microRNA 与急性粒细胞白血病PPT.ppt

Case: Follow-up BM (%) 0 20 40 60 80 100 Day 0 Day 15 Day 30 Day 75 LD cycle 1 BM blasts BM cellularity WBC count Hemoglobin (g/dL) 0 2 4 6 8 10 12 Day 0 Day 15 Day 30 Day 75 LD cycle 1 Hemoglobin Platelets 0 2.0 4.0 6.0 8.0 10.0 0 50 100 200 250 300 Platelets (x103/?L) WBC (x 103/?L) 150 CR Aspirate 100X CR Leder 10X CR Leder 100X Lenalidomide: Mechanism? N N H O O O N H 2 Block Angiogenesis Direct Effects on tumor Alter cytokine profiles Immune modulation Phosphatase modulation Lenalidomide (Revlimid) Multiple Myeloma Lymphoma MDS (w/ 5q-) Activity Potential Mechanism(s) CLL AML Lenalidomide has activity in AML – how does it work? Modulation of NK cell responses? Correlative studies evaluating NK cells prior to, during, and after therapy Direct effects on AML? BM blasts at Dx: In vitro lenalidomide exposure, follow blast cell death compared to vehicle; correlation to response? Leukemia microenvironment? Flow for CXCR4 on AML blasts This would be a great project for a fellow! Acknowledgments Ravi Vij Alissa Nelson Kim Trinkaus Jackie Payton BMT/leukemia physicians and team members ASCO Foundation Siteman Cancer Center Disclosures: This study was funded in part by Celgene Non-FDA approved (investigational) use of Revlimid (lenalidomide) No financial interest * * * * * * * * * * * * * * * * * * Todd A Fehniger Hematology Grand Round March 13, 2009 Lenalidomide therapy for untreated acute myeloid leukemia in older adults ( 60 years of age) Disclosure Clinical study funded in part by Celgene Non-FDA approved use of Revlimid (lenalidomide) Case 71 yo M presented with dyspnea, fatigue, and pancytopenia Performance status: ECOG 1 PMH: HTN, GERD, BPH PE: petechiae, pale CBC WBC 1900/uL (ANC 190/uL) Hgb 6.7 g/dL Plts 74,000/uLf Differential: 33% blasts Blood 113: 1002, 2009 Case Bone marrow biopsy and aspirate 30% cellular 90% myeloblasts FAB M0 (undifferentiated) Flow: CD34+CD33+CD13+CD117+ Routine cytogenetics: trisomy 13 47,XY+13[5]/46,XY[15] FLT3ITD: Positive Bloo