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@#ObjectiveTo develop a highly sensitive method for detection of mutation of FMS-like tyrosine kinase-3-tyrosine kinase domain(FLT3-TKD)of acute myeloid leukemia(AML)and apply to the monitor of minimal residual disease(MRD).MethodsRecombinant plasmids containing wild FLT3 and mutant FLT3-D835Y were constructed respectively and mixed at certain ratios.The obtained standard plasmids with mutation rates of 50%,1%,0.1% and 0% respectively were determined by restriction fragment length polymorphism(RFLP)in combination with Sanger method.The plasmid DNA standards and blood DNA standards,at various FLT3-D835Y mutation rates,were determined by the developed method to verify the sensitivity.The genomic DNA samples of patients with AML before and after treatment were determined by the developed method to monitor the MRD.ResultsSequencing proved that both the recombinant plasmids containing wild FLT3 and mutant FLT3-D835Y were constructed correctly.The sensitivity of developed method increased to 0.1% through Sanger method combined with digestion with EcoR Ⅴ/Xho Ⅰ and recovery of mutant fragments in determination of purified plasmid DNA and collected blood DNA samples.MRD was detected in the peripheral blood sample of a patients with AML in complete remission period by the developed method but not by Sanger method.ConclusionA highly sensitive method for detection of FLT3-TKD mutation was developed,which was of an important clinical significance in guiding the treatment of AML and monitoring the MRD in complete remission period.
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【Objective】 To explore the association of HLAII(-DRB1, -DQB1, -DPB1) alleles and haplotypes polymorphisms with acute myeloid leukemia (AML) in northern Han population. 【Methods】 A total of 308 AML (non-M3) patients (patient group) and 824 unrelated healthy bone marrow donors (control group) were genotyped at a high-resolution level using polymerase chain reaction-sequence-based typing (PCR-SBT), next-generation sequencing (NGS) with Ion Torrent S5 platform and sequence specific oligonueleotide probes (SSO) with LABScan® 3D platform. Frequencies of HLA II alleles and haplotypes were calculated with Arlequin 3.5.2.2 software. The odds ratio (OR) of AML was also calculated for case-control study. 【Results】 By χ2 test and correction, an increased frequency of HLA-DRB1*07∶01(14.61% vs 9.53%, P<0.01), HLA-DQB1*02∶02(12.82% vs 8.31%, P<0.01), HLA-DQB1*06∶02(11.53% vs 8.74%, P<0.05) and HLA-DPB1*17∶01(5.84% vs 3.16%, P<0.01) among AML patients was discovered in significant comparison with the control group. After Bonferroni correction, the frequency of HLA-DRB1*07∶01(Pc<0.05), HLA-DQB1*02: 02(Pc<0.05) and HLA-DPB1*17∶01(Pc<0.05) in AML patients were still higher than those in the control group, which had a strong positive correlation with AML (OR=1.62 (95% CI=1.23~2.14), 1.62(95% CI=1.21~2.18) and 1.91(95% CI=1.23~2.94), respectively. The frequency of two loci haplotype HLA-DRB1*07∶01-DQB1*02∶02 in AML patients was still higher than that of the control group after Bonferroni correction (12.66% vs 8.19%, Pc<0.05). The frequency of the 3 loci haplotype HLA-DRB1*07∶01-DQB1*02∶02-DPB1*17∶01, as a susceptible haplotype of AML, was higher than that of the control group and was strongly correlated with AML. 【Conclusion】 The data on the association of HLA II (-DRB1, -DQB1, -DPB1) alleles and haplotype polymorphisms with AML in northern Han populations was obtained in this study. HLA-DRB1*07∶01, HLA-DQB1*02∶02, HLA-DPB1*17∶01 and the HLA-DRB1*07∶01-DQB1*02∶02-DPB1*17∶01 haplotype are the risk genes and susceptible extended haplotype for AML. The risk prediction based on HLA haplotype might be more accurate than that based on single allele.
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@#[Abstract] Objective: To develop a new type of CD7 chimeric antigen receptor modified T cell (CD7-CAR-T) for the treatment of CD7 positive acute myeloid leukemia (AML), and to observe its killing effect on CD7 positive AML cells. Methods: The CD7-CAR lentiviral vector was constructed based on the CD7 Nanobody sequence and costimulatory domain sequence of CD28 and 4-1BB. The lentiviral particles were packaged and used to co-transfect human T cells with protein expression blocker (PEBL), so as to prepare CD7- CAR-T cells. Real time cellular analysis (RTCA) was used to monitor the cytotoxicity of CD7-CAR-T cells on CD7 overexpressed 293T cells. Flow cytometry assay was used to detect the effect of CD7-CAR-T cells on proliferation and cytokine secretion of AML cells with high, medium and low CD7 expressions (KG-1, HEL and Kasumi-1 cells, respectively). Results: CD7-CAR-T cell was successfully constructed and its surface expression of CD7 was successfully blocked. Compared with T cells, CD7-CAR-T cells could significantly inhibit the proliferation of CD7-293T cells and promote the release of TNF, Granzyme B and INF-γ; in addition, CD7-CAR-T cells also significantly promoted the apoptosis (t=147.1, P<0.01; t=23.57, P<0.01) and cytokine release (P<0.05 or P<0.01) in CD7 positive KG-1 and HEL cells, but had little effect on Kasumi-1 cells that only expressed minimal CD7 antigen (t=0.7058, P>0.05). Conclusion: CD7-CAR-T cells can specifically kill CD7-positive AML cells in vitro.
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Introducción: La leucemia mieloide aguda representa el 80 por ciento de las leucemias agudas entre los adultos; el tratamiento de inducción a la remisión, para los pacientes menores de 60 años, está basado en la combinación de antraciclinas y arabinósido de citosina. Objetivo: incorporar las altas dosis de antraciclinas al tratamiento de inducción de la leucemia mieloide aguda no promielocítica en pacientes adultos menores de 60 años. Método: Se realizó un estudio cuasiexperimental en 41 pacientes con este diagnóstico, atendidos en el servicio de Adultos del Instituto de Hematología e Inmunología, desde septiembre del 2013 hasta diciembre del 2016. A todos los pacientes se les realizó estudios morfológicos, inmunológicos, citogenéticos y moleculares al inicio de la enfermedad y ecocardiografía para determinar la fracción de eyección y de acortamiento del ventrículo izquierdo al año de finalizado el tratamiento, para determinar la cardiotoxicidad por el uso de las altas dosis de antraciclinas. Resultados: La distribución por edad fue mayor en el grupo de 46 a 52 años representado por el 26,8 por ciento de los casos y predominó el sexo masculino 60,9 por ciento. En el 85 por ciento de los casos la enfermedad apareció de novo. Según los criterios morfológicos de la clasificación Franco Británico Americana el 31,7 por ciento correspondió a la variante M1, en estrecha relación con las determinaciones por citometría de flujo, para esta variedad. Los genes más comúnmente involucrados fueron el NPM1 y el AML/ETO, para el 24 por ciento y 22 por ciento, respectivamente. El 56,1 por ciento de los pacientes alcanzó la remisión hematológica con un solo ciclo de tratamiento y el 14,6 por ciento, necesitó realizar un segundo esquema de inducción. No se reportaron eventos de cardiotoxocidad por antraciclina durante el tratamiento, ni al año de culminado este. Conclusiones: Con el uso de las altas dosis de antraciclina se lograron remisiones hematológicas, sin toxicidad cardiovascular demostrada(AU)
Introduction: Acute myeloid leukemia represents 80 percent of acute leukemias among adults; the induction treatment to obtain remission in patients under 60 years old is based on the combination of anthracyclines and cytosine arabinoside. Objective: to incorporate the high doses of anthracyclines to the treatment of induction of non-promyelocytic acute myeloid leukemia in adult patients under 60 years of age. Method: We conducted a quasi-experimental study in 41 patients with this diagnosis, at the adult clinic service of the Institute of Hematology and Immunology, from september 2013 to december 2016. Morphological, immunological, cytogenetic and molecular studies were carried out at the beginning of the disease and also echocardiography was performed to determine the ejection fraction and shortening of the left ventricle a year after the end of treatment, to determine cardiotoxicity due to the use of high doses of anthracyclines. Results: The distribution by age was higher in the group of 46 to 52 years represented by 26.8 percent of the cases and the male sex predominated 60.9 percent. In 85 percent of the cases the disease appeared de novo. According to the morphological criteria of the French American British classification, 31.7 percent corresponded to the M1 variant, in close relation with the determinations by flow cytometry, for this variety. The genes most commonly involved were NPM1 and AML / ETO, for 24 percent and 22 percent respectively. 56.1 percent of patients achieved hematological remission with a single treatment cycle and 14.6 percent of patients needed a second induction scheme. No anthracycline cardiotoxicity events were reported during the treatment, nor a year after the treatment, in the patients evaluated. Conclusions: With the use of high doses of anthracycline, have been hematological remissions, without demonstrated cardiovascular toxicity(AU)
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Humans , Middle Aged , Aged , Aged, 80 and over , Leukemia, Myeloid, Acute/drug therapy , Anthracyclines/therapeutic use , Remission Induction/methodsABSTRACT
Objective: To explore the molecular mechanisms underlying the acute myeloid leukemia(AML)HL-60 cell differentiation induced by natural compound vibsanin A combined with tyrosine kinase inhibitors(TKI). Methods: Cell surface marker CD11b expression was detected by flow cytometry in HL-60 cells after treatment of the cells with vibsanin A in combination with imatinib or saracatinib for 72 h,and the cell morphology was examined by Wrigh-Giemsa staining. qRT-PCR and Western blot were used to examine the expression of differentiation-related C/EBPα,C/EBPβ, and c-Myc at both mRNA and protein levels in HL-60 cells after the cells were treated with the two drug combinations for various time(0-24 h). The recombinant lentiviral vector expressing c-Myc was constructed and used to transfect HL-60 cells in which the c-Myc cDNA was ectopically over expressed. The effect of c-Myc expression on the HL-60 cell differen-tiation induced by vibsanin A combined with TKI was investigated using the transfected HL-60 cells. Results: Vibsanin A combined with imatinib or saracatinib significantly enhanced HL-60 cell differentiation. Both drug combinations downregulated the expression of c-Myc at both mRNA and protein levels(P<0.01)in the HL-60 cells. In the transfected HL60 cells,the ectopic c-Myc overexpression could significantly counteract the down-regulated c-Myc expression and inhibit the cell differentiation induced by the vibsanin A/TKI combination. Conclusion: The combination of vibsanin A with imatinib or saracatinib could induce the HL-60 cell differentiation,probably via the downregulation of c-Myc expression
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Objective To investigate the effect of fluacrypyrim on the induction of apoptosis in human acute myeloid leuke-mia(AML)cell lines,NB4,THP-1 and HL-60,and explore the related mechanisms.Methods Trypan blue dye exclusion assay was used to estimate the growth of NB4,THP-1,and HL-60 cells after treatment with various concentrations of fluacrypyrim(1.25, 2.5,5 and 7.5 μmol/L)for 72 h.Cell apoptosis was evaluated by AnnexinⅤ-FITC/PI double stainning for the NB4 and THP-1 cells treated with fluacrypyrim(1.25,2.5 and 5 μmol/L)for 48 h as well as the HL-60 cells treated with fluacrypyrim(2.5,5 and 7.5 μmol/L) for 72 h.Western blotting was used to examine the protein expression of apoptotic regulators Bax,Mcl-1 and Caspase 3 in the NB4 cells treated with fluacrypyrim(1.25,2.5 and 5 μmol/L)for 24 h.Then,NB4 Cells were pretreated with Caspases inhibitor benzyloxy-carbonyl-Val-Ala-Asp-fluoromethylketone(Z-VAD-FMK)and exposed to fluacrypyrim at 2.5 μmol/L for 24 h,which was then evaluat-ed for the apoptosis using AnnexinⅤ-FITC/PI double stainning.Western blotting was used to examine the expression of the phosphory-lated and total proteins of mitogen-activated protein kinase(MAPK)signaling molecules,ERK,JNK and P38,in the NB4 cells treat-ed with fluacrypyrim(1.25,2.5 and 5 μmol/L)for 24 h. NB4 Cells were pretreated with ERK inhibitor U0126,JNK inhibitor SP600125,or P38 inhibitor SB203580 for 1 h and then exposed to fluacrypyrim at 2.5 μmol/L for 24 h,which was then analyzed for the apoptosis by the AnnexinⅤ-FITC/PI double stainning.Results The proliferation of NB4,THP-1 and HL-60 cells was inhibited by the treatment with fluacrypyrim(2.5,5 and 7.5 μmol/L)for 72 h.The apoptosis induced in the NB4 and THP-1 cells by the fluacry-pyrim treatment at 5 μmol/L for 48 h and in the HL-60 cells by the fluacrypyrim treatment at 7.5 μmol/L for 72 h were significant as compared with the control group(P<0.01).Mechanically,fluacrypyrim at the concentrations of 2.5 and 5 μmol/L effectively up-regu-lated the expression of Bax(P<0.01 and P<0.05)for the 2.5 and 5 μmol/L,respectively,down-regulated the expression of Mcl-1 (P<0.01)and activated Caspase 3(P<0.01)in the NB4 cells when compared with the control group(P<0.01).The pretreatment of the NB4 cells with Z-VAD-FMK blocked the apoptosis induced by fluacrypyrim.Furthermore,the fluacrypyrim(2.5 and 5 μmol/L) treatment increased the ERK,JNK and P38 phosphorylation(P<0.01),while the pretreatment of the NB4 cells with U0126 signifi-cantly inhibited the the fluacrypyrim-induced apoptosis(P<0.01),as compared with the control group.Conclusion Fluacrypyrim effectively inhibits the cell proliferation and induces caspase-dependent cell apoptosis in AML cells.Activation of ERK/MAPK signal-ing pathway might play an important role in the action of fluacrypyrim.
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Objective To observe the efficacy of autologous hematopoietic stem cell transplantation on the treatment of patients with acute myeloid leukemia (AML) in complete remission stage. Methods Clinical data of 14 AML patients underwent autologous hematopoietic stem cell transplantation were analyzed retrospectively, including 7 low-risk patients, 6 moderate-risk patients and 1 high-risk patient. After pretreatment, pre-cryopreserved autologous peripheral blood stem cells were retransfused. And component blood transfusion, increasing white blood cell (WBC) count and preventing from infection, etc. were given. Hematopoietic reconstitution of autologous stem cells in the patients was observed, and incidence of transplantation related complications was obtained. Furthermore, survival curves were drawn, and postoperative 1- and 3-year overall survival rates and disease-free survival (DFS) rates were calculated. Results Hematopoietic reconstitution was achieved in all 14 patients. The median time of WBC implantation was 12(9-28) d, and that of platelet implantation was 29(8-158) d. Two patients suffered from E. coli septicemia during neutropenia stage, 1 from proteus vulgaris septicemia, 1 from cytomegalovirus viremia within 29 d after transplantation and the remaining from infection or gastrointestinal reaction after pretreated. All patients were cured by anti-infection and other symptomatic relief and supportive treatment. All patients were followed up for 29.8(5.3-61.5) months. In 14 patients, 5 cases recurred. 11 patients survived and 3 died of recurrence. The postoperative 1- and 3-year overall survival rates were 86％ and 79％, and the postoperative 1- and 3-year DFS rates were 64％ and 57％. Conclusions Autologous hematopoietic stem cell transplantation is effective in the treatment of majority patients with low- or moderate-risk AML.
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@#[Abstract] Objective: To construct CD33-CAR modified NK92 cells based on CD33-scFv sequence, and to explore its killing effect on CD33+ AML (acute myeloid leukemia) cells. Methods: DNA fragment encoding CD33-CAR was synthesized by gene synthesis and molecular cloning technology and then cloned into lentiviral vector. Lentivirus were packaged and used to transfect NK92 cells. The transfection efficiency was detected by flow cytometry, and puromycin was used to screen NK92 cells stably expressing CD33-CAR (CD33-CAR-NK92). Killing effect of CD33-CAR-NK92 cells on AML cells in vitro was examined with calcein-AM release assays. IFN-γ secretions of NK92 cells and CD33-CAR-NK92 cells were measured by ELISA. Results: The pCDH-CD33-CAR lentiviral vector was successfully constructed. After lentiviral transfection, about 18.7% of NK92 cells express CD33-CAR (referred as CD33-CARNK92 cells). The percentage of CD33-CAR+ NK92 cells was about 86.3% after puromycin selection. In contrast to unmodified NK92 cells, significantly higher cytotoxic effect against CD33+ MOLM-13 cells was found in CD33-CAR-NK92 cells (P<0.01); however, there was no significant difference in cytotoxicity against CD33- JURKAT cells between NK92 cells and CD33-CAR-NK92 cells (P> 0.05). After co-culture at an effect-target ratio of 2∶1 for 6 hours, the level of IFN-γ secreted by the CD33-CAR modified NK92 cells was significantly higher than that of the unmodified ([190.97±11.52] vs [88.41±2.75]pg/ml, P<0.01). Conclusion: The CD33-CARNK92 cells could specifically recognize CD33 antigen and kill CD33+ AML cells in comparison with the unmodified NK92 cells, which provides experimental basis for clinical transformation of CD33-CAR-NK92 cells in treatingAML.
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Isocitrate dehydrogenase (IDH) is an important metabolic enzyme involved in the tricarboxylic acid cycle. In recent years, IDH has become the most frequent tumor metabolic mutation gene in acute myeloid leukemia (AML). Unlike other mutations, it gains new functions which can catalyze α-ketoglutarate (α-KG) to produce the tumor metabolite D-2-hydroxyglutarate (D-2-HG). The increased D-2-HG in the cells can affect bone marrow cell differentiation and proliferation and induce myeloid tumors by the genetic controls, cell signaling, bone marrow microenvironment changes and other ways. Currently, the new IDH2 inhibitors AG-221 and IDH1 inhibitors become the first-line drugs targeted therapy in patients with IDH mutations in AML. This paper focused on the mutation of IDH and its mutation characteristics, the formation mechanism of AML by the metabolites produced by mutation, the metabolic pathway of tumor metabolites and the research progress of IDH inhibitors.
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Myeloid Sarcoma1 (also termed as chloroma, granulocytic sarcoma, extra medullary myeloid tumor) is a rare extra medullary tumor composed of immature myeloid cells (myeloblast)2. It is usually associated with leukemia or other myeloproliferative disorder. Myeloid Sarcoma in the central nervous system, around the brain stem is the commonest site of presentation and require high suspicion for diagnosis. We report a forty years male patient with history of dysphagia, dysphonia for last two months. MRI showed chloromas around the brain stem. Laboratory investigations revealed the presence of AML. This is a rare case of Myeloid Sarcoma around the brain stem in a patient of AML.