scholarly journals In vitro drug-resistance profile in infant acute lymphoblastic leukemia in relation to age, MLL rearrangements and immunophenotype

Leukemia ◽  
2004 ◽  
Vol 18 (3) ◽  
pp. 521-529 ◽  
Author(s):  
N L Ramakers-van Woerden ◽  
H B Beverloo ◽  
A J P Veerman ◽  
B M Camitta ◽  
A H Loonen ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Resistance Profile ◽  
Drug Resistance Profile ◽  
Infant Acute Lymphoblastic Leukemia

scholarly journals Differential in Vitro Drug Resistance Profile Between First and Second Relapsed Acute Lymphoblastic Leukemia and Acute Myeloblastic Leukemia in Children

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3696-3696
Author(s):  
Jan Styczynski ◽  
Beata Kurylo-Rafinska ◽  
Malgorzata Kubicka ◽  
Beata Kolodziej ◽  
Monika Pogorzala ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Ex Vivo ◽  
Lymphoblastic Leukemia ◽  
Relative Resistance ◽  
Resistance Profile ◽  
Cellular Sensitivity ◽  
Drug Resistance Profile ◽  
First Relapse ◽  
Subsequent Relapse

Abstract Introduction: In vitro drug resistance profile has so far provided information on chemosensitivity of leukemic cells in acute lymphoblastic leukemia (ALL) and acute myeloblastic leukemia (AML). Previous studies have shown that for most tested drugs, patients with relapse had higher IRTR than those with de novo ALL or AML. The objective of this study was the analysis and comparison of the individualized tumor response testing (ITRT) between first and second relapse in children with ALL or AML. Patients: A total of 186 pediatric leukemic samples (154 ALL and 32 AML) were tested for ex vivo chemosensitivity for up to 22 drugs. ALL samples included 113 samples obtained at first relapse, and 41 obtained at second relapse. AML samples included 22 samples obtained at first relapse, and 10 obtained at second leukemic relapse. The distribution of patients between first and second relapse groups was comparable. Methods: In vitro drug resistance was tested by the MTT assay. The drug concentration that was inhibitory to 50% of the cells (IC50) was calculated from the dose-response curve and was used as a measure of ex vivo drug resistance for each sample. The relative resistance (RR) between groups analyzed for each drug was calculated as the ratio of the mean values of the IC50 of the respective groups for this drug. Only patients who had a successful MTT assay at diagnosis were included in the study. The following drugs were used: prednisolone, dexamethasone, vincristine, idarubicin, daunorubicin, doxorubicin, mitoxantrone, L-asparaginase, cytarabine, fludarabine, cladribine, clofarabine, treosulfan, thiotepa, melphalan, 4-HOO-cyclophosphamide, 4-HOO-ifosfamide, bortezomib, busulfan, 6-mercaptopurine, and 6-thioguanine. For patients with ALL, combined drug resistance profile to prednisolone, vincristine and L-asparaginase (PVA score) was also analyzed. Results: ALL: In comparison to first relapse, second relapsed childhood ALL were more resistant to most of tested drugs. Median PVA score in multiple relapsed patients was 8 vs 6 for patients at first relapse (p=0.004). The median relative resistance value between patients with multiple relapse and those with first relapse for all tested drugs was 2.0, indicating higher drug resistance on second relapse. Multiple relapsed ALL samples were more drug resistant to: prednisolone (>1.9-fold), dexamethasone (>1.5-fold), vincristine (3.1-fold), L-asparaginase (5-fold), mitoxantrone (2.4-fold), cytarabine (4.3-fold), mercaptopurine (2.2-fold), thioguanine (4.8-fold), etoposide (2.6-fold) and melphalan (2.7-fold). On the other hand, lymphoblasts at second relapse were comparably resistant to: daunorubicin, doxorubicin, 4-HOO-cyclophosphamide, 4-HOO-ifosfamide, busulfan, treosulfan, fludarabine, clofarabine and bortezomib. No drug showed a trend towards better cellular sensitivity at first versus second relapse. AML: No significant differences between ITRT at first and second relapse of childhood AML were found. Of the all drugs analyzed, no drug was found for which significantly higher resistance of myeloblasts was observed at second relapse when compared to first relapse of AML. The median RR value between second and first relapse of all tested drugs was 1.0; for 10 drugs the RR was less than 1 (i.e. assumed better sensitivity on subsequent relapse) and for another 11 drugs, the RR value was greater than 1 (i.e. higher drug resistance on subsequent relapse). No drug showed a trend towards better cellular sensitivity at first versus subsequent relapse, as the differences were not significant for each tested drug. Conclusion: In comparison to first relapse, leukemic blasts of children at second relapse of ALL are more in vitro resistant to most of tested drugs. Contrary, myeloblasts of children at second relapse of AML show drug resistance comparable to first relapse. (This study was supported by NCN Grant DEC-2011/03/D/NZ5/05749.) Disclosures No relevant conflicts of interest to declare.

scholarly journals In vitro cellular drug resistance in children with relapsed/refractory acute lymphoblastic leukemia

Blood ◽  
1995 ◽  
Vol 86 (10) ◽  
pp. 3861-3868 ◽  
Author(s):  
E Klumper ◽  
R Pieters ◽  
AJ Veerman ◽  
DR Huismans ◽  
AH Loonen ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Acute Lymphoblastic Leukemia ◽  
Poor Prognosis ◽  
De Novo ◽  
Lymphoblastic Leukemia ◽  
Childhood All ◽  
Acquired Drug Resistance ◽  
The Poor ◽  
Response To Chemotherapy

Cellular drug resistance is thought to be an important cause of the poor prognosis for children with relapsed or refractory acute lymphoblastic leukemia (ALL), but it is unknown when, to which drugs, and to what extent resistance is present. We determined in vitro resistance to 13 drugs with the MTT assay. Compared with 141 children with initial ALL, cells from 137 children with relapsed ALL were significantly more resistant to glucocorticoids, L-asparaginase, anthracyclines, and thiopurines, but not to vinca-alkaloids, cytarabine, ifosfamide, and epipodophyllotoxins. Relapsed ALL cells expressed the highest level of resistance to glucocorticoids, with a median level 357- and >24-fold more resistant to prednisolone and dexamethasone, respectively, than initial ALL cells, whereas the resistance ratios for the other drugs differed from 0.8- to 1.9-fold, intraindividual comparisons between initial and relapsed samples from 16 children with ALL showed that both de novo and acquired drug resistance were involved. Specific in vitro drug-resistance profiles were associated with high-risk relapsed ALL groups. In vitro drug resistance was also related to the clinical response to chemotherapy in relapsed/refractory childhood ALL. We conclude that drug resistance may explain the poor prognosis for children with relapsed/refractory ALL. These day may be helpful to design alternative treatment regimens for relapsed childhood ALL.

scholarly journals AVA4746, an Orally Available, Clinical Grade Antagonist of Integrin Alpha 4, Sensitizes Pre-B Cell Acute Lymphoblastic Leukemia to Chemotherapy

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2765-2765 ◽  
Author(s):  
Yongsheng Ruan ◽  
Eun Ji Gang ◽  
Hye-Na Kim ◽  
Chintan Parekh ◽  
Hisham Abdel-Azim ◽  
...  
Keyword(s):  
Overall Survival ◽  
Drug Resistance ◽  
Acute Lymphoblastic Leukemia ◽  
Metabolic Activity ◽  
Research Funding ◽  
Lymphoblastic Leukemia ◽  
Drug Resistant ◽  
Support Research

Abstract Background. Even though remarkable progress has been made in the treatment of childhood acute lymphoblastic leukemia (ALL), salvage of relapse patients remains a challenge. The role of the bone marrow (BM) microenvironment is critical to protect leukemia cells from chemotherapy. The BM microenvironment promotes cell adhesion-mediated drug resistance (CAM-DR) in ALL.We and others have shown that the adhesion molecule integrin α4, referred to hereafter as α4, mediates drug resistance of B-ALL. In our previous studies, we showed that both α4 blockade by natalizumab and inhibition by the small molecule α4 antagonist TBC3486 can sensitize relapsed ALL cells to chemotherapy. However, no α4 targeting therapy is currently clinically available to treat leukemia. Here, we preclinically evaluate a novel non-peptidic small molecule antagonist, AVA4746, which has been safely used in clinical studies, as a potential new approach to combat drug resistant ALL. Method. Six refractory or relapsed primary pre-B ALL cases were used for in vitro studies. Viability was assessed by trypan blue counts or annexin V/7AAD flow cytometric analysis and metabolic activity was evaluated by Cytoscan WST-1 assay. For in vivo evaluation a NOD/SCID IL2Rγ-/- xenograft model of primary pre-B ALL (LAX7R) was used.AVA4746 (15mg/kg) was administered by oral gavage twice a day continuously for 14 days, and vincristine, dexamethasone, L-asparaginase (VDL) was given intraperitoneally (weekly) for 4 weeks. Overall survival was determined by Kaplan-Meier Survival analysis. Results. AVA4746 caused a significant decrease in mean fluorescence intensity (MFI) of α4 expression in six out of six ALL cases at doses of both 5μM and 25μM after 24 hours and 96 hours compared to DMSO control. Interestingly, decreased protein expression of α4 was also observed by Western Blot analysis all six ALL cases. We tested next in two cases (LAX53, ICN13), if AVA4746 de-adheres ALL cells from its counter receptor VCAM-1. The percentages of adherence after treatment with AVA4746 (25μM) were significantly lower than after DMSO treatment (10.3%±4.9% vs. 99.9%±7.6%, p= 0.00007 for LAX7R; 8.1%±1.0% vs. 100.1%±13.6%, p= 0.0003 for LAX53; 9.0%±1.6% vs. 100.0%±14.0%, p=0.0004 for ICN13). AVA4746 was not associated with apoptosis in vitro alone or in combination with chemotherapy (VDL). Metabolic activity as assessed by WST-1 assay was markedly decreased by AVA4746 in two of two ALL cases. AVA4746 also decreased ALL proliferation in two out of two ALL samples tested. In vivo, AVA4746 in combination with VDL chemotherapy treatment led to significant prolongation of overall survival (n=6) compared with the VDL only treated group (n=6) (MST= 78.5 days vs MST= 68 days; P<0.05). There was no significant difference in survival between the PBS control group (n=5) and the AVA4746 mono-treatment group (n=5) (MST=38days vs MST= 38days). Conclusion. We have identified α4 as a central adhesion molecule in CAM-DR of ALL and have shown that AVA-4746, an orally available and specific α4 antagonist, which has been safely used in clinical studies, downregulates α4 in primary ALL and functionally de-adheres them from VCAM-1. Critically, we demonstrated that inhibition of α4 in combination with standard chemotherapy can prolong the survival of NSG mice bearing pre-B ALL. These data support further study of inhibition of α4 using AVA4746 as a novel strategy to treat drug resistant B lineage ALL. Disclosures Bhojwani: Amgen: Other: Blinatumumab global pediatric advisory board 2015. Wayne:Spectrum Pharmaceuticals: Honoraria, Other: Travel Support, Research Funding; Kite Pharma: Honoraria, Other: Travel support, Research Funding; Pfizer: Consultancy, Honoraria, Other: Travel Support; Medimmune: Honoraria, Other: Travel Support, Research Funding; NIH: Patents & Royalties. Kim:Antisense Therapeutics Ltd: Patents & Royalties.

Individualized Tumor Response Testing (ITRT) Profile Has a Prognostic Value in Childhood Acute Lymphoblastic Leukemia (ALL) and Acute Non-Lymphoblastic Leukemia (ANLL): The Multicenter Non-Interventional Long-Term Follow-up Study of Polish Pediatric Leukemia Study Group

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 1456-1456
Author(s):  
Magdalena Piatkowska ◽  
Jan Styczynski ◽  
Beata Kolodziej ◽  
Beata Kurylo-Rafinska ◽  
Malgorzata Kubicka ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Prognostic Value ◽  
Ex Vivo ◽  
Cox Model ◽  
Lymphoblastic Leukemia ◽  
Pediatric Leukemia ◽  
Predictive Values ◽  
Resistance Profile ◽  
Drug Resistance Profile

Abstract Abstract 1456 BACKGROUND: Individualized tumor response testing (ITRT) is a recently accepted term for ex vivo drug resistance profile testing in cancer patients. Previous studies have shown that ITRT results in children correspond with clinical response in initial acute lymphoblastic leukemia (iALL), but not in initial acute myeloid leukemia (iAML). ITRT combined profile to prednisolone, vincristine, and L-asparaginase (PVA score) showed a strong association with clinical outcome in iALL (Den Boer et al JCO; Hollemann et al, NEJM). OBJECTIVE: Polish Pediatric Leukemia Study Group carried out between 1999–2010 a multi-institutional, non-interventional study on correlation between ITRT profile and clinical response in long-term follow-up. The objective of the study was to assess the role of ITRT profile as prognostic factor in childhood iALL and iAML. MATERIALS AND METHODS: A total number of 998 children (median age 6.5 yrs, range 3 days - 21 yrs) were enrolled into the study, including 817 with initial ALL (iALL) and 181 children with initial AML (iAML). The median follow-up was 4.6 yrs (range 0–10,4). ITRT (ex vivo drug resistance profile) was determined by the MTT assay. Following drugs were tested: prednisolone (P), vincristine (V), L-asparaginase (A), daunorubicin (D), doxorubicin (Dox), idarubicin (I), mitoxantrone (M), cytarabine (C), busulfan (B) and etoposide (E). Apart from ITRT to single drugs, combined ex vivo drug resistance profiles PVA, PVADC, PVADoxC in iALL and CVIDM in iAML were also determined. Probability of DFS was estimated by the Kaplan-Meier method and compared by the log-rank test. Univariate and multivariate analyses were performed in Cox regression model. RESULTS: (1) For iALL patients, neither single drug nor 3-drugs PVA combined ITRT profile had prognostic value for pDFS. 5-drug PVADC and PVADoxC profiles had predictive values, with p-values 0.049 and 0.017, respectively. For 295 iALL patients with ITRT-sensitive PVADC profile, 5-year pDFS=0.892. No ITRT factor was discriminative between very early, early and late ALL relapses. In univariate analysis in Cox model, following factors had prognostic value for pDFS in iALL: steroid resistance by day 8 (p=0.002), bone marrow (BM) response by day 15 (p=0.005), BM response by day 33 (p=0.001) and PVADC ITRT profile (p=0.052). In multivariate analysis in Cox model, only BM response by day 33 (p=0.001) had prognostic value for pDFS in iALL, while bone marrow BM by day 15 had borderline significance (p=0.055). (2) For iAML patients, ITRT to cytarabine had an impact on pDFS (0.81 vs 0.63, p=0.047). For 55 iAML patients with ITRT-sensitive to cytarabine, 5-year pDFS=0.816. 5-drug CVIDM profile had also predictive values, with p-value 0.020. No ITRT factor was discriminative between very early, and late AML relapses. In univariate analysis in Cox model, no factor had prognostic value for pDFS in iAML, while ITRT to cytarabine almost reached significance (p=0.054). Multivariate analysis for iAML was not performed. CONCLUSION: Ex vivo drug resistance profile (ITRT) can be regarded as a risk factor in childhood acute leukemias. Combined ITRT profile to prednisolone, vincristine, L-asparaginase, daunorubicin and cytarabine (PVADC) has predictive value in pediatric iALL, while ITRT profile to cytarabine has prognostic value in pediatric iAML. ACKNOWLEDGEMENTS: Supported by grants: EFS-POKL.04.01.01-00-191/08-00 nr 1/2010; MNiSW Nr N N407 541339; MNiSW Nr N407 078 32/2964; UMK 09/2009; UMK 10/2009. Disclosures: No relevant conflicts of interest to declare.

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