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Brioli A, Lomaia E, Fabisch C, Sacha T, Klamova H, Morozova E, Golos A, Ernst P, Olsson-Stromberg U, Zackova D, Nicolini FE, Bao H, Castagnetti F, Patkowska E, Mayer J, Hirschbühl K, Podgornik H, Paczkowska E, Parry A, Ernst T, Voskanyan A, Szczepanek E, Saussele S, Franke GN, Kiani A, Faber E, Krause S, Casado LF, Lewandowski K, Eder M, Anhut P, Gil J, Südhoff T, Hebart H, Heibl S, Pfirrmann M, Hochhaus A, Lauseker M. Management and outcome of patients with chronic myeloid leukemia in blast phase in the tyrosine kinase inhibitor era - analysis of the European LeukemiaNet Blast Phase Registry. Leukemia 2024; 38:1072-1080. [PMID: 38548962 DOI: 10.1038/s41375-024-02204-y] [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: 09/14/2023] [Revised: 02/15/2024] [Accepted: 02/23/2024] [Indexed: 05/08/2024]
Abstract
Blast phase (BP) of chronic myeloid leukemia (CML) still represents an unmet clinical need with a dismal prognosis. Due to the rarity of the condition and the heterogeneity of the biology and clinical presentation, prospective trials and concise treatment recommendations are lacking. Here we present the analysis of the European LeukemiaNet Blast Phase Registry, an international collection of the clinical presentation, treatment and outcome of blast phases which had been diagnosed in CML patients after 2015. Data reveal the expected heterogeneity of the entity, lacking a clear treatment standard. Outcomes remain dismal, with a median overall survival of 23.8 months (median follow up 27.8 months). Allogeneic stem cell transplantation (alloSCT) increases the rate of deep molecular responses. De novo BP and BP evolving from a previous CML do show slightly different features, suggesting a different biology between the two entities. Data show that outside clinical trials and in a real-world setting treatment of blast phase is individualized according to disease- and patient-related characteristics, with the aim of blast clearance prior to allogeneic stem cell transplantation. AlloSCT should be offered to all patients eligible for this procedure.
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MESH Headings
- Humans
- Blast Crisis/pathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/mortality
- Registries
- Protein Kinase Inhibitors/therapeutic use
- Middle Aged
- Male
- Adult
- Female
- Aged
- Young Adult
- Transplantation, Homologous
- Europe
- Hematopoietic Stem Cell Transplantation/methods
- Prognosis
- Adolescent
- Treatment Outcome
- Survival Rate
- Disease Management
- Follow-Up Studies
- Tyrosine Kinase Inhibitors
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Affiliation(s)
- Annamaria Brioli
- Klinik und Poliklinik für Innere Medizin C, Hämatologie und Onkologie, Universitätsmedizin Greifswald, Greifswald, Germany.
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Comprehensive Cancer Center Central Germany, Campus Jena, Jena, Germany.
- Klinik für Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Medizinische Hochschule Hannover, Hannover, Germany.
| | - Elza Lomaia
- Research Department of Immuno-Oncology, Almazov National Medical Research Centre, Saint Petersburg, Russian Federation
| | - Christian Fabisch
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Comprehensive Cancer Center Central Germany, Campus Jena, Jena, Germany
| | - Tomasz Sacha
- Department of Hematology, Jagiellonian University Medical College, Krakow, Poland
| | - Hana Klamova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Elena Morozova
- Raisa Gorbacheva memorial Research Institute for Pediatric Oncology, Hematology, Transplantation, First State Pavlov Medical University of Saint Petersburg, Saint Petersburg, Russian Federation
| | - Aleksandra Golos
- Hematooncology Department, Copernicus Memorial Hospital, Lodz, Poland
| | - Philipp Ernst
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Comprehensive Cancer Center Central Germany, Campus Jena, Jena, Germany
| | | | - Daniela Zackova
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Franck E Nicolini
- Centre Léon Bérard, Hématology Départment and CRCL INSERM U590, Lyon, France
| | - Han Bao
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Medizinische Fakultät, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Fausto Castagnetti
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Elzbieta Patkowska
- Hematology Department, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Jiri Mayer
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Klaus Hirschbühl
- Hematology and Oncology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Helena Podgornik
- Department of Haematology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - Edyta Paczkowska
- Department of General Pathology, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Anne Parry
- Centre Hospitalier Annecy Genevois, Annecy, France
| | - Thomas Ernst
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Comprehensive Cancer Center Central Germany, Campus Jena, Jena, Germany
| | | | - Elzbieta Szczepanek
- Department of Hematology, Jagiellonian University Medical College, Cracow, Poland
| | - Susanne Saussele
- III. Med. Klinik, Med. Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - Georg-Nikolaus Franke
- University of Leipzig Medical Center, Department of Hematology, Cellular Therapy, Hemostaseology and Infectious Diseases, Comprehensive Cancer Center Central Germany, Campus Leipzig, Leipzig, Germany
| | - Alexander Kiani
- Medizinische Klinik IV, Klinikum Bayreuth GmbH, Bayreuth, and Comprehensive Cancer Center Erlangen-EMN, Bayreuth, Germany
| | - Edgar Faber
- Department of Hemato-Oncology, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacky University in Olomouc, Olomouc, Czech Republic
| | - Stefan Krause
- Uniklinik Erlangen, Medizinische Klinik 5, Erlangen, Germany
| | - Luis Felipe Casado
- Servicio de Hematología, Hospital General Universitario de Toledo, Toledo, Spain
| | - Krzysztof Lewandowski
- Department of Hematology & Bone Marrow Transplantation, Poznań University of Medical Sciences, Poznań, Poland
| | - Matthias Eder
- Klinik für Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Medizinische Hochschule Hannover, Hannover, Germany
| | - Peter Anhut
- Onkologische Schwerpunktpraxis Anhut, Kronach, Germany
| | - Justyna Gil
- Oncology Centre of the Podkarpackie Province, Department of Hematooncology, Brzozow, Poland
| | - Thomas Südhoff
- Klinikum Passau, Klinik für Onkologie, Hämatologie und Palliativmedizin, Passau, Germany
| | - Holger Hebart
- Zentrum für Innere Medizin, Hämatologie/Onkologie, Stauferklinikum Schwäbisch Gmünd, Mutlangen, Germany
| | - Sonja Heibl
- Abteilung für Innere Medizin IV, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Markus Pfirrmann
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Medizinische Fakultät, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Andreas Hochhaus
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Comprehensive Cancer Center Central Germany, Campus Jena, Jena, Germany
| | - Michael Lauseker
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Medizinische Fakultät, Ludwig-Maximilians-Universität München, Munich, Germany.
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2
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Komorowski L, Dabkowska A, Madzio J, Pastorczak A, Szczygiel K, Janowska M, Fidyt K, Bielecki M, Hunia J, Bajor M, Stoklosa T, Winiarska M, Patkowska E, Firczuk M. Concomitant inhibition of the thioredoxin system and nonhomologous DNA repair potently sensitizes Philadelphia-positive lymphoid leukemia to tyrosine kinase inhibitors. Hemasphere 2024; 8:e56. [PMID: 38486859 PMCID: PMC10938465 DOI: 10.1002/hem3.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/09/2024] [Indexed: 03/17/2024] Open
Abstract
Breakpoint cluster region-Abelson (BCR::ABL1) gene fusion is an essential oncogene in both chronic myeloid leukemia (CML) and Philadelphia-positive (Ph+) B-cell acute lymphoblastic leukemia (B-ALL). While tyrosine kinase inhibitors (TKIs) are effective in up to 95% of CML patients, 50% of Ph+ B-ALL cases do not respond to treatment or relapse. This calls for new therapeutic approaches for Ph+ B-ALL. Previous studies have shown that inhibitors of the thioredoxin (TXN) system exert antileukemic activity against B-ALL cells, particularly in combination with other drugs. Here, we present that peroxiredoxin-1 (PRDX1), one of the enzymes of the TXN system, is upregulated in Ph+ lymphoid as compared to Ph+ myeloid cells. PRDX1 knockout negatively affects the viability of Ph+ B-ALL cells and sensitizes them to TKIs. Analysis of global gene expression changes in imatinib-treated, PRDX1-deficient cells revealed that the nonhomologous end-joining (NHEJ) DNA repair is a novel vulnerability of Ph+ B-ALL cells. Accordingly, PRDX1-deficient Ph+ B-ALL cells were susceptible to NHEJ inhibitors. Finally, we demonstrated the potent efficacy of a novel combination of TKIs, TXN inhibitors, and NHEJ inhibitors against Ph+ B-ALL cell lines and primary cells, which can be further investigated as a potential therapeutic approach for the treatment of Ph+ B-ALL.
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Affiliation(s)
- Lukasz Komorowski
- Department of ImmunologyMedical University of WarsawWarsawPoland
- Postgraduate School of Molecular MedicineMedical University of WarsawWarsawPoland
| | - Agnieszka Dabkowska
- Department of ImmunologyMedical University of WarsawWarsawPoland
- Laboratory of Immunology, Mossakowski Medical Research InstitutePolish Academy of SciencesWarsawPoland
| | - Joanna Madzio
- Department of Pediatrics, Oncology and HematologyMedical University of LodzLodzPoland
| | - Agata Pastorczak
- Department of Pediatrics, Oncology and HematologyMedical University of LodzLodzPoland
| | - Kacper Szczygiel
- Department of ImmunologyMedical University of WarsawWarsawPoland
- Polpharma Biologics SAGdańskPoland
| | - Martyna Janowska
- Laboratory of Immunology, Mossakowski Medical Research InstitutePolish Academy of SciencesWarsawPoland
| | - Klaudyna Fidyt
- Department of ImmunologyMedical University of WarsawWarsawPoland
| | - Maksymilian Bielecki
- Department of PsychologySWPS University of Social Sciences and HumanitiesWarsawPoland
| | - Jaromir Hunia
- Department of ImmunologyMedical University of WarsawWarsawPoland
| | - Malgorzata Bajor
- Laboratory of Immunology, Mossakowski Medical Research InstitutePolish Academy of SciencesWarsawPoland
| | - Tomasz Stoklosa
- Department of Tumor Biology and GeneticsMedical University of WarsawWarsawPoland
| | - Magdalena Winiarska
- Department of ImmunologyMedical University of WarsawWarsawPoland
- Laboratory of Immunology, Mossakowski Medical Research InstitutePolish Academy of SciencesWarsawPoland
| | | | - Malgorzata Firczuk
- Department of ImmunologyMedical University of WarsawWarsawPoland
- Laboratory of Immunology, Mossakowski Medical Research InstitutePolish Academy of SciencesWarsawPoland
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3
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Casey NP, Klee CH, Fåne A, Caulier B, Graczyk-Jarzynka A, Krawczyk M, Fidyt K, Josefsson SE, Köksal H, Dillard P, Patkowska E, Firczuk M, Smeland EB, Winiarska M, Myklebust JH, Inderberg EM, Wälchli S. Efficient chimeric antigen receptor (CAR) targeting of a central epitope of CD22. J Biol Chem 2023:104883. [PMID: 37269947 PMCID: PMC10331463 DOI: 10.1016/j.jbc.2023.104883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 06/05/2023] Open
Abstract
Chimeric antigen receptor (CAR) T cell therapy has had considerable success in the treatment of B cell malignancies. Targeting the B-lineage markerCD19 has brought great advances to treatment of acute lymphoblastic leukemia (ALL) and B cell lymphomas. However, relapse remains an issue in many cases. Such relapse can result from downregulation or loss of CD19 from the malignant cell population, or expression of alternate isoforms. Consequently, there remains a need to target alternative B-cell antigens and diversify the spectrum of epitopes targeted within the same antigen. CD22 has been identified as a substitute target in cases of CD19-negative relapse. One anti-CD22 antibody - clone m971 - targets a membrane-proximal epitope of CD22 and has been widely validated and used in the clinic. Here we have compared m971-CAR with a novel CAR derived from IS7, an antibody that targets a central epitope on CD22. The IS7-CAR has superior avidity, and is active and specific against CD22 positive targets, including B-ALL patient-derived xenograft (PDX) samples. Side-by-side comparisons indicated that while IS7-CAR killed less rapidly than m971-CAR in vitro, it remains efficient in controlling lymphoma xenograft models in vivo. Thus, IS7-CAR presents a potential alternative candidate for treatment of refractory B-cell malignancies.
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Affiliation(s)
- Nicholas Paul Casey
- Translational Research Unit, Section of Cellular Therapy, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Clara Helena Klee
- Translational Research Unit, Section of Cellular Therapy, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Anne Fåne
- Translational Research Unit, Section of Cellular Therapy, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Benjamin Caulier
- Translational Research Unit, Section of Cellular Therapy, Department of Oncology, Oslo University Hospital, Oslo, Norway; Center for Cancer Cell Reprogramming (CanCell), Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Molecular Cell Biology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Agnieszka Graczyk-Jarzynka
- Department of Immunology, Medical University of Warsaw, Warsaw, Poland; Laboratory of Immunology, Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw, Poland
| | - Marta Krawczyk
- Department of Immunology, Medical University of Warsaw, Warsaw, Poland; Laboratory of Immunology, Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw, Poland
| | - Klaudyna Fidyt
- Department of Immunology, Medical University of Warsaw, Warsaw, Poland
| | - Sarah E Josefsson
- Department of Cancer Immunology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Hakan Köksal
- Translational Research Unit, Section of Cellular Therapy, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Pierre Dillard
- Translational Research Unit, Section of Cellular Therapy, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | | | - Malgorzata Firczuk
- Department of Immunology, Medical University of Warsaw, Warsaw, Poland; Laboratory of Immunology, Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw, Poland
| | - Erlend B Smeland
- Department of Cancer Immunology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Magdalena Winiarska
- Department of Immunology, Medical University of Warsaw, Warsaw, Poland; Laboratory of Immunology, Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw, Poland
| | - June H Myklebust
- Department of Cancer Immunology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Else Marit Inderberg
- Translational Research Unit, Section of Cellular Therapy, Department of Oncology, Oslo University Hospital, Oslo, Norway.
| | - Sébastien Wälchli
- Translational Research Unit, Section of Cellular Therapy, Department of Oncology, Oslo University Hospital, Oslo, Norway.
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4
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Wang ES, Montesinos P, Minden MD, Lee JH, Heuser M, Naoe T, Chou WC, Laribi K, Esteve J, Altman JK, Havelange V, Watson AM, Gambacorti-Passerini C, Patkowska E, Liu S, Wu R, Philipose N, Hill JE, Gill SC, Rich ES, Tiu RV. Phase 3 trial of gilteritinib plus azacitidine vs azacitidine for newly diagnosed FLT3mut+ AML ineligible for intensive chemotherapy. Blood 2022; 140:1845-1857. [PMID: 35917453 PMCID: PMC10653009 DOI: 10.1182/blood.2021014586] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [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: 12/01/2021] [Accepted: 07/12/2022] [Indexed: 11/20/2022] Open
Abstract
Treatment results for patients with newly diagnosed FMS-like tyrosine kinase 3 (FLT3)-mutated (FLT3mut+) acute myeloid leukemia (AML) ineligible for intensive chemotherapy are disappointing. This multicenter, open-label, phase 3 trial randomized (2:1) untreated adults with FLT3mut+ AML ineligible for intensive induction chemotherapy to receive gilteritinib (120 mg/d orally) and azacitidine (GIL + AZA) or azacitidine (AZA) alone. The primary end point was overall survival (OS). At the interim analysis (August 26, 2020), a total of 123 patients were randomized to treatment (GIL + AZA, n = 74; AZA, n = 49). Subsequent AML therapy, including FLT3 inhibitors, was received by 20.3% (GIL + AZA) and 44.9% (AZA) of patients. Median OS was 9.82 (GIL + AZA) and 8.87 (AZA) months (hazard ratio, 0.916; 95% CI, 0.529-1.585; P = .753). The study was closed based on the protocol-specified boundary for futility. Median event-free survival was 0.03 month in both arms. Event-free survival defined by using composite complete remission (CRc) was 4.53 months for GIL + AZA and 0.03 month for AZA (hazard ratio, 0.686; 95% CI, 0.433-1.087; P = .156). CRc rates were 58.1% (GIL + AZA) and 26.5% (AZA) (difference, 31.4%; 95% CI, 13.1-49.7; P < .001). Adverse event (AE) rates were similar for GIL + AZA (100%) and AZA (95.7%); grade ≥3 AEs were 95.9% and 89.4%, respectively. Common AEs with GIL + AZA included pyrexia (47.9%) and diarrhea (38.4%). Gilteritinib steady-state trough concentrations did not differ between GIL + AZA and gilteritinib. GIL + AZA resulted in significantly higher CRc rates, although similar OS compared with AZA. Results support the safety/tolerability and clinical activity of upfront therapy with GIL + AZA in older/unfit patients with FLT3mut+ AML. This trial was registered at www.clinicaltrials.gov as #NCT02752035.
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Affiliation(s)
| | - Pau Montesinos
- Hospital Universitari i Politècnic La Fe, Valencia & CIBERONC, Instituto Carlos III, Madrid, Spain
| | | | | | | | - Tomoki Naoe
- National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | | | - Kamel Laribi
- Hematology Department, Centre Hospitalier Du Mans, Le Mans, France
| | | | | | | | | | | | - Elzbieta Patkowska
- Hematology Department, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
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5
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Polak A, Bialopiotrowicz E, Krzymieniewska B, Wozniak J, Stojak M, Cybulska M, Kaniuga E, Mikula M, Jablonska E, Gorniak P, Noyszewska-Kania M, Szydlowski M, Piechna K, Piwocka K, Bugajski L, Lech-Maranda E, Barankiewicz J, Kolkowska-Lesniak A, Patkowska E, Glodkowska-Mrowka E, Baran N, Juszczynski P. SYK inhibition targets acute myeloid leukemia stem cells by blocking their oxidative metabolism. Cell Death Dis 2020; 11:956. [PMID: 33159047 PMCID: PMC7648638 DOI: 10.1038/s41419-020-03156-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 10/17/2020] [Accepted: 10/19/2020] [Indexed: 12/15/2022]
Abstract
Spleen tyrosine kinase (SYK) is an important oncogene and signaling mediator activated by cell surface receptors crucial for acute myeloid leukemia (AML) maintenance and progression. Genetic or pharmacologic inhibition of SYK in AML cells leads to increased differentiation, reduced proliferation, and cellular apoptosis. Herein, we addressed the consequences of SYK inhibition to leukemia stem-cell (LSC) function and assessed SYK-associated pathways in AML cell biology. Using gain-of-function MEK kinase mutant and constitutively active STAT5A, we demonstrate that R406, the active metabolite of a small-molecule SYK inhibitor fostamatinib, induces differentiation and blocks clonogenic potential of AML cells through the MEK/ERK1/2 pathway and STAT5A transcription factor, respectively. Pharmacological inhibition of SYK with R406 reduced LSC compartment defined as CD34+CD38−CD123+ and CD34+CD38−CD25+ in vitro, and decreased viability of LSCs identified by a low abundance of reactive oxygen species. Primary leukemic blasts treated ex vivo with R406 exhibited lower engraftment potential when xenotransplanted to immunodeficient NSG/J mice. Mechanistically, these effects are mediated by disturbed mitochondrial biogenesis and suppression of oxidative metabolism (OXPHOS) in LSCs. These mechanisms appear to be partially dependent on inhibition of STAT5 and its target gene MYC, a well-defined inducer of mitochondrial biogenesis. In addition, inhibition of SYK increases the sensitivity of LSCs to cytarabine (AraC), a standard of AML induction therapy. Taken together, our findings indicate that SYK fosters OXPHOS and participates in metabolic reprogramming of AML LSCs in a mechanism that at least partially involves STAT5, and that SYK inhibition targets LSCs in AML. Since active SYK is expressed in a majority of AML patients and confers inferior prognosis, the combination of SYK inhibitors with standard chemotherapeutics such as AraC constitutes a new therapeutic modality that should be evaluated in future clinical trials.
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Affiliation(s)
- Anna Polak
- Department of Experimental Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Emilia Bialopiotrowicz
- Department of Experimental Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Beata Krzymieniewska
- Department of Diagnostic Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Jolanta Wozniak
- Department of Diagnostic Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Marta Stojak
- Jagiellonian Centre for Experimental Therapeutics (JCET), Jagiellonian University, Kraków, Poland
| | - Magdalena Cybulska
- Department of Genetics, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Ewelina Kaniuga
- Department of Genetics, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Michał Mikula
- Department of Genetics, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Ewa Jablonska
- Department of Experimental Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Patryk Gorniak
- Department of Experimental Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Monika Noyszewska-Kania
- Department of Experimental Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Maciej Szydlowski
- Department of Experimental Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Karolina Piechna
- Department of Experimental Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Katarzyna Piwocka
- Laboratory of Cytometry, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
| | - Lukasz Bugajski
- Laboratory of Cytometry, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
| | - Ewa Lech-Maranda
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Joanna Barankiewicz
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | | | - Elzbieta Patkowska
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Eliza Glodkowska-Mrowka
- Department of Experimental Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Natalia Baran
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Przemyslaw Juszczynski
- Department of Experimental Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland.
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6
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Pluta A, Robak T, Brzozowski K, Stepka K, Wawrzyniak E, Krawczynska A, Czemerska M, Szmigielska-Kaplon A, Grzybowska-Izydorczyk O, Nowicki M, Stelmach P, Kuydowicz M, Gromek T, Hus M, Helbig G, Grosicki S, Bodzenta E, Razny M, Wojcik K, Bolkun L, Kloczko J, Knopinska-Posluszny W, Piekarska A, Hellman A, Sobas M, Wrobel T, Patkowska E, Lech-Maranda E, Warzocha K, Holowiecki J, Giebel S, Wierzbowska A. Early induction intensification with cladribine, cytarabine, and mitoxantrone (CLAM) in AML patients treated with the DAC induction regimen: a prospective, non-randomized, phase II study of the Polish Adult Leukemia Group (PALG). Leuk Lymphoma 2019; 61:588-603. [PMID: 31661339 DOI: 10.1080/10428194.2019.1678151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We present the results of a prospective, non-randomized phase 2 trial in which 253 AML patients (pts) under 60 years old received DAC (Daunorubicin + AraC + Cladribine) as first induction followed by CLAM (Cladribine + AraC + Mitoxantrone) as early second induction on day 16 based on bone marrow (BM) blasts on day 14 (D14). The CR/CRi rate after a single course of DAC was 83% for pts with D14 BM blasts less than 10%. Forty-six pts had >10% BM blasts on D14, of whom 35 received CLAM with rates of CR/CRi 60% and early death (ED) 23%. The remaining 11 pts were not fit to receive CLAM, with rates of CR/CRi 28%, PR 18%, and ED 18%. Median OS was 7.2 versus 7.5 months, respectively. The overall CR/CRi rate was 77% after the first induction, with final CR/CRi rate 80% after DAC reinduction for pts who achieved PR with initial DAC course. CLAM used as early second induction might improve CR/CRi rates for younger AML pts with poor early response to DAC induction, but may be associated with higher mortality.
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Affiliation(s)
- Agnieszka Pluta
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - Tadeusz Robak
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - Kamil Brzozowski
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - Konrad Stepka
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - Ewa Wawrzyniak
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - Anna Krawczynska
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | | | | | | | - Mateusz Nowicki
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - Piotr Stelmach
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - Marta Kuydowicz
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - Tomasz Gromek
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland
| | - Marek Hus
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland
| | - Grzegorz Helbig
- Department of Hematology and BMT, Medical School of Silesia, Katowice, Poland
| | - Sebastian Grosicki
- Department of Cancer Prevention, School of Public Health, Medical University of Silesia, Katowice, Poland
| | - Ewa Bodzenta
- Department of Hematology, Municipal Hospital, Chorzow, Poland
| | - Małgorzata Razny
- Hematology Department, Rydygier Memorial Hospital, Krakow, Poland
| | - Karol Wojcik
- Hematology Department, Rydygier Memorial Hospital, Krakow, Poland
| | - Lukasz Bolkun
- Department of Hematology, Medical University Hospital, Bialystok, Poland
| | - Janusz Kloczko
- Department of Hematology, Medical University Hospital, Bialystok, Poland
| | | | - Agnieszka Piekarska
- Department of Hematology, Transplantation Medical University of Gdansk, Gdansk, Poland
| | - Andrzej Hellman
- Department of Hematology, Transplantation Medical University of Gdansk, Gdansk, Poland
| | - Marta Sobas
- Department of Hematology, Blood Neoplasm and Bone Marrow Transplantation, Wroclaw, Poland
| | - Tomasz Wrobel
- Department of Hematology, Blood Neoplasm and Bone Marrow Transplantation, Wroclaw, Poland
| | - Elzbieta Patkowska
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland.,Department of Hematology and Transfusion Medicine, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Ewa Lech-Maranda
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland.,Department of Hematology and Transfusion Medicine, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Krzysztof Warzocha
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Jerzy Holowiecki
- Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Institute - Cancer Center, Gliwice Branch, Gliwice, Poland
| | - Sebastian Giebel
- Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Institute - Cancer Center, Gliwice Branch, Gliwice, Poland
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7
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Fidyt K, Pastorczak A, Goral A, Szczygiel K, Fendler W, Muchowicz A, Bartlomiejczyk MA, Madzio J, Cyran J, Graczyk-Jarzynka A, Jansen E, Patkowska E, Lech-Maranda E, Pal D, Blair H, Burdzinska A, Pedzisz P, Glodkowska-Mrowka E, Demkow U, Gawle-Krawczyk K, Matysiak M, Winiarska M, Juszczynski P, Mlynarski W, Heidenreich O, Golab J, Firczuk M. Targeting the thioredoxin system as a novel strategy against B-cell acute lymphoblastic leukemia. Mol Oncol 2019; 13:1180-1195. [PMID: 30861284 PMCID: PMC6487705 DOI: 10.1002/1878-0261.12476] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/13/2019] [Accepted: 02/21/2019] [Indexed: 01/26/2023] Open
Abstract
B‐cell precursor acute lymphoblastic leukemia (BCP‐ALL) is a genetically heterogeneous blood cancer characterized by abnormal expansion of immature B cells. Although intensive chemotherapy provides high cure rates in a majority of patients, subtypes harboring certain genetic lesions, such as MLL rearrangements or BCR‐ABL1 fusion, remain clinically challenging, necessitating a search for other therapeutic approaches. Herein, we aimed to validate antioxidant enzymes of the thioredoxin system as potential therapeutic targets in BCP‐ALL. We observed oxidative stress along with aberrant expression of the enzymes associated with the activity of thioredoxin antioxidant system in BCP‐ALL cells. Moreover, we found that auranofin and adenanthin, inhibitors of the thioredoxin system antioxidant enzymes, effectively kill BCP‐ALL cell lines and pediatric and adult BCP‐ALL primary cells, including primary cells cocultured with bone marrow‐derived stem cells. Furthermore, auranofin delayed the progression of leukemia in MLL‐rearranged patient‐derived xenograft model and prolonged the survival of leukemic NSG mice. Our results unveil the thioredoxin system as a novel target for BCP‐ALL therapy, and indicate that further studies assessing the anticancer efficacy of combinations of thioredoxin system inhibitors with conventional anti‐BCP‐ALL drugs should be continued.
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Affiliation(s)
- Klaudyna Fidyt
- Department of Immunology, Medical University of Warsaw, Poland.,Postgraduate School of Molecular Medicine, Medical University of Warsaw, Poland
| | - Agata Pastorczak
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Poland
| | - Agnieszka Goral
- Department of Immunology, Medical University of Warsaw, Poland
| | | | - Wojciech Fendler
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Poland.,Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | - Joanna Madzio
- Postgraduate School of Molecular Medicine, Medical University of Warsaw, Poland.,Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Poland
| | - Julia Cyran
- Department of Immunology, Medical University of Warsaw, Poland
| | | | - Eugene Jansen
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | | | - Ewa Lech-Maranda
- Institute of Hematology and Transfusion Medicine, Warsaw, Poland.,Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Deepali Pal
- Newcastle Cancer Centre at the Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Helen Blair
- Newcastle Cancer Centre at the Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Anna Burdzinska
- Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, Poland
| | - Piotr Pedzisz
- Department of Orthopaedics and Traumatology, Medical University of Warsaw, Poland
| | - Eliza Glodkowska-Mrowka
- Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Medical University of Warsaw, Poland
| | - Urszula Demkow
- Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Medical University of Warsaw, Poland
| | | | - Michal Matysiak
- Department of Pediatrics, Hematology and Oncology, Medical University of Warsaw, Poland
| | | | | | - Wojciech Mlynarski
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Poland
| | - Olaf Heidenreich
- Newcastle Cancer Centre at the Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Jakub Golab
- Department of Immunology, Medical University of Warsaw, Poland.,Centre for Preclinical Research and Technology, Medical University of Warsaw, Poland
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8
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Budziszewska BK, Pluta A, Sulek K, Wierzbowska A, Robak T, Giebel S, Holowiecka-Goral A, Sawicki W, Ejduk A, Patkowska E, Manko J, Gajkowska-Kulik J, Piszcz J, Mordak-Domagala M, Madry K, Holowiecki J, Kyrcz-Krzemien S, Nowakowska-Domagala M, Dmoszynska A, Calbecka M, Kloczko J, Wiktor Jędrzejczak W, Lange A, Razny M, Bilinski P, Warzocha K, Lech-Maranda E. Treatment of elderly patients with acute myeloid leukemia adjusted for performance status and presence of comorbidities: a Polish Adult Leukemia Group study. Leuk Lymphoma 2015; 56:2331-8. [PMID: 25393675 DOI: 10.3109/10428194.2014.985672] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This prospective study estimated outcomes in 509 elderly patients with acute myeloid leukemia (AML) with different treatment approaches depending on Eastern Cooperative Oncology Group (ECOG) performance status and Charlson Comorbidity Index (CCI). Patients were stratified into fit (ECOG 0-2 and CCI 0-2) or frail (ECOG>2 and/or CCI>2) groups. Fit patients with CCI 0 received intensive chemotherapy whilst reduced-intensive chemotherapy (R-IC) was given to those with CCI 1-2. Frail patients received best supportive therapy. Fit patients presented a longer overall survival (OS) than frail subjects, but 8-week mortality rates were similar. The complete response (CR) rate between fit CCI 0 and CCI 1-2 subgroups was significantly different. Both of the fit subgroups showed similar 8-week mortality rates and OS probabilities. Allocating fit patients with CCI 1-2 to R-IC enabled an increase in the group of elderly patients who could be treated with the intention of inducing remission.
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Affiliation(s)
- Bozena Katarzyna Budziszewska
- a Hematology Department, Institute of Hematology and Transfusion Medicine , Warsaw , Poland.,b Center of Postgraduate Medical Education , Warsaw , Poland
| | - Agnieszka Pluta
- c Hematology Department, Medical University of Lodz , Lodz , Poland
| | - Kazimierz Sulek
- d Hematology Department, Military Medical Institute , Warsaw , Poland
| | | | - Tadeusz Robak
- c Hematology Department, Medical University of Lodz , Lodz , Poland
| | - Sebastian Giebel
- e Department of Bone Marrow Transplantation , Comprehensive Cancer Center, M. Sklodowska-Curie Memorial Institute , Gliwice , Poland
| | | | - Waldemar Sawicki
- d Hematology Department, Military Medical Institute , Warsaw , Poland
| | - Anna Ejduk
- a Hematology Department, Institute of Hematology and Transfusion Medicine , Warsaw , Poland
| | - Elzbieta Patkowska
- a Hematology Department, Institute of Hematology and Transfusion Medicine , Warsaw , Poland.,b Center of Postgraduate Medical Education , Warsaw , Poland
| | - Joanna Manko
- f Hematology Department, Medical University of Lublin , Lublin , Poland
| | | | - Jaroslaw Piszcz
- h Hematology Department, Medical University of Bialystok , Bialystok , Poland
| | | | - Krzysztof Madry
- j Hematology and Oncology Department, Warsaw Medical University , Warsaw , Poland
| | - Jerzy Holowiecki
- e Department of Bone Marrow Transplantation , Comprehensive Cancer Center, M. Sklodowska-Curie Memorial Institute , Gliwice , Poland
| | | | | | - Anna Dmoszynska
- f Hematology Department, Medical University of Lublin , Lublin , Poland
| | | | - Janusz Kloczko
- h Hematology Department, Medical University of Bialystok , Bialystok , Poland
| | | | - Andrzej Lange
- i Lower Silesian Centrum for Cellular Transplantation , Wroclaw , Poland
| | - Malgorzata Razny
- m Hematology Department, Rydygier Memorial Hospital , Krakow , Poland
| | - Przemyslaw Bilinski
- a Hematology Department, Institute of Hematology and Transfusion Medicine , Warsaw , Poland
| | - Krzysztof Warzocha
- a Hematology Department, Institute of Hematology and Transfusion Medicine , Warsaw , Poland
| | - Ewa Lech-Maranda
- a Hematology Department, Institute of Hematology and Transfusion Medicine , Warsaw , Poland.,b Center of Postgraduate Medical Education , Warsaw , Poland
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