GLORIA

GEOMAR Library Ocean Research Information Access

Your email was sent successfully. Check your inbox.

An error occurred while sending the email. Please try again.

Proceed reservation?

Export
  • 1
    Online Resource
    Online Resource
    Wiley ; 2014
    In:  European Journal of Haematology Vol. 93, No. 4 ( 2014-10), p. 297-301
    In: European Journal of Haematology, Wiley, Vol. 93, No. 4 ( 2014-10), p. 297-301
    Abstract: Although the introduction of imatinib dramatically improved the outcomes for patients with P hiladelphia chromosome‐positive B ‐cell precursor acute lymphoblastic leukemia ( P h+ BCP ‐ ALL ), the survival benefit of imatinib has not been assessed in the context of P h+ mixed phenotype acute leukemia ( P h+ MPAL ). To clarify this important issue, we studied 42 P h+ acute leukemia ( P h+ AL ) patients who received intensive chemotherapy and concurrent administration of imatinib. Of the 42 P h+ AL patients, 13 (31%) patients were categorized as P h+ MPAL (positive for both myeloid and B ‐cell lineage), 27 (64%) were categorized as P h+ BCP ‐ ALL , and two (5%) were categorized as P h+ acute myeloid leukemia. The complete remission rates after the initial induction therapy were not significantly different when comparing P h+ MPAL and P h+ BCP ‐ ALL patients (100% vs. 85%, respectively, P  = 0.14). Likewise, there were no significant differences in the 5‐yr overall survival ( OS ) or disease‐free survival ( DFS ) rates when comparing the MPAL and BCP ‐ ALL groups ( OS : 55% vs. 53%, respectively, P  = 0.87, DFS : 46% vs. 42%, respectively, P  = 0.94). These findings suggest that concurrent imatinib administration with chemotherapy improved the outcomes of P h+ MPAL patients to the level seen in P h+ BCP ‐ ALL patients and should, therefore, be considered as the standard therapy for these patients.
    Type of Medium: Online Resource
    ISSN: 0902-4441 , 1600-0609
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2014
    detail.hit.zdb_id: 2027114-1
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
  • 2
    In: Blood, American Society of Hematology, Vol. 132, No. Supplement 1 ( 2018-11-29), p. 2820-2820
    Abstract: Background:Although cytogenetic abnormalities at diagnosis are recognized as one of the most potent prognostic factors in acute leukemia patients, CCH acquisition at diagnosis, which are considered as a result of clonal evolution of leukemia cells, is not taken into account in prognostic classifications. Recent studies reported that CCH acquisition was observed in 24 - 32% of adult AML patients with abnormal karyotype, was more likely to occur in patients with older age and complex karyotype, and showed adverse prognostic impact. However, the clinical significance of CCH acquisition has not been investigated in adult ALL patients to date. Patients and methods: Of the 238 adult ALL patients diagnosed between 1990 and 2016, 120 patients with abnormal karyotype at diagnosis, who underwent intensive chemotherapy, were included in this study. CCH was defined as presence of two or more cytogenetically abnormal clones. A defined ancestral clonal evolution included either mother-daughter and/or branched patterns. In the mother-daughter pattern, a daughter clone showed all cytogenetic abnormalities of a mother clone plus additional abnormality(s), which define a distinct subclone. In a branch pattern, all subclones possessed common cytogenetic abnormalities suggesting presence of a common ancestry, but each subclone acquires unique additional abnormality(s), which define them as distinctive subclones. Both patterns of cytogenetic clonal evolution were sometimes seen in a patient. Composite karyotypes were applied to patients where a common ancestry could not be clearly determined because of too complicated cytogenetic findings. Fisher's exact test was used to compare binary variables. The logistic regression model was used for multivariate analysis of predisposing factors. Overall survival (OS) was estimated with the Kaplan-Meier method and compared using the log-rank test. The Cox proportional hazard model was used for multivariate analysis of prognostic factors. Values of p 〈 0.05 were considered to indicate statistical significance. Results:Of the 120 patients included in this study, 64 patients were male, and 56 were female. The median age was 50 years (range, 16-79 years). Karyotypes at diagnosis were Philadelphia chromosome (Ph) in 56 patients, complex in 15, and t(8;14) in seven. According to the definition described above, 47 patients (39%) showed CCH at diagnosis, and two (4%) among them were categorized as composite karyotype. Of the 45 patients harboring a defined ancestral clonal evolution, numbers of subclones were two, three, and four in 32 patients (68%), 11 (24%), and 2 (4%), respectively. Mother-daughter pattern, branched pattern, and both were seen in 34 patients (76%), 5 (11%), and 6 (13%). In univariate analysis for predisposing factors of CCH acquisition, only younger age was significantly associated with CCH acquisition (48% in age 〈 = 50 vs. 29% in age 〉 50; p = 0.04), but not karyotype. This statistical significance was confirmed with multivariate analysis (odds ratio = 0.44; p = 0.03). When investigating the prognostic impact of CCH acquisition, patients were divided into Ph-negative or Ph-positive ALL groups. In the 64 Ph-negative ALL patients, the CR rates were not significantly different between patients with or without CCH (78% vs. 78%, respectively; p = 1.00). The OS rates were similar between two groups (26% vs. 39% at five years, respectively; p = 0.56). Multivariate analysis for OS revealed that complex karyotype and t(8;14) were independent prognostic factors, but not CCH acquisition. Likewise, in the 56 Ph-positive ALL patients, CCH acquisition was not significantly associated with the CR rates (92% vs. 78%, respectively; p = 0.27), and the OS rates did not significantly differ between the two groups (34% vs. 40% at five years, respectively; p = 0.90). In multivariate analysis for OS, no independent prognostic factor was identified. Conclusion: Adult ALL patients with abnormal karyotype acquired CCH at diagnosis with a frequency comparable to that of AML patients. However, unlike AML patients, CCH acquisition was more frequently observed in younger population and did not show any prognostic impact in ALL patients. These findings suggested that biological backgrounds of CCH acquisition at diagnosis were possibly different between in patients with ALL and AML. So, to confirm these important findings, clinical studies with larger study subjects are warranted. Disclosures Handa: Celgene: Honoraria, Research Funding, Speakers Bureau; Takeda: Consultancy, Honoraria, Research Funding, Speakers Bureau.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2018
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
  • 3
    In: Blood, American Society of Hematology, Vol. 134, No. Supplement_1 ( 2019-11-13), p. 1431-1431
    Abstract: Background: Acute myeloid leukemia (AML) is a hematological malignancy characterized by the autonomous growth of immature myeloid cells with impaired differentiation and maturation. Cytokines are low-molecular-weight proteins that play a basic and fundamental role in communication within the immune system. Cytokines induce various effects such as differentiation, proliferation, hematopoiesis, and inflammation of target cells. AML is also closely associated with cytokine networks in terms of proliferation, apoptosis, and differentiation of leukemic cells. Cytokines produced by Th1 involved in cell-mediated immunity are called Th1 cytokines. Th1 cytokine includes TNF-α and IL-2. Several studies have reported that TNF-α is highly expressed in leukemia cells with AML patients. Other studies have also reported that high serum level of TNF-α of AML patients is associated with poor survival outcome. However, the association between Th1 cytokine polymorphisms: TNF-α -857C/T and IL-2-330T/G and the pathogenesis of AML is unclear. Therefore, we investigated the role of these polymorphisms in AML. Materials and Methods: This study included 101 patients with AML [male/female, 56/45; age, 15-86 years; median age, 58 years; MRC classification favorable (n = 38), intermediate (n =56), and adverse (n = 7)] and 202 healthy race-matched controls. All participants provided written informed consent. This study was approved by the Institutional Review Board of Gunma University Hospital. Genotyping was performed by the polymerase chain reaction (PCR)-restriction fragment length polymorphism method. Genotype and allele frequency were compared between patient group and control group by χ2-test. Clinical features were compared using Student's t and χ2 tests. Overall survival (OS) and leukemia free survival (LFS) were calculated using the Kaplan-Meier method. Survival curves were compared using the log-rank test. Analyses were performed using the SPSS software package ver. 25 (IBM, Armonk, NY, USA). P & lt; 0.05 was considered to represent statistical significance. Results: TNF-α -857 C/T nonCC genotype (higher producer type) increases the risk of AML (AML vs. controls = 39.6% vs. 28.2%, OR = 1.67, 95% CI = 1.01-2.75, p = 0.045). Moreover, the frequency of TNF-α -857 C/T T allele (higher producer type) was higher in AML patients compared to controls (AML vs. controls = 24.8% vs. 16.8%, OR = 1.625, 95%CI = 1.078-2.451 p = 0.02). There was no significant difference between AML patients and controls in genotype and allele frequencies of IL-2 -330 T/G. In the analysis of clinical features, the average platelet count was significantly lower in TNF-α -857 C/T TT genotype (higher producer type) (TT vs. nonTT = 2.4±1.4 vs. 4.4±5.9, p & lt; 0.01). TT genotype (higher producer type) was also significantly higher in frequency of MRC classification adverse (TT vs. nonTT = 30.0% vs. 4.4%, p = 0.02) and history of tumor (TT vs. nonTT = 30.0% vs. 6.6%. p =0.04). Moreover, in survival time analysis, patients with TNF-α -857 C/T TT genotype (higher producer type) had significantly shortened OS compared with patients with nonTT genotype (lower producer type) (TT vs. nonTT = 17.2 months vs not reached, p & lt; 0.01). Patients with TT genotype (high producer type) also experienced significantly shortened LFS (TT vs. nonTT = 24.0 months vs not reached, p = 0.04). Furthermore, multivariate analysis of OS revealed TNF-α -857 C/T TT genotype (higher producer type) as an independent prognostic factor (HR = 3.01, 95% CI = 1.04-8.69, p = 0.04), like age and white blood cell count. Conclusion: These results suggest that TNF-α-857 C/T T allele (higher producer type) increases the risk of AML. Furthermore, TNF-α-857 C/T TT genotype (higher producer type) affects the poor prognosis. Therefore, these data suggest the new role of TNF-α polymorphism in AML leukemogenesis. Figure Disclosures Handa: Ono: Research Funding.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2019
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
  • 4
    In: Blood, American Society of Hematology, Vol. 128, No. 22 ( 2016-12-02), p. 3440-3440
    Abstract: Background: Although the number of long-term survivors after allo-SCT has been increasing with the recent improvements of transplant procedures, late complications have emerged as an important unsolved issue in these transplant recipients. CKD is generally recognized as a stage prior to end-stage renal disease, which requires renal replacement therapy, and the incidence of CKD among transplant recipients has been reported to be around 30%. We recently reported that administration of low-dose carperitide in the early phase of transplant had the potential to prevent development of CKD after allo-SCT. However, risk factors for CKD after allo-SCT have not been fully elucidated, so that suitable candidates for this preventive approach are unclear. To this end, this retrospective study was conducted. Patients and methods: In this study, 149 consecutive patients who underwent allo-SCT for the first time at Gunma University and Saiseikai Maebashi Hospital between 2006 and 2013 and survived without a relapse of underlying disease three months after transplant were included. There was no restriction on underlying disease, donor source, or conditioning regimen. CKD was defined as estimated glomerular filtration rate (eGFR) of less than 60 ml/min/1.73 m2 lasting more than three months, according to the KDIGO guideline. Overall survival (OS) was defined as the interval from the date of transplant to the date of death. Non-relapse mortality (NRM) was defined as any death without a relapse of underlying disease. Fisher's exact test was used for comparison of binary variables. Cumulative incidences (CIs) of CKD were compared using the stratified Gray test, considering death without the event as a competing risk. The Fine-Gray proportional hazard model was used for multivariate analysis of risk factors for CKD. In the analysis of OS and NRM, CKD was treated as a time-dependent covariate. P 〈 0.05 was considered significant. Results: Of the 149 transplant recipients included in this study, 80 were male and 69 were female. The median age was 48 years (range, 18-72 years), and the median baseline eGFR was 92.2 ml/min/1.73 m2 (range, 19.4 - 172.8 ml/min/1.73 m2). Underlying diseases were acute myeloid leukemia in 77 patients, acute lymphoblastic leukemia in 39, and myelodysplastic syndrome in 20. Stem cell donors were related donors in 30 patients, unrelated donors in 78, and cord blood in 41, and almost all patients were conditioned with total body irradiation (TBI)-containing myeloablative conditioning (MAC) regimens. The 2-year cumulative incidence of CKD after transplant was 35.6%. On univariate analysis, age 〉 50 years, baseline eGFR 〈 90 ml/min/1.73 m2, use of FK506 for GVHD prophylaxis, prolonged calcineurin inhibitor use ( 〉 6 months), and acute kidney injury (AKI) development within 90 days after transplant were significant risk factors for CKD development. Multivariate analysis showed that age 〉 50 years (hazard ratio [HR] = 3.322; p-value 〈 0.001), baseline eGFR 〈 90 ml/min/1.73 m2 (HR = 2.088; p-value = 0.018), use of MAC regimens (HR = 2.122; p-value = 0.035), prolonged calcineurin inhibitor use (HR = 2.078; p-value = 0.035), and AKI development within 90 days after transplant (HR = 2.697; p-value 〈 0.001) were independent risk factors for CKD development, but disease type, disease risk, donor type, HLA mismatch, TBI-containing conditioning regimen, transplant year, acute GVHD, and chronic GVHD were not. CKD development showed no significant impact on OS (HR = 1.063; p-value = 0.823), and CKD development was not associated with increased NRM (HR = 1.439; p-value = 0.335). Conclusion: These findings suggest that transplant recipients with some of the features mentioned above, including higher age, lower baseline eGFR, and use of MAC regimens, should be recognized as patients at high risk for CKD at the time of transplant. Thus, we plan to conduct a prospective trial to explore whether low-dose carperitide treatment can reduce the incidence of CKD after allo-SCT among such high-risk transplant recipients. Disclosures No relevant conflicts of interest to declare.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2016
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
  • 5
    In: Cancer Science, Wiley, Vol. 103, No. 8 ( 2012-08), p. 1513-1517
    Type of Medium: Online Resource
    ISSN: 1347-9032
    Language: English
    Publisher: Wiley
    Publication Date: 2012
    detail.hit.zdb_id: 2115647-5
    detail.hit.zdb_id: 2111204-6
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
  • 6
    In: Blood, American Society of Hematology, Vol. 124, No. 21 ( 2014-12-06), p. 3535-3535
    Abstract: Background: 5-methylation (5-mC) is the predominant epigenetic mark in mammalian genomic DNA. When promoter region of certain gene is hypermethylated, the gene becomes transcription silent. Promoter of tumor suppressor genes (TSG) usually exists in CpG islands, and silencing of TSGs in cancer cells is often associated with hypermethylation. p15, CDH1 are frequently methylated in myeloid malignancies such as acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS). Common Fragile Site (CFS) is a fragile site on the chromosomes easy to produce gap and break, and it contains putative TSGs. FHIT, WWOX and PARK2 are the CFS genes known to be frequently methylated in solid tumors, but their status of hematologic malignancies has not been fully elucidated yet. 5-hydroxymethylaiton (5-hmC) is a newly discovered epigenetic modification that is presumably generated by oxidation of 5-mC by the TET family of cytosine oxygenases. Techniques identifying 5-mC cannot distinguish between 5-mC and 5-hmC, therefore 5-hmC status of the genes have not fully elucidated yet too. Recently it has been demonstrated that mutation of epigenetic modifiers (DNMT3A, TET2, IDH1/2) play important role on AML pathogenesis. We tried to clarify 5-mC and 5-hmC status of TSG p15, CDH1 and CFS genes FHIT, WWOX and PARK2 by using new techniques and the relationships with expression levels of epigenetic modifiers in AML. Methods: BM samples obtained from 74 of AML patients are subjected to the study after informed consent. This study was approved by IRB of Gunma University Hospital. DNA, RNA were extracted from BM mononuclear cells. Methylation specific PCR (MSP) was carried out to assay 5-mC of p15, CDH1, WWOX, PARK2. Quantification of 5-mC and 5-hmC (except PARK2) was carried out by methylation sensitive restriction enzyme assay (MSRE) with glucosylation and Q-PCR. Total DNA 5-mC and 5-hmC were analyzed by ELISA. The mRNA expression levels of p15, CDH1, FHIT, WWOX, PARK2, DNMT1, 3A, TET2 were quantified by Q-PCR. Results: MSP revealed that p15, CDH1, WWOX and PARK2 were methylated in 43.1%, 94.3%, 35.7% and 36.9% of AML, respectively. PARK2 methylation was not found in t(15;17) APL, but in 32% of normal karyotype AML (NK-AML), in 67% of t(8;21) CBF-AML. In contrast, the p15 methylation was found in 83.3% of APL, 45.5% of NK-AML, 50% of CBF-AML. WWOX methylation was found in 42.9% of APL, in 16% of NK-AML and 66.7% of CBF-AML. Adverse karyotype AML (adv-AML) tended to show lower % of WWOX, PARK2 and p15 methylation with 15.8%, 21.1% and 18.8% compare to good risk karyotype. The frequency of the methylation of PARK2 and WWOX were varied among karyotypes and the methylation was mutually exclusive. ELISA demonstrated that mean % of total 5-mC DNA was 1.08% and ratio of 5-hmC in 5-mC was 0.95% in AML. Interestingly, 5-hmC was 0% in adv-AML although 5-mC existed (mean: 1.05%). Locus specific MSRE-QPCR demonstrated that mean % of 5-mC of p15, CDH1, WWOX and FHIT were 6.62%, 1.25%, 8.33%, 2.88%, respectively., In adv-AML, 5-hmC of CDH1, WWOX and FHIT were not detected, although 5-mC of these genes were detected (0.41%, 9.0%, 2.14%) in accordance with whole DNA analysis. In good and intermediate AML, 5-hmC of these genes was 3.44%, 1.07%, 2.69% ,respectively. RQ-PCR demonstrated that CDH1, p15, WWOX, PARK2 and epigenetic modifier DNMT1, DNMT3A and TET2 expression were not different among various karyotype risks, but only FHIT expression significantly higher in good risk group (p=0.047). The expression levels of the genes were not significantly different between mentylated and unmethylated. The ratio of 5-hmC/5-mC of the TSGs tended to be associated with the expression levels of the corresponding genes, but the association did not reach statistical significance. DNMT3A expression in AML with 5-mC PARK2 was higher than in other AML (p=0.016). Contrary to the intuition, DNMT3A expression was positively correlated with FHIT, PARK2 expression (r=0.776, p & lt;0.001, r=0.689, p & lt;0.001). CDH1 expression was positively correlated with DNMT1 and negatively correlated with TET2 expression (r=0.447, p=0.009, r=-0.349, p=0.022). OS and EFS were not different among the methylation status of these genes. Conclusion: CFS genes are selectively methylated in AML. MSRE-QPCR can distinguish 5-mC and 5-hmC and quantify the ratio of them with locus specific manner. The relationship between gene expression and 5-hmC, 5-mC should be pursued. Disclosures No relevant conflicts of interest to declare.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2014
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
  • 7
    In: Blood, American Society of Hematology, Vol. 116, No. 21 ( 2010-11-19), p. 4373-4373
    Abstract: Abstract 4373 Background We reported that adult AML patients with granulocytic sarcoma (GS) at diagnosis were associated with younger age, higher WBC counts, and monocytic differentiation of leukemia cells and GS adversely affected relapse rate and DFS at the 51st ASH annual meeting. However clinical impact of GS at relapse has not been clear. The objective of this study was to describe the frequency and clinical characteristics of adult AML patients with GS at relapse. Methods Between January, 1990 and March 2010, 517 patients (median age 57 (15-88), male/female; 313/204) diagnosed as AML were included. 58 patients (11.2%) were with GS at diagnosis and 459 patients were without GS. 480 younger patients were treated according to Japan Adult Leukemia Study Group treatment protocols (JALSG AML92, AML95, AML97, GML200, or AML201). 37 older patients were treated with low-dose Ara-C based regimen. The χ2-test was used for the binary variable comparison. The Mann-Whitney U test was used for continuous variable comparison. P 〈 0.05 was considered to indicate statistical significance. Results A total of 295 relapses was occurred in 233 patients. 32 relapses (11.0%) were with GS and 263 were without GS. 30 patients with GS at relapse had the same characteristics as patients with GS at diagnosis, including younger age (p 〈 0.001), higher WBC counts at relapse (p=0.045), and high frequency of FAB M4 (p=0.001) and M5 (p=0.042) morphology. No significant differences in sex, the distribution of cytogenetic risk groups, and the frequency of each cytogenetic change including t(8;21), 11q23, inv(16), and the complex karyotype demonstrated. 38 relapses occurred in 34 patients with GS at diagnosis and 257 relapses in 199 patients without GS. The frequency of relapse with GS in patients with GS at diagnosis was significantly higher than that in patients without GS (29% vs 8%; p=0.0006). 41 relapses occurred in 37 patients after allogenic stem cell transplantation (allo-SCT) and 254 relapses in 196 patients after chemotherapy. 8 patients received allo-SCT from peripheral blood stem cell, 24 from bone marrow, and 6 from cord blood. 31 patients received conditioning regimen containing total body irradiation (TBI) and 6 received non-TBI regimen. The frequency of relapses with GS after allo-SCT was significantly higher than that after chemotherapy (27% vs 9%; p=0.0035). In patients after allo-SCT cell source and conditioning regimen did not affected frequency of GS. 58% of patients achieved CR with any salvage chemotherapy. Patients with GS had a trend of a lower CR rate than without GS (47% vs 63%; p=0.068). Conclusions Patients with GS at relapse had the same characteristics as patients with GS at diagnosis, including younger age, higher WBC counts, and monocytic differentiation of leukemia cells. This study shows the high frequency of relapse with GS in patients with GS at diagnosis and after allo-SCT independently of cell source and the conditioning regimen. As patients with GS at relapse tended to get chemotherapy-resistant we should give the attention to relapse with GS in follow-up of such AML patients. Disclosures: No relevant conflicts of interest to declare.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2010
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
  • 8
    In: Hematological Oncology, Wiley, Vol. 36, No. 1 ( 2018-02), p. 252-257
    Abstract: We retrospectively investigated 144 patients with relapsed acute myeloid leukemia (AML) to clarify predisposing factors and the prognostic impact of acquisition of additional cytogenetic abnormalities (ACA) at the first relapse. Additional cytogenetic abnormalities are recognized as clonal evolution at the cytogenetic level. Fifty‐nine patients (41%) acquired ACA at the first relapse. The incidences of ACA acquisition varied depending on cytogenetic abnormalities at initial diagnosis. Multivariate analysis identified t(8;21), complex karyotype, and a duration of fewer than 12 months of complete remission as independent predisposing factors for ACA acquisition. Notably, patients with ACA acquisition showed a significantly lower second complete remission rate compared with those without ACA acquisition (20.0% vs 72.5%, respectively, P   〈  .001). Furthermore, the 3‐year overall survival rates after the first relapse were significantly different between patients with and without ACA acquisition (8.5% vs 36.8%, respectively, P   〈  .001). This prognostic significance was confirmed with multivariate analysis. The hazard ratio of ACA acquisition was similar or higher than reported prognostic factors for relapsed AML patients. These findings suggested that clonal evolution detected with conventional cytogenetic analysis at the first relapse induces severe chemo‐refractory characteristics in AML cells and should be considered as a potent prognostic factor when evaluating accurate prognosis in relapsed AML patients.
    Type of Medium: Online Resource
    ISSN: 0278-0232 , 1099-1069
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2018
    detail.hit.zdb_id: 2001443-0
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
  • 9
    In: Leukemia Research, Elsevier BV, Vol. 103 ( 2021-04), p. 106535-
    Type of Medium: Online Resource
    ISSN: 0145-2126
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
    detail.hit.zdb_id: 2008028-1
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
  • 10
    In: Blood, American Society of Hematology, Vol. 134, No. Supplement_1 ( 2019-11-13), p. 5690-5690
    Abstract: Background: Extramedullary (EM) relapses were sometimes observed in acute leukemia patients both after chemotherapy and allo-SCT. Our recent study described that the rate of EM relapses after allo-SCT was significantly higher when comparing with that after chemotherapy in acute myeloid leukemia (AML) patients. Since more potent graft-versus-leukemia (GVL) effect in EM lesion than bone marrow (BM) is proposed as potential biological basis of this phenomenon, it is expected that EM relapses after allo-SCT more frequently occurred than after chemotherapy also in ALL patients. However, this hypothesis has not been examined, and risk factors of EM relapses after allo-SCT have not been elucidated. So, we conducted this retrospective study to address this unsolved issue. Patients and methods: The study population included in this study was 215 adult patients who were diagnosed as ALL between 1990 and 2017 and received intensive chemotherapy. In the first part of this study, to compare the rates of EM relapses between after chemotherapy and allo-SCT, the initial relapses of the 88 patients were analyzed. In the second part, to investigate risk factors for EM relapses after allo-SCT, 110 patients who underwent allo-SCT against ALL were analyzed. EM relapses included both one only in EM lesions and in concurrent EM and BM lesions. Fisher's exact test was used to compare binary variables. Cumulative incidences (CIs) of EM relapse were compared using the stratified Gray test, considering relapse without EM lesions and death without the event as a competing risk. The logistic regression model and the Fine-Gray proportional hazard model were used for multivariate analysis of risk factors of EM relapses among the initial relapses and after allo-SCT, respectively. Values of p 〈 0.05 were considered significant. Results: Of the 88 relapsed patients included in the first part of this study, the median age at diagnosis was 47 years (range, 15-79 years), and the median duration of the first complete remission (CR1) was 7.1 months (range, 0.7-105.7 months). Philadelphia chromosome (Ph) and EM lesions at diagnosis were observed in 21 and 21 patients, respectively. Allo-SCT in CR1 was undergone in 12 patients. EM relapses occurred in 21 patients, and the sites of EM relapses were central nervous system (CNS) in 13, mediastinum in two, and bone in two. The median durations of CR1 were not significantly different between relapses with and without EM lesions (16.8 vs. 6.7 months, respectively; p = 0.295). In univariate analysis for risk factors of EM relapses, there was no significant difference in EM relapse rates between relapses after allo-SCT and chemotherapy (8.3% vs. 26.3%, respectively; p = 0.279), and in multivariate analysis, only EM lesion at diagnosis was identified as independent risk factor (odds ratio 4.21; p = 0.008). Of the 110 allo-SCT recipients included in the second part, the median age at diagnosis was 43 years (range, 16-66 years). Ph and EM lesions at diagnosis were observed in 43 and 21 patients, respectively. Disease status at the time of transplant was CR1 in 67, advanced CR in 17, and non-CR in 26. Stem cell sources were related, unrelated, and cord blood in 30, 50, and 25 patients, respectively, and almost all patients were conditioned with total body irradiation-containing myeloablative regimens. EM relapse after allo-SCT occurred in nine patients, and the 2-year CI of EM relapses was 6.5%. The sites of EM relapses after allo-SCT were CNS in three, lymph node in two, and skin in two. In univariate analysis for EM relapses after allo-SCT, the significantly higher CI of EM relapses after allo-SCT was observed in patients with EM lesion at diagnosis when comparing with those without EM lesion (28.6% vs. 1.1%, respectively; p = 0.279). Multivariate analysis extracted only EM lesion at diagnosis as an independent risk factor for EM relapses after allo-SCT (hazard ratio 24.09; p = 0.004). Conclusion: As a higher frequency of EM relapse after allo-SCT in ALL patients was not confirmed in this study, the hypothesis, more potent GVL effect in EM lesion than BM, was not able to apply to these patients. To determine whether this hypothesis is correct or not, further investigation in patients with other hematologic malignancy such as chronic myeloid leukemia is warranted. The vigilance is required regarding EM relapses in adult ALL patients with EM lesion at diagnosis both after chemotherapy and allo-SCT. Disclosures Handa: Ono: Research Funding.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2019
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
Close ⊗
This website uses cookies and the analysis tool Matomo. More information can be found here...