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Fandrei D, Huynh T, Sébert M, Aguinaga L, Bisio V, Kim R, Clappier E, Espéli M, Balabanian K, Moins-Teisserenc H, Toubert A, Dulphy N, Fenaux P, Adès L, Zhao LP. Lymphopenia confers poorer prognosis in Myelodysplastic Syndromes with very low and low IPSS-M. Blood Cancer J 2023; 13:193. [PMID: 38123548 PMCID: PMC10733334 DOI: 10.1038/s41408-023-00965-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/22/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023] Open
Affiliation(s)
- David Fandrei
- Université Paris Cité, Assistance Publique des Hôpitaux de Paris (APHP) Nord, Hôpital Saint-Louis, Hématologie Seniors, Paris, France
- Université Paris Cité, INSERM UMR 1160, Institut de Recherche Saint-Louis, Paris, France
| | - Tony Huynh
- Université Paris Cité, Assistance Publique des Hôpitaux de Paris (APHP) Nord, Hôpital Saint-Louis, Hématologie Seniors, Paris, France
| | - Marie Sébert
- Université Paris Cité, Assistance Publique des Hôpitaux de Paris (APHP) Nord, Hôpital Saint-Louis, Hématologie Seniors, Paris, France
- Université Paris Cité, INSERM UMR 944, Institut de Recherche Saint-Louis, Paris, France
| | - Lorea Aguinaga
- Université Paris Cité, Assistance Publique des Hôpitaux de Paris (APHP) Nord, Hôpital Saint-Louis, Hématologie Seniors, Paris, France
| | - Valeria Bisio
- Université Paris Cité, INSERM UMR 1160, Institut de Recherche Saint-Louis, Paris, France
| | - Rathana Kim
- Université Paris Cité, Assistance Publique des Hôpitaux de Paris (APHP) Nord, Hôpital Saint-Louis, Laboratoire d'Hématologie, Paris, France
| | - Emmanuelle Clappier
- Université Paris Cité, Assistance Publique des Hôpitaux de Paris (APHP) Nord, Hôpital Saint-Louis, Laboratoire d'Hématologie, Paris, France
| | - Marion Espéli
- Université Paris Cité, INSERM UMR 1160, Institut de Recherche Saint-Louis, Paris, France
| | - Karl Balabanian
- Université Paris Cité, INSERM UMR 1160, Institut de Recherche Saint-Louis, Paris, France
| | | | - Antoine Toubert
- Université Paris Cité, INSERM UMR 1160, Institut de Recherche Saint-Louis, Paris, France
- Université Paris Cité, Assistance Publique des Hôpitaux de Paris (APHP) Nord, Hôpital Saint-Louis, Laboratoire d'Immunologie et Histocompatibilité, Paris, France
| | - Nicolas Dulphy
- Université Paris Cité, INSERM UMR 1160, Institut de Recherche Saint-Louis, Paris, France
- Université Paris Cité, Assistance Publique des Hôpitaux de Paris (APHP) Nord, Hôpital Saint-Louis, Laboratoire d'Immunologie et Histocompatibilité, Paris, France
| | - Pierre Fenaux
- Université Paris Cité, Assistance Publique des Hôpitaux de Paris (APHP) Nord, Hôpital Saint-Louis, Hématologie Seniors, Paris, France
- Université Paris Cité, INSERM UMR 944, Institut de Recherche Saint-Louis, Paris, France
| | - Lionel Adès
- Université Paris Cité, Assistance Publique des Hôpitaux de Paris (APHP) Nord, Hôpital Saint-Louis, Hématologie Seniors, Paris, France
- Université Paris Cité, INSERM UMR 944, Institut de Recherche Saint-Louis, Paris, France
| | - Lin-Pierre Zhao
- Université Paris Cité, Assistance Publique des Hôpitaux de Paris (APHP) Nord, Hôpital Saint-Louis, Hématologie Seniors, Paris, France.
- Université Paris Cité, INSERM UMR 1160, Institut de Recherche Saint-Louis, Paris, France.
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Cytogenetic and Genetic Abnormalities with Diagnostic Value in Myelodysplastic Syndromes (MDS): Focus on the Pre-Messenger RNA Splicing Process. Diagnostics (Basel) 2022; 12:diagnostics12071658. [PMID: 35885562 PMCID: PMC9320363 DOI: 10.3390/diagnostics12071658] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 12/19/2022] Open
Abstract
Myelodysplastic syndromes (MDS) are considered to be diseases associated with splicing defects. A large number of genes involved in the pre-messenger RNA splicing process are mutated in MDS. Deletion of 5q and 7q are of diagnostic value, and those chromosome regions bear the numbers of splicing genes potentially deleted in del(5q) and del(7q)/-7 MDS. In this review, we present the splicing genes already known or suspected to be implicated in MDS pathogenesis. First, we focus on the splicing genes located on chromosome 5 (HNRNPA0, RBM27, RBM22, SLU7, DDX41), chromosome 7 (LUC7L2), and on the SF3B1 gene since both chromosome aberrations and the SF3B1 mutation are the only genetic abnormalities in splicing genes with clear diagnostic values. Then, we present and discuss other splicing genes that are showing a prognostic interest (SRSF2, U2AF1, ZRSR2, U2AF2, and PRPF8). Finally, we discuss the haploinsufficiency of splicing genes, especially from chromosomes 5 and 7, the important amplifier process of splicing defects, and the cumulative and synergistic effect of splicing genes defects in the MDS pathogenesis. At the time, when many authors suggest including the sequencing of some splicing genes to improve the diagnosis and the prognosis of MDS, a better understanding of these cooperative defects is needed.
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Mangaonkar AA, Farrukh F, Reichard KK, Ketterling RP, Gangat N, Al‐Kali A, Begna K, Pardanani A, Patnaik MM, Tefferi A. Lymphocytopenia predicts shortened survival in myelodysplastic syndrome with ring sideroblasts (MDS-RS) but not in MDS/MPN-RS-T. Am J Hematol 2022; 97:E109-E112. [PMID: 34961962 DOI: 10.1002/ajh.26448] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/17/2021] [Indexed: 12/26/2022]
Affiliation(s)
| | - Faiqa Farrukh
- Division of Hematology, Department of Medicine Mayo Clinic Rochester Minnesota USA
| | - Kaaren K. Reichard
- Department of Laboratory Medicine and Pathology Mayo Clinic Rochester Minnesota USA
| | - Rhett P. Ketterling
- Department of Laboratory Medicine and Pathology Mayo Clinic Rochester Minnesota USA
| | - Naseema Gangat
- Division of Hematology, Department of Medicine Mayo Clinic Rochester Minnesota USA
| | - Aref Al‐Kali
- Division of Hematology, Department of Medicine Mayo Clinic Rochester Minnesota USA
| | - Kebede Begna
- Division of Hematology, Department of Medicine Mayo Clinic Rochester Minnesota USA
| | - Animesh Pardanani
- Division of Hematology, Department of Medicine Mayo Clinic Rochester Minnesota USA
| | - Mrinal M. Patnaik
- Division of Hematology, Department of Medicine Mayo Clinic Rochester Minnesota USA
| | - Ayalew Tefferi
- Division of Hematology, Department of Medicine Mayo Clinic Rochester Minnesota USA
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Venugopal S, Mascarenhas J, Steensma DP. Loss of 5q in myeloid malignancies - A gain in understanding of biological and clinical consequences. Blood Rev 2020; 46:100735. [PMID: 32736878 DOI: 10.1016/j.blre.2020.100735] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/22/2020] [Accepted: 06/25/2020] [Indexed: 02/07/2023]
Abstract
Hemizygous interstitial or terminal deletion of the long arm of chromosome 5 [del(5q)] is a recurrent cytogenetic abnormality in myeloid malignancies, including myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML). These deletions cause loss of a large contiguous chromosomal region encompassing more than 30 genes, which results in disease through haploinsufficiency of one or more genes including RPS14. In MDS, del(5q) in isolation is a lower-risk cytogenetic anomaly and is sometimes associated with a unique clinicopathological phenotype, but in AML it represents a higher-risk lesion, often denoting secondary AML arising from prior MDS. Lenalidomide effectively targets the del(5q)-bearing clone in MDS, resulting in sustained erythroid transfusion independence in most patients and cytogenetic remission in a subset of treated patients. Since the initial regulatory approval of lenalidomide for del(5q) MDS in 2005, translational research endeavors in del(5q)-associated myeloid malignancies have improved our understanding of how allelic haploinsufficiency underlies both the hematological phenotype and selective sensitivity to lenalidomide therapy. This review will focus on the molecular pathogenesis of del(5q) in myeloid malignancies, clinical development of lenalidomide and emerging data on lenalidomide-refractory del (5q) MDS, and possible novel targeted therapeutic strategies.
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Affiliation(s)
- Sangeetha Venugopal
- Tisch Cancer Institute, Division of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - John Mascarenhas
- Tisch Cancer Institute, Division of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - David P Steensma
- Division of Hematological Malignancies, Department of Medical Oncology, Dana-Farber Cancer Institute; Harvard Medical School, Boston, MA, USA.
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5
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Shi ZX, Qin TJ, Xu ZF, Huang HJ, Li B, Qu SQ, Hu NB, Pan LJ, Liu D, Cai YN, Zhang YD, Xiao ZJ. [Mean corpuscular volume ≤100 fl was an independent prognostic factor in patients with myelodysplastic syndrome and bone marrow blast<5 percent]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2020; 41:28-33. [PMID: 32023751 PMCID: PMC7357904 DOI: 10.3760/cma.j.issn.0253-2727.2020.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Indexed: 11/05/2022]
Abstract
Objective: To explore the prognostic effects of mean corpuscular volume (MCV) in patients with myelodysplastic syndromes (MDS) . Methods: 321 newly diagnosed, untransfused primary MDS patients who administered from December 2009 to December 2017 were enrolled. The association of MCV with prognosis and several clinical features and genetic mutations were analyzed. Results: Patients were divided into MCV≤100 fl (n=148) and MCV>100 fl (n=173) cohorts. Median overall survival of patients with MCV≤100 fl was shorter than their counterparts (27 months vs 72 months, P<0.001) . In subgroup analysis, MCV≤100 fl patients had worse survivals in bone marrow blast <5% cohort (34 months vs not reached, P=0.002) , but not so in ≥5 % cohort (17 months vs 20 months, P=0.078) . MCV≤100 fl was still an independent adverse variable (HR=1.890, 95%CI 1.007-3.548, P=0.048) after adjusting for clinical and laboratory variables and mutation topography in bone marrow blasts<5% cohort. In bone marrow blasts<5% cohort, patients with MCV≤100 fl had higher hemoglobin levels [90 (42-153) g/L vs 78.5 (28-146) g/L, P=0.015].The proportions of Revised International Prognostic Scoring System (IPSS-R) high/very high risks and poor/very poor IPSS-R karyotypes were higher in MCV≤100 fl cohort (28.8% vs 10.8%, P=0.003; 24.7% vs 12.9%, P=0.049) . MCV≤100 fl cohort had more genetic mutations than those with MCV>100 fl though without significance (0.988 vs 0.769, P=0.064) . Mutated SF3B1 was less frequently in MCV≤100 fl cohort (4.7% vs 15.4%, P=0.018) . Conclusion: MCV≤100 fl was an independent adverse variable after adjusting for clinical and laboratory variables and mutation topography in MDS patients with bone marrow blasts<5%.
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Affiliation(s)
- Z X Shi
- Institute of Hematology and Blood Diseases Hospital, CAMS & PUMC, the State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Tianjin 300020, China
| | - T J Qin
- Institute of Hematology and Blood Diseases Hospital, CAMS & PUMC, the State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Tianjin 300020, China
| | - Z F Xu
- Institute of Hematology and Blood Diseases Hospital, CAMS & PUMC, the State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Tianjin 300020, China
| | - H J Huang
- Institute of Hematology and Blood Diseases Hospital, CAMS & PUMC, the State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Tianjin 300020, China
| | - B Li
- Institute of Hematology and Blood Diseases Hospital, CAMS & PUMC, the State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Tianjin 300020, China
| | - S Q Qu
- Institute of Hematology and Blood Diseases Hospital, CAMS & PUMC, the State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Tianjin 300020, China
| | - N B Hu
- Institute of Hematology and Blood Diseases Hospital, CAMS & PUMC, the State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Tianjin 300020, China
| | - L J Pan
- Institute of Hematology and Blood Diseases Hospital, CAMS & PUMC, the State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Tianjin 300020, China
| | - D Liu
- Institute of Hematology and Blood Diseases Hospital, CAMS & PUMC, the State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Tianjin 300020, China
| | - Y N Cai
- Institute of Hematology and Blood Diseases Hospital, CAMS & PUMC, the State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Tianjin 300020, China
| | - Y D Zhang
- Institute of Hematology and Blood Diseases Hospital, CAMS & PUMC, the State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Tianjin 300020, China
| | - Z J Xiao
- Institute of Hematology and Blood Diseases Hospital, CAMS & PUMC, the State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Tianjin 300020, China
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Silzle T, Blum S, Schuler E, Kaivers J, Rudelius M, Hildebrandt B, Gattermann N, Haas R, Germing U. Lymphopenia at diagnosis is highly prevalent in myelodysplastic syndromes and has an independent negative prognostic value in IPSS-R-low-risk patients. Blood Cancer J 2019; 9:63. [PMID: 31399557 PMCID: PMC6689049 DOI: 10.1038/s41408-019-0223-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/05/2019] [Accepted: 06/18/2019] [Indexed: 02/01/2023] Open
Abstract
Lymphopenia is associated with an increased mortality in several medical conditions. Its prognostic impact in myelodysplastic syndromes (MDS) is less well studied. Hence, we analyzed 1023 patients from the Düsseldorf MDS-registry with regard to the absolute lymphocyte count (ALC) at diagnosis. An ALC below the median of the population (1.2 × 109/l) was associated with lower counts of neutrophils (median 1.35 vs. 1.92 × 109/l, p < 0.001) and platelets (median 100 vs. 138 × 109/l, p < 0.001) and with a significant lower overall survival in univariate analysis (whole cohort: median 36 vs. 46 months, p = 0.016; 721 patients without hematopoietic stem cell transplantation or induction chemotherapy: median 36 vs. 56 months, p = 0.001). For low-risk MDS according to IPSS-R, an ALC < 1.2 × 109/l was of additional prognostic value in a multivariate Cox regression model together with age (< or ≥65 years) and LDH (< or ≥normal value of 240 U/l; HR 1.46, 95% CI: 1.03-2.08, p = 0.033). These data support the hypothesis of subtle but clinical relevant changes of the adaptive immune system in MDS. Further studies are necessary to identify the ALC cut-off best suitable for prognostication and the mechanisms responsible for the impairment of lymphoid homeostasis in MDS.
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Affiliation(s)
- Tobias Silzle
- Department of Medical Oncology and Hematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Sabine Blum
- Service and Central Laboratory of Hematology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Esther Schuler
- Department of Hematology, Oncology, and Clinical Immunology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Jennifer Kaivers
- Department of Hematology, Oncology, and Clinical Immunology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Martina Rudelius
- Institute of Pathology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Barbara Hildebrandt
- Department of Human Genetics, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Norbert Gattermann
- Department of Hematology, Oncology, and Clinical Immunology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Rainer Haas
- Department of Hematology, Oncology, and Clinical Immunology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Ulrich Germing
- Department of Hematology, Oncology, and Clinical Immunology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
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7
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Saeed L, Patnaik MM, Begna KH, Al-Kali A, Litzow MR, Hanson CA, Ketterling RP, Porrata LF, Pardanani A, Gangat N, Tefferi A. Prognostic relevance of lymphocytopenia, monocytopenia and lymphocyte-to-monocyte ratio in primary myelodysplastic syndromes: a single center experience in 889 patients. Blood Cancer J 2017; 7:e550. [PMID: 28362440 PMCID: PMC5380913 DOI: 10.1038/bcj.2017.30] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 03/02/2017] [Indexed: 11/09/2022] Open
Abstract
Current prognostic models for myelodysplastic syndromes (MDS), including the Revised International Prognostic Scoring System (IPSS-R), do not account for host immunity. We retrospectively examined the prognostic relevance of monocytopenia, lymphocytopenia and lymphocyte-to-monocyte ratio (LMR) in a cohort of 889 patients with primary MDS. After a median follow-up of 27 months, 712 (80%) deaths and 116 (13%) leukemic transformation were documented. In univariate analysis, subnormal absolute lymphocyte count (ALC) <0.9 × 109/l; P=0.001), ALC<1.2 × 109/l (P=0.0002), subnormal absolute monocyte count (AMC) <0.3 × 109/l (P=0.0003), LMR (P⩽0.0001) and LMR⩾5 (P=0.03) were all associated with inferior overall survival. In multivariable analysis that included other risk factors, significance was retained for LMR (P=0.02) and became borderline for ALC <1.2 × 109/l (P=0.06). Analysis in the context of IPSS-R resulted in P-values of 0.06 for ALC<1.2 × 109/l, 0.7 for monocytopenia and 0.2 for LMR. Leukemia-free survival was not affected by ALC, AMC or LMR. The observations from the current study suggest a possible detrimental role for altered host immunity in primary MDS, which might partly explain the therapeutic benefit of immune-directed therapy, including the use of immune modulators; however, IPSS-R-independent prognostic value for either ALC or AMC was limited.
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Affiliation(s)
- L Saeed
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M M Patnaik
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - K H Begna
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - A Al-Kali
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M R Litzow
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - C A Hanson
- Department of Laboratory Medicine, Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - R P Ketterling
- Department of Laboratory Medicine, Division of Cytogenetics, Mayo Clinic, Rochester, MN, USA
| | - L F Porrata
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - A Pardanani
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - N Gangat
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - A Tefferi
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
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8
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Geyer JT, Verma S, Mathew S, Wang YL, Racchumi J, Espinal-Witter R, Subramaniyam S, Knowles DM, Orazi A. Bone marrow morphology predicts additional chromosomal abnormalities in patients with myelodysplastic syndrome with del(5q). Hum Pathol 2012; 44:346-56. [PMID: 22995330 DOI: 10.1016/j.humpath.2012.05.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 05/25/2012] [Accepted: 05/30/2012] [Indexed: 12/14/2022]
Abstract
The current World Health Organization classification considers myelodysplastic syndrome with isolated del(5q) a distinct entity owing to its characteristic clinical and pathologic features. Recently, several studies have examined survival, leukemic transformation, and various prognostic factors in these patients. However, there is a lack of detailed comparative pathologic analysis of myelodysplastic syndrome cases in which del(5q) is present in association with additional cytogenetic abnormalities. We studied 26 cases of myelodysplastic syndrome at initial diagnosis with 5q- alone, 5q- plus 1 additional abnormality, and 5q- as part of a complex karyotype. Four of 17 patients had evidence of JAK2 V617F mutation. In contrast to cases of myelodysplastic syndrome with isolated 5q-, patients with additional abnormalities had normal mean corpuscular volume and decreased platelet counts (P < .001). Based on bone marrow examination, they were significantly more likely to have increased cellularity, trilineage dysplasia, lower proportion of small hypolobated megakaryocytes, higher number of blasts, and fibrosis. The presence of these morphologic features can be used to distinguish these more aggressive cases from those with myelodysplastic syndrome with isolated 5q- and a more benign clinical course.
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Affiliation(s)
- Julia Turbiner Geyer
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY 10065, USA.
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9
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Douet-Guilbert N, De Braekeleer E, Basinko A, Herry A, Gueganic N, Bovo C, Trillet K, Dos Santos A, Le Bris MJ, Morel F, Eveillard JR, Berthou C, De Braekeleer M. Molecular characterization of deletions of the long arm of chromosome 5 (del(5q)) in 94 MDS/AML patients. Leukemia 2012; 26:1695-7. [PMID: 22290067 DOI: 10.1038/leu.2012.9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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10
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Patnaik MM, Lasho TL, Finke CM, Knudson RA, Ketterling RP, Chen D, Hoyer JD, Hanson CA, Tefferi A. Isolated del(5q) in myeloid malignancies: clinicopathologic and molecular features in 143 consecutive patients. Am J Hematol 2011; 86:393-8. [PMID: 21523797 DOI: 10.1002/ajh.21984] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
World Health Organization (WHO) criteria were used to identify 143 consecutive patients (median age 73 years; 90 females) with myeloid neoplasms and isolated del(5q) seen between 1989 and 2009. We have previously reported on 88 (61%) of these patients who met criteria for WHO defined "myelodysplastic syndromes (MDS) with isolated del(5q)." The remaining 55 patients were classified as having "other" MDS variants (n = 29; 20%), acute myeloid leukemia (AML; n = 14; 10%), or myeloproliferative neoplasms (MPN; n = 12; 8%). DNA was available in 138 patients and mutation screening revealed 20 cases with JAK2, 6 with IDH, and 3 with MPL mutations; JAK2 and MPL mutations were seen mostly in MPN or "MDS with isolated del(5q)" whereas IDH mutations were frequent in other MDS variants. Overall median survival for the 143 patient cohort was 35 months and leukemic transformation (LT) was documented in 19 (~13%) cases. "MDS with isolated del(5q)" had the best prognosis with median survival of 66 months and LT rate of ~6%. Survival was poor among the other myeloid neoplasm subgroups regardless of specific morphologic diagnosis. Multivariable analysis identified higher leukocyte count and percentage of bone marrow and circulating blasts as independent predictors of shortened survival. The first two parameters and the presence of IDH mutations predicted inferior leukemia-free survival. The current study validates the prognostic relevance of considering "MDS with isolated del(5q)" as a separate WHO subcategory and identifies leukocytosis, higher blast count, and IDH mutations as being prognostically detrimental, in myeloid neoplasms associated with isolated del(5q).
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Cell Transformation, Neoplastic/genetics
- Chromosome Deletion
- Chromosomes, Human, Pair 15
- Female
- Follow-Up Studies
- Humans
- Isocitrate Dehydrogenase/genetics
- Janus Kinase 2/genetics
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/physiopathology
- Leukemia, Myeloid, Acute/therapy
- Leukocytosis
- Male
- Medical Records
- Middle Aged
- Mutation
- Myelodysplastic Syndromes/diagnosis
- Myelodysplastic Syndromes/genetics
- Myelodysplastic Syndromes/physiopathology
- Myelodysplastic Syndromes/therapy
- Myeloproliferative Disorders/diagnosis
- Myeloproliferative Disorders/genetics
- Myeloproliferative Disorders/physiopathology
- Myeloproliferative Disorders/therapy
- Prognosis
- Receptors, Thrombopoietin/genetics
- Retrospective Studies
- Survival Analysis
- United States
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Affiliation(s)
- Mrinal M Patnaik
- Department of Medicine, Division of Hematology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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11
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Impact of adjunct cytogenetic abnormalities for prognostic stratification in patients with myelodysplastic syndrome and deletion 5q. Leukemia 2011; 25:110-20. [PMID: 20882045 DOI: 10.1038/leu.2010.231] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This cooperative study assessed prognostic factors for overall survival (OS) and risk of transformation to acute myeloid leukemia (AML) in 541 patients with de novo myelodysplastic syndrome (MDS) and deletion 5q. Additional chromosomal abnormalities were strongly related to different patients' characteristics. In multivariate analysis, the most important predictors of both OS and AML transformation risk were number of chromosomal abnormalities (P<0.001 for both outcomes), platelet count (P<0.001 and P=0.001, respectively) and proportion of bone marrow blasts (P<0.001 and P=0.016, respectively). The number of chromosomal abnormalities defined three risk categories for AML transformation (del(5q), del(5q)+1 and del(5q)+ ≥ 2 abnormalities) and two for OS (one group: del(5q) and del(5q)+1; and del(5q)+ ≥ 2 abnormalities, as the other one); with a median survival time of 58.0 and 6.8 months, respectively. Platelet count (P=0.001) and age (P=0.034) predicted OS in patients with '5q-syndrome'. This study demonstrates the importance of additional chromosomal abnormalities in MDS patients with deletion 5q, challenges the current '5q-syndrome' definition and constitutes a useful reference series to properly analyze the results of clinical trials in these patients.
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Naresh KN, Reid A. Bone marrow morphology in myelodysplastic syndrome associated with isolated del(5q). Am J Hematol 2010; 85:609-10. [PMID: 20658591 DOI: 10.1002/ajh.21775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Kikkeri N Naresh
- Department of Histopathology, Hammersmith Hospital Campus, Imperial College Healthcare NHS Trust, London, United Kingdom.
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WHO-defined 'myelodysplastic syndrome with isolated del(5q)' in 88 consecutive patients: survival data, leukemic transformation rates and prevalence of JAK2, MPL and IDH mutations. Leukemia 2010; 24:1283-9. [PMID: 20485371 PMCID: PMC3035970 DOI: 10.1038/leu.2010.105] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The 2008 World Health Organization (WHO) criteria were used to identify 88 consecutive Mayo Clinic patients with ‘myelodysplastic syndrome with isolated del(5q)' (median age 74 years; 60 females). In all, 60 (68%) patients were followed up to the time of their death. Overall median survival was 66 months; leukemic transformation was documented in five (5.7%) cases. Multivariable analysis identified age ⩾70 years (P=0.01), transfusion need at diagnosis (P=0.04) and dysgranulopoiesis (P=0.02) as independent predictors of shortened survival; the presence of zero (low risk), one (intermediate risk) or ⩾2 (high risk) risk factors corresponded to median survivals of 102, 52 and 27 months, respectively. Janus kinase 2 (JAK2), thrombopoietin receptor (MPL), isocitrate dehydrogenase 1 (IDH1) and IDH2 mutational analysis was performed on archived bone marrows in 78 patients; JAK2V617F and MPLW515L mutations were shown in five (6.4%) and three (3.8%) patients, respectively, and did not seem to affect phenotype or prognosis. IDH mutations were not detected. Survival was not affected by serum ferritin and there were no instances of death directly related to iron overload. The current study is unique in its strict adherence to WHO criteria for selecting study patients and providing information on long-term survival, practical prognostic factors, baseline risk of leukemic transformation and the prevalence of JAK2, MPL and IDH mutations.
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Jacobs NL, Holtan SG, Porrata LF, Markovic SN, Tefferi A, Steensma DP. Host immunity affects survival in myelodysplastic syndromes: Independent prognostic value of the absolute lymphocyte count. Am J Hematol 2010; 85:160-3. [PMID: 20131304 DOI: 10.1002/ajh.21618] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The prognostic significance of the peripheral blood absolute lymphocyte count (ALC) has been carefully examined in lymphoid malignancies, but the importance of the baseline ALC in chronic myeloid neoplasms is less clear. In a recent analysis of myelodysplastic syndromes (MDS) associated with deletion of chromosome 5q, we observed that an ALC < 1.2x 10(9) cells/L at diagnosis is independently associated with poorer survival. Clinicopathological data from 503 patients with non-del(5q) MDS evaluated at Mayo Clinic between 1996 and 2007 were reviewed to determine the prognostic impact of ALC at diagnosis in non-del(5q) MDS. Patients with MDS and an ALC at diagnosis > or =1.2x 10(9) (N = 248) experienced a superior overall survival (OS) compared with patients with an ALC < 1.2x 10(9)/L (N = 255, median OS of 26.6 months versus 18.5 months, P < 0.001, respectively). ALC at diagnosis was an independent predictor for OS when compared with the International Prognostic Scoring System and the WHO-based Prognostic Scoring System. This study suggests that ALC at diagnosis is a prognostic factor for OS in MDS, and argues in favor of further studies to assess the role of host immunity in MDS clinical outcomes.
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Affiliation(s)
- Nisha L Jacobs
- Department of Medicine, University of Minnesota, Minneapolis, USA
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Wang H, Wang X, Xu X, Lin G. Mean corpuscular volume predicts prognosis in MDS patients with abnormal karyotypes. Ann Hematol 2010; 89:671-9. [DOI: 10.1007/s00277-010-0912-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2009] [Accepted: 01/22/2010] [Indexed: 10/19/2022]
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Steensma DP. ASH 2009 meeting report-Top 10 clinically oriented abstracts in myelodysplastic syndromes. Am J Hematol 2010. [DOI: 10.1002/ajh.21629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Cytogenetic features and prognosis analysis in Chinese patients with myelodysplastic syndrome: a multicenter study. Ann Hematol 2009; 89:535-44. [DOI: 10.1007/s00277-009-0861-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Accepted: 10/27/2009] [Indexed: 10/20/2022]
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Kantarjian H, O’Brien S, Ravandi F, Borthakur G, Faderl S, Bueso-Ramos C, Abruzzo L, Pierce S, Shan J, Issa JP, Garcia-Manero G. The heterogeneous prognosis of patients with myelodysplastic syndrome and chromosome 5 abnormalities: how does it relate to the original lenalidomide experience in MDS? Cancer 2009; 115:5202-9. [PMID: 19691096 PMCID: PMC2783477 DOI: 10.1002/cncr.24575] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND To define the prognosis in myelodysplastic syndrome (MDS) and deletion 5q with or without other cytogenetic abnormalities. METHODS Patients with MDS (<20% blasts) and evaluable cytogenetic studies (1966-present) were reviewed. Outcome of patients with deletion 5q or with loss of chromosome 5 (monosomy 5) was analyzed. RESULTS Of 2743 patients analyzed, 287 (10%) had deletion 5q and 216 (8%) had monosomy 5 abnormalities. The median survival was 9 months with deletion 5q, 6 months with monosomy 5, and 17 months without a chromosome 5 abnormality. Considering patients with deletion 5q, the median survival was 33 months with deletion 5q alone, 17 months with deletion 5q and 1 additional abnormality, but only 6 months to 12 months with deletion 5q and > or =2 abnormalities or chromosome 7 abnormality. Only 93 patients (3.4% of total) had lower risk MDS (international prognostic scoring system low or intermediate 1) and deletion 5q; their median survival was 29 months (2-year survival 60%), and ranged from 13-41 months depending on the presence or absence of additional chromosomal abnormalities. Among 198 patients with MDS with deletion 5q and <10% blasts (a subset now often offered lenalidomide), the median survival was 12 months. Monosomy 5 was significantly more frequently associated with advanced MDS and with other chromosomal abnormalities. CONCLUSIONS This study provided baseline expectations of outcome in different MDS subsets and deletion 5q.
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Affiliation(s)
- Hagop Kantarjian
- Department of Leukemia, MD Anderson Cancer Center, Houston, Texas
| | - Susan O’Brien
- Department of Leukemia, MD Anderson Cancer Center, Houston, Texas
| | - Farhad Ravandi
- Department of Leukemia, MD Anderson Cancer Center, Houston, Texas
| | - Gautam Borthakur
- Department of Leukemia, MD Anderson Cancer Center, Houston, Texas
| | - Stefan Faderl
- Department of Leukemia, MD Anderson Cancer Center, Houston, Texas
| | | | - Lynne Abruzzo
- Hematopathology, MD Anderson Cancer Center, Houston, Texas
| | - Sherry Pierce
- Department of Leukemia, MD Anderson Cancer Center, Houston, Texas
| | - Jianqin Shan
- Department of Leukemia, MD Anderson Cancer Center, Houston, Texas
| | - Jean-Pierre Issa
- Department of Leukemia, MD Anderson Cancer Center, Houston, Texas
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Wang H, Wang XQ, Xu XP, Lin GW. ID4 methylation predicts high risk of leukemic transformation in patients with myelodysplastic syndrome. Leuk Res 2009; 34:598-604. [PMID: 19853913 DOI: 10.1016/j.leukres.2009.09.031] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2009] [Revised: 09/24/2009] [Accepted: 09/24/2009] [Indexed: 12/24/2022]
Abstract
Epigenetic gene silencing due to promoter methylation is observed in human cancers like acute myeloid leukemia (AML). Little is known about aberrant methylation in myelodysplastic syndrome (MDS), a heterogeneous clonal stem cell disorder with a approximately 30% risk of transformation into secondary AML. Recent evidence demonstrated that ID4, a negative regulator of transcription, may act as a tumor-suppressor gene. To clarify the role of ID4 in MDS, we employed methylation-specific PCR (MSP) to examine the methylation status of ID4 in 144 adult de novo MDS patients. We found that ID4 methylation was present in 35.4% (n=51) of these MDS patients and methylaiton was correlated significantly with World Health Organization (WHO) subtypes and International Prognostic Scoring System (IPSS) risk groups. Patients with advanced stages of WHO subtypes (45.8% vs. 21.3%, P=0.002) and higher risk IPSS subgroups (45.7% vs. 26.0%, P=0.014) exhibited a significantly higher frequency of ID4 methylation. The median survival of patients with ID4 methylation was shorter than patients without ID4 methylation (12.2 months vs. 26.9 months, P=0.005). Multivariate analysis indicated that ID4 methylation status was the independent factor that impacted leukemia-free survival (LFS). Disease in patients with ID4 methylation progressed more rapidly than those without ID4 methylation (P=0.047, HR=2.11). Our results suggest that ID4 may be a therapeutic target in MDS.
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Affiliation(s)
- Hong Wang
- Department of Haematology, Huashan Hospital of Fudan University, 12 Wulumuqi Road Central, 200040 Shanghai, China
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Hussein K, Van Dyke DL, Tefferi A. Conventional cytogenetics in myelofibrosis: literature review and discussion. Eur J Haematol 2009; 82:329-38. [DOI: 10.1111/j.1600-0609.2009.01224.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Ebert BL. Deletion 5q in myelodysplastic syndrome: a paradigm for the study of hemizygous deletions in cancer. Leukemia 2009; 23:1252-6. [PMID: 19322210 DOI: 10.1038/leu.2009.53] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Hemizygous deletions are common molecular abnormalities in cancer. In some cases, these deletions highlight chromosomal loci containing tumor suppressor genes that undergo homozygous inactivation. In other cases, hemizygous deletions cause disease by allelic insufficiency for one or more genes. As the intact allele has no identifiable lesions, functional approaches are critical for the identification of pathogenic genes within large deletions. Hemizygous, interstitial deletion of chromosome 5q is the most common cytogenetic abnormality in myelodysplastic syndrome (MDS) and has been the focus of functional analysis. Some patients with this molecular lesion have the 5q- syndrome, a disorder with a highly consistent clinical phenotype. A systematic RNA interference screen to interrogate the function of each gene in the common deleted region (CDR) for the 5q- syndrome identified RPS14 as a critical haploinsufficiency disease gene for the erythroid failure, which is a characteristic of this syndrome. Genes located in an adjacent deleted region have also been implicated in MDS. The full clinical phenotype is likely caused by the integration of effects from allelic insufficiency for multiple genes. With the identification and characterization of these genes, the 5q deletion is becoming a model for understanding hemizygous chromosomal deletions in cancer.
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Affiliation(s)
- B L Ebert
- Division of Hematology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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