Myelodysplastic syndromes and acute myeloid leukemias in the elderly

Mueller, Beatrice U.; Seipel, Katja; Pabst, Thomas

doi:10.1016/j.ejim.2018.05.026

Cited by 5 publications

(5 citation statements)

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“…Adverse molecular or cytogenetic abnormalities such as complex karyotypes, MLL gene rearrangements, and FLT3-ITD mutations are associated with poor prognosis and occur more frequently with increasing age 13,17. On the other hand, elderly AML patients may progress from myelodysplastic syndrome (MDS), and have a poor performance status or poor organ functions and cannot tolerate chemotherapy at a standard dosage 18–20. The above factors are probably the main causes of worse outcomes for elderly patients with AML.…”

Section: Discussionmentioning

confidence: 99%

<p>Impact Of ELN Risk Stratification, Induction Chemotherapy Regimens And Hematopoietic Stem Cell Transplantation On Outcomes In Hyperleukocytic Acute Myeloid Leukemia With Initial White Blood Cell Count More Than 100 × 109/L</p>

Feng¹,

Zhou²,

Zhang³

et al. 2019

CMAR

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BackgroundHyperleukocytic acute myeloid leukemia (AML) (initial white blood cell count≥100 × 109/L) is a clinical emergency often accompanied by leukostasis syndrome, tumor lysis syndrome (TLS), and disseminated intravascular coagulation (DIC), with a poor clinical prognosis. The aim of this study retrospectively analyzed the clinical features of hyperleukocytic AML, focusing on high-risk factors affecting prognosis, the selection of initial induction therapy, and the impact of hematopoietic stem cell transplantation (HSCT) on prognosis.Patients and methodsA total of 558 AML patients at our center from January 2013 to December 2017 were diagnosed, and 52 (9.32%) patients presented with hyperleukocytosis were retrospectively reviewed.ResultsThe 3-year overall survival (OS) rate in the 15–39 years old and 40–60 years old group was 58.8% and 25.4%, respectively; the longest survival time in patients aged >60 years was only 8 months, and the 8-month OS rate was 8.3% (p=0.002). The 3-year OS rate of the patients in the favorable risk group, intermediate risk group and high risk group, according to the 2017 ELN risk stratification, was 50%, 28.0%, and 29.5%, respectively (p=0.374). The 3-year OS rate of patients carrying CEBPA or NPM1 mutation and those with FLT3-ITD or MLL mutation was 37.5% and 30.0%, respectively (p=0.63). The 3-year OS rate of patients employing an induction regimen of a standard IA regimen was 58.4%, and of those employing a non-standard IA regimen was 22.2% (p=0.065). The 3-year OS rate of the transplantation patients reached 73.8%, while the 9-month OS rate of patients without transplantation was 11.4% (p<0.001).ConclusionThis study suggest that hyperleukocytosis is an independent risk factor for AML patients, regardless of the risk stratification based on cytogenetic or molecular abnormalities. Age is the main factor influencing the prognosis of hyperleukocytic AML. The use of a standard IA regimen and HSCT can significantly improve the patient’s prognosis.

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Section: Discussionmentioning

confidence: 99%

<p>Impact Of ELN Risk Stratification, Induction Chemotherapy Regimens And Hematopoietic Stem Cell Transplantation On Outcomes In Hyperleukocytic Acute Myeloid Leukemia With Initial White Blood Cell Count More Than 100 × 109/L</p>

Feng¹,

Zhou²,

Zhang³

et al. 2019

CMAR

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“…La LMA constituye la neoplasia mieloide más común en adultos, su incidencia aumenta de forma significativa en personas con más de 65 años. (5)(6)(7) En su desarrollo se produce la pérdida de respuesta a los reguladores normales de la proliferación celular en la medula ósea; lo que lleva a una aceleración del incremento de la población de células hemáticas inmaduras, desplazándose a la población celular normal, produciéndose una falla medular además de una infiltración extramedular que puede afectar el bazo, hígado, piel y sistema nervioso central. (2,6) La exposición reiterada al benceno está identificada como un potencial factor de riesgo de LMA, debido a la capacidad de dañar el ADN de las células normales de la médula ósea.…”

Section: Discussionunclassified

Leucemia mieloide aguda en adulto mayor comórbido. A propósito de un caso

Panta¹,

Torre²,

Mero

2019

EUGENIO ESPEJO

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Caso clínico: paciente masculino de 81 años de edad, con cuadro de 24 horas de evolución secundario a caída, caracterizado por somnolencia, desorientación en persona, tiempo y espacio, incontinencia urinaria y dificultad para la deambulación, motivo por el cual se le efectúa una tomografía simple de cráneo encontrándose hematomas subdurales bilaterales, presenta episodios de sangrado recurrente y leucocitosis sostenida , en frotis de sangre periférica se observó 28% de blastos por lo que se realiza una biopsia de medula ósea descubriéndose un cariotipo medular compatible con leucemia mieloide aguda, debido a sus características clínicas y a su mala evolución fue catalogado como paciente paliativo. Conclusiones: la leucemia mieloide aguda es una patología hematológica cuya evolución al no ser detectada genera un alto grado de mortalidad, sobre todo en el adulto mayor comórbido.

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“…49 Updated information on immunotoxins in clinical trials has been summarized by a number outstanding review articles recently. 6,13,14,52,53…”

Section: Immunotoxins In Clinical Trialsmentioning

confidence: 99%

Immunotoxins: Targeted Toxin Delivery for Cancer Therapy

Xin

Chen

Wang

et al. 2019

Pharmaceutical Fronts

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Immunotoxins are proteins that consist of a protein toxin conjugated to a specific targeting moiety. The targeting moiety is usually an antibody or ligand, such as monoclonal antibody, antibody fragment, a cytokine, or a growth factor. The toxins usually come from plant toxins, bacterial toxins, or human-origin cytotoxic elements. Nearly all toxins work by enzymatically inhibiting protein synthesis. After binding to antigens or receptors on target cell surfaces, immunotoxins are internalized and translocated to the cytosol where they can kill the cells. Immunotoxins have demonstrated high cytotoxicity to cancer cells and to date two immunotoxins have been approved by U.S. Food and Drug Administration on the markets for the treatment of hematological tumors: Lumoxiti and Ontak. Many other molecules are under development or clinical trials for different forms of cancer. Although immunotoxins exhibit great potency in xenograft model systems and early clinical trials, there are obstacles that limit successful treatments, including immunogenicity, nonspecific toxicity, and poor penetration. However, efforts are underway to address these problems. In this review, we summarize immunotoxins currently in clinical trials for either hematological tumors or solid tumors, outline the design of immunotoxins utilizing variety of components, and discuss the prominent examples of redesigned immunotoxins with reduced immunogenicity and nonspecific toxicity, as well as the strategies in manufacturing immunotoxins. With further improvements, it is anticipated that immunotoxins will play an increasing role in cancer therapy.

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Myelodysplastic syndromes and acute myeloid leukemias in the elderly

Cited by 5 publications

References 50 publications

<p>Impact Of ELN Risk Stratification, Induction Chemotherapy Regimens And Hematopoietic Stem Cell Transplantation On Outcomes In Hyperleukocytic Acute Myeloid Leukemia With Initial White Blood Cell Count More Than 100 × 109/L</p>

<p>Impact Of ELN Risk Stratification, Induction Chemotherapy Regimens And Hematopoietic Stem Cell Transplantation On Outcomes In Hyperleukocytic Acute Myeloid Leukemia With Initial White Blood Cell Count More Than 100 × 109/L</p>

Leucemia mieloide aguda en adulto mayor comórbido. A propósito de un caso

Immunotoxins: Targeted Toxin Delivery for Cancer Therapy

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