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Kovach AE, Brunner AM, Fathi AT, Chen YB, Hasserjian RP. Prognostic Significance of Residual Acute Myeloid Leukemia in Bone Marrow Samples Taken Prior to Allogeneic Hematopoietic Cell Transplantation. Am J Clin Pathol 2017; 147:50-59. [PMID: 28108471 DOI: 10.1093/ajcp/aqw203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES We sought to identify features in routine evaluation of pre-hematopoietic cell transplantation (HCT) bone marrow samples from patients with acute myeloid leukemia (AML) that influenced patient outcome. METHODS Of 140 patients, evidence of residual leukemia (RL) was identified in 38 (27%) of pre-HCT samples, as defined by 5% or more aspirate blasts, increased blood blasts, clustered or necrotic blasts on biopsy specimens, and/or leukemia-associated karyotypic abnormalities. RESULTS Morphologic or karyotypic evidence of RL was significantly associated with shorter leukemia-free survival (LFS) compared with cases without identifiable RL (median, 7.1 vs 28.3 months; P < .0001). Upon multivariable analysis, RL, prior relapse, age, high-risk karyotype, and alternate donor source were each independently associated with shorter LFS. RL in pre-HCT samples was more strongly associated with shorter LFS in patients with intermediate or favorable-risk AML karyotype ( P = .001) than secondary or adverse karyotype-risk AML ( P = .04). CONCLUSIONS Rigorous morphologic and karyotypic evaluation of pretransplant marrows is practical and important for posttransplant prognosis.
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Affiliation(s)
- Alexandra E Kovach
- From the Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, TN; and Departments of
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Borate U, Absher D, Erba HP, Pasche B. Potential of whole-genome sequencing for determining risk and personalizing therapy: focus on AML. Expert Rev Anticancer Ther 2012; 12:1289-97. [PMID: 23176617 PMCID: PMC3636990 DOI: 10.1586/era.12.116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
In spite of recent advances in molecular diagnostic techniques and expanded indications for allogeneic hematopoietic stem cell transplantation, treatment of acute myeloid leukemia (AML) remains a major challenge. In the last decade, several recurrent genetic abnormalities and gene mutations with prognostic implications have been identified. This has led to improved informed treatment decisions. However, there has been limited change in the use of nonspecific cytotoxic chemotherapy and mortality rates continue to be unacceptably high, with 5 year overall survival rates of older AML patients at 30% or less. Whole-genome sequencing offers hope for greater diagnostic accuracy and is likely to lead to further characterization of disease subsets with differential outcome and response to treatment. The holy grail of personalized targeted therapy for the individual AML patient, while minimizing toxicity and prolonging survival, appears closer than ever.
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Affiliation(s)
- Uma Borate
- Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham and UAB Comprehensive Cancer Center, Birmingham, AL, USA
| | - Devin Absher
- Hudson Alpha Institute for Biotechnology, Huntsville, AL, USA
| | - Harry P Erba
- Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham and UAB Comprehensive Cancer Center, Birmingham, AL, USA
| | - Boris Pasche
- Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham and UAB Comprehensive Cancer Center, Birmingham, AL, USA
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Abstract
The potential impact of stem cell technology on medical and dental practice is vast. Stem cell research will not only provide the foundation for future therapies, but also reveal unique insights into basic disease mechanisms. Therefore, an understanding of stem cell technology will be necessary for clinicians in the future. Herein, we give a basic overview of stem cell biology and therapeutics for the practicing clinician.
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Affiliation(s)
- A Leventhal
- Center for Molecular Medicine,National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10-CRC, Room 5-3132, Bethesda, MD 20817, USA
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Patel SA, Rameshwar P. Stem Cell Transplantation for Hematological Malignancies: Prospects for Personalized Medicine and Co-therapy with Mesenchymal Stem Cells. ACTA ACUST UNITED AC 2011; 9:229-239. [PMID: 21892378 DOI: 10.2174/187569211796957548] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Bone marrow transplantation is a form of cell therapy that has been in practice for decades for the treatment of hematological disorders and solid tumors. Immunosuppressive therapy has been a mainstay for treatment, but the severity of the adverse effects has made it an undesirable choice. Mesenchymal stem cells (MSCs), which reside in the vascular regions of the bone marrow, have been shown to serve as cellular support for the hematopoietic stem cell (HSC) niche. Furthermore, the immune suppressive properties of MSCs have been explored in the treatment of inflammatory and autoimmune disorders. Thus, co-therapy with MSCs has been shown to facilitate engraftment of hematopoietic cells by suppressive graft versus host disease (GvHD). Although the mechanism by which MSCs suppress GvHD is unclear, the experimental evidence suggests that this partly occurs by modulation of immune response such as the induction of regulatory T cells. This paper discusses the role of MSCs as co-therapy for the future of stem cell transplantation, with the overarching theme of personalized medicine for cell-based health interventions.
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Affiliation(s)
- Shyam A Patel
- Department of Medicine, Division of Hematology/Oncology, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA
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Welch JS, Westervelt P, Ding L, Larson DE, Klco JM, Kulkarni S, Wallis J, Chen K, Payton JE, Fulton RS, Veizer J, Schmidt H, Vickery TL, Heath S, Watson MA, Tomasson MH, Link DC, Graubert TA, DiPersio JF, Mardis ER, Ley TJ, Wilson RK. Use of whole-genome sequencing to diagnose a cryptic fusion oncogene. JAMA 2011; 305:1577-84. [PMID: 21505136 PMCID: PMC3156695 DOI: 10.1001/jama.2011.497] [Citation(s) in RCA: 211] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
CONTEXT Whole-genome sequencing is becoming increasingly available for research purposes, but it has not yet been routinely used for clinical diagnosis. OBJECTIVE To determine whether whole-genome sequencing can identify cryptic, actionable mutations in a clinically relevant time frame. DESIGN, SETTING, AND PATIENT We were referred a difficult diagnostic case of acute promyelocytic leukemia with no pathogenic X-RARA fusion identified by routine metaphase cytogenetics or interphase fluorescence in situ hybridization (FISH). The case patient was enrolled in an institutional review board-approved protocol, with consent specifically tailored to the implications of whole-genome sequencing. The protocol uses a "movable firewall" that maintains patient anonymity within the entire research team but allows the research team to communicate medically relevant information to the treating physician. MAIN OUTCOME MEASURES Clinical relevance of whole-genome sequencing and time to communicate validated results to the treating physician. RESULTS Massively parallel paired-end sequencing allowed identification of a cytogenetically cryptic event: a 77-kilobase segment from chromosome 15 was inserted en bloc into the second intron of the RARA gene on chromosome 17, resulting in a classic bcr3 PML-RARA fusion gene. Reverse transcription polymerase chain reaction sequencing subsequently validated the expression of the fusion transcript. Novel FISH probes identified 2 additional cases of t(15;17)-negative acute promyelocytic leukemia that had cytogenetically invisible insertions. Whole-genome sequencing and validation were completed in 7 weeks and changed the treatment plan for the patient. CONCLUSION Whole-genome sequencing can identify cytogenetically invisible oncogenes in a clinically relevant time frame.
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MESH Headings
- Adult
- Chromosome Breakpoints
- Chromosomes, Human, Pair 15/genetics
- Chromosomes, Human, Pair 17/genetics
- Gene Fusion
- Genome, Human
- Humans
- Introns
- Leukemia, Promyelocytic, Acute/genetics
- Leukemia, Promyelocytic, Acute/therapy
- Male
- Nuclear Proteins/genetics
- Oncogene Proteins, Fusion/genetics
- Promyelocytic Leukemia Protein
- Receptors, Retinoic Acid/genetics
- Retinoic Acid Receptor alpha
- Reverse Transcriptase Polymerase Chain Reaction
- Sequence Analysis, DNA
- Transcription Factors/genetics
- Tumor Suppressor Proteins/genetics
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Affiliation(s)
- John S. Welch
- Department of Medicine, Washington University, St. Louis, MO
| | | | - Li Ding
- The Genome Institute, Washington University, St. Louis, MO
| | | | - Jeffery M. Klco
- Department of Pathology and Immunology, Washington University, St. Louis, MO
| | - Shashikant Kulkarni
- Department of Pathology and Immunology, Washington University, St. Louis, MO
- Department of Genetics, Washington University, St. Louis, MO
- Department of Pediatrics, Washington University, St. Louis, MO
| | - John Wallis
- The Genome Institute, Washington University, St. Louis, MO
| | - Ken Chen
- The Genome Institute, Washington University, St. Louis, MO
| | | | | | - Joelle Veizer
- The Genome Institute, Washington University, St. Louis, MO
| | | | | | - Sharon Heath
- Department of Medicine, Washington University, St. Louis, MO
| | - Mark A. Watson
- The Genome Institute, Washington University, St. Louis, MO
- Department of Pathology and Immunology, Washington University, St. Louis, MO
| | | | - Daniel C. Link
- Department of Medicine, Washington University, St. Louis, MO
| | | | | | - Elaine R. Mardis
- The Genome Institute, Washington University, St. Louis, MO
- Department of Genetics, Washington University, St. Louis, MO
| | - Timothy J. Ley
- Department of Medicine, Washington University, St. Louis, MO
- The Genome Institute, Washington University, St. Louis, MO
- Department of Genetics, Washington University, St. Louis, MO
| | - Richard K. Wilson
- The Genome Institute, Washington University, St. Louis, MO
- Department of Genetics, Washington University, St. Louis, MO
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