In 2005, an activating mutation in the Janus kinase 2 (JAK2) was identified in a significant proportion of patients with myeloproliferative neoplasms, mainly polycythemia vera, essential thrombocythemia and primary myelofibrosis. Many types of mutations in the JAK-STAT pathway have been identified, the majority are related to JAK2. Currently JAK2 mutations are important in the area of diagnosis of myeloid neoplasms, but its role beyond the confirmation of clonality is growing and widening our knowledge about these disorders. In addition to that, clinical trials to target JAK2-STAT pathway will widen our knowledge and hopefully will offer more therapeutic options. In this review, we will discuss the role of JAK2 abnormalities in the pathogenesis, diagnosis, classification, severity and management of hematologic neoplasms.
{"title":"The role of JAK2 abnormalities in hematologic neoplasms","authors":"M. Alabdulaali","doi":"10.4081/hr.2009.e10","DOIUrl":"https://doi.org/10.4081/hr.2009.e10","url":null,"abstract":"In 2005, an activating mutation in the Janus kinase 2 (JAK2) was identified in a significant proportion of patients with myeloproliferative neoplasms, mainly polycythemia vera, essential thrombocythemia and primary myelofibrosis. Many types of mutations in the JAK-STAT pathway have been identified, the majority are related to JAK2. Currently JAK2 mutations are important in the area of diagnosis of myeloid neoplasms, but its role beyond the confirmation of clonality is growing and widening our knowledge about these disorders. In addition to that, clinical trials to target JAK2-STAT pathway will widen our knowledge and hopefully will offer more therapeutic options. In this review, we will discuss the role of JAK2 abnormalities in the pathogenesis, diagnosis, classification, severity and management of hematologic neoplasms.","PeriodicalId":12954,"journal":{"name":"Hematology Reviews","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2009-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91054938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
MicroRNAs (miRNAs) are small non-coding RNAs (ncRNAs) with important regulatory functions. After an initial phase, aimed at identifying whether a deregulation in miRNA expression occurred between hematologic malignancies and their normal counterparts, currently an increasing number of studies are focusing on the functional significance of these aberrancies. The identification of miRNA targeted genes has cast a new light on the role of these tiny ncRNAs in human cancerogenesis, providing a new rationale to the observed diagnostic, prognostic and therapeutic implications of miRNA aberrant expression in human hematologic malignancies.
{"title":"MicroRNAs: tiny players with a big role in the pathogenesis of leukemias and lymphomas","authors":"F. Fanini, I. Vannini, M. Fabbri","doi":"10.4081/hr.2009.e8","DOIUrl":"https://doi.org/10.4081/hr.2009.e8","url":null,"abstract":"MicroRNAs (miRNAs) are small non-coding RNAs (ncRNAs) with important regulatory functions. After an initial phase, aimed at identifying whether a deregulation in miRNA expression occurred between hematologic malignancies and their normal counterparts, currently an increasing number of studies are focusing on the functional significance of these aberrancies. The identification of miRNA targeted genes has cast a new light on the role of these tiny ncRNAs in human cancerogenesis, providing a new rationale to the observed diagnostic, prognostic and therapeutic implications of miRNA aberrant expression in human hematologic malignancies.","PeriodicalId":12954,"journal":{"name":"Hematology Reviews","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2009-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80496915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Deleu, E. Menu, E. Valckenborgh, B. Van Camp, J. Fraczek, I. Vande broek, Vera Rogiers, K. Vanderkerken
Novel drugs such as bortezomib and high-dose chemotherapy combined with stem cell transplantation improved the outcome of multiple myeloma patients in the past decade. However, multiple myeloma often remains incurable due to the development of drug resistance governed by the bone marrow microenvironment. Therefore targeting new pathways to overcome this resistance is needed. Histone deacetylase (HDAC) inhibitors represent a new class of anti-myeloma agents. Inhibiting HDACs results in histone hyperacetylation and alterations in chromatine structure, which, in turn, cause growth arrest differentiation and/or apoptosis in several tumor cells. Here we summarize the molecular actions of HDACi as a single agent or in combination with other drugs in different in vitro and in vivo myeloma models and in (pre-)clinical trials.
{"title":"Histone deacetylase inhibitors in multiple myeloma","authors":"S. Deleu, E. Menu, E. Valckenborgh, B. Van Camp, J. Fraczek, I. Vande broek, Vera Rogiers, K. Vanderkerken","doi":"10.4081/hr.2009.e9","DOIUrl":"https://doi.org/10.4081/hr.2009.e9","url":null,"abstract":"Novel drugs such as bortezomib and high-dose chemotherapy combined with stem cell transplantation improved the outcome of multiple myeloma patients in the past decade. However, multiple myeloma often remains incurable due to the development of drug resistance governed by the bone marrow microenvironment. Therefore targeting new pathways to overcome this resistance is needed. Histone deacetylase (HDAC) inhibitors represent a new class of anti-myeloma agents. Inhibiting HDACs results in histone hyperacetylation and alterations in chromatine structure, which, in turn, cause growth arrest differentiation and/or apoptosis in several tumor cells. Here we summarize the molecular actions of HDACi as a single agent or in combination with other drugs in different in vitro and in vivo myeloma models and in (pre-)clinical trials.","PeriodicalId":12954,"journal":{"name":"Hematology Reviews","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2009-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90360954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Emerging evidence suggests that the three tyrosine kinase inhibitors currently approved for the treatment of patients with chronic myelogenous leukemia (CML) – imatinib, dasatinib, and nilotinib – have potential cardiotoxic effects. The mechanisms behind these events, and the relations between them, are largely unclear. For example, relative to dasatinib and nilotinib, severe congestive heart failure and left ventricular dysfunction are rare but prominent with imatinib treatment, particularly in patients receiving higher doses (>600 mg/day). In comparison with imatinib, prolongation of the QT interval is relatively common in patients treated with either dasatinib or nilotinib. In contrast to nilotinib, pericardial effusions are observed with both imatinib and dasatinib. It is suggested that these data, an evaluation of cardiac status, use of concomitant medications, and potential risk factors should be considered in the management of CML.
{"title":"Cardiotoxicity of tyrosine kinase inhibitors in chronic myelogenous leukemia therapy","authors":"Zhenshu Xu, S. Cang, Ting Yang, Delong Liu","doi":"10.4081/hr.2009.e4","DOIUrl":"https://doi.org/10.4081/hr.2009.e4","url":null,"abstract":"Emerging evidence suggests that the three tyrosine kinase inhibitors currently approved for the treatment of patients with chronic myelogenous leukemia (CML) – imatinib, dasatinib, and nilotinib – have potential cardiotoxic effects. The mechanisms behind these events, and the relations between them, are largely unclear. For example, relative to dasatinib and nilotinib, severe congestive heart failure and left ventricular dysfunction are rare but prominent with imatinib treatment, particularly in patients receiving higher doses (>600 mg/day). In comparison with imatinib, prolongation of the QT interval is relatively common in patients treated with either dasatinib or nilotinib. In contrast to nilotinib, pericardial effusions are observed with both imatinib and dasatinib. It is suggested that these data, an evaluation of cardiac status, use of concomitant medications, and potential risk factors should be considered in the management of CML.","PeriodicalId":12954,"journal":{"name":"Hematology Reviews","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2009-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84150580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Borie, C. Fieschi, É. Oksenhendler, L. Galicier
Association of immune thrombocytopenic purpura and tuberculosis is a rare condition. In 5 patients presenting with this association, anti-tuberculous therapy was effective on both tuberculosis and thrombocytopenia suggesting a causal relationship between tuberculosis and immune thrombocytopenic purpura
{"title":"Tuberculosis associated thrombocytopenic purpura: effectiveness of antituberculous therapy","authors":"R. Borie, C. Fieschi, É. Oksenhendler, L. Galicier","doi":"10.4081/hr.2009.e3","DOIUrl":"https://doi.org/10.4081/hr.2009.e3","url":null,"abstract":"Association of immune thrombocytopenic purpura and tuberculosis is a rare condition. In 5 patients presenting with this association, anti-tuberculous therapy was effective on both tuberculosis and thrombocytopenia suggesting a causal relationship between tuberculosis and immune thrombocytopenic purpura","PeriodicalId":12954,"journal":{"name":"Hematology Reviews","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2009-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74517201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. Martinelli, C. Papayannidis, I. Iacobucci, S. Soverini, D. Cilloni, M. Baccarani
At present, there are no compounds in clinical development in the field of chronic myeloid leukemia (CML) or Philadelphia-positive (Ph+) acute lymphoblastic leukemia (ALL) that have been documented to harbor significant activity against the imatinib-resistant T315I mutation. Recent reports on the pre-clinical activity of some emerging tyrosine kinase inhibitors such as ON012380, VX-680 and PHA-739358 promise possible clinical efficacy against this specific Bcr-Abl mutant form. Here, we focus on the role of aurora kinase inhibitor VX-680 and PHA-739358 in blocking the leukemogenic pathways driven by wild-type and T315I-Bcr-Abl in CML or Ph+ ALL by reviewing recent research evidence. We also discuss the possibility of employing aurora kinase inhibitors as a promising new therapeutic approach in the treatment of CML and Ph+ ALL patients resistant to first and second generation TK inhibitors.
{"title":"Aurora kinase inhibitors: which role in the treatment of chronic myelogenous leukemia patients resistant to imatinib?","authors":"G. Martinelli, C. Papayannidis, I. Iacobucci, S. Soverini, D. Cilloni, M. Baccarani","doi":"10.4081/hr.2009.e1","DOIUrl":"https://doi.org/10.4081/hr.2009.e1","url":null,"abstract":"At present, there are no compounds in clinical development in the field of chronic myeloid leukemia (CML) or Philadelphia-positive (Ph+) acute lymphoblastic leukemia (ALL) that have been documented to harbor significant activity against the imatinib-resistant T315I mutation. Recent reports on the pre-clinical activity of some emerging tyrosine kinase inhibitors such as ON012380, VX-680 and PHA-739358 promise possible clinical efficacy against this specific Bcr-Abl mutant form. Here, we focus on the role of aurora kinase inhibitor VX-680 and PHA-739358 in blocking the leukemogenic pathways driven by wild-type and T315I-Bcr-Abl in CML or Ph+ ALL by reviewing recent research evidence. We also discuss the possibility of employing aurora kinase inhibitors as a promising new therapeutic approach in the treatment of CML and Ph+ ALL patients resistant to first and second generation TK inhibitors.","PeriodicalId":12954,"journal":{"name":"Hematology Reviews","volume":"70 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2009-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86112159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Björkstrand, T. Klausen, K. Remes, A. Gruber, L. Knudsen, O. Bergmann, S. Lenhoff, H. Johnsen
Autologous stem cell transplantation is still considered the standard of care in young patients with multiple myeloma (MM). This disease is the most common indication for high-dose therapy (HDT) supported by hematopoietic stem cell transplantation and much data support the benefit of this procedure. Results of randomized studies are in favor of tandem autologous transplantation although the effect on overall survival is unclear. Based on sequential registration trials in the Nordic area, we aimed to evaluate the outcome of conventional single or double HDT. During 1994–2000 we registered a total of 484 previously untreated patients under the age of 60 years at diagnosis who on a regional basis initially were treated with single [Trial NMSG #5/94 and #7/98 (N=383)] or double [Trial Huddinge Karolinska Turku Herlev (N=101)] high-dose melphalan (200 mg/m2) therapy supported by autologous stem cell transplantation. A complete or very good partial response was achieved by 40% of patients in the single transplant group and 60% of patients in the double transplant group (p=0.0006). The probability of surviving progression free for five years after the diagnosis was 25% (95% CL 18–32%) in the singletransplant group and 46% (95% CL 33–55%) in the double transplant group (p=0.0014). The estimated overall five-year survival rate was 60% in the single transplant group and 64% in the doubletransplant (p=0.9). In a multivariate analysis of variables, including single versus double transplantation, β2 microglobulin level, age, sex and disease stage, only β2 microglobulin level was predictive for overall survival (p>0.0001) and progression free survival (p=0.001). In accordance with these results, a 1:1 case-control matched comparison between double and single transplantation did not identify significant differences in overall and progression free survival. In this retrospective analysis up front double transplantation with melphalan (200 mg/m2) as compared to single transplantation did not seem to improve the final outcome among patients in the Nordic area. These data are in accordance with recent publications from the Bologna 96 trial indicating that a second transplant should not be recommended up front as standard care.
{"title":"Double versus single high-dose melphalan 200 mg/m2 and autologous stem cell transplantation for multiple myeloma: a region-based study in 484 patients from the Nordic area","authors":"B. Björkstrand, T. Klausen, K. Remes, A. Gruber, L. Knudsen, O. Bergmann, S. Lenhoff, H. Johnsen","doi":"10.4081/hr.2009.e2","DOIUrl":"https://doi.org/10.4081/hr.2009.e2","url":null,"abstract":"Autologous stem cell transplantation is still considered the standard of care in young patients with multiple myeloma (MM). This disease is the most common indication for high-dose therapy (HDT) supported by hematopoietic stem cell transplantation and much data support the benefit of this procedure. Results of randomized studies are in favor of tandem autologous transplantation although the effect on overall survival is unclear. Based on sequential registration trials in the Nordic area, we aimed to evaluate the outcome of conventional single or double HDT. During 1994–2000 we registered a total of 484 previously untreated patients under the age of 60 years at diagnosis who on a regional basis initially were treated with single [Trial NMSG #5/94 and #7/98 (N=383)] or double [Trial Huddinge Karolinska Turku Herlev (N=101)] high-dose melphalan (200 mg/m2) therapy supported by autologous stem cell transplantation. A complete or very good partial response was achieved by 40% of patients in the single transplant group and 60% of patients in the double transplant group (p=0.0006). The probability of surviving progression free for five years after the diagnosis was 25% (95% CL 18–32%) in the singletransplant group and 46% (95% CL 33–55%) in the double transplant group (p=0.0014). The estimated overall five-year survival rate was 60% in the single transplant group and 64% in the doubletransplant (p=0.9). In a multivariate analysis of variables, including single versus double transplantation, β2 microglobulin level, age, sex and disease stage, only β2 microglobulin level was predictive for overall survival (p>0.0001) and progression free survival (p=0.001). In accordance with these results, a 1:1 case-control matched comparison between double and single transplantation did not identify significant differences in overall and progression free survival. In this retrospective analysis up front double transplantation with melphalan (200 mg/m2) as compared to single transplantation did not seem to improve the final outcome among patients in the Nordic area. These data are in accordance with recent publications from the Bologna 96 trial indicating that a second transplant should not be recommended up front as standard care.","PeriodicalId":12954,"journal":{"name":"Hematology Reviews","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2009-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77237934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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