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Jimenez-Chillon C, Othman J, Taussig D, Jimenez-Vicente C, Martinez-Roca A, Tiong IS, Jain M, Aries J, Cakmak S, Knapper S, Kristensen DT, Murthy V, Galani JZ, Kallmeyer C, Ngu L, Veale D, Bolam S, Orfali N, Parker A, Manson C, Parker J, Erblich T, Richardson D, Mokretar K, Potter N, Overgaard UM, Roug AS, Wei AH, Esteve J, Jädersten M, Russell N, Dillon R. Venetoclax-based low intensity therapy in molecular failure of NPM1-mutated AML. Blood Adv 2024; 8:343-352. [PMID: 38039513 PMCID: PMC10788851 DOI: 10.1182/bloodadvances.2023011106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/26/2023] [Accepted: 11/06/2023] [Indexed: 12/03/2023] Open
Abstract
ABSTRACT Molecular failure in NPM1-mutated acute myeloid leukemia (AML) inevitably progresses to frank relapse if untreated. Recently published small case series show that venetoclax combined with low-dose cytarabine or azacitidine can reduce or eliminate measurable residual disease (MRD). Here, we report on an international multicenter cohort of 79 patients treated for molecular failure with venetoclax combinations and report an overall molecular response (≥1-log reduction in MRD) in 66 patients (84%) and MRD negativity in 56 (71%). Eighteen of 79 patients (23%) required hospitalization, and no deaths were reported during treatment. Forty-one patients were bridged to allogeneic transplant with no further therapy, and 25 of 41 were MRD negative assessed by reverse transcription quantitative polymerase chain reaction before transplant. Overall survival (OS) for the whole cohort at 2 years was 67%, event-free survival (EFS) was 45%, and in responding patients, there was no difference in survival in those who received a transplant using time-dependent analysis. Presence of FLT3-ITD mutation was associated with a lower response rate (64 vs 91%; P < .01), worse OS (hazard ratio [HR], 2.50; 95% confidence interval [CI], 1.06-5.86; P = .036), and EFS (HR, 1.87; 95% CI, 1.06-3.28; P = .03). Eighteen of 35 patients who did not undergo transplant became MRD negative and stopped treatment after a median of 10 months, with 2-year molecular relapse free survival of 62% from the end of treatment. Venetoclax-based low intensive chemotherapy is a potentially effective treatment for molecular relapse in NPM1-mutated AML, either as a bridge to transplant or as definitive therapy.
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Affiliation(s)
- Carlos Jimenez-Chillon
- Servicio de Hematología y Hemoterapia, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Department of Medical & Molecular Genetics, King’s College London, London, United Kingdom
| | - Jad Othman
- Department of Medical & Molecular Genetics, King’s College London, London, United Kingdom
- Guy’s and St Thomas Hospital, London, United Kingdom
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - David Taussig
- Department of Haematology, Royal Marsden Hospital, Sutton, United Kingdom
| | | | - Alexandra Martinez-Roca
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - Ing Soo Tiong
- Peter MacCallum Cancer Centre, Royal Melbourne Hospital and Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Alfred Hospital and Monash University, Melbourne, VIC, Australia
- Austin Health and Olivia Newton John Cancer Research Institute, Melbourne, VIC, Australia
| | - Manish Jain
- Department of Haematology, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - James Aries
- Department of Haemato-Oncology, St Bartholomew’s Hospital, London, United Kingdom
| | - Seda Cakmak
- Department of Haemato-Oncology, St Bartholomew’s Hospital, London, United Kingdom
| | - Steven Knapper
- Department of Haematology, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Daniel Tuyet Kristensen
- Department of Haematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Vidhya Murthy
- Department of Haematology, University Hospitals of Birmingham, Birmingham, United Kingdom
| | | | | | - Loretta Ngu
- Department of Haematology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
| | - David Veale
- Department of Haematology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
| | - Simon Bolam
- Department of Haematology, Taunton and Somerset NHS Foundation Trust, Taunton, United Kingdom
| | - Nina Orfali
- Department of Haematology, St. James's Hospital, Dublin, Ireland
| | - Anne Parker
- Department of Haematology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Cara Manson
- Department of Haematology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Jane Parker
- Department of Haematology, Northampton General Hospital, Northampton, United Kingdom
| | - Thomas Erblich
- Department of Haematology, The London Clinic, London, United Kingdom
| | - Deborah Richardson
- Department of Haematology, University Hospital Southampton, Southampton, United Kingdom
| | | | - Nicola Potter
- Department of Medical & Molecular Genetics, King’s College London, London, United Kingdom
| | - Ulrik Malthe Overgaard
- Department of Haematology, Rigshospitalet, Copenhagen, Denmark
- Department of Haematology, National Hospital, Copenhagen, Denmark
| | - Anne Stidsholt Roug
- Department of Haematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Andrew H. Wei
- Peter MacCallum Cancer Centre, Royal Melbourne Hospital and Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - Jordi Esteve
- Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - Martin Jädersten
- Department of Medicine, Center for Haematology and Regenerative Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Haematology, Karolinska University Hospital, Stockholm, Sweden
| | - Nigel Russell
- Guy’s and St Thomas Hospital, London, United Kingdom
| | - Richard Dillon
- Department of Medical & Molecular Genetics, King’s College London, London, United Kingdom
- Guy’s and St Thomas Hospital, London, United Kingdom
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2
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Russell NH, Wilhelm-Benartzi C, Othman J, Dillon R, Knapper S, Batten LM, Canham J, Hinson EL, Betteridge S, Overgaard UM, Gilkes A, Potter N, Mehta P, Kottaridis P, Cavenagh J, Hemmaway C, Arnold C, Freeman SD, Dennis M. Fludarabine, Cytarabine, Granulocyte Colony-Stimulating Factor, and Idarubicin With Gemtuzumab Ozogamicin Improves Event-Free Survival in Younger Patients With Newly Diagnosed AML and Overall Survival in Patients With NPM1 and FLT3 Mutations. J Clin Oncol 2024:JCO2300943. [PMID: 38215358 DOI: 10.1200/jco.23.00943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/07/2023] [Accepted: 10/20/2023] [Indexed: 01/14/2024] Open
Abstract
PURPOSE To determine the optimal induction chemotherapy regimen for younger adults with newly diagnosed AML without known adverse risk cytogenetics. PATIENTS AND METHODS One thousand thirty-three patients were randomly assigned to intensified (fludarabine, cytarabine, granulocyte colony-stimulating factor, and idarubicin [FLAG-Ida]) or standard (daunorubicin and Ara-C [DA]) induction chemotherapy, with one or two doses of gemtuzumab ozogamicin (GO). The primary end point was overall survival (OS). RESULTS There was no difference in remission rate after two courses between FLAG-Ida + GO and DA + GO (complete remission [CR] + CR with incomplete hematologic recovery 93% v 91%) or in day 60 mortality (4.3% v 4.6%). There was no difference in OS (66% v 63%; P = .41); however, the risk of relapse was lower with FLAG-Ida + GO (24% v 41%; P < .001) and 3-year event-free survival was higher (57% v 45%; P < .001). In patients with an NPM1 mutation (30%), 3-year OS was significantly higher with FLAG-Ida + GO (82% v 64%; P = .005). NPM1 measurable residual disease (MRD) clearance was also greater, with 88% versus 77% becoming MRD-negative in peripheral blood after cycle 2 (P = .02). Three-year OS was also higher in patients with a FLT3 mutation (64% v 54%; P = .047). Fewer transplants were performed in patients receiving FLAG-Ida + GO (238 v 278; P = .02). There was no difference in outcome according to the number of GO doses, although NPM1 MRD clearance was higher with two doses in the DA arm. Patients with core binding factor AML treated with DA and one dose of GO had a 3-year OS of 96% with no survival benefit from FLAG-Ida + GO. CONCLUSION Overall, FLAG-Ida + GO significantly reduced relapse without improving OS. However, exploratory analyses show that patients with NPM1 and FLT3 mutations had substantial improvements in OS. By contrast, in patients with core binding factor AML, outcomes were excellent with DA + GO with no FLAG-Ida benefit.
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Affiliation(s)
- Nigel H Russell
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Jad Othman
- Department of Medical and Molecular Genetics, Kings College London, London, United Kingdom
| | - Richard Dillon
- Department of Medical and Molecular Genetics, Kings College London, London, United Kingdom
| | - Steven Knapper
- School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Leona M Batten
- Centre for Trials Research, Cardiff University, Cardiff, United Kindgom
| | - Joanna Canham
- Centre for Trials Research, Cardiff University, Cardiff, United Kindgom
| | - Emily L Hinson
- Centre for Trials Research, Cardiff University, Cardiff, United Kindgom
| | - Sophie Betteridge
- Centre for Trials Research, Cardiff University, Cardiff, United Kindgom
| | | | - Amanda Gilkes
- School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Nicola Potter
- Department of Medical and Molecular Genetics, Kings College London, London, United Kingdom
| | - Priyanka Mehta
- University Hospitals of Bristol and Weston NHS Trust, Bristol, United Kingdom
| | | | - Jamie Cavenagh
- Department of Haematology, St Bartholomew's Hospital, London, United Kingdom
| | | | | | - Sylvie D Freeman
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Mike Dennis
- The Christie NHS Foundation Trust, Manchester, United Kingdom
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3
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Brierley CK, Yip BH, Orlando G, Goyal H, Wen S, Wen J, Levine MF, Jakobsdottir GM, Rodriguez-Meira A, Adamo A, Bashton M, Hamblin A, Clark SA, O'Sullivan J, Murphy L, Olijnik AA, Cotton A, Narina S, Pruett-Miller SM, Enshaei A, Harrison C, Drummond M, Knapper S, Tefferi A, Antony-Debré I, Thongjuea S, Wedge DC, Constantinescu S, Papaemmanuil E, Psaila B, Crispino JD, Mead AJ. Chromothripsis orchestrates leukemic transformation in blast phase MPN through targetable amplification of DYRK1A. bioRxiv 2023:2023.12.08.570880. [PMID: 38106192 PMCID: PMC10723394 DOI: 10.1101/2023.12.08.570880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Chromothripsis, the process of catastrophic shattering and haphazard repair of chromosomes, is a common event in cancer. Whether chromothripsis might constitute an actionable molecular event amenable to therapeutic targeting remains an open question. We describe recurrent chromothripsis of chromosome 21 in a subset of patients in blast phase of a myeloproliferative neoplasm (BP-MPN), which alongside other structural variants leads to amplification of a region of chromosome 21 in ∼25% of patients ('chr21amp'). We report that chr21amp BP-MPN has a particularly aggressive and treatment-resistant phenotype. The chr21amp event is highly clonal and present throughout the hematopoietic hierarchy. DYRK1A , a serine threonine kinase and transcription factor, is the only gene in the 2.7Mb minimally amplified region which showed both increased expression and chromatin accessibility compared to non-chr21amp BP-MPN controls. We demonstrate that DYRK1A is a central node at the nexus of multiple cellular functions critical for BP-MPN development, including DNA repair, STAT signalling and BCL2 overexpression. DYRK1A is essential for BP-MPN cell proliferation in vitro and in vivo , and DYRK1A inhibition synergises with BCL2 targeting to induce BP-MPN cell apoptosis. Collectively, these findings define the chr21amp event as a prognostic biomarker in BP-MPN and link chromothripsis to a druggable target.
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4
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Fang Z, Corbizi Fattori G, McKerrell T, Boucher RH, Jackson A, Fletcher RS, Forte D, Martin JE, Fox S, Roberts J, Glover R, Harris E, Bridges HR, Grassi L, Rodriguez-Meira A, Mead AJ, Knapper S, Ewing J, Butt NM, Jain M, Francis S, Clark FJ, Coppell J, McMullin MF, Wadelin F, Narayanan S, Milojkovic D, Drummond MW, Sekhar M, ElDaly H, Hirst J, Paramor M, Baxter EJ, Godfrey AL, Harrison CN, Méndez-Ferrer S. Tamoxifen for the treatment of myeloproliferative neoplasms: A Phase II clinical trial and exploratory analysis. Nat Commun 2023; 14:7725. [PMID: 38001082 PMCID: PMC10673935 DOI: 10.1038/s41467-023-43175-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023] Open
Abstract
Current therapies for myeloproliferative neoplasms (MPNs) improve symptoms but have limited effect on tumor size. In preclinical studies, tamoxifen restored normal apoptosis in mutated hematopoietic stem/progenitor cells (HSPCs). TAMARIN Phase-II, multicenter, single-arm clinical trial assessed tamoxifen's safety and activity in patients with stable MPNs, no prior thrombotic events and mutated JAK2V617F, CALRins5 or CALRdel52 peripheral blood allele burden ≥20% (EudraCT 2015-005497-38). 38 patients were recruited over 112w and 32 completed 24w-treatment. The study's A'herns success criteria were met as the primary outcome ( ≥ 50% reduction in mutant allele burden at 24w) was observed in 3/38 patients. Secondary outcomes included ≥25% reduction at 24w (5/38), ≥50% reduction at 12w (0/38), thrombotic events (2/38), toxicities, hematological response, proportion of patients in each IWG-MRT response category and ELN response criteria. As exploratory outcomes, baseline analysis of HSPC transcriptome segregates responders and non-responders, suggesting a predictive signature. In responder HSPCs, longitudinal analysis shows high baseline expression of JAK-STAT signaling and oxidative phosphorylation genes, which are downregulated by tamoxifen. We further demonstrate in preclinical studies that in JAK2V617F+ cells, 4-hydroxytamoxifen inhibits mitochondrial complex-I, activates integrated stress response and decreases pathogenic JAK2-signaling. These results warrant further investigation of tamoxifen in MPN, with careful consideration of thrombotic risk.
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Affiliation(s)
- Zijian Fang
- Wellcome-MRC Cambridge Stem Cell Institute, Cambridge, UK
- Department of Haematology, University of Cambridge, Cambridge, UK
- NHS Blood and Transplant, Cambridge, UK
| | - Giuditta Corbizi Fattori
- Wellcome-MRC Cambridge Stem Cell Institute, Cambridge, UK
- Department of Haematology, University of Cambridge, Cambridge, UK
- NHS Blood and Transplant, Cambridge, UK
| | - Thomas McKerrell
- Wellcome-MRC Cambridge Stem Cell Institute, Cambridge, UK
- NHS Blood and Transplant, Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Rebecca H Boucher
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Aimee Jackson
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Rachel S Fletcher
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Dorian Forte
- Wellcome-MRC Cambridge Stem Cell Institute, Cambridge, UK
- Department of Haematology, University of Cambridge, Cambridge, UK
- NHS Blood and Transplant, Cambridge, UK
| | - Jose-Ezequiel Martin
- Cancer Molecular Diagnostic Laboratory, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Sonia Fox
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - James Roberts
- Department of Haematology, University of Cambridge, Cambridge, UK
| | - Rachel Glover
- Department of Haematology, University of Cambridge, Cambridge, UK
| | - Erica Harris
- Department of Haematology, University of Cambridge, Cambridge, UK
| | - Hannah R Bridges
- MRC Mitochondrial Biology Unit, University of Cambridge, Cambridge, UK
| | - Luigi Grassi
- Department of Haematology, University of Cambridge, Cambridge, UK
| | - Alba Rodriguez-Meira
- NIHR Biomedical Research Centre and MRC Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Adam J Mead
- NIHR Biomedical Research Centre and MRC Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | | | - Joanne Ewing
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Nauman M Butt
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | | | | | - Fiona J Clark
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | | | | | | | | | | | | - Hesham ElDaly
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Judy Hirst
- MRC Mitochondrial Biology Unit, University of Cambridge, Cambridge, UK
| | - Maike Paramor
- Wellcome-MRC Cambridge Stem Cell Institute, Cambridge, UK
| | - E Joanna Baxter
- Department of Haematology, University of Cambridge, Cambridge, UK
| | - Anna L Godfrey
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Simón Méndez-Ferrer
- Wellcome-MRC Cambridge Stem Cell Institute, Cambridge, UK.
- Department of Haematology, University of Cambridge, Cambridge, UK.
- NHS Blood and Transplant, Cambridge, UK.
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5
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Freeman SD, Thomas A, Thomas I, Hills RK, Vyas P, Gilkes A, Metzner M, Jakobsen NA, Kennedy A, Moore R, Almuina NM, Burns S, King S, Andrew G, Gallagher KME, Sellar RS, Cahalin P, Weber D, Dennis M, Mehta P, Knapper S, Russell NH. Fractionated vs single-dose gemtuzumab ozogamicin with determinants of benefit in older patients with AML: the UK NCRI AML18 trial. Blood 2023; 142:1697-1707. [PMID: 37595359 PMCID: PMC10667325 DOI: 10.1182/blood.2023020630] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/25/2023] [Accepted: 08/08/2023] [Indexed: 08/20/2023] Open
Abstract
Addition of gemtuzumab ozogamicin (GO) to induction chemotherapy improves outcomes in older patients with acute myeloid leukemia (AML), but it is uncertain whether a fractionated schedule provides additional benefit to a single dose. We randomized 852 older adults (median age, 68-years) with AML/high-risk myelodysplasia to GO on day 1 (GO1) or on days 1 and 4 (GO2) of course 1 induction. The median follow-up period was 50.2 months. Although complete remission (CR) rates after course 1 did not significantly differ between arms (GO2, 63%; GO1, 57%; odds ratio [OR], 0.78; P = .08), there were significantly more patients who achieved CR with a measurable residual disease (MRD)<0.1% (50% vs 41%; OR, 0.72; P = .027). This differential MRD reduction with GO2 varied across molecular subtypes, being greatest for IDH mutations. The 5-year overall survival (OS) was 29% for patients in the GO2 arm and 24% for those in the GO1 arm (hazard ratio [HR], 0.89; P = .14). In a sensitivity analysis excluding patients found to have adverse cytogenetics or TP53 mutations, the 5-year OS was 33% for GO2 and 26% for GO1 (HR, 0.83; P = .045). In total, 228 (27%) patients received an allogeneic transplantation in first remission. Posttransplant OS was superior in the GO2 arm (HR, 0.67; P = .033); furthermore, the survival advantage from GO2 in the sensitivity analysis was lost when data of patients were censored at transplantation. In conclusion, GO2 was associated with a greater reduction in MRD and improved survival in older adults with nonadverse risk genetics. This benefit from GO2 was dependent on allogeneic transplantation to translate the better leukemia clearance into improved survival. This trial was registered at www.isrctn.com as #ISRCTN 31682779.
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Affiliation(s)
- Sylvie D. Freeman
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Abin Thomas
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Ian Thomas
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Robert K. Hills
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Paresh Vyas
- Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Amanda Gilkes
- Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Marlen Metzner
- Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Niels Asger Jakobsen
- Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Alison Kennedy
- Wellcome, Medical Research Council Cambridge Stem Cell Institute, University of Cambridge, Cambridge, United Kingdom
| | - Rachel Moore
- Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Sarah Burns
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Sophie King
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Georgia Andrew
- Laboratory of Myeloid Malignancies, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Kathleen M. E. Gallagher
- Cellular Immunotherapy Program, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Rob S. Sellar
- UCL Cancer Institute and University College London Hospital, London, United Kingdom
| | - Paul Cahalin
- Blackpool Teaching Hospitals National Health Service Foundation Trust, Blackpool, United Kingdom
| | | | - Mike Dennis
- The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Priyanka Mehta
- The University of Bristol and Weston National Health Service Trust, Bristol, United Kingdom
| | - Steven Knapper
- Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Nigel H. Russell
- Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
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6
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Othman J, Potter N, Mokretar K, Taussig D, Khan A, Krishnamurthy P, Latif AL, Cahalin P, Aries J, Amer M, Belsham E, Conneally E, Craddock C, Culligan D, Dennis M, Duncan C, Freeman SD, Furness C, Gilkes A, Gkreka P, Hodgson K, Ingram W, Jain M, King A, Knapper S, Kottaridis P, McMullin MF, Mohite U, Ngu L, O'Nions J, Patrick K, Rider T, Roberts W, Severinsen MT, Storrar N, Taylor T, Russell NH, Dillon R. FLT3 inhibitors as MRD-guided salvage treatment for molecular failure in FLT3 mutated AML. Leukemia 2023; 37:2066-2072. [PMID: 37558736 PMCID: PMC10539160 DOI: 10.1038/s41375-023-01994-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/17/2023] [Accepted: 08/02/2023] [Indexed: 08/11/2023]
Abstract
Patients with FLT3-mutated AML have a high relapse rate and suboptimal outcomes. Many have co-mutations suitable for measurable residual disease (MRD) monitoring by RT-qPCR and those destined to relapse can be identified by high or rising levels of MRD, called molecular failure. This provides a window for pre-emptive intervention, but there is little evidence to guide treatment. The use of FLT3 inhibitors (FLT3i) appears attractive but their use has not yet been evaluated. We identified 56 patients treated with FLT3i at molecular failure. The FLT3 mutation was an ITD in 52, TKD in 7 and both in 3. Over half of patients had previously received midostaurin. Molecular failure occurred at a median 9.2 months from diagnosis and was treated with gilteritinib (n = 38), quizartinib (n = 7) or sorafenib (n = 11). 60% achieved a molecular response, with 45% reaching MRD negativity. Haematological toxicity was low, and 22 patients were bridged directly to allogeneic transplant with another 6 to donor lymphocyte infusion. 2-year overall survival was 80% (95%CI 69-93) and molecular event-free survival 56% (95%CI 44-72). High-sensitivity next-generation sequencing for FLT3-ITD at molecular failure identified patients more likely to benefit. FLT3i monotherapy for molecular failure is a promising strategy which merits evaluation in prospective studies.
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Affiliation(s)
- Jad Othman
- Department of Medical and Molecular Genetics, King's College London, London, England, UK
- Guy's and St Thomas' NHS Foundation Trust, London, England, UK
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Nicola Potter
- Department of Medical and Molecular Genetics, King's College London, London, England, UK
| | | | - David Taussig
- The Royal Marsden NHS Foundation Trust, London, England, UK
| | - Anjum Khan
- Leeds Teaching Hospitals NHS Trust, Leeds, England, UK
| | | | | | - Paul Cahalin
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, England, UK
| | - James Aries
- Barts Cancer Institute, Queen Mary University of London, London, England, UK
| | - Mariam Amer
- University Hospital Southampton, Southampton, England, UK
| | | | | | | | | | - Mike Dennis
- The Christie NHS Foundation Trust, Manchester, England, UK
| | | | - Sylvie D Freeman
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, Scotland, UK
| | | | - Amanda Gilkes
- Department of Haematology, Cardiff University, Cardiff, Wales, UK
| | | | | | | | - Manish Jain
- Leeds Teaching Hospitals NHS Trust, Leeds, England, UK
| | - Andrew King
- Addenbrooke's Hospital, Cambridge, England, UK
| | - Steven Knapper
- School of Medicine, Cardiff University, Cardiff, Wales, UK
| | | | | | | | - Loretta Ngu
- Royal Devon & Exeter NHS Foundation Trust, Exeter, England, UK
| | - Jenny O'Nions
- University College London Hospital NHS Foundation Trust, London, England, UK
| | | | - Tom Rider
- The Royal Sussex County Hospital, Brighton and Hove, England, UK
| | - Wing Roberts
- Great North Children's Hospital, Newcastle upon Tyne, England, UK
| | - Marianne Tang Severinsen
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | | | - Tom Taylor
- Nottingham University Hospital, Nottingham, England, UK
| | - Nigel H Russell
- Guy's and St Thomas' NHS Foundation Trust, London, England, UK
| | - Richard Dillon
- Department of Medical and Molecular Genetics, King's College London, London, England, UK.
- Guy's and St Thomas' NHS Foundation Trust, London, England, UK.
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7
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Harrison CN, Nangalia J, Boucher R, Jackson A, Yap C, O'Sullivan J, Fox S, Ailts I, Dueck AC, Geyer HL, Mesa RA, Dunn WG, Nadezhdin E, Curto-Garcia N, Green A, Wilkins B, Coppell J, Laurie J, Garg M, Ewing J, Knapper S, Crowe J, Chen F, Koutsavlis I, Godfrey A, Arami S, Drummond M, Byrne J, Clark F, Mead-Harvey C, Baxter EJ, McMullin MF, Mead AJ. Ruxolitinib Versus Best Available Therapy for Polycythemia Vera Intolerant or Resistant to Hydroxycarbamide in a Randomized Trial. J Clin Oncol 2023; 41:3534-3544. [PMID: 37126762 PMCID: PMC10306428 DOI: 10.1200/jco.22.01935] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [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] [Received: 08/25/2022] [Revised: 01/20/2023] [Accepted: 03/21/2023] [Indexed: 05/03/2023] Open
Abstract
PURPOSE Polycythemia vera (PV) is characterized by JAK/STAT activation, thrombotic/hemorrhagic events, systemic symptoms, and disease transformation. In high-risk PV, ruxolitinib controls blood counts and improves symptoms. PATIENTS AND METHODS MAJIC-PV is a randomized phase II trial of ruxolitinib versus best available therapy (BAT) in patients resistant/intolerant to hydroxycarbamide (HC-INT/RES). Primary outcome was complete response (CR) within 1 year. Secondary outcomes included duration of response, event-free survival (EFS), symptom, and molecular response. RESULTS One hundred eighty patients were randomly assigned. CR was achieved in 40 (43%) patients on ruxolitinib versus 23 (26%) on BAT (odds ratio, 2.12; 90% CI, 1.25 to 3.60; P = .02). Duration of CR was superior for ruxolitinib (hazard ratio [HR], 0.38; 95% CI, 0.24 to 0.61; P < .001). Symptom responses were better with ruxolitinib and durable. EFS (major thrombosis, hemorrhage, transformation, and death) was superior for patients attaining CR within 1 year (HR, 0.41; 95% CI, 0.21 to 0.78; P = .01); and those on ruxolitinib (HR, 0.58; 95% CI, 0.35 to 0.94; P = .03). Serial analysis of JAK2V617F variant allele fraction revealed molecular response was more frequent with ruxolitinib and was associated with improved outcomes (progression-free survival [PFS] P = .001, EFS P = .001, overall survival P = .01) and clearance of JAK2V617F stem/progenitor cells. ASXL1 mutations predicted for adverse EFS (HR, 3.02; 95% CI, 1.47 to 6.17; P = .003). The safety profile of ruxolitinib was as previously reported. CONCLUSION The MAJIC-PV study demonstrates ruxolitinib treatment benefits HC-INT/RES PV patients with superior CR, and EFS as well as molecular response; importantly also demonstrating for the first time, to our knowledge, that molecular response is linked to EFS, PFS, and OS.
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Affiliation(s)
- Claire N. Harrison
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Jyoti Nangalia
- Wellcome-MRC Cambridge Stem Cell Institute, University of Cambridge, Cambridge, United Kingdom
- Wellcome Sanger Institute Hinxton, Cambridgeshire, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Rebecca Boucher
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Aimee Jackson
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Christina Yap
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, United Kingdom
| | - Jennifer O'Sullivan
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- Medical Research Council (MRC) Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, NIHR, Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Sonia Fox
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Isaak Ailts
- Department of Internal Medicine, Mayo Clinic, Phoenix, AZ
| | - Amylou C. Dueck
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ
| | - Holly L. Geyer
- Department of Internal Medicine, Mayo Clinic, Phoenix, AZ
| | - Ruben A. Mesa
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, TX
| | - William G. Dunn
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Eugene Nadezhdin
- Wellcome Sanger Institute Hinxton, Cambridgeshire, United Kingdom
| | - Natalia Curto-Garcia
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Anna Green
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Bridget Wilkins
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Jason Coppell
- Royal Devon & Exeter NHS Foundation Trust, Exeter, United Kingdom
| | - John Laurie
- Worthing Hospital, Western Sussex NHS Foundation Trust, Worthing, United Kingdom
| | - Mamta Garg
- University Hospital of Leicester, Leicester, United Kingdom
| | - Joanne Ewing
- Birmingham Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - Steven Knapper
- School of Medicine, Cardiff University, Cardiff, United Kingdom
| | | | | | - Ioannis Koutsavlis
- Western General Hospital, Lothian Health Board, Edinburgh, United Kingdom
| | - Anna Godfrey
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Siamak Arami
- London North West Healthcare NHS Trust, London, United Kingdom
| | - Mark Drummond
- The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Jennifer Byrne
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Fiona Clark
- Queen Elizabeth Hospital, Birmingham, United Kingdom
| | | | - Elizabeth Joanna Baxter
- Haematology, Cambridge Blood and Stem Cell Biobank NHS-BT Cambridge Centre, Cambridge, United Kingdom
| | | | - Adam J. Mead
- Medical Research Council (MRC) Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, NIHR, Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
- Cancer and Haematology Centre, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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8
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Wolf J, Thomas I, Stanworth S, Knapper S, Griffin J. Leukocytapheresis in the management of adults with acute myeloid leukaemia: A survey of AML treating centres highlighting variability in practice. Transfus Med 2023; 33:181-187. [PMID: 36260030 DOI: 10.1111/tme.12929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/01/2022] [Accepted: 10/03/2022] [Indexed: 12/01/2022]
Affiliation(s)
| | - Ian Thomas
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, UK
| | - Simon Stanworth
- Transfusion Medicine, NHS Blood and Transplant, Oxford, UK
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- University of Oxford, Oxford, UK
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9
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Dennis M, Thomas IF, Ariti C, Upton L, Burnett AK, Gilkes A, Radia R, Hemmaway C, Mehta P, Knapper S, Clark RE, Copland M, Russell N, Hills RK. Randomized evaluation of quizartinib and low-dose ara-C vs low-dose ara-C in older acute myeloid leukemia patients. Blood Adv 2021; 5:5621-5625. [PMID: 34597366 PMCID: PMC8714727 DOI: 10.1182/bloodadvances.2021005038] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/02/2021] [Indexed: 11/20/2022] Open
Abstract
Survival for older patients with acute myeloid leukemia (AML) unsuitable for intensive chemotherapy is unsatisfactory. Standard nonintensive therapies have low response rates and only extend life by a few months. Quizartinib is an oral Fms-like tyrosine kinase 3 (FLT3) inhibitor with reported activity in wild-type patients. As part of the AML LI trial, we undertook a randomized evaluation of low-dose ara-C (LDAC) with or without quizartinib in patients not fit for intensive chemotherapy. Overall, survival was not improved (202 patients), but in the 27 FLT3-ITD patients, the addition of quizartinib to LDAC improved response (P = .05) with complete remission/complete remission with incomplete haematological recovery for quizartinib + LDAC in 5/13 (38%) vs 0/14 (0%) in patients receiving LDAC alone. Overall survival (OS) in these FLT3-ITD+ patients was also significantly improved at 2 years for quizartinib + LDAC (hazard ratio 0.36; 95% confidence intervals: 0.16, 0.85, P = .04). Median OS was 13.7 months compared with 4.2 months with LDAC alone. This is the first report of an FLT3-targeted therapy added to standard nonintensive chemotherapy that has improved survival in this population. Quizartinib merits consideration for future triplet-based treatment approaches. This trial was registered at www.clinicaltrials.gov as ISRCTN #ISRCTN40571019 and EUDRACT @2011-000749-19.
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Affiliation(s)
| | - Ian F. Thomas
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Cono Ariti
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Laura Upton
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Alan K. Burnett
- Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Amanda Gilkes
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Rohini Radia
- Department of Haematology, Nottingham University Hospital, Nottingham, United Kingdom
| | | | - Priyanka Mehta
- Department of Haematology, Queen's Hospital, Romford, United Kingdom
- Department of Haematology, University Hospitals Bristol, Bristol, United Kingdom
| | - Steven Knapper
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Richard E. Clark
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom; and
| | - Mhairi Copland
- Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Nigel Russell
- Department of Haematology, Nottingham University Hospital, Nottingham, United Kingdom
| | - Robert K. Hills
- Nuffield Department of Population Health, Oxford, United Kingdom
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10
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Salisbury RA, Curto-Garcia N, O'Sullivan J, Chen F, Polzella P, Godfrey AL, Russell J, Knapper S, Willan J, Frewin R, Joshi S, Arami S, Burns S, Teh CH, Wadelin F, Dhanapal J, Neelakantan P, Milojkovic D, Psaila B, Szydlo R, Francis S, Cargo C, Jain M, McGregor A, Wallis L, Duncombe A, Hussein H, Dyer P, Munro L, Bond L, McMullin MF, Somervaille TCP, Garg M, Sekhar M, Harrison C, Mead AJ, Innes AJ. Results of a national UK physician reported survey of COVID-19 infection in patients with a myeloproliferative neoplasm. Leukemia 2021; 35:2424-2430. [PMID: 33580204 PMCID: PMC7880652 DOI: 10.1038/s41375-021-01143-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/20/2020] [Accepted: 01/18/2021] [Indexed: 01/29/2023]
Affiliation(s)
- Richard A Salisbury
- NIHR Biomedical Research Centre and MRC Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | | | - Jennifer O'Sullivan
- NIHR Biomedical Research Centre and MRC Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Frederick Chen
- Department of Haematology, Barts Health NHS Trust, London, UK
| | - Paolo Polzella
- Department of Haematology, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
| | - Anna L Godfrey
- Department of Haematology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - James Russell
- Department of Haematology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Steven Knapper
- Division of Cancer and Genetics, Cardiff University, Cardiff, UK
| | - John Willan
- Department of Haematology, Frimley Health NHS Foundation Trust, Slough, UK
| | - Rebecca Frewin
- Department of Haematology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Shivani Joshi
- Department of Haematology, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Siamak Arami
- Department of Haematology, London Northwest Healthcare University NHS Trust, Harrow, UK
| | - Sarah Burns
- Department of Haematology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Chun Huat Teh
- Department of Haematology, Western General Hospital, Edinburgh, UK
| | - Frances Wadelin
- Department of Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jaymathi Dhanapal
- Department of Haematology, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Pratap Neelakantan
- Department of Haematology, Royal Berkshire NHS Foundation Trust, Reading, UK
| | | | - Beth Psaila
- NIHR Biomedical Research Centre and MRC Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Richard Szydlo
- Centre for Haematology, Imperial College London, London, UK
| | - Sebastian Francis
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Catherine Cargo
- Department of Haematology, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Manish Jain
- Department of Haematology, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Andrew McGregor
- Department of Haematology, The Newcastle upon Tyne Teaching Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle, UK
| | - Louise Wallis
- Department of Haematology, The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK
| | - Andrew Duncombe
- Department of Haematology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Hayder Hussein
- Department of Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Peter Dyer
- Department of Haematology, University Hospitals of North Midlands NHS Trust, Stoke, UK
| | - Laura Munro
- Department of Haematology, York Teaching Hospital NHS Foundation Trust, York, UK
| | - Lee Bond
- Department of Haematology, York Teaching Hospital NHS Foundation Trust, York, UK
| | | | - Tim C P Somervaille
- Leukaemia Biology Laboratory, Cancer Research UK Manchester Institute, The University of Manchester, Manchester, UK
- The Christie NHS Foundation Trust, Manchester, UK
| | - Mamta Garg
- Department of Haematology, University Hospitals of Leicester NHS Foundation Trust, Leicester, UK
| | - Mallika Sekhar
- Department of Haematology, Royal Free London NHS Foundation Trust, London, UK
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Claire Harrison
- Department of Haematology, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Adam J Mead
- NIHR Biomedical Research Centre and MRC Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK.
| | - Andrew J Innes
- Centre for Haematology, Imperial College London, London, UK.
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11
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Hogan FL, Williams V, Knapper S. FLT3 Inhibition in Acute Myeloid Leukaemia - Current Knowledge and Future Prospects. Curr Cancer Drug Targets 2021; 20:513-531. [PMID: 32418523 DOI: 10.2174/1570163817666200518075820] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 03/12/2020] [Accepted: 03/29/2020] [Indexed: 12/20/2022]
Abstract
Activating mutations of FMS-like tyrosine kinase 3 (FLT3) are present in 30% of acute myeloid leukaemia (AML) patients at diagnosis and confer an adverse clinical prognosis. Mutated FLT3 has emerged as a viable therapeutic target and a number of FLT3-directed tyrosine kinase inhibitors have progressed through clinical development over the last 10-15 years. The last two years have seen United States Food and Drug Administration (US FDA) approvals of the multi-kinase inhibitor midostaurin for newly-diagnosed FLT3-mutated patients, when used in combination with intensive chemotherapy, and of the more FLT3-selective agent gilteritinib, used as monotherapy, for patients with relapsed or treatment-refractory FLT3-mutated AML. The 'second generation' agents, quizartinib and crenolanib, are also at advanced stages of clinical development. Significant challenges remain in negotiating a variety of potential acquired drug resistance mechanisms and in optimizing sequencing of FLT3 inhibitory drugs with existing and novel treatment approaches in different clinical settings, including frontline therapy, relapsed/refractory disease, and maintenance treatment. In this review, the biology of FLT3, the clinical challenge posed by FLT3-mutated AML, the developmental history of the key FLT3-inhibitory compounds, mechanisms of disease resistance, and the future outlook for this group of agents, including current and planned clinical trials, is discussed.
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Affiliation(s)
- Francesca L Hogan
- Department of Haematology, University Hospital of Wales, Cardiff, United Kingdom
| | - Victoria Williams
- Department of Haematology, University Hospital of Wales, Cardiff, United Kingdom
| | - Steven Knapper
- School of Medicine, Cardiff University, Cardiff, United Kingdom
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12
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Rastogi N, Baker S, Man S, Uger RA, Wong M, Coles SJ, Hodges M, Gilkes AF, Knapper S, Darley RL, Tonks A. Use of an anti-CD200-blocking antibody improves immune responses to AML in vitro and in vivo. Br J Haematol 2021; 193:155-159. [PMID: 32996123 PMCID: PMC9851282 DOI: 10.1111/bjh.17125] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/02/2020] [Accepted: 09/04/2020] [Indexed: 01/22/2023]
Abstract
Treatment of relapsed/resistant acute myeloid leukaemia (AML) remains a significant area of unmet patient need, the outlook for most patients remaining extremely poor. A promising approach is to augment the anti-tumour immune response in these patients; most cancers do not activate immune effector cells because they express immunosuppressive ligands. We have previously shown that CD200 (an immunosuppressive ligand) is overexpressed in AML and confers an inferior overall survival compared to CD200low/neg patients. Here we show that a fully human anti-CD200 antibody (TTI-CD200) can block the interaction of CD200 with its receptor and restore AML immune responses in vitro and in vivo.
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MESH Headings
- Animals
- Antibodies, Blocking/immunology
- Antibodies, Blocking/pharmacology
- Antigens, CD/drug effects
- Antigens, CD/immunology
- Antineoplastic Agents, Immunological/therapeutic use
- Case-Control Studies
- Cytokine-Induced Killer Cells/immunology
- Humans
- Immunity/drug effects
- Immunity/immunology
- Immunosuppression Therapy/methods
- Leukemia, Myeloid, Acute/immunology
- Leukemia, Myeloid, Acute/mortality
- Leukemia, Myeloid, Acute/therapy
- Ligands
- Mice
- Models, Animal
- Secondary Prevention/methods
- Transplantation, Heterologous/methods
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Affiliation(s)
- Namrata Rastogi
- Department of HaematologyDivision of Cancer & GeneticsSchool of MedicineCardiff UniversityCardiffCF14 4XNUK
- School of BiosciencesEuropean Cancer Stem Cell Research InstituteCardiff UniversityCardiffCF24 4HQUK
| | - Sarah Baker
- Department of HaematologyDivision of Cancer & GeneticsSchool of MedicineCardiff UniversityCardiffCF14 4XNUK
| | - Stephen Man
- Department of HaematologyDivision of Cancer & GeneticsSchool of MedicineCardiff UniversityCardiffCF14 4XNUK
| | | | - Mark Wong
- Trillium Therapeutics IncMississaugaONCanada
| | - Steven J. Coles
- School of Science and the EnvironmentUniversity of WorcesterWorcestershireWR2 6AJUK
| | - Marie Hodges
- Department of HaematologyDivision of Cancer & GeneticsSchool of MedicineCardiff UniversityCardiffCF14 4XNUK
- Cardiff Experimental and Cancer Medicine Centre (ECMC)School of MedicineCardiff UniversityCardiffCF14 4XNUK
| | - Amanda F. Gilkes
- Department of HaematologyDivision of Cancer & GeneticsSchool of MedicineCardiff UniversityCardiffCF14 4XNUK
- Cardiff Experimental and Cancer Medicine Centre (ECMC)School of MedicineCardiff UniversityCardiffCF14 4XNUK
| | - Steven Knapper
- Department of HaematologyDivision of Cancer & GeneticsSchool of MedicineCardiff UniversityCardiffCF14 4XNUK
| | - Richard L. Darley
- Department of HaematologyDivision of Cancer & GeneticsSchool of MedicineCardiff UniversityCardiffCF14 4XNUK
| | - Alex Tonks
- Department of HaematologyDivision of Cancer & GeneticsSchool of MedicineCardiff UniversityCardiffCF14 4XNUK
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13
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Legge SE, Christensen RH, Petersen L, Pardiñas AF, Bracher-Smith M, Knapper S, Bybjerg-Grauholm J, Baekvad-Hansen M, Hougaard DM, Werge T, Nordentoft M, Mortensen PB, Owen MJ, O’Donovan MC, Benros ME, Walters JTR. The Duffy-null genotype and risk of infection. Hum Mol Genet 2020; 29:3341-3349. [PMID: 32959868 PMCID: PMC7906776 DOI: 10.1093/hmg/ddaa208] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/16/2020] [Accepted: 09/16/2020] [Indexed: 11/26/2022] Open
Abstract
Many medical treatments, from oncology to psychiatry, can lower white blood cell counts and thus access to these treatments can be restricted to individuals with normal levels of white blood cells, principally in order to minimize risk of serious infection. This adversely affects individuals of African or Middle Eastern ancestries who have on average a reduced number of circulating white blood cells, because of the Duffy-null (CC) genotype at rs2814778 in the ACKR1 gene. Here, we investigate whether the Duffy-null genotype is associated with the risk of infection using the UK Biobank sample and the iPSYCH Danish case-cohort study, two population-based samples from different countries and age ranges. We found that a high proportion of those with the Duffy-null genotype (21%) had a neutrophil count below the threshold often used as a cut-off for access to relevant treatments, compared with 1% of those with the TC/TT genotype. In addition we found that despite its strong association with lower average neutrophil counts, the Duffy-null genotype was not associated with an increased risk of infection, viral or bacterial. These results have widespread implications for the clinical treatment of individuals of African ancestry and indicate that neutrophil thresholds to access treatments could be lowered in individuals with the Duffy-null genotype without an increased risk of infection.
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Affiliation(s)
- Sophie E Legge
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff CF24 4HQ, UK
| | - Rune H Christensen
- Copenhagen Research Centre for Mental Health, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen 2605, Denmark
| | - Liselotte Petersen
- National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, 8210, Denmark
- Centre for Integrated Register-Based Research, Aarhus University, Aarhus, 8210, Denmark
- The Lundbeck Foundation for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus 8210, Denmark
| | - Antonio F Pardiñas
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff CF24 4HQ, UK
| | - Matthew Bracher-Smith
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff CF24 4HQ, UK
| | - Steven Knapper
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff CF14 4XN, UK
| | - Jonas Bybjerg-Grauholm
- Centre for Neonatal Screening, Department for Congenital Disorders, Statens Serum Institut, Copenhagen 2300, Denmark
| | - Marie Baekvad-Hansen
- Centre for Neonatal Screening, Department for Congenital Disorders, Statens Serum Institut, Copenhagen 2300, Denmark
| | - David M Hougaard
- Centre for Neonatal Screening, Department for Congenital Disorders, Statens Serum Institut, Copenhagen 2300, Denmark
| | - Thomas Werge
- Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Mental Health Services Copenhagen, Roskilde 4000, Denmark
| | - Merete Nordentoft
- Copenhagen Research Centre for Mental Health, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen 2605, Denmark
- The Lundbeck Foundation for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus 8210, Denmark
| | - Preben Bo Mortensen
- National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, 8210, Denmark
- Centre for Integrated Register-Based Research, Aarhus University, Aarhus, 8210, Denmark
- The Lundbeck Foundation for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus 8210, Denmark
| | - Michael J Owen
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff CF24 4HQ, UK
| | - Michael C O’Donovan
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff CF24 4HQ, UK
| | - Michael E Benros
- Copenhagen Research Centre for Mental Health, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen 2605, Denmark
- Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
| | - James T R Walters
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff CF24 4HQ, UK
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14
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Abstract
In contrast to Fms-like tyrosine kinase 3 (FLT3), the influence of FLT3 ligand (FLT3L) on acute myeloid leukemia (AML) biology and disease prognosis has been poorly described. Here we provide an overview of the role played by FLT3L in AML. While being a cytokine implicated in the regulation of hematopoiesis, both in normal situation and after intensive chemotherapy, FLT3L has also a role in enhancing proliferation, inhibiting apoptosis and conferring resistance to FLT3 inhibitors in AML. Moreover, recent independent data show how its measurement may be helpful in the disease management. Indeed, FLT3L could provide a low cost, rapid and noninvasive assessment of chemosensitivity and blast clearance that has robust prognostic significance for patients with AML.
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Affiliation(s)
- Pierre Peterlin
- Hematology Clinic, CHU de Nantes, Nantes, France.,CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France
| | - Patrice Chevallier
- Hematology Clinic, CHU de Nantes, Nantes, France.,CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France
| | - Steven Knapper
- Division of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - Matthew Collin
- Newcastle University Translational and Clinical Research Institute and NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle Upon Tyne, UK
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15
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Dillon R, Hills R, Freeman S, Potter N, Jovanovic J, Ivey A, Kanda AS, Runglall M, Foot N, Valganon M, Khwaja A, Cavenagh J, Smith M, Ommen HB, Overgaard UM, Dennis M, Knapper S, Kaur H, Taussig D, Mehta P, Raj K, Novitzky-Basso I, Nikolousis E, Danby R, Krishnamurthy P, Hill K, Finnegan D, Alimam S, Hurst E, Johnson P, Khan A, Salim R, Craddock C, Spearing R, Gilkes A, Gale R, Burnett A, Russell NH, Grimwade D. Molecular MRD status and outcome after transplantation in NPM1-mutated AML. Blood 2020; 135:680-688. [PMID: 31932839 PMCID: PMC7059484 DOI: 10.1182/blood.2019002959] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 12/11/2019] [Indexed: 12/15/2022] Open
Abstract
Relapse remains the most common cause of treatment failure for patients with acute myeloid leukemia (AML) who undergo allogeneic stem cell transplantation (alloSCT), and carries a grave prognosis. Multiple studies have identified the presence of measurable residual disease (MRD) assessed by flow cytometry before alloSCT as a strong predictor of relapse, but it is not clear how these findings apply to patients who test positive in molecular MRD assays, which have far greater sensitivity. We analyzed pretransplant blood and bone marrow samples by reverse-transcription polymerase chain reaction in 107 patients with NPM1-mutant AML enrolled in the UK National Cancer Research Institute AML17 study. After a median follow-up of 4.9 years, patients with negative, low (<200 copies per 105ABL in the peripheral blood and <1000 copies in the bone marrow aspirate), and high levels of MRD had an estimated 2-year overall survival (2y-OS) of 83%, 63%, and 13%, respectively (P < .0001). Focusing on patients with low-level MRD before alloSCT, those with FLT3 internal tandem duplications(ITDs) had significantly poorer outcome (hazard ratio [HR], 6.14; P = .01). Combining these variables was highly prognostic, dividing patients into 2 groups with 2y-OS of 17% and 82% (HR, 13.2; P < .0001). T-depletion was associated with significantly reduced survival both in the entire cohort (2y-OS, 56% vs 96%; HR, 3.24; P = .0005) and in MRD-positive patients (2y-OS, 34% vs 100%; HR, 3.78; P = .003), but there was no significant effect of either conditioning regimen or donor source on outcome. Registered at ISRCTN (http://www.isrctn.com/ISRCTN55675535).
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MESH Headings
- Adolescent
- Adult
- Aged
- Female
- Hematopoietic Stem Cell Transplantation/mortality
- Humans
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/mortality
- Leukemia, Myeloid, Acute/therapy
- Male
- Middle Aged
- Neoplasm Recurrence, Local/genetics
- Neoplasm Recurrence, Local/mortality
- Neoplasm, Residual/diagnosis
- Neoplasm, Residual/genetics
- Nuclear Proteins/genetics
- Nucleophosmin
- Recurrence
- Young Adult
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Affiliation(s)
- Richard Dillon
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
- Cancer Genetics Service, Viapath, Guy's Hospital, London, United Kingdom
- Department of Haematology, Guy's Hospital, London, United Kingdom
| | - Robert Hills
- Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Sylvie Freeman
- Institute of Immunology and Immunotherapy, University of Birmingham, United Kingdom
| | - Nicola Potter
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
- Cancer Genetics Service, Viapath, Guy's Hospital, London, United Kingdom
| | - Jelena Jovanovic
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
| | - Adam Ivey
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
| | - Anju Shankar Kanda
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
| | - Manohursingh Runglall
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
| | - Nicola Foot
- Cancer Genetics Service, Viapath, Guy's Hospital, London, United Kingdom
| | - Mikel Valganon
- Cancer Genetics Service, Viapath, Guy's Hospital, London, United Kingdom
| | - Asim Khwaja
- Department of Haematology, University College, London, United Kingdom
| | | | | | | | | | - Mike Dennis
- Christie Hospital, Manchester, United Kingdom
| | - Steven Knapper
- Department of Haematology, Cardiff University, Cardiff, United Kingdom
| | - Harpreet Kaur
- Royal Hallamshire Hospital, Sheffield, United Kingdom
| | | | - Priyanka Mehta
- Bristol Haematology and Oncology Centre, Bristol, United Kingdom
| | - Kavita Raj
- Department of Haematology, Guy's Hospital, London, United Kingdom
| | | | | | | | | | - Kate Hill
- University Hospital, Southampton, United Kingdom
| | | | - Samah Alimam
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
- Department of Haematology, Guy's Hospital, London, United Kingdom
| | - Erin Hurst
- Royal Victoria Infirmary, Newcastle, United Kingdom
| | | | - Anjum Khan
- St James' Hospital, Leeds, United Kingdom
| | - Rahuman Salim
- Clatterbridge Cancer Centre, Liverpool, United Kingdom
| | | | | | - Amanda Gilkes
- Department of Haematology, Cardiff University, Cardiff, United Kingdom
| | - Rosemary Gale
- Department of Haematology, University College, London, United Kingdom
| | - Alan Burnett
- Blackwaterfoot, Isle of Arran, United Kingdom; and
| | - Nigel H Russell
- Department of Haematology, Guy's Hospital, London, United Kingdom
- Nottingham University Hospital, Nottingham, United Kingdom
| | - David Grimwade
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
- Department of Haematology, Guy's Hospital, London, United Kingdom
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16
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Alanazi B, Munje CR, Rastogi N, Williamson AJK, Taylor S, Hole PS, Hodges M, Doyle M, Baker S, Gilkes AF, Knapper S, Pierce A, Whetton AD, Darley RL, Tonks A. Integrated nuclear proteomics and transcriptomics identifies S100A4 as a therapeutic target in acute myeloid leukemia. Leukemia 2020; 34:427-440. [PMID: 31611628 PMCID: PMC6995695 DOI: 10.1038/s41375-019-0596-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 09/18/2019] [Accepted: 09/30/2019] [Indexed: 12/20/2022]
Abstract
Inappropriate localization of proteins can interfere with normal cellular function and drive tumor development. To understand how this contributes to the development of acute myeloid leukemia (AML), we compared the nuclear proteome and transcriptome of AML blasts with normal human CD34+ cells. Analysis of the proteome identified networks and processes that significantly affected transcription regulation including misexpression of 11 transcription factors with seven proteins not previously implicated in AML. Transcriptome analysis identified changes in 40 transcription factors but none of these were predictive of changes at the protein level. The highest differentially expressed protein in AML nuclei compared with normal CD34+ nuclei (not previously implicated in AML) was S100A4. In an extended cohort, we found that over-expression of nuclear S100A4 was highly prevalent in AML (83%; 20/24 AML patients). Knock down of S100A4 in AML cell lines strongly impacted their survival whilst normal hemopoietic stem progenitor cells were unaffected. These data are the first analysis of the nuclear proteome in AML and have identified changes in transcription factor expression or regulation of transcription that would not have been seen at the mRNA level. These data also suggest that S100A4 is essential for AML survival and could be a therapeutic target in AML.
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Affiliation(s)
- Bader Alanazi
- Department of Haematology, Division of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, CF14 4XN, Wales, UK
| | - Chinmay R Munje
- Department of Haematology, Division of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, CF14 4XN, Wales, UK
- Paul O'Gorman Leukaemia Research Centre, University of Glasgow, Glasgow, G12 0ZD, UK
| | - Namrata Rastogi
- Department of Haematology, Division of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, CF14 4XN, Wales, UK
| | - Andrew J K Williamson
- Stoller Biomarker Discovery Centre, The University of Manchester, Manchester, M20 3LJ, UK
| | - Samuel Taylor
- Stoller Biomarker Discovery Centre, The University of Manchester, Manchester, M20 3LJ, UK
| | - Paul S Hole
- Department of Haematology, Division of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, CF14 4XN, Wales, UK
| | - Marie Hodges
- Department of Haematology, Division of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, CF14 4XN, Wales, UK
- Cardiff Experimental and Cancer Medicine Centre (ECMC), School of Medicine, Cardiff University, Cardiff, CF14 4XN, Wales, UK
| | - Michelle Doyle
- Department of Haematology, Division of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, CF14 4XN, Wales, UK
- Cardiff Experimental and Cancer Medicine Centre (ECMC), School of Medicine, Cardiff University, Cardiff, CF14 4XN, Wales, UK
| | - Sarah Baker
- Department of Haematology, Division of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, CF14 4XN, Wales, UK
- Cardiff Experimental and Cancer Medicine Centre (ECMC), School of Medicine, Cardiff University, Cardiff, CF14 4XN, Wales, UK
| | - Amanda F Gilkes
- Department of Haematology, Division of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, CF14 4XN, Wales, UK
- Cardiff Experimental and Cancer Medicine Centre (ECMC), School of Medicine, Cardiff University, Cardiff, CF14 4XN, Wales, UK
| | - Steven Knapper
- Department of Haematology, Division of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, CF14 4XN, Wales, UK
| | - Andrew Pierce
- Stoller Biomarker Discovery Centre, The University of Manchester, Manchester, M20 3LJ, UK
| | - Anthony D Whetton
- Stoller Biomarker Discovery Centre, The University of Manchester, Manchester, M20 3LJ, UK
| | - Richard L Darley
- Department of Haematology, Division of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, CF14 4XN, Wales, UK
| | - Alex Tonks
- Department of Haematology, Division of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, CF14 4XN, Wales, UK.
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17
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Milne P, Wilhelm-Benartzi C, Grunwald MR, Bigley V, Dillon R, Freeman SD, Gallagher K, Publicover A, Pagan S, Marr H, Jones GL, Dickinson AM, Grech A, Burnett AK, Russell NH, Levis M, Knapper S, Collin M. Serum Flt3 ligand is a biomarker of progenitor cell mass and prognosis in acute myeloid leukemia. Blood Adv 2019; 3:3052-3061. [PMID: 31648336 PMCID: PMC6849950 DOI: 10.1182/bloodadvances.2019000197] [Citation(s) in RCA: 14] [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] [Received: 03/20/2019] [Accepted: 07/30/2019] [Indexed: 11/20/2022] Open
Abstract
Fms-like tyrosine kinase 3 (Flt3) is expressed on progenitor cells and acute myeloid leukemia (AML) blasts. Fms-like tyrosine kinase 3 ligand (Flt3L) is detectable during homeostasis and increases in hypoplasia due to genetic defects or treatment with cytoreductive agents. Conversely, Flt3+ AML is associated with depletion of Flt3L to undetectable levels. After induction chemotherapy, Flt3L is restored in patients entering complete remission (CR) but remains depressed in those with refractory disease. Weekly sampling reveals marked differences in the kinetics of Flt3L response during the first 6 weeks of treatment, proportionate to the clearance of blasts and cellularity of the bone marrow. In the UK NCRI AML17 trial, Flt3L was measured at day 26 in a subgroup of 140 patients with Flt3 mutation randomized to the tyrosine kinase inhibitor lestaurtinib or placebo. In these patients, attainment of CR was associated with higher Flt3L at day 26 (Mann-Whitney UP < .0001). Day 26 Flt3L was also associated with survival; Flt3L ≤291 pg/mL was associated with inferior event-free survival (EFS), and Flt3L >1185 pg/mL was associated with higher overall survival (OS; P = .0119). The separation of EFS and OS curves increased when minimal residual disease (MRD) status was combined with Flt3L measurement, and Flt3L retained a near-significant association with survival after adjusting for MRD in a proportional hazards model. Serial measurement of Flt3L in patients who had received a hematopoietic stem cell transplant for AML illustrates the potential value of monitoring Flt3L to identify relapse. Measurement of Flt3L is a noninvasive test with the potential to inform clinical decisions in patients with AML.
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Affiliation(s)
- Paul Milne
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
- NIHR Newcastle Biomedical Research Centre at Newcastle upon Tyne Hospitals, Newcastle upon Tyne, United Kingdom
| | - Charlotte Wilhelm-Benartzi
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom
| | - Michael R Grunwald
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Venetia Bigley
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
- NIHR Newcastle Biomedical Research Centre at Newcastle upon Tyne Hospitals, Newcastle upon Tyne, United Kingdom
| | - Richard Dillon
- Department of Medical and Molecular Genetics, King's College, Strand, London, United Kingdom
| | - Sylvie D Freeman
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham Edgbaston, Birmingham, United Kingdom
| | - Kathleen Gallagher
- Immune Monitoring Laboratory, Massachusetts General Hospital Center for Cancer Research, Boston, MA
| | - Amy Publicover
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Sarah Pagan
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
- NIHR Newcastle Biomedical Research Centre at Newcastle upon Tyne Hospitals, Newcastle upon Tyne, United Kingdom
| | - Helen Marr
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Gail L Jones
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Anne M Dickinson
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
- NIHR Newcastle Biomedical Research Centre at Newcastle upon Tyne Hospitals, Newcastle upon Tyne, United Kingdom
| | - Angela Grech
- Department of Haematology, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Alan K Burnett
- Department of Haematology, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Nigel H Russell
- Department of Haematology, Nottingham University Hospital, Nottingham, United Kingdom; and
| | - Mark Levis
- Division of Hematological Malignancies, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD
| | - Steven Knapper
- Department of Haematology, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Matthew Collin
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
- NIHR Newcastle Biomedical Research Centre at Newcastle upon Tyne Hospitals, Newcastle upon Tyne, United Kingdom
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18
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McMullin MFF, Mead AJ, Ali S, Cargo C, Chen F, Ewing J, Garg M, Godfrey A, Knapper S, McLornan DP, Nangalia J, Sekhar M, Wadelin F, Harrison CN. A guideline for the management of specific situations in polycythaemia vera and secondary erythrocytosis: A British Society for Haematology Guideline. Br J Haematol 2019; 184:161-175. [PMID: 30426472 PMCID: PMC6519221 DOI: 10.1111/bjh.15647] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | - Adam J. Mead
- MRC Molecular Haematology UnitMRC Weatherall Institute of Molecular MedicineRadcliffe Department of MedicineUniversity of OxfordOxfordUK
| | - Sahra Ali
- Castle Hill HospitalHull and East Yorkshire Hospitals NHS TrustHullUK
| | | | - Frederick Chen
- The Royal London HospitalBart's Health NHS TrustLondonUK
| | - Joanne Ewing
- Birmingham Heart of England NHS Foundation TrustBirminghamUK
| | - Mamta Garg
- University Hospital of Leicester NHS TrustLeicester (BSH representative)UK
| | - Anna Godfrey
- Department of Haematology and Haematopathology and Oncology Diagnostic ServiceCambridge University Hospitals NHS Foundation TrustCambridgeUK
| | | | | | | | - Mallika Sekhar
- Royal Free London NHS Foundation TrustUniversity College London HospitalLondonUK
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19
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Zabkiewicz J, Gilmour M, Hills R, Vyas P, Bone E, Davidson A, Burnett A, Knapper S. The targeted histone deacetylase inhibitor tefinostat (CHR-2845) shows selective in vitro efficacy in monocytoid-lineage leukaemias. Oncotarget 2017; 7:16650-62. [PMID: 26934551 PMCID: PMC4941341 DOI: 10.18632/oncotarget.7692] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 01/17/2016] [Indexed: 01/18/2023] Open
Abstract
Tefinostat (CHR-2845) is a novel monocyte/macrophage-targeted histone deacetylase (HDAC) inhibitor which is cleaved into its active acid by the intracellular esterase human carboxylesterase-1 (hCE-1). The in vitro efficacy of tefinostat was characterised in cell lines and in a cohort of 73 primary AML and CMML samples. Dose-dependent induction of apoptosis and significant growth inhibitory effects were seen in myelomonocytic (M4), monocytic/monoblastic (M5) and CMML samples in comparison to non-monocytoid AML sub-types (p = 0.007). Importantly, no growth inhibitory effects were seen in normal bone marrow CD34+ cells exposed to AML-toxic doses of tefinostat in clonogenic assays. Expression of hCE-1 was measured by intracellular flow cytometry and immunoblotting across the cohort, with highest levels seen in M5 AML patients. hCE-1 levels correlated with significantly increased tefinostat sensitivity (low EC50) as measured by growth inhibition assays (p = 0.001) and concomitant elevation of the mature monocytoid marker CD14+. Strong induction of intracellular histone protein acetylation was observed in tefinostat-responsive samples, as were high levels of the DNA damage sensor γ-H2A.X, highlighting potential biomarkers of patient responsiveness. Synergistic interaction between tefinostat and the current standard treatment cytarabine was demonstrated in dose response and clonogenic assays using simultaneous drug addition in primary samples (median Combination Index value = 0.51). These data provide a strong rationale for the further clinical evaluation of tefinostat in monocytoid-lineage haematological neoplasms including CMML and monocyte-lineage AMLs.
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Affiliation(s)
- Joanna Zabkiewicz
- Department of Haematology, Experimental Cancer Medicine Centre (ECMC), Institute of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - Marie Gilmour
- Department of Haematology, Experimental Cancer Medicine Centre (ECMC), Institute of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - Robert Hills
- Department of Haematology, Experimental Cancer Medicine Centre (ECMC), Institute of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - Pares Vyas
- Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | | | | | - Alan Burnett
- Department of Haematology, Experimental Cancer Medicine Centre (ECMC), Institute of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - Steven Knapper
- Department of Haematology, Experimental Cancer Medicine Centre (ECMC), Institute of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK
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20
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Harrison CN, Mead AJ, Panchal A, Fox S, Yap C, Gbandi E, Houlton A, Alimam S, Ewing J, Wood M, Chen F, Coppell J, Panoskaltsis N, Knapper S, Ali S, Hamblin A, Scherber R, Dueck AC, Cross NCP, Mesa R, McMullin MF. Ruxolitinib vs best available therapy for ET intolerant or resistant to hydroxycarbamide. Blood 2017; 130:1889-1897. [PMID: 29074595 PMCID: PMC6410531 DOI: 10.1182/blood-2017-05-785790] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [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] [Received: 05/24/2017] [Accepted: 07/24/2017] [Indexed: 01/11/2023] Open
Abstract
Treatments for high-risk essential thrombocythemia (ET) address thrombocytosis, disease-related symptoms, as well as risks of thrombosis, hemorrhage, transformation to myelofibrosis, and leukemia. Patients resistant/intolerant to hydroxycarbamide (HC) have a poor outlook. MAJIC (ISRCTN61925716) is a randomized phase 2 trial of ruxolitinib (JAK1/2 inhibitor) vs best available therapy (BAT) in ET and polycythemia vera patients resistant or intolerant to HC. Here, findings of MAJIC-ET are reported, where the modified intention-to-treat population included 58 and 52 patients randomized to receive ruxolitinib or BAT, respectively. There was no evidence of improvement in complete response within 1 year reported in 27 (46.6%) patients treated with ruxolitinib vs 23 (44.2%) with BAT (P = .40). At 2 years, rates of thrombosis, hemorrhage, and transformation were not significantly different; however, some disease-related symptoms improved in patients receiving ruxolitinib relative to BAT. Molecular responses were uncommon; there were 2 complete molecular responses (CMR) and 1 partial molecular response in CALR-positive ruxolitinib-treated patients. Transformation to myelofibrosis occurred in 1 CMR patient, presumably because of the emergence of a different clone, raising questions about the relevance of CMR in ET patients. Grade 3 and 4 anemia occurred in 19% and 0% of ruxolitinib vs 0% (both grades) in the BAT arm, and grade 3 and 4 thrombocytopenia in 5.2% and 1.7% of ruxolitinib vs 0% (both grades) of BAT-treated patients. Rates of discontinuation or treatment switching did not differ between the 2 trial arms. The MAJIC-ET trial suggests that ruxolitinib is not superior to current second-line treatments for ET. This trial was registered at www.isrctn.com as #ISRCTN61925716.
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Affiliation(s)
| | - Adam J Mead
- Weatherall Institute of Molecular Medicine, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Anesh Panchal
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Sonia Fox
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Christina Yap
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Emmanouela Gbandi
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Aimee Houlton
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Samah Alimam
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Joanne Ewing
- Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - Marion Wood
- Colchester Hospital University NHS Foundation Trust, Colchester, United Kingdom
| | - Frederick Chen
- Centre for Clinical Hematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Jason Coppell
- Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
| | - Nicki Panoskaltsis
- Department of Hematology, London North West Healthcare NHS Trust, London, United Kingdom
| | - Steven Knapper
- Department of Hematology, Cardiff University, Cardiff, United Kingdom
| | - Sahra Ali
- Castle Hill Hospital, Hull, United Kingdom
| | - Angela Hamblin
- NIHR Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Robyn Scherber
- Department of Hematology and Oncology, Oregon Health and Sciences University, Portland, OR
- Mayo Clinic, Phoenix, AZ
| | - Amylou C Dueck
- Division of Health Sciences Research, Mayo Clinic, Scottsdale, AZ
| | - Nicholas C P Cross
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom; and
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21
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Williams J, Heppel NH, Britt-Compton B, Grimstead JW, Jones RE, Tauro S, Bowen DT, Knapper S, Groves M, Hills RK, Pepper C, Baird DM, Fegan C. Telomere length is an independent prognostic marker in MDS but not in de novo AML. Br J Haematol 2017; 178:240-249. [PMID: 28486748 DOI: 10.1111/bjh.14666] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 01/16/2017] [Indexed: 02/11/2024]
Abstract
Telomere dysfunction is implicated in the generation of large-scale genomic rearrangements that drive progression to malignancy. In this study we used high-resolution single telomere length analysis (STELA) to examine the potential role of telomere dysfunction in 80 myelodysplastic syndrome (MDS) and 95 de novo acute myeloid leukaemia (AML) patients. Despite the MDS cohort being older, they had significantly longer telomeres than the AML cohort (P < 0·0001) where telomere length was also significantly shorter in younger AML patients (age <60 years) (P = 0·02) and in FLT3 internal tandem duplication-mutated AML patients (P = 0·03). Using a previously determined telomere length threshold for telomere dysfunction (3·81 kb) did not provide prognostic resolution in AML [Hazard ratio (HR) = 0·68, P = 0·2]. In contrast, the same length threshold was highly prognostic for overall survival in the MDS cohort (HR = 5·0, P < 0·0001). Furthermore, this telomere length threshold was an independent parameter in multivariate analysis when adjusted for age, gender, cytogenetic risk group, number of cytopenias and International Prognostic Scoring System (IPSS) score (HR = 2·27, P < 0·0001). Therefore, telomere length should be assessed in a larger prospective study to confirm its prognostic role in MDS with a view to integrating this variable into a revised IPSS.
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Affiliation(s)
- Jenna Williams
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - Nicole H Heppel
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - Bethan Britt-Compton
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - Julia W Grimstead
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - Rhiannon E Jones
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - Sudhir Tauro
- Department of Haematology, Ninewells Hospital, Dundee, UK
| | - David T Bowen
- Department of Haematology, St James's Institute of Oncology, Leeds, UK
| | - Steven Knapper
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - Michael Groves
- Department of Haematology, Ninewells Hospital, Dundee, UK
| | - Robert K Hills
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - Chris Pepper
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - Duncan M Baird
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - Chris Fegan
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK
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22
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Khan N, Hills RK, Virgo P, Couzens S, Clark N, Gilkes A, Richardson P, Knapper S, Grimwade D, Russell NH, Burnett AK, Freeman SD. Expression of CD33 is a predictive factor for effect of gemtuzumab ozogamicin at different doses in adult acute myeloid leukaemia. Leukemia 2017; 31:1059-1068. [PMID: 27795558 PMCID: PMC5419583 DOI: 10.1038/leu.2016.309] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/05/2016] [Accepted: 10/04/2016] [Indexed: 12/28/2022]
Abstract
It remains unclear in adult acute myeloid leukaemia (AML) whether leukaemic expression of CD33, the target antigen for gemtuzumab ozogamicin (GO), adds prognostic information on GO effectiveness at different doses. CD33 expression quantified in 1583 patients recruited to UK-NCRI-AML17 (younger adults) and UK-NCRI-AML16 (older adults) trials was correlated with clinical outcomes and benefit from GO including a dose randomisation. CD33 expression associated with genetic subgroups, including lower levels in both adverse karyotype and core-binding factor (CBF)-AML, but was not independently prognostic. When comparing GO versus no GO (n=393, CBF-AMLs excluded) by stratified subgroup-adjusted analysis, patients with lowest quartile (Q1) %CD33-positivity had no benefit from GO (relapse risk, HR 2.41 (1.27-4.56), P=0.009 for trend; overall survival, HR 1.52 (0.92-2.52)). However, from the dose randomisation (NCRI-AML17, n=464, CBF-AMLs included), 6 mg/m2 GO only had a relapse benefit without increased early mortality in CD33-low (Q1) patients (relapse risk HR 0.64 (0.36-1.12) versus 1.70 (0.99-2.92) for CD33-high, P=0.007 for trend). Thus CD33 expression is a predictive factor for GO effect in adult AML; although GO does not appear to benefit the non-CBF AML patients with lowest CD33 expression a higher GO dose may be more effective for CD33-low but not CD33-high younger adults.
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MESH Headings
- Adolescent
- Adult
- Age Factors
- Aminoglycosides/administration & dosage
- Aminoglycosides/pharmacology
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/pharmacology
- Biomarkers/analysis
- Dose-Response Relationship, Drug
- Female
- Gemtuzumab
- Humans
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/mortality
- Male
- Middle Aged
- Predictive Value of Tests
- Prognosis
- Recurrence
- Sialic Acid Binding Ig-like Lectin 3/analysis
- Survival Rate
- Treatment Outcome
- Young Adult
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Affiliation(s)
- Naeem Khan
- Department of Clinical Immunology, Institute of Immunology and Immunotherapy, University of Birmingham, Edgbaston Birmingham B15 2TT UK
| | - Robert K Hills
- Institute of Cancer and Genetics, Cardiff University School of Medicine, University Hospital Wales, Heath Park, Cardiff
| | - Paul Virgo
- Department of Immunology, North Bristol NHS Trust, UK
| | - Stephen Couzens
- Institute of Cancer and Genetics, Cardiff University School of Medicine, University Hospital Wales, Heath Park, Cardiff
| | - Nithiya Clark
- Department of Clinical Immunology, Institute of Immunology and Immunotherapy, University of Birmingham, Edgbaston Birmingham B15 2TT UK
| | - Amanda Gilkes
- Institute of Cancer and Genetics, Cardiff University School of Medicine, University Hospital Wales, Heath Park, Cardiff
| | - Peter Richardson
- Department of Clinical Immunology, Institute of Immunology and Immunotherapy, University of Birmingham, Edgbaston Birmingham B15 2TT UK
| | - Steven Knapper
- Institute of Cancer and Genetics, Cardiff University School of Medicine, University Hospital Wales, Heath Park, Cardiff
| | - David Grimwade
- Department of Medical and Molecular Genetics, King’s College London School of Medicine, Guy’s & St. Thomas’ NHS Foundation Trust, London UK
| | - Nigel H Russell
- Department of Haematology, Nottingham University Hospital NHS Trust, Nottingham
| | - Alan K Burnett
- Institute of Cancer and Genetics, Cardiff University School of Medicine, University Hospital Wales, Heath Park, Cardiff
| | - Sylvie D Freeman
- Department of Clinical Immunology, Institute of Immunology and Immunotherapy, University of Birmingham, Edgbaston Birmingham B15 2TT UK
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23
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Knapper S, Russell N, Gilkes A, Hills RK, Gale RE, Cavenagh JD, Jones G, Kjeldsen L, Grunwald MR, Thomas I, Konig H, Levis MJ, Burnett AK. A randomized assessment of adding the kinase inhibitor lestaurtinib to first-line chemotherapy for FLT3-mutated AML. Blood 2017; 129:1143-1154. [PMID: 27872058 PMCID: PMC5364440 DOI: 10.1182/blood-2016-07-730648] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [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: 07/26/2016] [Accepted: 11/06/2016] [Indexed: 01/28/2023] Open
Abstract
The clinical benefit of adding FMS-like tyrosine kinase-3 (FLT3)-directed small molecule therapy to standard first-line treatment of acute myeloid leukemia (AML) has not yet been established. As part of the UK AML15 and AML17 trials, patients with previously untreated AML and confirmed FLT3-activating mutations, mostly younger than 60 years, were randomly assigned either to receive oral lestaurtinib (CEP701) or not after each of 4 cycles of induction and consolidation chemotherapy. Lestaurtinib was commenced 2 days after completing chemotherapy and administered in cycles of up to 28 days. The trials ran consecutively. Primary endpoints were overall survival in AML15 and relapse-free survival in AML17; outcome data were meta-analyzed. Five hundred patients were randomly assigned between lestaurtinib and control: 74% had FLT3-internal tandem duplication mutations, 23% FLT3-tyrosine kinase domain point mutations, and 2% both types. No significant differences were seen in either 5-year overall survival (lestaurtinib 46% vs control 45%; hazard ratio, 0.90; 95% CI 0.70-1.15; P = .3) or 5-year relapse-free survival (40% vs 36%; hazard ratio, 0.88; 95% CI 0.69-1.12; P = .3). Exploratory subgroup analysis suggested survival benefit with lestaurtinib in patients receiving concomitant azole antifungal prophylaxis and gemtuzumab ozogamicin with the first course of chemotherapy. Correlative studies included analysis of in vivo FLT3 inhibition by plasma inhibitory activity assay and indicated improved overall survival and significantly reduced rates of relapse in lestaurtinib-treated patients who achieved sustained greater than 85% FLT3 inhibition. In conclusion, combining lestaurtinib with intensive chemotherapy proved feasible in younger patients with newly diagnosed FLT3-mutated AML, but yielded no overall clinical benefit. The improved clinical outcomes seen in patients achieving sustained FLT3 inhibition encourage continued evaluation of FLT3-directed therapy alongside front-line AML treatment. The UK AML15 and AML17 trials are registered at www.isrctn.com/ISRCTN17161961 and www.isrctn.com/ISRCTN55675535 respectively.
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Affiliation(s)
- Steven Knapper
- Department of Haematology, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Nigel Russell
- Department of Haematology, Nottingham University Hospital, Nottingham, United Kingdom
| | - Amanda Gilkes
- Experimental Cancer Medicine Centre, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Robert K Hills
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom
| | - Rosemary E Gale
- Department of Haematology, University College London Cancer Institute, London, United Kingdom; Department of Haematology, Bart's Health NHS Trust, London, United Kingdom
| | - James D Cavenagh
- Department of Haematology, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Gail Jones
- Department of Haematology, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Lars Kjeldsen
- Department of Haematology, Rigshospitalet, Copenhagen, Denmark
| | - Michael R Grunwald
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC
| | - Ian Thomas
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom
| | - Heiko Konig
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; and
| | - Mark J Levis
- Division of Hematological Malignancies, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD
| | - Alan K Burnett
- Department of Haematology, Cardiff University School of Medicine, Cardiff, United Kingdom
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24
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Butt NM, Lambert J, Ali S, Beer PA, Cross NCP, Duncombe A, Ewing J, Harrison CN, Knapper S, McLornan D, Mead AJ, Radia D, Bain BJ. Guideline for the investigation and management of eosinophilia. Br J Haematol 2017; 176:553-572. [PMID: 28112388 DOI: 10.1111/bjh.14488] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Nauman M Butt
- Royal Liverpool and Broadgreen University Teaching Hospitals NHS Trust, Liverpool, UK
| | - Jonathan Lambert
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Sahra Ali
- Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | | | | | - Andrew Duncombe
- Department of Haematology, University Hospital Southampton, Southampton, UK
| | - Joanne Ewing
- Heart of England NHS Foundation Trust, Birmingham, UK
| | | | - Steven Knapper
- Division of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - Donal McLornan
- King's College Hospital NHS Foundation Trust, London, UK
| | - Adam J Mead
- MRC Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, University of Oxford and BRC Blood Theme, NIHR Oxford Biomedical Centre, Oxford, UK
| | - Deepti Radia
- Guy's and St Thomas' NHS Foundation Trust, London, UK
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25
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Affiliation(s)
- Steven Knapper
- Institute of Cancer and Genetics, School of Medicine, Cardiff University, UK
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26
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Mead AJ, Milojkovic D, Knapper S, Garg M, Chacko J, Farquharson M, Yin J, Ali S, Clark RE, Andrews C, Dawson MK, Harrison C. Response to ruxolitinib in patients with intermediate-1-, intermediate-2-, and high-risk myelofibrosis: results of the UK ROBUST Trial. Br J Haematol 2015; 170:29-39. [PMID: 25824940 DOI: 10.1111/bjh.13379] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 01/26/2015] [Indexed: 12/15/2022]
Abstract
Myelofibrosis is characterized by splenomegaly and debilitating constitutional symptoms that negatively impact patients' quality of life. ROBUST, a UK, open-label, phase II study, evaluated the safety and efficacy of ruxolitinib in patients with myelofibrosis (N = 48), including intermediate-1 risk patients. The primary composite endpoint was the proportion of patients achieving treatment success [≥ 50% reduction in palpable spleen length and/or a ≥ 50% decrease in Myelofibrosis Symptom Assessment Form Total Symptom Score (MF-SAF TSS)] at 48 weeks. This was the first time that efficacy of ruxolitinib in myelofibrosis has been evaluated based on these criteria and the first time the MF-SAF was used in a population of patients solely from the United Kingdom. Overall, 50% of patients and 57% of intermediate-1 risk patients, achieved treatment success; reductions in spleen length and symptoms were observed in all risk groups. The majority of patients (66.7%) experienced ≥ 50% reductions from baseline in spleen length at any time. Improvements in MF-SAF TSS were seen in 80.0%, 72.7%, and 72.2% of intermediate-1, intermediate-2, and high-risk patients, respectively. Consistent with other studies of ruxolitinib, the most common haematological adverse events were anaemia and thrombocytopenia. Results indicate that most patients with myelofibrosis, including intermediate-1 risk patients, may benefit from ruxolitinib treatment.
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Affiliation(s)
- Adam J Mead
- MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | | | - Steven Knapper
- Department of Haematology, Cardiff University, Heath Park, Cardiff, UK
| | - Mamta Garg
- Leicester Royal Infirmary, Leicester, UK
| | - Joseph Chacko
- The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK
| | - Mira Farquharson
- Department of Haematology, Western General Hospital, Edinburgh, UK
| | - John Yin
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - Sahra Ali
- Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Richard E Clark
- Department of Haematology, Royal Liverpool University Hospital, Liverpool, UK
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27
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Coles SJ, Gilmour MN, Reid R, Knapper S, Burnett AK, Man S, Tonks A, Darley RL. The immunosuppressive ligands PD-L1 and CD200 are linked in AML T-cell immunosuppression: identification of a new immunotherapeutic synapse. Leukemia 2015; 29:1952-4. [PMID: 25748687 DOI: 10.1038/leu.2015.62] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- S J Coles
- Institute of Science and the Environment, University of Worcester, Worcester, UK.,Department of Haematology, Institute of Cancer and Genetics, School of Medicine, Cardiff University, Wales, UK
| | - M N Gilmour
- Department of Haematology, Institute of Cancer and Genetics, School of Medicine, Cardiff University, Wales, UK
| | - R Reid
- Department of Haematology, Institute of Cancer and Genetics, School of Medicine, Cardiff University, Wales, UK
| | - S Knapper
- Department of Haematology, Institute of Cancer and Genetics, School of Medicine, Cardiff University, Wales, UK
| | - A K Burnett
- Department of Haematology, Institute of Cancer and Genetics, School of Medicine, Cardiff University, Wales, UK
| | - S Man
- Department of Haematology, Institute of Cancer and Genetics, School of Medicine, Cardiff University, Wales, UK
| | - A Tonks
- Department of Haematology, Institute of Cancer and Genetics, School of Medicine, Cardiff University, Wales, UK
| | - R L Darley
- Department of Haematology, Institute of Cancer and Genetics, School of Medicine, Cardiff University, Wales, UK
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28
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Andersen CL, Bjørn ME, McMullin MF, Harrison C, Samuelsson J, Ejerblad E, Zweegman S, Fernandes S, Bareford D, Knapper S, Löfvenberg E, Linder O, Andreasson B, Ahlstrand E, Jensen MK, Bjerrum OW, Vestergaard H, Larsen H, Klausen TW, Mourits-Andersen T, Skov V, Thomassen M, Kruse T, Grønbæk K, Hasselbalch HC. Circulating YKL-40 in patients with essential thrombocythemia and polycythemia vera treated with the novel histone deacetylase inhibitor vorinostat. Leuk Res 2014; 38:816-21. [DOI: 10.1016/j.leukres.2014.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 04/02/2014] [Accepted: 04/04/2014] [Indexed: 11/26/2022]
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29
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Reilly JT, McMullin MF, Beer PA, Butt N, Conneally E, Duncombe AS, Green AR, Mikhaeel G, Gilleece MH, Knapper S, Mead AJ, Mesa RA, Sekhar M, Harrison CN. Use of JAK inhibitors in the management of myelofibrosis: a revision of the British Committee for Standards in Haematology Guidelines for Investigation and Management of Myelofibrosis 2012. Br J Haematol 2014; 167:418-20. [PMID: 24961987 DOI: 10.1111/bjh.12985] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- John T Reilly
- Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
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30
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Knapper S, Chevassut T, Duarte R, Bergua JM, Salamero O, Johansen M, Jacobsen TF, Hals PA, Rasch W, Gianella-Borradori A, Smith M. Elacytarabine in relapsed/refractory acute myeloid leukaemia: an evaluation of clinical efficacy, pharmacokinetics, cardiac safety and effects on lipid profile. Leuk Res 2014; 38:346-51. [PMID: 24433865 DOI: 10.1016/j.leukres.2013.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 12/13/2013] [Accepted: 12/16/2013] [Indexed: 11/25/2022]
Abstract
Elacytarabine is the elaidic acid ester derivative of cytarabine, designed to enter cells independently of nucleoside transporters. Effects of elacytarabine on QT interval, serum lipid profile and clinical activity were investigated in 43 relapsed/refractory AML patients. Mean maximum increase in corrected QT interval of 24( ± 29)ms occurred 48 h after elacytarabine infusion without associated arrhythmias or clinical symptoms. A non-clinically significant, elacytarabine exposure-dependent increase in cholesterol was caused by a cholesterol rich lipoprotein depleted of apolipoprotein B formed by infused phospholipids complexing cholesterol. Elacytarabine is clinically active in relapsed/refractory AML: overall response rate (CR + CRi) was 44% (16/36 with 7 non-evaluable patients) and adverse events were manageable. Clinical Trials.gov Identifier: NCT01258816.
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Affiliation(s)
- Steven Knapper
- Department of Haematology, Cardiff University, Cardiff, UK.
| | | | | | | | - Olga Salamero
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
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31
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Moore AS, Kearns PR, Knapper S, Pearson ADJ, Zwaan CM. Novel therapies for children with acute myeloid leukaemia. Leukemia 2013; 27:1451-60. [PMID: 23563239 DOI: 10.1038/leu.2013.106] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [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: 03/06/2013] [Revised: 03/24/2013] [Accepted: 04/04/2013] [Indexed: 12/22/2022]
Abstract
Significant improvements in survival for children with acute myeloid leukaemia (AML) have been made over the past three decades, with overall survival rates now approximately 60-70%. However, these gains can be largely attributed to more intensive use of conventional cytotoxics made possible by advances in supportive care, and although over 90% of children achieve remission with frontline therapy, approximately one third in current protocols relapse. Furthermore, late effects of therapy cause significant morbidity for many survivors. Novel therapies are therefore desperately needed. Early-phase paediatric trials of several new agents such as clofarabine, sorafenib and gemtuzumab ozogamicin have shown encouraging results in recent years. Due to the relatively low incidence of AML in childhood, the success of paediatric early-phase clinical trials is largely dependent upon collaborative clinical trial design by international cooperative study groups. Successfully incorporating novel therapies into frontline therapy remains a challenge, but the potential for significant improvement in the duration and quality of survival for children with AML is high.
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Affiliation(s)
- A S Moore
- Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Australia.
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32
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Andersen CL, McMullin MF, Ejerblad E, Zweegman S, Harrison C, Fernandes S, Bareford D, Knapper S, Samuelsson J, Löfvenberg E, Linder O, Andreasson B, Ahlstrand E, Jensen MK, Bjerrum OW, Vestergaard H, Larsen H, Klausen TW, Mourits-Andersen T, Hasselbalch HC. A phase II study of vorinostat (MK-0683) in patients with polycythaemia vera and essential thrombocythaemia. Br J Haematol 2013; 162:498-508. [PMID: 23758082 DOI: 10.1111/bjh.12416] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 05/02/2013] [Indexed: 02/02/2023]
Abstract
Inhibition of histone deacetylases may be an important target in patients with myeloproliferative neoplasms. This investigator-initiated, non-randomized, open-label phase II multi-centre study included 63 patients (19 essential thrombocythaemia, 44 polycythaemia vera) from 15 centres. The primary objective was to evaluate if vorinostat was followed by a decline in clonal myeloproliferation as defined by European Leukaemia Net. Thirty patients (48%) completed the intervention period (24 weeks of therapy). An intention-to-treat response rate of 35% was identified. Pruritus was resolved [19% to 0% (P = 0·06)] and the prevalence of splenomegaly was lowered from 50% to 27% (P = 0·03). Sixty-five per cent of the patients experienced a decrease in JAK2 V617F allele burden (P = 0·006). Thirty-three patients (52% of patients) discontinued study drug before end of intervention due to adverse events (28 patients) or lack of response (5 patients). In conclusion, vorinostat showed effectiveness by normalizing elevated leucocyte and platelet counts, resolving pruritus and significantly reducing splenomegaly. However, vorinostat was associated with significant side effects resulting in a high discontinuation rate. A lower dose of vorinostat in combination with conventional and/or novel targeted therapies may be warranted in future studies.
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33
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Walsby EJ, Lazenby M, Pepper CJ, Knapper S, Burnett AK. The HSP90 inhibitor NVP-AUY922-AG inhibits the PI3K and IKK signalling pathways and synergizes with cytarabine in acute myeloid leukaemia cells. Br J Haematol 2013; 161:57-67. [PMID: 23356405 DOI: 10.1111/bjh.12215] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 11/19/2012] [Indexed: 12/30/2022]
Abstract
Heat shock protein 90 (HSP90; HSP90AA1) is a molecular chaperone involved in signalling pathways for cell proliferation, survival, and cellular adaptation. Inhibitors of HSP90 are being examined as anti-cancer agents, but the critical molecular mechanism(s) of their activity remains unresolved. HSP90 inhibition potentially facilitates the simultaneous targeting of multiple molecules within tumour cells and represents an attractive therapeutic proposition. Here, we investigated HSP90 as a molecular target for acute myeloid leukaemia (AML) using the novel HSP90 inhibitor NVP-AUY922-AG. NVP-AUY922-AG induced dose-dependent killing in myeloid cell lines and primary AML blasts. In primary blasts, cell death in response to NVP-AUY922-AG was seen at concentrations almost 2 logs lower than cytarabine (Ara-C) (50% lethal dose = 0·12 μ mol/l ± 0·28). NVP-AUY922-AG was significantly less toxic to normal bone marrow (P = 0·02). In vitro response to NVP-AUY922-AG did not correlate with response to Ara-C (r(2) = 0·0006). NVP-AUY922-AG was highly synergistic with Ara-C in cell lines and in 20/25 of the primary samples tested. NVP-AUY922-AG induced increases in HSP70 expression and depletion of total AKT, IKKα and IKKβ in cell lines and primary blasts. This study shows that the novel HSP90 inhibitor NVP-AUY922-AG has significant single agent activity in AML cells and is synergistic with Ara-C.
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Affiliation(s)
- Elisabeth J Walsby
- Cardiff Experimental Cancer Medicine Centre, Institute of Cancer and Genetics, Institute of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK.
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34
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Craddock C, Quek L, Goardon N, Freeman S, Siddique S, Raghavan M, Aztberger A, Schuh A, Grimwade D, Ivey A, Virgo P, Hills R, McSkeane T, Arrazi J, Knapper S, Brookes C, Davies B, Price A, Wall K, Griffiths M, Cavenagh J, Majeti R, Weissman I, Burnett A, Vyas P. Azacitidine fails to eradicate leukemic stem/progenitor cell populations in patients with acute myeloid leukemia and myelodysplasia. Leukemia 2012; 27:1028-36. [PMID: 23223186 DOI: 10.1038/leu.2012.312] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Epigenetic therapies demonstrate significant clinical activity in acute myeloid leukemia (AML) and myelodysplasia (MDS) and constitute an important new class of therapeutic agents. However hematological responses are not durable and disease relapse appears inevitable. Experimentally, leukemic stem/progenitor cells (LSC) propagate disease in animal models of AML and it has been postulated that their relative chemo-resistance contributes to disease relapse. We serially measured LSC numbers in patients with high-risk AML and MDS treated with 5'-azacitidine and sodium valproate (VAL-AZA). Fifteen out of seventy-nine patients achieved a complete remission (CR) or complete remission with incomplete blood count recovery (CRi) with VAL-AZA therapy. There was no significant reduction in the size of the LSC-containing population in non-responders. While the LSC-containing population was substantially reduced in all patients achieving a CR/CRi it was never eradicated and expansion of this population antedated morphological relapse. Similar studies were performed in seven patients with newly diagnosed AML treated with induction chemotherapy. Eradication of the LSC-containing population was observed in three patients all of whom achieved a durable CR in contrast to patients with resistant disease where LSC persistence was observed. LSC quantitation provides a novel biomarker of disease response and relapse in patients with AML treated with epigenetic therapies. New drugs that target this cellular population in vivo are required.
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Affiliation(s)
- C Craddock
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK.
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35
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Reilly JT, McMullin MF, Beer PA, Butt N, Conneally E, Duncombe A, Green AR, Michaeel NG, Gilleece MH, Hall GW, Knapper S, Mead A, Mesa RA, Sekhar M, Wilkins B, Harrison CN. Guideline for the diagnosis and management of myelofibrosis. Br J Haematol 2012; 158:453-71. [DOI: 10.1111/j.1365-2141.2012.09179.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 05/02/2012] [Indexed: 01/09/2023]
Affiliation(s)
- John T. Reilly
- Sheffield Teaching Hospitals NHS Foundation Trust; Sheffield; UK
| | | | - Philip A. Beer
- Terry Fox Laboratory; BC Cancer Agency; Vancouver; BC; Canada
| | - Nauman Butt
- Wirral University Teaching Hospital; Wirral; UK
| | | | - Andrew Duncombe
- University Hospital Southampton NHS Foundation Trust; Southampton; UK
| | | | | | | | | | | | - Adam Mead
- Oxford University Hospitals NHS Trust; Oxford; UK
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Szegezdi E, Reis CR, van der Sloot AM, Natoni A, O'Reilly A, Reeve J, Cool RH, O'Dwyer M, Knapper S, Serrano L, Quax WJ, Samali A. Targeting AML through DR4 with a novel variant of rhTRAIL. J Cell Mol Med 2012; 15:2216-31. [PMID: 21070598 PMCID: PMC4394230 DOI: 10.1111/j.1582-4934.2010.01211.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [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: 02/02/2023] Open
Abstract
Despite progress in the treatment of acute myelogenous leukaemia (AML) the outcome often remains poor. Tumour necrosis factor related apoptosis-inducing ligand (TRAIL) is a promising therapeutic agent in many different types of tumours, but AML cells are relatively insensitive to TRAIL-induced apoptosis. Here we show that TRAIL-induced apoptosis in AML cells is predominantly mediated by death receptor 4 (DR4) and not DR5. Therefore, we constructed a variant of TRAIL (rhTRAIL-C3) that is a strong inducer of DR4-mediated apoptosis. TRAIL-C3 demonstrated much stronger pro-apoptotic activity than wild-type (WT) TRAIL in a panel of AML cell lines as well as in primary AML blasts. The higher pro-apoptotic potential was further enhanced when the TRAIL mutant was used in combination with BMS-345541, a selective inhibitor of inhibitor-κB kinases. It illustrates that combination of this TRAIL variant with chemotherapeutics or other targeted agents can kill AML with high efficacy. This may represent a major advantage over the currently used therapies that have serious toxic side effects. The high efficacy of rhTRAIL-C3 containing therapies may enable the use of lower drug doses to reduce the toxic side effects and improve patient outcome. Our findings suggest that the rational design of TRAIL variants that target DR4 potentiate the death-inducing activity of TRAIL and offer a novel therapeutic strategy for the treatment of AML.
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Affiliation(s)
- Eva Szegezdi
- Department of Biochemistry and the National Centre for Biomedical Engineering Science, National University of Ireland, Galway, Ireland
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Sato T, Yang X, Knapper S, White P, Smith BD, Galkin S, Small D, Burnett A, Levis M. FLT3 ligand impedes the efficacy of FLT3 inhibitors in vitro and in vivo. Blood 2011; 117:3286-93. [PMID: 21263155 PMCID: PMC3069670 DOI: 10.1182/blood-2010-01-266742] [Citation(s) in RCA: 189] [Impact Index Per Article: 14.5] [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] [Received: 01/26/2010] [Accepted: 12/02/2010] [Indexed: 01/01/2023] Open
Abstract
We examined in vivo FLT3 inhibition in acute myeloid leukemia patients treated with chemotherapy followed by the FLT3 inhibitor lestaurtinib, comparing newly diagnosed acute myeloid leukemia patients with relapsed patients. Because we noted that in vivo FLT3 inhibition by lestaurtinib was less effective in the relapsed patients compared with the newly diagnosed patients, we investigated whether plasma FLT3 ligand (FL) levels could influence the efficacy of FLT3 inhibition in these patients. After intensive chemotherapy, FL levels rose to a mean of 488 pg/mL on day 15 of induction therapy for newly diagnosed patients, whereas they rose to a mean of 1148 pg/mL in the relapsed patients. FL levels rose even higher with successive courses of chemotherapy, to a mean of 3251 pg/mL after the fourth course. In vitro, exogenous FL at concentrations similar to those observed in patients mitigated FLT3 inhibition and cytotoxicity for each of 5 different FLT3 inhibitors (lestaurtinib, midostaurin, sorafenib, KW-2449, and AC220). The dramatic increase in FL level after chemotherapy represents a possible obstacle to inhibiting FLT3 in this clinical setting. These findings could have important implications regarding the design and outcome of trials of FLT3 inhibitors and furthermore suggest a rationale for targeting FL as a therapeutic strategy.
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Affiliation(s)
- Takashi Sato
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD 21231, USA
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van Dijk M, Murphy E, Morrell R, Knapper S, O'Dwyer M, Samali A, Szegezdi E. The Proteasome Inhibitor Bortezomib Sensitizes AML with Myelomonocytic Differentiation to TRAIL Mediated Apoptosis. Cancers (Basel) 2011; 3:1329-50. [PMID: 24212664 PMCID: PMC3756416 DOI: 10.3390/cancers3011329] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [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: 02/05/2011] [Revised: 02/15/2011] [Accepted: 03/10/2011] [Indexed: 11/16/2022] Open
Abstract
Acute myeloid leukemia (AML) is an aggressive stem cell malignancy that is difficult to treat. There are limitations to the current treatment regimes especially after disease relapse, and therefore new therapeutic agents are urgently required which can overcome drug resistance whilst avoiding unnecessary toxicity. Among newer targeted agents, both tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL) and proteasome inhibitors show particular promise. In this report we show that a combination of the proteasome inhibitor bortezomib and TRAIL is effective against AML cell lines, in particular, AML cell lines displaying myelomonocytic/monocytic phenotype (M4/M5 AML based on FAB classification), which account for 20-30% of AML cases. We show that the underlying mechanism of sensitization is at least in part due to bortezomib mediated downregulation of c-FLIP and XIAP, which is likely to be regulated by NF-κB. Blockage of NF-κB activation with BMS-345541 equally sensitized myelomonocytic AML cell lines and primary AML blasts to TRAIL.
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Affiliation(s)
- Marianne van Dijk
- Apoptosis Research Center, National University of Ireland, University Road, Galway, Ireland; E-Mails: (M.V.D); (E.M); (R.M); (A.S); (M.O.)
- School of Natural Sciences, National University of Ireland, University Road, Galway, Ireland
| | - Eoin Murphy
- Apoptosis Research Center, National University of Ireland, University Road, Galway, Ireland; E-Mails: (M.V.D); (E.M); (R.M); (A.S); (M.O.)
- School of Natural Sciences, National University of Ireland, University Road, Galway, Ireland
| | - Ruth Morrell
- Apoptosis Research Center, National University of Ireland, University Road, Galway, Ireland; E-Mails: (M.V.D); (E.M); (R.M); (A.S); (M.O.)
- School of Natural Sciences, National University of Ireland, University Road, Galway, Ireland
- School of Medicine, National University of Ireland, University Road, Galway, Ireland
| | - Steven Knapper
- Department of Haematology, School of Medicine, Cardiff University, Heath Park, CF14 4XN Cardiff, UK; E-Mail:
| | - Michael O'Dwyer
- Apoptosis Research Center, National University of Ireland, University Road, Galway, Ireland; E-Mails: (M.V.D); (E.M); (R.M); (A.S); (M.O.)
- School of Medicine, National University of Ireland, University Road, Galway, Ireland
| | - Afshin Samali
- Apoptosis Research Center, National University of Ireland, University Road, Galway, Ireland; E-Mails: (M.V.D); (E.M); (R.M); (A.S); (M.O.)
- School of Natural Sciences, National University of Ireland, University Road, Galway, Ireland
| | - Eva Szegezdi
- Apoptosis Research Center, National University of Ireland, University Road, Galway, Ireland; E-Mails: (M.V.D); (E.M); (R.M); (A.S); (M.O.)
- School of Natural Sciences, National University of Ireland, University Road, Galway, Ireland
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +353-91-495037; Fax: +353-91-494-596
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Moore C, Galiano M, Lackenby A, Abdelrahman T, Barnes R, Evans MR, Fegan C, Froude S, Hastings M, Knapper S, Litt E, Price N, Salmon R, Temple M, Davies E. Evidence of person-to-person transmission of oseltamivir-resistant pandemic influenza A(H1N1) 2009 virus in a hematology unit. J Infect Dis 2011; 203:18-24. [PMID: 21148492 DOI: 10.1093/infdis/jiq007] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We describe the first confirmed person-to-person transmission of oseltamivir-resistant pandemic influenza A(H1N1) 2009 virus that occurred in a hematology unit in the United Kingdom. Eleven cases of (H1N1) 2009 virus infection were identified, of which, ten were related as shown by sequence analysis of the hemagglutinin and neuraminidase genes. H275Y analysis demonstrated that 8 of 10 case patients had oseltamivir-resistant virus, with 4 of 8 case patients infected by direct transmission of resistant virus. Zanamivir should be considered as first-line therapy for influenza in patients with lymphopenic hematological conditions and uptake of influenza vaccination encouraged to further reduce the number of susceptible individuals.
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Affiliation(s)
- Catherine Moore
- Public Health Wales Microbiology, Public Health Wales NHS Trust, Cardiff, UK
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Walsby EJ, Coles SJ, Knapper S, Burnett AK. The topoisomerase II inhibitor voreloxin causes cell cycle arrest and apoptosis in myeloid leukemia cells and acts in synergy with cytarabine. Haematologica 2010; 96:393-9. [PMID: 21134979 DOI: 10.3324/haematol.2010.032680] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Topoisomerase II is essential for the maintenance of DNA integrity and the survival of proliferating cells. Topoisomerase II poisons, including etoposide and doxorubicin, inhibit enzyme-mediated DNA ligation causing the accumulation of double-stranded breaks and have been front-line drugs for the treatment of leukemia for many years. Voreloxin is a first-in-class anti-cancer quinolone derivative that intercalates DNA and inhibits topoisomerase II. The efficacy and mechanisms of action of voreloxin in acute myeloid leukaemia were addressed in this study. DESIGN AND METHODS Primary acute myeloid leukemia blasts (n = 88) and myeloid cell lines were used in vitro to study voreloxin through viability assays to assess cell killing and synergy with other drugs. Apoptosis and cell cycling were assessed by flow cytometry. DNA relaxation assays were utilized to determine that voreloxin was active on topoisomerase II. RESULTS The mean lethal dose 50% (LD(50)) (± standard deviation) of voreloxin for primary acute myeloid leukemia blasts was 2.30 μM (± 1.87). Synergy experiments between voreloxin and cytarabine identified synergism in 22 of 25 primary acute myeloid leukemia samples tested, with a mean combination index of 0.79. Apoptosis was shown to increase in a dose-dependent manner. Furthermore, voreloxin was active in the p53-null K562 cell line suggesting that the action of voreloxin is not affected by p53 status. The action of voreloxin on topoisomerase II was confirmed using a DNA relaxation assay. CONCLUSIONS Voreloxin may provide an interesting addition to the cache of drugs available for the treatment of acute myeloid leukemia, a disease with a poor long-term survival. In addition to its potent action as a single agent in dividing cells, the synergy we demonstrated between voreloxin and cytarabine recommends further investigation of this topoisomerase II inhibitor.
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Affiliation(s)
- Elisabeth J Walsby
- Cardiff Experimental Cancer Medicine Centre, Department of Haematology, School of Medicine, Cardiff University, Heath Park, Cardiff, UK.
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Hewamana S, Pepper C, Couzens S, Thomas A, Knapper S. IgM multiple myeloma: a diagnostic challenge in a patient with coexisting chronic lymphocytic leukaemia. Int J Hematol 2008; 88:424-427. [PMID: 18846322 DOI: 10.1007/s12185-008-0179-z] [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] [Received: 06/09/2008] [Revised: 07/27/2008] [Accepted: 08/18/2008] [Indexed: 11/29/2022]
Abstract
As IgM multiple myeloma is a rare poorly characterised disease entity; there is only limited published data on its clinical, microscopic and immunophenotypic features. We report a 72-year-old man misdiagnosed as Waldenström's macroglobulinemia. Also the diagnosis was further complicated by coexisting chronic lymphocytic leukaemia. Following confirmation of IgM myeloma, in view of the patient's deteriorating clinical condition; he was entered into the UK Medical Research Council Myeloma IX trial where he had partial response to chemotherapy. This case highlights the value of detailed immunophenotypic evaluation when clinical and morphological markers are equivocal.
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Affiliation(s)
- Saman Hewamana
- Department of Haematology, School of Medicine, Cardiff University, Heath Park, CF14 4XN, Cardiff, UK.
| | - Chris Pepper
- Department of Haematology, School of Medicine, Cardiff University, Heath Park, CF14 4XN, Cardiff, UK
| | - Steve Couzens
- Department of Haematology, University Hospital of Wales, Heath Park, CF14 4XW, Cardiff, UK
| | - Alun Thomas
- Department of Haematology, University Hospital of Wales, Heath Park, CF14 4XW, Cardiff, UK
| | - Steven Knapper
- Department of Haematology, School of Medicine, Cardiff University, Heath Park, CF14 4XN, Cardiff, UK
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Abstract
FMS-like tyrosine kinase 3 (FLT3) is a receptor tyrosine kinase that appears to play a significant role in leukaemogenesis. Activating mutations of FLT3 are present in approximately one-third of acute myeloid leukaemia patients and are associated with adverse clinical outcome, while many non-mutated cases also show evidence of FLT3 activation. FLT3 thus represents a potentially exciting molecular therapeutic target. A number of small-molecule tyrosine kinase inhibitors with anti-FLT3 activity have been developed and several of these compounds have entered early phase clinical trials where clinical anti-leukaemic activity has been demonstrated. The depth and duration of clinical responses to FLT3 inhibitor monotherapy have been modest, however, and a number of mechanisms by which blasts may acquire resistance have been proposed. Based on preclinical evidence of synergy with conventional chemotherapy, several combination trials are now underway. FLT3 inhibition may also be effective used in combination with other molecularly targeted agents, in postchemotherapy stem-cell-directed maintenance therapy and in MLL-rearranged infant acute lymphoblastic leukaemia.
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Affiliation(s)
- Steven Knapper
- Department of Haematology, Cardiff University, Heath Park, Cardiff CF14 4XW, UK.
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Knapper S, Mills KI, Gilkes AF, Austin SJ, Walsh V, Burnett AK. The effects of lestaurtinib (CEP701) and PKC412 on primary AML blasts: the induction of cytotoxicity varies with dependence on FLT3 signaling in both FLT3-mutated and wild-type cases. Blood 2006; 108:3494-503. [PMID: 16868253 DOI: 10.1182/blood-2006-04-015487] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractThe receptor tyrosine kinase FLT3 is a promising molecular therapeutic target in acute myeloid leukemia (AML). Activating mutations of FLT3 are present in approximately one-third of patients, while many nonmutants show evidence of FLT3 activation, which appears to play a significant role in leukemogenesis. We studied the effects of lestaurtinib (CEP701) and PKC412, 2 small molecule inhibitors of FLT3, on 65 diagnostic AML blast samples. Both agents induced concentration-dependent cytotoxicity in most cases, although responses to PKC412 required higher drug concentrations. Cytotoxic responses were highly heterogeneous and were only weakly associated with FLT3 mutation status and FLT3 expression. Importantly, lestaurtinib induced cytotoxicity in a synergistic fashion with cytarabine, particularly in FLT3 mutant samples. Both lestaurtinib and PKC412 caused inhibition of FLT3 phosphorylation in all samples. Translation of FLT3 inhibition into cytotoxicity was influenced by the degree of residual FLT3 phosphorylation remaining and correlated with deactivation of STAT5 and MAP kinase. FLT3 mutant and wild-type cases both varied considerably in their dependence on FLT3 signaling for survival. These findings support the continued clinical assessment of FLT3 inhibitors in combination with cytotoxic chemotherapy: Entry to future clinical trials should include FLT3 wild-type patients and should remain unrestricted by FLT3 expression level.
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Affiliation(s)
- Steven Knapper
- Department of Haematology, Cardiff University School of Medicine, Heath Park, Cardiff, CF14 4XW, United Kingdom.
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Knapper S, Burnett AK, Littlewood T, Kell WJ, Agrawal S, Chopra R, Clark R, Levis MJ, Small D. A phase 2 trial of the FLT3 inhibitor lestaurtinib (CEP701) as first-line treatment for older patients with acute myeloid leukemia not considered fit for intensive chemotherapy. Blood 2006; 108:3262-70. [PMID: 16857985 DOI: 10.1182/blood-2006-04-015560] [Citation(s) in RCA: 334] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Activating mutations of FMS-like tyrosine kinase 3 (FLT3) are present in approximately one third of patients with acute myeloid leukemia (AML) and are associated with adverse prognosis. The important role played by FLT3 in the survival and proliferation of blasts, and its overexpression in most patients with AML, make FLT3 an attractive therapeutic target. We undertook a phase 2 trial of the FLT3-selective tyrosine kinase inhibitor lestaurtinib (CEP701) used as monotherapy in untreated older patients with AML not considered fit for intensive chemotherapy, irrespective of FLT3 mutation status. Lestaurtinib was administered orally for 8 weeks, initially at a dose of 60 mg twice daily, escalating to 80 mg twice daily, and was generally well tolerated. Clinical activity, manifest as transient reductions in bone marrow and peripheral-blood blasts or longer periods of transfusion independence, was seen in 3 (60%) of 5 patients with mutated FLT3 and 5 (23%) of 22 evaluable wild-type FLT3 patients. Laboratory data demonstrated that clinical responses occurred where the presence of sustained FLT3-inhibitory drug levels were combined with in vitro cytotoxic sensitivity of blasts to lestaurtinib. Further evaluation of this compound, in combination with cytotoxic chemotherapy or other targeted agents, is warranted in both FLT3 mutant and wild-type patients.
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Affiliation(s)
- Steven Knapper
- Department of Haematology, Cardiff University School of Medicine, Heath Park, Cardiff, CF14 4XW, United Kingdom
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Mills KI, Walsh V, Gilkes AF, Agrawal SG, Knapper S. Novel observation of three FLT3 codons mutated in tandem in an elderly acute myeloid leukaemia patient. Br J Haematol 2006; 132:116-7. [PMID: 16371029 DOI: 10.1111/j.1365-2141.2005.05836.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Vassiliou GS, Webb DK, Pamphilon D, Knapper S, Veys PA. Improved outcome of alternative donor bone marrow transplantation in children with severe aplastic anaemia using a conditioning regimen containing low-dose total body irradiation, cyclophosphamide and Campath. Br J Haematol 2001; 114:701-5. [PMID: 11553001 DOI: 10.1046/j.1365-2141.2001.02993.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.1] [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]
Abstract
The increasing success of human leucocyte antigen (HLA)-matched sibling donor (MSD) transplants and combination immunosuppressive treatments have dramatically improved the prognosis of severe aplastic anaemia (SAA) in children and young adults. For patients who lack a MSD there is a significant minority who fail immunosuppressive therapy or suffer from a severe constitutional aplastic anaemia in which immunosuppression would be ineffective. Alternative donor bone marrow transplantation (AD-BMT) has only had limited success in this context. We report the successful outcome of AD-BMT in eight consecutive patients aged 7 months to 15 years, six of whom had acquired aplastic anaemia who had previously failed to respond to immunosuppression, and two of whom had a severe (non-Fanconi) constitutional aplastic anaemia. All eight patients had received multiple red cell and platelet transfusions. We used a new combination of agents for pretransplant conditioning aiming to maximize immunosuppression and minimize toxicity, consisting of Campath-1G or -1H, cyclophosphamide and low-dose total body irradiation (LD TBI) or fludarabine. Toxicity was minimal and all eight children are alive, well and free of disease at a median follow-up of 32 months. We suggest that this approach could facilitate the successful treatment of children with SAA in whom immunosuppressive therapy has failed or is not appropriate.
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Affiliation(s)
- G S Vassiliou
- Bone Marrow Transplant Unit, Host Defence, Great Ormond Street Hospital for Children NHS Trust, London, UK
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