Medical School, University of Torino, 10043 Orbassano, Italy; (M.S.A.); (C.P.); (C.C.); (A.M.); (D.C.); (G.S.)
| | - Barbara Pergolizzi
- Department of Clinical and Biological Science, Medical School, University of Torino, 10043 Orbassano, Italy; (M.S.A.); (C.P.); (C.C.); (A.M.); (D.C.); (G.S.)
- Correspondence: (B.P.); (E.B.)
| | - Enrico Bracco
- Department of Oncology, Medical School, University of Torino, 10043 Orbassano, Italy
- Correspondence: (B.P.); (E.B.)
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28
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Lo Iacono M, Signorino E, Petiti J, Pradotto M, Calabrese C, Panuzzo C, Caciolli F, Pergolizzi B, De Gobbi M, Rege-Cambrin G, Fava C, Giachino C, Bracco E, Saglio G, Frassoni F, Cilloni D. Genetic Screening for Potential New Targets in Chronic Myeloid Leukemia Based on Drosophila Transgenic for Human BCR-ABL1. Cancers (Basel) 2021; 13:cancers13020293. [PMID: 33466839 PMCID: PMC7830713 DOI: 10.3390/cancers13020293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/23/2020] [Accepted: 01/11/2021] [Indexed: 11/16/2022] Open
Abstract
Chronic myeloid leukemia is a myeloproliferative neoplasm characterized by the presence of the Philadelphia chromosome that originates from the reciprocal translocation t(9;22)(q34;q11.2) and encodes for the constitutively active tyrosine kinase protein BCR-ABL1 from the Breakpoint Cluster Region (BCR) sequence and the Abelson (ABL1) gene. Despite BCR-ABL1 being one of the most studied oncogenic proteins, some molecular mechanisms remain enigmatic, and several of the proteins, acting either as positive or negative BCR-ABL1 regulators, are still unknown. The Drosophila melanogaster represents a powerful tool for genetic investigations and a promising model to study the BCR-ABL1 signaling pathway. To identify new components involved in BCR-ABL1 transforming activity, we conducted an extensive genetic screening using different Drosophila mutant strains carrying specific small deletions within the chromosomes 2 and 3 and the gmrGal4,UAS-BCR-ABL1 4M/TM3 transgenic Drosophila as the background. From the screening, we identified several putative candidate genes that may be involved either in sustaining chronic myeloid leukemia (CML) or in its progression. We also identified, for the first time, a tight connection between the BCR-ABL1 protein and Rab family members, and this correlation was also validated in CML patients. In conclusion, our data identified many genes that, by interacting with BCR-ABL1, regulate several important biological pathways and could promote disease onset and progression.
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Affiliation(s)
- Marco Lo Iacono
- Department of Clinical and Biological Sciences, University of Turin, 10043 Turin, Italy; (E.S.); (J.P.); (M.P.); (C.C.); (C.P.); (F.C.); (B.P.); (M.D.G.); (G.R.-C.); (C.F.); (C.G.); (G.S.); (F.F.); (D.C.)
- Correspondence: ; Tel.: +39-011-6705445
| | - Elisabetta Signorino
- Department of Clinical and Biological Sciences, University of Turin, 10043 Turin, Italy; (E.S.); (J.P.); (M.P.); (C.C.); (C.P.); (F.C.); (B.P.); (M.D.G.); (G.R.-C.); (C.F.); (C.G.); (G.S.); (F.F.); (D.C.)
| | - Jessica Petiti
- Department of Clinical and Biological Sciences, University of Turin, 10043 Turin, Italy; (E.S.); (J.P.); (M.P.); (C.C.); (C.P.); (F.C.); (B.P.); (M.D.G.); (G.R.-C.); (C.F.); (C.G.); (G.S.); (F.F.); (D.C.)
| | - Monica Pradotto
- Department of Clinical and Biological Sciences, University of Turin, 10043 Turin, Italy; (E.S.); (J.P.); (M.P.); (C.C.); (C.P.); (F.C.); (B.P.); (M.D.G.); (G.R.-C.); (C.F.); (C.G.); (G.S.); (F.F.); (D.C.)
| | - Chiara Calabrese
- Department of Clinical and Biological Sciences, University of Turin, 10043 Turin, Italy; (E.S.); (J.P.); (M.P.); (C.C.); (C.P.); (F.C.); (B.P.); (M.D.G.); (G.R.-C.); (C.F.); (C.G.); (G.S.); (F.F.); (D.C.)
| | - Cristina Panuzzo
- Department of Clinical and Biological Sciences, University of Turin, 10043 Turin, Italy; (E.S.); (J.P.); (M.P.); (C.C.); (C.P.); (F.C.); (B.P.); (M.D.G.); (G.R.-C.); (C.F.); (C.G.); (G.S.); (F.F.); (D.C.)
| | - Francesca Caciolli
- Department of Clinical and Biological Sciences, University of Turin, 10043 Turin, Italy; (E.S.); (J.P.); (M.P.); (C.C.); (C.P.); (F.C.); (B.P.); (M.D.G.); (G.R.-C.); (C.F.); (C.G.); (G.S.); (F.F.); (D.C.)
| | - Barbara Pergolizzi
- Department of Clinical and Biological Sciences, University of Turin, 10043 Turin, Italy; (E.S.); (J.P.); (M.P.); (C.C.); (C.P.); (F.C.); (B.P.); (M.D.G.); (G.R.-C.); (C.F.); (C.G.); (G.S.); (F.F.); (D.C.)
| | - Marco De Gobbi
- Department of Clinical and Biological Sciences, University of Turin, 10043 Turin, Italy; (E.S.); (J.P.); (M.P.); (C.C.); (C.P.); (F.C.); (B.P.); (M.D.G.); (G.R.-C.); (C.F.); (C.G.); (G.S.); (F.F.); (D.C.)
| | - Giovanna Rege-Cambrin
- Department of Clinical and Biological Sciences, University of Turin, 10043 Turin, Italy; (E.S.); (J.P.); (M.P.); (C.C.); (C.P.); (F.C.); (B.P.); (M.D.G.); (G.R.-C.); (C.F.); (C.G.); (G.S.); (F.F.); (D.C.)
| | - Carmen Fava
- Department of Clinical and Biological Sciences, University of Turin, 10043 Turin, Italy; (E.S.); (J.P.); (M.P.); (C.C.); (C.P.); (F.C.); (B.P.); (M.D.G.); (G.R.-C.); (C.F.); (C.G.); (G.S.); (F.F.); (D.C.)
| | - Claudia Giachino
- Department of Clinical and Biological Sciences, University of Turin, 10043 Turin, Italy; (E.S.); (J.P.); (M.P.); (C.C.); (C.P.); (F.C.); (B.P.); (M.D.G.); (G.R.-C.); (C.F.); (C.G.); (G.S.); (F.F.); (D.C.)
| | - Enrico Bracco
- Department of Oncology, University of Turin, 10043 Turin, Italy;
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences, University of Turin, 10043 Turin, Italy; (E.S.); (J.P.); (M.P.); (C.C.); (C.P.); (F.C.); (B.P.); (M.D.G.); (G.R.-C.); (C.F.); (C.G.); (G.S.); (F.F.); (D.C.)
| | - Francesco Frassoni
- Department of Clinical and Biological Sciences, University of Turin, 10043 Turin, Italy; (E.S.); (J.P.); (M.P.); (C.C.); (C.P.); (F.C.); (B.P.); (M.D.G.); (G.R.-C.); (C.F.); (C.G.); (G.S.); (F.F.); (D.C.)
| | - Daniela Cilloni
- Department of Clinical and Biological Sciences, University of Turin, 10043 Turin, Italy; (E.S.); (J.P.); (M.P.); (C.C.); (C.P.); (F.C.); (B.P.); (M.D.G.); (G.R.-C.); (C.F.); (C.G.); (G.S.); (F.F.); (D.C.)
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Mughal TI, Pemmaraju N, Psaila B, Radich J, Bose P, Lion T, Kiladjian JJ, Rampal R, Jain T, Verstovsek S, Yacoub A, Cortes JE, Mesa R, Saglio G, van Etten RA. Illuminating novel biological aspects and potential new therapeutic approaches for chronic myeloproliferative malignancies. Hematol Oncol 2020; 38:654-664. [PMID: 32592408 PMCID: PMC8895354 DOI: 10.1002/hon.2771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/20/2020] [Indexed: 01/18/2023]
Abstract
This review reflects the presentations and discussion at the 14th post-American Society of Hematology (ASH) International Workshop on Chronic Myeloproliferative Malignancies, which took place on the December 10 and 11, 2019, immediately after the 61st ASH Annual Meeting in Orlando, Florida. Rather than present a resume of the proceedings, we address some of the topical translational science research and clinically relevant topics in detail. We consider how recent studies using single-cell genomics and other molecular methods reveal novel aspects of hematopoiesis which in turn raise the possibility of new therapeutic approaches for patients with myeloproliferative neoplasms (MPNs). We discuss how alternative therapies could benefit patients with chronic myeloid leukemia who develop BCR-ABL1 mutant subclones following ABL1-tyrosine kinase inhibitor therapy. In MPNs, we focus on efforts beyond JAK-STAT and the merits of integrating activin receptor ligand traps, interferon-α, and allografting in the current treatment algorithm for patients with myelofibrosis.
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MESH Headings
- Anemia/diagnosis
- Anemia/etiology
- Anemia/therapy
- Biomarkers
- Biomarkers, Tumor
- Combined Modality Therapy/adverse effects
- Combined Modality Therapy/methods
- Disease Management
- Disease Susceptibility
- Drug Development
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/etiology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Molecular Diagnostic Techniques
- Molecular Targeted Therapy
- Myeloproliferative Disorders/complications
- Myeloproliferative Disorders/diagnosis
- Myeloproliferative Disorders/etiology
- Myeloproliferative Disorders/therapy
- Prognosis
- Single-Cell Analysis/methods
- Translational Research, Biomedical
- Treatment Outcome
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Affiliation(s)
| | | | - Bethan Psaila
- MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Jerald Radich
- Frederick Hutchinson Cancer Research Center, Seattle, Washington, USA
| | | | - Thomas Lion
- Childrens Cancer Research Institute, Vienna, Austria
| | | | - Raajit Rampal
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Tania Jain
- Sidney Kimmel Cancer Center, John Hopkins Hospital, Baltimore, Maryland, USA
| | | | - Abdulraheem Yacoub
- Division of Hematologic Malignancies, University of Kansas, Kansas City, Kansas, USA
| | - Jorge E. Cortes
- Georgia Cancer Center, Augusta University, Augusta, Georgia, USA
| | - Ruben Mesa
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, Texas, USA
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Dragani M, Rege Cambrin G, Berchialla P, Dogliotti I, Rosti G, Castagnetti F, Capodanno I, Martino B, Cerrano M, Ferrero D, Gambacorti-Passerini C, Crugnola M, Elena C, Breccia M, Iurlo A, Cattaneo D, Galimberti S, Gozzini A, Bocchia M, Lunghi F, Cedrone M, Sgherza N, Luciano L, Russo S, Santoro M, Giai V, Caocci G, Levato L, Abruzzese E, Sora F, Saglio G, Fava C. A Retrospective Analysis about Frequency of Monitoring in Italian Chronic Myeloid Leukemia Patients after Discontinuation. J Clin Med 2020; 9:jcm9113692. [PMID: 33213044 PMCID: PMC7698481 DOI: 10.3390/jcm9113692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 10/16/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 01/26/2023] Open
Abstract
Successful discontinuation of tyrosine kinase inhibitors has been achieved in patients with chronic-phase chronic myeloid leukemia (CML). Careful molecular monitoring after discontinuation warrants safe and prompt resumption of therapy. We retrospectively evaluated how molecular monitoring has been conducted in Italy in a cohort of patients who discontinued tyrosine kinase inhibitor (TKI) treatment per clinical practice. The outcome of these patients has recently been reported-281 chronic-phase CML patients were included in this subanalysis. Median follow-up since discontinuation was 2 years. Overall, 2203 analyses were performed, 17.9% in the first three months and 38.4% in the first six months. Eighty-six patients lost major molecular response (MMR) in a mean time of 5.7 months-65 pts (75.6%) during the first six months. We evaluated the number of patients who would experience a delay in diagnosis of MMR loss if a three-month monitoring schedule was adopted. In the first 6 months, 19 pts (29.2%) would have a one-month delay, 26 (40%) a 2-month delay. Very few patients would experience a delay in the following months. A less intense frequency of monitoring, particularly after the first 6 months off treatment, would not have affected the success of treatment-free remission (TFR) nor put patients at risk of progression.
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Affiliation(s)
- Matteo Dragani
- Department of Clinical and Biological Sciences, University of Turin, 10043 Orbassano, Italy; (G.R.C.); (P.B.); (G.S.); (C.F.)
- Correspondence: ; Tel.: +39-011-902-6709
| | - Giovanna Rege Cambrin
- Department of Clinical and Biological Sciences, University of Turin, 10043 Orbassano, Italy; (G.R.C.); (P.B.); (G.S.); (C.F.)
| | - Paola Berchialla
- Department of Clinical and Biological Sciences, University of Turin, 10043 Orbassano, Italy; (G.R.C.); (P.B.); (G.S.); (C.F.)
| | - Irene Dogliotti
- Hematology Unit, Department of Biotechnology and Health Sciences, University of Turin, 10126 Turin, Italy; (I.D.); (M.C.); (D.F.)
| | - Gianantonio Rosti
- Institute of Hematology “L. e A. Seràgnoli”, University of Bologna, 40138 Bologna, Italy; (G.R.); (F.C.)
| | - Fausto Castagnetti
- Institute of Hematology “L. e A. Seràgnoli”, University of Bologna, 40138 Bologna, Italy; (G.R.); (F.C.)
| | - Isabella Capodanno
- Hematology Unit, Azienda Unità Sanitaria Locale-IRCCS, 42123 Reggio Emilia, Italy;
| | - Bruno Martino
- Hematology Unit, Grande Ospedale Metropolitano “Bianchi-Melacrino-Morelli”, 89124 Reggio Calabria, Italy;
| | - Marco Cerrano
- Hematology Unit, Department of Biotechnology and Health Sciences, University of Turin, 10126 Turin, Italy; (I.D.); (M.C.); (D.F.)
| | - Dario Ferrero
- Hematology Unit, Department of Biotechnology and Health Sciences, University of Turin, 10126 Turin, Italy; (I.D.); (M.C.); (D.F.)
| | | | - Monica Crugnola
- Division of Hematology, Azienda Ospedaliero-Universitaria di Parma, 43126 Parma, Italy;
| | - Chiara Elena
- Department of Hematology Oncology, Foundation IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy;
| | - Massimo Breccia
- Department of Translational and Precision Medicine, Sapienza University, 00161 Rome, Italy;
| | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.I.); (D.C.)
| | - Daniele Cattaneo
- Hematology Division, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.I.); (D.C.)
| | - Sara Galimberti
- Hematology Department, University of Pisa, 56126 Pisa, Italy;
| | - Antonella Gozzini
- Hematology Division, Policlinico Careggi di Firenze, 50139 Firenze, Italy;
| | - Monica Bocchia
- Hematology Unit, University of Siena, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy;
| | - Francesca Lunghi
- Hematology and Bone Marrow Transplant Unit, San Raffaele Scientific Institute IRCCS, 20132 Milano, Italy;
| | - Michele Cedrone
- Hematology Division, Az. Ospedaliera San Giovanni Addolorata, 00184 Rome, Italy;
| | - Nicola Sgherza
- Division of Hematology, IRCCS Ospedale Casa Sollievo Sofferenza, 71043 San Giovanni Rotondo, Italy;
| | - Luigia Luciano
- Hematology Unit, “Federico II” Hospital, University of Naples, 80131 Napoli, Italy;
| | - Sabina Russo
- Department of Internal Medicine, AOU Policlinico di Messina, 98124 Messina, Italy;
| | - Marco Santoro
- Hematology Unit, University of Palermo, 90127 Palermo, Italy;
| | - Valentina Giai
- Hematology Unit, Antonio e Biagio e Cesare Arrigo Hospital, 15121 Alessandria, Italy;
| | - Giovanni Caocci
- Hematology Unit, Department of Medical Sciences, University of Cagliari, 09121 Cagliari, Italy;
| | - Luciano Levato
- Department Hematology-Oncology, Azienda Ospedaliera Pugliese-Ciaccio, 88100 Catanzaro, Italy;
| | - Elisabetta Abruzzese
- Hematology Unit, S. Eugenio Hospital, Tor Vergata University, 00144 Rome, Italy;
| | - Federica Sora
- Hematology Unit, Fondazione Policlinico Universitario Gemelli IRCCS, 00168 Rome, Italy;
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences, University of Turin, 10043 Orbassano, Italy; (G.R.C.); (P.B.); (G.S.); (C.F.)
| | - Carmen Fava
- Department of Clinical and Biological Sciences, University of Turin, 10043 Orbassano, Italy; (G.R.C.); (P.B.); (G.S.); (C.F.)
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Gale RP, Saglio G. Point: Is there a best duration of deep molecular response to achieve therapy-free remission in chronic myeloid leukaemia? Br J Haematol 2020; 192:22-23. [PMID: 33169841 DOI: 10.1111/bjh.17112] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 08/25/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Robert Peter Gale
- Centre of Haematology, Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences, University Hospital San Luigi, University of Turin, Turin, Italy
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Jovanovski A, Petiti J, Giugliano E, Gottardi EM, Saglio G, Cilloni D, Fava C. Standardization of BCR-ABL1 p210 Monitoring: From Nested to Digital PCR. Cancers (Basel) 2020; 12:cancers12113287. [PMID: 33172063 PMCID: PMC7694607 DOI: 10.3390/cancers12113287] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/02/2020] [Accepted: 11/04/2020] [Indexed: 11/16/2022] Open
Abstract
The introduction of tyrosine kinase inhibitors in 2001 as a targeted anticancer therapy has significantly improved the quality of life and survival of patients with chronic myeloid leukemia. At the same time, with the introduction of tyrosine kinase inhibitors, the need for precise monitoring of the molecular response to therapy has emerged. Starting with a qualitative polymerase chain reaction, followed by the introduction of a quantitative polymerase chain reaction to determine the exact quantity of the transcript of interest-p210 BCR-ABL1, molecular monitoring in patients with chronic myeloid leukemia was internationally standardized. This enabled precise monitoring of the therapeutic response, unification of therapeutic protocols, and comparison of results between different laboratories. This review aims to summarize the steps in the diagnosis and molecular monitoring of p210 BCR-ABL1, as well as to consider the possible future application of a more sophisticated method such as digital polymerase chain reaction.
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Affiliation(s)
- Aleksandar Jovanovski
- Department of Clinical and Biological Sciences, University of Turin, 10043 Turin, Italy; (G.S.); (D.C.); (C.F.)
- Correspondence: (A.J.); (J.P.); Tel.: +39-0119026800 (A.J. & J.P.)
| | - Jessica Petiti
- Department of Clinical and Biological Sciences, University of Turin, 10043 Turin, Italy; (G.S.); (D.C.); (C.F.)
- Correspondence: (A.J.); (J.P.); Tel.: +39-0119026800 (A.J. & J.P.)
| | - Emilia Giugliano
- Division of Internal Medicine and Hematology, San Luigi Gonzaga Hospital, Orbassano, 10043 Turin, Italy; (E.G.); (E.M.G.)
| | - Enrico Marco Gottardi
- Division of Internal Medicine and Hematology, San Luigi Gonzaga Hospital, Orbassano, 10043 Turin, Italy; (E.G.); (E.M.G.)
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences, University of Turin, 10043 Turin, Italy; (G.S.); (D.C.); (C.F.)
| | - Daniela Cilloni
- Department of Clinical and Biological Sciences, University of Turin, 10043 Turin, Italy; (G.S.); (D.C.); (C.F.)
| | - Carmen Fava
- Department of Clinical and Biological Sciences, University of Turin, 10043 Turin, Italy; (G.S.); (D.C.); (C.F.)
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Calabrese C, Panuzzo C, Stanga S, Andreani G, Ravera S, Maglione A, Pironi L, Petiti J, Shahzad Ali M, Scaravaglio P, Napoli F, Fava C, De Gobbi M, Frassoni F, Saglio G, Bracco E, Pergolizzi B, Cilloni D. Deferasirox-Dependent Iron Chelation Enhances Mitochondrial Dysfunction and Restores p53 Signaling by Stabilization of p53 Family Members in Leukemic Cells. Int J Mol Sci 2020; 21:ijms21207674. [PMID: 33081324 PMCID: PMC7589297 DOI: 10.3390/ijms21207674] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/02/2020] [Accepted: 10/10/2020] [Indexed: 12/11/2022] Open
Abstract
Iron is crucial to satisfy several mitochondrial functions including energy metabolism and oxidative phosphorylation. Patients affected by Myelodysplastic Syndromes (MDS) and acute myeloid leukemia (AML) are frequently characterized by iron overload (IOL), due to continuous red blood cell (RBC) transfusions. This event impacts the overall survival (OS) and it is associated with increased mortality in lower-risk MDS patients. Accordingly, the oral iron chelator Deferasirox (DFX) has been reported to improve the OS and delay leukemic transformation. However, the molecular players and the biological mechanisms laying behind remain currently mostly undefined. The aim of this study has been to investigate the potential anti-leukemic effect of DFX, by functionally and molecularly analyzing its effects in three different leukemia cell lines, harboring or not p53 mutations, and in human primary cells derived from 15 MDS/AML patients. Our findings indicated that DFX can lead to apoptosis, impairment of cell growth only in a context of IOL, and can induce a significant alteration of mitochondria network, with a sharp reduction in mitochondrial activity. Moreover, through a remarkable reduction of Murine Double Minute 2 (MDM2), known to regulate the stability of p53 and p73 proteins, we observed an enhancement of p53 transcriptional activity after DFX. Interestingly, this iron depletion-triggered signaling is enabled by p73, in the absence of p53, or in the presence of a p53 mutant form. In conclusion, we propose a mechanism by which the increased p53 family transcriptional activity and protein stability could explain the potential benefits of iron chelation therapy in terms of improving OS and delaying leukemic transformation.
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Affiliation(s)
- Chiara Calabrese
- Department of Clinical and Biological Sciences, University of Turin, 10043 Turin, Italy; (C.C.); (G.A.); (A.M.); (L.P.); (J.P.); (M.S.A.); (P.S.); (C.F.); (M.D.G.); (F.F.); (G.S.); (B.P.); (D.C.)
| | - Cristina Panuzzo
- Department of Clinical and Biological Sciences, University of Turin, 10043 Turin, Italy; (C.C.); (G.A.); (A.M.); (L.P.); (J.P.); (M.S.A.); (P.S.); (C.F.); (M.D.G.); (F.F.); (G.S.); (B.P.); (D.C.)
- Correspondence:
| | - Serena Stanga
- Department of Neuroscience Rita Levi Montalcini, Neuroscience Institute Cavalieri Ottolenghi, University of Turin, 10126 Turin, Italy;
| | - Giacomo Andreani
- Department of Clinical and Biological Sciences, University of Turin, 10043 Turin, Italy; (C.C.); (G.A.); (A.M.); (L.P.); (J.P.); (M.S.A.); (P.S.); (C.F.); (M.D.G.); (F.F.); (G.S.); (B.P.); (D.C.)
| | - Silvia Ravera
- Human Anatomy Section, Department of Experimental Medicine, University of Genoa, 16132 Genova, Italy;
| | - Alessandro Maglione
- Department of Clinical and Biological Sciences, University of Turin, 10043 Turin, Italy; (C.C.); (G.A.); (A.M.); (L.P.); (J.P.); (M.S.A.); (P.S.); (C.F.); (M.D.G.); (F.F.); (G.S.); (B.P.); (D.C.)
| | - Lucrezia Pironi
- Department of Clinical and Biological Sciences, University of Turin, 10043 Turin, Italy; (C.C.); (G.A.); (A.M.); (L.P.); (J.P.); (M.S.A.); (P.S.); (C.F.); (M.D.G.); (F.F.); (G.S.); (B.P.); (D.C.)
| | - Jessica Petiti
- Department of Clinical and Biological Sciences, University of Turin, 10043 Turin, Italy; (C.C.); (G.A.); (A.M.); (L.P.); (J.P.); (M.S.A.); (P.S.); (C.F.); (M.D.G.); (F.F.); (G.S.); (B.P.); (D.C.)
| | - Muhammad Shahzad Ali
- Department of Clinical and Biological Sciences, University of Turin, 10043 Turin, Italy; (C.C.); (G.A.); (A.M.); (L.P.); (J.P.); (M.S.A.); (P.S.); (C.F.); (M.D.G.); (F.F.); (G.S.); (B.P.); (D.C.)
| | - Patrizia Scaravaglio
- Department of Clinical and Biological Sciences, University of Turin, 10043 Turin, Italy; (C.C.); (G.A.); (A.M.); (L.P.); (J.P.); (M.S.A.); (P.S.); (C.F.); (M.D.G.); (F.F.); (G.S.); (B.P.); (D.C.)
| | - Francesca Napoli
- Department of Oncology, University of Turin, 10043 Turin, Italy; (F.N.); (E.B.)
| | - Carmen Fava
- Department of Clinical and Biological Sciences, University of Turin, 10043 Turin, Italy; (C.C.); (G.A.); (A.M.); (L.P.); (J.P.); (M.S.A.); (P.S.); (C.F.); (M.D.G.); (F.F.); (G.S.); (B.P.); (D.C.)
| | - Marco De Gobbi
- Department of Clinical and Biological Sciences, University of Turin, 10043 Turin, Italy; (C.C.); (G.A.); (A.M.); (L.P.); (J.P.); (M.S.A.); (P.S.); (C.F.); (M.D.G.); (F.F.); (G.S.); (B.P.); (D.C.)
| | - Francesco Frassoni
- Department of Clinical and Biological Sciences, University of Turin, 10043 Turin, Italy; (C.C.); (G.A.); (A.M.); (L.P.); (J.P.); (M.S.A.); (P.S.); (C.F.); (M.D.G.); (F.F.); (G.S.); (B.P.); (D.C.)
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences, University of Turin, 10043 Turin, Italy; (C.C.); (G.A.); (A.M.); (L.P.); (J.P.); (M.S.A.); (P.S.); (C.F.); (M.D.G.); (F.F.); (G.S.); (B.P.); (D.C.)
| | - Enrico Bracco
- Department of Oncology, University of Turin, 10043 Turin, Italy; (F.N.); (E.B.)
| | - Barbara Pergolizzi
- Department of Clinical and Biological Sciences, University of Turin, 10043 Turin, Italy; (C.C.); (G.A.); (A.M.); (L.P.); (J.P.); (M.S.A.); (P.S.); (C.F.); (M.D.G.); (F.F.); (G.S.); (B.P.); (D.C.)
| | - Daniela Cilloni
- Department of Clinical and Biological Sciences, University of Turin, 10043 Turin, Italy; (C.C.); (G.A.); (A.M.); (L.P.); (J.P.); (M.S.A.); (P.S.); (C.F.); (M.D.G.); (F.F.); (G.S.); (B.P.); (D.C.)
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Petiti J, Lo Iacono M, Rosso V, Andreani G, Jovanovski A, Podestà M, Lame D, Gobbi MD, Fava C, Saglio G, Frassoni F, Cilloni D. Bcl-xL represents a therapeutic target in Philadelphia negative myeloproliferative neoplasms. J Cell Mol Med 2020; 24:10978-10986. [PMID: 32790151 PMCID: PMC7521327 DOI: 10.1111/jcmm.15730] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 06/03/2020] [Revised: 07/14/2020] [Accepted: 07/16/2020] [Indexed: 12/19/2022] Open
Abstract
Myeloproliferative neoplasms are divided into essential thrombocythemia (ET), polycythemia vera (PV) and primary myelofibrosis (PMF). Although ruxolitinib was proven to be effective in reducing symptoms, patients rarely achieve complete molecular remission. Therefore, it is relevant to identify new therapeutic targets to improve the clinical outcome of patients. Bcl‐xL protein, the long isoform encoded by alternative splicing of the Bcl‐x gene, acts as an anti‐apoptotic regulator. Our study investigated the role of Bcl‐xL as a marker of severity of MPN and the possibility to target Bcl‐xL in patients. 129 MPN patients and 21 healthy patients were enrolled in the study. We analysed Bcl‐xL expression in leucocytes and in enriched CD34+ and CD235a+ cells. Furthermore, ABT‐737, a Bcl‐xL inhibitor, was tested in HEL cells and in leucocytes from MPN patients. Bcl‐xL was found progressively over‐expressed in cells from ET, PV and PMF patients, independently by JAK2 mutational status. Moreover, our data indicated that the combination of ABT‐737 and ruxolitinib resulted in a significantly higher apoptotic rate than the individual drug. Our study suggests that Bcl‐xL plays an important role in MPN independently from JAK2 V617F mutation. Furthermore, data demonstrate that targeting simultaneously JAK2 and Bcl‐xL might represent an interesting new approach.
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Affiliation(s)
- Jessica Petiti
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Marco Lo Iacono
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Valentina Rosso
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Giacomo Andreani
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | | | - Marina Podestà
- Department of Pediatric Hemato-Oncology and Stem Cell and Cellular Therapy Laboratory, Institute G. Gaslini, Genova, Italy
| | - Dorela Lame
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Marco De Gobbi
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Carmen Fava
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Francesco Frassoni
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Daniela Cilloni
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
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35
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Breccia M, Abruzzese E, Bocchia M, Bonifacio M, Castagnetti F, Fava C, Galimberti S, Gozzini A, Gugliotta G, Iurlo A, Latagliata R, Luciano L, Pregno P, Rege-Cambrin G, Rosti G, Stagno F, Tiribelli M, Foà R, Saglio G. Chronic myeloid leukemia management at the time of the COVID-19 pandemic in Italy. A campus CML survey. Leukemia 2020; 34:2260-2261. [PMID: 32555369 PMCID: PMC7301058 DOI: 10.1038/s41375-020-0904-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 05/28/2020] [Accepted: 06/01/2020] [Indexed: 12/03/2022]
MESH Headings
- Betacoronavirus/isolation & purification
- COVID-19
- Coronavirus Infections/epidemiology
- Coronavirus Infections/prevention & control
- Coronavirus Infections/transmission
- Coronavirus Infections/virology
- Disease Management
- Humans
- Infection Control/methods
- Italy/epidemiology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/virology
- Pandemics/prevention & control
- Pneumonia, Viral/epidemiology
- Pneumonia, Viral/prevention & control
- Pneumonia, Viral/transmission
- Pneumonia, Viral/virology
- Practice Guidelines as Topic/standards
- Protein Kinase Inhibitors/therapeutic use
- SARS-CoV-2
- Surveys and Questionnaires
- Telemedicine
- Time-to-Treatment/statistics & numerical data
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Affiliation(s)
- Massimo Breccia
- Department of Precision and Translational Medicine, Sapienza University, Rome, Italy
| | | | | | | | - Fausto Castagnetti
- Department of Hematology/Oncology, University of Bologna, Bologna, Italy
| | - Carmen Fava
- Azienda Ospedaliera Mauriziano, Torino, Italy
| | | | | | - Gabriele Gugliotta
- Department of Hematology/Oncology, University of Bologna, Bologna, Italy
| | - Alessandra Iurlo
- Fondazione IRCSS Ca' Granda Ospedale Maggiore Policlinico of Milan, Milan, Italy
| | - Roberto Latagliata
- Department of Precision and Translational Medicine, Sapienza University, Rome, Italy
| | | | | | | | - Gianantonio Rosti
- Department of Hematology/Oncology, University of Bologna, Bologna, Italy
| | - Fabio Stagno
- Ospedale Ferrarotto-University of Catania, Catania, Italy
| | | | - Robin Foà
- Department of Precision and Translational Medicine, Sapienza University, Rome, Italy.
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36
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Cortes JE, Jiang Q, Wang J, Weng J, Zhu H, Liu X, Hochhaus A, Kim DW, Radich J, Savona M, Martin-Regueira P, Sy O, Gurnani R, Saglio G. Dasatinib vs. imatinib in patients with chronic myeloid leukemia in chronic phase (CML-CP) who have not achieved an optimal response to 3 months of imatinib therapy: the DASCERN randomized study. Leukemia 2020; 34:2064-2073. [PMID: 32265500 PMCID: PMC7387297 DOI: 10.1038/s41375-020-0805-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/06/2020] [Accepted: 03/13/2020] [Indexed: 02/05/2023]
Abstract
Early molecular response is associated with improved probability of deep molecular response and superior survival in patients with CML-CP. However, ~1 in 3 patients on first-line imatinib do not achieve this threshold. The phase 2b DASCERN trial (NCT01593254) assessed the outcome of early switch to dasatinib in patients with suboptimal response to first-line imatinib. Adult patients with CML-CP were randomized (2:1) to receive 100 mg dasatinib (n = 174) or continue imatinib at ≥400 mg (n = 86). The primary endpoint was the rate of major molecular response (MMR) at 12 months, which was 29% (dasatinib) and 13% (imatinib; P = 0.005). After ≥2 years of follow-up, 45 patients (52%) randomized to continue imatinib had crossed over to dasatinib. Considering treatment crossover, the 2-year cumulative MMR rate was 64% with dasatinib and 41% with imatinib (66% and 67%, respectively by intent-to-treat). Adverse events were consistent with the established safety profiles of both drugs. The results of this first prospective study support early monitoring of patients treated with first-line imatinib, and suggest that switching to dasatinib in cases of suboptimal response may offer clinical benefit. Further follow-up is needed to assess the long-term clinical benefit of early switching.
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Affiliation(s)
- Jorge E Cortes
- Georgia Cancer Center, Augusta University, Augusta, GA, USA.
| | - Qian Jiang
- Peking University People's Hospital, Beijing, China
| | - Jianxiang Wang
- Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences, Tianjin, China
| | - Jianyu Weng
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Huanling Zhu
- West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xiaoli Liu
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | | | - Dong-Wook Kim
- The Catholic University of Korea, Seoul, Republic of Korea
| | - Jerald Radich
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Michael Savona
- Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | - Oumar Sy
- Bristol Myers Squibb, Princeton, NJ, USA
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37
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Saglio G, Gale RP. Prospects for achieving treatment-free remission in chronic myeloid leukaemia. Br J Haematol 2020; 190:318-327. [PMID: 32057102 PMCID: PMC7496116 DOI: 10.1111/bjh.16506] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/29/2019] [Accepted: 12/30/2019] [Indexed: 12/17/2022]
Abstract
In addition to the best possible overall survival, discontinuation of the tyrosine kinase-inhibitor (TKI) treatment [treatment free remission (TFR)] without observing a recurrence of the disease has become a major goal of the therapy of chronic myelogenous leukemia (CML). Many clinical studies have demonstrated that TFR is possible, although for the moment limited to a fraction of the CML patients able to achieve a stable deep molecular response (DMR). The factors associated to the possibility of remaining in TFR or of losing it, have been investigated by a number of controlled and observation clinical trials and although total TKI treatment duration, DMR duration and stability and, more recently, also the depth of the molecular response obtained at the time of discontinuation have been shown to be significant elements, most of the factors associated with a higher possibility of a successful discontinuation still remain elusive and are here reviewed.
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MESH Headings
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/therapeutic use
- Clinical Trials as Topic
- Disease Progression
- Drug Administration Schedule
- Duration of Therapy
- Fusion Proteins, bcr-abl/antagonists & inhibitors
- Fusion Proteins, bcr-abl/blood
- Humans
- Immune Checkpoint Inhibitors/administration & dosage
- Immune Checkpoint Inhibitors/therapeutic use
- Immunotherapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/blood
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/immunology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Neoplastic Stem Cells/drug effects
- Neoplastic Stem Cells/enzymology
- Neoplastic Stem Cells/immunology
- Observational Studies as Topic
- Protein Kinase Inhibitors/administration & dosage
- Protein Kinase Inhibitors/therapeutic use
- Remission Induction
- Treatment Outcome
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Affiliation(s)
- Giuseppe Saglio
- Department of Clinical and Biological Sciences of the University of TurinOrbassano‐TorinoItaly
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38
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Gaidano V, Tenace V, Santoro N, Varvello S, Cignetti A, Prato G, Saglio G, De Rosa G, Geuna M. A Clinically Applicable Approach to the Classification of B-Cell Non-Hodgkin Lymphomas with Flow Cytometry and Machine Learning. Cancers (Basel) 2020; 12:cancers12061684. [PMID: 32599959 PMCID: PMC7352227 DOI: 10.3390/cancers12061684] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 05/05/2020] [Revised: 06/15/2020] [Accepted: 06/19/2020] [Indexed: 12/12/2022] Open
Abstract
The immunophenotype is a key element to classify B-cell Non-Hodgkin Lymphomas (B-NHL); while it is routinely obtained through immunohistochemistry, the use of flow cytometry (FC) could bear several advantages. However, few FC laboratories can rely on a long-standing practical experience, and the literature in support is still limited; as a result, the use of FC is generally restricted to the analysis of lymphomas with bone marrow or peripheral blood involvement. In this work, we applied machine learning to our database of 1465 B-NHL samples from different sources, building four artificial predictive systems which could classify B-NHL in up to nine of the most common clinico-pathological entities. Our best model shows an overall accuracy of 92.68%, a mean sensitivity of 88.54% and a mean specificity of 98.77%. Beyond the clinical applicability, our models demonstrate (i) the strong discriminatory power of MIB1 and Bcl2, whose integration in the predictive model significantly increased the performance of the algorithm; (ii) the potential usefulness of some non-canonical markers in categorizing B-NHL; and (iii) that FC markers should not be described as strictly positive or negative according to fixed thresholds, but they rather correlate with different B-NHL depending on their level of expression.
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Affiliation(s)
- Valentina Gaidano
- Department of Clinical and Biological Sciences, University of Turin, 10043 Orbassano, Italy; (V.G.); (G.S.)
- Division of Hematology, A.O. SS Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Valerio Tenace
- Department of Electrical and Computer Engineering, University of Utah, Salt Lake City, UT 84112, USA
- Correspondence: (V.T.); (M.G.)
| | - Nathalie Santoro
- Laboratory of Immunopathology, Division of Pathology, A.O. Ordine Mauriziano, 10128 Turin, Italy; (N.S.); (G.D.R.)
| | - Silvia Varvello
- University Division of Hematology and Cell Therapy, A.O. Ordine Mauriziano, 10128 Turin, Italy; (S.V.); (A.C.)
| | - Alessandro Cignetti
- University Division of Hematology and Cell Therapy, A.O. Ordine Mauriziano, 10128 Turin, Italy; (S.V.); (A.C.)
| | - Giuseppina Prato
- Division of Pathology, San Lazzaro Hospital, ASL CN2, 12051 Alba, Italy;
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences, University of Turin, 10043 Orbassano, Italy; (V.G.); (G.S.)
- University Division of Hematology and Cell Therapy, A.O. Ordine Mauriziano, 10128 Turin, Italy; (S.V.); (A.C.)
| | - Giovanni De Rosa
- Laboratory of Immunopathology, Division of Pathology, A.O. Ordine Mauriziano, 10128 Turin, Italy; (N.S.); (G.D.R.)
| | - Massimo Geuna
- Laboratory of Immunopathology, Division of Pathology, A.O. Ordine Mauriziano, 10128 Turin, Italy; (N.S.); (G.D.R.)
- Correspondence: (V.T.); (M.G.)
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39
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Cilloni D, Ravera S, Calabrese C, Gaidano V, Niscola P, Balleari E, Gallo D, Petiti J, Signorino E, Rosso V, Panuzzo C, Sabatini F, Andreani G, Dragani M, Finelli C, Poloni A, Crugnola M, Voso MT, Fenu S, Pelizzari A, Santini V, Saglio G, Podestà M, Frassoni F. Iron overload alters the energy metabolism in patients with myelodysplastic syndromes: results from the multicenter FISM BIOFER study. Sci Rep 2020; 10:9156. [PMID: 32514107 PMCID: PMC7280296 DOI: 10.1038/s41598-020-66162-y] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 05/11/2020] [Indexed: 11/30/2022] Open
Abstract
Myelodysplastic syndromes (MDS) are hematological malignancies characterized by ineffective hematopoiesis and increased apoptosis in the bone marrow, which cause peripheral cytopenia. Mitochondria are key regulators of apoptosis and a site of iron accumulation that favors reactive oxygen species (ROS) production with detrimental effects on cell survival. Although the energy metabolism could represent an attractive therapeutic target, it was poorly investigated in MDS. The purpose of the study was to analyze how the presence of myelodysplastic hematopoiesis, iron overload and chelation impact on mitochondrial metabolism. We compared energy balance, OxPhos activity and efficiency, lactic dehydrogenase activity and lipid peroxidation in mononuclear cells (MNCs), isolated from 38 MDS patients and 79 healthy controls. Our data show that ATP/AMP ratio is reduced during aging and even more in MDS due to a decreased OxPhos activity associated with an increment of lipid peroxidation. Moreover, the lactate fermentation enhancement was observed in MDS and elderly subjects, probably as an attempt to restore the energy balance. The biochemical alterations of MNCs from MDS patients have been partially restored by the in vitro iron chelation, while only slight effects were observed in the age-matched control samples. By contrast, the addition of iron chelators on MNCs from young healthy subjects determined a decrement in the OxPhos efficiency and an increment of lactate fermentation and lipid peroxidation. In summary, MDS-MNCs display an altered energy metabolism associated with increased oxidative stress, due to iron accumulation. This condition could be partially restored by iron chelation.
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Affiliation(s)
- Daniela Cilloni
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.
| | - Silvia Ravera
- Stem Cell and Cellular Therapy Laboratory, Institute G. Gaslini, Genova, Italy.,Department of Experimental Medicine, University of Genova, Genova, Italy
| | - Chiara Calabrese
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Valentina Gaidano
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | | | - Enrico Balleari
- Department of Haematology and Oncology, IRCCS AOU San Martino - IST, Genova, Italy
| | - Daniela Gallo
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Jessica Petiti
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Elisabetta Signorino
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Valentina Rosso
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Cristina Panuzzo
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Federica Sabatini
- Stem Cell and Cellular Therapy Laboratory, Institute G. Gaslini, Genova, Italy
| | - Giacomo Andreani
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Matteo Dragani
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Carlo Finelli
- Department of Haematology, S. Orsola-Malpighi Hospital, Bologna, Italy
| | | | - Monica Crugnola
- Division of Hematology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Maria Teresa Voso
- Department of Biomedicine and Prevention, Universita' Tor Vergata, Rome, Italy
| | - Susanna Fenu
- Haematology Department, San Giovanni-Addolorata Hospital, Rome, Italy
| | | | - Valeria Santini
- Department of Experimental and Clinical Medicine, Università degli Studi di Firenze, Florence, Italy
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Marina Podestà
- Stem Cell and Cellular Therapy Laboratory, Institute G. Gaslini, Genova, Italy
| | - Francesco Frassoni
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.
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40
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Hochhaus A, Breccia M, Saglio G, García-Gutiérrez V, Réa D, Janssen J, Apperley J. Expert opinion-management of chronic myeloid leukemia after resistance to second-generation tyrosine kinase inhibitors. Leukemia 2020; 34:1495-1502. [PMID: 32366938 PMCID: PMC7266739 DOI: 10.1038/s41375-020-0842-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/16/2020] [Accepted: 04/16/2020] [Indexed: 11/20/2022]
Abstract
Regardless of line of therapy, treatment goals in chronic phase chronic myeloid leukemia (CML) are: avoid progression to accelerated phase or blast crisis CML such that patients achieve a life expectancy comparable with that of the general population; avoid adverse events (AEs); and restore and maintain quality of life. The most important prognostic factor for achieving these goals is response to tyrosine kinase inhibitors (TKIs) at key milestones. For patients failing a TKI, a treatment change is mandatory to limit the risk of progression and death. There is currently no precise guideline for patients that fail a second-generation TKI, and there is a paucity of data to guide clinical decision making in this setting. There is, therefore, an unmet need for practical and actionable guidance on how to manage patients who fail a second-generation TKI. Although the term 'failure' includes patients failing for resistance or intolerance, the focus of this paper is failure of a second-generation TKI because of resistance. CML patients who fail their first second-generation TKI for true resistance need a more potent therapy. In these patients, the key issues to consider are the relative appropriateness of early allogeneic hematopoietic stem cell transplantation or the use of a further TKI. Selection of the next line of treatment after second-generation TKI resistance should be individualized and must be based on patient-specific factors including cytogenetics, mutation profile, comorbidities, age, previous history of AEs with prior TKI therapy, and risk profile for AEs on specific TKIs. This expert opinion paper is not in conflict with existing recommendations, but instead represents an evolution of previous notions, based on new data, insights, and clinical experience. We review the treatment options for patients resistant to second-generation TKI therapy and provide our clinical opinions and guidance on key considerations for treatment decision making.
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Affiliation(s)
- Andreas Hochhaus
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany.
| | | | | | | | | | - Jeroen Janssen
- Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Centers, loc. VUMC, Amsterdam, The Netherlands
| | - Jane Apperley
- Hammersmith Hospital, Imperial College London, London, UK
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41
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Hochhaus A, Baccarani M, Silver RT, Schiffer C, Apperley JF, Cervantes F, Clark RE, Cortes JE, Deininger MW, Guilhot F, Hjorth-Hansen H, Hughes TP, Janssen JJWM, Kantarjian HM, Kim DW, Larson RA, Lipton JH, Mahon FX, Mayer J, Nicolini F, Niederwieser D, Pane F, Radich JP, Rea D, Richter J, Rosti G, Rousselot P, Saglio G, Saußele S, Soverini S, Steegmann JL, Turkina A, Zaritskey A, Hehlmann R. European LeukemiaNet 2020 recommendations for treating chronic myeloid leukemia. Leukemia 2020; 34:966-984. [PMID: 32127639 PMCID: PMC7214240 DOI: 10.1038/s41375-020-0776-2] [Citation(s) in RCA: 706] [Impact Index Per Article: 176.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 02/07/2023]
Abstract
The therapeutic landscape of chronic myeloid leukemia (CML) has profoundly changed over the past 7 years. Most patients with chronic phase (CP) now have a normal life expectancy. Another goal is achieving a stable deep molecular response (DMR) and discontinuing medication for treatment-free remission (TFR). The European LeukemiaNet convened an expert panel to critically evaluate and update the evidence to achieve these goals since its previous recommendations. First-line treatment is a tyrosine kinase inhibitor (TKI; imatinib brand or generic, dasatinib, nilotinib, and bosutinib are available first-line). Generic imatinib is the cost-effective initial treatment in CP. Various contraindications and side-effects of all TKIs should be considered. Patient risk status at diagnosis should be assessed with the new EUTOS long-term survival (ELTS)-score. Monitoring of response should be done by quantitative polymerase chain reaction whenever possible. A change of treatment is recommended when intolerance cannot be ameliorated or when molecular milestones are not reached. Greater than 10% BCR-ABL1 at 3 months indicates treatment failure when confirmed. Allogeneic transplantation continues to be a therapeutic option particularly for advanced phase CML. TKI treatment should be withheld during pregnancy. Treatment discontinuation may be considered in patients with durable DMR with the goal of achieving TFR.
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MESH Headings
- Aniline Compounds/therapeutic use
- Antineoplastic Agents/therapeutic use
- Clinical Decision-Making
- Consensus Development Conferences as Topic
- Dasatinib/therapeutic use
- Disease Management
- Fusion Proteins, bcr-abl/antagonists & inhibitors
- Fusion Proteins, bcr-abl/genetics
- Fusion Proteins, bcr-abl/metabolism
- Gene Expression
- Humans
- Imatinib Mesylate/therapeutic use
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/mortality
- Life Expectancy/trends
- Monitoring, Physiologic
- Nitriles/therapeutic use
- Protein Kinase Inhibitors/therapeutic use
- Pyrimidines/therapeutic use
- Quality of Life
- Quinolines/therapeutic use
- Survival Analysis
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Affiliation(s)
- A Hochhaus
- Klinik für Innere Medizin II, Universitätsklinikum, Jena, Germany.
| | - M Baccarani
- Department of Hematology/Oncology, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - R T Silver
- Weill Cornell Medical College, New York, NY, USA
| | - C Schiffer
- Karmanos Cancer Center, Detroit, MI, USA
| | - J F Apperley
- Hammersmith Hospital, Imperial College, London, UK
| | | | - R E Clark
- Department of Molecular & Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - J E Cortes
- Georgia Cancer Center, Augusta University, Augusta, GA, USA
| | - M W Deininger
- Huntsman Cancer Center Salt Lake City, Salt Lake City, UT, USA
| | - F Guilhot
- Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - H Hjorth-Hansen
- Norwegian University of Science and Technology, Trondheim, Norway
| | - T P Hughes
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - J J W M Janssen
- Amsterdam University Medical Center, VUMC, Amsterdam, The Netherlands
| | | | - D W Kim
- St. Mary´s Hematology Hospital, The Catholic University, Seoul, Korea
| | | | | | - F X Mahon
- Institut Bergonie, Université de Bordeaux, Bordeaux, France
| | - J Mayer
- Department of Internal Medicine, Masaryk University Hospital, Brno, Czech Republic
| | | | | | - F Pane
- Department Clinical Medicine and Surgery, University Federico Secondo, Naples, Italy
| | - J P Radich
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - D Rea
- Hôpital St. Louis, Paris, France
| | | | - G Rosti
- Department of Hematology/Oncology, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - P Rousselot
- Centre Hospitalier de Versailles, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France
| | - G Saglio
- University of Turin, Turin, Italy
| | - S Saußele
- III. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - S Soverini
- Department of Hematology/Oncology, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy
| | | | - A Turkina
- National Research Center for Hematology, Moscow, Russian Federation
| | - A Zaritskey
- Almazov National Research Centre, St. Petersburg, Russian Federation
| | - R Hehlmann
- III. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany.
- ELN Foundation, Weinheim, Germany.
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Giona F, Malaspina F, Putti MC, Ladogana S, Mura R, Burnelli R, Vacca N, Rizzo L, Bianchi S, Moleti ML, Testi AM, Biondi A, Locatelli F, Saglio G, Foà R. Results and outcome of intermittent imatinib (ON/OFF schedule) in children and adolescents with chronic myeloid leukaemia. Br J Haematol 2020; 188:e101-e105. [DOI: 10.1111/bjh.16388] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Fiorina Giona
- Department of Translational and Precision Medicine Sapienza University Rome Italy
| | - Francesco Malaspina
- Department of Translational and Precision Medicine Sapienza University Rome Italy
| | - Maria Caterina Putti
- Hemato‐Oncology Unit Department of Women’s and Children’s Health University of Padua Padua Italy
| | - Saverio Ladogana
- Department of Pediatrics Hemato‐Oncology Unit ‘Casa Sollievo della Sofferenza’ Hospital San Giovanni Rotondo Italy
| | - Rosamaria Mura
- Pediatric Hemato‐Oncology Unit Ospedale Regionale per le Microcitemie Cagliari Italy
| | | | - Nadia Vacca
- Pediatric Unit Ospedale di Sassari Sassari Italy
| | - Lorenzo Rizzo
- Department of Translational and Precision Medicine Sapienza University Rome Italy
| | - Simona Bianchi
- Department of Translational and Precision Medicine Sapienza University Rome Italy
| | - Maria Luisa Moleti
- Department of Translational and Precision Medicine Sapienza University Rome Italy
| | - Anna Maria Testi
- Department of Translational and Precision Medicine Sapienza University Rome Italy
| | - Andrea Biondi
- Department of Pediatrics University of Milano‐Bicocca Monza Italy
| | - Franco Locatelli
- Department of Pediatrics Pediatric Hematology‐Oncology University of Pavia IRCCS Ospedale Pediatrico Bambino Gesù Rome Italy
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences University of Turin at Orbassano Turin Italy
| | - Robin Foà
- Department of Translational and Precision Medicine Sapienza University Rome Italy
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Petiti J, Rosso V, Croce E, Franceschi V, Andreani G, Dragani M, De Gobbi M, Lunghi M, Saglio G, Fava C, Lo Iacono M, Cilloni D. Highly Sensitive Detection of IDH2 Mutations in Acute Myeloid Leukemia. J Clin Med 2020; 9:jcm9010271. [PMID: 31963812 PMCID: PMC7019902 DOI: 10.3390/jcm9010271] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/13/2020] [Accepted: 01/16/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Acute myeloid leukemia is a heterogeneous hematological disease, characterized by karyotypic and molecular alterations. Mutations in IDH2 have a role in diagnosis and as a minimal residue disease marker. Often the variant allele frequency during follow up is less than 20%, which represents the limit of detection of Sanger sequencing. Therefore, the development of sensitive methodologies to identify IDH2 mutations might help to monitor patients’ response to therapy. We compared three different methods to identify and monitor IDH2 mutations in patients’ specimens. Methods: Performances of PNA-PCR clamping, droplet digital PCR and Sanger for IDH2 status identification were evaluated and compared in 96 DNA patients’ specimens. Results: In contrast with Sanger sequencing, our results highlighted the concordance between PNA clamping and digital PCR. Furthermore, PNA-PCR clamping was able to detect more mutated DNA with respect to Sanger sequencing that showed several false negatives independently from the allelic frequency. Conclusions: We found that PNA-PCR clamping and digital PCR identified IDH2 mutations in DNA samples with comparable results in a percentage significantly higher compared to Sanger sequencing. PNA-PCR clamping can be used even in laboratories not equipped for sophisticated analyses, decreasing cost and time for IDH2 characterization.
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Affiliation(s)
- Jessica Petiti
- Department of Clinical and Biological Sciences of the University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043 Orbassano (Turin), Italy; (V.R.); (E.C.); (V.F.); (G.A.); (M.D.); (M.D.G.); (G.S.); (C.F.); (M.L.I.)
- Correspondence: (J.P.); (D.C.); Tel.: +39-011-9026800 (J.P.); +39-011-9026610 (D.C.); Fax: +39-11-9038636 (J.P. & D.C.)
| | - Valentina Rosso
- Department of Clinical and Biological Sciences of the University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043 Orbassano (Turin), Italy; (V.R.); (E.C.); (V.F.); (G.A.); (M.D.); (M.D.G.); (G.S.); (C.F.); (M.L.I.)
| | - Eleonora Croce
- Department of Clinical and Biological Sciences of the University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043 Orbassano (Turin), Italy; (V.R.); (E.C.); (V.F.); (G.A.); (M.D.); (M.D.G.); (G.S.); (C.F.); (M.L.I.)
| | - Vanessa Franceschi
- Department of Clinical and Biological Sciences of the University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043 Orbassano (Turin), Italy; (V.R.); (E.C.); (V.F.); (G.A.); (M.D.); (M.D.G.); (G.S.); (C.F.); (M.L.I.)
| | - Giacomo Andreani
- Department of Clinical and Biological Sciences of the University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043 Orbassano (Turin), Italy; (V.R.); (E.C.); (V.F.); (G.A.); (M.D.); (M.D.G.); (G.S.); (C.F.); (M.L.I.)
| | - Matteo Dragani
- Department of Clinical and Biological Sciences of the University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043 Orbassano (Turin), Italy; (V.R.); (E.C.); (V.F.); (G.A.); (M.D.); (M.D.G.); (G.S.); (C.F.); (M.L.I.)
| | - Marco De Gobbi
- Department of Clinical and Biological Sciences of the University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043 Orbassano (Turin), Italy; (V.R.); (E.C.); (V.F.); (G.A.); (M.D.); (M.D.G.); (G.S.); (C.F.); (M.L.I.)
| | - Monia Lunghi
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale, Corso Giuseppe Mazzini, 18, 28100 Novara, Italy;
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences of the University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043 Orbassano (Turin), Italy; (V.R.); (E.C.); (V.F.); (G.A.); (M.D.); (M.D.G.); (G.S.); (C.F.); (M.L.I.)
| | - Carmen Fava
- Department of Clinical and Biological Sciences of the University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043 Orbassano (Turin), Italy; (V.R.); (E.C.); (V.F.); (G.A.); (M.D.); (M.D.G.); (G.S.); (C.F.); (M.L.I.)
| | - Marco Lo Iacono
- Department of Clinical and Biological Sciences of the University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043 Orbassano (Turin), Italy; (V.R.); (E.C.); (V.F.); (G.A.); (M.D.); (M.D.G.); (G.S.); (C.F.); (M.L.I.)
| | - Daniela Cilloni
- Department of Clinical and Biological Sciences of the University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043 Orbassano (Turin), Italy; (V.R.); (E.C.); (V.F.); (G.A.); (M.D.); (M.D.G.); (G.S.); (C.F.); (M.L.I.)
- Correspondence: (J.P.); (D.C.); Tel.: +39-011-9026800 (J.P.); +39-011-9026610 (D.C.); Fax: +39-11-9038636 (J.P. & D.C.)
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Cilloni D, Andreani G, Dragani M, De Gobbi M, Saglio G. Synergistic effect of eltrombopag and deferasirox in aplastic anemia: a clinical case and review of the literature. Leuk Lymphoma 2020; 61:234-236. [DOI: 10.1080/10428194.2019.1660969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Daniela Cilloni
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Giacomo Andreani
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Matteo Dragani
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Marco De Gobbi
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
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45
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Affiliation(s)
- Giuseppe Saglio
- Department of Clinical and Biological Sciences of the University of Turin, Mauriziano Hospital, Italy
| | - Carmen Fava
- Department of Clinical and Biological Sciences of the University of Turin, Mauriziano Hospital, Italy
| | - Robert Peter Gale
- Haematology Research Center, Division of Experimental Medicine, Department of Medicine, Imperial College London, UK
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46
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Carrà G, Nicoli P, Lingua MF, Maffeo B, Cartellà A, Circosta P, Brancaccio M, Parvis G, Gaidano V, Guerrasio A, Saglio G, Taulli R, Morotti A. Inhibition of bromodomain and extra-terminal proteins increases sensitivity to venetoclax in chronic lymphocytic leukaemia. J Cell Mol Med 2019; 24:1650-1657. [PMID: 31821686 PMCID: PMC6991693 DOI: 10.1111/jcmm.14857] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 07/03/2019] [Revised: 11/06/2019] [Accepted: 11/08/2019] [Indexed: 01/03/2023] Open
Abstract
The development of drugs able to target BTK, PI3k‐delta and BCL2 has dramatically improved chronic lymphocytic leukaemia (CLL) therapies. However, drug resistance to these therapies has already been reported due to non‐recurrent changes in oncogenic pathways and genes expression signatures. In this study, we investigated the cooperative role of the BCL2 inhibitor venetoclax and the BRD4 inhibitor JQ1. In particular, we found that JQ1 shows additional activity with venetoclax, in CLL cell lines and in ex vivo isolated primary CD19+ lymphocytes, arguing in favour of combination strategies. Lastly, JQ1 is also effective in venetoclax‐resistant CLL cell lines. Together, our findings indicated that the BET inhibitor JQ1 could be a promising therapy in CLL, both as first‐line therapy in combination with venetoclax and as second‐line therapy, after the emergence of venetoclax‐resistant clones.
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Affiliation(s)
- Giovanna Carrà
- Dept. of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | - Paolo Nicoli
- Dept. of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | | | - Beatrice Maffeo
- Dept. of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | - Antonio Cartellà
- Dept. of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | - Paola Circosta
- Dept. of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | - Mara Brancaccio
- Dept. of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Guido Parvis
- Division of Hematology, Ospedale Mauriziano, Torino, Italy
| | | | - Angelo Guerrasio
- Dept. of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | - Giuseppe Saglio
- Dept. of Clinical and Biological Sciences, University of Turin, Orbassano, Italy.,Division of Hematology, Ospedale Mauriziano, Torino, Italy
| | | | - Alessandro Morotti
- Dept. of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
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47
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Soverini S, Abruzzese E, Bocchia M, Bonifacio M, Galimberti S, Gozzini A, Iurlo A, Luciano L, Pregno P, Rosti G, Saglio G, Stagno F, Tiribelli M, Vigneri P, Barosi G, Breccia M. Next-generation sequencing for BCR-ABL1 kinase domain mutation testing in patients with chronic myeloid leukemia: a position paper. J Hematol Oncol 2019; 12:131. [PMID: 31801582 PMCID: PMC6894351 DOI: 10.1186/s13045-019-0815-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 10/27/2019] [Indexed: 12/31/2022] Open
Abstract
BCR-ABL1 kinase domain (KD) mutation status is considered to be an important element of clinical decision algorithms for chronic myeloid leukemia (CML) patients who do not achieve an optimal response to tyrosine kinase inhibitors (TKIs). Conventional Sanger sequencing is the method currently recommended to test BCR-ABL1 KD mutations. However, Sanger sequencing has limited sensitivity and cannot always discriminate between polyclonal and compound mutations. The use of next-generation sequencing (NGS) is increasingly widespread in diagnostic laboratories and represents an attractive alternative. Currently available data on the clinical impact of NGS-based mutational testing in CML patients do not allow recommendations with a high grade of evidence to be prepared. This article reports the results of a group discussion among an ad hoc expert panel with the objective of producing recommendations on the appropriateness of clinical decisions about the indication for NGS, the performance characteristics of NGS platforms, and the therapeutic changes that could be applied based on the use of NGS in CML. Overall, these recommendations might be employed to inform clinicians about the practical use of NGS in CML.
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Affiliation(s)
- Simona Soverini
- Hematology/Oncology "L. e A. Seràgnoli", Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, S. Orsola-Malpighi Hospital, Via Massarenti 9, 40138, Bologna, Italy.
| | | | - Monica Bocchia
- Hematology Unit, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | | | - Sara Galimberti
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Antonella Gozzini
- Department of Cellular Therapies and Transfusion Medicine, AOU Careggi, Florence, Italy
| | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | | | - Patrizia Pregno
- Hematology Unit, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Gianantonio Rosti
- Hematology/Oncology "L. e A. Seràgnoli", Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, S. Orsola-Malpighi Hospital, Via Massarenti 9, 40138, Bologna, Italy
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences of the University of Turin, Mauriziano Hospital, Turin, Italy
| | - Fabio Stagno
- Hematology Section and BMT Unit, Rodolico Hospital, AOU Policlinico-V. Emanuele, Catania, Italy
| | - Mario Tiribelli
- Division of Hematology and Bone Marrow Transplantation, Department of Medical Area, University of Udine, Udine, Italy
| | - Paolo Vigneri
- Department of Clinical and Experimental Medicine and Center of Experimental Oncology and Hematology, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
| | - Giovanni Barosi
- Center for the Study of Myelofibrosis, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Massimo Breccia
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
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48
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49
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Mughal TI, Deininger MW, Kucine N, Saglio G, Van Etten RA. Children and Adolescents with Chronic Myeloproliferative Neoplasms: Still an Unmet Biological and Clinical Need? Hemasphere 2019; 3:e283. [PMID: 31942538 PMCID: PMC6919464 DOI: 10.1097/hs9.0000000000000283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 06/26/2019] [Indexed: 12/20/2022] Open
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50
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Houshmand M, Blanco TM, Circosta P, Yazdi N, Kazemi A, Saglio G, Zarif MN. Bone marrow microenvironment: The guardian of leukemia stem cells. World J Stem Cells 2019; 11:476-490. [PMID: 31523368 PMCID: PMC6716085 DOI: 10.4252/wjsc.v11.i8.476] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/13/2019] [Accepted: 06/20/2019] [Indexed: 02/06/2023] Open
Abstract
Bone marrow microenvironment (BMM) is the main sanctuary of leukemic stem cells (LSCs) and protects these cells against conventional therapies. However, it may open up an opportunity to target LSCs by breaking the close connection between LSCs and the BMM. The elimination of LSCs is of high importance, since they follow cancer stem cell theory as a part of this population. Based on cancer stem cell theory, a cell with stem cell-like features stands at the apex of the hierarchy and produces a heterogeneous population and governs the disease. Secretion of cytokines, chemokines, and extracellular vesicles, whether through autocrine or paracrine mechanisms by activation of downstream signaling pathways in LSCs, favors their persistence and makes the BMM less hospitable for normal stem cells. While all details about the interactions of the BMM and LSCs remain to be elucidated, some clinical trials have been designed to limit these reciprocal interactions to cure leukemia more effectively. In this review, we focus on chronic myeloid leukemia and acute myeloid leukemia LSCs and their milieu in the bone marrow, how to segregate them from the normal compartment, and finally the possible ways to eliminate these cells.
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Affiliation(s)
- Mohammad Houshmand
- Department of Clinical and Biological Sciences, University of Turin, Turin 10126, Italy
| | - Teresa Mortera Blanco
- Center for Hematology and Regenerative Medicine, Karolinska Institutet, Department of Medicine, Karolinska University Hospital Huddinge, Stockholm 14183, Sweden
| | - Paola Circosta
- Department of Clinical and Biological Sciences, University of Turin, Turin 10126, Italy
| | - Narjes Yazdi
- Department of Molecular Genetics, Tehran Medical Branch, Islamic Azad University, Tehran 1916893813, Iran
| | - Alireza Kazemi
- Department of Hematology and Blood Banking, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences, University of Turin, Turin 10126, Italy
| | - Mahin Nikougoftar Zarif
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran 146651157, Iran
- Center for Hematology and Regenerative Medicine, Karolinska Institutet, Department of Medicine, Karolinska University Hospital Huddinge, Stockholm 14183, Sweden
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