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1 Shinichiro Okamoto MD, PhD Keio University School of Medicine Tokyo Japan

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6 vincristine) Berberidaceae etoposide VP-16)

7 MRD PCR ( CR) ( CR)

8 AML Study n Ind Consol % 3 5yr CALGB 474 DA/HiDACx3 or HiDACx1, E, CTX or diaziquone, M GAMLCG 535 TAD, HAM/TAD HOVON 253 DA, AMSA A/ME ALFA 345 DA MA AMSA A; MEC ALLG 298 ICE ICE or IcEx JALSG 1,057 IA or DA MA, DA, ACR-A, A-triple-V or HiDACx

9

10 / P P PI3K/Akt

11 Mylotarg (gemtuzumab ozogamicin) gemtuzumab ozogamicin internalization CD33 calicheamicin DNA

12 ATP BCR-ABL 9 9 BCR-ABL (q+) Ph (22q-) Effector X Y abl bcr Effector bcr-abl

13 CML Imatinib IRIS Study % CML ASH 2009

14 Affinity of Three TKIs to Abl Imatinib Nilotinib Dasatinib

15 III AP24534 II Dasatinib Nilotinib AP SRC ABL1 ABL1 SRC ABL1 VEGF T315I T315I E255V E255K V V299L F317L E255K V Y253F H Q252H F359V T315I E255V

16

17 AML Farnesyl tranferase FLT3 P CD33 Tipifarnib PKC412 CEP-701 Bortezomib Decitabine Azacytidine Clofarabine Cloretazine Bcl-2 Oblimeresen sodium Zosuquidar GO

18 P15 P21 P15 P21 MAP P15 P210 AKT0 P15 P21 MAP MAP MAP C-KIT RAS ERK ERK PKC ERK IL ERK STAT BCR-ABL

19 ( Ph + ALL N= (3 100 (3 + (N=25 Probability (%) % % % % Including one CR after Salvage Tx + Imatinib P < P < Blood 2005; 105:

20

21

22 JMDP) 600 Nations

23 / Probability % % 37.2% % 57.5% 46.7% 17.5% % % BBMT 14: , 2008, BMT 39; , 2007

24 AML LFS OS % 100 % 100 Leukemia-free survival Transplant group No transplant group Overall survival Transplant group No transplant group P= P= Leukemia 23: , 2009

25 Painting its brighter future

26 GVHD

27 UVAR XTS TM or CELLEX TM Photopheresis Systems

28 Extracorporeal Photopheresis (ECP)

29 A Multicenter Prospective Phase 2 Randomized Study of Extracorporeal Photopheresis for Treatment of Chronic Graft-Versus-Host Disease Median % Change in Steroid Dose By 12W 50% reduction of PSL is achieved in 20.8% ECP group vs 6.4% Control p <0.04 ECP Control Probability of a Response / p < ECP Control W2 W4 W6 W8 W10 W12 Study Week Study Week Blood 2008; 112:

30 ECP Complete and Partial Response Rate % % 65% 12 50% 43% 36% 27% 12% 7% Complete and Partial Response Rate % % 70% 24 50% 50% 47% 42% 29% 26% Original Randomized Non-ECP Cross-over Open-Label ECP Study Original Randomized ECP Crossover Open-Label ECP Study

31

32 Nitch

33 G-CSF CXCR4 CD44 HA SDF- VLA-4 VCAM-1 c-kit KL MMP9 NE+ CG Plerixafor (AMD3100)

34 AMD3100 Washington University School of Medicine MD Anderson Cancer Center Dana Farber Cancer Institute Washington University School of Medicine Multicenter Multicenter Phase II. HLA plerixafor Phase I/II. plerixafor Phase I/II. AML MEC plerixafor Phase I/II. CLL plerixafor Phase I. plerixafor

35 Shh AMD3100 AMD3465 SDF-1 VEGF C CXCR4 FLT4 Notch Cell cycling p27 Kip1 PI3K/Akt & MAPK signaling mtor S6 kinase Bcl-2 expression Sorafeni b Sorafenib FLT3 KIT KL CD44 CD62L VLA-4 Natalizuma b BIO5192 VCAM-1 Osteopontin Fibronectin Collagen Hyaluronin PSGL GMI-1070 Blood 2009; 113:

36 Thank you for your attention!!

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告では DNR も IDR もさらに高い CR 率 (75~80% vs 79~82%) と DFS 率 (25~44% vs 26~30%) が報告されており meta-analysis の報告と異なって両者間に差を認めていない これは 欧米での DNR の総投与量が 135~150mg/m 2

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