Antibody-based therapy of acute myeloid leukemia with gemtuzumab ozogamicin.

Antibody-based therapy of acute myeloid leukemia with gemtuzumab ozogamicin.
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用gemtuzumab ozogamicin对急性髓性白血病的基于抗体的治疗。

DOI:
10.2741/4181
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发表时间:
2013-06-01
期刊:
Frontiers in bioscience (Landmark edition)
影响因子:
--
通讯作者:
Walter RB
Walter RB
中科院分区:
其他
文献类型:
--
作者:
Cowan AJ;Laszlo GS;Estey EH;Walter RB

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抗体在急性髓系白血病(AML)中为有效且耐受性良好的治疗方法带来了很高的期望。到目前为止,最常被利用的靶点是CD33,它是一种髓系分化抗原,在大多数患者的AML原始细胞中存在,在一些患者中可能也存在于白血病干细胞上。治疗工作集中在偶联抗体上,特别是吉妥珠单抗奥佐米星(GO),这是一种携带毒性刺孢霉素 - γ1衍生物的抗CD33抗体,在细胞内水解释放后,会诱导DNA链断裂、细胞凋亡和细胞死亡。作为这一策略的范例,GO是美国首个获得监管批准的抗癌免疫偶联物。虽然在急性早幼粒细胞白血病(APL)中作为单一疗法是有效的,但单独使用GO在非APL的AML患者中诱导缓解率不到25 - 35%。然而,来自严格控制的试验的新数据现在表明,GO可提高许多非APL的AML患者的生存率,这支持了CD33是某些疾病亚型的临床相关靶点这一结论。因此,不幸的是,GO在世界许多地方已无法获得,应该重新考虑该药物的有效性,并让选定的患者能够使用这种免疫偶联物。
Antibodies have created high expectations for effective yet tolerated therapeutics in acute myeloid leukemia (AML). Hitherto the most exploited target is CD33, a myeloid differentiation antigen found on AML blasts in most patients and, perhaps, leukemic stem cells in some. Treatment efforts have focused on conjugated antibodies, particularly gemtuzumab ozogamicin (GO), an anti-CD33 antibody carrying a toxic calicheamicin-γ1 derivative that, after intracellular hydrolytic release, induces DNA strand breaks, apoptosis, and cell death. Serving as paradigm for this strategy, GO was the first anti-cancer immunoconjugate to obtain regulatory approval in the U.S. While efficacious as monotherapy in acute promyelocytic leukemia (APL), GO alone induces remissions in less than 25–35% of non-APL AML patients. However, emerging data from well controlled trials now indicate that GO improves survival for many non-APL AML patients, supporting the conclusion that CD33 is a clinically relevant target for some disease subsets. It is thus unfortunate that GO has become unavailable in many parts of the world, and the drug’s usefulness should be reconsidered and selected patients granted access to this immunoconjugate.
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