Skip to main content

Mylotarg: Revisiting Its Clinical Potential Post-Withdrawal

  • Chapter
  • First Online:
Antibody-Drug Conjugates

Part of the book series: AAPS Advances in the Pharmaceutical Sciences Series ((AAPS,volume 17))

Abstract

Mylotarg® (gemtuzumab ozogamicin (GO)) was the first antibody–drug conjugate approved for the treatment of acute myeloid leukemia (AML) by the Food and Drug Administration (FDA) via the accelerated approval process in 2000. Mylotarg® consists of an antibody directed toward the CD33 antigen conjugated to the antitumor antibiotic, calicheamicin. Mainly due to concerns about the safety profile and lack of improvement of clinical benefit in post-approval clinical trials, the drug was voluntarily withdrawn by the market by Pfizer in June 2010. Since its withdrawal from the market, results from several clinical trials warrant revisiting the clinical use of the drug when used at a low-dose range in newly diagnosed AML with favorable cytogenetics.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Amadori S, Suciu S, Stasi R, Salih HR, Selleslag D, Muus P, De Fabritiis P, Venditti A, Ho AD, Lubbert M, Thomas X, Latagliata R, Halkes CJ, Falzetti F, Magro D, Guimaraes JE, Berneman Z, Specchia G, Karrasch M, Fazi P, Vignetti M, Willemze R, de Witte T, Marie JP (2013) Sequential combination of gemtuzumab ozogamicin and standard chemotherapy in older patients with newly diagnosed acute myeloid leukemia: results of a randomized phase III trial by the EORTC and GIMEMA consortium (AML-17). J Clin Oncol 31(35):4424–4430. doi:10.1200/JCO.2013.49.0771

    Article  CAS  PubMed  Google Scholar 

  • Andrews RG, Singer JW, Bernstein ID (1989) Precursors of colony-forming cells in humans can be distinguished from colony-forming cells by expression of the CD33 and CD34 antigens and light scatter properties. J Exp Med 169(5):1721–1731

    Article  CAS  PubMed  Google Scholar 

  • Aplenc R, Alonzo TA, Sung L, Meshinchi S, Gerbing RB, Raimondi SC, Hirsch B, Kahwash S, Heerema-McKenney A, Winter L, Glick K, Ccrp, Davies SM, Byron P, Smith FO (2013) Gemtuzumab Ozogamicin (GO) In Children With De Novo Acute Myeloid Leukemia (AML) Improves Event-Free Survival (EFS) By Reducing Relapse Risk—Results From The Randomized Phase III Children's Oncology Group (COG) Trial, AAML0531. Blood 122(21):355–355

    Google Scholar 

  • Audran R, Drenou B, Wittke F, Gaudin A, Lesimple T, Toujas L (1995) Internalization of human macrophage surface antigens induced by monoclonal antibodies. J Immunol Methods 188(1):147–154

    Article  CAS  PubMed  Google Scholar 

  • Breccia M, Cimino G, Diverio D, Gentilini F, Mandelli F, Lo Coco F (2007) Sustained molecular remission after low dose gemtuzumab-ozogamicin in elderly patients with advanced acute promyelocytic leukemia. Haematologica 92(9):1273–1274

    Article  CAS  PubMed  Google Scholar 

  • Bross PF, Beitz J, Chen G, Chen XH, Duffy E, Kieffer L, Roy S, Sridhara R, Rahman A, Williams G, Pazdur R (2001) Approval summary: gemtuzumab ozogamicin in relapsed acute myeloid leukemia. Clin Cancer Res 7(6):1490–1496

    CAS  PubMed  Google Scholar 

  • Burnett AK, Hills RK, Milligan D, Kjeldsen L, Kell J, Russell NH, Yin JA, Hunter A, Goldstone AH, Wheatley K (2011) Identification of patients with acute myeloblastic leukemia who benefit from the addition of gemtuzumab ozogamicin: results of the MRC AML15 trial. J Clin Oncol 29(4):369–377. doi:10.1200/JCO.2010.31.4310

    Article  CAS  PubMed  Google Scholar 

  • Burnett AK, Kell WJ, Hills RK, Russell NH, Yin J, Hunter A, Culligan D (2006) The feasibility of combining daunorubicin, clofarabine and gemtuzumab ozogamicin is feasible and effective. A Pilot Study. In: Blood, ASH Annual Meeting. vol Abstract 1950

    Google Scholar 

  • Burnett AK, Russell NH, Hills RK, Kell J, Freeman S, Kjeldsen L, Hunter AE, Yin J, Craddock CF, Dufva IH, Wheatley K, Milligan D (2012) Addition of gemtuzumab ozogamicin to induction chemotherapy improves survival in older patients with acute myeloid leukemia. J Clin Oncol 30(32):3924–3931. doi:10.1200/JCO.2012.42.2964

    Article  CAS  PubMed  Google Scholar 

  • Caron PC, Co MS, Bull MK, Avdalovic NM, Queen C, Scheinberg DA (1992) Biological and immunological features of humanized M195 (anti-CD33) monoclonal antibodies. Cancer Res 52(24):6761–6767

    CAS  PubMed  Google Scholar 

  • Caron PC, Jurcic JG, Scott AM, Finn RD, Divgi CR, Graham MC, Jureidini IM, Sgouros G, Tyson D, Old LJ et al (1994) A phase 1B trial of humanized monoclonal antibody M195 (anti-CD33) in myeloid leukemia: specific targeting without immunogenicity. Blood 83(7):1760–1768

    CAS  PubMed  Google Scholar 

  • Casasnovas RO, Meignan M, Berriolo-Riedinger A, Bardet S, Julian A, Thieblemont C, Vera P, Bologna S, Briere J, Jais JP, Haioun C, Coiffier B, Morschhauser F, Groupe d’etude des lymphomes de la (2011) SUVmax reduction improves early prognosis value of interim positron emission tomography scans in diffuse large B-cell lymphoma. Blood 118(1):37–43. doi:10.1182/blood-2010-12-327767

    Article  CAS  PubMed  Google Scholar 

  • Cowan AJ, Laszlo GS, Estey EH, Walter RB (2013) Antibody-based therapy of acute myeloid leukemia with gemtuzumab ozogamicin. Frontiers in Bioscience 18:1311–1334

    Article  CAS  Google Scholar 

  • Dinndorf PA, Andrews RG, Benjamin D, Ridgway D, Wolff L, Bernstein ID (1986) Expression of normal myeloid-associated antigens by acute leukemia cells. Blood 67(4):1048–1053

    CAS  PubMed  Google Scholar 

  • Fernandez HF, Sun Z, Litzow MR, Luger SM, Paietta EM, Racevskis J, Dewald G, Ketterling RP, Rowe JM, Lazarus HM, Tallman MS (2011) Autologous transplantation gives encouraging results for young adults with favorable-risk acute myeloid leukemia, but is not improved with gemtuzumab ozogamicin. Blood 117(20):5306–5313. doi:10.1182/blood-2010-09-309229

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Griffin JD, Linch D, Sabbath K, Larcom P, Schlossman SF (1984) A monoclonal antibody reactive with normal and leukemic human myeloid progenitor cells. Leukemia Res 8(4):521–534

    Article  CAS  Google Scholar 

  • Hamann PR, Hinman LM, Beyer CF, Lindh D, Upeslacis J, Flowers DA, Bernstein I (2002) An anti-CD33 antibody-calicheamicin conjugate for treatment of acute myeloid leukemia. Choice of linker. Bioconjugate Chem 13(1):40–46

    Article  CAS  Google Scholar 

  • Janeway C, Travers P, Walport M, Shlomchik M (2001) Immunobiology. The immune system in health and disease. Garland Science, New York

    Google Scholar 

  • Jilani I, Estey E, Huh Y, Joe Y, Manshouri T, Yared M, Giles F, Kantarjian H, Cortes J, Thomas D, Keating M, Freireich E, Albitar M (2002) Differences in CD33 intensity between various myeloid neoplasms. Am J Clin Pathol 118(4):560–566. doi:10.1309/1WMW-CMXX-4WN4-T55U

    Article  PubMed  Google Scholar 

  • Kirby T (2012) Louisa Degenhardt: hooked on addiction research. Lancet 379(9810):21. doi:10.1016/S0140-6736(12)60010–5

    Article  PubMed  Google Scholar 

  • Linenberger ML (2005) CD33-directed therapy with gemtuzumab ozogamicin in acute myeloid leukemia: progress in understanding cytotoxicity and potential mechanisms of drug resistance. Leukemia 19(2):176–182. doi:10.1038/sj.leu.2403598

    Article  CAS  PubMed  Google Scholar 

  • Lo-Coco F, Cimino G, Breccia M, Noguera NI, Diverio D, Finolezzi E, Pogliani EM, Di Bona E, Micalizzi C, Kropp M, Venditti A, Tafuri A, Mandelli F (2004) Gemtuzumab ozogamicin (Mylotarg) as a single agent for molecularly relapsed acute promyelocytic leukemia. Blood 104(7):1995–1999. doi:10.1182/blood-2004-04-1550

    Article  CAS  PubMed  Google Scholar 

  • Lowenberg B, Beck J, Graux C, van Putten W, Schouten HC, Verdonck LF, Ferrant A, Sonneveld P, Jongen-Lavrencic M, von Lilienfeld-Toal M, Biemond BJ, Vellenga E, Breems D, de Muijnck H, Schaafsma R, Verhoef G, Dohner H, Gratwohl A, Pabst T, Ossenkoppele GJ, Maertens J, Dutch-Belgian Hemato-Oncology Cooperative G, German Austrian AMLSG, Swiss Group for Clinical Cancer Research Collaborative G (2010) Gemtuzumab ozogamicin as postremission treatment in AML at 60 years of age or more: results of a multicenter phase 3 study. Blood 115(13):2586–2591. doi:10.1182/blood-2009-10-246470

    Article  PubMed  Google Scholar 

  • Naito K, Takeshita A, Shigeno K, Nakamura S, Fujisawa S, Shinjo K, Yoshida H, Ohnishi K, Mori M, Terakawa S, Ohno R (2000) Calicheamicin-conjugated humanized anti-CD33 monoclonal antibody (gemtuzumab zogamicin, CMA –676) shows cytocidal effect on CD33-positive leukemia cell lines, but is inactive on P-glycoprotein-expressing sublines. Leukemia 14(8):1436–1443

    Article  CAS  PubMed  Google Scholar 

  • Paul SP, Taylor LS, Stansbury EK, McVicar DW (2000) Myeloid specific human CD33 is an inhibitory receptor with differential ITIM function in recruiting the phosphatases SHP-1 and SHP-2. Blood 96(2):483–490

    CAS  PubMed  Google Scholar 

  • Peiper SC, Ashmun RA, Look AT (1988) Molecular cloning, expression, and chromosomal localization of a human gene encoding the CD33 myeloid differentiation antigen. Blood 72(1):314–321

    CAS  PubMed  Google Scholar 

  • Petersdorf SH, Kopecky KJ, Slovak M, Willman C, Nevill T, Brandwein J, Larson RA, Erba HP, Stiff PJ, Stuart RK, Walter RB, Tallman MS, Stenke L, Appelbaum FR (2013) A phase 3 study of gemtuzumab ozogamicin during induction and postconsolidation therapy in younger patients with acute myeloid leukemia. Blood 121(24):4854–4860. doi:10.1182/blood-2013-01-466706

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Press OW, Shan D, Howell-Clark J, Eary J, Appelbaum FR, Matthews D, King DJ, Haines AM, Hamann P, Hinman L, Shochat D, Bernstein ID (1996) Comparative metabolism and retention of iodine-125, yttrium-90, and indium-111 radioimmunoconjugates by cancer cells. Cancer Res 56(9):2123–2129

    CAS  PubMed  Google Scholar 

  • Ravandi F, Estey E, Jones D, Faderl S, O'Brien S, Fiorentino J, Pierce S, Blamble D, Estrov Z, Wierda W, Ferrajoli A, Verstovsek S, Garcia-Manero G, Cortes J, Kantarjian H (2009) Effective treatment of acute promyelocytic leukemia with all-trans-retinoic acid, arsenic trioxide, and gemtuzumab ozogamicin. J Clin Oncol 27(4):504–510. doi:10.1200/JCO.2008.18.6130

    Article  CAS  PubMed  Google Scholar 

  • Renneville A, Abdelali RB, Chevret S, Nibourel O, Cheok M, Pautas C, Dulery R, Boyer T, Cayuela JM, Hayette S, Raffoux E, Farhat H, Boissel N, Terre C, Dombret H, Castaigne S, Preudhomme C (2014) Clinical impact of gene mutations and lesions detected by SNP-array karyotyping in acute myeloid leukemia patients in the context of gemtuzumab ozogamicin treatment: results of the ALFA-0701 trial. Oncotarget 5(4):916–932

    PubMed Central  PubMed  Google Scholar 

  • Ricart AD (2011) Antibody-drug conjugates of calicheamicin derivative: gemtuzumab ozogamicin and inotuzumab ozogamicin. Clin Cancer Res 17(20):6417–6427. doi:10.1158/1078-0432.CCR-11-0486

    Article  CAS  PubMed  Google Scholar 

  • Robertson MJ, Soiffer RJ, Freedman AS, Rabinowe SL, Anderson KC, Ervin TJ, Murray C, Dear K, Griffin JD, Nadler LM et al (1992) Human bone marrow depleted of CD33-positive cells mediates delayed but durable reconstitution of hematopoiesis: clinical trial of MY9 monoclonal antibody-purged autografts for the treatment of acute myeloid leukemia. Blood 79(9):2229–2236

    CAS  PubMed  Google Scholar 

  • Scheinberg DA, Tanimoto M, McKenzie S, Strife A, Old LJ, Clarkson BD (1989) Monoclonal antibody M195: a diagnostic marker for acute myelogenous leukemia. Leukemia 3(6):440–445

    CAS  PubMed  Google Scholar 

  • Sievers EL (2003) Antibody-targeted chemotherapy of acute myeloid leukemia using gemtuzumab ozogamicin (Mylotarg). Blood cells Mol Dis 31(1):7–10

    Article  CAS  PubMed  Google Scholar 

  • Sievers EL, Appelbaum FR, Spielberger RT, Forman SJ, Flowers D, Smith FO, Shannon-Dorcy K, Berger MS, Bernstein ID (1999) Selective ablation of acute myeloid leukemia using antibody-targeted chemotherapy: a phase I study of an anti-CD33 calicheamicin immunoconjugate. Blood 93(11):3678–3684

    CAS  PubMed  Google Scholar 

  • Sievers EL, Larson RA, Stadtmauer EA, Estey E, Lowenberg B, Dombret H, Karanes C, Theobald M, Bennett JM, Sherman ML, Berger MS, Eten CB, Loken MR, van Dongen JJ, Bernstein ID, Appelbaum FR, Mylotarg Study G (2001) Efficacy and safety of gemtuzumab ozogamicin in patients with CD33-positive acute myeloid leukemia in first relapse. J Clin Oncol 19(13):3244–3254

    CAS  PubMed  Google Scholar 

  • Tanimoto T, Tsubokura M, Mori J, Pietrek M, Ono S, Kami M (2013) Differences in drug approval processes of 3 regulatory agencies: a case study of gemtuzumab ozogamicin. Investigational New Drugs 31(2):473–478. doi:10.1007/s10637-012-9877-8

    Article  PubMed  Google Scholar 

  • van der Jagt RH, Badger CC, Appelbaum FR, Press OW, Matthews DC, Eary JF, Krohn KA, Bernstein ID (1992) Localization of radiolabeled antimyeloid antibodies in a human acute leukemia xenograft tumor model. Cancer Res 52(1):89–94

    CAS  PubMed  Google Scholar 

  • van Der Velden VH, te Marvelde JG, Hoogeveen PG, Bernstein ID, Houtsmuller AB, Berger MS, van Dongen JJ (2001) Targeting of the CD33-calicheamicin immunoconjugate Mylotarg (CMA-676) in acute myeloid leukemia: in vivo and in vitro saturation and internalization by leukemic and normal myeloid cells. Blood 97(10):3197–3204

    Article  CAS  PubMed  Google Scholar 

  • Walter RB, Appelbaum FR, Estey EH, Bernstein ID (2012) Acute myeloid leukemia stem cells and CD33-targeted immunotherapy. Blood 119(26):6198–6208. doi:10.1182/blood-2011-11-325050

    Article  PubMed Central  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jennica L. Zaro .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 American Association of Pharmaceutical Scientists

About this chapter

Cite this chapter

Zaro, J. (2015). Mylotarg: Revisiting Its Clinical Potential Post-Withdrawal. In: Wang, J., Shen, WC., Zaro, J. (eds) Antibody-Drug Conjugates. AAPS Advances in the Pharmaceutical Sciences Series, vol 17. Springer, Cham. https://doi.org/10.1007/978-3-319-13081-1_10

Download citation

Publish with us

Policies and ethics