Epigenetic targeting to enhance acute myeloid leukemia-directed immunotherapy

AML is a malignant disease of hematopoietic progenitor cells with unsatisfactory treatment outcome, especially in patients that are ineligible for intensive chemotherapy. Immunotherapy, comprising checkpoint inhibition, T-cell engaging antibody constructs, and cellular therapies, has dramatically improved the outcome of patients with solid tumors and lymphatic neoplasms. In AML, these approaches have been far less successful. Discussed reasons are the relatively low mutational burden of AML blasts and the difficulty in defining AML-specific antigens not expressed on hematopoietic progenitor cells. On the other hand, epigenetic dysregulation is an essential driver of leukemogenesis, and non-selective hypomethylating agents (HMAs) are the current backbone of non-intensive treatment. The first clinical trials that evaluated whether HMAs may improve immune checkpoint inhibitors' efficacy showed modest efficacy except for the anti-CD47 antibody that was substantially more efficient against AML when combined with azacitidine. Combining bispecific antibodies or cellular treatments with HMAs is subject to ongoing clinical investigation, and efficacy data are awaited shortly. More selective second-generation inhibitors targeting specific chromatin regulators have demonstrated promising preclinical activity against AML and are currently evaluated in clinical trials. These drugs that commonly cause leukemia cell differentiation potentially sensitize AML to immune-based treatments by co-regulating immune checkpoints, providing a pro-inflammatory environment, and inducing (neo)-antigen expression. Combining selective targeted epigenetic drugs with (cellular) immunotherapy is, therefore, a promising approach to avoid unintended effects and augment efficacy. Future studies will provide detailed information on how these compounds influence specific immune functions that may enable translation into clinical assessment.

Primary therapy of metastatic prostate carcinoma with depot gonadotropin-releasing hormone analogue goserelin versus estramustine phosphate. The Prostate Cancer Study Group

OBJECTIVE

To determine if initial chemo-hormone therapy (estramustine phosphate) of metastatic prostate carcinomas can lengthen the period until progression, compared with hormone treatment (goserelin) alone? The time to progression, side effects and prognostic factors were assessed.

METHODS

The prospective phase III study (II 86 until V 91) involved 243 patients randomized consecutively in two groups. Progress was assessed according to NPCP criteria.

RESULTS

The following prognostic factors were established to be significant: metastatic status, metastatic bone pain, alkaline phosphatase and performance status. No difference was observed between the two methods of treatment in time to progression. However on stratifying according to groups with the same prognostic factors, progression in the high risk group occurred at a later stage during treatment with estramustine than during pure hormone treatment. The quality of life was clearly more heavily restricted by side effects from estramustine.

CONCLUSIONS

Thus, when comparing these treatments, there were no statistically significant differences. Patients in the high risk groups with unfavorable prognosis factors benefitted from the chemo-hormone treatment with estramustine phosphate.

Localization, incidence, diagnosis and treatment of extratesticular germ cell tumors

On the basis of a literature search yielding 243 case histories, the rare extratesticular germ cell tumor is surveyed with respect to incidence, primary localization, histology and treatment. In this context, we report on 6 patients with negative results on clinical examination of the testes (palpation, scrotal ultrasonography). We briefly discuss a suitable method of diagnosing occult and burnt-out tumors. Polychemotherapy (vinblastine, bleomycin, cis-platinum) has been found to be very effective. The resulting high rates of remission thus lead to an improvement of overall prognosis.

[Errors and hazards of retrograde infusion urethrography]

The indications, mistakes and risks of the retrograde urethrography of male by infusion will be discussed in a critical review. The method of infusion is not the alternative method in contrary to the injection.

[Subcapsular kidney hematoma: a rare complication of paravertebral infiltration]

Two patients developed subcapsular hematomas of the kidney following orthopaedic paravertebral injection. Clinical course and radiological findings are reported. Renal subcapsular hematomas are indeed frequent complications after stomach and lower thorax injuries; these are also known after diagnostic or therapeutic kidney-punctures. However, damage to the kidney by paravertebral injection is extremely unusual and not previously reported in the literature.

[Unusual cause of subcapsular renal hematoma]

In 2 woman patients, the authors found subcapsular renal haematomas after paravertebral injection of a local anaesthetic as part of lumbago treatment. Clinical course and radiological findings are demonstrated. Whereas formation of subcapsular renal haematomas is a well-known phenomenon after traumas, iatrogenic and intentional punctures and a few renal and general diseases, renal lesion after paravertebral injection of a local anaesthetic is an extremely rare occurrence.