-
American Journal of Health-system... Nov 2021
Topics: Acetamides; Humans; Imatinib Mesylate; Mesylates
PubMed: 34498057
DOI: 10.1093/ajhp/zxab335 -
The Lancet. Haematology Jan 2020Further improvement of preparative regimens before allogeneic haemopoietic stem cell transplantation (HSCT) is an unmet medical need for the growing number of older or... (Randomized Controlled Trial)
Randomized Controlled Trial
Treosulfan or busulfan plus fludarabine as conditioning treatment before allogeneic haemopoietic stem cell transplantation for older patients with acute myeloid leukaemia or myelodysplastic syndrome (MC-FludT.14/L): a randomised, non-inferiority, phase 3 trial.
BACKGROUND
Further improvement of preparative regimens before allogeneic haemopoietic stem cell transplantation (HSCT) is an unmet medical need for the growing number of older or comorbid patients with acute myeloid leukaemia or myelodysplastic syndrome. We aimed to evaluate the efficacy and safety of conditioning with treosulfan plus fludarabine compared with reduced-intensity busulfan plus fludarabine in this population.
METHODS
We did an open-label, randomised, non-inferiority, phase 3 trial in 31 transplantation centres in France, Germany, Hungary, Italy, and Poland. Eligible patients were 18-70 years, had acute myeloid leukaemia in first or consecutive complete haematological remission (blast counts <5% in bone marrow) or myelodysplastic syndrome (blast counts <20% in bone marrow), Karnofsky index of 60% or higher, and were indicated for allogeneic HSCT but considered at an increased risk for standard myeloablative preparative regimens based on age (≥50 years), an HSCT-specific comorbidity index of more than 2, or both. Patients were randomly assigned (1:1) to receive either intravenous 10 g/m treosulfan daily applied as a 2-h infusion for 3 days (days -4 to -2) or 0·8 mg/kg busulfan applied as a 2-h infusion at 6-h intervals on days -4 and -3. Both groups received 30 mg/m intravenous fludarabine daily for 5 days (days -6 to -2). The primary outcome was event-free survival 2 years after HSCT. The non-inferiority margin was a hazard ratio (HR) of 1·3. Efficacy was assessed in all patients who received treatment and completed transplantation, and safety in all patients who received treatment. The study is registered with EudraCT (2008-002356-18) and ClinicalTrials.gov (NCT00822393).
FINDINGS
Between June 13, 2013, and May 3, 2016, 476 patients were enrolled (240 in the busulfan group received treatment and transplantation, and in the treosulfan group 221 received treatment and 220 transplanation). At the second preplanned interim analysis (Nov 9, 2016), the primary endpoint was met and trial was stopped. Here we present the final confirmatory analysis (data cutoff May 31, 2017). Median follow-up was 15·4 months (IQR 8·8-23·6) for patients treated with treosulfan and 17·4 months (6·3-23·4) for those treated with busulfan. 2-year event-free survival was 64·0% (95% CI 56·0-70·9) in the treosulfan group and 50·4% (42·8-57·5) in the busulfan group (HR 0·65 [95% CI 0·47-0·90]; p<0·0001 for non-inferiority, p=0·0051 for superiority). The most frequently reported grade 3 or higher adverse events were abnormal blood chemistry results (33 [15%] of 221 patients in the treosulfan group vs 35 [15%] of 240 patients in the busulfan group) and gastrointestinal disorders (24 [11%] patients vs 39 [16%] patients). Serious adverse events were reported for 18 (8%) patients in the treosulfan group and 17 (7%) patients in the busulfan group. Causes of deaths were generally transplantation-related.
INTERPRETATION
Treosulfan was non-inferior to busulfan when used in combination with fludarabine as a conditioning regimen for allogeneic HSCT for older or comorbid patients with acute myeloid leukaemia or myelodysplastic syndrome. The improved outcomes in patients treated with the treosulfan-fludarabine regimen suggest its potential to become a standard preparative regimen in this population.
FUNDING
medac GmbH.
Topics: Adult; Aged; Antineoplastic Agents; Busulfan; Disease-Free Survival; Female; Hematopoietic Stem Cell Transplantation; Humans; Leukemia, Myeloid, Acute; Male; Middle Aged; Myelodysplastic Syndromes; Transplantation Conditioning; Vidarabine
PubMed: 31606445
DOI: 10.1016/S2352-3026(19)30157-7 -
IUCrData Oct 2020The central copper(II) atom of the title salt, {[Cu(CFSO)(CHCN)(CHNO)](CFSO)} or [[Cu(CHCN)(diOMe-bpy)(CFSO)](CFSO)] where diOMe-bpy is...
The central copper(II) atom of the title salt, {[Cu(CFSO)(CHCN)(CHNO)](CFSO)} or [[Cu(CHCN)(diOMe-bpy)(CFSO)](CFSO)] where diOMe-bpy is 4,4'-dimeth-oxy-2,2'-bi-pyridine, CHNO, is sixfold coordin-ated by the N atoms of the chelating bi-pyridine ligand, the N atoms of two aceto-nitrile mol-ecules, and two tri-fluoro-methane-sulfonate O atoms in a tetra-gonally distorted octa-hedral shape. The formation of polymeric chains [Cu(CHCN)(diOMe-bpy)(CFSO)] leaves voids for the non-coordinating tri-fluoro-methane-sulfonate anions that inter-act with the complex through weak hydrogen bonds. The presence of weakly coordinating ligands like aceto-nitrile and tri-fluoro-methane-sulfonate makes the title compound a convenient starting material for the synthesis of novel metal-organic frameworks.
PubMed: 36339021
DOI: 10.1107/S2414314620014078 -
American Journal of Hematology Aug 2022The phase III study was designed to compare event-free survival (EFS) after treosulfan-based conditioning with a widely applied reduced-intensity conditioning (RIC)... (Randomized Controlled Trial)
Randomized Controlled Trial
Treosulfan compared with reduced-intensity busulfan improves allogeneic hematopoietic cell transplantation outcomes of older acute myeloid leukemia and myelodysplastic syndrome patients: Final analysis of a prospective randomized trial.
The phase III study was designed to compare event-free survival (EFS) after treosulfan-based conditioning with a widely applied reduced-intensity conditioning (RIC) busulfan regimen in older or comorbid patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) undergoing allogeneic hematopoietic cell transplantation (HCT). A previously reported confirmatory interim analysis of the randomized clinical study including 476 patients demonstrated statistically significant noninferiority for treosulfan with clinically meaningful improvement in EFS. Here, the final study results and pre-specified subgroup analyses of all 570 randomized patients with completed longer-term follow-up are presented. Patients presenting HCT-specific comorbidity index >2 or aged ≥50 years were randomly assigned (1:1) to intravenous (IV) fludarabine with either treosulfan (30 g/m IV) or busulfan (6.4 mg/kg IV) after stratification by disease risk group, donor type, and participating institution. The primary endpoint was EFS with disease recurrence, graft failure, or death from any cause as events. EFS of patients (median age 60 years) was superior after treosulfan compared to RIC busulfan: 36-months-EFS rate 59.5% (95% CI, 52.2-66.1) vs. 49.7% (95% CI, 43.3-55.7) with a hazard ratio (HR) of 0.64 (95% CI, 0.49-0.84), p = 0.0006. Likewise, overall survival (OS) with treosulfan was superior compared to busulfan: 36-month-OS rate 66.8% vs. 56.3%; HR 0.64 (95% CI, 0.48-0.87), p = 0.0037. Post hoc analyses revealed that these differences were consistent with the confirmatory interim analysis, and thereby the treosulfan regimen appears particularly suitable for older AML and MDS patients.
Topics: Aged; Busulfan; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Humans; Leukemia, Myeloid, Acute; Middle Aged; Myelodysplastic Syndromes; Prospective Studies; Transplantation Conditioning; Vidarabine
PubMed: 35617104
DOI: 10.1002/ajh.26620 -
IUCrData Oct 2021The title mol-ecular salt, CHNOS·CHOS, consists of a cationic sulfonated pyridine -oxide moiety and a methane-sulfonate anion. An N-O bond length of 1.4004 (15) Å...
The title mol-ecular salt, CHNOS·CHOS, consists of a cationic sulfonated pyridine -oxide moiety and a methane-sulfonate anion. An N-O bond length of 1.4004 (15) Å is observed in the cation. In the crystal, weak C-H⋯O inter-actions link the components into a three-dimensional network.
PubMed: 36340987
DOI: 10.1107/S2414314621010269 -
IUCrData Oct 2021In the centrosymmetric title complex, [CuCl(CHN)](CFOS), the Cu metal center is fivefold coordinated by two chloride ions and three nitro-gen atoms of the terpyridine...
In the centrosymmetric title complex, [CuCl(CHN)](CFOS), the Cu metal center is fivefold coordinated by two chloride ions and three nitro-gen atoms of the terpyridine ligand in a distorted square-pyramidal geometry; two tri-fluoro-methane-sulfonate ions complete the outer coordination sphere. stacking inter-actions between the pyridyl rings in adjacent mol-ecules contribute to the alignment of the complexes in columns along the -axis. This structure represents the first example of a binuclear dication of formula [Cu(terpy)Cl] with tri-fluoro-methane-sulfonate as counter-ions.
PubMed: 36340990
DOI: 10.1107/S2414314621010968 -
Acta Crystallographica. Section E,... Apr 2024Two 2,4,6-tri-methyl-aniline-based trifuloro-methane-sulfonate (tri-fluoro-methane-sulfonate) salts were synthesized and characterized by single-crystal X-ray...
Synthesis and crystal structures of ,2,4,6-tetra-methyl-anilinium tri-fluoro-methane-sulfonate and -iso-propyl-idene-,2,4,6-tetra-methyl-anilinium tri-fluoro-methane-sulfonate.
Two 2,4,6-tri-methyl-aniline-based trifuloro-methane-sulfonate (tri-fluoro-methane-sulfonate) salts were synthesized and characterized by single-crystal X-ray diffraction. ,2,4,6-Tetra-methyl-anilinium tri-fluoro-methane-sulfonate, [CHNH ][CFOS] (), was synthesized methyl-ation of 2,4,6-tri-methyl-aniline. -Iso-propyl-idene-,2,4,6-tetra-methyl-anilinium tri-fluoro-meth-ane-sulfonate, [CHN][CFOS] (), was synthesized in a two-step reaction where the imine, -iso-propyl-idene-2,4,6-tri-methyl-aniline, was first prepared a dehydration reaction to form the Schiff base, followed by methyl-ation using methyl tri-fluoro-methane-sulfonate to form the iminium ion. In compound , both hydrogen bonding and π-π inter-actions form the main inter-molecular inter-actions. The primary inter-action is a strong N-H⋯O hydrogen bond with the oxygen atoms of the tri-fluoro-methane-sulfonate anions bonded to the hydrogen atoms of the ammonium nitro-gen atom to generate a one-dimensional chain. The [CHNH ] cations form dimers where the benzene rings form a π-π inter-action with a parallel-displaced geometry. The separation distance between the calculated centroids of the benzene rings is 3.9129 (8) Å, and the inter-planar spacing and ring slippage between the dimers are 3.5156 (5) and 1.718 Å, respectively. For , the [CHN] cations also form dimers as in , but with the benzene rings highly slipped. The distance between the calculated centroids of the benzene rings is 4.8937 (8) Å, and inter-planar spacing and ring slippage are 3.3646 (5) and 3.553 Å, respectively. The major inter-molecular inter-actions in are instead a series of weaker C-H⋯O hydrogen bonds [C⋯O distances of 3.1723 (17), 3.3789 (18), and 3.3789 (18) Å], an inter-action virtually absent in the structure of . Fluorine atoms are not involved in strong directional inter-actions in either structure.
PubMed: 38721416
DOI: 10.1107/S2056989024003438 -
Plants (Basel, Switzerland) Oct 2022synthesizes bioactive therapeutic metabolites, known as monoterpenoid indole alkaloids (MIAs), including antineoplastic vinblastine and vincristine, which have high...
Ethyl Methane Sulfonate and Sodium Azide-Mediated Chemical and X-ray-Mediated Physical Mutagenesis Positively Regulate Gene Activity and Biosynthesis of Antineoplastic Vinblastine in .
synthesizes bioactive therapeutic metabolites, known as monoterpenoid indole alkaloids (MIAs), including antineoplastic vinblastine and vincristine, which have high global demand, and antihypertensive ajmalicine, a serpentine. However, the in planta biosynthesis and accumulation of these phytopharmaceuticals are very low, attributed to their high cytotoxicity in the plant. Considering the low in planta concentration and over-harvesting of plant resources, biotechnological interventions have been undertaken to enhance the production of MIAs in plant systems. The present study was carried out to mutation through chemical and physical mutagenesis with sodium azide, ethyl methane sulfonate and X-rays, respectively, on to determine their possible effects on the transcriptional modulation of MIA biosynthetic pathways in planta. The chemical mutagenesis resulted in delayed seed pod development in mutated plants, with distinct leaf morphology and flower color. However, X-ray mutagenesis resulted in pollen-less sterile flowers. An HPLC analysis confirmed the higher catharanthine, vindoline and vinblastine content in sodium azide and X-ray mutants, and was further supported by higher transcript levels estimated through real-time PCR analysis. The transcription factors and were found negatively regulated along with major MIA pathway genes in chemical mutants and their M generation, but showed positive regulation in X-ray M mutants. The induced mutagenesis of provides a prospective strategy to modulate plant transcriptomes and enhance the biosynthesis of pharmaceutically important antineoplastic vinblastine in the plant.
PubMed: 36365340
DOI: 10.3390/plants11212885 -
Acta Crystallographica. Section E,... May 2024The synthesis, crystallization and characterization of a tri-fluoro-methane-sulfonate salt of 5,10,15,20-tetra-kis-(1-benzyl-pyridin-1-ium-4-yl)-21,23-por-phy-rin, CHN...
The synthesis, crystallization and characterization of a tri-fluoro-methane-sulfonate salt of 5,10,15,20-tetra-kis-(1-benzyl-pyridin-1-ium-4-yl)-21,23-por-phy-rin, CHN ·4CFSO ·4HO, ·OTf, are reported in this work. The reaction between 5,10,15,20-tetra-kis-(pyridin-4-yl)-21,23-porphyrin and benzyl bromide in the presence of 0.1 equiv. of Ca(OH) in CHCN under reflux with an N atmosphere and subsequent treatment with silver tri-fluoro-methane-sulfonate (AgOTf) salt produced a red-brown solution. This reaction mixture was filtered and the solvent was allowed to evaporate at room temperature for 3 d to give ·OTf. Crystal structure determination by single-crystal X-ray diffraction (SCXD) revealed that ·OTf crystallizes in the space group 2/. The asymmetric unit contains half a porphyrin mol-ecule, two tri-fluoro-methane-sulfonate anions and two water mol-ecules of crystallization. The macrocycle of tetra-pyrrole moieties is planar and unexpectedly it has coordinated Ca ions in occupational disorder. This Ca ion has only 10% occupancy (CHCaFNOS). The pyridinium rings bonded to methyl-ene groups from porphyrin are located in two different arrangements in almost orthogonal positions between the plane formed by the porphyrin and the pyridinium rings. The crystal structure features cation⋯π inter-actions between the Ca atom and the π-system of the phenyl ring of neighboring mol-ecules. Both tri-fluoro-methane-sulfonate anions are found at the periphery of , forming hydrogen bonds with water mol-ecules.
PubMed: 38845702
DOI: 10.1107/S205698902400447X -
Clinical Pharmacokinetics Jan 2021We aimed to review the pharmacokinetics (PK) of intravenous busulfan in paediatric patients, identify covariate factors influencing exposure, investigate evidence of... (Review)
Review
We aimed to review the pharmacokinetics (PK) of intravenous busulfan in paediatric patients, identify covariate factors influencing exposure, investigate evidence of changes in PK behaviour over time, and correlate exposure with efficacy and toxicity outcomes. A literature review was undertaken of original research published between 2007 and 2019, investigating the PK and pharmacodynamics (PD) of intravenous busulfan in patients ≤ 18 years of age. The review identified 41 publications characterising the PK, and 45 publications describing the PD, of busulfan. Median typical clearance (CL) was 0.22 L/h/kg and median typical volume of distribution was 0.69 L/kg. Patient weight, age, glutathione-S-transferase A1 (GSTA1) genotype and busulfan dosing day/time were the most commonly identified factors affecting CL. Of nine studies investigating changes in CL, seven reported reduced CL over the 4-day course of treatment. Exposure monitoring methods and therapeutic targets were heterogeneous across studies. Relationships between busulfan exposure and patient outcomes were observed in five studies. One study observed a cumulative area under the concentration-time curve over all days of treatment of between 78 and 101 mg/L·h, and two studies observed an average concentration at first dose of < 600 ng/mL improved overall survival, transplant-related mortality, or relapse. One study observed increased sinusoidal obstructive syndrome with maximum busulfan concentration > 1.88 ng/mL. Patient weight, age and GSTA1 genotype are important covariates to consider when individualising busulfan therapy. Reduced busulfan CL over time may need to be accounted for, particularly in patients not receiving phenytoin co-therapy. Standardised monitoring of busulfan exposure over the entire course of treatment and further investigation of the role of busulfan metabolites and pharmacogenomics is warranted.
Topics: Administration, Intravenous; Body Weight; Busulfan; Child; Genotype; Hematopoietic Stem Cell Transplantation; Humans
PubMed: 33128207
DOI: 10.1007/s40262-020-00947-2