CD19-Specific CAR-T Cell Treatment of 115 Children and Young Adults with Acute B Lymphoblastic Leukemia: Long-term Follow-up / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#Chemotherapy has been the primary treatment for patients with B-cell acute lymphoblastic leukemia (B-ALL). However, there are still patients who are not sensitive to chemotherapy, including those with refractory/relapse (R/R) disease and those experiencing minimal residual disease (MRD) re-emergence. Chimeric antigen receptor-T lymphocytes (CAR-T) therapy may provide a new treatment option for these patients. @*Materials and Methods@#Our institution conducted a single-arm prospective clinical trial (ChiCTR-OPN-17013507) using CAR-T-19 to treat R/R B-ALL and MRD re-emergent patients. One hundred and fifteen patients, aged 1-25 years (median age, 8 years), were enrolled, including 67 R/R and 48 MRD re-emergent CD19-positive B-ALL patients. @*Results@#All patients achieved morphologic complete remission (CR), and within 1 month after infusion, 111 out of 115 (96.5%) patients achieved MRD-negative CR. With a median follow-up time of 48.4 months, the estimated 4-year leukemia-free survival (LFS) rate and overall survival (OS) rate were 68.7%±4.5% and 70.7%±4.3%, respectively. There were no significant differences in long-term efficacy observed among patients with different disease statuses before infusion (4-year OS: MRD re-emergence vs. R/R B-ALL, 70.6%±6.6% vs. 66.5%±6.1%, p=0.755; 4-year LFS: MRD re-emergence vs. R/R B-ALL, 67.3%±7.0% vs. 63.8%±6.2%, p=0.704). R/R B-ALL patients bridging to transplantation after CAR-T treatment had a superior OS and LFS compared to those who did not. However, for MRD re-emergent patients, there was no significant difference in OS and LFS, regardless of whether they underwent hematopoietic stem cell transplantation or not. @*Conclusion@#CD19 CAR-T therapy effectively and safely cures both R/R B-ALL and MRD re-emergent patients.

The Impact of Induction Treatment Response on the Prognosis of Pediatric Core Binding Factor-Acute Myeloid Leukemia Patients / 中国实验血液学杂志

OBJECTIVE@#To explore the impact of induction treatment response on the prognosis of pediatric core binding factor-acute myeloid leukemia (CBF-AML).@*METHODS@#The result of induce reaction and survival data of 157 pediatric CBF-AML patients in our hospital from September 2008 to December 2018 were retrospectively analyzed．The survival rate of the patients with different degrees of morphological remission after induction chemotherapy was comparative analyzed.@*RESULTS@#Among the 157 children with CBF-AML, 113 (72.4%) patients achieved morphologic leukemia-free state (MLFS) after the first course of induction chemotherapy, 153 (98.1%) patients achieved MLFS after the second course of induction chemotherapy. The 5-year event-free survival (EFS) rate and 5-year overall survival (OS) rate of patients with non-remission (NR) status after the first course of induction of chemotherapy was significantly lower than the patients achieved MLFS and the patients achieved partial remission (PR). The 5-year EFS rate and 5-year OS rate of the patients with PR status after the second course of induction chemotherapy were lower than the patients achieved MLFS, but the difference was not statistically significant. Multivariable analyze showed that NR after the first course of induction chemotherapy and myeloid sarcoma were the independent risk factors affecting EFS of the patients. There were six patients with NR status after the first course of induction chemotherapy, in which all of them harbored t(8;21), three of them with sex chromosome deletion, two of them with myeloid sarcoma.@*CONCLUSION@#NR status after the first course of induction chemotherapy was the independent risk factor affecting EFS and OS of CBF-AML patients, it can be taken as an indicator for higher risk stratification. PR status after the first course of induction chemotherapy may not be used as a diagnostic criterion for primary drug resistance.

Type III familial hemophagocytic lymphohistiocytosis susceptibility gene UNC13D involves in homologous recombination repair / 中国实验血液学杂志

This study was aimed to explore the pathogenesis of type III familial hemophagocytic lymphohistiocytosis (FHL3) via susceptibility gene UNC13D involving in homologous recombination repair (HRR) of DNA double-strand break (DSB). By means of DNA homologous recombination repair, the change of homologous recombination repair rate of normal control cells and DR-U2OS cells after down-regulation of UNC13D was detected; the UNC13D gene related function was explored. The results showed that DR-U2OS cells displayed a significant reduction in homologous recombination repair of DNA DSB after siRNA knockdown of UNC13D, compared to its normal control cell counterparts (P < 0.05), suggesting that UNC13D was involved in DNA double-stranded breakage repair. It is concluded that UNC13D gene mutation may be involved in the pathogenesis of FHL3 via its dual effects of both the cytotoxic granule exocytosis and decrease of homologous recombination repair rate after the DNA double-strand break, therefore, providing a new theoretical basis to reveal the pathogenesis of FHL3.

Analysis of DNMT3a mutation in childhood acute myeloid leukemia / 中国实验血液学杂志

Within the past few years, the invention of next-generation sequencing has revealed several new genes associated with tumor formation and development, for example DNMT3a. This gene is an independent prognostic factor for acute myeloid leukemia (AML). The objective of this study was to analyze the DNMT3a mutation in childhood AML in a single center. PCR amplification of the entire coding region of DNMT3a was performed using 23 overlapping primer pairs in 57 patients who were diagnosed in Blood Disease Hospital of Chinese Academy of Medical Sciences, then the directly sequencing was underwent. The results showed that no DNMT3a mutation was found in these patients including the hotspot R882. But AML1/ETO mutation was found in 10 patients, CBFB/MYH11 mutation in 3 patients, PML/RARa mutation in 13 patients, FLT3/ITD mutation in 5 patients, FLT3/TKD mutation in 1 patient, PML/RARa and FLT3/TKD mutation coexisted in 2 patients. It is concluded that DNMT3a mutations are rare in childhood AML, and different mechanisms of myeloid leukemogenesis between childhood and adults maybe involved.

Regulatory mechanisms of PI3K/AKT signaling pathway in acute leukemia / 中国实验血液学杂志

This study was aimed to analyze the expression profiles of PI3K/AKT signaling pathway genes from bone marrow samples of AML and ALL patients and normal samples. AML, ALL and normal bone marrow samples were collected from 6 AML, 6 ALL patients and 4 normal persons. The expression of PI3K/AKT signaling pathway genes including PTEN, CCND1, mTOR, RICTOR, FOXO1 were detected by real-time fluorescent quantification RT-PCR while GAPDH gene expression was used as an internal reference. The relative gene expression level was calculated by the method of the 2(-ΔΔCt). The results showed that the gene expression profiles were different between normal and leukemic groups. PTEN, mTOR and RICTOR expression levels were down-regulated, while FOXO1 and CCND1 levels were up-regulated in AML and ALL. PTEN was down-regulated in 10 out of the 12 samples; mTOR was down-regulated in 9 out of the 12 samples; RICTOR was down-regulated in 7 out of the 12 samples; FOXO1 was up-regulated in 9 out of the 12 samples and CCND1 was up-regulated in 7 out of the 12 samples. It is concluded that PI3K/AKT signal pathway is activated in both AML and ALL leukemic cells.

114 children with acquired non-severe aplastic anemia benefitted from androgen / 中国实验血液学杂志

This study was purposed to assess the efficacy of stanozolol for treatment of childhood patients with acquired non-severe aplastic anemia (NSAA). The records of 114 children with acquired NSAA treated in hospital between January 1996 and January 2009 were analyzed retrospectively. All patients received stanozolol with the dose of 0.1 mg/(kg·d). Some patients were treated with supportive care. The incidence and the risk factors of progression severe aplastic anemia (SAA) including gender, age, absolute neutrophil count, absolute reticulocyte count, dependent or independent of transfusion, the ratio of granulocytes and erythrocytes were evaluated. The results indicated that at a median follow-up of 52 months (range 5 - 181), 6 patients (5.3%) progressed into SAA, 93 (81.6%) remained in NSAA, and 15 (13.2%) had complete remission. Patients with dependent of transfusion (platelet count < 10 × 10(9)/L and/or haemoglobin < 70 g/L) have higher risk to progress into SAA (19.2% vs 1.1%) (p = 0.016); patients with lower absolute neutrophil count (ANC) (< 0.8 × 10(9)/L) or with lower absolute reticulocyte count (ARC) (< 40 × 10(9)/L) at diagnosis have higher risk to progress into SAA (8.1% vs 0%) (p = 0.029); (9.1% vs 1.7%) (p = 0.034); Those patients with lower ANC (ANC < 0.8 × 10(9)/L) and lower ARC (ARC < 40 × 10(9)/L) have higher risk into progress to SAA (19.2% vs 1.1%) (p = 0.016). It is concluded that NSAA patients treated with Stanozolol progress into SAA with the rate of 5.3%. Those patients with dependent of transfusion or ANC < 0.8 × 10(9)/L or/and ARC < 40 × 10(9)/L have higher risk of progress into SAA.

Large sample clinical analysis of patients with children acute leukemia in single center / 中国实验血液学杂志

In order to investigate the epidemiology of childhood acute leukemia (CAL), such as onset age and time, risk factor, subtypes distribution and genetics, 1236 CAL patients admitted in blood disease hospital of Chinese Academy of Medical Sciences for treatment from April 2004 to April 2010 were analyzed retrospectively. The results showed that the sex ratio of ALL and AML patients were 1.80:1 and 1.73:1 respectively; the average peak age of incidence lasted from 2 to 6 years with the median age of 6 years, while the ALL peak age of incidence lasted from 2 to 5 years but AML showed no significant peak age of incidence. Winter, especially January was the peak time for both onset and birth. Among all the 631 ALL patients who had already been immunophenotyped, B-ALL patients accounted for 83%, T-ALL patients accounted for 9%. Among 361 AML patients, sub-leukemia phenotype from M(0) to M(7) accounted for 0.3%, 2.2%, 29.8%, 20.9%, 8.1%, 25.2%, 4.1% and 4.6% respectively. Among 631 pediatric ALL patients who had been examined by using molecular biology technique, the positive rate of TEL/AML1, BCR/ABL, MLL and E2A/PBX1 were 23%, 7.4%, 4.1%, 2.1% respectively. Among 361 pediatric AML patients who had been examined by using molecular biology technique, 19% of the patients showed positive AML1/ETO fusion gene, 18% of the patients showed positive PML/RARα fusion gene, while 4.2% of patients showed positive CBFβ/MYH11. It is concluded that the onset of pediatric acute leukemia is influenced by age, season, environment and different genetic background.

Advances on pathogenesis research of acute myeloid leukemia with t(8;21)-- review / 中国实验血液学杂志

Acquired chromosomal translocations can be identified in nearly 50% of human acute myeloid leukemias. The common chromosomal translocation in this disease is t(8;21) (q22;q22). It involves the aml1 (runx1) gene on chromosome 21 and the eto (mtg8, runx1t1) gene on chromosome 8 generating the aml1/eto fusion gene. An initial model for its pathogenesis emphasized the conversion of a hematopoietic transcriptional activator AML1 into a leukemogenic repressor which blocked myeloid differentiation at the level of target gene regulation. Aml1/eto fusion genes inhibit key hematopoietic transcription factor that function as tumor suppressors at several nodal point during hematopoietic differentiation. A new model is presented in which aml1/eto coordinates expansion of the stem cell compartment with diminished lineage commitment and with genome instability. In this review, the molecular role of aml1/eto fusion gene and his transcribed isoforms in regulating stem renewal, blocking hematopoietic differentiation and interacting with various lineage-specific transcription factors are summarized.