1. Effect of metformin on the survival of patients with ALL who express high levels of the ABCB1 drug resistance gene
- Author
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Juan Collazo-Jaloma, Etta Rozen-Fuller, Adolfo Martínez-Tovar, Rafael Cerón-Maldonado, Irma Olarte-Carrillo, Juan Julio Kassack-Ipiña, Guillermo Meléndez-Mier, and Christian Omar Ramos-Peñafiel
- Subjects
0301 basic medicine ,Oncology ,Male ,medicine.medical_treatment ,lcsh:Medicine ,Drug resistance ,Kaplan-Meier Estimate ,0302 clinical medicine ,Leukocytes ,Odds Ratio ,Medicine ,Prospective Studies ,media_common ,education.field_of_study ,Remission Induction ,General Medicine ,Middle Aged ,Precursor Cell Lymphoblastic Leukemia-Lymphoma ,Prognosis ,ATP binding cassette subfamily B member 1 (ABCB1) ,Metformin ,Treatment Outcome ,030220 oncology & carcinogenesis ,Female ,medicine.drug ,Drug ,Adult ,medicine.medical_specialty ,ATP Binding Cassette Transporter, Subfamily B ,Adolescent ,media_common.quotation_subject ,Population ,Acute lymphoblastic leukemia (ALL) ,General Biochemistry, Genetics and Molecular Biology ,Immunophenotyping ,03 medical and health sciences ,Young Adult ,Internal medicine ,Humans ,education ,Survival analysis ,Chemotherapy ,business.industry ,Research ,Gene Expression Profiling ,lcsh:R ,Odds ratio ,Confidence interval ,030104 developmental biology ,Quantitative real-time polymerase chain reaction (qRT-PCR) ,Drug Resistance, Neoplasm ,Neoplasm Recurrence, Local ,business - Abstract
Background In acute lymphoblastic leukemia (ALL), high ABCB1 gene expression has been associated with treatment resistance, which affects patient prognosis. Many preclinical reports and retrospective population studies have shown an anti-cancer effect of metformin. Therefore, the objective of this study was to assess the effect of metformin on the treatment regimen in patients with ALL who exhibited high levels of ABCB1 gene expression and to determine its impact on overall survival. Methods A total of 102 patients with ALL were recruited; one group (n = 26) received metformin, and the other received chemotherapy (n = 76). Measurement of ABCB1 transcript expression was performed using qRT-PCR prior to treatment initiation. Survival analysis was performed using Kaplan–Meier curves. The impact of both the type of treatment and the level of expression on the response (remission or relapse) was analyzed by calculating the odds ratio. Results The survival of patients with high ABCB1 expression was lower than those with low or absent ABCB1 gene expression (p = 0.030). In the individual analysis, we identified a benefit to adding metformin in the group of patients with high ABCB1 gene expression (p = 0.025). In the metformin user group, the drug acted as a protective factor against both therapeutic failure (odds ratio [OR] 0.07, 95% confidence interval [CI] 0.0037–1.53) and early relapse (OR 0.05, 95% CI 0.0028–1.153). Conclusion The combined use of metformin with chemotherapy is effective in patients with elevated levels of ABCB1 gene expression. Trial registration NCT 03118128: NCT
- Published
- 2018