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Stentoft J. The Mozart effect in chronic myeloid leukaemia. Br J Haematol 2024; 204:1139-1140. [PMID: 38375783 DOI: 10.1111/bjh.19351] [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: 02/06/2024] [Revised: 02/08/2024] [Accepted: 02/10/2024] [Indexed: 02/21/2024]
Abstract
Clinical research has not been able to establish whether the differences between first- and second-generation BCR-ABL 1 kinase inhibitors are clinically relevant with regard to outcome. In the study by Alcazer et al., a relevant difference seems to emerge-paradoxically in the absence of the drugs-as demonstrated by differences in the relapse kinetics after cessation of therapy. Commentary on: Alcazer et al. Kinetics of molecular recurrence after tyrosine kinase inhibitor cessation in chronic phase chronic myelogenous leukaemia patients. Br J Haematol 2024;204:1536-1539.
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Affiliation(s)
- Jesper Stentoft
- Department of Haematology, Aarhus University Hospital, Aarhus, Denmark
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2
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Flygt H, Söderlund S, Richter J, Saussele S, Koskenvesa P, Stenke L, Mustjoki S, Dimitrijevic A, Stentoft J, Majeed W, Roy L, Wolf D, Dreimane A, Gjertsen BT, Gedde-Dahl T, Ahlstrand E, Markevärn B, Hjorth-Hansen H, Janssen J, Olsson-Strömberg U. Correction: Treatment-free remission after a second TKI discontinuation attempt in patients with Chronic Myeloid Leukemia re-treated with dasatinib - interim results from the DAstop2 trial. Leukemia 2024; 38:925. [PMID: 38418611 PMCID: PMC10997495 DOI: 10.1038/s41375-024-02184-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Affiliation(s)
- Hjalmar Flygt
- Department of Medical Science and Division of Hematology, Uppsala University Hospital, Uppsala, Sweden.
| | - Stina Söderlund
- Department of Medical Science and Division of Hematology, Uppsala University Hospital, Uppsala, Sweden
| | - Johan Richter
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Susanne Saussele
- Medical Clinic, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Perttu Koskenvesa
- Department of Hematology, Hematology Research Unit Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
| | - Leif Stenke
- Department of Hematology, Karolinska University Hospital and Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Satu Mustjoki
- Department of Hematology, Hematology Research Unit Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
- Translational Immunology Research Program and Department of Clinical Chemistry and Hematology, University of Helsinki, Helsinki, Finland
- ICAN Digital Precision Cancer Medicine Flagship, Helsinki, Finland
| | | | - Jesper Stentoft
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Waleed Majeed
- Department of Hemato-Oncology, Stavanger University Hospital, Stavanger, Norway
| | - Lydia Roy
- French CML group Fi-LMC, Centre Léon Bérard, Lyon, Hôpital Universitaire Henri Mondor, AP-HP, Service d'hématologie Clinique & Faculté de Santé, Université Paris Est Créteil, Créteil, France
| | - Dominik Wolf
- Department of Hematology and Oncology, Comprehensive Cancer Center Innsbruck (CCCI), Tyrolean Cancer Research Institute (TKFI), Medical University Innsbruck, Innsbruck, Austria
- Medical Clinic 3, Universitätsklinikum, Bonn, Germany
| | - Arta Dreimane
- Department of Hematology, Linköping University Hospital, Linköping, Sweden
| | - Bjørn Tore Gjertsen
- Department of Internal Medicine, Hematology Section, Haukeland University Hospital, Bergen, Norway
| | - Tobias Gedde-Dahl
- Department of Hematology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Erik Ahlstrand
- Department of Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Berit Markevärn
- Department of Hematology, Umeå University Hospital, Umeå, Sweden
| | | | - Jeroen Janssen
- Department of Hematology, Radboud University medical center, Nijmegen, The Netherlands
| | - Ulla Olsson-Strömberg
- Department of Medical Science and Division of Hematology, Uppsala University Hospital, Uppsala, Sweden
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Flygt H, Söderlund S, Richter J, Saussele S, Koskenvesa P, Stenke L, Mustjoki S, Dimitrijevic A, Stentoft J, Majeed W, Roy L, Wolf D, Dreimane A, Gjertsen BT, Gedde-Dahl T, Ahlstrand E, Markevärn B, Hjorth-Hansen H, Janssen J, Olsson-Strömberg U. Treatment-free remission after a second TKI discontinuation attempt in patients with Chronic Myeloid Leukemia re-treated with dasatinib - interim results from the DAstop2 trial. Leukemia 2024; 38:781-787. [PMID: 38278960 PMCID: PMC10997502 DOI: 10.1038/s41375-024-02145-6] [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: 11/01/2023] [Revised: 12/25/2023] [Accepted: 01/08/2024] [Indexed: 01/28/2024]
Abstract
Tyrosine kinase inhibitor (TKI) discontinuation in chronic myeloid leukemia (CML) has become part of routine care for patients with a sustained deep molecular response (DMR). Approximately 50% experience a molecular relapse upon TKI cessation. Most of them quickly regain DMR upon TKI resumption. Whether these patients can achieve a second treatment-free remission (TFR) remains unclear. DAstop2 (ClinicalTrials.gov ID: NCT03573596) is a prospective study including patients with a failed first TFR attempt re-treated with any TKI for ≥ one year. Upon entering the study, patients received the TKI dasatinib for additional two years. Patients with sustained DMR for ≥1 year qualified for a second TKI stop. Ninety-four patients were included between Oct 2017-Dec 2021. At the time of data analysis, 62 patients had attempted a 2nd stop. After a median follow-up of 27 months from 2nd stop, TFR rates were 61, 56 and 46% at 6, 12 and 24 months respectively. No progression to advanced stage disease was seen and 87% had re-achieved MR4 within a median of 3 months from TKI re-initiation. In summary, we show that a 2nd TFR attempt after dasatinib treatment is safe, feasible and TFR rates seem in the range of those reported in trials of a first TKI stop.
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Affiliation(s)
- Hjalmar Flygt
- Department of Medical Science and Division of Hematology, Uppsala University Hospital, Uppsala, Sweden.
| | - Stina Söderlund
- Department of Medical Science and Division of Hematology, Uppsala University Hospital, Uppsala, Sweden
| | - Johan Richter
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Susanne Saussele
- Medical Clinic, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Perttu Koskenvesa
- Department of Hematology, Hematology Research Unit Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
| | - Leif Stenke
- Department of Hematology, Karolinska University Hospital and Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Satu Mustjoki
- Department of Hematology, Hematology Research Unit Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
- Translational Immunology Research Program and Department of Clinical Chemistry and Hematology, University of Helsinki, Helsinki, Finland
- ICAN Digital Precision Cancer Medicine Flagship, Helsinki, Finland
| | | | - Jesper Stentoft
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Waleed Majeed
- Department of Hemato-Oncology, Stavanger University Hospital, Stavanger, Norway
| | - Lydia Roy
- French CML group Fi-LMC, Centre Léon Bérard, Lyon, Hôpital Universitaire Henri Mondor, AP-HP, Service d'hématologie Clinique & Faculté de Santé, Université Paris Est Créteil, Créteil, France
| | - Dominik Wolf
- Department of Hematology and Oncology, Comprehensive Cancer Center Innsbruck (CCCI), Tyrolean Cancer Research Institute (TKFI), Medical University Innsbruck, Innsbruck, Austria
- Medical Clinic 3, Universitätsklinikum, Bonn, Germany
| | - Arta Dreimane
- Department of Hematology, Linköping University Hospital, Linköping, Sweden
| | - Bjørn Tore Gjertsen
- Department of Internal Medicine, Hematology Section, Haukeland University Hospital, Bergen, Norway
| | - Tobias Gedde-Dahl
- Department of Hematology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Erik Ahlstrand
- Department of Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Berit Markevärn
- Department of Hematology, Umeå University Hospital, Umeå, Sweden
| | | | - Jeroen Janssen
- Department of Hematology, Radboud University medical center, Nijmegen, The Netherlands
| | - Ulla Olsson-Strömberg
- Department of Medical Science and Division of Hematology, Uppsala University Hospital, Uppsala, Sweden
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Svingel LS, Christensen SF, Kjærsgaard A, Stenling A, Paulsson B, Andersen CL, Christiansen CF, Stentoft J, Starklint J, Severinsen MT, Borg Clausen M, Hagemann Hilsøe M, Hasselbalch HC, Frederiksen H, Bak M, Mikkelsen EM. Labor market affiliation of patients with myeloproliferative neoplasms: a population-based matched cohort study. Acta Oncol 2023; 62:1286-1294. [PMID: 37656802 DOI: 10.1080/0284186x.2023.2251670] [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: 03/01/2023] [Accepted: 08/19/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND Patients with myeloproliferative neoplasms (MPNs) suffer from substantial symptoms and risk of debilitating complications, yet observational data on their labor market affiliation are scarce. MATERIAL AND METHODS We conducted a descriptive cohort study using data from Danish nationwide registries, including patients diagnosed with MPN in 2010-2016. Each patient was matched with up to ten comparators without MPN on age, sex, level of education, and region of residence. We assessed pre- and post-diagnosis labor market affiliation, defined as working, unemployed, or receiving sickness benefit, disability pension, retirement pension, or other health-related benefits. Labor market affiliation was assessed weekly from two years pre-diagnosis until death, emigration, or 31 December 2018. For patients and comparators, we reported percentage point (pp) changes in labor market affiliation cross-sectionally from week -104 pre-diagnosis to week 104 post-diagnosis. RESULTS The study included 3,342 patients with MPN and 32,737 comparators. From two years pre-diagnosis until two years post-diagnosis, a larger reduction in the proportion working was observed among patients than comparators (essential thrombocythemia: 10.2 [95% CI: 6.3-14.1] vs. 6.8 [95% CI: 5.5-8.0] pp; polycythemia vera: 9.6 [95% CI: 5.9-13.2] vs. 7.4 [95% CI: 6.2-8.7] pp; myelofibrosis: 8.1 [95% CI: 3.0-13.2] vs. 5.8 [95% CI: 4.2-7.5] pp; and unclassifiable MPN: 8.0 [95% CI: 3.0-13.0] vs. 7.4 [95% CI: 5.7-9.1] pp). Correspondingly, an increase in the proportion of patients receiving sickness benefits including other health-related benefits was evident around the time of diagnosis. CONCLUSION Overall, we found that Danish patients with essential thrombocythemia, polycythemia vera, myelofibrosis, and unclassifiable MPN had slightly impaired labor market affiliation compared with a population of the same age and sex. From two years pre-diagnosis to two years post-diagnosis, we observed a larger reduction in the proportion of patients with MPN working and a greater proportion receiving sickness benefits compared with matched individuals.
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Affiliation(s)
- Lise Skovgaard Svingel
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Denmark
| | | | - Anders Kjærsgaard
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Denmark
| | | | | | | | - Christian Fynbo Christiansen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Denmark
| | - Jesper Stentoft
- Department of Hematology, Aarhus University Hospital, Denmark
| | | | | | - Mette Borg Clausen
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | | | | | | | - Marie Bak
- Department of Hematology, Zealand University Hospital, Denmark
| | - Ellen Margrethe Mikkelsen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Denmark
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5
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Christensen SF, Svingel LS, Kjærsgaard A, Stenling A, Darvalics B, Paulsson B, Andersen CL, Christiansen CF, Stentoft J, Starklint J, Severinsen MT, Clausen MB, Hilsøe MH, Hasselbalch HC, Frederiksen H, Mikkelsen EM, Bak M. Healthcare resource utilization in patients with myeloproliferative neoplasms: A Danish nationwide matched cohort study. Eur J Haematol 2022; 109:526-541. [PMID: 35900040 PMCID: PMC9804288 DOI: 10.1111/ejh.13841] [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: 04/26/2022] [Revised: 07/15/2022] [Accepted: 07/19/2022] [Indexed: 01/05/2023]
Abstract
Few studies have assessed healthcare resource utilization (HRU) in patients with Philadelphia-negative myeloproliferative neoplasms (MPN) using a matched cohort design. Further, no detailed assessment of HRU in the years preceding an MPN diagnosis exists. We conducted a registry-based nationwide Danish cohort study, including patients with essential thrombocythemia, polycythemia vera, myelofibrosis, and unclassifiable MPN diagnosed between January 2010 and December 2016. HRU data were summarized annually from 2 years before MPN diagnosis until emigration, death, or end of study (December 2017). We included 3342 MPN patients and 32 737 comparisons without an MPN diagnosis, matched on sex, age, region of residence, and level of education. During the study period, the difference in HRU (rate ratio) between patients and matched comparisons ranged from 1.0 to 1.5 for general practitioner contacts, 0.9 to 2.2 for hospitalizations, 0.9 to 3.8 for inpatient days, 1.0 to 4.0 for outpatient visits, 1.3 to 2.1 for emergency department visits, and 1.0 to 4.1 for treatments/examinations. In conclusion, MPN patients had overall higher HRU than the matched comparisons throughout the follow-up period (maximum 8 years). Further, MPN patients had substantially increased HRU in both the primary and secondary healthcare sector in the 2 years preceding the diagnosis.
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Affiliation(s)
| | - Lise Skovgaard Svingel
- Department of Clinical Epidemiology, Department of Clinical MedicineAarhus University Hospital and Aarhus UniversityAarhusDenmark
| | - Anders Kjærsgaard
- Department of Clinical Epidemiology, Department of Clinical MedicineAarhus University Hospital and Aarhus UniversityAarhusDenmark
| | | | - Bianka Darvalics
- Department of Clinical Epidemiology, Department of Clinical MedicineAarhus University Hospital and Aarhus UniversityAarhusDenmark
| | | | - Christen Lykkegaard Andersen
- Department of HematologyCopenhagen University HospitalRigshospitaletDenmark,The Research Unit for General Practice and Section of General Practice, Department of Public HealthUniversity of CopenhagenCopenhagenDenmark
| | - Christian Fynbo Christiansen
- Department of Clinical Epidemiology, Department of Clinical MedicineAarhus University Hospital and Aarhus UniversityAarhusDenmark
| | - Jesper Stentoft
- Department of HematologyAarhus University HospitalAarhusDenmark
| | - Jørn Starklint
- Department of HematologyHolstebro HospitalHolstebroDenmark
| | | | - Mette Borg Clausen
- Department of HematologyCopenhagen University HospitalRigshospitaletDenmark
| | | | | | | | - Ellen Margrethe Mikkelsen
- Department of Clinical Epidemiology, Department of Clinical MedicineAarhus University Hospital and Aarhus UniversityAarhusDenmark
| | - Marie Bak
- Department of HematologyZealand University HospitalRoskildeDenmark,Department of HematologyCopenhagen University HospitalRigshospitaletDenmark
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Huuhtanen J, Ilander M, Yadav B, Dufva OM, Lähteenmäki H, Kasanen T, Klievink J, Olsson-Strömberg U, Stentoft J, Richter J, Koskenvesa P, Höglund M, Söderlund S, Dreimane A, Porkka K, Gedde-Dahl T, Gjertsen BT, Stenke L, Myhr-Eriksson K, Markevärn B, Lübking A, Dimitrijevic A, Udby L, Bjerrum OW, Hjorth-Hansen H, Mustjoki S. IFN-α with dasatinib broadens the immune repertoire in patients with chronic-phase chronic myeloid leukemia. J Clin Invest 2022; 132:152585. [PMID: 36047494 PMCID: PMC9433106 DOI: 10.1172/jci152585] [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: 07/06/2021] [Accepted: 07/07/2022] [Indexed: 11/24/2022] Open
Abstract
In chronic myeloid leukemia (CML), combination therapies with tyrosine kinase inhibitors (TKIs) aim to improve the achievement of deep molecular remission that would allow therapy discontinuation. IFN-α is one promising candidate, as it has long-lasting effects on both malignant and immune cells. In connection with a multicenter clinical trial combining dasatinib with IFN-α in 40 patients with chronic-phase CML (NordCML007, NCT01725204), we performed immune monitoring with single-cell RNA and T cell receptor (TCR) sequencing (n = 4, 12 samples), bulk TCRβ sequencing (n = 13, 26 samples), flow cytometry (n = 40, 106 samples), cytokine analyses (n = 17, 80 samples), and ex vivo functional studies (n = 39, 80 samples). Dasatinib drove the immune repertoire toward terminally differentiated NK and CD8+ T cells with dampened functional capabilities. Patients with dasatinib-associated pleural effusions had increased numbers of CD8+ recently activated effector memory T (Temra) cells. In vitro, dasatinib prevented CD3-induced cell death by blocking TCR signaling. The addition of IFN-α reversed the terminally differentiated phenotypes and increased the number of costimulatory intercellular interactions and the number of unique putative epitope-specific TCR clusters. In vitro IFN-α had costimulatory effects on TCR signaling. Our work supports the combination of IFN-α with TKI therapy, as IFN-α broadens the immune repertoire and restores immunological function.
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Affiliation(s)
- Jani Huuhtanen
- Translational Immunology Research Program and Department of Clinical Chemistry and Hematology, University of Helsinki, Helsinki, Finland.,Hematology Research Unit Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Department of Hematology, Helsinki, Finland.,Department of Computer Science, Aalto University, Espoo, Finland
| | - Mette Ilander
- Translational Immunology Research Program and Department of Clinical Chemistry and Hematology, University of Helsinki, Helsinki, Finland.,Hematology Research Unit Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Department of Hematology, Helsinki, Finland
| | - Bhagwan Yadav
- Translational Immunology Research Program and Department of Clinical Chemistry and Hematology, University of Helsinki, Helsinki, Finland.,Hematology Research Unit Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Department of Hematology, Helsinki, Finland
| | - Olli Mj Dufva
- Translational Immunology Research Program and Department of Clinical Chemistry and Hematology, University of Helsinki, Helsinki, Finland.,Hematology Research Unit Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Department of Hematology, Helsinki, Finland
| | - Hanna Lähteenmäki
- Translational Immunology Research Program and Department of Clinical Chemistry and Hematology, University of Helsinki, Helsinki, Finland.,Hematology Research Unit Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Department of Hematology, Helsinki, Finland
| | - Tiina Kasanen
- Translational Immunology Research Program and Department of Clinical Chemistry and Hematology, University of Helsinki, Helsinki, Finland.,Hematology Research Unit Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Department of Hematology, Helsinki, Finland
| | - Jay Klievink
- Translational Immunology Research Program and Department of Clinical Chemistry and Hematology, University of Helsinki, Helsinki, Finland.,Hematology Research Unit Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Department of Hematology, Helsinki, Finland
| | - Ulla Olsson-Strömberg
- Department of Medical Sciences, Uppsala University and Hematology Section, Uppsala University Hospital, Uppsala, Sweden
| | - Jesper Stentoft
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Johan Richter
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Perttu Koskenvesa
- Hematology Research Unit Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Department of Hematology, Helsinki, Finland
| | - Martin Höglund
- Department of Medical Sciences, Uppsala University and Hematology Section, Uppsala University Hospital, Uppsala, Sweden
| | - Stina Söderlund
- Department of Medical Sciences, Uppsala University and Hematology Section, Uppsala University Hospital, Uppsala, Sweden
| | - Arta Dreimane
- Department of Medical and Health Sciences, Linköping University, Department of Hematology, County Council of Östergötland, Linköping, Sweden
| | - Kimmo Porkka
- Hematology Research Unit Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Department of Hematology, Helsinki, Finland.,iCAN Digital Precision Cancer Medicine Flagship, Helsinki, Finland
| | - Tobias Gedde-Dahl
- Department of Hematology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Björn T Gjertsen
- Department of Internal Medicine, Hematology Section, Haukeland University Hospital and Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Leif Stenke
- Department of Hematology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | | | - Berit Markevärn
- Department of Hematology, Umeå University Hospital, Umeå, Sweden
| | - Anna Lübking
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | | | - Lene Udby
- Department of Hematology, Zealand University Hospital, Roskilde, Denmark
| | - Ole Weis Bjerrum
- Department of Hematology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Henrik Hjorth-Hansen
- Department of Hematology, St. Olavs Hospital, Trondheim, Norway.,Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Satu Mustjoki
- Translational Immunology Research Program and Department of Clinical Chemistry and Hematology, University of Helsinki, Helsinki, Finland.,Hematology Research Unit Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Department of Hematology, Helsinki, Finland.,iCAN Digital Precision Cancer Medicine Flagship, Helsinki, Finland
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7
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Hasselbalch HC, Knudsen TA, Sørensen AL, Christensen SF, Larsen MK, Bak M, El Fassi D, Cordua S, Brabrand M, Thomsen G, Stentoft J, Starklint J, Ellervik C, Wienecke T, Bruun NE, Eickhardt-Dalbøge CE, Kjær L, Skov V. [Elevated blood cell counts and vascular disease with the myeloproliferative neoplasms as model diseases]. Ugeskr Laeger 2021; 183:V03210282. [PMID: 34709157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Recent studies have shown the Philadelphia-negative myeloproliferative neoplasms (MPN) to be massively underdiagnosed and often preceded by a long pre-diagnostic phase of several years, in which many patients suffer serious vascular events. In this review, we focus on the urgent need for earlier diagnosis and treatment of MPN. Such efforts are foreseen to decrease morbidity and mortality for the individual patients and potentially reduce costs for health and social care systems.
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8
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Flygt H, Söderlund S, Stentoft J, Richter J, Koskenvesa P, Mustjoki S, Majeed W, Lübking A, Dreimane A, Markevärn B, Stenke L, Myhr Eriksson K, Gjertsen BT, Gedde-Dahl T, Dimitrijevic A, Udby L, Olsson-Strömberg U, Hjorth-Hansen H. Long-term tolerability and efficacy after initial PegIFN-α addition to dasatinib in CML-CP: Five-year follow-up of the NordCML007 study. Eur J Haematol 2021; 107:617-623. [PMID: 34418168 DOI: 10.1111/ejh.13699] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Treatment-free remission (TFR) has emerged as a treatment goal in chronic myeloid leukemia in the chronic phase (CML-CP). Attempts to increase proportion of patients achieving TFR include combination of tyrosine kinase inhibitors (TKI) and other drugs. Interferon-α in addition to TKI has shown promising efficacy but with dose-dependent toxicity and discontinuations. NordCML007 was initiated to study the efficacy and safety of low dose pegylated IFN-α (PegIFN-α) in combination with dasatinib (DAS) in CML-CP. METHODS Forty patients with newly diagnosed CML-CP were given DAS upfront. After month 3 (M3) 15 μg/wk of PegIFN-α was added and increased to 25 μg/wk from M7 until M15. DAS treatment was continued and adverse events and BCR-ABL1 qRT-PCR values were reported yearly after M24. Results from M1 to M18 have previously been published, and here we present long-term data. RESULTS After 5 years of follow-up, there were no suspected unexpected serious adverse reactions, no increase in serosal effusions, no disease progressions and no CML-related deaths. Rates of MR3.0 (MMR), MR4.0 and MR4.5 were 84.6%, 64.1% and 51.3% respectively at M60, and 95% of patients reached MMR at some point during the study. CONCLUSION Initial addition of PegIFN-α to DAS shows good long-term efficacy without increased toxicity.
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Affiliation(s)
- Hjalmar Flygt
- Department of Medical Science and Division of Hematology, Uppsala University Hospital, Uppsala, Sweden
| | - Stina Söderlund
- Department of Medical Science and Division of Hematology, Uppsala University Hospital, Uppsala, Sweden
| | - Jesper Stentoft
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Johan Richter
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Perttu Koskenvesa
- Hematology Research Unit Helsinki, and Department of Hematology, Helsinki University Hospital Comprehensive Cancer Center, University of Helsinki, Helsinki, Finland
| | - Satu Mustjoki
- Hematology Research Unit Helsinki, and Department of Hematology, Helsinki University Hospital Comprehensive Cancer Center, University of Helsinki, Helsinki, Finland.,Translational Immunology Research Program and Department of Clinical Chemistry and Hematology, University of Helsinki, Helsinki, Finland
| | - Waleed Majeed
- Department of Hemato-Oncology, Stavanger University Hospital, Stavanger, Norway
| | - Anna Lübking
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Arta Dreimane
- Department of Hematology, Linköping University Hospital, Linköping, Sweden
| | - Berit Markevärn
- Department of Hematology, Umeå University Hospital, Umeå, Sweden
| | - Leif Stenke
- Department of Medicine Solna, Karolinska Institutet and Division of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Bjørn Tore Gjertsen
- Department of Internal Medicine, Hematology Section, Haukeland University Hospital, Bergen, Norway
| | - Tobias Gedde-Dahl
- Department of Hematology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | | | - Lene Udby
- Department of Hematology, Zealand University Hospital, Roskilde, Denmark
| | - Ulla Olsson-Strömberg
- Department of Medical Science and Division of Hematology, Uppsala University Hospital, Uppsala, Sweden
| | - Henrik Hjorth-Hansen
- Department of Hematology, St Olavs Hospital Trondheim, Trondheim, Norway.,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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9
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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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10
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Cooper N, Bird R, Chinthammitr Y, George B, Stentoft J, Tomiyama Y, Zaja F, Hokland P. How I treat immune thrombocytopenia - a global view. Br J Haematol 2021; 193:1076-1086. [PMID: 33570179 DOI: 10.1111/bjh.17324] [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: 11/17/2020] [Accepted: 12/21/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Nichola Cooper
- Department of Haematology. Division of Immunology and Inflammation, Imperial College London, London, UK
| | - Robert Bird
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Australia
| | - Yingyong Chinthammitr
- Department of Medicine, Division of Hematology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Biju George
- Department of Haematology, Christian Medical College, Vellore, India
| | - Jesper Stentoft
- Department of Haematology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Francesco Zaja
- SC Ematologia, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - Peter Hokland
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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11
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Holst JM, Plesner TL, Pedersen MB, Frederiksen H, Møller MB, Clausen MR, Hansen MC, Hamilton-Dutoit SJ, Nørgaard P, Johansen P, Eberlein TR, Mortensen BK, Mathiasen G, Øvlisen A, Wang R, Wang C, Zhang W, Ommen HB, Stentoft J, Ludvigsen M, Tam W, Chan WC, Inghirami G, d’Amore F. Myeloproliferative and lymphoproliferative malignancies occurring in the same patient: a nationwide discovery cohort. Haematologica 2020; 105:2432-2439. [PMID: 33054083 PMCID: PMC7556673 DOI: 10.3324/haematol.2019.225839] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 11/26/2019] [Indexed: 11/22/2022] Open
Abstract
Myeloid and lymphoid malignancies are postulated to have distinct pathogenetic mechanisms. The recent observation that patients with a myeloproliferative neoplasm have an increased risk of developing lymphoproliferative malignancy has challenged this assumption. We collected a nationwide cohort of patients with both malignancies. Patients diagnosed in 1990-2015 were identified through the national Danish Pathology Registry. We identified 599 patients with myeloproliferative neoplasm and a concomitant or subsequent diagnosis of lymphoma. Histopathological review of the diagnostic samples from each patient led to a final cohort of 97 individuals with confirmed dual diagnoses of myeloproliferative neoplasm and lymphoma. The age range at diagnosis was 19-94 years (median: 71 years). To avoid the inclusion of cases of therapy-induced myeloproliferative neoplasm occurring in patients previously treated for lymphoma, only patients with myeloproliferative neoplasm diagnosed unequivocally before the development of lymphoma were included. The average time interval between the diagnoses of the two malignancies was 1.5 years. In the majority of patients (90%) both diagnoses were established within 5 years from each other. Among the lymphoma entities, the frequency of peripheral T-cell lymphomas was markedly increased. Interestingly, all but one of the T-cell lymphomas were of angioimmunoblastic type. These findings suggest that myeloproliferative neoplasm and lymphoproliferative malignancy developing in the same patient may have common pathogenetic events, possibly already at progenitor level. We believe that the molecular characterization of the newly developed biorepository will help to highlight the mechanisms driving the genesis and clonal evolution of these hematopoietic malignancies.
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Affiliation(s)
- Johanne M. Holst
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | | | | | - Michael B. Møller
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Michael R. Clausen
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Marcus C. Hansen
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Peter Nørgaard
- Department of Pathology, Herlev Hospital, Copenhagen, Denmark
| | - Preben Johansen
- Department of Pathology, Aalborg University Hospital, Aalborg, Denmark
| | | | | | | | - Andreas Øvlisen
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
| | - Rui Wang
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York City, NY, USA
| | - Chao Wang
- Department of Pathology, City of Hope Medical Center, Duarte, CA, USA
| | - Weiwei Zhang
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Hans Beier Ommen
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Jesper Stentoft
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Maja Ludvigsen
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Wayne Tam
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York City, NY, USA
| | - Wing C. Chan
- Department of Pathology, City of Hope Medical Center, Duarte, CA, USA
| | - Giorgio Inghirami
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York City, NY, USA
| | - Francesco d’Amore
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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12
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Stentoft J. Leukaemia Diagnosis, fifth edition. Barbara J.Bain, Wiley Blackwell,2017. ISBN 9781119210542 (cloth, 559 pages). Also available as e‐book. Br J Haematol 2019. [DOI: 10.1111/bjh.16351] [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: 12/01/2022]
Affiliation(s)
- Jesper Stentoft
- Department of Haematology Aarhus University Hospital Aarhus N 8200 Denmark
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13
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Kreutzman A, Yadav B, Brummendorf TH, Gjertsen BT, Hee Lee M, Janssen J, Kasanen T, Koskenvesa P, Lotfi K, Markevärn B, Olsson-Strömberg U, Stentoft J, Stenke L, Söderlund S, Udby L, Richter J, Hjorth-Hansen H, Mustjoki S. Immunological monitoring of newly diagnosed CML patients treated with bosutinib or imatinib first-line. Oncoimmunology 2019; 8:e1638210. [PMID: 31428530 PMCID: PMC6685516 DOI: 10.1080/2162402x.2019.1638210] [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: 01/03/2019] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 12/19/2022] Open
Abstract
Changes in the immune system induced by tyrosine kinase inhibitors (TKI) have been shown to positively correlate with therapy responses in chronic myeloid leukemia (CML). However, only a few longitudinal studies exist and no randomized comparisons between two TKIs have been reported. Therefore, we prospectively analyzed the immune system of newly diagnosed CML patients treated with imatinib (n = 20) or bosutinib (n = 13), that participated in the randomized BFORE trial (NCT02130557). Comprehensive immunophenotyping, plasma protein profiling, and functional assays to determine activation levels of T and NK cells were performed at diagnosis, 3, and 12 months after therapy start. All results were correlated with clinical parameters such as Sokal risk and BCR-ABL load measured according to IS%. At diagnosis, low Sokal risk CML patients had a higher frequency of cytotoxic cells (CD8 + T and NK cells), increased cytotoxic potential of NK cells and lower frequency of naïve and central memory CD4 + T cells. Further, soluble plasma protein profile divided patients into two distinct clusters with different disease burden at diagnosis. During treatment, BCR-ABL IS% correlated with immunological parameters such as plasma proteins, together with different memory subsets of CD4+ and CD8 + T cells. Interestingly, the proportion and cytotoxic potential of NK cells together with several soluble proteins increased during imatinib treatment. In contrast, no major immunological changes were observed during bosutinib treatment. In conclusion, imatinib and bosutinib were shown to have differential effects on the immune system in this randomized clinical trial. Increased number and function of NK cells were especially observed during imatinib therapy.
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Affiliation(s)
- Anna Kreutzman
- Hematology Research Unit Helsinki, University of Helsinki and Department of Hematology, Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland.,Department of Clinical Chemistry, University of Helsinki, Helsinki, Finland
| | - Bhagwan Yadav
- Hematology Research Unit Helsinki, University of Helsinki and Department of Hematology, Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland.,Department of Clinical Chemistry, University of Helsinki, Helsinki, Finland
| | - Tim H Brummendorf
- Department of Hematology and Oncology, Universitätsklinikum RWTH Aachen, Aachen, Germany
| | - Bjorn Tore Gjertsen
- Department of Internal Medicine, Hematology Section, Haukeland University Hospital and Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Moon Hee Lee
- Hematology Research Unit Helsinki, University of Helsinki and Department of Hematology, Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland.,Department of Clinical Chemistry, University of Helsinki, Helsinki, Finland
| | - Jeroen Janssen
- Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Tiina Kasanen
- Hematology Research Unit Helsinki, University of Helsinki and Department of Hematology, Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
| | - Perttu Koskenvesa
- Hematology Research Unit Helsinki, University of Helsinki and Department of Hematology, Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
| | - Kourosh Lotfi
- Department of Medical and Health Sciences, Linköping University, Department of Hematology, County Council of Östergötland, Linköping, Sweden
| | - Berit Markevärn
- Department of Hematology, Umeå University Hospital, Umeå, Sweden
| | - Ulla Olsson-Strömberg
- Department of Medical Sciences, Uppsala University and Hematology Section, Uppsala University Hospital, Uppsala, Sweden
| | - Jesper Stentoft
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Leif Stenke
- Department of Hematology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Stina Söderlund
- Department of Medical Sciences, Uppsala University and Hematology Section, Uppsala University Hospital, Uppsala, Sweden
| | - Lene Udby
- Department of Hematology, Zealand University Hospital, Roskilde, Denmark
| | - Johan Richter
- Department of Hematology, Skåne University Hospital, Lund, Sweden
| | - Henrik Hjorth-Hansen
- Department of Hematology, St Olavs Hospital, Trondheim, Norway.,Department of Clinical and Molecular Medicine (IKOM), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Satu Mustjoki
- Hematology Research Unit Helsinki, University of Helsinki and Department of Hematology, Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland.,Department of Clinical Chemistry, University of Helsinki, Helsinki, Finland
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14
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Giles FJ, Masszi T, Gómez Casares MT, Hellmann A, Stentoft J, Conneally E, García Gutierrez V, Gattermann N, Le Coutre PD, Martino B, Saussele S, Radich JP, Ross DM, Saglio G, Sondhi M, Acharyya S, Aimone P, Hochhaus A. Treatment-free remission (TFR) following frontline (1L) nilotinib (NIL) in patients (pts) with chronic myeloid leukemia in chronic phase (CML-CP): 192-week data from the ENESTfreedom study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.7013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7013 Background: In ENESTfreedom (NCT01784068), which evaluated TFR following 1L NIL in CML-CP pts, 51.6% remained in TFR 48 wks after stopping treatment (primary endpoint) and durability of TFR was demonstrated at 144 wks. Data from longer follow-up (192 wks) evaluating maintenance of TFR are reported. Methods: Pts with MR4.5 ( BCR-ABL1IS ≤0.0032%) and ≥2y of 1L NIL entered a 1y consolidation; pts with sustained deep molecular response (MR) were eligible for TFR. NIL was resumed after loss of major MR (MMR; BCR-ABL1IS ≤0.1%). At the latest data cut-off (Sep 17 2018), all pts had completed ≥192 wks of TFR, resumed NIL, or discontinued the study. Results: By the data cut-off, of 190 pts entering TFR, 87 were ongoing, 91 had resumed NIL, and 12 had permanently discontinued. The TFR rate at 192 wks was 44.2% (84/190, 95% CI: 37.0–51.6%). Of 89 pts with successful TFR at 144 wks, 5 were not assessable for TFR at 192 wks as 2 had discontinued by 192 wks due to pt/physician decision, and 3 with MR4.5 previously did not have 192 wk PCR data. Of 91 pts who resumed NIL, 90 (98.9%) regained MMR and 84 (92.3%) regained MR4.5. 75/90 and 73/84 pts, respectively, had stable MMR and MR4.5 at 48 wks later. There were no cases of disease progression or new deaths. 10 deaths were reported in the 144-wk analysis, none due to CML. The 192-wk treatment-free survival rate was 48.7% (95% CI 41.4–55.6%). Of 89 pts remaining in TFR for > 144 wks (including 87 pts for > 192 wks), all-grade AE rates during consolidation and each subsequent 48 wk period of TFR were 84.3%, 77.5%, 70.8%, 48.3%, and 52.8%, respectively. All-grade musculoskeletal pain AE rates were 15.7%, 40.4%, 9.0%, 3.4% and 3.4%, respectively; cardiovascular event rates were low across these periods. Among pts who resumed NIL, most common AEs were nasopharyngitis (18.7%) and pruritus, fatigue, and increased lipase (14.3% each); the majority of AEs were grade 1/2. Conclusions: Results continue to support the long-term durability and safety of TFR at 192 wks after stopping 1L NIL; overall AE rates declined during the TFR phase and musculoskeletal pain AEs were transient. Pts should continue to be regularly monitored during TFR. Clinical trial information: NCT01784068.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Bruno Martino
- Azienda Ospedaliera Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | - Susanne Saussele
- III. Med. Klinik, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - Jerald P. Radich
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | | | - Manu Sondhi
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | | | | | - Andreas Hochhaus
- Abteilung Hämatologie/Onkologie, Universitätsklinikum Jena, Jena, Germany
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15
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Bjerrum OW, Fassi DE, Madsen G, Stentoft J, Vestergaard H, Rønnov-Jessen D, Pedersen PT, Pulczynski S, Overgaard UM, Andersen CL. [Eosinophilia]. Ugeskr Laeger 2018; 180:V01180032. [PMID: 30259829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
When the number of eosinophil granulocytes in blood increases, the cause is not always easy to disentangle. This review highlights the symptoms of rare clonal and common reactive diagnoses, how to approach the patient clinically, and how to implement the armamentarium of available tests in order to identify the correct diagnosis and offer the proper treatment. Two referral centres for eosinophilia have been established in Denmark to support this activity by a collaboration between all departments of haematology and the relevant specialities, meeting the manifestations of eosinophilia.
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16
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Radich JP, Masszi T, Gómez Casares MT, Hellmann A, Stentoft J, Conneally E, García Gutierrez V, Gattermann N, Le Coutre PD, Martino B, Saussele S, Giles FJ, Ross DM, Saglio G, Sondhi M, Acharyya S, Chaturvedi S, Bédoucha V, Hochhaus A. Long-term treatment-free remission (TFR) following frontline (1L) nilotinib in patients (pts) with chronic myeloid leukemia in chronic phase (CML-CP): ENESTfreedom 144-wk results. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.7063] [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: 11/20/2022] Open
Affiliation(s)
- Jerald P. Radich
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | | | | | | | | | | | | | | | - Bruno Martino
- Azienda Ospedaliera Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | - Susanne Saussele
- III. Med. Klinik, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | | | | | | | - Manu Sondhi
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | | | | | | | - Andreas Hochhaus
- Abteilung Hämatologie/Onkologie, Universitätsklinikum Jena, Jena, Germany
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17
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Ross DM, Masszi T, Gómez Casares MT, Hellmann A, Stentoft J, Conneally E, Garcia-Gutierrez V, Gattermann N, le Coutre PD, Martino B, Saussele S, Giles FJ, Radich JP, Saglio G, Deng W, Krunic N, Bédoucha V, Gopalakrishna P, Hochhaus A. Durable treatment-free remission in patients with chronic myeloid leukemia in chronic phase following frontline nilotinib: 96-week update of the ENESTfreedom study. J Cancer Res Clin Oncol 2018; 144:945-954. [PMID: 29468438 PMCID: PMC5916993 DOI: 10.1007/s00432-018-2604-x] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [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: 01/22/2018] [Accepted: 02/02/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE ENESTfreedom is evaluating treatment-free remission (TFR) following frontline nilotinib in patients with chronic myeloid leukemia (CML) in chronic phase. Following our primary analysis at 48 weeks, we here provide an updated 96-week analysis. METHODS Attempting TFR required ≥ 3 years of nilotinib, a molecular response of MR4.5 [BCR-ABL1 ≤ 0.0032% on the International Scale (BCR-ABL1IS)], and sustained deep molecular response (DMR) during a 1-year consolidation phase. Patients restarted nilotinib following loss of major molecular response (MMR; BCR-ABL1IS ≤ 0.1%). RESULTS Ninety-six weeks after stopping treatment (3.6-year median prior nilotinib duration), 93 of 190 patients (48.9%) remained in TFR. Of 88 patients who restarted nilotinib following loss of MMR, 87 regained MMR and 81 regained MR4.5 by the data cut-off. Ninety-six-week TFR rates were 61.3, 50.0, and 28.6% in patients with low, intermediate, and high Sokal risk scores at diagnosis, respectively. Patients consistently in MR4.5 during consolidation had higher TFR rates (50.6%) than patients with ≥ 1 assessment without MR4.5 during consolidation (35.0%). In a landmark analysis, 96-week TFR rates for patients with MR4.5, MR4 (BCR-ABL1IS ≤ 0.01%) but not MR4.5, and MMR but not MR4 at TFR week 12 were 82.6, 23.1, and 0%, respectively. There were no reports of disease progression or death due to CML; overall adverse event frequency decreased following TFR. Within the follow-up period, TFR did not adversely affect disease outcomes. CONCLUSIONS These results demonstrate the feasibility and durability of TFR following frontline nilotinib and emphasize the importance of sustained DMR for TFR.
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Affiliation(s)
- David M Ross
- Division of Haematology, SA Pathology, Room 6E359, Royal Adelaide Hospital, 1 Port Rd, Adelaide, SA, 5000, Australia.
| | | | | | | | | | | | | | | | | | - Bruno Martino
- Azienda Ospedaliera Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | - Susanne Saussele
- III. Med. Klinik, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | | | - Jerald P Radich
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Weiping Deng
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Nancy Krunic
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | | | | | - Andreas Hochhaus
- Abteilung Hämatologie/Onkologie, Universitätsklinikum Jena, Jena, Germany
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18
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Tøstesen M, Østergård LSG, Kjeldsen E, Stentoft J, Nørgaard JM. [Acute promyelocytic leukaemia]. Ugeskr Laeger 2018; 180:V06170490. [PMID: 29336301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Acute promyelocytic leukaemia has changed from being a highly fatal to a highly curable disease. Over time, key discoveries have identified the genetic and molecular abnormalities, which cause the disease. First choice of treatment has now changed from all-trans retinoic acid (ATRA) and chemotherapy to a chemo-free combination of arsenic trixoide and ATRA. This new regimen has shown equal responses and overall cure rates compared with the previous standard of care containing conventional chemotherapy, but with much lower toxicity. This will pave the way for better and easier treatment for elderly and frail patients.
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MESH Headings
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Arsenic Trioxide/administration & dosage
- Arsenic Trioxide/therapeutic use
- Disseminated Intravascular Coagulation/etiology
- History, 20th Century
- Humans
- In Situ Hybridization, Fluorescence
- Leukemia, Promyelocytic, Acute/complications
- Leukemia, Promyelocytic, Acute/diagnosis
- Leukemia, Promyelocytic, Acute/drug therapy
- Leukemia, Promyelocytic, Acute/history
- Tretinoin/administration & dosage
- Tretinoin/therapeutic use
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19
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Tøstesen M, Østgård LSG, Kjeldsen E, Stentoft J, Nørgaard JM. [Successful treatment of acute promyelocytic leukaemia without chemotherapy and blood transfusion]. Ugeskr Laeger 2018; 180:V06170489. [PMID: 29336300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Untreated acute promyelocytic leukaemia (APL) is a rapidly lethal blood cancer. Conventional treatment consists of all-trans retinoic acid and chemotherapy. Standard chemo-therapy-containing treatments necessitate the use of blood products. This is a case report of typical APL in a 32-year-old female patient, who due to religious conviction refused supportive therapy with blood products. A treatment regimen consisting of all-trans retinoic acid and arsenic trioxide was successful without the use of blood transfusions.
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20
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Gullaksen SE, Skavland J, Gavasso S, Tosevski V, Warzocha K, Dumrese C, Ferrant A, Gedde-Dahl T, Hellmann A, Janssen J, Labar B, Lang A, Majeed W, Mihaylov G, Stentoft J, Stenke L, Thaler J, Thielen N, Verhoef G, Voglova J, Ossenkoppele G, Hochhaus A, Hjorth-Hansen H, Mustjoki S, Sopper S, Giles F, Porkka K, Wolf D, Gjertsen BT. Single cell immune profiling by mass cytometry of newly diagnosed chronic phase chronic myeloid leukemia treated with nilotinib. Haematologica 2017; 102:1361-1367. [PMID: 28522574 PMCID: PMC5541871 DOI: 10.3324/haematol.2017.167080] [Citation(s) in RCA: 21] [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: 02/19/2017] [Accepted: 05/08/2017] [Indexed: 12/27/2022] Open
Abstract
Monitoring of single cell signal transduction in leukemic cellular subsets has been proposed to provide deeper understanding of disease biology and prognosis, but has so far not been tested in a clinical trial of targeted therapy. We developed a complete mass cytometry analysis pipeline for characterization of intracellular signal transduction patterns in the major leukocyte subsets of chronic phase chronic myeloid leukemia. Changes in phosphorylated Bcr-Abl1 and the signaling pathways involved were readily identifiable in peripheral blood single cells already within three hours of the patient receiving oral nilotinib. The signal transduction profiles of healthy donors were clearly distinct from those of the patients at diagnosis. Furthermore, using principal component analysis, we could show that phosphorylated transcription factors STAT3 (Y705) and CREB (S133) within seven days reflected BCR-ABL1IS at three and six months. Analyses of peripheral blood cells longitudinally collected from patients in the ENEST1st clinical trial showed that single cell mass cytometry appears to be highly suitable for future investigations addressing tyrosine kinase inhibitor dosing and effect. (clinicaltrials.gov identifier: 01061177)
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Affiliation(s)
- Stein-Erik Gullaksen
- Centre of Cancer Biomarkers CCBIO, Department of Clinical Science, Precision Oncology Research Group, University of Bergen, Norway
| | - Jørn Skavland
- Centre of Cancer Biomarkers CCBIO, Department of Clinical Science, Precision Oncology Research Group, University of Bergen, Norway
| | - Sonia Gavasso
- Department of Clinical Medicine, University of Bergen, Norway.,Neuroimmunology Lab, Haukeland University Hospital, Bergen, Norway
| | - Vinko Tosevski
- Mass Cytometry Facility, University of Zurich, Switzerland
| | - Krzysztof Warzocha
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | | | - Augustin Ferrant
- Hematology Department, Cliniques Universitaires St Luc, Brussels, Belgium
| | | | | | - Jeroen Janssen
- Department of Hematology, VU University Medical Center, Amsterdam, the Netherlands
| | - Boris Labar
- Department of Hematology, University Hospital Center Rebro, Zagreb, Croatia
| | - Alois Lang
- Internal Medicine, Hospital Feldkirch, Austria
| | - Waleed Majeed
- Department of Hemato-Oncology, Stavanger University Hospital, Norway
| | | | | | - Leif Stenke
- Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Josef Thaler
- Department of Internal Medicine IV, Wels-Grieskirchen Hospital, Wels, Austria
| | - Noortje Thielen
- Department of Hematology, VU University Medical Center, Amsterdam, the Netherlands
| | - Gregor Verhoef
- Department of Hematology, University Hospital Leuven, Belgium
| | - Jaroslava Voglova
- 4 Department of Internal Medicine - Hematology, University Hospital Hradec Kralove, Czech Republic
| | - Gert Ossenkoppele
- Department of Hematology, VU University Medical Center, Amsterdam, the Netherlands
| | - Andreas Hochhaus
- Department of Hematology and Medical Oncology, Universitätsklinikum Jena, Germany
| | - Henrik Hjorth-Hansen
- Department of Hematology, St Olavs Hospital, Trondheim, Norway.,IKM, NTNU, Trondheim, Norway
| | - Satu Mustjoki
- Hematology Research Unit Helsinki, University of Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Department of Hematology, Finland.,Department of Clinical Chemistry, University of Helsinki, Finland
| | - Sieghart Sopper
- Department of Hematology and Oncology, Innsbruck Medical University and Tyrolean Cancer Research Institute, Innsbruck, Austria
| | - Francis Giles
- NMDTI, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
| | - Kimmo Porkka
- Hematology Research Unit Helsinki, University of Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Department of Hematology, Finland
| | - Dominik Wolf
- Department of Hematology and Oncology, Innsbruck Medical University and Tyrolean Cancer Research Institute, Innsbruck, Austria.,Medical Clinic 3, Oncology, Hematology and Rheumatology, University Hospital Bonn (UKB), Germany
| | - Bjørn Tore Gjertsen
- Centre of Cancer Biomarkers CCBIO, Department of Clinical Science, Precision Oncology Research Group, University of Bergen, Norway .,Department of Internal Medicine, Haukeland University Hospital, Bergen, Norway
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21
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Abstract
Whole blood aggregometry is a functional assay for determination of platelet function. Until now, whole blood aggregometry has not been considered feasible at low platelet counts. Hence, the objectives of the present study were to explore platelet function in thrombocytopenia using a novel index of impedance aggregometry adjusted for platelet count and evaluate the association to platelet function assessed by flow cytometry. Hirudin anticoagulated blood was collected from 20 healthy volunteers, 20 patients with primary immune thrombocytopenia (ITP), and 17 hematological cancer patients. Platelet function was analyzed by impedance aggregometry and by flow cytometry. Collagen, adenosine diphosphate, thrombin receptor agonist peptide-6, and ristocetin were used as agonists for both analyses. Thrombocytopenia in healthy whole blood was induced in vitro employing a recently published method. Platelet aggregation of thrombocytopenic patients was evaluated relative to the aggregation of healthy volunteers at the same platelet count. In flow cytometry, platelet function was described as expression of the platelet surface glycoproteins: bound fibrinogen, CD63, and P-selectin. Similar platelet counts were obtained in the patient groups (p = 0.69) (range: 13-129 × 109/l). Aggregation adjusted for platelet count was significantly increased in ITP patients compared to healthy platelets across all agonists. The platelet aggregation was high in the 95% prediction interval, with 18 ITP patients above the prediction interval in at least two agonists. In contrast, the platelet aggregation was low in the prediction interval in cancer patients, and three cancer patients with platelet aggregation below the prediction interval in at least one agonist. ITP patients displayed increased expression of bound fibrinogen and CD63 following activation, compared with particularly cancer patients, but also compared with healthy platelets. This study demonstrated the feasibility of a novel approach to perform platelet function analyses in thrombocytopenia using impedance aggregometry adjusted for platelet count.
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Affiliation(s)
- Mette Tiedemann Skipper
- a Centre for Haemophilia and Thrombosis , Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus , Denmark
| | - Peter Rubak
- a Centre for Haemophilia and Thrombosis , Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus , Denmark
| | - Jesper Stentoft
- b Department of Haematology , Aarhus University Hospital, Aarhus University Hospital , Denmark
| | - Anne-Mette Hvas
- a Centre for Haemophilia and Thrombosis , Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus , Denmark
| | - Ole Halfdan Larsen
- a Centre for Haemophilia and Thrombosis , Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus , Denmark
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22
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Hochhaus A, Masszi T, Giles FJ, Radich JP, Ross DM, Gómez Casares MT, Hellmann A, Stentoft J, Conneally E, García-Gutiérrez V, Gattermann N, Wiktor-Jedrzejczak W, le Coutre PD, Martino B, Saussele S, Menssen HD, Deng W, Krunic N, Bedoucha V, Saglio G. Treatment-free remission following frontline nilotinib in patients with chronic myeloid leukemia in chronic phase: results from the ENESTfreedom study. Leukemia 2017; 31:1525-1531. [PMID: 28218239 PMCID: PMC5508077 DOI: 10.1038/leu.2017.63] [Citation(s) in RCA: 193] [Impact Index Per Article: 27.6] [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: 12/12/2016] [Revised: 01/19/2017] [Accepted: 02/02/2017] [Indexed: 12/14/2022]
Abstract
The single-arm, phase 2 ENESTfreedom trial assessed the potential for treatment-free remission (TFR; i.e., the ability to maintain a molecular response after stopping therapy) following frontline nilotinib treatment. Patients with Philadelphia chromosome-positive chronic myeloid leukemia in chronic phase with MR4.5 (BCR-ABL1⩽0.0032% on the International Scale (BCR-ABL1IS)) and ⩾2 years of frontline nilotinib therapy were enrolled. Patients with sustained deep molecular response during the 1-year nilotinib consolidation phase were eligible to stop treatment and enter the TFR phase. Patients with loss of major molecular response (MMR; BCR-ABL1IS⩽0.1%) during the TFR phase reinitiated nilotinib. In total, 215 patients entered the consolidation phase, of whom 190 entered the TFR phase. The median duration of nilotinib before stopping treatment was 43.5 months. At 48 weeks after stopping nilotinib, 98 patients (51.6% 95% confidence interval, 44.2–58.9%) remained in MMR or better (primary end point). Of the 86 patients who restarted nilotinib in the treatment reinitiation phase after loss of MMR, 98.8% and 88.4%, respectively, regained MMR and MR4.5 by the data cutoff date. Consistent with prior reports of imatinib-treated patients, musculoskeletal pain-related events were reported in 24.7% of patients in the TFR phase (consolidation phase, 16.3%).
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Affiliation(s)
- A Hochhaus
- Abteilung Hämatologie/Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - T Masszi
- Department of Haematology and Stem Cell Transplantation St István and St László Hospital, Budapest, Hungary
| | - F J Giles
- Developmental Therapeutics Program, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - J P Radich
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - D M Ross
- SA Pathology, Adelaide, SA, Australia
| | - M T Gómez Casares
- Hospital Universitario Doctor Negrin, Las Palmas de Gran Canaria, Spain
| | - A Hellmann
- Medical University of Gdańsk, Gdańsk, Poland
| | - J Stentoft
- Aarhus University Hospital, Aarhus, Denmark
| | | | - V García-Gutiérrez
- Servicio de Hematología, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | - N Gattermann
- Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | | | | | - B Martino
- Azienda Ospedaliera Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | - S Saussele
- III. Med. Klinik, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | | | - W Deng
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - N Krunic
- Novartis Institute for Biomedical Research, Cambridge, MA, USA
| | | | - G Saglio
- University of Turin, Orbassano, Italy
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23
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Affiliation(s)
- Jesper Stentoft
- Department of Haematology, Aarhus University Hospital, Aarhus C, Denmark
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24
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Hochhaus A, Masszi T, Giles FJ, Radich JP, Ross DM, Gómez Casares MT, Hellmann A, Stentoft J, Conneally E, García Gutierrez V, Gattermann N, Wiktor-Jedrzejczak W, Le Coutre PD, Martino B, Saussele S, Menssen HD, Deng W, Krunic N, Bedoucha V, Saglio G. Treatment-free remission (TFR) in patients (pts) with chronic myeloid leukemia in chronic phase (CML-CP) treated with frontline nilotinib: Results from the ENESTFreedom study. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.7001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Tamas Masszi
- Fovarosi Onkormanyzat Szent Laszlo Korhaza, Hematologia, Budapest, Hungary
| | - Francis J. Giles
- Northwestern Medicine Developmental Therapeutics Institute, Chicago, IL
| | - Jerald P. Radich
- Seattle Cancer Care Alliance/Fred Hutchinson Cancer Research Center, Seattle, WA
| | - David M. Ross
- SA Pathology, Flinders Medical Centre, Adelaide, Australia
| | | | | | | | | | | | | | | | | | - Bruno Martino
- Azienda Ospedaliera Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | - Susanne Saussele
- III. Med. Klinik, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | | | - Weiping Deng
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Nancy Krunic
- Novartis Institute for Biomedical Research, Cambridge, MA
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25
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Christensen AM, Thagaard MS, Stentoft J. [Wrong administration of methotrexate can lead to fatal haematological complications in elderly patients]. Ugeskr Laeger 2013; 175:435-436. [PMID: 23402255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We present four cases of life-threatening methotrexate intoxications of patients with rheumatological disease. In two of the cases, the direct cause of intoxication was accidentally daily administration of the drug instead of weekly. The patients presented with uncharacteristic symptoms, including nausea, mucositis and fever. All of them had pancytopenia, and despite therapy with broad spectrum antibiotics three patients died in a state of septic shock. These cases demonstrate the importance of adequate communication between health-care professionals, who are involved in the administration of methotrexate and in particular it emphazises that methotrexate should be administrated as weekly doses.
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Affiliation(s)
- Anders Mark Christensen
- Institut for Klinisk Medicin, Aarhus Universitet, Brendstrupgårdsvej 100, 8200 Aarhus N, Denmark.
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26
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Larsen OH, Stentoft J, Radia D, Ingerslev J, Sørensen B. Combination of recombinant factor VIIa and fibrinogen corrects clot formation in primary immune thrombocytopenia at very low platelet counts. Br J Haematol 2012; 160:228-36. [DOI: 10.1111/bjh.12118] [Citation(s) in RCA: 12] [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: 04/19/2012] [Accepted: 09/12/2012] [Indexed: 11/26/2022]
Affiliation(s)
| | - Jesper Stentoft
- Department of Haematology; Aarhus University Hospital; Aarhus; Denmark
| | - Deepti Radia
- Department of Haematology; Guy's and St Thomas' NHS Foundation Trust; London; UK
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27
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Kristensen T, Randers E, Stentoft J. Bilateral renal artery stenosis in a patient with chronic myeloid leukemia treated with nilotinib. Leuk Res Rep 2012; 1:1-3. [PMID: 24371759 DOI: 10.1016/j.lrr.2012.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 09/09/2012] [Accepted: 09/17/2012] [Indexed: 11/24/2022] Open
Abstract
Previously authors have recently described an association between nilotinib therapy for chronic myeloid leukemia (CML) and severe peripheral artery disease, coronary artery disease and sudden death. We present a case report of a male patient with CML who received nilotinib therapy. He developed bilateral renal artery stenosis and renovascular hypertension. He had no history of hypertension, cardiovascular disease, or diabetes, and he was a nonsmoker. Together, these observations indicated that obtaining further understanding of the effects is necessary and that extreme caution is warranted when considering second-generation tyrosine kinase inhibitors for first-line therapy in CML.
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Affiliation(s)
- Tilde Kristensen
- Department of Internal Medicine, Viborg Regional Hospital, Viborg, Denmark
| | - Else Randers
- Department of Internal Medicine, Viborg Regional Hospital, Viborg, Denmark
| | - Jesper Stentoft
- Department of Hematology, University Hospital Aarhus, Aarhus, Denmark
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28
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Gudbrandsdottir S, Frederiksen H, Birgens HS, Nielsen CH, Nielsen OJ, Stentoft J, Hasselbalch HC. [The pathogenesis of primary immune thrombocytopenia]. Ugeskr Laeger 2011; 173:274-277. [PMID: 21262172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Primary immune thrombocytopenia (ITP)--formerly known as idiopathic thrombocytopenic purpura--is an autoimmune disorder characterized by immune-mediated thrombocytopenia. The aetiology of ITP remains unknown, but studies have shown that multiple immunological mechanisms are involved in the pathogenesis of ITP.This article aims to provide an overview of our knowledge of the pathogenesis of ITP.
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Affiliation(s)
- Sif Gudbrandsdottir
- Afsnit 7521, Institut for Inflammationsforskning, Finsenscenter, Rigshospitalet, 2200 København N, Denmark.
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29
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Gudbrandsdottir S, Frederiksen H, Birgens HS, Nielsen CH, Nielsen OJ, Stentoft J, Hasselbalch HC. [New treatment options for primary immune thrombocytopenia]. Ugeskr Laeger 2011; 173:271-274. [PMID: 21262171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Primary immune thrombocytopenia (ITP)--formerly known as idiopathic thrombocytopenic purpura--is an autoimmune disorder characterized by immune mediated thrombocytopenia. The aetiology of ITP remains unknown, but studies have shown that multiple immunological mechanisms are involved in the pathogenesis of ITP. This article aims to provide an overview of current treatment options, with particular emphasis on new biological therapies: rituximab, a monoclonal anti-CD20 antibody, and the thrombopoietin receptor agonists romiplostim and eltrombopag.
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Affiliation(s)
- Sif Gudbrandsdottir
- Afsnit 7521, Institut for Inflammationsforskning, Finsenscenter, Rigshospitalet, 2200 København N, Denmark.
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30
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Abstract
A 26-year-old woman with extra-pulmonary Wegener's granulomatosis was treated with cyclophosphamide for 3.25 years, cumulated dose of 91 g. Six months before cessation of therapy discrete radiological signs of apical fibrosis appeared. The changes were progressive regardless of discontinuation of cyclophosphamide and led to severe restrictive ventilatory defect.
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31
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Hokland P, Ommen HB, Nyvold CG, Stentoft J, Braendstrup K, Andersen BL, Mikkelsen LS, Ostergaard M. [Minimal residual disease in malignant diseases of the blood II. Translation and therapeutic consequences]. Ugeskr Laeger 2009; 171:232-235. [PMID: 19174038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The translation of quantitative polymerase chain reaction technology for the quantitative detection of minimal residual disease (MRD) arising from molecular aberrations in leukaemias has progressed from the pre-clinical setting to daily clinical practice. Thus, it is now part of the mainstay in following patients with chronic myeloid leukaemia treated with the tyrosine kinase inhibitor imatinib. Moreover, the methodology is being integrated in an increasing number of clinical trials, where it is expected to result in more rational and individualized clinical decision-making. A special point in favour of the techniques is the powerful and early detection of disease relapses, in some cases up to one year prior to clinical detection.
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MESH Headings
- Antineoplastic Agents/therapeutic use
- Benzamides
- Biomarkers, Tumor/analysis
- Early Detection of Cancer
- Humans
- Imatinib Mesylate
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Neoplasm Recurrence, Local/diagnosis
- Neoplasm Recurrence, Local/genetics
- Neoplasm, Residual/diagnosis
- Neoplasm, Residual/genetics
- Piperazines/therapeutic use
- Polymerase Chain Reaction/methods
- Protein Kinase Inhibitors/therapeutic use
- Pyrimidines/therapeutic use
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Affiliation(s)
- Peter Hokland
- Immunhaematologisk Laboratorium, Haematologisk Afdeling R, Arhus Universitetshospital, Arhus Sygehus, DK-8000 Arhus C.
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32
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Hokland P, Nyvold CG, Stentoft J, Ommen HB, Ebbesen LH, Braendstrup K, Andersen BL, Mikkelsen LS, Ostergaard M. [Minimal residual disease in malignant diseases of the blood I. Background and pre-clinical validation]. Ugeskr Laeger 2009; 171:229-231. [PMID: 19174037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
In haematological malignancies, molecular markers like fusion DNA from balanced translocations, point mutations, or over-expressed genes can now be used not only for diagnosis, but also for determination of the minimal residual disease (MRD) after cytoreduction with a sensitivity by far exceeding that of previous methodologies. The sensitivity of quantitative polymerase chain reaction typically reaches a validated identification of 1 malignant cell in 100,000.
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Affiliation(s)
- Peter Hokland
- Immunhaematologisk Laboratorium, Haematologisk Afdeling R, Arhus Universitetshospital, Arhus Sygehus, DK-8000 Arhus C.
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33
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Bjerrum OW, Dufva IH, Stentoft J, Hasselbalch HC. [Dasatinib. A novel tyrosine kinase inhibitor for the treatment of chronic myeloid leukaemia]. Ugeskr Laeger 2008; 170:331-333. [PMID: 18252160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Chronic myeloid leukaemia is characterized by an abnormal tyrosin kinase in the cytoplasm of the clonal cells. The enzyme is derived from a fusion gene on the Philadelphia-chromosome, evolved by a translocation between chromosomes 9 and 22. Understanding the biology of the tyrosin kinase led to targeted therapy, inhibiting the ATP-binding site by a small molecule--imatinib (Glivec). A novel 2nd generation tyrosin kinase inhibitor--dasatinib (Sprycel)--is now available in cases of insufficient response or intolerance to imatinib.
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Affiliation(s)
- Ole Weis Bjerrum
- Rigshospitalet, Finsenscentret, Haematologisk Klinik, København Ø.
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34
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Nyvold CG, Stentoft J, Braendstrup K, Melsvik D, Moestrup SK, Juhl-Christensen C, Hasle H, Hokland P. Wilms' tumor 1 mutation accumulated during therapy in acute myeloid leukemia: biological and clinical implications. Leukemia 2006; 20:2051-4. [PMID: 16990770 DOI: 10.1038/sj.leu.2404389] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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35
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Stentoft J, Hokland P, Ostergaard M, Hasle H, Nyvold CG. Minimal residual core binding factor AMLs by real time quantitative PCR—Initial response to chemotherapy predicts event free survival and close monitoring of peripheral blood unravels the kinetics of relapse. Leuk Res 2006; 30:389-95. [PMID: 16243396 DOI: 10.1016/j.leukres.2005.08.030] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2005] [Revised: 08/24/2005] [Accepted: 08/24/2005] [Indexed: 11/19/2022]
Abstract
Minimal residual disease (MRD) was measured by RQ-PCR in 11 AML1/ETO and 13 CBFbeta/MYH11 patients at diagnosis, after induction chemotherapy, and at all subsequent visits. Median detection limits were 1:50,000 and 1:10,000, respectively. In 64/103 samples MRD was detectable and highly correlated in PB and BM. In 38/103 samples, where MRD was only detectable in BM, median BM MRD was 3.5log lower than at diagnosis. Event free survival was significantly inferior in case of <2log reduction post-induction MRD. Persistent MRD was always followed by hematological relapse. Molecular progression rate in relapsing CBFbeta/MYH11 was surprisingly slow with a time lag to hematological relapse approaching 1 year. This direct comparison between the two subgroups of CBF AMLs delineates clear biological differences and corroborates the value of RQ-PCR.
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Affiliation(s)
- Jesper Stentoft
- Department of Hematology, Aarhus University Hospital, Tage-Hansens Gade 2, DK-8000 Aarhus C, Denmark.
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36
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Simonsson B, Oberg G, Bjoreman M, Bjorkholm M, Carneskog J, Karlsson K, Gahrton G, Grimfors G, Hast R, Karle H, Linder O, Ljungman P, Nielsen JL, Nilsson J, Lofvenberg E, Malm C, Olsson K, Olsson-Stromberg U, Paul C, Stenke L, Stentoft J, Turesson I, Udén AM, Wahlin A, Vilén L, Weis-Bjerrum O. Intensive treatment and stem cell transplantation in chronic myelogenous leukemia: long-term follow-up. Acta Haematol 2005; 113:155-62. [PMID: 15870485 DOI: 10.1159/000084445] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2003] [Accepted: 07/07/2004] [Indexed: 11/19/2022]
Abstract
In the present study we combined interferon (IFN) and hydroxyurea (HU) treatment, intensive chemotherapy and autologous stem cell transplantation (SCT) in newly diagnosed chronic myelogenous leukemia patients aged below 56 years, not eligible for allogeneic SCT. Patients who had an HLA-identical sibling donor and no contraindication went for an allogeneic SCT (related donor, RD). After diagnosis, patients not allotransplanted received HU and IFN to keep WBC and platelet counts low. After 6 months patients with Ph-positive cells still present in the bone marrow received 1-3 courses of intensive chemotherapy. Those who became Ph-negative after IFN + HU or after 1-3 chemotherapy courses underwent autologous SCT. Some patients with poor cytogenetic response were allotransplanted with an unrelated donor (URD). IFN + HU reduced the percentage of Ph-positive metaphases in 56% of patients, and 1 patient became Ph-negative. After one or two intensive cytotherapies 86 and 88% had a Ph reduction, and 34 and 40% became Ph-negative, respectively. In patients receiving a third intensive chemotherapy 92% achieved a Ph reduction and 8% became Ph-negative. The median survival after auto-SCT (n = 46) was 7.5 years. The chance of remaining Ph-negative for up to 10 years after autologous SCT was around 20%. The overall survival for allo-SCT RD (n = 91) and URD (n = 28) was almost the same, i.e. approximately 60% at 10 years. The median survival for all 251 patients registered was 8 years (historical controls 3.5 years). The role of the treatment schedule presented in the imatinib era is discussed.
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Affiliation(s)
- Bengt Simonsson
- Department of Medicine and Hematology, University Hospital, Uppsala, Sweden.
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37
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Østergaard M, Stentoft J, Hokland P. A real-time quantitative RT-PCR assay for monitoring DEK-CAN fusion transcripts arising from translocation t(6;9) in acute myeloid leukemia. Leuk Res 2004; 28:1213-5. [PMID: 15380347 DOI: 10.1016/j.leukres.2004.03.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2004] [Accepted: 03/24/2004] [Indexed: 10/26/2022]
Abstract
We have developed a real-time quantitative RT-PCR (RQ-PCR) assay for the DEK-CAN fusion transcript, which results from t(6;9)(p23;q34) and is found in about 1% of acute myeloid leukemia (AML) cases. In diagnostic samples from three acute myeloid leukemia patients an RQ-PCR assay sensitivity of 1:396-1:3446 was obtained. In a single patient followed closely for 57 weeks, an increasing DEK-CAN level was detected 40 days before an early hematological relapse. This assay should enable the widespread longitudinal minimal residual disease (MRD) follow-up in this rare subgroup of AML patients, thus adding to our knowledge of its course.
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Affiliation(s)
- Mette Østergaard
- Department of Hematology, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 C, Denmark
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38
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Abstract
Imatinib is a potent drug used in treatment of chronic myeloid leukaemia (CML). It acts by inhibition of the CML-specific p210 BCR-ABL tyrosine kinase, but also blocks other pathways such as platelet-derived growth factor (PDGF) and c-kit receptor signalling. Clinical trials have confirmed the efficacy of imatinib, which has toxic effects in cells that express BCR-ABL. Side-effects, although frequent, are generally mild and include superficial oedema and fluid retention. Here, we describe two patients with cerebral oedema, which in one patient was fatal. The pathophysiological mechanisms remain unknown, although the drug could act through inhibition of the PDGF receptor.
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Affiliation(s)
- M Ebnöether
- Division of Haematology, Department of Internal Medicine, University Hospital, Basel, Switzerland
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39
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Stentoft J, Pallisgaard N, Kjeldsen E, Holm MS, Nielsen JL, Hokland P. Kinetics of BCR-ABL fusion transcript levels in chronic myeloid leukemia patients treated with STI571 measured by quantitative real-time polymerase chain reaction. Eur J Haematol 2001; 67:302-8. [PMID: 11872078 DOI: 10.1034/j.1600-0609.2001.00556.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The activated tyrosine kinase, which arises as a result of the balanced t(9,22) translocation in chronic myeloid leukemia (CML), is thought to be essential for the development of the leukemic phenotype. Recently, designer drugs have been introduced which specifically inhibit such specific kinases. Among these, STI571 (Glivec) has entered clinical trials and shown promising activities in chronic phase (CP), accelerated phase (AP) and blast crisis (BC) as evidenced by significant hematological and cytogenetic responses in CML patients. To evaluate the effect of STI571 at the molecular level we have employed quantitative real-time PCR (RQ-PCR) to measure the amount of BCR-ABL fusion transcript in a series of 19 patients treated with STI571, either in CP(11) or in (AP)(8) of the disease for 3--9 months (median 6 months). Employing this method, which is able to detect at least one BCR-ABL+ cell in 500,000, in serial blood and bone marrow specimens we found decreases in transcript levels in 10/11 CP patients, but only in 1/8 of the AP patients. When present such decreases were gradual and became evident only after 3 months of STI571 treatment, and their kinetics in blood closely mirrored those seen in parallel marrow samples. Moreover, decreases were between 10- and 100-fold in 11/13 patients, with only two patients reaching residual disease levels below 10(-2) (a 900-fold decrease). Thus, no patient reached PCR negativity. We conclude that the RQ-PCR method is a highly suitable tool for following the effect of STI571 in CML and that further validation of the method, performed in a prospective manner, will contribute significantly to the elucidation of the proper role of STI571 in CML.
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MESH Headings
- Adult
- Aged
- Antineoplastic Agents/therapeutic use
- Benzamides
- Biomarkers, Tumor
- Enzyme Inhibitors/therapeutic use
- Female
- Fusion Proteins, bcr-abl/blood
- Fusion Proteins, bcr-abl/genetics
- Gene Expression Regulation, Neoplastic/drug effects
- Humans
- Imatinib Mesylate
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/blood
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Male
- Middle Aged
- Piperazines/therapeutic use
- Protein-Tyrosine Kinases/antagonists & inhibitors
- Pyrimidines/therapeutic use
- Reverse Transcriptase Polymerase Chain Reaction
- Sensitivity and Specificity
- Transcription, Genetic
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Affiliation(s)
- J Stentoft
- Department of Hematology, Arhus University Hospital, Arhus, Denmark
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40
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Krejci K, Stentoft J, Koch J. Molecular cytogenetics investigation of the telomeres in a case of Philadelphia positive B-ALL with a single telomere expansion. Neoplasia 1999; 1:492-7. [PMID: 10935496 PMCID: PMC1508118 DOI: 10.1038/sj.neo.7900065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [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] [Indexed: 11/09/2022] Open
Abstract
We have investigated a single telomere expansion in a case of acute lymphoblastic B-cell leukemia (B-ALL), where half of the cells in the bone marrow sample appeared with a Philadelphia chromosome. Comparing telomere sizes in Philadelphia-positive versus -negative cells, we found generally shorter telomeres in the Philadelphia-positive cells, but with an expansion of the telomere on the long arm of one chromosome 11 homologue. This expansion was also found in a minority of Philadelphia-negative cells. The telomeres in these cells were of the same overall size as the telomeres in the Philadelphia-negative cells without the 11q expansion. Together, these findings suggest that the order of events was: 11q telomere expansion, Philadelphia translocation, overall telomere shortening. The expanded 11q telomere contained the standard telomeric (AGGGTT)(n) repeat, but also variant repeat sequences. The single telomere expansion suggests a non-telomerase mechanism behind the expansion which may also explain the presence of variant repeats in the expanded telomere. The present case illustrates that telomere changes may occur at only some chromosome ends in a subset of cells. To reveal such changes, telomere morphology should be studied with in situ methodology.
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Affiliation(s)
- Katerina Krejci
- Department of Medicine and Hematology, Aarhus University Hospital, Tage Hansens Gade 2, DK-8000 Aarhus C, Denmark
| | - Jesper Stentoft
- Department of Medicine and Hematology, Aarhus University Hospital, Tage Hansens Gade 2, DK-8000 Aarhus C, Denmark
| | - Jørn Koch
- The Danish Cancer Society, Department of Cytogenetics, Aarhus University Hospital, Tage Hansens Gade 2, DK-8000 Aarhus C, Denmark
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41
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Pedersen G, Stentoft J, Pedersen JO, Jensen MK. [Treatment of acute myeloid leukemia in the elderly with low-dose cytosine arabinoside]. Ugeskr Laeger 1994; 156:6380-4. [PMID: 7810014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We report the outcome of 95 patients older than 60 years with de novo acute non-lymphocytic leukaemia (ANLL), treated in two institutions during a 10 year period. Thirty-two patients, mean age 78 years, did not receive any chemotherapy, and their median survival was 38 days. Five patients in good clinical condition, aged 60-63 years, were treated conventionally with an anthracycline and cytarabine, and three patients obtained a complete remission (CR) lasting 73, 417, and 1050 days. Fifty-eight patients were treated with low-dose cytarabine (LDC) for remission-induction and maintenance. Eighteen patients obtained CR, yielding a remission rate of 31%. The median duration of remission was 380 days and median survival of the same group was 498 days. LDC is valuable in the treatment of ANLL in the elderly. Controlled studies are warranted to define the indications for LDC versus conventional therapy in the large grey zone of elderly patients.
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Affiliation(s)
- G Pedersen
- Medicinsk-haematologisk afdeling, Aalborg Sygehus Syd
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42
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Stentoft J, Nielsen JL, Hvidman LE. All-trans retinoic acid in acute promyelocytic leukemia in late pregnancy. Leukemia 1994; 8:1585-8. [PMID: 8090035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
All-trans retinoic acid (ATRA) was used in a case of acute promyelocytic leukemia (APL) in late pregnancy. A very prompt maternal risk reduction was achieved with subsequent complete remission and spontaneous delivery of two live children in whom no fetal damage seems to have occurred.
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Affiliation(s)
- J Stentoft
- Department of Medicine and Haematology, Aarhus University Hospital, Denmark
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Jensen MK, Johansen P, Stentoft J, Jensen MK. Salvage therapy with low-dose cytosine arabinoside in refractory or relapsed acute non-lymphocytic leukaemia: a report on 25 patients. Eur J Haematol 1994; 52:236-9. [PMID: 8005235 DOI: 10.1111/j.1600-0609.1994.tb00652.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Thirteen patients with de novo acute non-lymphocytic leukaemia (ANLL) refractory to standard chemotherapy for remission induction and 12 patients with ANLL in relapse were treated with low-dose cytosine arabinoside (LD ara-C) 10 mg/m2 subcutaneously every 12 hours for 21 days. Five of 13 patients (38%) and 6 of 12 patients (50%), respectively, obtained a complete remission (CR). Of these, 7 patients subsequently relapsed after 2-76 months, while 4 patients remain in CR after 7-131 months. Compared to standard intensive regimens treatment with LD ara-C was rather non-toxic, requiring platelet transfusions and antibiotics in only 6 and 13 cases, respectively. Three patients (12%) died during induction therapy with LD ara-C; 2 had a cerebral haemorrhage and 1 developed anuria following a staphylococcal septicaemia. In conclusion, therapy with LD ara-C may be preferable to more intensive and toxic regimens in the treatment of patients with relapsed or refractory ANLL.
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Affiliation(s)
- M K Jensen
- Department of Haematology, Aalborg Hospital, Denmark
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44
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Rix P, Stentoft J, Aunsholt NA, Dueholm M, Tilma KA, Høier-Madsen M. Lupus anticoagulant and anticardiolipin antibodies in an obstetric population. Acta Obstet Gynecol Scand 1992; 71:605-9. [PMID: 1336919 DOI: 10.3109/00016349209006228] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Lupus anticoagulant (LA) and anticardiolipin antibodies (ACA) have been reported to be associated with fetal loss. OBJECTIVE. Our aim was to estimate the incidence of LA and to examine the correlation between LA and ACA in pregnant women. To investigate the clinical significance of LA and ACA in an obstetric population. STUDY DESIGN. A prospective, cross sectional study of 2856 consecutive women admitted to a department of obstetrics and gynecology for delivery or due to pregnancy complications during an 11 month period. METHODS. Activated partial thromboplastin time (APTT) was determined in all patients. LA and ACA were determined if APTT > or = 35 sec. For reference ACA was determined in a group of randomly selected patients with APTT < 35 sec. The results were analyzed in relation to the obstetrical records. RESULTS. Overall incidence of APTT > or = 35 sec.: 7.0%, significantly more frequent in patients with early spontaneous abortion (18.6%) and intrauterine growth retardation (17.5%). Incidence of LA 0.07%. The patients had undetectable ACA and no clinical condition related to LA. Incidence of ACA class IgM (IgM-ACA) in patients with APTT > or = 35: 20.4%, significantly higher than in the reference group (9.6%). Uncomplicated pregnancy in 84% of patients with IgM-ACA. No cases of ACA class IgG (IgG-ACA) in patients with APTT > or = 35 but two cases in the reference group (one normal pregnancy, one spontaneous abortion). CONCLUSION. LA is a rare manifestation with uncertain significance in otherwise healthy pregnant women. IgM-ACA in low titer occurs relatively frequently during normal pregnancy.
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Affiliation(s)
- P Rix
- Department of Obstetrics and Gynecology, Aalborg Hospital, Denmark
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45
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Abstract
The principal toxicity of standard induction regimens for acute non-lymphocytic leukemia (ANLL) [including cytarabine (ARA-C) 100 mg/m2 for 7 days plus an anthracycline] is myelotoxicity, leading to death in at least 25% of cases during induction in non-selected patients. The complete remission rate is less than 35% in patients over 65 years of age, due in part to an age-related increase of myelotoxicity. The other important adverse effect of standard-dose cytarabine is gastrointestinal toxicity, especially oral mucositis, diarrhoea, intestinal ulceration, ileus and subsequent Gram-negative septicaemia. Idiosyncratic reactions like exanthema, fever and elevation of hepatic enzymes are relatively frequent, but do not represent therapeutic problems. Intermittent high-dose cytarabine (3 g/m2 in 8 to 12 doses) is extremely myelosuppressive. Similarly, the gastrointestinal toxicity is formidable and dose-limiting. Severe, and sometimes irreversible, cerebellar/cerebral toxicity in 5 to 15% of courses of treatment limits the peak dose of cytarabine. The pathogenesis, prophylactic and therapeutic measures are unknown. These major toxicities are age-related and prohibitive to the use of high-dose cytarabine therapy in patients older than 55 to 60 years. Subacute noncardiogenic pulmonary oedema occurs in some patients, with an incidence of about 20%, and seems to have an intriguing coincidence with precedent streptococcal septicaemia; high-dose systemic steroids may be beneficial. Corneal toxicity is very frequent in high-dose cytarabine therapy but is always reversible. It is largely preventable with prophylactic steroid or 2-deoxycytidine eyedrops. Fever, exanthema and hepatic toxicity have an incidence similar to that in standard dosage. The maximum tolerable cumulated dose of cytarabine is significantly lower when the agent is administered as a continuous infusion, due to myelosuppression and gastrointestinal toxicity. Conversely, continuous infusion may be less neurotoxic. The antileukaemic effect of continuous infusion high-dose cytarabine is less well established. The only significant toxicity of low-dose cytarabine is myelosuppression. Given the generally poor condition of leukaemia patients, low-dose cytarabine therapy is well tolerated, although occasional cases of diarrhoea, reversible cerebellar symptoms, peritoneal and pericardial reactions, and ocular toxicity have been reported. Continuous infusion may be more toxic than the usual intermittent dosage. It is concluded that the toxicity of the standard induction regimen for ANLL is acceptable in patients younger than 60 to 65 years with no concurrent disease. Low dose cytarabine is tolerable for virtually all ANLL patients, but the overall therapeutic efficacy still needs to be defined and compared to standard therapy in the relevant age groups.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- J Stentoft
- Department of Internal Medicine and Haematology B, Aalborg Hospital South, Denmark
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46
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Jensen IW, Stentoft J, Toft E, Faber J. [Familial dysalbuminemic hyperthyroxinemia. A diagnostic pitfall]. Ugeskr Laeger 1988; 150:2178-80. [PMID: 3206581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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47
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Toft E, Stentoft J, Andersen PT. False-negative latex-agglutination test for myoglobin owing to antigen excess. Clin Chem 1988; 34:177. [PMID: 3338157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- E Toft
- Dept. of Clin. Chem. Aalborg Hospital, Denmark
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48
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Nielsen JF, Stentoft J, Aunsholt NA. Haemoptysis caused by aneurysm of saphenous bypass graft to a coronary artery. Scand J Thorac Cardiovasc Surg 1988; 22:189-91. [PMID: 3261452 DOI: 10.3109/14017438809105957] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In a 51-year-old man, coronary artery bypass surgery for severe angina pectoris was followed by protracted mediastinal infection. After recovery the patient had several haemoptyses. Angiography revealed aneurysm of a graft near its distal anastomosis. Upper left lobectomy and ligation of the graft were necessitated by bleeding from the aneurysm into a segmental bronchus. Angina pectoris recurred but was successfully treated with verapamil.
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Affiliation(s)
- J F Nielsen
- Department of Thoracic Surgery, Aalborg Hospital, Denmark
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49
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Affiliation(s)
- E Toft
- Dept. of Clin. Chem. Aalborg Hospital, Denmark
| | - J Stentoft
- Dept. of Clin. Chem. Aalborg Hospital, Denmark
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50
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Andersen PT, Svendsen F, Stentoft J. [Raised CK-B after an acute cerebral insult]. Ugeskr Laeger 1987; 149:785-6. [PMID: 3576769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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