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Chen Y, Zou D, Niu T, Wu Y, Zhang Z, Zhang Y, Xu K, Ouyang G, Mu Q. Transient extra copy of Y chromosome without driver mutation after autologous hematopoietic stem cell transplantation for acute myeloid leukemia: a case report and literature review. ALL LIFE 2022. [DOI: 10.1080/26895293.2022.2108148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Affiliation(s)
- Ying Chen
- Laboratory of Stem Cell Transplantation, Ningbo First Hospital, Ningbo, People’s Republic of China
- Ningbo Clinical Research Center for Hematologic Malignancies, Ningbo, People’s Republic of China
| | - Duobing Zou
- Laboratory of Stem Cell Transplantation, Ningbo First Hospital, Ningbo, People’s Republic of China
- Ningbo Clinical Research Center for Hematologic Malignancies, Ningbo, People’s Republic of China
| | - Tingting Niu
- Laboratory of Stem Cell Transplantation, Ningbo First Hospital, Ningbo, People’s Republic of China
- Ningbo Clinical Research Center for Hematologic Malignancies, Ningbo, People’s Republic of China
| | - Ying Wu
- Laboratory of Stem Cell Transplantation, Ningbo First Hospital, Ningbo, People’s Republic of China
- Ningbo Clinical Research Center for Hematologic Malignancies, Ningbo, People’s Republic of China
| | - Zhaoyi Zhang
- Laboratory of Stem Cell Transplantation, Ningbo First Hospital, Ningbo, People’s Republic of China
- Ningbo Clinical Research Center for Hematologic Malignancies, Ningbo, People’s Republic of China
| | - Yi Zhang
- Laboratory of Stem Cell Transplantation, Ningbo First Hospital, Ningbo, People’s Republic of China
- Ningbo Clinical Research Center for Hematologic Malignancies, Ningbo, People’s Republic of China
| | - Kaihong Xu
- Ningbo Clinical Research Center for Hematologic Malignancies, Ningbo, People’s Republic of China
- Hematology Department, Ningbo First Hospital, Ningbo, People’s Republic of China
| | - Guifang Ouyang
- Ningbo Clinical Research Center for Hematologic Malignancies, Ningbo, People’s Republic of China
- Hematology Department, Ningbo First Hospital, Ningbo, People’s Republic of China
| | - Qitian Mu
- Laboratory of Stem Cell Transplantation, Ningbo First Hospital, Ningbo, People’s Republic of China
- Ningbo Clinical Research Center for Hematologic Malignancies, Ningbo, People’s Republic of China
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2
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Tang G, Medeiros LJ, Wang SA. How I investigate Clonal cytogenetic abnormalities of undetermined significance. Int J Lab Hematol 2018; 40:385-391. [PMID: 29624895 DOI: 10.1111/ijlh.12826] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 02/27/2018] [Indexed: 01/06/2023]
Abstract
Myelodysplastic syndromes are a group of hematopoietic stem cell diseases characterized by cytopenia(s), morphological dysplasia, and clonal hematopoiesis. In some patients, the cause of cytopenia(s) is uncertain, even after thorough clinical and laboratory evaluation. Evidence of clonal hematopoiesis has been used to support a diagnosis of myelodysplastic syndrome in this setting. In patients with cytopenia(s), the presence of clonal cytogenetic abnormalities, except for +8, del(20q) and -Y, can serve as presumptive evidence of myelodysplastic syndrome. Recent advances in next-generation sequencing have detected myeloid neoplasm-related mutations in patients who do not meet the diagnostic criteria for myelodysplastic syndrome. Various terms have been adopted to describe these cases, including clonal hematopoiesis of indeterminate potential (CHIP) and clonal cytopenia of undetermined significance (CCUS). Similarly, studies have shown that certain chromosomal abnormalities, including ones commonly detected in myelodysplastic syndrome, may not be associated necessarily with an underlying myelodysplastic syndrome. These clonal cytogenetic abnormalities of undetermined significance (CCAUS) are similar to CHIP and CCUS. Here, we review the features of CCAUS, distinguishing CCAUS from clonal cytogenetic abnormalities associated with myelodysplastic syndrome, and the potential impact of CCAUS on patient management.
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Affiliation(s)
- G Tang
- Department of Hematopathology, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - L J Medeiros
- Department of Hematopathology, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - S A Wang
- Department of Hematopathology, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
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3
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A case of lenalidomide-dependent myelodysplastic syndrome. Blood Adv 2017; 1:1238-1242. [PMID: 29296763 DOI: 10.1182/bloodadvances.2017006114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 05/11/2017] [Indexed: 11/20/2022] Open
Abstract
A man with cytopenias, dysplasia, excess blasts, P53 and RUNX1 mutations, and ring chromosome 7 recovered after stopping lenalidomide.
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4
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Aikawa V, Porter D, Luskin MR, Bagg A, Morrissette JJD. Transmission of an expanding donor-derived del(20q) clone through allogeneic hematopoietic stem cell transplantation without the development of a hematologic neoplasm. Cancer Genet 2015; 208:625-9. [PMID: 26628205 DOI: 10.1016/j.cancergen.2015.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 10/23/2015] [Accepted: 10/23/2015] [Indexed: 10/22/2022]
Abstract
Donor cell leukemia is a rare complication of allogeneic hematopoietic stem cell transplantation (HSCT), which may result from the development of a new malignancy in previously healthy donor cells after transplant into the recipient, or it may derive from the transmission of an occult leukemia from donor to recipient. We report a case of donor derived 20q11.2 deletion in a male patient who received an allogeneic HSCT from his HLA-identical sister for the treatment of his chronic lymphocytic leukemia. Bone marrow cells from the donor were found to contain the 20q deletion that expanded over time, but which was absent in her peripheral blood cells. Although cases of donor cell leukemia after HSCT have been reported, in this case there has been no evidence of an associated hematologic neoplasm in either the donor or recipient. Pre-transplant donor bone marrow evaluations are not practical or warranted, however the finding of new cytogenetic abnormalities after transplant mandates a thorough evaluation of the donor.
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Affiliation(s)
- Vania Aikawa
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - David Porter
- Division of Hematology and Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Marlise R Luskin
- Division of Hematology and Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Adam Bagg
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jennifer J D Morrissette
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
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5
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Isolated clonal cytogenetic abnormalities after high-dose therapy. Biol Blood Marrow Transplant 2014; 20:1130-8. [PMID: 24732780 DOI: 10.1016/j.bbmt.2014.03.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 03/31/2014] [Indexed: 11/24/2022]
Abstract
Therapy-related myeloid neoplasms (t-MN) are well-recognized complications of high-dose cytotoxic therapy (HDT), such as autologous stem cell transplantation (ASCT). Clonal marrow cytogenetic abnormalities (CMCA) in the setting of normal bone marrow pathology have also been reported after HDT, but their significance remains unclear. We retrospectively evaluated occurrences of CMCA and t-MN in 785 patients treated with HDT at Johns Hopkins University between 1997 and 2007. Most patients received ASCT, but 106 patients who received high-dose cyclophosphamide without ASCT were also included in this study, as this is our institutional standard for malignant and nonmalignant lymphoproliferative disorders in need of HDT. Twenty-two patients developed t-MN, with an estimated cumulative incidence of 3.5% at 4 years. Eleven patients developed isolated CMCA, either transient or persistent without pathologic evidence of t-MN. Altogether, only 20 of the patients with reported CMCA subsequently developed t-MN during the follow-up period. Therefore, in the absence of pathologic evidence of t-MN, CMCA should not be considered diagnostic of t-MN.
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6
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Akhtari M, Bhatt VR, Tandra PK, Krishnamurthy J, Horstman H, Dreessen A, Chen PX, Armitage JO. Therapy-related myeloid neoplasms after autologous hematopoietic stem cell transplantation in lymphoma patients. Cancer Biol Ther 2013; 14:1077-88. [PMID: 24025414 DOI: 10.4161/cbt.26342] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Lymphoma patients treated with autologous transplantation (ASCT) live an increasingly long life with the recent advancement in therapeutic modalities. This has resulted in an increase in the incidence of therapy-related myeloid neoplasms (t-MN), which is one of the leading causes of non-relapse mortality. Several observational studies have linked the development of t-MN after ASCT with the intensity and frequency of chemotherapy, particularly alkylating agents, use of total body irradiation (TBI), and peripheral blood progenitor cells. In addition, role of genetic factors is increasingly being identified. It is postulated that the use of chemotherapy prior to ASCT results in DNA damage of progenitor cells, mitochondrial dysfunction, and altered gene expression related to DNA repair, metabolism as well as hematopoietic regulation. Cytogenetic studies have shown the presence of abnormalities in the peripheral blood progenitor cells prior to ASCT. It is, therefore, likely that the reinfusion of peripheral blood progenitor cells, proliferative stress on infused progenitor cells during hematopoietic regeneration and associated telomere shortening ultimately result in clonal hematopoiesis and blastic transformation. Cytopenias, myelodysplasia, or cytogenetic abnormalities are common and can be transient after ASCT; therefore, only when present together, they do confirm the diagnosis of t-MN. Attempts to reduce the occurrence of t-MN should be directed toward minimizing the exposure to the identified risk factors. Although the median survival is few months to less than a year, studies have shown the promising role of allogeneic transplantation in select young t-MN patients without high-risk cytogenetics. In this review we will explain the recent findings in the field of t-MN in lymphoma patients that have implications for identifying the molecular and genetic mechanisms of leukemogenesis and discuss potential strategies to reduce the risk of t-MN in this patient population.
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Affiliation(s)
- Mojtaba Akhtari
- Division of Hematology and Oncology; Department of Internal Medicine; University of Nebraska Medical Center; Omaha, NE USA
| | - Vijaya Raj Bhatt
- Division of Hematology and Oncology; Department of Internal Medicine; University of Nebraska Medical Center; Omaha, NE USA
| | - Pavan Kumar Tandra
- Division of Hematology and Oncology; Department of Internal Medicine; University of Nebraska Medical Center; Omaha, NE USA
| | - Jairam Krishnamurthy
- Division of Hematology and Oncology; Department of Internal Medicine; University of Nebraska Medical Center; Omaha, NE USA
| | - Heidi Horstman
- Division of Hematology and Oncology; Department of Internal Medicine; University of Nebraska Medical Center; Omaha, NE USA
| | - Amy Dreessen
- Division of Hematology and Oncology; Department of Internal Medicine; University of Nebraska Medical Center; Omaha, NE USA
| | - Pei Xian Chen
- Division of Hematology and Oncology; Department of Internal Medicine; University of Nebraska Medical Center; Omaha, NE USA
| | - James O Armitage
- Division of Hematology and Oncology; Department of Internal Medicine; University of Nebraska Medical Center; Omaha, NE USA
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Abstract
Sustained clinical cytopenia is a frequent laboratory finding in ambulatory and hospitalized patients. For pathologists and hematopathologists who examine the bone marrow (BM), a diagnosis of cytopenia secondary to an infiltrative BM process or acute leukemia can be readily established based on morphologic evaluation and flow cytometry immunophenotyping. However, it can be more challenging to establish a diagnosis of myelodysplastic syndrome (MDS). In this article, the practical approaches for establishing or excluding a diagnosis of MDS (especially low-grade MDS) in patients with clinical cytopenia are discussed along with the current diagnostic recommendations provided by the World Health Organization and the International Working Group for MDS.
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Kadam PS, Jain HV, Parikh PM, Saikia TK, Agarwal S, Ambulkar I. Emergence of an unrelated highly aberrant clone in an AML patient at relapse four months after peripheral blood stem cell transplantation. INDIAN JOURNAL OF HUMAN GENETICS 2011; 13:114-8. [PMID: 21957359 PMCID: PMC3168137 DOI: 10.4103/0971-6866.38986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We report a case of AML-M1 with 5q aberration at diagnosis. The patient was treated with high-dose chemotherapy (HDCT). After remission induction, he received allogenic peripheral blood stem cell transplantation (PBSCT) from an HLA-match donor brother. The successive follow-up conventional cytogenetics investigations in remission after HDCT and PBSCT revealed cytogenetic remission. The most interesting observation in this case is that relapsed marrow revealed the emergence of an entirely new, highly aberrant, unrelated clone with unusual translocations t(6;17)(p23;p11.2),+8,der(8)dup inv(8)(q23qter), t(10;19)(q26;q13.3) 4½ months after PBSCT. Our findings suggest the possibility of a mutagenic effect of HDCT and myeloablative intense chemotherapy before PBSCT that could have induced a genetic lesion in the recipient's genetically unstable stem cells in an environment of immunosuppression. The highly complex nature of the clone and the rapid clonal evolution indicates the possibility of selective pressure with proliferative advantage.
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Affiliation(s)
- Pratibha S Kadam
- Cancer Cytogenetics Laboratory, Tata Memorial Hospital, Mumbai, India
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9
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Abstract
Sustained clinical cytopenia is a frequent laboratory finding in ambulatory and hospitalized patients. For pathologists and hematopathologists who examine the bone marrow (BM), a diagnosis of cytopenia secondary to an infiltrative BM process or acute leukemia can be readily established based on morphologic evaluation and flow cytometry immunophenotyping. However, it can be more challenging to establish a diagnosis of myelodysplastic syndrome (MDS). In this article, the practical approaches for establishing or excluding a diagnosis of MDS (especially low-grade MDS) in patients with clinical cytopenia are discussed along with the current diagnostic recommendations provided by the World Health Organization and the International Working Group for MDS.
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Affiliation(s)
- Sa A Wang
- Department of Hematopathology, University of Texas, MD Anderson Cancer Center, Unit 72, 1515 Holcombe Boulevard, Houston, TX 77030-4009, USA.
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10
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Kushner BH, Kramer K, Modak S, Qin LX, Yataghena K, Jhanwar SC, Cheung NKV. Reduced risk of secondary leukemia with fewer cycles of dose-intensive induction chemotherapy in patients with neuroblastoma. Pediatr Blood Cancer 2009; 53:17-22. [PMID: 19148951 PMCID: PMC4079040 DOI: 10.1002/pbc.21931] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND We report a prospective study of secondary leukemia (SL)/myelodysplastic syndrome (MDS) in neuroblastoma (NB) patients treated with > or =5 cycles of dose-intensive chemotherapy. PROCEDURE NB patients received induction with high-dose cyclophosphamide (4,200 mg/m(2))-doxorubicin (75 mg/m(2))-vincristine (cycles 1, 2, 4, 6, 8), and high-dose cisplatin (200 mg/m(2))-etoposide (600 mg/m(2)) (cycles 3, 5, 7). Bone marrow was examined every 1-3 months for > or =36 months, with inclusion of extensive chromosomal studies 1-3 months post-induction and 1-2x/year thereafter. RESULTS One hundred eight four patients received 5 (n = 76), 6 (n = 45), 7 (n = 59), or 8 (n = 4) cycles. Eight patients developed SL/MDS (only one each in the 5- and 6-cycle groups), at 12-50 months, including two cases detected in surveillance studies. Among 108 patients who received > or =6 cycles, the 5-year cumulative incidence was 7.1% (95% CI: 2%, 12.2%), versus 0% among 54 patients who received 5 cycles without maintenance oral etoposide. Five-year cumulative incidences were 1.46%, 2.28%, and 8.47% among patients in the 5-, 6-, and 7-cycle groups, with fewer cycles having a significantly lower risk (P = 0.048). There was no significant association of risk with potentially leukemogenic consolidative treatments (targeted radiotherapy, myeloablative therapy, and oral etoposide). CONCLUSIONS Reducing the number of dose-intensive cycles significantly decreases the risk of SL/MDS, yielding 5-year rates matching the low range (0.4-2.2%) reported for moderate-dose combination chemotherapy regimens used against other pediatric solid tumors.
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Affiliation(s)
- Brian H. Kushner
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065. Tel: 212-639-6793. Fax: 212-717-3239.
| | - Kim Kramer
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065. Tel: 212-639-6410. Fax: 212-717-3239.
| | - Shakeel Modak
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065. Tel: 212-639-7623. Fax: 212-717-3695.
| | - Li-Xuan Qin
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, E. 63 Street, New York, NY 10065, Tel: 646-735-8116; Fax: 646-735-0010;
| | - Karima Yataghena
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065. Tel: 212-639-6140. Fax: 212-717-3492.
| | - Suresh C. Jhanwar
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065. Tel: 212-639-8895. Fax: 212-794-5830.
| | - Nai-Kong V. Cheung
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065. Tel: 646-888-2313. Fax: 212-744-2245.
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11
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Ostronoff F, Bueso-Ramos C, Cortes J, Giralt S. Normal hematopoietic function and multiple bone marrow clonal abnormalities in a patient with acute myeloid leukemia after two mismatched stem-cell transplants with graft failure and autologous reconstitution. Am J Hematol 2007; 82:744-7. [PMID: 17506066 DOI: 10.1002/ajh.20927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A 13-year-old male with primary refractory acute myelogenous leukemia (AML-M0), underwent two mismatched stem cell transplantations (SCT) and experienced graft failure after both procedures. Of interest, his peripheral blood cell counts are normal 7 years after his first SCT, his bone marrow is morphologically normal, however, cytogenetic analysis reveals multiple recurring cytogenetic abnormalities. This is the third case of chromosomal instability with morphological normal marrow and peripheral blood to be reported, these rare cases suggest that hematopoietic stem cells must have compensating mechanisms that allow normal function despite extensive chromosomal damage, supporting the notion that normal marrow function is possible even with extensive chromosomal damage.
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Affiliation(s)
- Fabiana Ostronoff
- Department of Blood and Marrow Transplantation, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA
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12
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Pawarode A, Finlay E, Sait SNJ, Barcos M, Baer MR. Isochromosome 1q in a myelodysplastic syndrome after treatment for acute promyelocytic leukemia. ACTA ACUST UNITED AC 2006; 167:155-60. [PMID: 16737916 DOI: 10.1016/j.cancergencyto.2005.11.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2005] [Revised: 11/23/2005] [Accepted: 11/29/2005] [Indexed: 12/26/2022]
Abstract
A growing body of literature reports therapy-related myelodysplastic syndrome (t-MDS) and acute myeloid leukemia (t-AML) in patients treated successfully for acute promyelocytic leukemia (APL). We report a t-MDS with an isochromosome 1q as a sole abnormality, 47,XY,+1,i(1)(q10), in a 46-year-old man with APL 14 years after he was treated with cytosine arabinosine and daunorubicin. The literature on t-MDS/t-AML after APL therapy and on isochromosome 1q is reviewed.
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Affiliation(s)
- Attaphol Pawarode
- Leukemia Section, Department of Medicine, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA
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13
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Yoshihara T, Hibi S, Yamane Y, Morimoto A, Hashida T, Iwami H, Tsunamoto K, Imashuku S. Numerous nonclonal chromosomal aberrations arising in residual recipient hematopoietic cells following allogeneic bone marrow transplantation. Bone Marrow Transplant 2005; 35:587-9. [PMID: 15756284 DOI: 10.1038/sj.bmt.1704860] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A young female patient in a second remission of acute lymphoblastic leukemia underwent bone marrow transplantation after total body irradiation and high-dose cytarabine from her HLA-matched brother. Following successful engraftment, mixed chimerism was seen 75 days post transplant. The karyotype contained numerous abnormalities in residual recipient cells. Chromosomes 1, 7, 13, and X were significantly more affected than other chromosomes. The high-frequency breakpoints identified were 1p22.2, 5q31.2, and 13q14.2. Some karyotypes specific for leukemia, such as t(9;22)(q34.1;q11.2) and t(8;21)(q22.2;q22.2), not seen with the original disease, were also present. As the frequency of aberrant chromosomes increased markedly with time, donor leukocytes were infused 14 months after BMT, which effectively eradicated the abnormal karyotypes.
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Affiliation(s)
- T Yoshihara
- Department of Pediatrics, Matsushita Memorial Hospital, Osaka, Japan.
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14
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Fassas AB, Tricot G. Myelodysplastic syndromes complicating hematopoietic stem cell transplantation. Cancer Treat Res 2002; 108:169-84. [PMID: 11702599 DOI: 10.1007/978-1-4615-1463-3_10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
MESH Headings
- Actuarial Analysis
- Acute Disease
- Adult
- Alkylating Agents/adverse effects
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Blood Cells/transplantation
- Bone Marrow Transplantation
- Chromosome Aberrations
- Clone Cells/pathology
- Female
- Hematopoietic Stem Cell Transplantation/adverse effects
- Humans
- Leukemia, Myeloid/etiology
- Leukemia, Myeloid/genetics
- Leukemia, Myeloid/mortality
- Leukemia, Myeloid/pathology
- Leukemia, Myeloid/therapy
- Leukemia, Radiation-Induced/etiology
- Male
- Middle Aged
- Multicenter Studies as Topic
- Mutagenesis
- Myelodysplastic Syndromes/etiology
- Myelodysplastic Syndromes/genetics
- Myelodysplastic Syndromes/mortality
- Myelodysplastic Syndromes/pathology
- Myelodysplastic Syndromes/therapy
- Neoplasms, Second Primary/etiology
- Neoplasms, Second Primary/genetics
- Neoplasms, Second Primary/mortality
- Neoplasms, Second Primary/pathology
- Neoplasms, Second Primary/therapy
- Retrospective Studies
- Risk Factors
- Transplantation Conditioning/adverse effects
- Transplantation, Autologous/adverse effects
- Transplantation, Homologous
- Whole-Body Irradiation/adverse effects
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Affiliation(s)
- A B Fassas
- Myeloma and Transplantation Research Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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15
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Hosing C, Munsell M, Yazji S, Andersson B, Couriel D, de Lima M, Donato M, Gajewski J, Giralt S, Körbling M, Martin T, Ueno NT, Champlin RE, Khouri IF. Risk of therapy-related myelodysplastic syndrome/acute leukemia following high-dose therapy and autologous bone marrow transplantation for non-Hodgkin's lymphoma. Ann Oncol 2002; 13:450-9. [PMID: 11996478 DOI: 10.1093/annonc/mdf109] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Several recent reports have suggested that patients with non-Hodgkin's lymphomas (NHL) who undergo autologous stem cell transplantation (ASCT) are at increased risk of developing therapy-related myelodysplastic syndrome (tMDS) and acute myelogenous leukemia (tAML). PATIENTS AND METHODS We analyzed 493 patients with NHL who underwent ASCT at The University of Texas M.D. Anderson Cancer Center between January 1990 and August 1999. RESULTS With a median follow-up time of 21 months after HDT, 22 patients developed persistent cytopenia in at least one cell line with morphologic or cytogenetic evidence of tMDS or tAML. Univariate analysis identified prior fludarabine therapy, bone marrow involvement with lymphoma, and total body irradiation (TBI) as significant risk factors for the development of tMDS/tAML (P <0.05). Multiple logistic regression analysis showed that TBI was independently associated with an increased risk of developing tMDS/tAML (P <0.01). Further analysis of the patients who received TBI revealed that patients receiving TBI in combination with cyclophosphamide and etoposide were more likely to develop tMDS/tAML than those who received TBI with cyclophosphamide or thiotepa (P <0.01). The median survival of patients developing tMDS/tAML was 7.5 months (range 0-32 months). CONCLUSIONS TBI, especially when used in combination with cyclophosphamide and etoposide as the pretransplant conditioning regimen, is a significant risk factor for the development of tMDS/tAML.
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Affiliation(s)
- C Hosing
- Department of Blood and Marrow Transplantation, The University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
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16
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Lin YW, Hamahata K, Watanabe K, Adachi S, Akiyama Y, Kubota M, Nakahata T. Repetitious appearance and disappearance of different kinds of clonal cytogenetic abnormalities after allogeneic bone marrow transplantation. Int J Hematol 2001; 74:86-9. [PMID: 11530811 DOI: 10.1007/bf02982555] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We report a childhood case that showed the repeated appearance and disappearance of various kinds of cytogenetic abnormalities (CA) for 5.5 years after allogeneic bone marrow transplantation (BMT). The patient underwent allogeneic BMT from an HLA-matched unrelated donor during the second complete remission of acute lymphoblastic leukemia. The conditioning regimen for BMT consisted of etoposide, cyclophosphamide, anti-human thymocyte immunoglobulin, and total body irradiation. There were no leukemic relapses or secondary acute myeloid leukemia/myelodysplastic syndrome (AML/MDS) since the BMT. The CA occurred from residual recipient cells, which were damaged by chemotherapy or radiation prior to BMT. Although previous studies about post-BMT CA had reported the continuous emergence of identical clones, the present case showed the appearance of one different type of clone after another. Although the appearance of different types of CA may mean that these clones did not obtain any growth advantages, it may be a sign of genomic instability, which is probably a risk factor for the development of secondary AML/MDS.
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Affiliation(s)
- Y W Lin
- Department of Pediatrics, Faculty of Medicine, Kyoto University, Japan.
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Seiter K, Feldman EJ, Sreekantaiah C, Pozzuoli M, Weisberger J, Liu D, Papageorgio C, Weiss M, Kancherla R, Ahmed T. Secondary acute myelogenous leukemia and myelodysplasia without abnormalities of chromosome 11q23 following treatment of acute leukemia with topoisomerase II-based chemotherapy. Leukemia 2001; 15:963-70. [PMID: 11417484 DOI: 10.1038/sj.leu.2402122] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Therapy-related MDS and AML are complications of intensive chemotherapy regimens. Traditionally, patients exposed to topoisomerase II inhibitors are reported to develop secondary AML with abnormalities of chromosome 11q23. We evaluated the long-term hematologic toxicity of topoisomerase II-intensive high-dose mitoxantrone-based chemotherapy in 163 newly diagnosed acute leukemia patients treated over an 8 year period. Nine (5.5%) patients developed new cytogenetic abnormalities. Four patients developed MDS with progression to AML, three patients developed new abnormalities at the time of relapse, and three patients (including one of the former patients) had changes that were not associated with hematologic disease. The abnormalities most frequently involved chromosomes 7q, 20q, 1q, and 13q. Despite the use of topoisomerase II-intensive treatment, no patient developed an abnormality involving chromosome 11q23. Spontaneous resolution of some changes and prolonged persistence of others in the absence of hematologic disease indicates that some cytogenetic changes are not sufficient to promote leukemogenesis.
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MESH Headings
- Acute Disease
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Chromosome Aberrations
- Chromosomes, Human, Pair 11/ultrastructure
- Clinical Trials, Phase II as Topic
- Clinical Trials, Phase III as Topic
- Cytarabine/administration & dosage
- Disease Progression
- Disease-Free Survival
- Enzyme Inhibitors/administration & dosage
- Enzyme Inhibitors/adverse effects
- Etoposide/administration & dosage
- Female
- Humans
- Idarubicin/administration & dosage
- Incidence
- Karyotyping
- Leukemia, Myeloid/chemically induced
- Leukemia, Myeloid/drug therapy
- Leukemia, Myeloid/epidemiology
- Leukemia, Myeloid/genetics
- Life Tables
- Male
- Middle Aged
- Mitoxantrone/administration & dosage
- Mitoxantrone/adverse effects
- Myelodysplastic Syndromes/chemically induced
- Myelodysplastic Syndromes/epidemiology
- Myelodysplastic Syndromes/genetics
- Neoplasm Proteins/antagonists & inhibitors
- Neoplasms, Second Primary/chemically induced
- Neoplasms, Second Primary/epidemiology
- Neoplasms, Second Primary/genetics
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy
- Randomized Controlled Trials as Topic
- Remission Induction
- Retrospective Studies
- Topoisomerase II Inhibitors
- Treatment Outcome
- Tretinoin/administration & dosage
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Affiliation(s)
- K Seiter
- Department of Medicine, Division of Oncology/Hematology, New York Medical College, New York, NY, USA
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Martínez-Climent JA, Comes AM, Vizcarra E, Benet I, Arbona C, Prósper F, Solano C, García Clavel B, Marugán I, Lluch A, García-Conde J. Chromosomal abnormalities in women with breast cancer after autologous stem cell transplantation are infrequent and may not predict development of therapy-related leukemia or myelodysplastic syndrome. Bone Marrow Transplant 2000; 25:1203-8. [PMID: 10849534 DOI: 10.1038/sj.bmt.1702416] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We determined prospectively the incidence of chromosomal abnormalities in patients with high-risk breast cancer (HRBC) after high-dose chemotherapy (HDCT) and autologous stem cell transplantation (ASCT), and correlated the cytogenetic abnormalities with the development of post-transplant myelodysplastic syndrome or acute myeloid leukemia (MDS/AML). From 1990 to 1999, 229 women with HRBC underwent ASCT. Cytogenetic analysis of bone marrow (BM) cells was performed 12-59 months after ASCT in 60 consecutive women uniformly treated with six courses of FAC/FEC followed by HDCT and ASCT. With a median follow-up of 36 months after ASCT, there were no cases of MDS/AML among the 229 patients. In the selected cohort of 60 patients, three (5%) showed clonal chromosomal abnormalities (two single trisomy X and one t(1;6)), whereas two additional patients showed non-clonal reciprocal translocations. Two of the patients with clonal aberrations had blood cytopenias as well as subtle dysplastic pictures in BM which were not classifiable as MDS according to the FAB criteria. Similar dysplastic features were also observed in four patients with normal karyotypes. All cytogenetic aberrations were transient and disappeared, except a +X detected by FISH in a residual cell population in one of the patients. Retrospective cytogenetic and FISH studies of samples obtained after six cycles of FAC/FEC and before transplant demonstrated no chromosomal abnormalities in any of the five patients with post-ASCT karyotypic changes. Early changes in karyotype detected in breast cancer patients following ASCT are transient and do not correlate with or predict development of MDS/AML. As these aberrations were not present before ASCT, they may be related to the HDCT regimen or transplant procedure rather than to the prior adjuvant therapy. Our results suggest that ASCT may be less likely to cause MDS or AML in breast cancer patients as compared to other malignancies. Bone Marrow Transplantation (2000) 25, 1203-1208.
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Affiliation(s)
- J A Martínez-Climent
- Department of Hematology and Medical Oncology, Hospital Clinico Universitario, University of Valencia, Spain
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Therapy-related acute myeloid leukemia and myelodysplasia after high-dose chemotherapy and autologous stem cell transplantation. Blood 2000. [DOI: 10.1182/blood.v95.11.3273] [Citation(s) in RCA: 181] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Therapy-related myelodysplasia (t-MDS) and acute myeloid leukemia (t-AML) after high-dose chemotherapy (HD-CT) and autologous stem cell transplantation (ASCT) for malignant diseases have become an important problem. The actuarial risk has varied, but has often been high if compared to the risk after conventional therapy. Prior chemotherapy with large cumulative doses of alkylating agents is the most important risk factor. In addition, patient age and previous radiotherapy, particularly the use of total body irradiation (TBI) in the preparative regimen for ASCT, have been identified as risk factors. In 3 studies, patients transplanted with CD34+ cells from peripheral blood after chemotherapy priming showed a higher risk of t-MDS or t-AML than patients transplanted with cells isolated from the bone marrow without priming. To what extent this higher risk relates to the prior therapy with a different contamination with preleukemic, hematopoietic precursors of the CD34+ cells obtained by the 2 methods, or is a direct result of chemotherapy priming, or of an increasing awareness of these complications, remains to be determined. The latent period from ASCT to t-MDS and t-AML has often been short, 12 months or less in 27% of the patients. Bone marrow pathology of early cases of t-MDS after ASCT has often been neither diagnostic nor prognostic, but most patients presented chromosome aberrations, primarily deletions or loss of the long arms of chromosomes 5 and 7. The prognosis was in general poor, although 17% with indolent t-MDS survived more than 18 months from diagnosis, and most of these presented a normal karyotype or a single chromosome aberration.
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20
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Therapy-related acute myeloid leukemia and myelodysplasia after high-dose chemotherapy and autologous stem cell transplantation. Blood 2000. [DOI: 10.1182/blood.v95.11.3273.011k15_3273_3279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Therapy-related myelodysplasia (t-MDS) and acute myeloid leukemia (t-AML) after high-dose chemotherapy (HD-CT) and autologous stem cell transplantation (ASCT) for malignant diseases have become an important problem. The actuarial risk has varied, but has often been high if compared to the risk after conventional therapy. Prior chemotherapy with large cumulative doses of alkylating agents is the most important risk factor. In addition, patient age and previous radiotherapy, particularly the use of total body irradiation (TBI) in the preparative regimen for ASCT, have been identified as risk factors. In 3 studies, patients transplanted with CD34+ cells from peripheral blood after chemotherapy priming showed a higher risk of t-MDS or t-AML than patients transplanted with cells isolated from the bone marrow without priming. To what extent this higher risk relates to the prior therapy with a different contamination with preleukemic, hematopoietic precursors of the CD34+ cells obtained by the 2 methods, or is a direct result of chemotherapy priming, or of an increasing awareness of these complications, remains to be determined. The latent period from ASCT to t-MDS and t-AML has often been short, 12 months or less in 27% of the patients. Bone marrow pathology of early cases of t-MDS after ASCT has often been neither diagnostic nor prognostic, but most patients presented chromosome aberrations, primarily deletions or loss of the long arms of chromosomes 5 and 7. The prognosis was in general poor, although 17% with indolent t-MDS survived more than 18 months from diagnosis, and most of these presented a normal karyotype or a single chromosome aberration.
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