Blockade of adaptive defensive changes in cholesterol uptake and synthesis in AML by the addition of pravastatin to idarubicin + high-dose Ara-C: a phase 1 study
Following exposure to cytotoxic agents, acute myeloid leukemia (AML) blasts elevate cellular cholesterol in a defensive adaptation that increases chemoresistance, but blockade of HMG-CoA reductase with statins restores chemosensitivity in vitro. This phase 1 study evaluated adding pravastatin (PV) (...
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Veröffentlicht in: | Blood 2007-04, Vol.109 (7), p.2999-3006 |
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creator | Kornblau, Steven M. Banker, Deborah E. Stirewalt, Derek Shen, Danny Lemker, Elizabeth Verstovsek, Srdan Estrov, Zeev Faderl, Stefan Cortes, Jorge Beran, Miloslav Jackson, C. Ellen Chen, Wenjing Estey, Elihu Appelbaum, Frederick R. |
description | Following exposure to cytotoxic agents, acute myeloid leukemia (AML) blasts elevate cellular cholesterol in a defensive adaptation that increases chemoresistance, but blockade of HMG-CoA reductase with statins restores chemosensitivity in vitro. This phase 1 study evaluated adding pravastatin (PV) (40-1680 mg/day, days 1-8) to idarubicin (Ida) ([12 mg/(M2 · day), days 4-6]) + high-dose cytarabine (Ara-C; HDAC) [1.5 g/(M2 · day) by CI, days 4-7] in 15 newly diagnosed and 22 salvage patients with unfavorable (n = 26) or intermediate (n = 10) prognosis cytogenetics. Compared with historical experience with Ida-HDAC, the duration of neutropenia and throbmbocytopenia and the toxicity profile were unaffected by the addition of PV. During PV loading (day 0-4) serum triglyceride and total and LDL cholesterol levels decreased in nearly all patients. Pharmacokinetic studies demonstrated higher and more sustained serum PV levels with PV doses above 1280 mg/day. CR/CRp was obtained in 11 of 15 new patients, including 8 of 10 with unfavorable cytogenetics, and 9 of 22 salvage patients. An MTD for PV + Ida-HDAC was not reached. Addition of PV to Ida-HDAC was safe, and the encouraging response rates support conducting further trials evaluating the effect of cholesterol modulation on response in AML. |
doi_str_mv | 10.1182/blood-2006-08-044446 |
format | Article |
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Ellen ; Chen, Wenjing ; Estey, Elihu ; Appelbaum, Frederick R.</creator><creatorcontrib>Kornblau, Steven M. ; Banker, Deborah E. ; Stirewalt, Derek ; Shen, Danny ; Lemker, Elizabeth ; Verstovsek, Srdan ; Estrov, Zeev ; Faderl, Stefan ; Cortes, Jorge ; Beran, Miloslav ; Jackson, C. Ellen ; Chen, Wenjing ; Estey, Elihu ; Appelbaum, Frederick R.</creatorcontrib><description>Following exposure to cytotoxic agents, acute myeloid leukemia (AML) blasts elevate cellular cholesterol in a defensive adaptation that increases chemoresistance, but blockade of HMG-CoA reductase with statins restores chemosensitivity in vitro. This phase 1 study evaluated adding pravastatin (PV) (40-1680 mg/day, days 1-8) to idarubicin (Ida) ([12 mg/(M2 · day), days 4-6]) + high-dose cytarabine (Ara-C; HDAC) [1.5 g/(M2 · day) by CI, days 4-7] in 15 newly diagnosed and 22 salvage patients with unfavorable (n = 26) or intermediate (n = 10) prognosis cytogenetics. Compared with historical experience with Ida-HDAC, the duration of neutropenia and throbmbocytopenia and the toxicity profile were unaffected by the addition of PV. During PV loading (day 0-4) serum triglyceride and total and LDL cholesterol levels decreased in nearly all patients. Pharmacokinetic studies demonstrated higher and more sustained serum PV levels with PV doses above 1280 mg/day. CR/CRp was obtained in 11 of 15 new patients, including 8 of 10 with unfavorable cytogenetics, and 9 of 22 salvage patients. An MTD for PV + Ida-HDAC was not reached. Addition of PV to Ida-HDAC was safe, and the encouraging response rates support conducting further trials evaluating the effect of cholesterol modulation on response in AML.</description><identifier>ISSN: 0006-4971</identifier><identifier>EISSN: 1528-0020</identifier><identifier>DOI: 10.1182/blood-2006-08-044446</identifier><identifier>PMID: 17158228</identifier><language>eng</language><publisher>Washington, DC: Elsevier Inc</publisher><subject>Adult ; Aged ; Antineoplastic agents ; Antineoplastic Combined Chemotherapy Protocols - administration & dosage ; Biological and medical sciences ; Chemotherapy ; Cholesterol - blood ; Cytarabine - administration & dosage ; Female ; Hematologic and hematopoietic diseases ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage ; Hydroxymethylglutaryl-CoA Reductase Inhibitors - adverse effects ; Hydroxymethylglutaryl-CoA Reductase Inhibitors - blood ; Idarubicin - administration & dosage ; Leukemia, Myeloid, Acute - blood ; Leukemia, Myeloid, Acute - drug therapy ; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis ; Male ; Medical sciences ; Middle Aged ; Neoplasia ; Pharmacology. Drug treatments ; Pravastatin - administration & dosage ; Pravastatin - adverse effects ; Pravastatin - blood ; Safety</subject><ispartof>Blood, 2007-04, Vol.109 (7), p.2999-3006</ispartof><rights>2007 American Society of Hematology</rights><rights>2007 INIST-CNRS</rights><rights>2007 by The American Society of Hematology 2007</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4726-2156478231ff3ad19cea2ba9b5e66efa2e05a758230f9f2b00f0b1a2381d4ff23</citedby><cites>FETCH-LOGICAL-c4726-2156478231ff3ad19cea2ba9b5e66efa2e05a758230f9f2b00f0b1a2381d4ff23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27903,27904</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=18646680$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17158228$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kornblau, Steven M.</creatorcontrib><creatorcontrib>Banker, Deborah E.</creatorcontrib><creatorcontrib>Stirewalt, Derek</creatorcontrib><creatorcontrib>Shen, Danny</creatorcontrib><creatorcontrib>Lemker, Elizabeth</creatorcontrib><creatorcontrib>Verstovsek, Srdan</creatorcontrib><creatorcontrib>Estrov, Zeev</creatorcontrib><creatorcontrib>Faderl, Stefan</creatorcontrib><creatorcontrib>Cortes, Jorge</creatorcontrib><creatorcontrib>Beran, Miloslav</creatorcontrib><creatorcontrib>Jackson, C. Ellen</creatorcontrib><creatorcontrib>Chen, Wenjing</creatorcontrib><creatorcontrib>Estey, Elihu</creatorcontrib><creatorcontrib>Appelbaum, Frederick R.</creatorcontrib><title>Blockade of adaptive defensive changes in cholesterol uptake and synthesis in AML by the addition of pravastatin to idarubicin + high-dose Ara-C: a phase 1 study</title><title>Blood</title><addtitle>Blood</addtitle><description>Following exposure to cytotoxic agents, acute myeloid leukemia (AML) blasts elevate cellular cholesterol in a defensive adaptation that increases chemoresistance, but blockade of HMG-CoA reductase with statins restores chemosensitivity in vitro. This phase 1 study evaluated adding pravastatin (PV) (40-1680 mg/day, days 1-8) to idarubicin (Ida) ([12 mg/(M2 · day), days 4-6]) + high-dose cytarabine (Ara-C; HDAC) [1.5 g/(M2 · day) by CI, days 4-7] in 15 newly diagnosed and 22 salvage patients with unfavorable (n = 26) or intermediate (n = 10) prognosis cytogenetics. Compared with historical experience with Ida-HDAC, the duration of neutropenia and throbmbocytopenia and the toxicity profile were unaffected by the addition of PV. During PV loading (day 0-4) serum triglyceride and total and LDL cholesterol levels decreased in nearly all patients. Pharmacokinetic studies demonstrated higher and more sustained serum PV levels with PV doses above 1280 mg/day. CR/CRp was obtained in 11 of 15 new patients, including 8 of 10 with unfavorable cytogenetics, and 9 of 22 salvage patients. An MTD for PV + Ida-HDAC was not reached. Addition of PV to Ida-HDAC was safe, and the encouraging response rates support conducting further trials evaluating the effect of cholesterol modulation on response in AML.</description><subject>Adult</subject><subject>Aged</subject><subject>Antineoplastic agents</subject><subject>Antineoplastic Combined Chemotherapy Protocols - administration & dosage</subject><subject>Biological and medical sciences</subject><subject>Chemotherapy</subject><subject>Cholesterol - blood</subject><subject>Cytarabine - administration & dosage</subject><subject>Female</subject><subject>Hematologic and hematopoietic diseases</subject><subject>Humans</subject><subject>Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage</subject><subject>Hydroxymethylglutaryl-CoA Reductase Inhibitors - adverse effects</subject><subject>Hydroxymethylglutaryl-CoA Reductase Inhibitors - blood</subject><subject>Idarubicin - administration & dosage</subject><subject>Leukemia, Myeloid, Acute - blood</subject><subject>Leukemia, Myeloid, Acute - drug therapy</subject><subject>Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Neoplasia</subject><subject>Pharmacology. Drug treatments</subject><subject>Pravastatin - administration & dosage</subject><subject>Pravastatin - adverse effects</subject><subject>Pravastatin - blood</subject><subject>Safety</subject><issn>0006-4971</issn><issn>1528-0020</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9UcuOEzEQtBCIzS78AUK-cEIDtuflcEAKEQtIQVzgbPXY7YzZWXtkO5HyOfwpziYicMEXd7urqt1dhLzg7A3nUrwdphBMJRjrKiYr1pTTPSIL3oqSMcEekwU7Fptlz6_IdUo_GeNNLdqn5Ir3vJVCyAX59WEK-g4M0mApGJiz2yM1aNGnY6RH8FtM1PkShglTxhgmupsz3CEFb2g6-Dxicg-Y1dcNHQ60PBQx47IL_ig8R9hDypALJAfqDMTd4HTJXtPRbcfKhIR0FaFav6NA5xFKymnKO3N4Rp5YmBI-P9835Mftx-_rz9Xm26cv69Wm0k0vukrwtmt6KWpubQ2GLzWCGGA5tNh1aEEga6EvU9fMLq0YGLNs4CBqyU1jrahvyPuT7rwb7tFo9DnCpObo7iEeVACn_q14N6pt2CsuW1F2WQSak4COIaWI9g-XM3W0TD1Ypo6WKSbVybJCe_l33wvp7FEBvDoDIGmYbASvXbrgZNd0nWSXAbBsae8wqqQdeo3GRdRZmeD-_5Pf7QG39w</recordid><startdate>20070401</startdate><enddate>20070401</enddate><creator>Kornblau, Steven M.</creator><creator>Banker, Deborah E.</creator><creator>Stirewalt, Derek</creator><creator>Shen, Danny</creator><creator>Lemker, Elizabeth</creator><creator>Verstovsek, Srdan</creator><creator>Estrov, Zeev</creator><creator>Faderl, Stefan</creator><creator>Cortes, Jorge</creator><creator>Beran, Miloslav</creator><creator>Jackson, C. Ellen</creator><creator>Chen, Wenjing</creator><creator>Estey, Elihu</creator><creator>Appelbaum, Frederick R.</creator><general>Elsevier Inc</general><general>The Americain Society of Hematology</general><general>American Society of Hematology</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope></search><sort><creationdate>20070401</creationdate><title>Blockade of adaptive defensive changes in cholesterol uptake and synthesis in AML by the addition of pravastatin to idarubicin + high-dose Ara-C: a phase 1 study</title><author>Kornblau, Steven M. ; Banker, Deborah E. ; Stirewalt, Derek ; Shen, Danny ; Lemker, Elizabeth ; Verstovsek, Srdan ; Estrov, Zeev ; Faderl, Stefan ; Cortes, Jorge ; Beran, Miloslav ; Jackson, C. Ellen ; Chen, Wenjing ; Estey, Elihu ; Appelbaum, Frederick R.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4726-2156478231ff3ad19cea2ba9b5e66efa2e05a758230f9f2b00f0b1a2381d4ff23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Antineoplastic agents</topic><topic>Antineoplastic Combined Chemotherapy Protocols - administration & dosage</topic><topic>Biological and medical sciences</topic><topic>Chemotherapy</topic><topic>Cholesterol - blood</topic><topic>Cytarabine - administration & dosage</topic><topic>Female</topic><topic>Hematologic and hematopoietic diseases</topic><topic>Humans</topic><topic>Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage</topic><topic>Hydroxymethylglutaryl-CoA Reductase Inhibitors - adverse effects</topic><topic>Hydroxymethylglutaryl-CoA Reductase Inhibitors - blood</topic><topic>Idarubicin - administration & dosage</topic><topic>Leukemia, Myeloid, Acute - blood</topic><topic>Leukemia, Myeloid, Acute - drug therapy</topic><topic>Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Neoplasia</topic><topic>Pharmacology. Drug treatments</topic><topic>Pravastatin - administration & dosage</topic><topic>Pravastatin - adverse effects</topic><topic>Pravastatin - blood</topic><topic>Safety</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kornblau, Steven M.</creatorcontrib><creatorcontrib>Banker, Deborah E.</creatorcontrib><creatorcontrib>Stirewalt, Derek</creatorcontrib><creatorcontrib>Shen, Danny</creatorcontrib><creatorcontrib>Lemker, Elizabeth</creatorcontrib><creatorcontrib>Verstovsek, Srdan</creatorcontrib><creatorcontrib>Estrov, Zeev</creatorcontrib><creatorcontrib>Faderl, Stefan</creatorcontrib><creatorcontrib>Cortes, Jorge</creatorcontrib><creatorcontrib>Beran, Miloslav</creatorcontrib><creatorcontrib>Jackson, C. Ellen</creatorcontrib><creatorcontrib>Chen, Wenjing</creatorcontrib><creatorcontrib>Estey, Elihu</creatorcontrib><creatorcontrib>Appelbaum, Frederick R.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Blood</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kornblau, Steven M.</au><au>Banker, Deborah E.</au><au>Stirewalt, Derek</au><au>Shen, Danny</au><au>Lemker, Elizabeth</au><au>Verstovsek, Srdan</au><au>Estrov, Zeev</au><au>Faderl, Stefan</au><au>Cortes, Jorge</au><au>Beran, Miloslav</au><au>Jackson, C. Ellen</au><au>Chen, Wenjing</au><au>Estey, Elihu</au><au>Appelbaum, Frederick R.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Blockade of adaptive defensive changes in cholesterol uptake and synthesis in AML by the addition of pravastatin to idarubicin + high-dose Ara-C: a phase 1 study</atitle><jtitle>Blood</jtitle><addtitle>Blood</addtitle><date>2007-04-01</date><risdate>2007</risdate><volume>109</volume><issue>7</issue><spage>2999</spage><epage>3006</epage><pages>2999-3006</pages><issn>0006-4971</issn><eissn>1528-0020</eissn><abstract>Following exposure to cytotoxic agents, acute myeloid leukemia (AML) blasts elevate cellular cholesterol in a defensive adaptation that increases chemoresistance, but blockade of HMG-CoA reductase with statins restores chemosensitivity in vitro. This phase 1 study evaluated adding pravastatin (PV) (40-1680 mg/day, days 1-8) to idarubicin (Ida) ([12 mg/(M2 · day), days 4-6]) + high-dose cytarabine (Ara-C; HDAC) [1.5 g/(M2 · day) by CI, days 4-7] in 15 newly diagnosed and 22 salvage patients with unfavorable (n = 26) or intermediate (n = 10) prognosis cytogenetics. Compared with historical experience with Ida-HDAC, the duration of neutropenia and throbmbocytopenia and the toxicity profile were unaffected by the addition of PV. During PV loading (day 0-4) serum triglyceride and total and LDL cholesterol levels decreased in nearly all patients. Pharmacokinetic studies demonstrated higher and more sustained serum PV levels with PV doses above 1280 mg/day. CR/CRp was obtained in 11 of 15 new patients, including 8 of 10 with unfavorable cytogenetics, and 9 of 22 salvage patients. An MTD for PV + Ida-HDAC was not reached. Addition of PV to Ida-HDAC was safe, and the encouraging response rates support conducting further trials evaluating the effect of cholesterol modulation on response in AML.</abstract><cop>Washington, DC</cop><pub>Elsevier Inc</pub><pmid>17158228</pmid><doi>10.1182/blood-2006-08-044446</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Adult Aged Antineoplastic agents Antineoplastic Combined Chemotherapy Protocols - administration & dosage Biological and medical sciences Chemotherapy Cholesterol - blood Cytarabine - administration & dosage Female Hematologic and hematopoietic diseases Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage Hydroxymethylglutaryl-CoA Reductase Inhibitors - adverse effects Hydroxymethylglutaryl-CoA Reductase Inhibitors - blood Idarubicin - administration & dosage Leukemia, Myeloid, Acute - blood Leukemia, Myeloid, Acute - drug therapy Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis Male Medical sciences Middle Aged Neoplasia Pharmacology. Drug treatments Pravastatin - administration & dosage Pravastatin - adverse effects Pravastatin - blood Safety |
title | Blockade of adaptive defensive changes in cholesterol uptake and synthesis in AML by the addition of pravastatin to idarubicin + high-dose Ara-C: a phase 1 study |
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