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Zhou Y, Othus M, Araki D, Wood BL, Radich JP, Halpern AB, Mielcarek M, Estey EH, Appelbaum FR, Walter RB. Pre- and post-transplant quantification of measurable ('minimal') residual disease via multiparameter flow cytometry in adult acute myeloid leukemia. Leukemia 2016; 30:1456-64. [PMID: 27012865 PMCID: PMC4935622 DOI: 10.1038/leu.2016.46] [Citation(s) in RCA: 124] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 01/18/2016] [Accepted: 02/02/2016] [Indexed: 12/15/2022]
Abstract
Measurable (“minimal”) residual disease (MRD) before or after hematopoietic cell transplantation (HCT) identifies adults with AML at risk of poor outcomes. Here, we studied whether peri-transplant MRD dynamics can refine risk assessment. We analyzed 279 adults receiving myeloablative allogeneic HCT in first or second remission who survived at least 35 days and underwent 10-color multiparametric flow cytometry (MFC) analyses of marrow aspirates before and 28±7 days after transplantation. MFC-detectable MRD before (n=63) or after (n=16) transplantation identified patients with high relapse risk and poor survival. Forty-nine patients cleared MRD with HCT conditioning, whereas 2 patients developed new evidence of disease. The 214 MRDneg/MRDneg patients had excellent outcomes, whereas both MRDneg/MRDpos patients died within 100 days following transplantation. For patients with pre-HCT MRD, outcomes were poor regardless of post-HCT MRD status, although survival beyond 3 years was observed among the 58 patients with decreasing but not the 7 patients with increasing peri-HCT MRD levels. In multivariable models, pre-HCT but not post-HCT MRD was independently associated with OS and RR. These data indicate that MRDpos patients before transplantation have a high relapse risk regardless of whether or not they clear MFC-detectable disease with conditioning and should be considered for pre-emptive therapeutic strategies.
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Affiliation(s)
- Y Zhou
- Department of Laboratory Medicine, Division of Hematopathology, University of Washington, Seattle, WA, USA
| | - M Othus
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - D Araki
- Department of Medicine, Residency Program, University of Washington, Seattle, WA, USA
| | - B L Wood
- Department of Laboratory Medicine, Division of Hematopathology, University of Washington, Seattle, WA, USA
| | - J P Radich
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA, USA
| | - A B Halpern
- Hematology/Oncology Fellowship Program, University of Washington, Seattle, WA
| | - M Mielcarek
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA, USA
| | - E H Estey
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA
| | - F R Appelbaum
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Hematology/Oncology Fellowship Program, University of Washington, Seattle, WA
| | - R B Walter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
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2
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Othus M, Mukherjee S, Sekeres MA, Godwin J, Petersdorf S, Appelbaum FR, Erba H, Estey E. Prediction of CR following a second course of '7+3' in patients with newly diagnosed acute myeloid leukemia not in CR after a first course. Leukemia 2016; 30:1779-80. [PMID: 27055872 PMCID: PMC4980556 DOI: 10.1038/leu.2016.48] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- M Othus
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - S Mukherjee
- Leukemia Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - M A Sekeres
- Leukemia Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - J Godwin
- Earle A. Chiles Research Institute, Providence Cancer Center, Portland, OR, USA
| | | | - F R Appelbaum
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - H Erba
- Division of Hematology & Oncology, University of Alabama, Birmingham, AL, USA
| | - E Estey
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Huang JC, Basu SK, Zhao X, Chien S, Fang M, Oehler VG, Appelbaum FR, Becker PS. Mesenchymal stromal cells derived from acute myeloid leukemia bone marrow exhibit aberrant cytogenetics and cytokine elaboration. Blood Cancer J 2015; 5:e302. [PMID: 25860293 PMCID: PMC4450324 DOI: 10.1038/bcj.2015.17] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [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: 01/30/2015] [Accepted: 02/02/2015] [Indexed: 02/08/2023] Open
Abstract
Bone marrow-derived mesenchymal stromal cells (BM-MSCs) play a fundamental role in the BM microenvironment (BME) and abnormalities of these cells may contribute to acute myeloid leukemia (AML) pathogenesis. The aim of the study was to characterize the cytokine and gene expression profile, immunophenotype and cytogenetics of BM-MSCs from AML patients compared to normal BM-MSCs from healthy donors. AML BM-MSCs showed decreased monocyte chemoattractant protein-1 levels compared to normal BM-MSCs. AML BM-MSCs expressed similar β1 integrin, CD44, CD73, CD90 and E-cadherin compared to normal BM-MSCs. Cytogenetic analysis revealed chromosomal aberrations in AML BM-MSCs, some overlapping with and others distinct from their corresponding AML blasts. No significant difference in gene expression was detected between AML BM-MSCs compared to normal BM-MSCs; however, comparing the differences between AML and MSCs from AML patients with the differences between normal hematopoietic cells and normal MSCs by Ingenuity pathway analysis showed key distinctions of the AML setting: (1) upstream gene regulation by transforming growth factor beta 1, tumor necrosis factor, tissue transglutaminase 2, CCAAT/enhancer binding protein alpha and SWItch/Sucrose NonFermentable related, matrix associated, actin dependent regulator of chromatin, subfamily a, member 4; (2) integrin and interleukin 8 signaling as overrepresented canonical pathways; and (3) upregulation of transcription factors FBJ murine osteosarcoma viral oncogene homolog and v-myb avian myeloblastosis viral oncogene homolog. Thus, phenotypic abnormalities of AML BM-MSCs highlight a dysfunctional BME that may impact AML survival and proliferation.
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Affiliation(s)
- J C Huang
- 1] Division of Hematology, Institute for Stem Cell and Regenerative Medicine, Seattle, WA, USA [2] Division of Gerontology & Geriatric Medicine, University of Washington, Seattle, WA, USA
| | - S K Basu
- Section of Hematology & Oncology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - X Zhao
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - S Chien
- Division of Hematology, Institute for Stem Cell and Regenerative Medicine, Seattle, WA, USA
| | - M Fang
- 1] Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA [2] Department of Pathology and Laboratory Medicine, University of Washington, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - V G Oehler
- 1] Division of Hematology, Institute for Stem Cell and Regenerative Medicine, Seattle, WA, USA [2] Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - F R Appelbaum
- 1] Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA [2] Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - P S Becker
- 1] Division of Hematology, Institute for Stem Cell and Regenerative Medicine, Seattle, WA, USA [2] Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Yezefski T, Xie H, Walter R, Pagel J, Becker PS, Hendrie P, Sandhu V, Shannon-Dorcy K, Abkowitz J, Appelbaum FR, Estey E. Value of routine 'day 14' marrow exam in newly diagnosed AML. Leukemia 2014; 29:247-9. [PMID: 25204570 DOI: 10.1038/leu.2014.268] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- T Yezefski
- University of Washington School of Medicine, Seattle, WA, USA
| | - H Xie
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - R Walter
- 1] Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA [2] Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA [3] Division of Hematology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - J Pagel
- 1] Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA [2] Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - P S Becker
- 1] Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA [2] Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA [3] Division of Hematology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - P Hendrie
- Division of Hematology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - V Sandhu
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - K Shannon-Dorcy
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - J Abkowitz
- Division of Hematology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - F R Appelbaum
- 1] Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA [2] Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - E Estey
- 1] Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA [2] Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA [3] Division of Hematology, Department of Medicine, University of Washington, Seattle, WA, USA
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Walter RB, Othus M, Burnett AK, Löwenberg B, Kantarjian HM, Ossenkoppele GJ, Hills RK, Ravandi F, Pabst T, Evans A, Pierce SR, Vekemans MC, Appelbaum FR, Estey EH. Resistance prediction in AML: analysis of 4601 patients from MRC/NCRI, HOVON/SAKK, SWOG and MD Anderson Cancer Center. Leukemia 2014; 29:312-20. [PMID: 25113226 PMCID: PMC4318722 DOI: 10.1038/leu.2014.242] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [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: 05/13/2014] [Revised: 07/23/2014] [Accepted: 07/30/2014] [Indexed: 11/09/2022]
Abstract
Therapeutic resistance remains the principal problem in acute myeloid leukemia (AML). We used area under receiver-operating characteristic curves (AUCs) to quantify our ability to predict therapeutic resistance in individual patients, where AUC=1.0 denotes perfect prediction and AUC=0.5 denotes a coin flip, using data from 4601 patients with newly diagnosed AML given induction therapy with 3+7 or more intense standard regimens in UK Medical Research Council/National Cancer Research Institute, Dutch-Belgian Cooperative Trial Group for Hematology/Oncology/Swiss Group for Clinical Cancer Research, US cooperative group SWOG and MD Anderson Cancer Center studies. Age, performance status, white blood cell count, secondary disease, cytogenetic risk and FLT3-ITD/NPM1 mutation status were each independently associated with failure to achieve complete remission despite no early death ('primary refractoriness'). However, the AUC of a bootstrap-corrected multivariable model predicting this outcome was only 0.78, indicating only fair predictive ability. Removal of FLT3-ITD and NPM1 information only slightly decreased the AUC (0.76). Prediction of resistance, defined as primary refractoriness or short relapse-free survival, was even more difficult. Our limited ability to forecast resistance based on routinely available pretreatment covariates provides a rationale for continued randomization between standard and new therapies and supports further examination of genetic and posttreatment data to optimize resistance prediction in AML.
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Affiliation(s)
- R B Walter
- 1] Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA [2] Division of Hematology, Department of Medicine, University of Washington, Seattle, WA, USA [3] Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - M Othus
- SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - A K Burnett
- Department of Haematology, School of Medicine, Cardiff University, Cardiff, UK
| | - B Löwenberg
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - H M Kantarjian
- Leukemia Department, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - G J Ossenkoppele
- Division of Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - R K Hills
- Department of Haematology, School of Medicine, Cardiff University, Cardiff, UK
| | - F Ravandi
- Leukemia Department, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - T Pabst
- Department of Medical Oncology, University Hospital, Bern, Switzerland
| | - A Evans
- Department of Haematology, School of Medicine, Cardiff University, Cardiff, UK
| | - S R Pierce
- Leukemia Department, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M-C Vekemans
- Department of Hematology, Cliniques Universitaires Saint-Luc UCL, Brussels, Belgium
| | - F R Appelbaum
- 1] Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA [2] Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA, USA
| | - E H Estey
- 1] Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA [2] Division of Hematology, Department of Medicine, University of Washington, Seattle, WA, USA
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Walter RB, Gyurkocza B, Storer BE, Godwin CD, Pagel JM, Buckley SA, Sorror ML, Wood BL, Storb R, Appelbaum FR, Sandmaier BM. Comparison of minimal residual disease as outcome predictor for AML patients in first complete remission undergoing myeloablative or nonmyeloablative allogeneic hematopoietic cell transplantation. Leukemia 2014; 29:137-44. [PMID: 24888275 PMCID: PMC4254901 DOI: 10.1038/leu.2014.173] [Citation(s) in RCA: 168] [Impact Index Per Article: 16.8] [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: 04/03/2014] [Revised: 05/01/2014] [Accepted: 05/07/2014] [Indexed: 12/02/2022]
Abstract
Minimal residual disease (MRD) is associated with adverse outcome in AML after myeloablative (MA) hematopoietic cell transplantation (HCT). We compared this association with that seen after nonmyeloablative (NMA) conditioning in 241 adults receiving NMA (n=86) or MA (n=155) HCT for AML in first remission with pre-HCT bone marrow aspirates assessed by flow cytometry. NMA patients were older and had more comorbidities and secondary leukemias. Three-year relapse estimates were 28% and 57% for MRDneg and MRDpos NMA patients, and 22% and 63% for MA patients. Three-year overall survival (OS) estimates were 48% and 41% for MRDneg and MRDpos NMA patients and 76% and 25% for MA patients. This similar OS after NMA conditioning was largely accounted for by higher non-relapse mortality (NRM) in MRDneg (30%) compared to MRDpos (10%) patients, whereas the reverse was found for MRDneg (7%) and MRDpos (23%) MA patients. A statistically significant difference between MA and NMA patients in the association of MRD with OS (P<0.001) and NRM (P=0.002) but not relapse (P=0.17) was confirmed. After adjustment, the risk of relapse was 4.51-times (P<0.001) higher for MRDpos patients. These data indicate that the negative impact of MRD on relapse risk is similar after NMA and MA conditioning.
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Affiliation(s)
- R B Walter
- 1] Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA [2] Division of Hematology, Department of Medicine, University of Washington, Seattle, WA, USA [3] Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - B Gyurkocza
- 1] Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA [2] Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - B E Storer
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - C D Godwin
- Department of Medicine, Residency Program, University of Washington, Seattle, WA, USA
| | - J M Pagel
- 1] Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA [2] Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - S A Buckley
- Department of Medicine, Residency Program, University of Washington, Seattle, WA, USA
| | - M L Sorror
- 1] Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA [2] Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - B L Wood
- Division of Hematopathology, Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
| | - R Storb
- 1] Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA [2] Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - F R Appelbaum
- 1] Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA [2] Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - B M Sandmaier
- 1] Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA [2] Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
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Appelbaum FR, Sale GE, Storb R, Charrier K, Deeg HJ, Graham T, Wulff JC. Phenotyping of canine lymphoma with monoclonal antibodies directed at cell surface antigens: Classification, morphology, clinical presentation and response to chemotherapy. Hematol Oncol 2013; 2:151-68. [PMID: 6540237 DOI: 10.1002/hon.2900020205] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Forty cases of naturally occurring canine lymphoma were studied using a panel of murine monoclonal antibodies which identify defined subsets of normal canine lymphocytes. The distribution of phenotypes was similar to that which is seen in man in that the majority (78 per cent) of canine lymphomas were of B-cell origin but a definite minority were phenotypically of T-cell (10 per cent) or non-B, non-T-cell (12 per cent) origin. The expression of Ia-like antigens was restricted to B-cell neoplasms. Within each histologic subgroup of canine lymphomas there was considerable heterogeneity of cell surface marker expression. Immunophenotype appeared to correlate with clinical presentation. Finally, the reactivity of lymphoma cells with murine monoclonal antibody DLy-6, an antibody which appears to react with a differentiation antigen on canine B and T cells, strongly predicted the outcome of initial induction chemotherapy in that all ten evaluable dogs with DLy-6-tumors achieved complete responses to initial chemotherapy while only four of 11 dogs with DLy-6+ tumors responded completely.
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8
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Roshal M, Chien S, Othus M, Wood BL, Fang M, Appelbaum FR, Estey EH, Papayannopoulou T, Becker PS. The proportion of CD34(+)CD38(low or neg) myeloblasts, but not side population frequency, predicts initial response to induction therapy in patients with newly diagnosed acute myeloid leukemia. Leukemia 2012; 27:728-31. [PMID: 22926686 DOI: 10.1038/leu.2012.217] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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9
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Michelson AP, Kopecky KJ, Koegle ER, Anderson JE, Godwin JE, Petersdorf SH, List AF, Willman CL, Appelbaum FR, Radich JP, Ganapathi MK, Ganapathi RN, Advani A. Expression of topoisomerase (topo) II in adult acute myeloid leukemia (AML): Relationships to immunophenotype and treatment outcomes. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.6564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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10
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Walter RB, Pagel JM, Gooley TA, Petersdorf EW, Sorror ML, Woolfrey AE, Hansen JA, Salter AI, Lansverk E, Stewart FM, O'Donnell PV, Appelbaum FR. Comparison of matched unrelated and matched related donor myeloablative hematopoietic cell transplantation for adults with acute myeloid leukemia in first remission. Leukemia 2010; 24:1276-82. [PMID: 20485378 PMCID: PMC3001162 DOI: 10.1038/leu.2010.102] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [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] [Indexed: 01/01/2023]
Abstract
Hematopoietic cell transplantation (HCT) from a matched related donor (MRD) benefits many adults with acute myeloid leukemia (AML) in first complete remission (CR1). The majority of patients do not have such a donor, however, requiring use of an alternative donor if HCT is undertaken. We retrospectively analyzed 226 adult AML CR1 patients undergoing myeloablative unrelated donor (URD) (10/10 match, n=62; ≤9/10, n=29) or MRD (n=135) HCT from 1996–2007. Five-year estimates of overall survival (OS), relapse, and non-relapse mortality (NRM) were 57.9%, 29.7%, and 16.0%, respectively. Failure for each of these outcomes was slightly higher for 10/10 URD than MRD HCT, although statistical significance was not reached for any endpoint. The adjusted hazard ratios (HR) were 1.43 (0.89–2.30, p=0.14) for overall mortality, 1.17 (0.66–2.08, p=0.60) for relapse, and 1.79 (0.86–3.74, p=0.12) for NRM, respectively, and the adjusted odds ratio (OR) for grades 2–4 acute graft-versus-host disease was 1.50 (0.70–3.24, p=0.30). Overall mortality among 9/10 and 10/10 URD recipients was similar (adjusted HR=1.16 [0.52–2.61], p=0.71). These data indicate that URD HCT can provide long-term survival for CR1 AML; outcomes for 10/10 URD HCT, and possibly 9/10 URD HCT, suggest that this modality should be considered in the absence of a suitable MRD.
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Affiliation(s)
- R B Walter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA.
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11
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Ho PA, Alonzo TA, Kopecky KJ, Miller KL, Kuhn J, Zeng R, Gerbing RB, Raimondi SC, Hirsch BA, Oehler V, Hurwitz CA, Franklin JL, Gamis AS, Petersdorf SH, Anderson JE, Reaman GH, Baker LH, Willman CL, Bernstein ID, Radich JP, Appelbaum FR, Stirewalt DL, Meshinchi S. Molecular alterations of the IDH1 gene in AML: a Children's Oncology Group and Southwest Oncology Group study. Leukemia 2010; 24:909-13. [PMID: 20376086 PMCID: PMC2945692 DOI: 10.1038/leu.2010.56] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Recent whole-genome sequencing efforts led to the identification of IDH1R132 mutations in AML patients. We studied the prevalence and clinical implications of IDH1 genomic alterations in pediatric and adult AML. Diagnostic DNA from 531 AML patients treated on Children’s Oncology Group trial COG-AAML03P1 (N=257), and Southwest Oncology Group trials SWOG-9031, SWOG-9333, and SWOG-9500 (N=274), were tested for IDH1 mutations. Codon R132 mutations were absent in the pediatric cohort, but were found in 12/274 adult patients (4.4%, 95% CI 2.3-7.5%). IDH1R132 mutations occurred most commonly in patients with normal karyotype, and those with FLT3/ITD and NPMc mutations. Patients with IDH1R132 mutations trended towards higher median diagnostic WBC counts (59.2 × 109/L vs. 29.1 × 109/L, P=0.19) than those without mutations, but the two groups did not differ significantly in age, bone marrow blast percentage, overall survival, or relapse-free survival. Eleven patients (2.1%) harbored a novel V71I sequence alteration, which was found to be a germline polymorphism. IDH1 mutations were not detected in pediatric AML, and are uncommon in adult AML.
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Affiliation(s)
- P A Ho
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Sanders JE, Hoffmeister PA, Storer BE, Appelbaum FR, Storb RF, Syrjala KL. The quality of life of adult survivors of childhood hematopoietic cell transplant. Bone Marrow Transplant 2009; 45:746-54. [PMID: 19718073 PMCID: PMC2850957 DOI: 10.1038/bmt.2009.224] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Survival rates after myeloablative hematopoietic cell transplantation (HCT) in childhood have improved. We conducted a cross-sectional study evaluating the quality of life (QOL) of 214 adult survivors of a childhood HCT compared with controls using standardized self-report measures with strong psychometric properties to evaluate physical function, psychological function and cognitive symptoms. From these results we conducted a multivariate analysis of risk factors. This analysis for physical functioning showed poorer function among myeloid disease survivors compared with patients with all other diagnoses (P=0.02), men functioned better than women (P=0.05) and those >18 years after transplant functioned more poorly than those <18 years after transplant (P=0.05). Psychological functioning showed that those who received more therapy and females were more likely to be depressed (P=0.03) and (P=0.005). Perceived cognitive symptoms showed that female survivors had more symptoms than male survivors (P=0.01), and those receiving more preceding therapy compared with those with less preceding therapy (P=0.001) or cranial irradiation compared with those without cranial irradiation (P=0.002) had more perceived cognitive symptoms. Overall, these data indicate that the majority of adult survivors of a childhood transplant are functioning well, but some have problems that need to be addressed.
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Affiliation(s)
- J E Sanders
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA.
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13
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Buckner CD, Fefer A, Bensinger WI, Storb R, Durie BG, Appelbaum FR, Petersen FB, Weiden P, Clift RA, Sanders JE. Marrow transplantation for malignant plasma cell disorders: summary of the Seattle experience. Eur J Haematol Suppl 2009; 51:186-90. [PMID: 2697590 DOI: 10.1111/j.1600-0609.1989.tb01515.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
28 patients with plasma cell malignancies received marrow transplants from identical twins (N = 8), HLA-identical family members (N = 15), HLA partially-matched relatives (N = 3) or cryopreserved autologous marrow (N = 2). Treatment regimens included cyclophosphamide (CY) and total body irradiation (TBI) for 15 patients and busulphan (BU) and CY for 13 patients. 3 of 8 twins are alive, 2 without disease at 24 and 34 months, and 1 is alive and well at 116 months without evidence of disease except for at small residual monoclonal protein spike. 12 of the 18 allografted patients died of transplant-related causes and 2 died of progressive disease. 4 of 18 allograft recipients are alive; 2 are free of disease at 16 and 15 months, 1 is alive at 6 months without disease except for persistent monoclonal Kappa protein. 1 patient is alive with residual marrow involvement and a persistent IGA lambda monoclonal protein at 7 months. 1 of the 2 autograft recipients is alive 2 months after transplant and is not yet evaluable for tumor response and the other patient died early of transplant-related complications. Both CY + TBI and BU + CY resulted in remissions in patients with advanced plasma cell malignancies. However, the optimal treatment regimen and timing of transplantation remain to be determined.
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14
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McCune JS, Batchelder A, Guthrie KA, Witherspoon R, Appelbaum FR, Phillips B, Vicini P, Salinger DH, McDonald GB. Personalized dosing of cyclophosphamide in the total body irradiation-cyclophosphamide conditioning regimen: a phase II trial in patients with hematologic malignancy. Clin Pharmacol Ther 2009; 85:615-22. [PMID: 19295506 DOI: 10.1038/clpt.2009.27] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study investigates the efficacy and safety of personalized cyclophosphamide (CY) dosing in 50 patients receiving CY along with total body irradiation (TBI). Participants received CY 45 mg/kg with subsequent therapeutic drug monitoring using Bayesian parameter estimation to personalize the second CY dose to a target area under the curve (AUC) for carboxyethylphosphoramide mustard (CEPM) (a reporter molecule for CY-derived toxins) and for hydroxycyclophosphamide (to ensure engraftment). The mean second CY dose was 66 mg/kg; the total dose ranged from 45 to 145 mg/kg. After completion of this phase II study, we compared participants' clinical outcomes with those of concurrent controls (n = 100) who received TBI along with standard CY doses of 120 mg/kg. Patients receiving personalized CY dosing had significantly lower postconditioning peak total serum bilirubin (P = 0.03); a 38% reduction in the hazard of acute kidney injury (AKI) (P = 0.03); and nonrelapse and overall survival rates similar to those in the controls (P = 0.70 and 0.63, respectively) despite the lower doses of CY administered to most of the patients in the personalized dosage group.
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Affiliation(s)
- J S McCune
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
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15
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Stirewalt DL, Choi YE, Sharpless NE, Pogosova-Agadjanyan EL, Cronk MR, Yukawa M, Larson EB, Wood BL, Appelbaum FR, Radich JP, Heimfeld S. Erratum: Decreased IRF8 expression found in aging hematopoietic progenitor/stem cells. Leukemia 2009. [DOI: 10.1038/leu.2008.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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16
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Stock W, Moser B, Powell BL, Appelbaum FR, Tallman MS, Larson RA, Feusner JH, Bloomfield CD, Willman C, Gallagher RE. Prognostic significance of initial clinical and molecular genetic features of acute promyelocytic leukemia (APL): Results from the North American Intergroup Trial, C9710. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.7016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7016 Background: The impact of previously defined prognostic variables can change with advances in treatment. Thus, the significance of initial clinical and molecular genetic features of APL were explored in the context of the first randomized trial designed to evaluate the potential benefit of adding As2O3 consolidation into front-line all-trans retinoic acid (ATRA)-based therapy of APL (Powell et al, ASCO 2007). Methods: We evaluated pre-treatment white blood cell (WBC) and platelet count, age, PML-RARA transcript level and isoform type in the first 180 untreated APL patients (pts) who underwent molecular analysis on C9710 and explored their relationship to disease- free (DFS) and overall survival (S). PML-RARA transcripts were measured using real-time quantitative RT-PCR and expressed as a normalized quotient (NQ) of PML-RARA/GAPDH. Results: Using a multivariate proportional hazard model, pre-treatment PML-RARA level and WBC count were independently associated with DFS; p = 0.0073 and p = 0.05, respectively. Pre-treatment WBC count was the only feature significantly associated with S; p<0.0001. With a median follow-up of 29 months, neither median DFS nor S have been reached and only 30 DFS events have been reported among these 180 pts. Pts with higher presenting WBC > 10K/μl had both shorter DFS and S with hazard ratios (HR) of 2.3 and 5.5, respectively. The relationships between treatment arm and pre-treatment WBC and PML-RARA transcript level were explored by categorical analyses. For non-As2O3-treated pts, a striking difference was observed in DFS at 2.5 years between those above or below cut-off values: WBC <10K, 78%; WBC >10K, 50%; NQ <median, 87%; NQ >median, 60%. For As2O3-treated pts smaller and the reverse differences were observed: WBC <10K, 94%; WBC >10K, no DFS events reported; NQ < median, 93%; NQ >median, no DFS events reported. Conclusion: These preliminary results (based on analysis of 31% of total C9710 pts) indicate that pre-treatment PML-RARA transcript level and WBC are prognostic variables for newly diagnosed APL pts in first remission treated with standard ATRA-based chemotherapy but suggest that they may not apply in pts receiving two 25-day courses of As2O3 as first consolidation. No significant financial relationships to disclose.
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Affiliation(s)
- W. Stock
- Cancer and Leukemia Group B, Chicago, IL; Southwest Cncology Group, San Antonio, TX; Eastern Cooperative Oncology Group, Philadelphia, PA; Children's Oncology Group, Arcadia, CA
| | - B. Moser
- Cancer and Leukemia Group B, Chicago, IL; Southwest Cncology Group, San Antonio, TX; Eastern Cooperative Oncology Group, Philadelphia, PA; Children's Oncology Group, Arcadia, CA
| | - B. L. Powell
- Cancer and Leukemia Group B, Chicago, IL; Southwest Cncology Group, San Antonio, TX; Eastern Cooperative Oncology Group, Philadelphia, PA; Children's Oncology Group, Arcadia, CA
| | - F. R. Appelbaum
- Cancer and Leukemia Group B, Chicago, IL; Southwest Cncology Group, San Antonio, TX; Eastern Cooperative Oncology Group, Philadelphia, PA; Children's Oncology Group, Arcadia, CA
| | - M. S. Tallman
- Cancer and Leukemia Group B, Chicago, IL; Southwest Cncology Group, San Antonio, TX; Eastern Cooperative Oncology Group, Philadelphia, PA; Children's Oncology Group, Arcadia, CA
| | - R. A. Larson
- Cancer and Leukemia Group B, Chicago, IL; Southwest Cncology Group, San Antonio, TX; Eastern Cooperative Oncology Group, Philadelphia, PA; Children's Oncology Group, Arcadia, CA
| | - J. H. Feusner
- Cancer and Leukemia Group B, Chicago, IL; Southwest Cncology Group, San Antonio, TX; Eastern Cooperative Oncology Group, Philadelphia, PA; Children's Oncology Group, Arcadia, CA
| | - C. D. Bloomfield
- Cancer and Leukemia Group B, Chicago, IL; Southwest Cncology Group, San Antonio, TX; Eastern Cooperative Oncology Group, Philadelphia, PA; Children's Oncology Group, Arcadia, CA
| | - C. Willman
- Cancer and Leukemia Group B, Chicago, IL; Southwest Cncology Group, San Antonio, TX; Eastern Cooperative Oncology Group, Philadelphia, PA; Children's Oncology Group, Arcadia, CA
| | - R. E. Gallagher
- Cancer and Leukemia Group B, Chicago, IL; Southwest Cncology Group, San Antonio, TX; Eastern Cooperative Oncology Group, Philadelphia, PA; Children's Oncology Group, Arcadia, CA
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17
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Pagel JM, Gooley T, Sandmaier BM, Drouet L, Petersdorf EW, Sorror ML, Hansen JA, Deeg HJ, Martin PJ, Storb R, Appelbaum FR. Unrelated donor hematopoietic cell transplantation (HCT) as treatment for acute myeloid leukemia (AML) in first remission. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.7000] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7000 Background: Unrelated donor HCT has been used with increasing frequency for the treatment of AML patients in first remission. Methods: Between 1990 and 2005, 105 adult patients with AML [66 (62%) primary and 39 (38%) secondary] received T- cell-replete HCT from unrelated donors in Seattle. Results: Median age was 44 (range, 18–74) years. Seventy-nine patients received ablative conditioning for HCT (57% conditioned with cyclophosphamide plus total body irradiation (TBI), 43% with chemotherapy alone). Non- myeloablative doses of fludarabine (FLU; 25 mg/m2 daily for 3 days) and TBI (200 cGy) were delivered to 26 patients. Ninety-six percent of patients who underwent reduced-intensity conditioning received unrelated peripheral blood stem cells (PBSC) while 59% of myeloablative HCT patients received PBSC as their source of stem cells. For all patients, the leukemia-free survival (LFS) and non-relapse mortality estimated at 2 years were 53%, and 26%, respectively, as 27 patients died of transplant-related causes (pulmonary-6, cardiac-1, graft versus host disease (GVHD)-6, infection-5, and unknown-9). Twenty-two patients (21%) relapsed 2 to 83 months (median 5) post-transplant, and 56 patients are surviving disease-free 1 to 168 months (median 27) post-transplant. For 90 patients (86%) with intermediate-risk cytogenetics, 51 (57%) are surviving disease-free, with 16 (18%) relapsing. Fourteen patients (13%) were considered high risk based on unfavorable cytogenetics; 4 of these 14 (29%) are surviving disease-free and 6 (43%) have relapsed. The probability of grade 3/4 acute GVHD was 19% while the probability of clinical extensive chronic GVHD was 54% one year after transplant. Unfavorable cytogenetics (HR=2.16, p=.08), secondary leukemia (HR=1.71, p=.10), higher co-morbidity score (p<.0001), and HLA mismatching (HR=2.35, p=.02) were associated with an increased hazard of mortality. After controlling for these factors, non-ablative conditioning was not statistically worse than ablative conditioning (HR=1.21, p=.61). Conclusions: These data suggest that HCT using unrelated allografts has the potential to provide significant LFS for patients undergoing HCT for AML in first remission when an HLA family match is not available. No significant financial relationships to disclose.
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Affiliation(s)
- J. M. Pagel
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - T. Gooley
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - L. Drouet
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - M. L. Sorror
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - J. A. Hansen
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - H. J. Deeg
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - P. J. Martin
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - R. Storb
- Fred Hutchinson Cancer Research Center, Seattle, WA
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18
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Grever MR, Dewald GW, Neuberg DS, Reed JC, Kitada S, Flinn IW, Appelbaum FR, Larson RA, Tallman MS, Gribben JG, Byrd JC. Select high risk genetic features predict earlier progression following chemotherapy in chronic lymphocytic leukemia: Prospective randomized trial (Intergroup E2997) to evaluate justification for risk-adapted therapy. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.6521] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6521 Background: Genomic features including lack of IgVH mutations, del(11q), del(17p), and p53 mutations have been reported to predict clinical course and overall survival in CLL patients (pts). Bcl-2 family proteins and ZAP-70 have also been explored as predictors in CLL. Methods: We prospectively evaluated the prognostic significance of clinical features and laboratory variables on response and progression-free survival (PFS) following treatment with fludarabine (F, n=132) or fludarabine plus cyclophosphamide (FC, n=137) as part of the US Intergroup Trial E2997 for previously untreated CLL. Results: FC therapy had higher complete response (CR) (23.4% versus 4.6%), overall response (OR) (74.3% versus 59%), and median PFS (31.6 mos versus 19.2 mos) compared to F. CR and OR were not significantly different based on interphase cytogenetics, IgVH status, or p53 mutation. IgVH status or levels of ZAP-70, Bcl-2, Bax, Mcl-1, XIAP, Caspase-3, and Traf-1 proteins were not associated with clinical response or PFS. IgVH status and ZAP-70 levels were associated with time from diagnosis to treatment. Using a model including treatment arm, pts with del(17p) or (11q) had significantly shorter PFS (hazard ratios 3.54 and 2.05 respectively). In pts with a p53 mutation without del(17p) there was no enhancement of the model predicting poorer outcome, nor did IgVH status enter the model for predicting PFS. Conclusions: Combination chemotherapy is associated with a higher CR, OR, and PFS. Also, initiation of therapy for pts with Rai stages 0/1 resulted in a higher response rate. Del(17p) and del(11q) are highly predictive of shortened PFS with fludarabine-based chemotherapy. IgVH and p53 mutational status, as well as expression of ZAP-70, Bcl-2 family proteins, and CD38, did not predict response or PFS. ZAP-70 expression is associated with cytogenetic subsets predicted to have a worse overall prognosis, but did not identify pts who will do poorly with therapy. A combination of clinical staging and cytogenetics provide support for future risk-stratified treatment of CLL. Pts with a projected short response duration can be identified for future investigational strategies. No significant financial relationships to disclose.
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Affiliation(s)
- M. R. Grever
- Ohio State University, Columbus, OH; Mayo Clinic, Rochester, MN; Dana-Farber Cancer Institute, Boston, MA; Burnham Institute for Medical Research, La Jolla, CA; Johns Hopkins University, Baltimore, MD; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Chicago, Chicago, IL; Northwestern University Feinberg School of Medicine, Chicago, IL; Institute of Cancer at Barts, London, United Kingdom
| | - G. W. Dewald
- Ohio State University, Columbus, OH; Mayo Clinic, Rochester, MN; Dana-Farber Cancer Institute, Boston, MA; Burnham Institute for Medical Research, La Jolla, CA; Johns Hopkins University, Baltimore, MD; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Chicago, Chicago, IL; Northwestern University Feinberg School of Medicine, Chicago, IL; Institute of Cancer at Barts, London, United Kingdom
| | - D. S. Neuberg
- Ohio State University, Columbus, OH; Mayo Clinic, Rochester, MN; Dana-Farber Cancer Institute, Boston, MA; Burnham Institute for Medical Research, La Jolla, CA; Johns Hopkins University, Baltimore, MD; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Chicago, Chicago, IL; Northwestern University Feinberg School of Medicine, Chicago, IL; Institute of Cancer at Barts, London, United Kingdom
| | - J. C. Reed
- Ohio State University, Columbus, OH; Mayo Clinic, Rochester, MN; Dana-Farber Cancer Institute, Boston, MA; Burnham Institute for Medical Research, La Jolla, CA; Johns Hopkins University, Baltimore, MD; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Chicago, Chicago, IL; Northwestern University Feinberg School of Medicine, Chicago, IL; Institute of Cancer at Barts, London, United Kingdom
| | - S. Kitada
- Ohio State University, Columbus, OH; Mayo Clinic, Rochester, MN; Dana-Farber Cancer Institute, Boston, MA; Burnham Institute for Medical Research, La Jolla, CA; Johns Hopkins University, Baltimore, MD; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Chicago, Chicago, IL; Northwestern University Feinberg School of Medicine, Chicago, IL; Institute of Cancer at Barts, London, United Kingdom
| | - I. W. Flinn
- Ohio State University, Columbus, OH; Mayo Clinic, Rochester, MN; Dana-Farber Cancer Institute, Boston, MA; Burnham Institute for Medical Research, La Jolla, CA; Johns Hopkins University, Baltimore, MD; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Chicago, Chicago, IL; Northwestern University Feinberg School of Medicine, Chicago, IL; Institute of Cancer at Barts, London, United Kingdom
| | - F. R. Appelbaum
- Ohio State University, Columbus, OH; Mayo Clinic, Rochester, MN; Dana-Farber Cancer Institute, Boston, MA; Burnham Institute for Medical Research, La Jolla, CA; Johns Hopkins University, Baltimore, MD; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Chicago, Chicago, IL; Northwestern University Feinberg School of Medicine, Chicago, IL; Institute of Cancer at Barts, London, United Kingdom
| | - R. A. Larson
- Ohio State University, Columbus, OH; Mayo Clinic, Rochester, MN; Dana-Farber Cancer Institute, Boston, MA; Burnham Institute for Medical Research, La Jolla, CA; Johns Hopkins University, Baltimore, MD; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Chicago, Chicago, IL; Northwestern University Feinberg School of Medicine, Chicago, IL; Institute of Cancer at Barts, London, United Kingdom
| | - M. S. Tallman
- Ohio State University, Columbus, OH; Mayo Clinic, Rochester, MN; Dana-Farber Cancer Institute, Boston, MA; Burnham Institute for Medical Research, La Jolla, CA; Johns Hopkins University, Baltimore, MD; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Chicago, Chicago, IL; Northwestern University Feinberg School of Medicine, Chicago, IL; Institute of Cancer at Barts, London, United Kingdom
| | - J. G. Gribben
- Ohio State University, Columbus, OH; Mayo Clinic, Rochester, MN; Dana-Farber Cancer Institute, Boston, MA; Burnham Institute for Medical Research, La Jolla, CA; Johns Hopkins University, Baltimore, MD; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Chicago, Chicago, IL; Northwestern University Feinberg School of Medicine, Chicago, IL; Institute of Cancer at Barts, London, United Kingdom
| | - J. C. Byrd
- Ohio State University, Columbus, OH; Mayo Clinic, Rochester, MN; Dana-Farber Cancer Institute, Boston, MA; Burnham Institute for Medical Research, La Jolla, CA; Johns Hopkins University, Baltimore, MD; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Chicago, Chicago, IL; Northwestern University Feinberg School of Medicine, Chicago, IL; Institute of Cancer at Barts, London, United Kingdom
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19
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Slovak ML, Gundacker H, Bloomfield CD, Dewald G, Appelbaum FR, Larson RA, Tallman MS, Bennett JM, Stirewalt DL, Meshinchi S, Willman CL, Ravindranath Y, Alonzo TA, Carroll AJ, Raimondi SC, Heerema NA. A retrospective study of 69 patients with t(6;9)(p23;q34) AML emphasizes the need for a prospective, multicenter initiative for rare ‘poor prognosis’ myeloid malignancies. Leukemia 2006; 20:1295-7. [PMID: 16628187 DOI: 10.1038/sj.leu.2404233] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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20
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Hussein MA, Gundacker H, Head DR, Elias L, Foon KA, Boldt DH, Dobin SM, Dakhil SR, Budd GT, Appelbaum FR. Cyclophosphamide followed by fludarabine for untreated chronic lymphocytic leukemia: a phase II SWOG TRIAL 9706. Leukemia 2005; 19:1880-6. [PMID: 16193091 DOI: 10.1038/sj.leu.2403940] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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] [Indexed: 11/09/2022]
Abstract
B-cell chronic lymphocytic leukemia (CLL) accounts for 95% of chronic leukemia cases and 25% of all leukemia. Despite the prevalence of CLL, progress in its treatment has been only modest over the past three decades. Based upon the ability of fludarabine to produce high-grade remissions especially among patients with low initial tumor mass, and the ability of alkylators to reduce tumor mass, we hypothesized that sequential administration of a limited number of cycles of intermediate-dose cyclophosphamide followed by fludarabine could result in a larger percentage of patients with complete remissions (CRs). In all, 27 of the 49 eligible patients achieved overall responses of CR, unconfirmed complete remission (UCR), or PR, for a total response rate of 55% (95% confidence interval (CI) 40-69%). Considering the confounding medical issues of this patient population with advanced aggressive disease, the regimen was generally well tolerated. This study demonstrates that high-dose cyclophosphamide followed by fludarabine was relatively well tolerated in this group of advanced CLL patients. The study's criterion for testing whether the regimen is sufficiently effective to warrant further investigation was met: 14 (32%) of the first 44 eligible patients achieved CR or UCR.
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Affiliation(s)
- M A Hussein
- Cleveland Clinic Foundation, Myeloma Program, Cleveland, OH, USA.
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21
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Appelbaum FR, Kopecky KJ, Slovak ML, Gundacker HM, Tallman M, Kim H, Dewald GW, Estey E, Kantarjian H, Pierce S. The clinical spectrum of adult acute myeloid leukemia (AML) associated with core binding factor (CBF) translocations. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.6513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- F. R. Appelbaum
- Southwest Oncology Group, Seattle, WA; Eastern Cooperative Group, Philadelphia, PA; MD Anderson Cancer Ctr, Houston, TX
| | - K. J. Kopecky
- Southwest Oncology Group, Seattle, WA; Eastern Cooperative Group, Philadelphia, PA; MD Anderson Cancer Ctr, Houston, TX
| | - M. L. Slovak
- Southwest Oncology Group, Seattle, WA; Eastern Cooperative Group, Philadelphia, PA; MD Anderson Cancer Ctr, Houston, TX
| | - H. M. Gundacker
- Southwest Oncology Group, Seattle, WA; Eastern Cooperative Group, Philadelphia, PA; MD Anderson Cancer Ctr, Houston, TX
| | - M. Tallman
- Southwest Oncology Group, Seattle, WA; Eastern Cooperative Group, Philadelphia, PA; MD Anderson Cancer Ctr, Houston, TX
| | - H. Kim
- Southwest Oncology Group, Seattle, WA; Eastern Cooperative Group, Philadelphia, PA; MD Anderson Cancer Ctr, Houston, TX
| | - G. W. Dewald
- Southwest Oncology Group, Seattle, WA; Eastern Cooperative Group, Philadelphia, PA; MD Anderson Cancer Ctr, Houston, TX
| | - E. Estey
- Southwest Oncology Group, Seattle, WA; Eastern Cooperative Group, Philadelphia, PA; MD Anderson Cancer Ctr, Houston, TX
| | - H. Kantarjian
- Southwest Oncology Group, Seattle, WA; Eastern Cooperative Group, Philadelphia, PA; MD Anderson Cancer Ctr, Houston, TX
| | - S. Pierce
- Southwest Oncology Group, Seattle, WA; Eastern Cooperative Group, Philadelphia, PA; MD Anderson Cancer Ctr, Houston, TX
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22
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Affiliation(s)
- F R Appelbaum
- Fred Hutchinson Cancer Research Center and University of Washington School of Medicine, Seattle, WA, USA.
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23
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Yusuf U, Frangoul HA, Gooley TA, Woolfrey AE, Carpenter PA, Andrews RG, Deeg HJ, Appelbaum FR, Anasetti C, Storb R, Sanders JE. Allogeneic bone marrow transplantation in children with myelodysplastic syndrome or juvenile myelomonocytic leukemia: the Seattle experience. Bone Marrow Transplant 2004; 33:805-14. [PMID: 14755311 DOI: 10.1038/sj.bmt.1704438] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [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] [Indexed: 11/09/2022]
Abstract
The purpose of this study was to evaluate the role of allogeneic bone marrow transplantation (BMT) in children with myelodysplastic syndrome (MDS). In total, 94 consecutive pediatric patients with MDS received an allogeneic BMT from 1976 to 2001 for refractory anemia (RA) (n=25), RA with ringed sideroblasts (RARS) (n=2), RA with excess blasts (RAEB) (n=20), RAEB in transformation (RAEB-T) (n=14), juvenile myelomonocytic leukemia (JMML) (n=32) or chronic myelomonocytic leukemia (CMML) (n=1). The estimated 3-year probabilities of survival, event-free survival (EFS), nonrelapse mortality and relapse were 50, 41, 28 and 29%, respectively. Patients with RA/RARS had an estimated 3-year survival of 74% compared to 68% in those with RAEB and 33% in patients with JMML/CMML. In multivariable analysis, patients with RAEB-T or JMML were 3.9 and 3.7 times more likely to die compared to those with RA/RARS and RAEB (P=0.005 and 0.004, respectively). Patients with RAEB-T were 5.5 times more likely to relapse (P=0.01). The median follow-up among the 43 surviving patients is 10 years (range 1-25). We conclude that allogeneic BMT for children with MDS is well tolerated and can be curative.
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MESH Headings
- Adolescent
- Anemia, Sideroblastic/therapy
- Bone Marrow Transplantation/adverse effects
- Child
- Child, Preschool
- Chromosomes, Human, Pair 7/genetics
- Female
- Graft vs Host Disease/etiology
- Humans
- Infant
- Leukemia, Myelomonocytic, Acute/genetics
- Leukemia, Myelomonocytic, Acute/therapy
- Leukemia, Myelomonocytic, Chronic/therapy
- Male
- Monosomy
- Myelodysplastic Syndromes/genetics
- Myelodysplastic Syndromes/therapy
- Survival Rate
- Transplantation, Homologous
- Washington
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Affiliation(s)
- U Yusuf
- Fred Hutchinson Cancer Research Center and University of Washington Department of Pediatrics, Seattle, WA 98109, USA
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24
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Appelbaum FR. Bone marrow transplantation for leukaemia--current status and strategies for improvement. Ann Acad Med Singap 2004; 33:S4-6. [PMID: 15651181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Thirty-five years ago, bone marrow transplantation was first being explored as a last-ditch effort to treat patients with end stage leukaemia. Through the efforts of a large number of laboratory and clinical scientists, the application of transplantation has broadened and outcomes have dramatically improved. The science of transplantation continues to attract a great deal of research, and with this effort we can expect continued progress and patient benefit.
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Affiliation(s)
- F R Appelbaum
- Clinical Research Division, Fred Hutchinson Cancer Research Center and University of Washington Medical Center, Seattle, Washington 98109-1024, USA.
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25
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Benesch M, McDonald GB, Schubert M, Appelbaum FR, Deeg HJ. Lack of cytoprotective effect of amifostine following HLA-identical sibling transplantation for advanced myelodysplastic syndrome (MDS): a pilot study. Bone Marrow Transplant 2003; 32:1071-5. [PMID: 14625578 DOI: 10.1038/sj.bmt.1704277] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [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] [Indexed: 01/27/2023]
Abstract
The objective of this prospective study was to determine whether amifostine (Ethyol) reduced conditioning-related toxicity following a regimen of busulfan (7 mg/kg) and fractionated total body irradiation (6 x 200 cGy). In all, 12 patients with advanced myelodysplastic syndrome transplanted from HLA-identical siblings were enrolled. Patients received 340 mg/m(2) amifostine i.v. twice daily during conditioning (days -7 through -1). All patients developed oropharyngeal mucositis. Six patients had evidence of sinusoidal obstruction syndrome of the liver. Six patients experienced pulmonary toxicity of grades II-III. A total of 11 patients died, one with relapse and 10 with infectious complications or regimen-related toxicity. Nonrelapse causes of death included invasive aspergillosis in three, multiorgan failure in three, and idiopathic interstitial pneumonitis in two patients. One patient each died of organizing pneumonia and CMV pneumonia. One patient is alive in complete remission 31 months after transplantation. These results were not superior to those in patients conditioned with busulfan plus fractionated total body irradiation and not given amifostine, and suggest that amifostine, as administered here, has no protective effect against toxicity from this myeloablative regimen.
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Affiliation(s)
- M Benesch
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
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26
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Chen CS, Boeckh M, Seidel K, Clark JG, Kansu E, Madtes DK, Wagner JL, Witherspoon RP, Anasetti C, Appelbaum FR, Bensinger WI, Deeg HJ, Martin PJ, Sanders JE, Storb R, Storek J, Wade J, Siadak M, Flowers MED, Sullivan KM. Incidence, risk factors, and mortality from pneumonia developing late after hematopoietic stem cell transplantation. Bone Marrow Transplant 2003; 32:515-22. [PMID: 12942099 DOI: 10.1038/sj.bmt.1704162] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.8] [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] [Indexed: 11/08/2022]
Abstract
The incidence, etiology, outcome, and risk factors for developing pneumonia late after hematopoietic stem cell transplantation (SCT) were investigated in 1359 patients transplanted in Seattle. A total of 341 patients (25% of the cohort) developed at least one pneumonic episode. No microbial or tissue diagnosis (ie clinical pneumonia) was established in 197 patients (58% of first pneumonia cases). Among the remaining 144 patients, established etiologies included 33 viral (10%), 31 bacterial (9%), 25 idiopathic pneumonia syndrome (IPS, 7%), 20 multiple organisms (6%), 19 fungal (6%), and 16 Pneumocystis carinii pneumonia (PCP) (5%). The overall cumulative incidence of first pneumonia at 4 years after discharge home was 31%. The cumulative incidences of pneumonia according to donor type at 1 and 4 years after discharge home were 13 and 18% (autologous/syngeneic), 22 and 34% (HLA-matched related), and 26 and 39% (mismatched related/unrelated), respectively. Multivariate analysis of factors associated with development of late pneumonia after allografting were increasing patient age (RR 0.5 for <20 years, 1.2 for >40 years, P=0.009), donor HLA-mismatch (RR 1.6 for unrelated/mismatched related, P=0.01), and chronic graft-versus-host disease (GVHD; RR 1.5, P=0.007). Our data suggest that extension of PCP prophylaxis may be beneficial in high-risk autograft recipients. Further study of long-term anti-infective prophylaxis based on patient risk factors after SCT appear warranted.
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Affiliation(s)
- Chien-Shing Chen
- Clinical Research Division, Fred Hutchinson Cancer Research Center and the University of Washington, School of Medicine Seattle, WA, USA
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27
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Affiliation(s)
- F R Appelbaum
- Fred Hutchinson Cancer Research Center and the University of Washington, School of Medicine, Seattle 98109, USA
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28
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Stirewalt DL, Appelbaum FR, Willman CL, Zager RA, Banker DE. Mevastatin can increase toxicity in primary AMLs exposed to standard therapeutic agents, but statin efficacy is not simply associated with ras hotspot mutations or overexpression. Leuk Res 2003; 27:133-45. [PMID: 12526919 DOI: 10.1016/s0145-2126(02)00085-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [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] [Indexed: 10/27/2022]
Abstract
The 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase is a rate-limiting enzyme in the mevalonate biochemical pathway and HMG-CoA reductase inhibitors (statins) show toxicity for certain tumors, including acute myeloid leukemia (AML). This toxicity has been attributed to statin inhibition of Ras isoprenylation in tumors like AML where oncogenic ras mutations and/or overexpression are common. We show that mevastatin kills certain AML cell lines and is more toxic to a majority of primary AML cell samples than to myeloid cells in bone marrow (BM) samples from normal donors, and that mevastatin can produce more than additive kill with standard chemotherapeutics. Mevastatin reduces Ras membrane localization, but statin sensitivity in primary AML cells is not consistently associated with ras mutations nor with Ras overexpression, suggesting that another mevalonate pathway by-product(s) is the statin target in at least some AMLs.
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Affiliation(s)
- D L Stirewalt
- Clinical Research Division, Fred Hutchinson Cancer Research Center, D-100, 1124 Columbia Street, Seattle, WA 98104-2092, USA
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29
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Larson RA, Boogaerts M, Estey E, Karanes C, Stadtmauer EA, Sievers EL, Mineur P, Bennett JM, Berger MS, Eten CB, Munteanu M, Loken MR, Van Dongen JJM, Bernstein ID, Appelbaum FR. Antibody-targeted chemotherapy of older patients with acute myeloid leukemia in first relapse using Mylotarg (gemtuzumab ozogamicin). Leukemia 2002; 16:1627-36. [PMID: 12200674 DOI: 10.1038/sj.leu.2402677] [Citation(s) in RCA: 180] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2002] [Accepted: 05/30/2002] [Indexed: 11/08/2022]
Abstract
We analyzed the safety and efficacy of Mylotarg (gemtuzumab ozogamicin, an antibody-targeted chemotherapy consisting of a humanized anti-CD33 antibody linked to calicheamicin, a potent antitumor antibiotic) in the treatment of 101 patients > or =60 years of age with acute myeloid leukemia (AML) in untreated first relapse in three open-label trials. Mylotarg is administered as a 2-h intravenous infusion at 9 mg/m(2) for two doses with 14 days between doses. The overall remission rate was 28%, with complete remission (CR) in 13% of patients and complete remission with incomplete platelet recovery (CRp) in 15%. Median survival was 5.4 months for all patients and 14.5 months and 11.8 months for patients achieving CR and CRp, respectively. CD33 antigen is present on normal hematopoietic progenitor cells; thus, an expected high incidence of grade 3 or 4 neutropenia (99%) and thrombocytopenia (99%) was observed. The incidences of grade 3 or 4 elevations of bilirubin and hepatic transaminases were 24% and 15%, respectively. There was a low incidence of grade 3 or 4 mucositis (4%) and infections (27%) and no treatment-related cardiotoxicity, cerebellar toxicity, or alopecia. Mylotarg is an effective treatment for older patients with CD33-positive AML in first relapse and has acceptable toxicity.
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MESH Headings
- Acute Disease
- Adult
- Aged
- Aged, 80 and over
- Aminoglycosides
- Anti-Bacterial Agents/therapeutic use
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antigens, CD/metabolism
- Antigens, Differentiation, Myelomonocytic/metabolism
- Disease-Free Survival
- Female
- Gemtuzumab
- Humans
- Immunotoxins/therapeutic use
- Leukemia, Myeloid/diagnosis
- Leukemia, Myeloid/drug therapy
- Leukemia, Myeloid/mortality
- Leukemia, Myeloid/pathology
- Male
- Middle Aged
- Monitoring, Physiologic
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/pathology
- Prognosis
- Sialic Acid Binding Ig-like Lectin 3
- Survival Rate
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Affiliation(s)
- R A Larson
- Department of Medicine, University of Chicago, Chicago, IL 60637-1470, USA
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30
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McCune JS, Gooley T, Gibbs JP, Sanders JE, Petersdorf EW, Appelbaum FR, Anasetti C, Risler L, Sultan D, Slattery JT. Busulfan concentration and graft rejection in pediatric patients undergoing hematopoietic stem cell transplantation. Bone Marrow Transplant 2002; 30:167-73. [PMID: 12189535 DOI: 10.1038/sj.bmt.1703612] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.4] [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: 09/28/2001] [Accepted: 02/28/2002] [Indexed: 11/08/2022]
Abstract
We retrospectively analyzed the relationship between busulfan average steady-state plasma concentration (C(SS)) and graft rejection in 53 children receiving busulfan/cyclophosphamide (BU/CY) preparative regimens prior to hematopoietic stem cell transplantation (HSCT). Patients received a total oral busulfan dose of 11 to 28 mg/kg followed by a total cyclophosphamide dose of 120 to 335 mg/kg in preparation for allogeneic grafts (HLA-matched or HLA partially matched sibling, parent or unrelated donor). Graft rejection occurred in eight (15%) patients. Busulfan C(SS) (P = 0.0024) was the only statistically significant predictor of rejection on univariate logistic regression analysis, with the risk of rejection decreasing with an increase in busulfan C(SS). Severe (grade 3 or 4) regimen-related toxicity (RRT) occurred in four patients. Ten patients (19%) had a busulfan C(SS) higher than 900 ng/ml, one of whom had severe RRT. Higher and variable doses of cyclophosphamide may explain the lack of a relationship between busulfan C(SS) and RRT in children. It may be possible to improve the outcome of HSCT in pediatric patients receiving the BU/CY regimen through optimization of busulfan C(SS) and better definition of the contribution of activated cyclophosphamide metabolites to toxicity.
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Affiliation(s)
- J S McCune
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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31
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Abstract
Through the hard work of a large number of investigators, the biology of acute myeloid leukemia (AML) is becoming increasingly well understood, and as a consequence, new therapeutic targets have been identified and new model systems have been developed for testing novel therapies. How these new therapies can be most effectively studied in the clinic and whether they will ultimately improve cure rates are questions of enormous importance. In this article, Dr. Jacob Rowe presents a summary of the current state-of-the-art therapy for adult AML. His contribution emphasizes the fact that AML is not a single disease, but a number of related diseases each distinguished by unique cytogenetic markers which in turn help determine the most appropriate treatment. Dr. Jerald Radich continues on this theme, emphasizing how these cytogenetic abnormalities, as well as other mutations, give rise to abnormal signal transduction and how these abnormal pathways may represent ideal targets for the development of new therapeutics. A third contribution by Dr. Frederick Appelbaum describes how AML might be made the target of immunologic attack. Specifically, strategies using antibody-based or cell-based immunotherapies are described including the use of unmodified antibodies, drug conjugates, radioimmunoconjugates, non-ablative allogeneic transplantation, T cell adoptive immunotherapy and AML vaccines. Finally, Dr. John Dick provides a review of the development of the NOD/SCID mouse model of human AML emphasizing both what it has taught us about the biology of the disease as well as how it can be used to test new therapies. Taken together, these reviews are meant to help us understand more about where we are in the treatment of AML, where we can go and how we might get there.
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Affiliation(s)
- F R Appelbaum
- Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA
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32
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Doney KC, Chauncey T, Appelbaum FR. Allogeneic related donor hematopoietic stem cell transplantation for treatment of chronic lymphocytic leukemia. Bone Marrow Transplant 2002; 29:817-23. [PMID: 12058231 DOI: 10.1038/sj.bmt.1703548] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2001] [Accepted: 02/07/2002] [Indexed: 11/09/2022]
Abstract
Between 1980 and 1999, 25 patients with chronic lymphocytic leukemia (CLL) received related donor hematopoietic stem cell transplants. Median patient age was 46.6 years. Preparative regimens included busulfan (BU) plus cyclophosphamide (CY), CY plus TBI, and etoposide, CY plus TBI. Twenty-one donors were HLA-identical siblings, one was a DR mismatched sibling, and three were identical twins. Bone marrow was the source of hematopoietic stem cells in 22 cases and G-CSF stimulated peripheral blood in three cases. Most patients received methotrexate and cyclosporine for GVHD prophylaxis. Fourteen patients developed grades 2-4 acute GVHD and 10 developed clinical extensive chronic GVHD. Late clearance of CLL cells was associated with the development of chronic GVHD in one patient. Two patients had recurrent CLL. Nonrelapse mortality at day 100 was 57% for the seven patients conditioned with BU/CY and 17% for the 18 patients conditioned with TBI-containing regimens. Actuarial survival at 5 years for the 25 patients is 32%. All patients who received BU/CY died within 3 years of transplant. For the 14 patients transplanted since 1992 and who received TBI, actuarial 5-year survival is 56%. The maximum response of CLL to hematopoietic cell transplantation may be delayed, but long-term disease-free survival can be achieved.
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Affiliation(s)
- K C Doney
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA
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33
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Abstract
Radiolabeled monoclonal antibodies have been used with encouraging results in conjunction with stem cell transplantation for patients with hematologic malignancies targeting a variety of surface antigens including CD33, CD45 and CD66 for leukemias, CD20 and CD22 for non-Hodgkin's lymphomas, and ferritin for Hodgkin's disease. The results obtained targeting epithelial antigens on solid tumors, however, have generally been less encouraging, primarily due to the relative insensitivity of these malignancies to ionizing radiation. In this report we review clinical studies that have incorporated myeloablative doses of targeted radiation using radiolabeled antibodies in conjunction with stem cell transplant regimens.
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Affiliation(s)
- J M Pagel
- Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
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34
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Affiliation(s)
- F R Appelbaum
- Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine, Seattle, WA, USA
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35
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Benito AI, Furlong T, Martin PJ, Anasetti C, Appelbaum FR, Doney K, Nash RA, Papayannopoulou T, Storb R, Sullivan KM, Witherspoon R, Deeg HJ. Sirolimus (rapamycin) for the treatment of steroid-refractory acute graft-versus-host disease. Transplantation 2001; 72:1924-9. [PMID: 11773890 DOI: 10.1097/00007890-200112270-00010] [Citation(s) in RCA: 156] [Impact Index Per Article: 6.8] [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] [Indexed: 12/22/2022]
Abstract
BACKGROUND In a pilot trial we evaluated the toxicity and efficacy of sirolimus (rapamycin) as second-line therapy for the treatment of acute graft-versus-host disease (GVHD) in 21 patients (1-46 years of age) after allogeneic hematopoietic stem cell transplantation (HSCT). METHODS All patients were treated with methylprednisolone at 2 mg/kg/day, but failed to respond satisfactorily. Sirolimus was started 19-78 (median 37) days after HSCT when 10 patients had grade III and 11 had grade IV GVHD. The first four patients received a loading dose (15 mg/m2) of oral sirolimus on day 1 followed by 5 mg/m2/day for 13 days. The next 17 patients received either 5 (n=7) or 4 (n=10) mg/m2/day for 14 days without a loading dose. Eleven patients completed the 14-day sirolimus course. Five patients were treated for 9-13 days, two for 6 days, and three for 1-3 days. RESULTS Sirolimus was discontinued early in 10 patients because of lack of improvement in GVHD (n=5), myelosuppression (n=2), seizure (n=2), and attending physician preference (n=1). The most common and significant adverse events were thrombocytopenia (n=7) and neutropenia (n=4). Other side effects included increased blood triglycerides (n=8) and cholesterol (n=3). Five patients had evidence of a hemolytic uremic syndrome concurrently with or after sirolimus treatment. Eighteen of the 21 patients received 6 or more doses of sirolimus and 12 responded, 5 with complete and 7 with partial responses. Six of the 12 responders (28% of all patients enrolled) and 1 nonresponder are currently alive at 400-907 days after HSCT, 3 with chronic GVHD. Fourteen of the 21 patients (66%) died 40-263 days after transplant. CONCLUSION These data suggest that sirolimus has activity in the treatment of steroid-refractory acute GVHD. However, there was considerable toxicity and further dose optimization studies seem warranted.
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Affiliation(s)
- A I Benito
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave., North, D1-100, P.O. Box 19204, Seattle, WA 98109-1204, USA
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36
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Storek J, Joseph A, Espino G, Dawson MA, Douek DC, Sullivan KM, Flowers ME, Martin P, Mathioudakis G, Nash RA, Storb R, Appelbaum FR, Maloney DG. Immunity of patients surviving 20 to 30 years after allogeneic or syngeneic bone marrow transplantation. Blood 2001; 98:3505-12. [PMID: 11739150 DOI: 10.1182/blood.v98.13.3505] [Citation(s) in RCA: 109] [Impact Index Per Article: 4.7] [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] [Indexed: 11/20/2022] Open
Abstract
The duration of immunodeficiency following marrow transplantation is not known. Questionnaires were used to study the infection rates in 72 patients surviving 20 to 30 years after marrow grafting. Furthermore, in 33 of the 72 patients and in 16 donors (siblings who originally donated the marrow) leukocyte subsets were assessed by flow cytometry. T-cell receptor excision circles (TRECs), markers of T cells generated de novo, were quantitated by real-time polymerase chain reaction. Immunoglobulin G(2) (IgG(2)) and antigen-specific IgG levels were determined by enzyme-linked immunosorbent assay. Infections diagnosed more than [corrected] 15 years after transplantation occurred rarely. The average rate was 0.07 infections per patient-year (one infection every 14 years), excluding respiratory tract infections, gastroenteritis, lip sores, and hepatitis C. The counts of circulating monocytes, natural killer cells, B cells, CD4 T cells, and CD8 T cells in the patients were not lower than in the donors. The counts of TREC(+) CD4 T cells in transplant recipients younger than age 18 years (at the time of transplantation) were not different from the counts in their donors. In contrast, the counts of TREC(+) CD4 T cells were lower in transplant recipients age 18 years or older, even in those with no history of clinical extensive chronic graft-versus-host disease, compared with their donors. The levels of total IgG(2) and specific IgG against Haemophilus influenzae and Streptococcus pneumoniae were similar in patients and donors. Overall, the immunity of patients surviving 20 to 30 years after transplantation is normal or near normal. Patients who received transplants in adulthood have a clinically insignificant deficiency of de novo-generated CD4 T cells, suggesting that in these patients the posttransplantation thymic insufficiency may not be fully reversible.
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Affiliation(s)
- J Storek
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA, USA.
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37
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Kansu E, Gooley T, Flowers ME, Anasetti C, Deeg HJ, Nash RA, Sanders JE, Witherspoon RP, Appelbaum FR, Storb R, Martin PJ. Administration of cyclosporine for 24 months compared with 6 months for prevention of chronic graft-versus-host disease: a prospective randomized clinical trial. Blood 2001; 98:3868-70. [PMID: 11739201 DOI: 10.1182/blood.v98.13.3868] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.3] [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] [Indexed: 11/20/2022] Open
Abstract
This study compared the incidence of clinical extensive chronic graft-versus-host disease (GVHD), transplantation-related mortality, survival, and relapse-free survival among recipients randomly assigned to receive a 24-month or a 6-month course of cyclosporine prophylaxis after transplantation of allogeneic marrow from an HLA-identical sibling or alternative donor. Patients who did not have clinical manifestations of chronic GVHD on day 80 after transplantation were eligible for the study if they previously had acute GVHD or if a skin biopsy showed histologic evidence of chronic GVHD. Clinical extensive chronic GVHD developed in 35 of the 89 patients (39%) in the 24-month group and 37 of the 73 patients (51%) in the 6-month group. The hazard of developing chronic GVHD was not significantly different in the 2 groups (hazard ratio = 0.76; 95% confidence interval, 0.48-1.21; P =.25). In addition, there were no significant differences between the 2 groups in transplantation-related mortality, survival, or disease-free survival.
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Affiliation(s)
- E Kansu
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, USA
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38
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List AF, Kopecky KJ, Willman CL, Head DR, Persons DL, Slovak ML, Dorr R, Karanes C, Hynes HE, Doroshow JH, Shurafa M, Appelbaum FR. Benefit of cyclosporine modulation of drug resistance in patients with poor-risk acute myeloid leukemia: a Southwest Oncology Group study. Blood 2001; 98:3212-20. [PMID: 11719356 DOI: 10.1182/blood.v98.12.3212] [Citation(s) in RCA: 325] [Impact Index Per Article: 14.1] [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] [Indexed: 11/20/2022] Open
Abstract
Cyclosporine A (CsA) inhibits P-glycoprotein (Pgp)-mediated cellular export of anthracyclines at clinically achievable concentrations. This randomized controlled trial was performed to test the benefit of CsA addition to treatment with cytarabine and daunorubicin (DNR) in patients with poor-risk acute myeloid leukemia (AML). A total of 226 patients were randomly assigned to sequential treatment with cytarabine and infusional DNR with or without intravenous CsA. Remitting patients received one course of consolidation chemotherapy that included DNR with or without CsA as assigned during induction. Addition of CsA significantly reduced the frequency of resistance to induction chemotherapy (31% versus 47%, P =.0077). Whereas the rate of complete remission was not significantly improved (39% versus 33%, P =.14), relapse-free survival (34% versus 9% at 2 years, P =.031) and overall survival (22% versus 12%, P =.046) were significantly increased with CsA. The effect of CsA on survival was greatest in patients with moderate or bright Pgp expression (median 12 months with CsA versus 4 months for controls) compared to patients with absent or low Pgp expression (median 6 months in both arms). The frequency of induction deaths was 15% with CsA and 18% in controls. Steady-state serum concentrations of DNR (P =.0089) and daunorubicinol (P <.0001) were significantly higher in CsA-treated patients. Survival (P =.0003) and induction response (P =.028) improved with increasing DNR concentration in CsA-treated patients but not in controls, suggesting a targeted interaction by CsA to enhance anthracycline cytotoxicity. These results indicate that addition of CsA to an induction and consolidation regimen containing infusional DNR significantly reduces resistance to DNR, prolongs the duration of remission, and improves overall survival in patients with poor-risk AML.
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MESH Headings
- ATP Binding Cassette Transporter, Subfamily B, Member 1/analysis
- ATP Binding Cassette Transporter, Subfamily B, Member 1/genetics
- Adolescent
- Adult
- Aged
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cyclosporine/administration & dosage
- Cyclosporine/adverse effects
- Cyclosporine/therapeutic use
- Cytarabine/administration & dosage
- Cytarabine/adverse effects
- Cytarabine/therapeutic use
- Cytogenetic Analysis
- Daunorubicin/administration & dosage
- Daunorubicin/adverse effects
- Daunorubicin/therapeutic use
- Disease-Free Survival
- Drug Interactions
- Drug Resistance, Neoplasm
- Gene Expression
- Humans
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/mortality
- Male
- Middle Aged
- Remission Induction
- Risk Factors
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Affiliation(s)
- A F List
- Southwest Oncology Group, Operations Office, 14980 Omicron Dr, San Antonio, TX, USA.
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39
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Radich JP, Gooley T, Bryant E, Chauncey T, Clift R, Beppu L, Edmands S, Flowers ME, Kerkof K, Nelson R, Appelbaum FR. The significance of bcr-abl molecular detection in chronic myeloid leukemia patients "late," 18 months or more after transplantation. Blood 2001; 98:1701-7. [PMID: 11535500 DOI: 10.1182/blood.v98.6.1701] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.6] [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] [Indexed: 11/20/2022] Open
Abstract
The bcr-abl chimeric messenger RNA is frequently detected in chronic myeloid leukemia (CML) patients after bone marrow transplantation. It was previously reported that the relapse risk of bcr-abl detection 6 to 12 months after transplantation was greater than 40%. This risk decreased as the time between transplantation and detection increased. To further define the relapse risk associated with bcr-abl molecular detection in "late" CML survivors, 379 consecutive CML patients alive at 18 months after transplantation or later were studied. Ninety of 379 patients (24%) had at least one positive bcr-abl test 18 months after transplantation or later; 13 of 90 bcr-abl-positive patients (14%) and 3 of 289 bcr-abl-negative patients (1.0%) relapsed. The median time from bcr-abl detection to relapse was 916 days (range, 251-2654 days). The hazard ratio of relapse associated with bcr-abl detection was 19.2 (P <.0001). The stage of disease, chronic graft-versus-host disease, and the donor type did not alter the association between bcr-abl and relapse. Quantification of bcr-abl was performed on 344 samples from 85 bcr-abl-positive patients by means of a real-time quantitative reverse transcriptase-polymerase chain reaction assay. The median bcr-abl change of patients who relapsed was significantly greater than those that remained in remission (P =.002). The median bcr-abl level at relapse was 40 443 bcr-abl copies per microg RNA (range, 960-299 552). Of 73 bcr-abl-positive patients who failed to relapse, 69% had only one positive test at a median of 24 copies bcr-abl per microg RNA. The detection of bcr-abl is common following transplantation. The prognostic significance of a qualitative bcr-abl can be refined by quantitative assays and thus may target patients who would benefit from early intervention.
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MESH Headings
- Adolescent
- Adult
- Bone Marrow Transplantation
- Child
- Child, Preschool
- Female
- Fusion Proteins, bcr-abl/biosynthesis
- Fusion Proteins, bcr-abl/genetics
- Humans
- Kinetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/metabolism
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Male
- Middle Aged
- Neoplasm Recurrence, Local
- RNA, Neoplasm/biosynthesis
- Risk Factors
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Affiliation(s)
- J P Radich
- Clinical Research Division, Fred Hutchinson Cancer Research Center, the University of Washington School of Medicine, Seattle, WA, USA.
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40
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Gutierrez-Delgado F, Maloney DG, Press OW, Golden J, Holmberg LA, Maziarz RT, Hooper H, Buckner CD, Appelbaum FR, Bensinger WI. Autologous stem cell transplantation for non-Hodgkin's lymphoma: comparison of radiation-based and chemotherapy-only preparative regimens. Bone Marrow Transplant 2001; 28:455-61. [PMID: 11593318 DOI: 10.1038/sj.bmt.1703179] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [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: 01/26/2001] [Accepted: 05/25/2001] [Indexed: 11/09/2022]
Abstract
The aim of this study was to compare toxicity and efficacy of total body irradiation (TBI), cyclophosphamide (CY) and etoposide (E) (TBI/CY/E) vs busulfan, melphalan and thiotepa (Bu/Mel/T) in patients receiving autologous stem cell infusion (ASCI) for malignant lymphoma (NHL). Between September 1990 and July 1998, 351 patients with NHL were treated with TBI/CY/E (n = 221) or Bu/Mel/T (n = 130) followed by ASCI. Patients in first, or second remission, first responding or untreated relapse were defined as having less advanced disease before transplantation. The median follow-up was 5 years (range 1-9) and 3.5 years (1-6) for patients receiving TBI/CY/E and Bu/Mel/T, respectively. The cumulative probabilities of survival, event-free survival (EFS) and relapse at 5 years were 44%, 32%, 49% following TBI/CY/E and 42%, 34% and 42% following Bu/Mel/T. The probability of EFS at 5 years for patients who had prior dose-limiting radiation (n = 59) was 32% after Bu/Mel/T therapy. Transplant-related mortality was 16% for TBI/CY/E and 21% for Bu/Mel/T. In univariate and multivariate analyses, more advanced disease status was associated with poor outcome (TBI/CY/E: RR 0.70, CI 0.50 to 0.97 P = 0.04; Bu/Mel/T: RR 0.61, CI 0.39 to 0.97 P = 0.03). No significant differences in toxicities and outcomes were observed between these two regimens despite the inclusion of patients who had received dose-limiting irradiation in the Bu/Mel/T regimen.
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Affiliation(s)
- F Gutierrez-Delgado
- The Fred Hutchinson Cancer Research Center, 1100 Fairview Av North D5-390, Seattle, WA 98109, USA
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41
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Bennett CL, Hynes D, Godwin J, Stinson TJ, Golub RM, Appelbaum FR. Economic analysis of granulocyte colony stimulating factor as adjunct therapy for older patients with acute myelogenous leukemia (AML): estimates from a Southwest Oncology Group clinical trial. Cancer Invest 2001; 19:603-10. [PMID: 11486703 DOI: 10.1081/cnv-100104288] [Citation(s) in RCA: 34] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Considerable morbidity, mortality, and economic costs result during remission induction therapy for elderly patients with acute myeloid leukemia (AML). In this study, the economic costs of adjunct granulocyte colony stimulating factor (G-CSF) are estimated for AML patients > 55 years of age who received induction chemotherapy on a recently completed Southwest Oncology Group study (SWOG). Clinical data were based on Phase III trial information from 207 AML patients who were randomized to receive either placebo or G-CSF post-induction therapy. Analyses were conducted using a decision analytic model with the primary source of clinical event probabilities based on in-hospital care with or without an active infection requiring intravenous antibiotics. Estimates of average daily costs of care with and without an infection were imputed from a previously reported economic model of a similar population. When compared to AML patients who received placebo, patients who received G-CSF had significantly fewer days on intravenous antibiotics (median 22 vs. 26, p = 0.05), whereas overall duration of hospitalization did not differ (median 29 days). The median cost per day with an active infection that required intravenous antibiotics was estimated to be $1742, whereas the median cost per day without an active infection was estimated to be $1467. Overall, costs were $49,693 for the placebo group and $50,593 for the G-CSF patients. G-CSF during induction chemotherapy for elderly patients with AML had some clinical benefits, but it did not reduce the duration of hospitalization, prolong survival, or reduce the overall cost of supportive care. Whether the benefits of G-CSF therapy justify its use in individual patients with acute leukemia for the present remains a matter of clinical judgment.
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Affiliation(s)
- C L Bennett
- VA Chicago Health Care System-Lakeside, Chicago, Illinois 60611, USA
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42
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Morrison VA, Rai KR, Peterson BL, Kolitz JE, Elias L, Appelbaum FR, Hines JD, Shepherd L, Martell RE, Larson RA, Schiffer CA. Impact of therapy With chlorambucil, fludarabine, or fludarabine plus chlorambucil on infections in patients with chronic lymphocytic leukemia: Intergroup Study Cancer and Leukemia Group B 9011. J Clin Oncol 2001; 19:3611-21. [PMID: 11504743 DOI: 10.1200/jco.2001.19.16.3611] [Citation(s) in RCA: 106] [Impact Index Per Article: 4.6] [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] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We sought to determine whether therapy with single-agent fludarabine compared with chlorambucil alone or the combination of both agents had an impact on the incidence and spectrum of infections among a series of previously untreated patients with B-cell chronic lymphocytic leukemia (CLL). PATIENTS AND METHODS Five hundred fifty-four previously untreated CLL patients with intermediate/high-risk Rai-stage disease were enrolled onto an intergroup protocol. Patients were randomized to therapy with chlorambucil, fludarabine, or fludarabine plus chlorambucil. Data pertaining to infection were available on 518 patients. Differences in infections among treatment arms were tested with the Kruskal-Wallis, Wilcoxon, and chi(2) tests. RESULTS A total of 1,107 infections (241 major infections) occurred in 518 patients over the infection follow-up period (interval from study entry until either reinstitution of initial therapy, therapy with a second agent, or death). Patients treated with fludarabine plus chlorambucil had more infections than those receiving either single agent (P <.0001). Comparing the two single-agent arms, there were more infections on the fludarabine arm (P =.055) per month of follow-up. Fludarabine therapy was associated with more major infections and more herpesvirus infections compared with chlorambucil (P =.008 and P =.004, respectively). Rai stage and best response to therapy were not associated with infection. A low serum immunoglobulin G was associated with number of infections (P =.02). Age was associated with incidence of major infection in the combination arm (P =.004). CONCLUSION Combination therapy with fludarabine plus chlorambucil resulted in significantly more infections than treatment with either single agent. Patients receiving single-agent fludarabine had more major infections and herpesvirus infections compared with chlorambucil-treated patients.
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MESH Headings
- Administration, Oral
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Chlorambucil/administration & dosage
- Drug Administration Schedule
- Female
- Humans
- Infusions, Intravenous
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Male
- Middle Aged
- Ontario
- Respiratory Tract Infections/complications
- Respiratory Tract Infections/mortality
- Skin Diseases, Infectious/complications
- Skin Diseases, Infectious/mortality
- Treatment Outcome
- United States
- Vidarabine/administration & dosage
- Vidarabine/analogs & derivatives
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Affiliation(s)
- V A Morrison
- Section of Hematology/Oncology and Infectious Disease, Veterans Affairs Medical Center, Minneapolis, MN 55417, USA.
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43
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Linenberger ML, Hong T, Flowers D, Sievers EL, Gooley TA, Bennett JM, Berger MS, Leopold LH, Appelbaum FR, Bernstein ID. Multidrug-resistance phenotype and clinical responses to gemtuzumab ozogamicin. Blood 2001; 98:988-94. [PMID: 11493443 DOI: 10.1182/blood.v98.4.988] [Citation(s) in RCA: 146] [Impact Index Per Article: 6.3] [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: 11/20/2022] Open
Abstract
Expression of multidrug resistance (MDR) features by acute myeloid leukemia (AML) cells predicts a poor response to many treatments. The MDR phenotype often correlates with expression of P-glycoprotein (Pgp), and Pgp antagonists such as cyclosporine (CSA) have been used as chemosensitizing agents in AML. Gemtuzumab ozogamicin, an immunoconjugate of an anti-CD33 antibody linked to calicheamicin, is effective monotherapy for CD33(+) relapsed AML. However, the contribution of Pgp to gemtuzumab ozogamicin resistance is poorly defined. In this study, blast cell samples from relapsed AML patients eligible for gemtuzumab ozogamicin clinical trials were assayed for Pgp surface expression and Pgp function using a dye efflux assay. In most cases, surface expression of Pgp correlated with Pgp function, as indicated by elevated dye efflux that was inhibited by CSA. Among samples from patients who either failed to clear marrow blasts or failed to achieve remission, 72% or 52%, respectively, exhibited CSA-sensitive dye efflux compared with 29% (P =.003) or 24% (P <.001) among samples from responders. In vitro gemtuzumab ozogamicin--induced apoptosis was also evaluated using an annexin V--based assay. Low levels of drug-induced apoptosis were associated with CSA-sensitive dye efflux, whereas higher levels correlated strongly with achievement of remission and marrow blast clearance. In vitro drug-induced apoptosis could be increased by CSA in 14 (29%) of 49 samples exhibiting low apoptosis in the absence of CSA. Together, these findings indicate that Pgp plays a role in clinical resistance to gemtuzumab ozogamicin and suggest that treatment trials combining gemtuzumab ozogamicin with MDR reversal agents are warranted. (Blood. 2001;98:988-994)
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MESH Headings
- ATP Binding Cassette Transporter, Subfamily B, Member 1/metabolism
- ATP Binding Cassette Transporter, Subfamily B, Member 1/physiology
- Acute Disease
- Aminoglycosides
- Anti-Bacterial Agents/pharmacology
- Antibodies, Monoclonal/pharmacology
- Antibodies, Monoclonal, Humanized
- Apoptosis/drug effects
- Bone Marrow/pathology
- Carbocyanines/pharmacokinetics
- Clinical Trials, Phase II as Topic
- Cyclosporine/pharmacology
- Drug Resistance, Multiple/genetics
- Drug Resistance, Multiple/immunology
- Drug Synergism
- Fluorescent Dyes
- Gemtuzumab
- Humans
- Immunotoxins/pharmacology
- Leukemia, Myeloid/drug therapy
- Leukemia, Myeloid/pathology
- Leukocytes, Mononuclear/pathology
- Phenotype
- Regression Analysis
- Remission Induction
- Treatment Outcome
- Tumor Cells, Cultured/drug effects
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Affiliation(s)
- M L Linenberger
- Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, USA.
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44
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Anderson JE, Tefferi A, Craig F, Holmberg L, Chauncey T, Appelbaum FR, Guardiola P, Callander N, Freytes C, Gazitt Y, Razvillas B, Deeg HJ. Myeloablation and autologous peripheral blood stem cell rescue results in hematologic and clinical responses in patients with myeloid metaplasia with myelofibrosis. Blood 2001; 98:586-93. [PMID: 11468154 DOI: 10.1182/blood.v98.3.586] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.7] [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] [Indexed: 11/20/2022] Open
Abstract
Current therapeutic options for myeloid metaplasia with myelofibrosis (MMM) are limited. A pilot study was conducted of autologous peripheral blood stem cell (PBSC) collection in 27, followed by transplantation in 21 patients with MMM. The median age was 59 (range 45-75) years. PBSCs were mobilized at steady state (n = 2), after granulocyte colony-stimulating factor (G-CSF) alone (n = 17), or after anthracycline-cytarabine induction plus G-CSF (n = 8). A median of 11.6 x 10(6) (range 0 to 410 x 10(6)) CD34(+) cells per kilogram were collected. Twenty-one patients then underwent myeloablation with oral busulfan (16 mg/kg) and PBSC transplantation. The median times to neutrophil and platelet recovery after transplantation were 21 (range 10-96) and 21 (range, 13 to > or = 246) days, respectively. Five patients received back-up PBSC infusion because of delayed neutrophil or platelet recovery. The median follow-up is 390 (range 70-1623) days after transplantation, and the 2-year actuarial survival is 61%. After transplantion, 6 patients died: 3 of nonrelapse causes (1 within 100 days of PBSC infusion) and 3 of disease progression. Erythroid response (hemoglobin > or = 100 g/L [10 gm/dL] without transfusion for > or = 8 weeks) occurred in 10 of 17 anemic patients. Four of 8 patients with a platelet count less than 100 x 10(9)/L (100 000/microL) responded with a durable platelet count more than 100 x 10(9)/L (100 000/microL). Symptomatic splenomegaly improved in 7 of 10 patients. It is concluded that (1) PBSC collection was feasible and stable engraftment occurred after transplantation in most patients with MMM, (2) myeloablation with busulfan was associated with acceptable toxicity, (3) a significant proportion of patients derived clinical benefit after treatment, and (4) further investigation of this novel approach is warranted. (Blood. 2001;98:586-593)
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Affiliation(s)
- J E Anderson
- Division of Hematology, Department of Medicine, University of Texas Health Science Center at San Antonio, TX, USA
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45
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Anderson JE, Appelbaum FR, Schoch G, Barnett T, Chauncey TR, Flowers ME, Storb R. Relapse after allogeneic bone marrow transplantation for refractory anemia is increased by shielding lungs and liver during total body irradiation. Biol Blood Marrow Transplant 2001; 7:163-70. [PMID: 11302550 DOI: 10.1053/bbmt.2001.v7.pm11302550] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [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] [Indexed: 11/11/2022]
Abstract
Patients with the refractory anemia (RA) subtype of myelodysplastic syndrome who undergo allogeneic bone marrow transplantation (BMT) have a low risk of relapse, but they have a high risk of nonrelapse mortality when prepared with conventional preparative regimens. To try to reduce nonrelapse mortality, we treated 14 RA patients with a modified approach to total body irradiation (TBI) followed by cyclophosphamide (CY) and HLA-identical sibling BMT. Median patient age was 44 years (range, 28 to 65 years). Patients received TBI with shielding of the right lobe of the liver and both lungs followed by electron beam boosts to shielded ribs. Total radiation exposure in nonshielded areas was 12 Gy (n = 10), 10 Gy (n = 3), or 6 Gy (n = 1). After TBI, patients received CY at 120 mg/kg over 2 days, followed by transplantation of unmanipulated bone marrow. All patients initially achieved engraftment with donor cells, although 2 patients had subsequent reemergence of host hematopoiesis without evidence of disease relapse. Five patients died of transplantation-related causes between 22 and 1262 days post-BMT. Four patients relapsed between 157 and 1096 days post-BMT. These 14 patients were compared with 46 historical controls with RA who received conventional CY/TBI or busulfan/CY preparative regimens. Patients in the experimental group had a similar nonrelapse mortality rate compared with the historical control group (29% versus 37%, respectively; P = .8), but a higher relapse rate (34% versus 2%, P = .0004) and a lower disease-free survival (38% versus 61%, P = .16). We conclude that this modified TBI approach is associated with an unacceptably high risk of relapse for patients with RA undergoing BMT.
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Affiliation(s)
- J E Anderson
- Department of Medicine, University of Texas Health Science Center at San Antonio, 78284-7880, USA.
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46
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Sievers EL, Larson RA, Stadtmauer EA, Estey E, Löwenberg B, Dombret H, Karanes C, Theobald M, Bennett JM, Sherman ML, Berger MS, Eten CB, Loken MR, van Dongen JJ, Bernstein ID, Appelbaum FR. Efficacy and safety of gemtuzumab ozogamicin in patients with CD33-positive acute myeloid leukemia in first relapse. J Clin Oncol 2001; 19:3244-54. [PMID: 11432892 DOI: 10.1200/jco.2001.19.13.3244] [Citation(s) in RCA: 605] [Impact Index Per Article: 26.3] [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: 11/20/2022] Open
Abstract
PURPOSE Three open-label, multicenter trials were conducted to evaluate the efficacy and safety of single-agent Mylotarg (gemtuzumab ozogamicin; CMA-676; Wyeth Laboratories, Philadelphia, PA), an antibody-targeted chemotherapy agent, in patients with CD33-positive acute myeloid leukemia (AML) in untreated first relapse. PATIENTS AND METHODS The study population comprised 142 patients with AML in first relapse with no history of an antecedent hematologic disorder and a median age of 61 years. All patients received Mylotarg as a 2-hour intravenous infusion, at a dose of 9 mg/m(2), at 2-week intervals for two doses. Patients were evaluated for remission, survival, and treatment-emergent adverse events. RESULTS Thirty percent of patients treated with Mylotarg obtained remission as characterized by 5% or less blasts in the marrow, recovery of neutrophils to at least 1,500/microL, and RBC and platelet transfusion independence. Although patients treated with Mylotarg had relatively high incidences of myelosuppression, grade 3 or 4 hyperbilirubinemia (23%), and elevated hepatic transaminase levels (17%), the incidences of grade 3 or 4 mucositis (4%) and infections (28%) were relatively low. There was a low incidence of severe nausea and vomiting (11%) and no treatment-related cardiotoxicity, cerebellar toxicity, or alopecia. Many patients received Mylotarg on an outpatient basis (38% and 41% of patients for the first and second doses, respectively). Among the 142 patients, the median total duration of hospitalization was 24 days; 16% of patients required 7 days of hospitalization or less. CONCLUSION Administration of the antibody-targeted chemotherapy agent Mylotarg to patients with CD33-positive AML in first relapse induces complete remissions with what appears to be a favorable safety profile.
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MESH Headings
- Acute Disease
- Adult
- Aged
- Aged, 80 and over
- Aminoglycosides
- Anti-Bacterial Agents/adverse effects
- Anti-Bacterial Agents/pharmacology
- Anti-Bacterial Agents/therapeutic use
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal/pharmacology
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antigens, CD/metabolism
- Antigens, Differentiation, Myelomonocytic/metabolism
- Disease-Free Survival
- Europe/epidemiology
- Female
- Gemtuzumab
- Humans
- Immunotoxins/adverse effects
- Immunotoxins/pharmacology
- Immunotoxins/therapeutic use
- Leukemia, Myeloid/diagnosis
- Leukemia, Myeloid/drug therapy
- Leukemia, Myeloid/mortality
- Male
- Middle Aged
- Multivariate Analysis
- North America/epidemiology
- Prognosis
- Recurrence
- Sialic Acid Binding Ig-like Lectin 3
- Survival Rate
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Affiliation(s)
- E L Sievers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Department of Pediatrics, University of Washington, and Hematologics Inc, Seattle WA
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47
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Abstract
Chronic myeloid leukemia (CML) is probably the best understood human malignancy at the molecular level, but among the hardest to explain to patients concerning appropriate treatment options. At present, we do not know the long-term outcome of promising new therapies such as the tyrosine kinase inhibitor imatinib mesylate (Gleevec, Novartis Pharmaceuticals Corp, East Hanover, NJ) (formerly STI571) and nonmyeloablative transplants. There is also no reliable way to predict which patients will respond to a particular therapy. The development of methods to predict therapeutic response will be of major benefit to patients, and the newly emerging science of gene array analysis may provide such a tool. In this context, given the proven likelihood of cure with allogeneic transplantation and the negative effects of delay, in Seattle we continue to suggest transplantation as the initial form of therapy for patients below age 55 years with matched sibling donors. For patients without matched donors below the age of 40, we would suggest an unrelated donor search and only proceed directly to transplant for those with allele-level matches. For younger patients without matches and those aged 40 to 55, an initial trial of imatinib mesylate might be preferred. For patients over age 55 with CML, initial therapy with imatinib mesylate, possibly an interferon-containing regimen or nonmyeloablative allogeneic transplantation may be considered.
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Affiliation(s)
- F R Appelbaum
- Fred Hutchinson Cancer Research Center, University of Washington School of Medicine, Seattle, WA 98109-1024, USA
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48
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Storek J, Dawson MA, Storer B, Stevens-Ayers T, Maloney DG, Marr KA, Witherspoon RP, Bensinger W, Flowers ME, Martin P, Storb R, Appelbaum FR, Boeckh M. Immune reconstitution after allogeneic marrow transplantation compared with blood stem cell transplantation. Blood 2001; 97:3380-9. [PMID: 11369627 DOI: 10.1182/blood.v97.11.3380] [Citation(s) in RCA: 300] [Impact Index Per Article: 13.0] [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] [Indexed: 01/25/2023] Open
Abstract
Allogeneic peripheral blood stem cell grafts contain about 10 times more T and B cells than marrow grafts. Because these cells may survive in transplant recipients for a long time, recipients of blood stem cells may be less immunocompromised than recipients of marrow. Immune reconstitution was studied in 115 patients randomly assigned to receive either allogeneic marrow or filgrastim-mobilized blood stem cell transplantation. Between day 30 and 365 after transplantation, counts of most lymphocyte subsets were higher in the blood stem cell recipients. The difference was most striking for CD4 T cells (about 4-fold higher counts for CD45RA(high) CD4 T cells and about 2-fold higher counts for CD45RA(low/-)CD4 T cells; P <.05). On assessment using phytohemagglutinin and herpesvirus antigen-stimulated proliferation, T cells in the 2 groups of patients appeared equally functional. Median serum IgG levels were similar in the 2 groups. The rate of definite infections after engraftment was 1.7-fold higher in marrow recipients (P =.001). The rate of severe (inpatient treatment required) definite infections after engraftment was 2.4-fold higher in marrow recipients (P =.002). The difference in the rates of definite infections was greatest for fungal infections, intermediate for bacterial infections, and lowest for viral infections. Death associated with a fungal or bacterial infection occurred between day 30 and day 365 after transplantation in 9 marrow recipients and no blood stem cell recipients (P =.008). In conclusion, blood stem cell recipients have higher lymphocyte-subset counts and this appears to result in fewer infections. (Blood. 2001;97:3380-3389)
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Affiliation(s)
- J Storek
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA, USA.
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49
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McSweeney PA, Niederwieser D, Shizuru JA, Sandmaier BM, Molina AJ, Maloney DG, Chauncey TR, Gooley TA, Hegenbart U, Nash RA, Radich J, Wagner JL, Minor S, Appelbaum FR, Bensinger WI, Bryant E, Flowers ME, Georges GE, Grumet FC, Kiem HP, Torok-Storb B, Yu C, Blume KG, Storb RF. Hematopoietic cell transplantation in older patients with hematologic malignancies: replacing high-dose cytotoxic therapy with graft-versus-tumor effects. Blood 2001; 97:3390-400. [PMID: 11369628 DOI: 10.1182/blood.v97.11.3390] [Citation(s) in RCA: 1041] [Impact Index Per Article: 45.3] [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] [Indexed: 01/15/2023] Open
Abstract
Toxicities have limited the use of allogeneic hematopoietic cell transplantation (HCT) to younger, medically fit patients. In a canine HCT model, a combination of postgrafting mycophenolate mofetil (MMF) and cyclosporine (CSP) allowed stable allogeneic engraftment after minimally toxic conditioning with low-dose (200 cGy) total-body irradiation (TBI). These findings, together with the known antitumor effects of donor leukocyte infusions (DLIs), led to the design of this trial. Forty-five patients (median age 56 years) with hematologic malignancies, HLA-identical sibling donors, and relative contraindications to conventional HCT were treated. Immunosuppression involved TBI of 200 cGy before and CSP/MMF after HCT. DLIs were given after HCT for persistent malignancy, mixed chimerism, or both. Regimen toxicities and myelosuppression were mild, allowing 53% of eligible patients to have entirely outpatient transplantations. Nonfatal graft rejection occurred in 20% of patients. Grades II to III acute graft-versus-host disease (GVHD) occurred in 47% of patients with sustained engraftment. With median follow-up of 417 days, survival was 66.7%, nonrelapse mortality 6.7%, and relapse mortality 26.7%. Fifty-three percent of patients with sustained engraftment were in complete remission, including 8 with molecular remissions. This novel allografting approach, based on the use of postgrafting immunosuppression to control graft rejection and GVHD, has dramatically reduced the acute toxicities of allografting. HCT with the induction of potent graft-versus-tumor effects can be performed in previously ineligible patients, largely in an outpatient setting. Future protocol modifications should reduce rejection and GVHD, thereby facilitating studies of allogeneic immunotherapy for a variety of malignancies. (Blood. 2001;97:3390-3400)
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Affiliation(s)
- P A McSweeney
- Fred Hutchinson Cancer Research Center, University of Washington School of Medicine, Seattle, WA, USA.
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50
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Abstract
The graft-versus-tumour effect seen after allogeneic (genetically different) haematopoietic cell transplantation for human malignancies represents the clearest example of the power of the human immune system to eradicate cancer. Recent advances in our understanding of the immunobiology of stem-cell engraftment, tolerance and tumour eradication are allowing clinicians to better harness this powerful effect.
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Affiliation(s)
- F R Appelbaum
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, D5-310, PO Box 19024, Seattle, Washington 98109-1024, USA
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