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Zonder JA, Pemberton P, Brandt H, Mohamed AN, Schiffer CA. The effect of dose increase of imatinib mesylate in patients with chronic or accelerated phase chronic myelogenous leukemia with inadequate hematologic or cytogenetic response to initial treatment. Clin Cancer Res 2003; 9:2092-7. [PMID: 12796373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
PURPOSE Imatinib mesylate is a tyrosine kinase inhibitor with high affinity for the BCR-ABL fusion protein expressed by the hematopoietic cells in chronic myelogenous leukemia (CML). Some patients with chronic-phase or accelerated-phase CML either relapse after an initial response or are refractory to imatinib, prompting us to evaluate the efficacy of dose increase in such patients. EXPERIMENTAL DESIGN Twelve chronic-phase patients initially receiving 400 mg/day and 4 patients with accelerated phase initially receiving either 400 mg/day (two patients) or 600 mg/day (two patients) had their dose increased (14 to 800 mg/day and 2 to 600 mg/day) because of progressive disease (usually clonal evolution) or inadequate cytogenetic response after at least 1 year of therapy. RESULTS Six patients had major cytogenetic responses after dose increase (3 complete and 3 partial). Two others had minor cytogenetic responses. Two patients with clonal evolution transiently lost the additional clonal aberrations. Almost all of the responses occurred within 6 months, and were typically 3-6 months in duration. However, 3 patients have continuing major cytogenetic responses of >18 months duration. Dose increase was well tolerated, with thrombocytopenia, mild leukopenia, and exacerbation of prior edema being the most common adverse events. CONCLUSIONS Although increasing the dose of imatinib can benefit a subgroup of patients with CML with either an inadequate cytogenetic response or disease progression, our results suggest the majority will not have a sustained meaningful response, and that other options, such as allogeneic stem cell transplant or investigational therapies, also need to be considered at the time of dose increase.
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MESH Headings
- Adult
- Aged
- Antineoplastic Agents/administration & dosage
- Benzamides
- Female
- Humans
- Imatinib Mesylate
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/blood
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myeloid, Accelerated Phase/blood
- Leukemia, Myeloid, Accelerated Phase/drug therapy
- Leukemia, Myeloid, Accelerated Phase/genetics
- Male
- Middle Aged
- Philadelphia Chromosome
- Piperazines/administration & dosage
- Piperazines/adverse effects
- Pyrimidines/administration & dosage
- Pyrimidines/adverse effects
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Affiliation(s)
- Jeffrey A Zonder
- Karmanos Cancer Institute, Wayne State University, Detroit, Michigan 48201, USA.
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2
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MESH Headings
- Adult
- Aged
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/therapeutic use
- Benzamides
- Blast Crisis/blood
- Blast Crisis/drug therapy
- Clinical Trials, Phase II as Topic
- Enzyme Inhibitors/adverse effects
- Enzyme Inhibitors/therapeutic use
- Female
- Follow-Up Studies
- Granulocyte Colony-Stimulating Factor/therapeutic use
- Humans
- Imatinib Mesylate
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/blood
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myeloid, Accelerated Phase/blood
- Leukemia, Myeloid, Accelerated Phase/drug therapy
- Male
- Middle Aged
- Neutropenia/chemically induced
- Neutropenia/drug therapy
- Piperazines/adverse effects
- Piperazines/therapeutic use
- Pyrimidines/adverse effects
- Pyrimidines/therapeutic use
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3
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Ogawa H, Tamaki H, Ikegame K, Soma T, Kawakami M, Tsuboi A, Kim EH, Hosen N, Murakami M, Fujioka T, Masuda T, Taniguchi Y, Nishida S, Oji Y, Oka Y, Sugiyama H. The usefulness of monitoring WT1 gene transcripts for the prediction and management of relapse following allogeneic stem cell transplantation in acute type leukemia. Blood 2003; 101:1698-704. [PMID: 12406915 DOI: 10.1182/blood-2002-06-1831] [Citation(s) in RCA: 187] [Impact Index Per Article: 8.9] [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
In acute-type leukemia, no method for the prediction of relapse following allogeneic stem cell transplantation based on minimal residual disease (MRD) levels is established yet. In the present study, MRD in 72 cases of allogeneic transplantation for acute myeloid leukemia, acute lymphoid leukemia, and chronic myeloid leukemia (accelerated phase or blast crisis) was monitored frequently by quantitating the transcript of WT1 gene, a "panleukemic MRD marker," using reverse transcriptase-polymerase chain reaction. Based on the negativity of expression of chimeric genes, the background level of WT1 transcripts in bone marrow following allogeneic transplantation was significantly decreased compared with the level in healthy volunteers. The probability of relapse occurring within 40 days significantly increased step-by-step according to the increase in WT1 expression level (100% for 1.0 x 10(-2)-5.0 x 10(-2), 44.4% for 4.0 x 10(-3)-1.0 x 10(-2), 10.2% for 4.0 x 10(-4)-4.0 x 10(-3), and 0.8% for < 4.0 x 10(-4)) when WT1 level in K562 was defined as 1.0). WT1 levels in patients having relapse increased exponentially with a constant doubling time. The doubling time of the WT1 level in patients for whom the discontinuation of immunosuppressive agents or donor leukocyte infusion was effective was significantly longer than that for patients in whom it was not (P <.05). No patients with a short doubling time of WT1 transcripts (< 13 days) responded to these immunomodulation therapies. These findings strongly suggest that the WT1 assay is very useful for the prediction and management of relapse following allogeneic stem cell transplantation regardless of the presence of chimeric gene markers.
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MESH Headings
- Acute Disease
- Blast Crisis/blood
- Blast Crisis/genetics
- Blast Crisis/pathology
- Blast Crisis/therapy
- Gene Expression Regulation, Leukemic
- Genes, Wilms Tumor
- Humans
- K562 Cells/metabolism
- Leukemia/blood
- Leukemia/genetics
- Leukemia/pathology
- Leukemia/therapy
- Leukemia, Myeloid, Accelerated Phase/blood
- Leukemia, Myeloid, Accelerated Phase/genetics
- Leukemia, Myeloid, Accelerated Phase/pathology
- Leukemia, Myeloid, Accelerated Phase/therapy
- Neoplasm Proteins/biosynthesis
- Neoplasm Proteins/genetics
- Neoplasm, Residual/diagnosis
- Peripheral Blood Stem Cell Transplantation
- Predictive Value of Tests
- RNA, Messenger/biosynthesis
- RNA, Neoplasm/biosynthesis
- Recurrence
- Retrospective Studies
- Reverse Transcriptase Polymerase Chain Reaction
- Transcription, Genetic
- Transplantation, Homologous
- Treatment Outcome
- WT1 Proteins/biosynthesis
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Affiliation(s)
- Hiroyasu Ogawa
- Department of Molecular Medicine, Osaka University Graduate School of Medicine, Japan.
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4
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Cortes J, Albitar M, Thomas D, Giles F, Kurzrock R, Thibault A, Rackoff W, Koller C, O'Brien S, Garcia-Manero G, Talpaz M, Kantarjian H. Efficacy of the farnesyl transferase inhibitor R115777 in chronic myeloid leukemia and other hematologic malignancies. Blood 2003; 101:1692-7. [PMID: 12411300 DOI: 10.1182/blood-2002-07-1973] [Citation(s) in RCA: 172] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We investigated the clinical activity of the farnesyl transferase inhibitor R115777 in 22 patients with chronic myelogenous leukemia (CML) in chronic, accelerated, or blastic phase and in 8 patients with myelofibrosis (MF) and 10 patients with multiple myeloma (MM). R115777 was administered at 600 mg orally twice daily for 4 weeks every 6 weeks. Seven patients with CML (6 in chronic phase, 1 in advanced phase) achieved complete or partial hematologic response. Four of them had a minor cytogenetic response. Responses were transient, with a median duration of 9 weeks (range, 3-23 weeks). Two patients discontinued therapy because of toxicity while in complete hematologic response. Two MF patients had a significant decrease in splenomegaly, one had normalization of white blood cell count and differential, and one became transfusion independent. One patient with MM had a reduction in monoclonal protein of 34%. Adverse events included nausea in 22 patients (55%; all grade 2 or lower) and fatigue in 19 (48%; grade 3 or higher in 1). Other grade 3 or 4 toxicities included skin rash (4 patients, 10%), peripheral neuropathy (2 patients, 5%), and liver toxicity (2 patients, 5%). Patients who responded to therapy had significantly higher plasma vascular endothelial growth factor (VEGF) concentrations prior to treatment than nonresponders. Plasma concentrations decreased significantly during therapy among responders. R115777 showed clinical activity in patients with CML and MF. The effect on VEGF needs to be further investigated to determine whether this might be a possible mechanism of action of R115777.
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MESH Headings
- Adult
- Aged
- Alkyl and Aryl Transferases/antagonists & inhibitors
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/pharmacology
- Antineoplastic Agents/therapeutic use
- Blast Crisis/blood
- Blast Crisis/drug therapy
- Drug Administration Schedule
- Drug Eruptions/etiology
- Endothelial Growth Factors/blood
- Enzyme Inhibitors/administration & dosage
- Enzyme Inhibitors/adverse effects
- Enzyme Inhibitors/pharmacology
- Enzyme Inhibitors/therapeutic use
- Farnesyltranstransferase
- Fatigue/chemically induced
- Female
- Fibroblast Growth Factor 2/blood
- Hepatocyte Growth Factor/blood
- Humans
- Intercellular Signaling Peptides and Proteins/blood
- Interferon-alpha/blood
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/blood
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myeloid, Accelerated Phase/blood
- Leukemia, Myeloid, Accelerated Phase/drug therapy
- Leukemia, Myeloid, Chronic-Phase/blood
- Leukemia, Myeloid, Chronic-Phase/drug therapy
- Lymphokines/blood
- Male
- Middle Aged
- Multiple Myeloma/blood
- Multiple Myeloma/drug therapy
- Nausea/chemically induced
- Neoplasm Proteins/antagonists & inhibitors
- Neoplasm Proteins/blood
- Primary Myelofibrosis/blood
- Primary Myelofibrosis/drug therapy
- Quinolones/administration & dosage
- Quinolones/adverse effects
- Quinolones/pharmacology
- Quinolones/therapeutic use
- Salvage Therapy
- Treatment Outcome
- Tumor Necrosis Factor-alpha/analysis
- Vascular Endothelial Growth Factor A
- Vascular Endothelial Growth Factors
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Affiliation(s)
- Jorge Cortes
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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5
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Inokuchi K, Yamaguchi H, Tarusawa M, Futaki M, Hanawa H, Tanosaki S, Dan K. Abnormality of c-kit oncoprotein in certain patients with chronic myelogenous leukemia--potential clinical significance. Leukemia 2002; 16:170-7. [PMID: 11840282 DOI: 10.1038/sj.leu.2402341] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2000] [Accepted: 10/03/2001] [Indexed: 11/09/2022]
Abstract
Chronic myelogenous leukemia (CML) is characterized by the Philadelphia (Ph) chromosome and bcr/abl gene rearrangement which occurs in pluripotent hematopoietic progenitor cells expressing the c-kit receptor tyrosine kinase (KIT). To elucidate the biological properties of KIT in CML leukemogenesis, we performed analysis of alterations of the c-kit gene and functional analysis of altered KIT proteins. Gene alterations in the c-kit juxtamembrane domain of 80 CML cases were analyzed by reverse transcriptase and polymerase chain reaction-single strand conformation polymorphism (RT-PCR-SSCP). One case had an abnormality at codon 564 (AAT --> AAG, Asn --> Lys), and six cases had the same base abnormality at codon 541 (ATG --> CTG, Met --> Leu) in the juxtamembrane domain. Because the change from Met to Leu at codon 541 was a conservative one which was also observed in the normal population and normal tissues of CML patients, it probably represents a polymorphic variation. Although samples of hair roots and leukemic cells from the chronic phase of one CML patient showed no abnormality, an abnormality at codon 541 (ATG --> CTG, Met --> Leu) was found only at blastic crisis (BC) of this case. In the case with the abnormality at codon 564, the mutation was detected only in a sample of leukemic cells collected at BC. To examine the biological consequence and biological significance of these abnormalities, murine KIT(L540) and KIT(K563) expression vectors were introduced into interleukin-3 (IL-3)-dependent murine Ba/F3 cells to study their state of tyrosine phosphorylation and their growth rate. Ba/F3 cells expressing KIT(WT), KIT(L540) and KIT(K563) showed dose-dependent tyrosine phosphorylation after treatment with increasing concentrations of recombinant mouse stem cell factor (rmSCF). The cells expressing KIT(L540) and KIT(K563) were found to have greater tyrosine phosphorylation than cells expressing KIT(WT) at 0.1 and 1.0 ng/ml of rmSCF. The Ba/F3 cells expressing KIT(K563) proliferated in response to 0.1 and 1.0 ng/ml of rmSCF as well as IL-3. The Ba/F3 cells expressing KIT(L540)showed a relatively higher proliferative response to 0.1 ng/ml of rmSCF than the response of cells expressing KIT(WT). These mutations and in vitro functional analyses raise the possibility that the KIT abnormalities influence the white blood cell counts (P < 0.05) and survival (P < 0.04) of CML patients.
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MESH Headings
- Amino Acid Substitution
- Animals
- Blast Crisis/genetics
- Blast Crisis/pathology
- Bone Marrow/chemistry
- Bone Marrow/pathology
- Cell Division/drug effects
- Cell Line/drug effects
- Codon/genetics
- DNA Mutational Analysis
- DNA, Neoplasm/genetics
- Fusion Proteins, bcr-abl/genetics
- Hematopoietic Stem Cells/cytology
- Hematopoietic Stem Cells/drug effects
- Humans
- Interleukin-3/pharmacology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/blood
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia, Myeloid, Accelerated Phase/blood
- Leukemia, Myeloid, Accelerated Phase/genetics
- Leukemia, Myeloid, Accelerated Phase/pathology
- Leukemia, Myeloid, Chronic-Phase/blood
- Leukemia, Myeloid, Chronic-Phase/genetics
- Leukemia, Myeloid, Chronic-Phase/pathology
- Mice
- Mutagenesis, Site-Directed
- Mutation, Missense
- Neoplasm Proteins/analysis
- Neoplasm Proteins/genetics
- Phosphorylation
- Polymorphism, Genetic
- Polymorphism, Single-Stranded Conformational
- Protein Processing, Post-Translational
- Proto-Oncogene Proteins c-kit/analysis
- Proto-Oncogene Proteins c-kit/genetics
- RNA, Messenger/analysis
- RNA, Neoplasm/analysis
- Recombinant Fusion Proteins/physiology
- Reverse Transcriptase Polymerase Chain Reaction
- Transfection
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Affiliation(s)
- K Inokuchi
- Division of Hematology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
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6
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Slattery JT, Clift RA, Buckner CD, Radich J, Storer B, Bensinger WI, Soll E, Anasetti C, Bowden R, Bryant E, Chauncey T, Deeg HJ, Doney KC, Flowers M, Gooley T, Hansen JA, Martin PJ, McDonald GB, Nash R, Petersdorf EW, Sanders JE, Schoch G, Stewart P, Storb R, Sullivan KM, Thomas ED, Witherspoon RP, Appelbaum FR. Marrow transplantation for chronic myeloid leukemia: the influence of plasma busulfan levels on the outcome of transplantation. Blood 1997; 89:3055-60. [PMID: 9108427] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The influence of busulfan (BU) plasma concentration on outcome of transplantation from HLA identical family members for the treatment of chronic myelogenous leukemia (CML) was examined in 45 patients transplanted in chronic phase (CP) (n = 39) or accelerated phase (AP) (n = 6). All patients received the same regimen of BU, 16 mg/kg orally and cyclophosphamide (CY), 120 mg/kg intravenously. Plasma concentrations of BU at steady state (C(SS)BU) during the dosing interval were measured for each patient. The mean C(SS)BU was 917 ng/mL (range, 642 to 1,749; median, 917; standard deviation, 213). Of patients with C(SS)BU below the median, seven (five of 18 in CP and two of four in AP) developed persistent cytogenetic relapse and three of these patients died. There were no relapses in patients with C(SS)BU above the median. The difference in the cumulative incidence of relapse between the two groups was statistically significant (P = .0003). C(SS)BU was the only statistically significant determinant of relapse in univariable or multivariable analysis. The 3-year survival estimates were 0.82 and 0.64 for patients with C(SS)BU above and below the median (P = .33). There was no statistically significant association of C(SS)BU with survival or nonrelapse mortality, although the power to detect a difference in survival between 0.82 and 0.64 was only 0.24, similarly C(SS)BU above the median was not associated with an increased risk of severe regimen-related toxicity. We conclude that low BU plasma levels are associated with an increased risk of relapse.
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MESH Headings
- Adult
- Bone Marrow Transplantation/mortality
- Busulfan/administration & dosage
- Busulfan/adverse effects
- Busulfan/blood
- Cause of Death
- Cyclophosphamide/administration & dosage
- Female
- Graft Rejection/epidemiology
- Graft vs Host Disease/mortality
- Humans
- Infections/etiology
- Infections/mortality
- Leukemia, Myeloid, Accelerated Phase/blood
- Leukemia, Myeloid, Accelerated Phase/mortality
- Leukemia, Myeloid, Accelerated Phase/pathology
- Leukemia, Myeloid, Accelerated Phase/therapy
- Leukemia, Myeloid, Chronic-Phase/blood
- Leukemia, Myeloid, Chronic-Phase/mortality
- Leukemia, Myeloid, Chronic-Phase/pathology
- Leukemia, Myeloid, Chronic-Phase/therapy
- Male
- Middle Aged
- Neoplasm, Residual
- Quality of Life
- Recurrence
- Remission Induction
- Survival Analysis
- Transplantation Conditioning/adverse effects
- Transplantation, Homologous
- Treatment Outcome
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Affiliation(s)
- J T Slattery
- Fred Hutchinson Cancer Research Center, Seattle, WA 98104-2092, USA
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7
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Van den Berg D, Wessman M, Murray L, Tong J, Chen B, Chen S, Simonetti D, King J, Yamasaki G, DiGiusto R, Gearing D, Reading C. Leukemic burden in subpopulations of CD34+ cells isolated from the mobilized peripheral blood of alpha-interferon-resistant or -intolerant patients with chronic myeloid leukemia. Blood 1996; 87:4348-57. [PMID: 8639795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
We attempted to determine the frequency of normal hematopoietic stem cells (HSC) and contaminating leukemic cells in mobilized peripheral blood (MPB) collected from chronic myeloid leukemia (CML) patients, intolerant of alpha-interferon or with interferon-resistant disease. A total of 14 MPB samples, six from patients in chronic phase (CP) and eight from patients in accelerated phase or blast crisis (AP/BC) were studied. Cytogenetic analysis of MPB collected from AP/BC patients showed that 100% of the cells were Ph+, whereas cells from four of five CP MPB were Ph-. By contrast, fluorescence in situ hybridization (FISH) analysis of CP MPB showed a mean frequency of 14.7% Ph+ cells, while AP/BC MPB contained 39.2% Ph+ cells. In an attempt to purify normal HSC, subpopulations of the MPB CD34+ cells were isolated based on expression of the Thy-1 antigen (CDw90). The mean Ph+ cell frequency as determined by FISH within the CD34+Thy-1+Lin- and CD34+Thy-1-Lin- populations from CP patients was 19.2% and 33.9%, respectively. In the AP/BC patients, levels of residual leukemic cells were significantly greater with mean Ph+ cell frequencies of 59.2% and 72.7% for the CD34+Thy-1+Lin- and CD34+Thy-1-Lin- fractions, respectively. The frequency of cobblestone area forming cells (CAFC) was used as a means of quantitating the numbers of functional HSC within these cell subpopulations. The mean CAFC frequency was 1 of 19 for the CD34+Thy-1+Lin- cells as compared with 1 of 133 for the Thy-1-fraction indicating a higher frequency of primitive progenitor cells in the Thy-1+ subpopulation. CD34+ cell subsets from two patients were also injected into SCID-hu bone assays to determine the in vivo behavior of these cell populations. After 8 weeks, multilineage donor engraftment was observed in these grafts. FISH analysis of the donor cells within the grafts showed that 55.3% and 60.0% of the cells were Ph+. We conclude that unfractionated MPB from this patient population is not leukemia-free and that the CD34+Thy-1+Lin- cell subpopulation, although predominantly enriched for normal HSC, still contains substantial numbers of residual leukemic cells.
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MESH Headings
- Adolescent
- Adult
- Animals
- Antigens, CD34/analysis
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Blast Crisis/blood
- Blast Crisis/therapy
- Blood Cell Count
- Bone Transplantation
- Cisplatin/administration & dosage
- Cisplatin/pharmacology
- Combined Modality Therapy
- Drug Resistance
- Etoposide/administration & dosage
- Etoposide/pharmacology
- Fetal Tissue Transplantation
- Flow Cytometry
- Graft Survival
- Granulocyte Colony-Stimulating Factor/pharmacology
- Hematopoietic Stem Cell Transplantation
- Hematopoietic Stem Cells/chemistry
- Humans
- Ifosfamide/administration & dosage
- Ifosfamide/pharmacology
- Immunologic Factors/therapeutic use
- Immunomagnetic Separation
- In Situ Hybridization, Fluorescence
- Interferon-alpha/therapeutic use
- Leukapheresis/methods
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/blood
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Leukemia, Myeloid, Accelerated Phase/blood
- Leukemia, Myeloid, Accelerated Phase/therapy
- Leukemia, Myeloid, Chronic-Phase/blood
- Leukemia, Myeloid, Chronic-Phase/therapy
- Mice
- Mice, SCID
- Middle Aged
- Neoplasm Transplantation
- Neoplastic Cells, Circulating/chemistry
- Philadelphia Chromosome
- Radiation Chimera
- Specific Pathogen-Free Organisms
- Transplantation, Heterologous
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8
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Turkina AG, Baryshnikov AY, Sedyakhina NP, Folomeshkina SV, Sokolova MA, Choroshco ND, Stavrovskaya AA. Studies of P-glycoprotein in chronic myelogenous leukaemia patients: expression, activity and correlations with CD34 antigen. Br J Haematol 1996; 92:88-96. [PMID: 8562416 DOI: 10.1046/j.1365-2141.1996.273807.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Over-expression of the P-glycoprotein (Pgp), transmembrane drug efflux pump, has been shown to cause multidrug resistance of tumour cells (MDR). To investigate the clinical significance of Pgp expression for chronic myeloid leukaemia (CML) diagnosis and monitoring we have studied 38 CML patients in various phases of the disease (chronic phase, CP; accelerated phase, AP; blast crisis, BC). Anti-Pgp monoclonal antibody UIC2 and FACScan analysis were used. Pgp functional activity was investigated by evaluation of verapamil influence upon rhodamine 123 efflux from the cells. Correlations between Pgp and CD34 expression were investigated. In CP, Pgp-expressing cells were found in 2/14 patients; in one of them Pgp proved to be non-functional. There were few Pgp-expressing cells in AP cases. The group of BC patients consisted of cases resistant to chemotherapy. This gave us the opportunity to consider whether drug resistance of BC CML patients is preferentially connected with Pgp-mediated MDR. 11/22 BC patients had 20% or more of Pgp-expressing blasts in the peripheral blood. In all four Pgp+ BC cases studied for Pgp activity this protein was functional. Only 4/22 BC patients demonstrated large (40% or more) fractions of Pgp+ blasts. Moreover, sequential studies of 11 BC CML patients during treatment revealed an increase in the number of Pgp-expressing cells in only two cases. This suggests that Pgp+ cells did not often accumulate in BC CML patients due to chemotherapy and are the cause of drug resistance in only a few cases. A positive correlation between Pgp and CD34 expression was found (r = 0.69; P = 0.0004). 3/22 BC CML patients had large fractions of both Pgp+ and CD34+ blasts in their peripheral blood. The BC CML patients with this immunophenotype of blast cells may represent a subtype of BC CML resistant to treatment due to Pgp overexpression.
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MESH Headings
- ATP Binding Cassette Transporter, Subfamily B, Member 1/blood
- Adult
- Aged
- Antigens, CD34/blood
- Blast Crisis/blood
- Drug Resistance, Multiple
- Drug Resistance, Neoplasm
- Female
- Flow Cytometry
- Fluorescent Antibody Technique
- Follow-Up Studies
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/blood
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia, Myeloid, Accelerated Phase/blood
- Leukemia, Myeloid, Chronic-Phase/blood
- Male
- Middle Aged
- Neoplasm Proteins/metabolism
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Affiliation(s)
- A G Turkina
- Cancer Research Centre of Academy of Medical Sciences, Moscow, Russia
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9
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Carella AM, Podestà M, Frassoni F, Pungolino E, Pollicardo N, Raffo MR, Ferrero R, Benvenuto F, Figari O, Giordano D. Selective overshoot of Ph-negative blood hemopoietic cells after intensive idarubicin-containing regimen and their repopulating capacity after reinfusion. Stem Cells 1993; 11 Suppl 3:67-72. [PMID: 7905325 DOI: 10.1002/stem.5530110917] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Twenty-seven patients with chronic myelogenous leukemia (CML)--17 in the chronic phase and 10 in the accelerated phase--were treated with an intensive chemotherapy regimen consisting of idarubicin, arabinosylcytosine, and etoposide. All patients were ineligible for bone marrow transplantation (BMT) and showed little or no cytogenetic response to interferon alpha (IFN-alpha). Blood hemopoietic cells (BHC) were collected by leukapheresis in all patients during early recovery from chemotherapy-induced aplasia. In 13/27 patients (48%), all metaphases were Ph-negative (Ph-); in another five patients, the percentage of Ph-positive (Ph+) metaphases decreased to less than 50%. Complete Ph+ disappearance was found in 66% of the patients treated within two years of diagnosis and in only 30% of those treated later. The collected Ph- cells have been used as autotransplants in nine patients: seven have shown sustained engraftment, and five are alive and well, with Ph- at 3+, 4+, 7+, 11+, and 19+ months after transplant. It is remarkable that one patient, now Ph- at 19 months after transplant, is also PCR negative. These results suggest that it is possible to collect Ph- hemopoietic cells even years after diagnosis and to perform autologous transplants with these cells.
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MESH Headings
- Adult
- Blast Crisis/therapy
- Bone Marrow Transplantation
- Combined Modality Therapy
- Female
- Hematopoietic Stem Cell Transplantation
- Hematopoietic Stem Cells/pathology
- Humans
- Idarubicin/therapeutic use
- Leukapheresis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Leukemia, Myeloid, Accelerated Phase/blood
- Leukemia, Myeloid, Accelerated Phase/therapy
- Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative/blood
- Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative/drug therapy
- Male
- Middle Aged
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Affiliation(s)
- A M Carella
- Hematology and ABMT Unit, Ospedale S. Martino, Genoa, Italy
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10
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Carella AM, Podesta M, Frassoni F, Raffo MR, Pollicardo N, Pungolino E, Vimercati R, Sessarego M, Parodi C, Rabitti C. Collection of 'normal' blood repopulating cells during early hemopoietic recovery after intensive conventional chemotherapy in chronic myelogenous leukemia. Bone Marrow Transplant 1993; 12:267-71. [PMID: 7694724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Twenty-five patients with CML (chronic phase (CP): 15 patients; accelerated phase (AP): 10 patients) at a median of 40 months after diagnosis and ineligible for allogeneic BMT, received an intensive chemotherapy regimen consisting of idarubicin, intermediate-dose ara-C and etoposide (ICE protocol). All patients had previously received alpha-interferon and only two patients had had partial cytogenetic response. During recovery from chemotherapy-induced aplasia, blood progenitors cells (BPC) were harvested by leukapheresis. All metaphases were found to be Ph-negative in the collection of 12 of 25 (48%) patients (CP: 9 of 15 (60%), AP: 3 of 10 (30%)) and a decrease of < 50% Ph-positive metaphases was seen in an additional five (CP: 4 patients; AP: 1 patient). The percentage of complete Ph-disappearance was 66% in patients receiving this procedure within the first 2 years of diagnosis and 30% in those treated after the second year of diagnosis. So far, the Ph-negative collections have been used in 9 patients (CP: 8 patients; AP: 1 patient) as autograft after conditioning with total body irradiation/etoposide/CY. Seven of 9 patients engrafted and 5 are alive and well, Ph-negative at 2+, 3+, 6+, 10+ and 18+ months.
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MESH Headings
- Adult
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Blood Component Transfusion
- Blood Transfusion, Autologous
- Cell Separation
- Combined Modality Therapy
- Cytarabine/therapeutic use
- Etoposide/therapeutic use
- Female
- Fusion Proteins, bcr-abl/genetics
- Granulocyte Colony-Stimulating Factor/therapeutic use
- Hematopoietic Stem Cell Transplantation
- Hematopoietic Stem Cells
- Humans
- Idarubicin/therapeutic use
- Immunologic Factors/therapeutic use
- Interferon-alpha/therapeutic use
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/blood
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Leukemia, Myeloid, Accelerated Phase/blood
- Leukemia, Myeloid, Accelerated Phase/drug therapy
- Leukemia, Myeloid, Accelerated Phase/pathology
- Leukemia, Myeloid, Accelerated Phase/therapy
- Leukemia, Myeloid, Chronic-Phase/blood
- Leukemia, Myeloid, Chronic-Phase/drug therapy
- Leukemia, Myeloid, Chronic-Phase/pathology
- Leukemia, Myeloid, Chronic-Phase/therapy
- Male
- Middle Aged
- Polymerase Chain Reaction
- RNA, Messenger/analysis
- RNA, Neoplasm/analysis
- Recombinant Proteins/therapeutic use
- Remission Induction
- Time Factors
- Treatment Outcome
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Affiliation(s)
- A M Carella
- Hematology and Autologous Bone Marrow Transplantation Unit, Ospedale S. Martino, Genoa, Italy
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11
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Abstract
We studied the multimeric composition of plasma von Willebrand factor (vWf) in 26 patients with chronic myelocytic leukaemia (CML); 13 in chronic phase, 8 in blast crisis, 5 in both chronic phase and blast crisis. The relative amount of large (multimer band greater than or equal to 11) multimers calculated by densitometer scan following SDS-agarose gel electrophoresis was 14.6 +/- 2.9% (mean +/- SD) in normal controls, 8.7 +/- 4.7% in chronic phase and 15.0 +/- 5.2% in blast crisis. CML patients in chronic phase (but not in blast crisis) had a significantly lower percentage of large multimers than normal controls (p less than 0.001). The relative amount of large multimers was positively correlated with a ratio of ristocetin cofactor/vWf antigen (p less than 0.005), and was negatively correlated with platelet count (p less than 0.001), WBC count (p less than 0.05) and granulocyte count (p less than 0.05). We conclude that some patients with CML, especially in chronic phase, lack large multimers. The negative correlation of the relative amount of large multimers with platelet and granulocyte count suggests that large multimers may be consumed in high platelet count states or degraded by protease(s) from increased blood cells.
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MESH Headings
- Adult
- Aged
- Female
- Hemorrhage/etiology
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/blood
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myeloid, Accelerated Phase/blood
- Leukemia, Myeloid, Chronic-Phase/blood
- Male
- Middle Aged
- Protein Conformation
- von Willebrand Factor/metabolism
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Affiliation(s)
- W Tatewaki
- First Department of Internal Medicine, Niigata University School of Medicine, Japan
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