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Pinlac V, Bonifacio L. A Case Report of Kidney Transplantation in a Patient With Pre-existing Chronic Myeloid Leukemia: The Role of Achieving Molecular Response and Treatment-Free Remission. Transplant Proc 2024; 56:738-741. [PMID: 38538381 DOI: 10.1016/j.transproceed.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 03/13/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Treatment-free remission (TFR) in chronic myeloid leukemia (CML) is achieved when a patient who has discontinued tyrosine-kinase inhibitor treatment sustains major molecular response (MMR) and does not require restarting therapy. The feasibility of kidney transplantation (KT), and achieving TFR post-transplantation in patients with a pre-existing CML, are currently not well-studied. METHODS We describe the clinical course of a 39-year-old Filipino woman with IgA nephropathy who developed CML during treatment. She received nilotinib 600 mg daily and was able to achieve MMR after 5 months. Eight years later, the patient sustained MMR; however, she ultimately underwent KT due to advancing kidney disease. Before the transplant, she was able to achieve deep molecular response. In anticipation of possible drug-to-drug interaction of nilotinib with tacrolimus and everolimus, a shared decision was made to discontinue nilotinib despite not fulfilling the criteria for TFR. Twelve months post-transplant, the patient remains in MMR without nilotinib. Good renal allograft function was maintained, and there were no signs of allograft rejection. CONCLUSIONS Attempting TFR may be feasible after KT in patients with low-risk chronic phase CML especially if good molecular response is obtained before the transplant. Data regarding the length at which TFR can be maintained after KT is still yet to be determined. In this regard, low-risk chronic phase CML in good disease control may not be considered a contraindication to KT.
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Affiliation(s)
- Vienne Pinlac
- Division of Internal Medicine, National Kidney and Transplant Institute, Quezon City, Philippines.
| | - Lynn Bonifacio
- Division of Internal Medicine, National Kidney and Transplant Institute, Quezon City, Philippines
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2
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Shi XY, Zhang JX, Tang ZX, Sun H, Shen Z. Severe spontaneous acute arterial subdural hematoma as an initial symptom of chronic myeloid leukemia. Br J Neurosurg 2023; 37:1721-1724. [PMID: 33605812 DOI: 10.1080/02688697.2021.1885625] [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: 08/18/2020] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
Acute subdural hematoma (SDH) is a rare occurrence in chronic myeloid leukemia (CML) patients with only two cases reported in literature. However, sudden severe acute SDH caused by CML has not been reported on. Our patient was admitted for 'sudden unconsciousness for more than 1 hour'. Computed tomography (CT) angiography revealed a large amount of acute SDH on the left side. Physical exam showed the patient's left pupil was dilated and signs of cerebral herniation were present. The preoperative coagulation profile was normal. Emergency craniotomy for hematoma clearance and decompression was performed. During the surgery, a ruptured cerebral artery was located in the perisylvian region and hemostasis was achieved through electrocautery. Pre-operative white blood count was 58,100 cell/µl, with post-operative bone marrow examination、cytogenetic analysis and RT-PCR detection revealing a diagnosis of CML, for which hydroxyurea chemotherapy was initiated. Leukocyte count of the patient gradually returned to normal. After 24 days, the patient regained consciousness and on day 30, repeat CT scan showed no SDH recurrence. The patient recovered with no neurological deficits and achieved a good prognosis.
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MESH Headings
- Humans
- Hematoma, Subdural, Acute/surgery
- Arteries
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/surgery
- Tomography, X-Ray Computed/adverse effects
- Computed Tomography Angiography
- Hematoma, Subdural, Chronic/diagnostic imaging
- Hematoma, Subdural, Chronic/etiology
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Affiliation(s)
- Xiao-Yong Shi
- Brain Center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Jin-Xia Zhang
- Department of Clinical Psychology(Sleep Medical Center), Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University,Hangzhou 310000, Zhejiang Province, China
| | - Zhu-Xiao Tang
- Brain Center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Hu Sun
- Brain Center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Zheng Shen
- Brain Center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
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3
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Zuo S, Sun L, Wang Y, Chen B, Wang J, Ge X, Lu Y, Yang N, Shen P. Establishment of a novel mesenchymal stem cell-based regimen for chronic myeloid leukemia differentiation therapy. Cell Death Dis 2021; 12:208. [PMID: 33627636 PMCID: PMC7904926 DOI: 10.1038/s41419-021-03499-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 01/27/2021] [Accepted: 02/01/2021] [Indexed: 12/25/2022]
Abstract
Chronic myeloid leukemia (CML) is characterized by the accumulation of malignant and immature white blood cells which spread to the peripheral blood and other tissues/organs. Despite the fact that current tyrosine kinase inhibitors (TKIs) are capable of achieving the complete remission by reducing the tumor burden, severe adverse effects often occur in CML patients treated with TKIs. The differentiation therapy exhibits therapeutic potential to improve cure rates in leukemia, as evidenced by the striking success of all-trans-retinoic acid in acute promyelocytic leukemia treatment. However, there is still a lack of efficient differentiation therapy strategy in CML. Here we showed that MPL, which encodes the thrombopoietin receptor driving the development of hematopoietic stem/progenitor cells, decreased along with the progression of CML. We first elucidated that MPL signaling blockade impeded the megakaryocytic differentiation and contributed to the progression of CML. While allogeneic human umbilical cord-derived mesenchymal stem cells (UC-MSCs) treatment efficiently promoted megakaryocytic lineage differentiation of CML cells through restoring the MPL expression and activating MPL signaling. UC-MSCs in combination with eltrombopag, a non-peptide MPL agonist, further activated JAK/STAT and MAPK signaling pathways through MPL and exerted a synergetic effect on enhancing CML cell differentiation. The established combinational treatment not only markedly reduced the CML burden but also significantly eliminated CML cells in a xenograft CML model. We provided a new molecular insight of thrombopoietin (TPO) and MPL signaling in MSCs-mediated megakaryocytic differentiation of CML cells. Furthermore, a novel anti-CML treatment regimen that uses the combination of UC-MSCs and eltrombopag shows therapeutic potential to overcome the differentiation blockade in CML.
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MESH Headings
- Animals
- Benzoates/pharmacology
- Cell Lineage
- Coculture Techniques
- Gene Expression Regulation, Leukemic
- Humans
- Hydrazines/pharmacology
- Janus Kinases/metabolism
- K562 Cells
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/metabolism
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/surgery
- Mesenchymal Stem Cell Transplantation
- Mesenchymal Stem Cells/metabolism
- Mice, Nude
- Mitogen-Activated Protein Kinases/metabolism
- Pyrazoles/pharmacology
- Receptors, Thrombopoietin/agonists
- Receptors, Thrombopoietin/metabolism
- STAT Transcription Factors/metabolism
- Signal Transduction
- Thrombopoiesis/drug effects
- Umbilical Cord/cytology
- Xenograft Model Antitumor Assays
- Mice
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Affiliation(s)
- Shiman Zuo
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, School of life science, Nanjing University, Nanjing, 210023, China
| | - Luchen Sun
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, School of life science, Nanjing University, Nanjing, 210023, China
| | - Yuxin Wang
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, School of life science, Nanjing University, Nanjing, 210023, China
| | - Bing Chen
- Department of Hematology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Jingyue Wang
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, School of life science, Nanjing University, Nanjing, 210023, China
| | - Xiangyu Ge
- Department of Pathology, Yale University School of Medicine, New Haven, CT, 06510, USA
| | - Yan Lu
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, School of life science, Nanjing University, Nanjing, 210023, China
| | - Nanfei Yang
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, School of life science, Nanjing University, Nanjing, 210023, China.
| | - Pingping Shen
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, School of life science, Nanjing University, Nanjing, 210023, China.
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Tatsuta K, Harada T, Miyazaki S, Ogiku M, Hayashi T, Tamura H, Kanai T, Ikematsu Y, Naito K, Nishiwaki Y. [Postoperative Adjuvant Chemotherapy for Descending Colon Cancer Treated with Imatinib for Chronic Myeloid Leukemia]. Gan To Kagaku Ryoho 2019; 46:1319-1321. [PMID: 31501379] [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: 06/10/2023]
Abstract
A66 -year-old man was diagnosed with chronic myeloid leukemia(CML). Imatinib treatment had been initiated, and a major molecular response(MMR)was achieved. The patient had anemia and was diagnosed with descending colon cancer. The patient was surgically treated, and then received postoperative adjuvant chemotherapy with UFT/LV. However, imatinib was not administered during that period. The patient could undergo postoperative adjuvant chemotherapy for 6 months without acute exacerbation of the CML.
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Affiliation(s)
- Kyota Tatsuta
- Dept. of Gastroenterological Surgery, Hamamatsu Medical Center
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5
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Raghavendran M, Prahlad KA, Venugopal A, Kumar KG. Urological Surgery in CML- Is it Safe? J Assoc Physicians India 2019; 67:90-91. [PMID: 31311225] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Maniyur Raghavendran
- Consultant Urologist and Transplant Surgeon,Apollo BGS Hospitals, Mysore, Karnataka
| | - K A Prahlad
- Consultant Physician,Apollo BGS Hospitals, Mysore, Karnataka
| | - A Venugopal
- Consultant Pathologist, Apollo BGS Hospitals, Mysore, Karnataka
| | - Kiran G Kumar
- Consultant Urologist and Transplant Surgeon,Apollo BGS Hospitals, Mysore, Karnataka
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Miura S, Murase K, Sakurada A, Takada K, Iyama S, Sato T, Sato Y, Miyanishi K, Kobune M, Muranaka A, Tachibana K, Kato J. [A Case of Chronic Myelogenous Leukemia That Developed Fibrous Pericarditis Owing to Nilotinib Use]. Gan To Kagaku Ryoho 2017; 44:529-531. [PMID: 28698448] [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
A 64-year-old man was diagnosed with chronic-phase chronic myelogenous leukemia(CML)in May 2009. He was treated with imatinib and achieved complete cytogenetic response(CCyR)in 2 months. After 4 months of treatment, he developed interstitial pneumonia and became intolerant to imatinib. He was then switched to nilotinib from October of the same year. In June 2013, he was diagnosed with drug-induced pericarditis resulting from nilotinib use, and thus, nilotinib was discontinued. Subsequently, he was followed up without specific treatment for CML. In January 2014, he was admitted to the Dept. of Cardiovascular, Renal and Metabolic Medicine at our hospital because of heart failure. After examinations of cardiac function, he was diagnosed with constrictive pericarditis. Therefore, pericardiolysis was performed by the Dept. of Cardiovascular Surgery at our hospital. Pathologic findings showed hyaline-like fibrous tissue proliferation in the pericardium, which was diagnosed as fibrous pericarditis induced by nilotinib. We report a case of chronic myelogenous leukemia that developed fibrous pericarditis owing to nilotinib use.
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Affiliation(s)
- Shogo Miura
- Dept. of Medical Oncology and Hematology, Sapporo Medical University
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7
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Lee SE, Choi SY, Kim SH, Song HY, Yoo HL, Lee MY, Kang KH, Hwang HJ, Jang EJ, Kim DW. BCR-ABL1 transcripts (MR 4.5) at post-transplant 3 months as an early predictor for long-term outcomes in chronic myeloid leukemia. Korean J Intern Med 2017; 32:125-136. [PMID: 27334764 PMCID: PMC5214723 DOI: 10.3904/kjim.2015.187] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 07/23/2015] [Accepted: 08/04/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND/AIMS The aim of this study was to identify the role of BCR-ABL1 transcript level as a predictor for post-transplant relapse and outcome in patients who underwent allogeneic stem cell transplantation (SCT) for chronic phase (CP) chronic myeloid leukemia (CML). METHODS Of 101 patients receiving allograft in CML CP, 85 had available quantitative reverse transcriptase polymerase chain reaction data at post-transplant 3 months. These patients were divided into two groups according to molecular response (MR4.5), defined as a BCR-ABL1 transcript level ≤ 0.0032% on the international scale, at 3 months based on receiver operating characteristic curve analysis of relapse. RESULTS The 4-year overall survival and event-free survival (EFS) were 80.6% and 57.3%, respectively, and the cumulative incidence of relapse at 4 years was 29.6% after a median follow-up of 126.4 months. We performed multivariate analyses including potential variables to evaluate the early predictive role of MR4.5 at 3 months and found that MR4.5 at 3 months was associated with a higher EFS (p = 0.028) and showed a trend for a lower relapse rate (p = 0.089). CONCLUSIONS our results imply that frequent molecular monitoring and immune suppressive therapy modulation are required for patients without reduction of BCR-ABL1 transcripts to this level after SCT.
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MESH Headings
- Adolescent
- Adult
- Area Under Curve
- Biomarkers, Tumor/genetics
- Disease-Free Survival
- Drug Therapy, Combination
- Female
- Fusion Proteins, bcr-abl/genetics
- Graft vs Host Disease/etiology
- Humans
- Immunosuppressive Agents/therapeutic use
- Kaplan-Meier Estimate
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/metabolism
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/surgery
- Male
- Middle Aged
- Multivariate Analysis
- Predictive Value of Tests
- Proportional Hazards Models
- ROC Curve
- Recurrence
- Reverse Transcriptase Polymerase Chain Reaction
- Risk Factors
- Stem Cell Transplantation/adverse effects
- Stem Cell Transplantation/mortality
- Time Factors
- Transplantation, Homologous
- Treatment Outcome
- Young Adult
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Affiliation(s)
- Sung-Eun Lee
- Catholic Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea
- Department of Hematology, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Soo Young Choi
- Catholic Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Soo-Hyun Kim
- Catholic Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Hye-Young Song
- Catholic Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Hea-Lyun Yoo
- Catholic Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Mi-Young Lee
- Catholic Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Ki-Hoon Kang
- Catholic Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Hee-Jeong Hwang
- Catholic Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Eun-Jung Jang
- Catholic Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Dong-Wook Kim
- Catholic Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea
- Department of Hematology, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
- Correspondence to Dong-Wook Kim, M.D. Department of Hematology, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea Tel: +82-2-2258-7030 Fax: +82-2-593-2522 E-mail:
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Onizuka M, Matsushita H, Machida S, Toyosaki M, Amaki J, Aoyama Y, Miyamoto M, Ando K. Bacterial Pneumonia-induced Persistent Remission of Severe Immune Thrombocytopenia after Allogeneic Hematopoietic Stem Cell Transplantation. Intern Med 2016; 55:179-83. [PMID: 26781020 DOI: 10.2169/internalmedicine.55.4724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 53-year-old woman with chronic myeloid leukemia received allogeneic hematopoietic stem cell transplantation. After neutrophil engraftment, her platelet count exceeded 100,000/μL at day 64. While she was receiving corticosteroid treatment for chronic graft versus host disease (GVHD), her platelets suddenly dropped to 6,000/μL at day 210 and she was diagnosed with immune thrombocytopenia (ITP). Corticosteroids, intravenous high-dose gamma globulin (IVIg) and a splenectomy failed to increase her platelet count. She developed bacterial pneumonia at day 599 and antibiotic therapy was initiated. Soon after, her platelet count continuously increased. Her GVHD and ITP are now in remission without any ongoing treatment.
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Affiliation(s)
- Makoto Onizuka
- Hematology and Oncology, Tokai University School of Medicine, Japan
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Zhang GF, Zhou M, Bao XB, Qiu HY, Li Z, Xue SL. Imatinib Mesylate Versus Allogeneic Hematopoietic Stem Cell Transplantation for Patients with Chronic Myelogenous Leukemia. Asian Pac J Cancer Prev 2016; 17:4477-4481. [PMID: 27797264] [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: 06/06/2023] Open
Abstract
PURPOSE To compare the relative merits of imatinib and allogeneic hematopoietic stem cell transplantation (allo-HSCT) for chronic myelogenous leukemia (CML). MATERIALS AND METHODS This cohort study was designed to compare the outcomes of imatinib (n=292) versus allo-HSCT (n=141) for CML, the clinical data of these patients being retrospectively analyzed so as to compare the event free survival (EFS) and overall survival (OS) between these two groups with patients in the chronic phase (CP) and advanced phases, including accelerate (AP) and blast phases (BP). RESULTS (1) Patients treated with imatinib (278 in the CP) demonstrated superior EFS, OS, 5-year EFS and 5-year OS rates of 88.5% versus 70.0% (P<0.05), 93.2% versus 80.0% (P<0.05), 84% versus 75.0% (P<0.05) and 92% versus 79.0% (P<0.05), respectively, to those treated with allo-HSCT (120 patients in the CP). (2) Both treatments resulted in similar survival, with EFS and OS rates of 42.9% versus 47.6% (P>0.05), 42.9% versus 57.1% (P>0.05), respectively, for imatinib (14 patients in the AP and BP) and allo-HSCT (21 patients in the AP and BP). CONCLUSIONS Imatinib confers signi cant survival advantage (EFS and OS) for CML patients with CP compared with allo-HSCT treatment. However, the outcomes are equally good with both treatments in AP and BP patients.
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Affiliation(s)
- Gui-Fang Zhang
- Leukemia Research Division, Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of the Ministry of Health, First Af liated Hospital of Soochow University, Suzhou, China E-mail : ;
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10
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Alshehry NF, Al-Huneini M, Lipton JH, Michelis FV. Lymphoproliferative Disorders in Patients with Chronic Myeloid Leukemia: A Single-Center Case Series. Acta Haematol 2015; 134:161-7. [PMID: 25968918 DOI: 10.1159/000375150] [Citation(s) in RCA: 5] [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] [Received: 11/19/2014] [Accepted: 01/10/2015] [Indexed: 11/19/2022]
Abstract
Lymphoproliferative disorders presenting simultaneously with or subsequent to the occurrence of chronic myeloid leukemia (CML) have rarely been reported. Herein, we report 8 cases of a variety of lymphoproliferative conditions associated with CML at different times during the course of the disease. All 8 patients were treated with tyrosine kinase inhibitors at some point during the course of their illness. The literature regarding the uncommon association of these apparently unrelated disorders is reviewed as well as the possible underlying mechanisms that could be associated with this phenomenon.
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MESH Headings
- Adult
- Aged
- Antineoplastic Agents/pharmacology
- Antineoplastic Agents/therapeutic use
- Combined Modality Therapy
- Female
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/radiotherapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/surgery
- Lymphoproliferative Disorders/complications
- Male
- Middle Aged
- Protein-Tyrosine Kinases/antagonists & inhibitors
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Affiliation(s)
- Nawal F Alshehry
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ont., Canada
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Abstract
Concerns remain about total hip arthroplasty (THA) performed in very young patients, especially those with complex medical history such as allogeneic bone marrow transplantation (ABMT). This study retrospectively reviews the perioperative courses and functional outcomes of ABMT patients <21 years old undergoing primary uncemented THA. Nine THAs were performed in five ABMT patients at an average age of 19.7 years. The interval between ABMT and THA was 73.0 months with clinical follow-up of 25.8 months. Harris Hip Scores (HHS) increased dramatically from preoperatively 44.5 (range, 31.1-53.4) to postoperatively 85.2 (range, 72.0-96.0) and all patients subjectively reported a good (four hips) to excellent (five hips) overall outcome. There was one reoperation for periprosthetic fracture fixation but there were no infections or revisions performed. Despite the history of severe hematopoietic conditions requiring ABMT, these very young patients do appear to have improved pain and function following primary THA with short-term follow-up.
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Affiliation(s)
- Cameron K Ledford
- Duke University Medical Center, Department of Orthopaedic Surgery, Durham, North Carolina.
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12
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Abstract
OBJECTIVE To define indications and outcome in haematologic cases undergoing splenectomy. STUDY DESIGN A retrospective review of clinical records from consecutive patients having open or laparoscopic removal of the spleen in an academic centre in the private sector. Endpoints were survival, operating time, spleen size, histopathology, requirements for blood or related products complications and average costs. RESULTS In the total group (n = 69) there were two deaths. Referrals were for immune thrombocytopaenia (41%), acquired haemolytic anaemia (10%), myeloproliferative syndrome (9%), acute or chronic leukaemia (19%), lymphoma (13%) and a miscellaneous group (8%), comprising cholelithiasis, aplasia or as a diagnostic procedure for otherwise unexplained splenomegaly. An open midline approach was predicated by spleens greater than twice normal size and a history of any bleeding disorder. Here the mean operating time was 83 min (range 40-295) whereas for laparoscopy this was 251 min (range 181-272). SUMMARY Careful stratification between the two options facilitated optimum haemostasis and consequently reduced requirement for packed red cells and platelets. Neither underlying pathology nor the choice of treatment influenced morbidity or mortality. Overall local experience is consistent with published international standards of surgical practice. Outcome is directly proportional to the number of each procedure carried out by a single team, observance of consistent protocols for preoperative evaluation and standardized proactive management through the recovery period.
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Affiliation(s)
- Lucille Wood
- Constantiaberg Medi-Clinic, The Department of Haematology and Bone Marrow Transplantation Unit incorporating the Searll Laboratory for Cellular and Molecular Biology, Burnham Road, Plumstead, Cape Town, 7800, South Africa
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13
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Meadows ME, Chang G, Jones JA, Antin JR, Orav EJ. Predictors of neuropsychological change in patients with chronic myelogenous leukemia and myelodysplastic syndrome. Arch Clin Neuropsychol 2013; 28:363-74. [PMID: 23391504 PMCID: PMC3656510 DOI: 10.1093/arclin/acs141] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2012] [Indexed: 11/14/2022] Open
Abstract
This study examined the course of neuropsychological functioning in patients with chronic myelogeous leukemia (n = 91) or myelodysplastic syndrome (n = 15) who underwent standard treatment for their disease or allogeneic hematopoietic stem cell transplantation (HSCT) at baseline, 12 months, and 18 months post-treatment. At baseline, 23% of the participants (n = 75) in the longitudinal sample had Z-scores on at least one of the neuropsychological tests that were <1.4. Participants in the study showed improvement over baseline at the 12 and 18 months assessments. The average Z-scores for the six cognitive domains in the longitudinal data set over the course of the study ranged from -0.89 to 0.59. Significant predictors of change in neuropsychological test scores included age, with older participants showing less improvement over time. Other predictors included baseline cognitive domains (language, memory, and attention), previous cocaine use, disease status, intelligence quotient, and quality of life measures. Findings support previous studies in patients with hematological malignancies who showed cognitive impairments at baseline prior to HSCT. However, there was little evidence for further cognitive decline over the course of 18 months.
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Affiliation(s)
- Mary-Ellen Meadows
- Division of Cognitive and Behavioral Neurology, Brigham and Women's Hospital, Boston, MA 02115, USA.
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14
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Jiang H, Hu WT, Chen J, Luo CY, Wang JM, Zhou M, Ye QD, Tang YJ, Luo CJ. [Therapeutic efficacy of allogeneic hematopoietic stem cell transplantation in children with chronic myelogenous leukemia]. Zhongguo Dang Dai Er Ke Za Zhi 2013; 15:19-24. [PMID: 23336162] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To investigate the therapeutic efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in children with chronic myelogenous leukemia (CML), and to analyze the possible prognostic factors. METHODS The clinical data of 20 children with CML who had received allo-HSCT was analyzed retrospectively to investigate possible prognostic factors, including age, sex, interval between diagnosis and transplantation, HLA matching between donors and recipients, illness status on transplantation and acute and chronic graft-versus-host disease (GVHD). RESULTS At the end of follow-up, 13 of the 20 treated children had disease-free survival (DFS) and the rest (7 cases) died. Four died of severe acute GVHD, two of chronic GVHD and its complications, and one of relapse after transplantation. The three-year DFS was (64.6±1.1%). As shown by the univariate analysis, age was the most important prognostic factor in children with CML who had received allo-HSCT (P<0.05), and in children over 10 years, the prognosis was poor. No other of the above factors had a significant impact on prognosis (P>0.05). The multivariate logistic regression analysis also confirmed age as the only prognostic factor (P<0.01). Severe acute and/or chronic GVHD was the most important cause of patient death. 10/10 HLA-matched donors could improve the transplantation outcome. CONCLUSIONS Allo-HSCT is an effective treatment for children with CML. To improve the prognosis and treatment outcome, children with CML aged over 10 years should receive allo-HSCT as early as possible. 10/10 HLA-matched donors are preferred in allo-HSCT and GVHD should be prevented.
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Affiliation(s)
- Hua Jiang
- Department of Hematology/Oncology, Shanghai Jiaotong University, Shanghai, China.
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15
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Iori AP, Breccia M, Girmenia C, Perrone S, Valle V, Natalino F, Barberi W, Scalzulli E, Torelli GF, Puzzolo MC, Foà R. The limit for chronic myeloid leukemia relapse after allogeneic hematopoietic stem cell transplant moves ever forward: when can you safely talk about healing? Leuk Lymphoma 2012; 54:669-70. [PMID: 23036078 DOI: 10.3109/10428194.2012.715348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
MESH Headings
- Fusion Proteins, bcr-abl/genetics
- Hematopoietic Stem Cell Transplantation/methods
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/surgery
- Male
- Middle Aged
- Recurrence
- Reverse Transcriptase Polymerase Chain Reaction
- Time Factors
- Transplantation, Homologous
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16
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Wan DM, Zhang SP, Zhang C. [Haploidentical hematopoietic stem cell transplantation for treatment of T-lymphoblastic lymphoma with chronic myeloid leukemia: a case report and literature review]. Zhonghua Xue Ye Xue Za Zhi 2012; 33:227-228. [PMID: 22781614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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17
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Sullivan C, Chen Y, Shan Y, Hu Y, Peng C, Zhang H, Kong L, Li S. Functional ramifications for the loss of P-selectin expression on hematopoietic and leukemic stem cells. PLoS One 2011; 6:e26246. [PMID: 22039451 PMCID: PMC3200313 DOI: 10.1371/journal.pone.0026246] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 09/23/2011] [Indexed: 12/16/2022] Open
Abstract
Hematopoiesis is a tightly regulated biological process that relies upon complicated interactions between blood cells and their microenvironment to preserve the homeostatic balance of long-term hematopoietic stem cells (LT-HSCs), short-term HSCs (ST-HSCs), multipotent progenitors (MPPs), and differentiated cells. Adhesion molecules like P-selectin (encoded by the Selp gene) are essential to hematopoiesis, and their dysregulation has been linked to leukemogenesis. Like HSCs, leukemic stem cells (LSCs) depend upon their microenvironments for survival and propagation. P-selectin plays a crucial role in Philadelphia chromosome -positive (Ph+) chronic myeloid leukemia (CML). In this paper, we show that cells deficient in P-selectin expression can repopulate the marrow more efficiently than wild type controls. This results from an increase in HSC self-renewal rather than alternative possibilities like increased homing velocity or cell cycle defects. We also show that P-selectin expression on LT-HSCs, but not ST-HSCs and MPPs, increases with aging. In the absence of P-selectin expression, mice at 6 months of age possess increased levels of short-term HSCs and multipotent progenitors. By 11 months of age, there is a shift towards increased levels of long-term HSCs. Recipients of BCR-ABL-transduced bone marrow cells from P-selectin-deficient donors develop a more aggressive CML, with increased percentages of LSCs and progenitors. Taken together, our data reveal that P-selectin expression on HSCs and LSCs has important functional ramifications for both hematopoiesis and leukemogenesis, which is most likely attributable to an intrinsic effect on stem cell self-renewal.
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Affiliation(s)
- Con Sullivan
- Maine Institute for Human Genetics and Health, Bangor, Maine, United States of America
- The Jackson Laboratory, Bar Harbor, Maine, United States of America
| | - Yaoyu Chen
- Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
- The Jackson Laboratory, Bar Harbor, Maine, United States of America
| | - Yi Shan
- Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Yiguo Hu
- The Jackson Laboratory, Bar Harbor, Maine, United States of America
- Dana Farber Cancer Institute, Boston, Massachusetts, United States of America
| | - Cong Peng
- Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
- The Jackson Laboratory, Bar Harbor, Maine, United States of America
| | - Haojian Zhang
- Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
- The Jackson Laboratory, Bar Harbor, Maine, United States of America
| | - Linghong Kong
- The Jackson Laboratory, Bar Harbor, Maine, United States of America
| | - Shaoguang Li
- Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
- The Jackson Laboratory, Bar Harbor, Maine, United States of America
- * E-mail: *
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18
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Cai B, Yang W, Zhao Y, Yuan L, Wang L, Gao L, Wang N, Yu L, Gao C. Successful management with an effective induction regimen followed by allogeneic hematopoietic stem cell transplantation for promyelocytic blast crisis of chronic myelogenous leukemia. Ann Hematol 2011; 91:621-3. [PMID: 21643679 DOI: 10.1007/s00277-011-1269-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 05/26/2011] [Indexed: 11/26/2022]
MESH Headings
- Adult
- Blast Crisis/drug therapy
- Blast Crisis/physiopathology
- Hematopoietic Stem Cell Transplantation
- Humans
- Induction Chemotherapy/methods
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/physiopathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/surgery
- Male
- Survival
- Transplantation, Homologous
- Treatment Outcome
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19
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Yano S. [The role of allogenic hematopoietic stem cell transplantation for chronic myeloid leukemia in imatinib era]. Gan To Kagaku Ryoho 2011; 38:759-764. [PMID: 21714206] [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: 05/31/2023]
MESH Headings
- Antineoplastic Agents/therapeutic use
- Benzamides
- Hematopoietic Stem Cell Transplantation
- Humans
- Imatinib Mesylate
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/surgery
- Piperazines/therapeutic use
- Pyrimidines/therapeutic use
- Transplantation Conditioning
- Transplantation, Homologous
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Affiliation(s)
- Shingo Yano
- Department of Clinical Oncology and Hematology, Jikei University Daisan Hospital, 4-11-1, Izumi-honcho, Komae-shi, Tokyo 201-8601, Japan
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20
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ZHANG Y, CHEN YK, FAN ZP, XU D, JIANG QL, SUN J, LIU QF. [Impact of HLA compatibility on the outcome of allogeneic hematopoietic stem cell transplantation for chronic myeloid leukemia]. Nan Fang Yi Ke Da Xue Xue Bao 2011; 31:438-442. [PMID: 21421478] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To analyze the influence of HLA compatibility on the outcome of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with chronic myeloid leukemia (CML). METHODS This retrospective study involved 121 CML patients including 90 in chronic phase, 8 in accelerated phase and 23 with blast crisis. Of these patients, 85 received related and 36 had unrelated donor allo-HSCT. The conditioning regimens included total body irradiation with cyclophosphamide in 37 patients, and modified BUCY protocol in 84 patients. Cyclosporine A (CsA) and methotrexate (MTX) were used for graft-versus-host disease (GVHD) prophylaxis in patients undergoing HLA-matched sibling donor transplants. CsA, MTX, antihuman thymocyte globulin and mycophenolate were used in all the patients undergoing HLA-mismatched related donor and unrelated donor transplants. The prognostic factors of CML were evaluated using Cox regression and the cumulative overall survival and the disease-free survival were estimated using Kaplan and Meier survival analysis model. RESULTS The incidence of II-IV acute GVHD was 26.1% in HLA-matched and 53.3% in HLA-mismatched cases (P=0.006), with a 5-year cumulative incidence of chronic GVHD of 47.4% and 49.6%, respectively (P=0.947). The 5-year cumulative incidences of disease relapse was 16.7% in the total patients, with a 5-year cumulative overall survival (OS) of 70.5% and disease-free survival (DFS) of 63.4%. The 5-year OS was 78.2% in HLA-matched cases, as compared with 47.6% in HLA-mismatched cases. Multivariate analysis with Cox regression model identified HLA mismatch, II-IV acute GVHD, and advanced phase as the risk factors affecting the OS. CONCLUSION HLA mismatch can significantly increase the incidence of II-IV acute GVHD following allo-HSCT and decrease the long-term survival rate, which is not related to the donor source.
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Affiliation(s)
- Yu ZHANG
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
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21
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Song AX, Yang DL, Wei JL, Yan ZS, Wang M, Jiang EL, Huang Y, Ma QL, He Y, Zhai WH, Zhang RL, Feng SZ, Han MZ. [Preliminary analysis of therapeutic efficacy and prognosis of allogeneic hematopoietic stem cell transplantation in patients with advanced chronic myeloid leukemia]. Zhongguo Shi Yan Xue Ye Xue Za Zhi 2011; 19:149-153. [PMID: 21362241] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Chronic myeloid leukemia (CML) at advanced and blastic phase is a disease with poor prognosis, for which allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the only treatment choice with curative potential. This study was purposed to investigate the therapeutic efficacy of allo-HSCT and prognosis of advanced CML patients. The 28 cases of CML in accelerated phase or blast crisis received allo-HSCT were analysed retrospectively in terms curative efficacy, basic characteristics before transplant and prognosis, therapeutic strategy before transplant and prognosis, events after transplant and prognosis. The results indicated that 10 out of 28 patients were in complete remission, showing a 3-year overall survival and disease-free survival rate of 34.9% and 35.7% respectively; 18 patients died. Univariate analysis revealed that the clonal evolution and blast amount are baseline risk factor of poor prognosis, and combination of them can be used to predict the outcome of patients; application of imatinib before transplant and achievement of complete hematologic remission could not improve the prognosis; severe aGVHD among post-transplant events was proven to be a negative prognostic factor. It is concluded that for advanced CML patients received allo-HSCT, clonal evolution and blast percentage are prognostic factors, and the pre-transplant use of imatinib did not influence the outcome.
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MESH Headings
- Adolescent
- Adult
- Benzamides
- Child
- Child, Preschool
- Female
- Hematopoietic Stem Cell Transplantation/methods
- Humans
- Imatinib Mesylate
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/surgery
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Male
- Middle Aged
- Piperazines/therapeutic use
- Prognosis
- Pyrimidines/therapeutic use
- Retrospective Studies
- Young Adult
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Affiliation(s)
- A-Xia Song
- Institute of Hematology, Chinese Academy of Medical Sciences, Tianjin 300020, China
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22
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Hu J, Zhang WP, Yang D, Tang W, Song XM, Wang L, Zhao WL, Wu W, Wang JM. [Prognostic significance of EBMT score for chronic myeloid leukemia patients in allogeneic stem cell transplantation]. Zhonghua Xue Ye Xue Za Zhi 2011; 32:75-78. [PMID: 21429370] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To analyze the risk factors of allogeneic stem cell transplantation (allo-SCT) for chronic myeloid leukemia (CML) in an attempt to avoid transplant risks. METHODS A total of 121 CML patients received allo-SCT were analyzed retrospectively. The risk analysis was based on the EBMT score (gratwohl score) which included donor type, age of patients, disease status before transplantation, donor/recipient sex match and time interval between diagnosis to allo-SCT. Patients were divided into 3 risk groups based on their EBMT score: low risk (score 0-2), intermediate risk (3-4) and high-risk (5). RESULTS The median follow-up duration was 37 (1 - 126) months. The estimated 5-year overall survival (5 y-OS), non-relapse mortality (5 y-NRM) and relapse rate (5 y-RR) were (56.8 ± 5.0)%, (35.6 ± 4.9)% and (12.9 ± 3.7)%, respectively. The 5y-OS, NRM and RR were (66.0 ± 6.1)%, (28.8 ± 6.0)% and (7.8 ± 3.3)% in the low risk group being significantly superior to both intermediate-risk \[(47.2 ± 8.7)%, (43.6 ± 8.5)% and (18.7 ± 8.1)%\] and high-risk group \[(16.8 ± 15.2)%, (66.7 ± 25.5)% and (50.0 ± 25.0)%\] (P = 0.0015, 0.045 and 0.0053 for OS, NRM and RR respectively). CONCLUSION The EBMT risk score can effectively predict the overall outcome, relapse and transplant-related mortality of allo-SCT for CML patients.
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Affiliation(s)
- Jiong Hu
- Department of Hematology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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23
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Oyekunle A, Klyuchnikov E, Ocheni S, Kröger N, Zander AR, Baccarani M, Bacher U. Challenges for allogeneic hematopoietic stem cell transplantation in chronic myeloid leukemia in the era of tyrosine kinase inhibitors. Acta Haematol 2011. [PMID: 21411987 DOI: 10.1159/000323662)] [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: 05/03/2023]
Abstract
Following the introduction of the tyrosine kinase inhibitor (TKI) imatinib in the treatment of chronic myeloid leukemia (CML) patients, the allogeneic hematopoietic stem cell transplantation (HSCT) scene in CML has changed dramatically. The number of patients receiving HSCT in first chronic phase (CP) has declined rapidly, as allogeneic HSCT in CP is now performed in these patients only in case of failure or intolerance of TKIs. Second, those CML patients who undergo allogeneic HSCT represent a selection of high-risk patients due to more advanced disease with high rates of accelerated or blast phase (being associated with an increased relapse risk), advanced age and relevant co-morbidities. Efforts at meeting these special challenges are being developed: treatment with TKIs aims to improve the pre-transplant remission status before HSCT. Dose-reduced conditioning protocols were introduced to decrease transplant-related mortality in patients with co-morbidities or older age. In the post-transplant period, TKIs may be administered for prophylaxis and for treatment of post-transplant relapse. Still, the outcome of patients in advanced CML phases remains guarded, and requires an improvement in current transplant strategies.
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Affiliation(s)
- Anthony Oyekunle
- Department for Stem Cell Transplantation, University Cancer Center Hamburg, Hamburg, Germany
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24
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Weng WH, Shih LY. Occurrence of BCR-ABL1-positive chronic myeloid leukemia following essential thrombocythemia. Acta Haematol 2011; 126:220-3. [PMID: 21934297 DOI: 10.1159/000330524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Accepted: 06/26/2011] [Indexed: 11/19/2022]
MESH Headings
- Adult
- Antineoplastic Agents/therapeutic use
- Fusion Proteins, bcr-abl/blood
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/blood
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/surgery
- Male
- Protein Kinase Inhibitors/therapeutic use
- Recurrence
- Thrombocythemia, Essential/blood
- Thrombocythemia, Essential/complications
- Thrombocythemia, Essential/drug therapy
- Translocation, Genetic
- Treatment Outcome
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Affiliation(s)
- Wei-Hung Weng
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
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25
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Oyekunle A, Klyuchnikov E, Ocheni S, Kröger N, Zander AR, Baccarani M, Bacher U. Challenges for allogeneic hematopoietic stem cell transplantation in chronic myeloid leukemia in the era of tyrosine kinase inhibitors. Acta Haematol 2011; 126:30-9. [PMID: 21411987 DOI: 10.1159/000323662] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [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: 12/20/2010] [Accepted: 12/20/2010] [Indexed: 02/02/2023]
Abstract
Following the introduction of the tyrosine kinase inhibitor (TKI) imatinib in the treatment of chronic myeloid leukemia (CML) patients, the allogeneic hematopoietic stem cell transplantation (HSCT) scene in CML has changed dramatically. The number of patients receiving HSCT in first chronic phase (CP) has declined rapidly, as allogeneic HSCT in CP is now performed in these patients only in case of failure or intolerance of TKIs. Second, those CML patients who undergo allogeneic HSCT represent a selection of high-risk patients due to more advanced disease with high rates of accelerated or blast phase (being associated with an increased relapse risk), advanced age and relevant co-morbidities. Efforts at meeting these special challenges are being developed: treatment with TKIs aims to improve the pre-transplant remission status before HSCT. Dose-reduced conditioning protocols were introduced to decrease transplant-related mortality in patients with co-morbidities or older age. In the post-transplant period, TKIs may be administered for prophylaxis and for treatment of post-transplant relapse. Still, the outcome of patients in advanced CML phases remains guarded, and requires an improvement in current transplant strategies.
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Affiliation(s)
- Anthony Oyekunle
- Department for Stem Cell Transplantation, University Cancer Center Hamburg, Hamburg, Germany
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26
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Lubin AS, Snydman DR, Miller KB. Persistent babesiosis in a stem cell transplant recipient. Leuk Res 2010; 35:e77-8. [PMID: 21185598 DOI: 10.1016/j.leukres.2010.11.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 11/24/2010] [Accepted: 11/29/2010] [Indexed: 11/17/2022]
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27
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Manabe SI, Kashii S, Miki Y, Honda Y. Analysis of cyclosporin A-induced reversible cortical blindness by diffusion-weighted magnetic resonance imaging techniques. Jpn J Ophthalmol 2010; 54:248-50. [PMID: 20577864 DOI: 10.1007/s10384-009-0792-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2009] [Accepted: 12/21/2009] [Indexed: 11/28/2022]
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28
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Dickinson AM, Pearce KF, Norden J, O'Brien SG, Holler E, Bickeböller H, Balavarca Y, Rocha V, Kolb HJ, Hromadnikova I, Sedlacek P, Niederwieser D, Brand R, Ruutu T, Apperley J, Szydlo R, Goulmy E, Siegert W, de Witte T, Gratwohl A. Impact of genomic risk factors on outcome after hematopoietic stem cell transplantation for patients with chronic myeloid leukemia. Haematologica 2010; 95:922-7. [PMID: 20305143 PMCID: PMC2878789 DOI: 10.3324/haematol.2009.016220] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Revised: 12/07/2009] [Accepted: 12/10/2009] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Non-HLA gene polymorphisms have been shown to influence outcome after allogeneic hematopoietic stem cell transplantation. Results were derived from heterogeneous, small populations and their value remains a matter of debate. DESIGN AND METHODS In this study, we assessed the effect of single nucleotide polymorphisms in genes for interleukin 1 receptor antagonist (IL1RN), interleukin 4 (IL4), interleukin 6 (IL6), interleukin 10 (IL10), interferon (IFNG), tumor necrosis factor (TNF) and the cell surface receptors tumor necrosis factor receptor II (TNFRSFIB), vitamin D receptor (VDR) and estrogen receptor alpha (ESR1) in a homogeneous cohort of 228 HLA identical sibling transplants for chronic myeloid leukemia. Three good predictors of overall survival, identified via statistical methods including Cox regression analysis, were investigated for their effects on transplant-related mortality and relapse. Predictive power was assessed after integration into the established European Group for Blood and Marrow Transplantation (EBMT) risk score. RESULTS Absence of patient TNFRSFIB 196R, absence of donor IL10 ATA/ACC and presence of donor IL1RN allele 2 genotypes were associated with increased transplantation-related mortality and decreased survival. Application of prediction error and concordance index statistics gave evidence that integration improved the EBMT risk score. CONCLUSIONS Non-HLA genotypes were associated with survival after allogeneic hematopoietic stem cell transplantation. When three genetic polymorphisms were added into the EBMT risk model they improved the goodness of fit. Non-HLA genotyping could, therefore, be used to improve donor selection algorithms and risk assessment prior to allogeneic hematopoietic stem cell transplantation.
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MESH Headings
- Adolescent
- Adult
- Cohort Studies
- Cytokines/genetics
- Female
- Genomic Instability
- Genotype
- Graft vs Host Disease/genetics
- Graft vs Host Disease/mortality
- Hematopoietic Stem Cell Transplantation/adverse effects
- Hematopoietic Stem Cell Transplantation/mortality
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/mortality
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/surgery
- Male
- Middle Aged
- Polymorphism, Single Nucleotide/genetics
- Prospective Studies
- Risk Factors
- Survival Rate/trends
- Treatment Outcome
- Young Adult
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Affiliation(s)
- Anne M Dickinson
- Haematological Sciences, Institute of Cellular Medicine, Newcastle University, UK.
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29
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Ramzi M, Nourani H, Zakerinia M, Dehghani M, Vojdani R, Haghshenas M. Results of hematopoietic stem cell transplant in Shiraz: 15 years experience in southern Iran. EXP CLIN TRANSPLANT 2010; 8:61-65. [PMID: 20199373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Over the past 2 decades, hematopoietic stem cell transplant has evolved from an experimental procedure to the standard of care, and it is integrated into the management of many diseases. Hematopoietic stem cell transplant was established at Shiraz University of Medical Sciences in 1993. Here, we describe 15 years experience with stem cell transplant at our center in southern Iran. We provide information on indication, donor type, conditioning chemotherapy regimen, outcome, survival, and long-term follow-up in our stem cell activity. PATIENTS AND METHODS From May 1993 to October 2008, 423 patients underwent allogeneic (n=311) and autologous (n=112) stem cell transplants at our center. For allogeneic stem cell transplant, the conditioning chemotherapy regimen comprised busulfan, cyclophosphamide, and antithymocyte globulin for thalassemic patients; busulfan and cyclophosphamide for leukemia patients; and cyclophosphamide and antithymocyte globulin for patients with aplastic anemia. RESULTS During this period, 155 B-thalassemia major patients (mean age, 9.5 years; range, 2-20 years) underwent allogeneic marrow transplant. Of 155 patients with a diagnosis of thalassemia major, 112 are alive (72%) with full engraftment after a median follow-up of about 8.1 years (range, 12-184 months). During this time, 127 leukemia patients including acute myelogenous leukemia (n=68), acute lymphoblastic leukemia (n=30) and chronic myelogenous leukemia (n=29), received allogeneic stem cell transplant. In this group, long-term, disease-free survival (cure rate) was 67%, 60%, and 62%. CONCLUSIONS These data reflect the important role of hematopoietic stem cell transplant in improving survival for a variety of hematopoietic system disorders at our center in Southern Iran. In patients with B-thalassemia major hematopoietic stem cell transplant seems to be the treatment of choice, because it leads to a cure in all classes (Lucarelli risk group, I-III). Based on high success rates in patients with class II and III thalassemia with the addition of the antithymocyte globulin to conditioning regimen of stem cell transplant, we also recommend using this new method of conditioning in transplant of thalassemia patients.
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MESH Headings
- Adolescent
- Adult
- Child
- Child, Preschool
- Combined Modality Therapy
- Drug Therapy
- Follow-Up Studies
- Hematopoietic Stem Cell Transplantation
- Humans
- Iran
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/mortality
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/surgery
- Middle Aged
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/mortality
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/surgery
- Retrospective Studies
- Survival Rate
- Treatment Outcome
- Young Adult
- beta-Thalassemia/drug therapy
- beta-Thalassemia/mortality
- beta-Thalassemia/surgery
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Affiliation(s)
- Mani Ramzi
- Department of Hematology, Shiraz University of Medical Sciences, Shiraz, Iran.
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30
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Abstract
Seven of one hundred twenty-one patients with chronic myeloid leukemia (CML) treated with imatinib mesylate developed subdural hematomas. All had advanced disease and were treated initially at a dose of 600 mg per day. Three patients had thrombocytopenia (platelet < 10 x 10(9)/l), one had leukocytosis (white blood cell count > 150 x 10(9)/l) and three had neither around the time of diagnosis of the subdural hematomas. Four patients required surgical evacuation. One patient, in blast crisis, died as a consequence of the subdural hematoma. Three patients survived but died of progressive CML. The remaining three patients having recommenced imatinib, are alive and well, and one has achieved a major cytogenetic response. Subdural hematomas must be considered even in mildly symptomatic patients receiving imatinib regardless of their peripheral blood counts. Patients who survive can be cautiously restarted on imatinib. Further studies are required to study the potential relationship between imatinib mesylate and subdural hematomas.
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MESH Headings
- Aged
- Antineoplastic Agents/adverse effects
- Benzamides
- Blast Crisis/chemically induced
- Blast Crisis/drug therapy
- Female
- Hematoma, Subdural/chemically induced
- Hematoma, Subdural/complications
- Hematoma, Subdural/drug therapy
- Humans
- Imatinib Mesylate
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/surgery
- Leukocytosis/chemically induced
- Male
- Middle Aged
- Piperazines/adverse effects
- Pyrimidines/adverse effects
- Remission Induction
- Risk Factors
- Thrombocytopenia/chemically induced
- Treatment Outcome
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Affiliation(s)
- K W Song
- Department of Medical Oncology and Hematology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario Canada
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31
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Xiao-Jun H, Lan-Ping X, Kai-Yan L, Dai-Hong L, Yu W, Huan C, Yu-Hong C, Wei H, Jing-Zhi W, Yao C, Xiao-Hui Z, Hong-Xia S, Feng-Rong W, Fei-Fei T. Partially Matched Related Donor Transplantation Can Achieve Outcomes Comparable with Unrelated Donor Transplantation for Patients with Hematologic Malignancies. Clin Cancer Res 2009; 15:4777-83. [PMID: 19584148 DOI: 10.1158/1078-0432.ccr-09-0691] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Huang Xiao-Jun
- Peking University People's Hospital, Institute of Hematology, Beijing 100044, China.
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32
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Chávez-González MA, Ayala-Sánchez M, Mayani H. [Chronic myeloid leukemia in the 21st century: biology and treatment]. Rev Invest Clin 2009; 61:221-232. [PMID: 19736811] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Chronic Myeloid Leukaemia (CML) is a clonal disease, originated at the level of Hematopoietic Stem Cells (HSC) and characterized by the presence of the Philadelphia (Ph) chromosome and its oncogenic product p210(BcrAbl). Such a protein has been shown to be essential for malignant transformation, since it is capable of altering cell adhesion, proliferation and apoptosis. Historically, CML has been treated by using different approaches: arsenic (in the early days), a variety of chemical agents (busulfan, hydroxyurea, cytarabine), cytokines (IFN-alpha, IFNalpha-PEG), hematopoietic cell transplant (HCT), and more recently drugs generated by design (imatinib, nilotinib, dasatinib). All these molecules exert specific effects on HSC and lead to a variety of clinical and biological responses. In this article, we present an overview about hematopoiesis in CML and its implications in the treatment of this disease.
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MESH Headings
- Adult
- Aged
- Antineoplastic Agents/therapeutic use
- Combined Modality Therapy
- Drug Design
- Fusion Proteins, bcr-abl/antagonists & inhibitors
- Fusion Proteins, bcr-abl/genetics
- Hematopoiesis/drug effects
- Hematopoiesis/physiology
- Hematopoietic Stem Cell Transplantation
- Hematopoietic Stem Cells/drug effects
- Hematopoietic Stem Cells/pathology
- Humans
- Immunologic Factors/therapeutic use
- Incidence
- Interferon-alpha/therapeutic use
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/epidemiology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/physiopathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/surgery
- Mexico/epidemiology
- Middle Aged
- Neoplastic Stem Cells/drug effects
- Neoplastic Stem Cells/pathology
- Protein Kinase Inhibitors/therapeutic use
- United States/epidemiology
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33
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Shindano A, Geubel A, Fervaille C, Azzouzi K. Asymptomatic eosinophilic colitis in a patient with previous allogeneic bone marrow transplantation for chronic myeloid leukaemia. Acta Gastroenterol Belg 2009; 72:267-268. [PMID: 19637788] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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34
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Poiré X, Artz A, Larson RA, Kline J, Odenike O, Rich E, Godley L, Stock W, van Besien K. Allogeneic stem cell transplantation with alemtuzumab-based conditioning for patients with advanced chronic myelogenous leukemia. Leuk Lymphoma 2009; 50:85-91. [PMID: 19142796 PMCID: PMC3617055 DOI: 10.1080/10428190802626624] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the treatment of choice for patients with chronic myelogenous leukemia (CML) who have failed or are intolerant to tyrosine kinase inhibitors (TKI). Myeloablative conditioning regimens have been associated with high treatment-related mortality (TRM) rate in such patients, and reduced-intensity conditioning (RIC) regimens are often preferred but have high rates of disease recurrence and graft-versus-host-disease (GVHD). We report our experience with nine CML patients (four chronic phase and five with accelerated phase or blast crisis) who failed TKI and underwent allo-HSCT using an alemtuzumab-based RIC regimen. The conditioning regimen was well tolerated and induced engraftment in all patients, and complete cytogenetic remission (CCyR) in eight of nine. Four patients, all with a history of accelerated phase or blast crisis, died. Four of the five remaining patients had a cytogenetic relapse a median of 10 months after transplantation. Donor lymphocyte infusion (DLI), TKI or both induced a CCyR in all cases. With a median follow-up of 47 months, five patients, including all those transplanted in first or second chronic phase, are alive and in remission. Allo-HSCT with an alemtuzumab-based conditioning regimen induces remission in patients with CML that have failed TKI therapy and has a low incidence of GVHD. Disease recurrence is frequent but responds to DLI. In some cases, restoration of susceptibility to TKI was observed. Outcomes may improve with the routine administration of post-transplant TKI.
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MESH Headings
- Adult
- Alemtuzumab
- Antibodies, Monoclonal/immunology
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antibodies, Neoplasm/immunology
- Antibodies, Neoplasm/therapeutic use
- Combined Modality Therapy
- Female
- Graft vs Host Disease/immunology
- Hematopoietic Stem Cell Transplantation
- Humans
- Immunotherapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/immunology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/surgery
- Male
- Middle Aged
- Neoplasm Staging
- Survival Rate
- Transplantation Conditioning
- Transplantation, Homologous
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Affiliation(s)
- Xavier Poiré
- Section of Hematology/Oncology, Department of Medicine and the Cancer Research Center, The University of Chicago, Chicago, IL 60637, USA
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35
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Hahn T, McCarthy PL, Zhang MJ, Wang D, Arora M, Frangoul H, Gale RP, Hale GA, Horan J, Isola L, Maziarz RT, van Rood JJ, Gupta V, Halter J, Reddy V, Tiberghien P, Litzow M, Anasetti C, Pavletic S, Ringdén O. Risk factors for acute graft-versus-host disease after human leukocyte antigen-identical sibling transplants for adults with leukemia. J Clin Oncol 2008; 26:5728-34. [PMID: 18981462 PMCID: PMC2645611 DOI: 10.1200/jco.2008.17.6545] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Accepted: 07/22/2008] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Acute graft-versus-host disease (GVHD) causes substantial morbidity and mortality after human leukocyte antigen (HLA)-identical sibling transplants. No large registry studies of acute GVHD risk factors have been reported in two decades. Risk factors may have changed in this interval as transplant-related techniques have evolved. PATIENTS AND METHODS Acute GVHD risk factors were analyzed in 1,960 adults after HLA-identical sibling myeloablative transplant for acute myeloid leukemia (AML), acute lymphocytic leukemia (ALL), or chronic myeloid leukemia (CML) reported by 226 centers worldwide to the Center for International Blood and Marrow Transplant Research from 1995 to 2002. Outcome was measured as time from transplant to onset of grade 2 to 4 acute GVHD, with death without acute GVHD as a competing risk. RESULTS Cumulative incidence of grade 2 to 4 acute GVHD was 35% (95% CI, 33% to 37%). In multivariable analyses, factors significantly associated with grade 2 to 4 acute GVHD were cyclophosphamide + total-body irradiation versus busulfan + cyclophosphamide (relative risk [RR] = 1.4; P < .0001), blood cell versus bone marrow grafts in patients age 18 to 39 years (RR = 1.43; P = .0023), recipient age 40 and older versus age 18 to 39 years receiving bone marrow grafts (RR = 1.44; P = .0005), CML versus AML/ALL (RR = 1.35; P = .0003), white/Black versus Asian/Hispanic race (RR = 1.54; P = .0003), Karnofsky performance score less than 90 versus 90 to 100 (RR = 1.27; P = .014), and recipient/donor cytomegalovirus-seronegative versus either positive (RR = 1.20; P = .04). Stratification by disease showed the same significant predictors of grade 2 to 4 acute GVHD for CML; however, KPS and cytomegalovirus serostatus were not significant predictors for AML/ALL. CONCLUSION This analysis confirmed several previously reported risk factors for grade 2 to 4 acute GVHD. However, several new factors were identified whereas others are no longer significant. These new data may facilitate individualized risk estimates and raise several interesting biologic questions.
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MESH Headings
- Acute Disease
- Adolescent
- Adult
- Bone Marrow Transplantation/adverse effects
- Canada
- Europe
- Female
- Graft vs Host Disease/etiology
- Graft vs Host Disease/mortality
- HLA Antigens/analysis
- Histocompatibility Testing
- Humans
- Leukemia/immunology
- Leukemia/surgery
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/immunology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/surgery
- Leukemia, Myeloid, Acute/immunology
- Leukemia, Myeloid, Acute/surgery
- Living Donors
- Male
- Peripheral Blood Stem Cell Transplantation/adverse effects
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/immunology
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/surgery
- Reproducibility of Results
- Retrospective Studies
- Risk Assessment
- Risk Factors
- Severity of Illness Index
- Siblings
- Time Factors
- Treatment Outcome
- United States
- Young Adult
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Affiliation(s)
- Theresa Hahn
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
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36
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Xue M, Wang HX, Duan LN, Yan HM, Zhu L, Liu J, Ding L. [Detection of bcr/abl fusion gene changes in patients with chronic myeloid leukemia after allo-HSCT by real-time quantitative reverse transcription polymerase chain reaction and its significance]. Zhongguo Shi Yan Xue Ye Xue Za Zhi 2008; 16:1350-1353. [PMID: 19099642] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This study was aimed to detect the changes of bcr/able gene level in ph+ CML patients at different stages after allo-HSCT by real-time quantitative PCR and to evaluate the significance of this detection. The serial detection of bcr/abl fusion gene levels in 21 cases of CML treated with allo-HSCT was performed by RQ-PCR. The results showed that the bcr/able fusion gene could not be detected in 7 out 21 CML cases with positive fusion gene after allo-HSCT, while the bcr/abl fusion gene of different levels could be detected in 14 cases within 1-6 months. Dynamic detection indicated that the bcr/abl fusion gene levels in 9 cases were lower with relative value 0.0074%-0.088% and then could not be detected within 3-7 months after allo-HSCT. The bcr/abl fusion gene levels in 5 cases diagnosed as molecular relapse were between 0.077%-75%. The bcr/abl fusion gene levels in 1 out of 5 cases were 0.95%, 1.5%, and 0.16% in month 1, 2 and 3, respectively, and turned to negative in the month 4 without any treatment after allo-HSCT. 2 cases received the donor peripheral blood stem cell infusion, and then their bcr/abl mRNA levels could not be detected in bone marrow. Another 2 cases developed to the hematologic relapse, 1 out of 2 cases reached CR again after infusion of donor peripheral blood stem cells and chemotherapy, the other one died. It is concluded that serial quantifications of bcr/abl mRNA levels by RQ-PCR are reliable and can be used to detect the MRD, to monitor the outcome and to predict the relapse.
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Affiliation(s)
- Mei Xue
- Department of Hematology, Air Force General Hospital, Beijing 100036, China.
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37
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Imataki O, Shintani T, Waki F, Ohnishi H, Ishida T. [Tolerability of imatinib for patients with chronic myelogeneous leukemia (CML)]. Gan To Kagaku Ryoho 2008; 35:1863-1867. [PMID: 19011333] [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 adequate dose of imatinib has not been defined for the Japanese population. Indeed, about half of patients experience mild to moderate adverse events due to this drug, some of which result in intolerance. We reviewed a patients' cohort treated with imatinib in our hospital in 2007 for chronic myelogeneous leukemia (CML). The cohort included 14 patients (5 men and 9 women) whose median age was 53 (range 16-81). The disease status at onset was chronic phase in 13 patients and accelerated phase in 1. During the 2-year observation period, 2 patients (14%) failed to respond and 6 (42%) became intolerant to imatinib. After the appearance of the intolerance, 5 of the 6 patients were treated with a reduced dose of imatinib (300 mg/day in 4, 200 mg/day in 1). In 4 of these 6 intolerant cases, CR was maintained 2 years after the start of imatinib therapy. Nevertheless, 42% of patients were intolerant to imatinib therapy through 2 years, and progression-free survival was 86%. In conclusion, an adjusted dose exerting minimal toxicity and showing a favorable outcome should be researched in Japanese patients including the elderly.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Agents/therapeutic use
- Benzamides
- Disease Progression
- Drug Tolerance
- Female
- Humans
- Imatinib Mesylate
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/surgery
- Male
- Middle Aged
- Piperazines/adverse effects
- Piperazines/therapeutic use
- Pyrimidines/adverse effects
- Pyrimidines/therapeutic use
- Stem Cell Transplantation
- Survival Rate
- Young Adult
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Affiliation(s)
- Osamu Imataki
- Division of Hematology, Dept. of Internal Medicine, Kagawa University
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38
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Aisa Y, Mori T, Tanikawa A, Takae Y, Kato J, Ikeda Y, Okamoto S. Demodicidosis as a cause of facial eruption developing early after allogeneic hematopoietic stem cell transplantation. Transpl Int 2008; 21:1192-3. [PMID: 18783387 DOI: 10.1111/j.1432-2277.2008.00749.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Byun JH, Park BW, Kim JR, Lee GW, Lee JH. Squamous cell carcinoma of the tongue after bone marrow transplant and graft-versus-host disease: a case report and review of the literature. J Oral Maxillofac Surg 2008; 66:144-7. [PMID: 18083430 DOI: 10.1016/j.joms.2006.11.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2006] [Revised: 06/19/2006] [Accepted: 11/15/2006] [Indexed: 12/16/2022]
Affiliation(s)
- June-Ho Byun
- Department of Oral and Maxillofacial Surgery, College of Medicine and Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
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40
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MESH Headings
- Bone Marrow Examination
- Colitis, Ulcerative/etiology
- Colitis, Ulcerative/pathology
- Colitis, Ulcerative/surgery
- Colorectal Neoplasms/complications
- Colorectal Neoplasms/pathology
- Colorectal Neoplasms/surgery
- Crohn Disease/complications
- Crohn Disease/pathology
- Crohn Disease/surgery
- Fatal Outcome
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/surgery
- Male
- Middle Aged
- Proctocolectomy, Restorative/adverse effects
- Reoperation
- Surgical Wound Infection/etiology
- Surgical Wound Infection/surgery
- Treatment Outcome
- Wound Healing
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41
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Abstract
Chronic myeloid leukemia (CML) is typified by robust marrow and extramedullary myeloid cell production. In the absence of therapy or sometimes despite it, CML has a propensity to progress from a relatively well tolerated chronic phase to an almost uniformly fatal blast crisis phase. The discovery of the Philadelphia chromosome followed by identification of its BCR-ABL fusion gene product and the resultant constitutively active P210 BCR-ABL tyrosine kinase, prompted the unraveling of the molecular pathogenesis of CML. Ground-breaking research demonstrating that BCR-ABL was necessary and sufficient to initiate chronic phase CML provided the rationale for targeted therapy. However, regardless of greatly reduced mortality rates with BCR-ABL targeted therapy, most patients harbor quiescent CML stem cells that may be a reservoir for disease progression to blast crisis. While the hematopoietic stem cell (HSC) origin of CML was first suggested over 30 years ago, only recently have the HSC and progenitor cell-specific effects of the molecular mutations that drive CML been investigated. This has provided the impetus for investigating the genetic and epigenetic events governing HSC and progenitor cell resistance to therapy and their role in disease progression. Accumulating evidence suggests that the acquired BCR-ABL mutation initiates chronic phase CML and results in aberrant stem cell differentiation and survival. This eventually leads to the production of an expanded progenitor population that aberrantly acquires self-renewal capacity resulting in leukemia stem cell (LSC) generation and blast crisis transformation. Therapeutic recalcitrance of blast crisis CML provides the rationale for targeting the molecular pathways that drive aberrant progenitor differentiation, survival and self-renewal earlier in disease before LSC predominate.
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MESH Headings
- Antigens, CD/genetics
- Blast Crisis/pathology
- Bone Marrow/pathology
- Cell Differentiation
- Cell Survival
- Gene Expression Profiling
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/surgery
- Philadelphia Chromosome
- Stem Cell Transplantation/methods
- Stem Cells/pathology
- Translocation, Genetic
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Affiliation(s)
- Catriona H Jamieson
- Moores Cancer Center, Department of Medicine, University of California, San Diego, La Jolla, CA 92093-0820, USA.
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Lamba A, Dey P, Kumari S, Marwaha N. Prognostic significance of the histomorphometric features of bone marrow trephine biopsies in patients with chronic myeloid leukemia. Anal Quant Cytol Histol 2007; 29:370-376. [PMID: 18225393] [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] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To study the correlation of histomorphometric data of bone marrow trephine biopsies at the time of initial diagnosis in chronic myeloid leukemia (CML) patients with the patient prognosis. STUDY DESIGN A total of 40 CML patients were divided equally in group I (developed accelerated phase or blast crisis within 18 months of initial diagnosis of chronic phase of CML) and group II (developed accelerated phase or blast crisis > 30 months after initial diagnosis of chronic phase of CML). The clinical, hematologic and histomorphometric data were compared in the 2 groups of CML patients. RESULTS The percentage of bone marrow promyelocytes was significantly increased in group I. On morphometry, the number of blasts per square millimeter, the area of reticulin fibers per square millimeter and the percentage area occupied by reticulin fibers were statistically significant. CONCLUSION There seems to be grounds for hope for predicting prognosis of CML patients at initial diagnosis based on histomorphometric findings. The percentage area of reticulin fibers and the number of blasts per square millimeter are important prognostic predictors in histomorphometry data.
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MESH Headings
- Adolescent
- Adult
- Biopsy/instrumentation
- Biopsy/methods
- Bone Marrow/pathology
- Erythroblasts/pathology
- Female
- Granulocyte Precursor Cells/pathology
- Granulocytes/pathology
- Humans
- Image Cytometry
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/classification
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/surgery
- Linear Models
- Male
- Megakaryocytes/pathology
- Middle Aged
- Multivariate Analysis
- Prognosis
- Reticulin/analysis
- Retrospective Studies
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Affiliation(s)
- Amit Lamba
- Department of Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
PURPOSE To describe the use of allogeneic serum eye drops to treat 2 patients with chronic graft-versus-host disease (GVHD)-induced severe ocular surface disease. METHODS Small case series. RESULTS Conventional therapy failed to control the ocular symptoms of 2 patients with GVHD who presented with severe dry eye syndrome. Because autologous serum was unavailable in these cases, we used allogeneic serum eye drops as an alternate option for treating their ocular surface disease. Both donors had serologic tests performed before donation. Use of the allogeneic serum eye drops had a beneficial clinical effect, with marked attenuation of the patients' symptoms. This therapy proved to be safe during 10 months of treatment. CONCLUSIONS Allogeneic serum eye drops may be a good alternative treatment for patients with severe dry eyes caused by GVHD.
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Affiliation(s)
- Chun-Chi Chiang
- Department of Ophthalmology, China Medical University Hospital, Taichung, Taiwan
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44
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Rodolakis A, Thomakos N, Harhalakis N, Iconomou T, Antsaklis A. Complete vaginal obstruction with hematometra after hematopoietic stem cell transplantation for chronic myeloid leukemia: a case report. J Reprod Med 2007; 52:959-961. [PMID: 17977175] [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] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Allogeneic hematopoietic stem cell transplantation (allo-HSCT) has become a curative treatment modality for many patients with malignant hematologic diseases. Despite impressive advances in the management of allo-HSCT, graft vs. host disease (GvHD) is a frequent complication that significantly contributes to the morbidity and mortality associated with transplantation and is a significant obstacle to overcome. CASE An unusual case of hematocolpometra secondary to vaginal stenosis occurred as a manifestation of chronic GvHD. CONCLUSION Management of vaginal stenosis and stricture formation as a manifestation of chronic GvHD consists of surgery with lysis of adhesions. Return of anatomic distortion to normal is followed by vaginal dilatation. Later, local estrogen cream and sexual activity help to avoid further adhesion formation.
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Affiliation(s)
- Alexandros Rodolakis
- First Department of Obstetrics and Gynaecology, Alexandra Hospital, University of Athens
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45
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Jabbour E, Cortes J, Kantarjian H, Giralt S, Andersson BS, Giles F, Shpall E, Kebriaei P, Champlin R, de Lima M. Novel tyrosine kinase inhibitor therapy before allogeneic stem cell transplantation in patients with chronic myeloid leukemia: no evidence for increased transplant-related toxicity. Cancer 2007; 110:340-4. [PMID: 17559140 DOI: 10.1002/cncr.22778] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) for chronic myeloid leukemia (CML) are increasingly likely to have received a novel tyrosine kinase inhibitor (NTKI) after failing imatinib mesylate. It is unknown whether the use of these NTKIs before HSCT increases transplant-related toxicity. METHODS The outcome of 12 patients with CML (1 in chronic phase, 6 in the accelerated phase, and 5 in the blastic phase) who received dasatinib (n = 2), nilotinib (n = 7), or both (n = 3) before HSCT were retrospectively analyzed. RESULTS The median time on treatment was 134 days, and the median time from the end of NTKI therapy to HSCT was 34 days. The preparative regimen was ablative in 8 patients and nonablative in 4. All patients engrafted within 13 days. There was no significant early transplant-related toxicity. One patient developed secondary graft failure after 6 months from the first HSCT that required a second HSCT. Acute and chronic graft-versus-host disease (GVHD) was observed in 7 and 6 patients, respectively. Nine patients achieved a molecular response: 4 complete and 5 major (quantitative reverse transcriptase-polymerase chain reaction <0.05%). Three patients had disease progression by Day 30 after HSCT. Two patients developed disease recurrence after a median of 12 months. After a median follow-up of 10 months, 7 patients were alive in molecular response and 5 patients had died, 4 of disease progression and 1 of extensive chronic GVHD. CONCLUSIONS Previous treatment with NTKI did not increase transplant-related toxicity in this preliminary experience. Further follow-up and a larger number of patients will be necessary to confirm these observations.
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Affiliation(s)
- Elias Jabbour
- Department of Blood and Marrow Transplantation, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA
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Johansson JE, Ekman T. Gut toxicity during hemopoietic stem cell transplantation may predict acute graft-versus-host disease severity in patients. Dig Dis Sci 2007; 52:2340-5. [PMID: 17415646 DOI: 10.1007/s10620-006-9404-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2005] [Accepted: 04/23/2006] [Indexed: 12/09/2022]
Abstract
Graft-versus-host disease (GVHD) is the primary complication of allogeneic, hemopoietic, stem cell transplantation (HSCT). Murine models suggest that gut toxicity, induced by the intensive chemotherapy preceding hematopoietic stem cell infusion, aggravates systemic GVHD. In HSCT patients gut toxicity correlates with chemotherapy intensity. The present study investigates acute GVHD severity and intestinal toxicity in patients undergoing allogeneic HSCT. In 38 patients intestinal permeability was assessed before and after chemotherapy (on days -1, +4, +7 and +14 as related to the stem cell infusion). Cumulative acute GVHD (days 0-100) and clinical intestinal toxicity (days 0-14) were evaluated in parallel. Patients with mild, acute GVHD (grades 0-I) had better-preserved intestinal barrier function (P=0.04) and less pronounced cumulative clinical intestinal toxicity (P=0.02) compared with patients with more severe acute GVHD (grades II-IV). Gut toxicity predicts acute GVHD severity. Therefore, gut protective strategies may diminish GVHD severity in allogeneic HSCT patients.
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Affiliation(s)
- Jan-Erik Johansson
- Department of Haematology, Sahlgrenska University Hospital, Faculty of Medicine, University of Göteborg, S-41345, Göteborg, Sweden.
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Unal S, Fidan G, Tavil B, Cetin M, Cetinkaya DU. Allogeneic hematopoietic stem cell transplantation in pediatric chronic myelogenous leukemia cases: Hacettepe experience. Pediatr Transplant 2007; 11:645-9. [PMID: 17663688 DOI: 10.1111/j.1399-3046.2007.00727.x] [Citation(s) in RCA: 6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Recently, there are emerging reports on the beneficial effect of imatinib mesylate for pediatric CML patients; however, the general recommendation is that high-risk CML patients with a human leukocyte antigen-identical donor should be transplanted within the first 12 months after diagnosis. Herein, the data of 16 allogeneic HSCT in 14 children with CML were analyzed retrospectively. In the present study, three-yr EFS was 54.1+/-10.8% and three-yr OS was found as 80.7+/-12.5%.
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Affiliation(s)
- Sule Unal
- Division of Pediatric Hematology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Sihhiye, Ankara, Turkey.
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Cho BS, Kim HJ, Lee S, Eom KS, Min WS, Lee JW, Kim CC. Successful interim therapy with imatinib prior to allogeneic stem cell transplantation in Philadelphia chromosome-positive acute myeloid leukemia. Eur J Haematol 2007; 79:170-3. [PMID: 17608710 DOI: 10.1111/j.1600-0609.2007.00890.x] [Citation(s) in RCA: 12] [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] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Imatinib (Glivec, STI571) has been successfully used in patients with chronic myelogenous leukemia and acute lymphoblastic leukemia with the Philadelphia chromosome (Ph). We used imatinib interim therapy for four consecutive patients with newly diagnosed Ph+ acute myeloid leukemia (AML). We monitored the patient status for minimal residual disease by real-time quantitative polymerase chain reaction. METHODS AND RESULTS Imatinib was administered on an interim schedule after each chemotherapy course. After the first imatinib cycle, all patients remained in sustained complete hematologic remission (CHR) with a decrease in the breakpoint cluster region of the Abelson oncogene locus transcript. All patients received a second imatinib cycle following consolidation and showed sustained CHR, including two cases with complete molecular remission. All cases underwent hematopoietic stem cell transplantation (HSCT) in favorable condition, and are still alive with a leukemia-free status at 6, 6, 9, and 25 months after HSCT. CONCLUSIONS As a first-line interim therapy, imatinib appears to be a useful treatment strategy to provide a bridge to HSCT in patients with Ph+ AML. Further studies with a larger patient population and longer follow-up are needed for accurate assessment of the impact of imatinib on the long-term outcome of transplantation for patients with Ph+ AML.
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MESH Headings
- Adolescent
- Adult
- Benzamides
- Chromosomes, Human/genetics
- Humans
- Imatinib Mesylate
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/surgery
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/pathology
- Leukemia, Myeloid, Acute/surgery
- Male
- Piperazines/administration & dosage
- Piperazines/therapeutic use
- Pyrimidines/administration & dosage
- Pyrimidines/therapeutic use
- Stem Cell Transplantation
- Transplantation, Homologous
- Treatment Outcome
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Affiliation(s)
- Byung-Sik Cho
- Division of Hematology, Department of Internal Medicine, Catholic Hemopoietic Stem Cell Transplantation Center, Catholic University of Korea College of Medicine, Seoul, Korea
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Medeiros BC, Chun K, Kamel-Reid S, Lipton J. Inv (11)(p15q21) in donor-derived Ph-negative cells in a patient with chronic myeloid leukemia in relapse successfully treated with imatinib mesylate post allogeneic stem cell transplantation. Am J Hematol 2007; 82:758-60. [PMID: 17301975 DOI: 10.1002/ajh.20882] [Citation(s) in RCA: 3] [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: 11/11/2022]
Abstract
Imatinib mesylate (IM) is the standard first-line treatment for patients with chronic myeloid leukemia (CML). Surprisingly, 2-15% of patients achieving a complete cytogenetic response develop cytogenetic abnormalities in Philadelphia (Ph)-negative cells. Following hematopoietic stem cell transplantation (HSCT), IM induces complete molecular responses (CMR) in approximately 70% patients with relapsed CML, and no IM-related cytogenetic abnormalities in Ph-negative donor-derived cells have been described after HSCT. We report a 56-year-old female who presented with a relapse from CML in September 2002. She had received a matched related HSCT for CML in chronic phase. Donor lymphocyte infusion was given 3 years post-HSCT for a relapse. Sustained CMR was achieved within 3 months of initiation of IM. In October 2005, routine evaluation demonstrated continuous CMR, full male donor engraftment and an inv (11) on donor cells. Evaluation of the donor demonstrated no dysplasia or cytogenetic abnormalities. This observation reinforces the possibility that IM therapy may be casually linked to the phenomenon of secondary cytogenetic changes in diploid cells.
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MESH Headings
- Adult
- Benzamides
- Chromosomes, Human, Pair 11/genetics
- Female
- Humans
- Imatinib Mesylate
- Karyotyping
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/surgery
- Male
- Middle Aged
- Philadelphia Chromosome
- Piperazines/therapeutic use
- Pyrimidines/therapeutic use
- Recurrence
- Stem Cell Transplantation
- Tissue Donors
- Transplantation, Homologous
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Affiliation(s)
- Bruno C Medeiros
- Department of Medical Oncology and Hematology, Princess Margaret Hospital/University Health Network, Toronto, Ontario, Canada.
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Xu YJ, Chen FP, Li XL, Zhao XL, He Q. [Effect of recombinant human interleukin 11 on the platelet after hematopoietic stem cell transplantation in patients with leukemia]. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2007; 32:433-6. [PMID: 17611320] [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] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To explore the effect and toxicity profile of recombinant human interleukin 11(rhIL-11) on the platelet after hematopoietic stem cell transplantation in patients with leukemia. METHODS Twenty-four patients with acute or chronic leukemia treated by allogeneic peripheral blood stem cell transplantation (PBSCT) were randomly divided into a test group and a control group. The patients in the test group were treated with rhIL-11 since the 13th day after PBSCT (1.5mg/d),while the control group were given symptomatic treatment. RESULTS The average time for the platelet to recover to the level of 20 x 10(9)/L was 20.8 days in the test group, and 26.0 days in control group respectively, there was significant difference (P<0.01). The average time for the platelet to recover to the level of 50 x 10(9)/L was 25.7 days in the test group, and 32.3 days in the control group respectively, there was also significant difference (P<0.01). The average time for the platelet transfusion was 2.2 in the test group, 4.1 in the control group, and there was significantly different (P<0.01). The average number of megakaryocytes was 12.2 in the test group, 4.8 in the control group on 30th day after the transplantation,and there was significant difference(P<0.01). The main side effects of rhIL-11 were nausea, vomit, debility, headache, dizzy and pain of injection site, and the degree was all Iapproximately II grade. CONCLUSION rhIL-11 has definite recuperative effect on the recovery of the platelet after PBSCT. There is little side effect, and it can be accepted.
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MESH Headings
- Adolescent
- Adult
- Female
- Hematopoietic Stem Cell Transplantation
- Humans
- Interleukin-11/genetics
- Interleukin-11/therapeutic use
- Leukemia/blood
- Leukemia/surgery
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/blood
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/surgery
- Leukemia, Myeloid, Acute/blood
- Leukemia, Myeloid, Acute/surgery
- Male
- Middle Aged
- Platelet Count
- Recombinant Proteins/therapeutic use
- Thrombocytopenia/drug therapy
- Treatment Outcome
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Affiliation(s)
- Ya-jing Xu
- Department of Hematology,Xiangya Hospital,Central South University,Changsha 410008,China.
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