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New Therapeutic Strategies for Adult Acute Myeloid Leukemia. Cancers (Basel) 2022; 14:cancers14112806. [PMID: 35681786 PMCID: PMC9179253 DOI: 10.3390/cancers14112806] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 05/27/2022] [Accepted: 05/29/2022] [Indexed: 12/19/2022] Open
Abstract
Simple Summary For almost 40 years, the combination of anthracyclines and cytarabine, called 3 + 7, has been the standard of induction chemotherapy for the treatment of acute myeloid leukemia (AML). However, with the advent of new drugs in recent years, it has become possible to improve the prognosis of patients with AML harboring certain genetic mutations. Additionally, immunotherapies and therapies targeting cell-surface antigens, which are highly expressed in AML, are emerging. Herein, we review new therapeutic strategies for AML that are evolving with the introduction of these drugs. Abstract Acute myeloid leukemia (AML) is a genetically heterogeneous hematological malignancy. Chromosomal and genetic analyses are important for the diagnosis and prognosis of AML. Some patients experience relapse or have refractory disease, despite conventional cytotoxic chemotherapies and allogeneic transplantation, and a variety of new agents and treatment strategies have emerged. After over 20 years during which no new drugs became available for the treatment of AML, the CD33-targeting antibody–drug conjugate gemtuzumab ozogamicin was developed. This is currently used in combination with standard chemotherapy or as a single agent. CPX-351, a liposomal formulation containing daunorubicin and cytarabine, has become one of the standard treatments for secondary AML in the elderly. FMS-like tyrosine kinase 3 (FLT3) inhibitors and isocitrate dehydrogenase 1/2 (IDH 1/2) inhibitors are mainly used for AML patients with actionable mutations. In addition to hypomethylating agents and venetoclax, a B-cell lymphoma-2 inhibitor is used in frail patients with newly diagnosed AML. Recently, tumor protein p53 inhibitors, cyclin-dependent kinase inhibitors, and NEDD8 E1-activating enzyme inhibitors have been gaining attention, and a suitable strategy for the use of these drugs is required. Antibody drugs targeting cell-surface markers and immunotherapies, such as antibody–drug conjugates and chimeric antigen receptor T-cell therapy, have also been developed for AML.
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Abstract
Introduction: Trisomy 8 is one of the most common cytogenetic alterations in acute myeloid leukemia (AML), with a frequency between 10% and 15%.Areas covered: The authors summarize the latest research regarding biological, translational and clinical aspects of trisomy 8 in AML.Expert opinion: Trisomy 8 can be found together with other karyotypes, although it also occurs as a sole aberration. The last decade's research has brought attention to molecular genetic alterations as strong contributors of leukemogenesis. AML with trisomy 8 seems to be associated with mutations in DNA methylation genes, spliceosome complex genes, and myeloid transcription factor genes, and these alterations probably have stronger implication for leukemic pathogenesis, treatment and hence prognosis, than the existence of trisomy 8 itself. Especially mutations in the RUNX1 and ASXL1 genes occur in high frequencies, and search for such mutations should be mandatory part of the diagnostic workup. AML with trisomy 8 is classified as intermediate-risk AML after recent European Leukemia Net (ELN) classification, and hence allogenic hematopoietic stem cell transplantation (Allo-HSCT) should be consider as consolidation therapy for this patient group.Trisomy 8 is frequently occurring in AML, although future molecular genetic workup should be performed, to optimize the diagnosis and treatment of these patients.
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Affiliation(s)
- Anette Lodvir Hemsing
- Division for Hematology, Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Randi Hovland
- Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway.,Department of Biological Sciences, University of Bergen, Bergen, Norway
| | - Galina Tsykunova
- Division for Hematology, Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Håkon Reikvam
- Division for Hematology, Department of Medicine, Haukeland University Hospital, Bergen, Norway.,Institute of Clinical Science, University of Bergen, Bergen, Norway
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3
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D'Alessandro E, Paterlini P, Menaguale L, Lo Re ML, Del Porto G, Quaglino D. Unusual Interstitial Deletion of the 8q 12 Band in a Case of Acute Monocytic Leukemia. TUMORI JOURNAL 2018; 73:437-43. [PMID: 3479856 DOI: 10.1177/030089168707300502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The authors describe a case of acute monocytic leukemia with a clonal deletion of the 8q12 band as a single chromosomal aberration. On the basis of this and other reports from the literature, they suggest that the 8q1 region, hitherto considered significantly involved in solid tumors, may be important also for hematologic malignancies.
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Affiliation(s)
- E D'Alessandro
- Cattedra di Genetica Medica, Università de L'Aquila, Italia
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4
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Orazi A, Cattoretti G, Sozzi G, Miozzo M, Polli N, Delia D, Viviani S, Negretti E, Della Porta G, Rilke F. Morphologic, Immunologic, and Cytogenetic Characteristics of Secondary Acute Unclassifiable Leukemia in Hodgkin's Disease. TUMORI JOURNAL 2018; 74:439-50. [PMID: 3188241 DOI: 10.1177/030089168807400411] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Blast cells from five cases of secondary unclassifiable leukemia following therapy for Hodgkin's disease were studied by cytochemical, immunological and cytogenetic analyses. Cytochemical and immunological reactivity were in accordance with poorly differentiated, myeloid blasts. The four cases in which karyotype analysis was performed showed specific chromosomal abnormalities. No evidence of multiple lineage involvement was found. Problems in classifying these cases of secondary ANLL were due to the high grade of undifferentiation of the blast cells. Their low cytochemical reactivity with markers of myeloid differentiation was similar to what may be observed in patients with acute undifferentiated leukemia or with chronic myeloid leukemia in blast crisis.
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Affiliation(s)
- A Orazi
- Divisione di Anatomia Patologica e Citologia, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milano, Italia
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5
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Park SH, Chi HS, Park SJ, Jang S, Park CJ. [Clinical importance of morphological multilineage dysplasia in acute myeloid leukemia with myelodysplasia related changes]. Korean J Lab Med 2010; 30:231-8. [PMID: 20603581 DOI: 10.3343/kjlm.2010.30.3.231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AML with myelodysplasia related changes (AML MRC) is known to show a poor prognosis compared with de novo AML, but controversies exist about the prognostic impact of multilineage dysplasia (MLD) among MRC. We investigated the prognostic impact of MLD in AML MRC. METHODS A total of 357 patients newly diagnosed as AML at Asan Medical Center from January 2001 to December 2005 were analyzed. They were diagnosed and classified as AML with recurrent genetic abnormalities, AML MRC, and AML not otherwise specified (AML NOS). Prognostic markers including overall survival (OS) and event free survival (EFS) were obtained through retrospective analysis of electronic medical records. RESULTS AML MRC patients showed a lower complete remission (CR) rate (44.7% vs. 64.9%, P=0.002) and shorter OS (297 vs. 561 days, P=0.004) and EFS (229 vs. 374 days, P=0.004) than AML NOS patients. Patients with MLD among AML MRC also showed a lower CR rate (37.7%, P=0.001) and shorter OS (351 days, P=0.036) and EFS (242 days, P=0.076) than AML NOS patients. However, among AML MRC patients, there were no differences in OS, EFS and CR between patients with and without MLD. CONCLUSIONS AML MRC patients showed a lower CR rate and shorter OS and EFS than AML NOS patients. AML MRC patients with MLD showed similar results and their prognosis was not different from those without MLD. MLD findings among AML MRC could be an independent poor prognostic factor in de novo AML.
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Affiliation(s)
- Sang Hyuk Park
- Department of Laboratory Medicine, University of Ulsan College of Medicine, Seoul, Korea
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Juliusson G, Oscier D, Juliusson G, Gahrton G, Oscier D, Fitchett M, Ross F, Brito-Babapulle V, Catovsky D, Knuutila S, Elonen E, Lechleitner M, Tanzer J, Schoenwald M, Castoldi GL, Cuneo A, Nowell P, Peterson L, Kay N. Cytogenetic Findings and Survival in B-cell Chronic Lymphocytic Leukemia. Second IWCCLL Compilation of Data on 662 Patients. Leuk Lymphoma 2009; 5 Suppl 1:21-5. [DOI: 10.3109/10428199109103374] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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7
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Paulsson K, Johansson B. Trisomy 8 as the sole chromosomal aberration in acute myeloid leukemia and myelodysplastic syndromes. ACTA ACUST UNITED AC 2007; 55:37-48. [PMID: 16697122 DOI: 10.1016/j.patbio.2006.04.007] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2006] [Accepted: 04/05/2006] [Indexed: 10/24/2022]
Abstract
Trisomy 8 as the sole abnormality is the most common karyotypic finding in acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS), occurring in approximately 5% and 10% of the cytogenetically abnormal cases, respectively. However, despite the high frequency of +8, much remains to be elucidated as regards its epidemiology, etiology, clinical impact, association with other chromosomal abnormalities, cell of origin, and functional and pathogenetic consequences. Here, we summarize and review these various aspects of trisomy 8, focusing on AMLs and MDS harboring this abnormality as a single change.
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Affiliation(s)
- K Paulsson
- Department of Clinical Genetics, University Hospital, SE-221 85 Lund, Sweden.
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8
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Jaff N, Chelghoum Y, Elhamri M, Tigaud I, Michallet M, Thomas X. Trisomy 8 as sole anomaly or with other clonal aberrations in acute myeloid leukemia: impact on clinical presentation and outcome. Leuk Res 2006; 31:67-73. [PMID: 16814381 DOI: 10.1016/j.leukres.2006.05.017] [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] [Received: 03/13/2006] [Revised: 05/13/2006] [Accepted: 05/18/2006] [Indexed: 10/24/2022]
Abstract
One hundred and fifty-four acute myeloid leukemia patients with trisomy 8 were studied for their clinical and biological characteristics, and treatment outcome. Forty-seven patients presented with trisomy 8 as the sole aberration, 107 with trisomy 8 associated with other cytogenetic abnormalities (13 with favorable, 54 with intermediate, and 40 with unfavorable risk cytogenetics). Overall complete remission (CR) proportion was 48%. Median disease-free survival (DFS) and overall survival (OS) were 7.8 and 8.3 months, respectively. In multivariate analysis, age >or=60 years (P<0.0001) and association with unfavorable karyotype (P=0.03) were of poor prognostic value for CR achievement. Age >or=60 years (P<0.0001) and antecedents of dysmyelopoiesis (P=0.02) were of poor prognostic value for OS. Patients with trisomy 8 alone did not show any difference in terms of outcome as compared with those in whom trisomy 8 was associated to intermediate risk cytogenetics (P=0.0002). Trisomy 8 in addition to favorable karyotype maintained a good clinical outcome, while trisomy 8 in addition to unfavorable cytogenetics showed the worst prognosis.
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MESH Headings
- Adolescent
- Adult
- Age Distribution
- Aged
- Aged, 80 and over
- Chromosome Aberrations
- Chromosomes, Human, Pair 8
- Female
- Humans
- Leukemia, Myeloid/blood
- Leukemia, Myeloid/genetics
- Leukemia, Myeloid/mortality
- Leukemia, Myeloid, Acute/blood
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/mortality
- Leukocyte Count
- Male
- Middle Aged
- Retrospective Studies
- Survival Analysis
- Treatment Outcome
- Trisomy/genetics
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Affiliation(s)
- Nabaz Jaff
- Service d'Hématologie, Hôpital Edouard Herriot, 69437 Lyon Cedex 03, France
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9
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. KAM, . AEG, . AE, . HM. Developmental, Behavioral and Genetic Factors in Correlation with Attention Deficit Hyperactivity Disorder in Egyptian Children. JOURNAL OF MEDICAL SCIENCES 2006. [DOI: 10.3923/jms.2006.569.576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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10
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Babicka L, Ransdorfova S, Brezinova J, Zemanova Z, Sindelarova L, Siskova M, Maaloufova J, Cermak J, Michalova K. Analysis of complex chromosomal rearrangements in adult patients with MDS and AML by multicolor FISH. Leuk Res 2006; 31:39-47. [PMID: 16687173 DOI: 10.1016/j.leukres.2006.03.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2006] [Revised: 02/28/2006] [Accepted: 03/04/2006] [Indexed: 11/16/2022]
Abstract
We analyzed complex chromosomal aberrations in 37 adult patients with myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) using classical cytogenetic method, FISH with locus-specific probes, multicolor FISH (mFISH) and multicolor banding (mBAND). Unbalanced structural aberrations, leading to a gain or loss of chromosomal material, were frequently observed in bone marrow cells. In 30 patients (81.1%) loss or rearrangement of chromosome 5, 7 and/or 11 was found. The most frequent numerical change was trisomy 8 as expected (detected in six patients-16.2%) and the most frequent breakpoints 5q13, 5q33, 7q31, 10p12, 11q23, 12p13, 17p11 and 21q22 were determined.
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Affiliation(s)
- Libuse Babicka
- Center of Oncocytogenetics, Institute of Clinical Biochemistry and Laboratory Diagnostics, General Faculty Hospital and 1st Faculty of Medicine of Charles University, Prague, Czech Republic.
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11
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Büchner T, Berdel WE, Wörmann B, Schoch C, Haferlach T, Schnittger S, Kern W, Aul C, Lengfelder E, Schumacher A, Reichle A, Staib P, Balleisen L, Eimermacher H, Grüneisen A, Rasche H, Sauerland MC, Heinecke A, Mesters RM, Serve HL, Kienast J, Hiddemann W. Treatment of older patients with AML. Crit Rev Oncol Hematol 2005; 56:247-59. [PMID: 16246568 DOI: 10.1016/j.critrevonc.2004.09.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2004] [Revised: 08/30/2004] [Accepted: 09/24/2004] [Indexed: 11/12/2022] Open
Abstract
Undertreatment of the older patients with AML can explain, in part, their inferior outcome when compared with that in younger patients. In analogy to the benefit of patients under the age of 60 years from high-dose AraC there are dosage related therapeutic effects in the patients over 60 years in particular for daunorubicin in the induction treatment, and for maintenance versus no maintenance in the post-remission treatment. Utilizing these effects can partly overcome the mostly unfavorable disease biology in older age AML, whereas the role of risk factors involved is not completely understood and the concept of dose-response needs to be requestioned. We recommend an adequate dosage of 60 mg/(m2day) daunorubicin for 3 days in a combination with standard dose AraC and 6-thioguanine given for induction and consolidation and followed by a prolonged monthly maintenance chemotherapy. Further improvements in supportive care may help delivering additional anti-leukemic cytotoxicity. As a novel approach, reduced toxicity preparative regimens may open up allogeneic transplantation for older patients with AML. Other new options like MDR modulators, antibody targeted therapies and tyrosine kinase inhibitors are under clinical investigation. A questionnaire study in patients with AML showed that according to patients' self-assessment intensive and prolonged treatment did not result in decreasing quality of life. This finding did not vary by age under or above 60 years. Given the actual median age in this disease being more than 60 years the adequate management of older age AML remains as the major challenge.
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Affiliation(s)
- Thomas Büchner
- University Hospital, Department of Medicine, Hematology and Oncology, Albert-Schweitzer-Str. 33, D-48129 Münster, Germany.
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12
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Liu CC, Chou YL, Ch'ang LY. Down-regulation of human NDR gene in megakaryocytic differentiation of erythroleukemia K562 cells. J Biomed Sci 2004; 11:104-16. [PMID: 14730214 DOI: 10.1007/bf02256553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2003] [Accepted: 07/29/2003] [Indexed: 10/25/2022] Open
Abstract
To study the control of hematopoietic cell differentiation, a human negative differentiation regulator (NDR) gene was identified by the comparative analysis of differentially expressed genes in hemato-lymphoid tissues. NDR is expressed preferentially in the adult bone marrow, fetal liver and testis. Immunocytochemistry with anti-NDR antiserum showed the presence of NDR in human erythroleukemia K562 cell line and CD34+ cells sorted from the umbilical cord blood. When fused to the green fluorescent protein (GFP), NDR was directed to the nucleus of mouse 3T3 and K562 cells. Fusion protein with a deletion from residues 7 to 87 was detected in the cytoplasm. NDR appeared not to affect the proliferation of K562 cells when overly expressed. However, its expression was down-regulated during megakaryocytic differentiation of K562 cells induced by 12-O-tetradecanoylphorbol-13-acetate (TPA). Down-regulation of NDR correlated well with up-regulation of megakaryocytic markers, CD41 and CD61. Overexpression of the nuclear NDR-GFP in K562 cells inhibited the expression of CD41 and CD61 in megakaryocytic differentiation. Treatment of K562 cells with GF-109203X (GFX), an antagonist of the protein kinase C (PKC), blocked NDR down-regulation, up-regulated expression of CD41/CD61 and TPA-induced megakaryocytic differentiation. These results suggest a novel function of nuclear NDR protein in regulating hematopoietic cell development.
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Affiliation(s)
- Cheng-Chung Liu
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan, ROC
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13
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Patnaik SC, Swain T, Jena RK, Ray B. Chromosomal Abnormalities in Acute Myeloid Leukemia Patients of Orissa and Their Prognostic Implications. CYTOLOGIA 2004. [DOI: 10.1508/cytologia.69.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | - Banishree Ray
- Cytogenetics Laboratory, Ravenshaw Autonomous College
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14
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Van Besien K, Devine S, Wickrema A, Jessop E, Amin K, Yassine M, Maynard V, Stock W, Peace D, Ravandi F, Chen YH, Hoffman R, Sossman J. Regimen-related toxicity after fludarabine-melphalan conditioning: a prospective study of 31 patients with hematologic malignancies. Bone Marrow Transplant 2003; 32:471-6. [PMID: 12942092 DOI: 10.1038/sj.bmt.1704166] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A total of 31 consecutive patients with hematologic malignancies who were considered poor candidates for TBI underwent allogeneic stem cell transplantation after conditioning with fludarabine and melphalan. A total of 25 matched sibling recipients received fludarabine 25 mg/m(2) x 5 days and melphalan 70 mg/m(2) x 2 days. For unrelated and haploidentical donor recipients, fludarabine was increased to 30 mg/m(2) and ATG 30 mg/kg x 4 days was added. Graft-versus-host disease prophylaxis consisted of tacrolimus and mini methotrexate. All patients engrafted. Regimen-related toxicity was considerable and included mainly renal, hepatic and mucosal toxicity. There were seven regimen-related-deaths including two VOD, two pulmonary, one renal, one cardiac and one mucosal toxicity. One case of fatal pulmonary toxicity death could be attributed to pre-existing pulmonary damage. Progression-free survival at 12 months was 44% (90% CI: 30-58%) for recipients of HLA-identical sibling transplants and 33% (90% CI: 21-45%) for all patients. In conclusion, the fludarabine-melphalan regimen leads to consistent engraftment. The regimen-related toxicity is considerable and cannot be explained solely by patient selection. Cardiac toxicity is emerging as a unique toxicity of this regimen. Despite toxicity, fludarabine-melphalan has considerable activity and leads to durable remission in a proportion of patients.
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Affiliation(s)
- K Van Besien
- University of Illinois at Chicago, Chicago, IL 60637, USA
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15
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Berger R, Coniat MBL. Double trisomy 8 and 21 in acute myelocytic leukemias, one with rearrangement of the RUNX1 gene. CANCER GENETICS AND CYTOGENETICS 2003; 142:158-61. [PMID: 12699896 DOI: 10.1016/s0165-4608(02)00869-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Fluorescence in situ hybridization analysis was carried out in five patients with acute myeloblastic leukemia of various French-American-British subtypes and with double trisomy of chromosomes 8 and 21. PML-RARA fusion was detected with appropriate molecular probes in one patient with acute promyelocytic leukemia without t(15;17). Two PAC probes covering the 5' and 3' part of the RUNX1 gene were used in the four other patients. While three copies were present in three patients, as expected from conventional karyotype analysis, only two hybridization signals were present in the fifth patient. This was due to the apparent loss of the 3' part of RUNX1. Since chromosome number abnormalities may be associated with submicroscopic gene rearrangements, it should be important to search for them for a better understanding of mechanisms of leukemogenesis, and to understand the prognostic heterogeneity in leukemic patients with aneusomies without apparent chromosome structure rearrangements.
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Affiliation(s)
- Roland Berger
- INSERM Equipe Mixte EMI 02 10/Unité U 434 and SD 401 No. 434 CNRS, Institut de Génétique Moléculaire, 75010 Paris, France.
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16
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Schoch C, Haferlach T, Bursch S, Gerstner D, Schnittger S, Dugas M, Kern W, Löffler H, Hiddemann W. Loss of genetic material is more common than gain in acute myeloid leukemia with complex aberrant karyotype: a detailed analysis of 125 cases using conventional chromosome analysis and fluorescence in situ hybridization including 24-color FISH. Genes Chromosomes Cancer 2002; 35:20-9. [PMID: 12203786 DOI: 10.1002/gcc.10088] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Patients with acute myeloid leukemia (AML) and a complex aberrant karyotype have a poor outcome despite intensive antileukemic treatment. The aim of this study was to analyze in detail the genetic abnormalities in this subgroup of AML. Therefore, 125 AML cases with complex aberrant karyotype detected by G-banding were examined in addition with 24-color FISH and FISH with locus-specific probes for EGR1 (5q31), D7S522 (7q31), and TP53 (17p13), given that these regions are known to be commonly deleted in AML with a complex aberrant karyotype. The number of chromosome abnormalities per case varied from 3 to 30 (median 10). A gain of a whole chromosome was observed 131 times, with +8 (n = 30), +10 (n = 11), and +22 (n = 10) being the most frequent trisomies. A loss of a whole chromosome occurred 128 times. The chromosomes most often lost were 7 (n = 25), 18 (n = 24), and 17 (n = 17). Structural aberrations, leading to a gain or loss of chromosomal material, were detected 104 times and 433 times, respectively. Aberrations including only two chromosomes that seemed to be balanced were found only 19 times. Losses resulting from structural abnormalities most frequently involved 5q (n = 100), 17p (n = 47), and 12p (n = 29), whereas gains of 11q (n = 21), 21q (n = 19), and 8q (n = 11) were observed. Using locus-specific probes, deletions of the EGR1 locus (5q31), of 7q31, and the TP53 gene were observed in 103 (82%), 57 (46%), and 66 (53%) cases, respectively. In conclusion, in AML with a complex aberrant karyotype, loss of chromosomal material was observed much more often than gain. Unbalanced rearrangements leading to loss of chromosomal material are much more frequent than loss of whole chromosomes. These data suggest that in AML with a complex aberrant karyotype, loss of tumor-suppressor genes is a more important mechanism of leukemogenesis than activation of oncogenes, and that gene-dosage effects may play a significant role in the pathogenesis of this AML subtype.
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MESH Headings
- Acute Disease
- Adult
- Aged
- Aged, 80 and over
- Chromosome Aberrations/classification
- Chromosome Banding
- Chromosome Deletion
- Chromosome Painting/methods
- Female
- Gene Amplification/genetics
- Genetic Markers/genetics
- Humans
- In Situ Hybridization, Fluorescence/methods
- Karyotyping
- Leukemia, Erythroblastic, Acute/genetics
- Leukemia, Megakaryoblastic, Acute/genetics
- Leukemia, Monocytic, Acute/genetics
- Leukemia, Myeloid/genetics
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myelomonocytic, Acute/genetics
- Leukemia, Promyelocytic, Acute/genetics
- Male
- Middle Aged
- Ring Chromosomes
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Affiliation(s)
- Claudia Schoch
- Department of Internal Medicine III, University Hospital Grosshadern, Ludwig-Maximilians-University, Munich, Germany
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17
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Creutzig U, Reinhardt D. Current controversies: which patients with acute myeloid leukaemia should receive a bone marrow transplantation?--a European view. Br J Haematol 2002; 118:365-77. [PMID: 12139720 DOI: 10.1046/j.1365-2141.2002.03697.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Ursula Creutzig
- Klinik und Poliklinik für Kinderheilkunde, Pädiatrische Hämatologie/Onkologie, Albert-Schweitzer-Strasse 33, D-48129 Münster, Germany.
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18
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Büchner T, Hiddemann W, Berdel W, Wörmann B, Schoch C, Löffler H, Haferlach T, Schumacher A, Staib P, Balleisen L, Grüneisen A, Rasche H, Aul C, Heyll A, Lengfelder E, Ludwig WD, Maschmeyer G, Eimermacher H, Karow J, Frickhofen N, Hirschmann WD, Sauerland MC. Acute myeloid leukemia: treatment over 60. REVIEWS IN CLINICAL AND EXPERIMENTAL HEMATOLOGY 2002; 6:46-59; discussion 86-7. [PMID: 12060483 DOI: 10.1046/j.1468-0734.2002.00059.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Undertreatment of older patients with acute myeloid leukemia (AML) can explain, in part, their inferior outcome when compared to that of younger patients. In agreement with the benefit seen by patients under age 60 from high-dose cytosine arabinoside (Ara-C), there are dose effects in the over 60s, in particular for daunorubicin, in induction treatment and for the duration of postremission treatment. The use of these effects can partly overcome the mostly unfavorable disease biology in older age AML, as expressed by the absence of favorable and the over-representation of adverse chromosomal abnormalities as well as the expression of drug resistance. We recommend an adequate dosage of 60 mg/m2 daunorubicin on 3 days in combination with standard dose Ara-C and 6-thioguanine given for induction and consolidation, and followed by a prolonged monthly maintenance chemotherapy for at least 1 year's duration. Further improvements in supportive care may help to deliver additional antileukemic cytotoxicity. As a novel approach, nonmyeloablative preparative regimens may open up the possibility of allogeneic transplantation for older patients with AML. Other new options like multidrug resistance modulators, antibody targeted therapies and molecular targeting are under clinical investigation. A questionnaire study in patients with AML showed that, according to patients' self-assessment, intensive and prolonged treatment did not result in a diminished quality of life. This finding did not vary by age, under or over 60 years. As the median age in this disease is more than 60 years, the adequate management of AML in older patients remains the major challenge.
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Affiliation(s)
- Thomas Büchner
- University of Münster, Department of Medicine, Hematology and Oncology, Germany.
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19
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Büchner T, Hiddemann W, Schoch C, Haferlach T, Sauerland MC, Heinecke A. Acute myeloid leukaemia (AML): treatment of the older patient. Best Pract Res Clin Haematol 2001; 14:139-51. [PMID: 11355928 DOI: 10.1053/beha.2000.0120] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Undertreatment of the older patients with acute myeloid leukaemia (AML) can explain, in part, their inferior outcome when compared with that of younger patients. Corresponding to the benefit to patients under the age of 60 from high-dose Ara-C there are also dose effects in those over 60 years old, in particular for daunorubicin in the induction treatment, and for the quantity in terms of duration of postremission treatment. The use of these effects can partly overcome the mostly unfavourable disease biology seen in older age AML patients, which is expressed by the absence of favourable and the over-representation of adverse chromosomal abnormalities as well as by the expression of drug resistance. We recommend an adequate dosage of 60 mg/m(2)daunorubicin for 3 days in combination with standard dose Ara-C and 6-thioguanine given for induction and consolidation, followed by a prolonged monthly maintenance chemotherapy for a duration of at least 1 year. Further improvements in supportive care may help in delivering additional anti-leukaemic cytotoxicity. As a novel approach, non-myeloablative preparative regimens may open up the field of allogeneic transplantation for older patients with AML. Given that the actual median age in this disease is more than 60 years the management of older age AML remains as the major challenge.
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Affiliation(s)
- T Büchner
- Department of Internal Medicine, University Hospital, Albert-Schweitzer-str. 33, Münster, D-48129, Germany.
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20
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Somjee S, Borker A, Gardner R, Velez MC. Multiple granulocytic sarcomas in acute myeloblastic leukemia with simultaneous occurrence of t(8:21) and trisomy 8. Leuk Lymphoma 2001; 42:1139-44. [PMID: 11697634 DOI: 10.3109/10428190109097737] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This report describes a rare case of multiple intracranial, extradural chloromas. A five year old African American male presented with headache, fever, and vomiting. The peripheral blood smear showed myeloblasts with Auer rods. The CTscan of the brain showed three intracranial, epidural lesions as well as soft tissue masses in the retroorbital region and sphenoid sinuses. CTscan of the chest showed two paraspinal epidural thoracic masses. Pathology of the epidural intracranial mass revealed a granulocytic sarcoma. Cytogenetic analysis showed simultaneous occurrence of t(8;21) and trisomy 8. Following induction therapy, he is now in complete remission.
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MESH Headings
- Brain Neoplasms/diagnosis
- Brain Neoplasms/diagnostic imaging
- Brain Neoplasms/genetics
- Child, Preschool
- Chromosome Aberrations
- Chromosomes, Human, Pair 21
- Chromosomes, Human, Pair 8
- Cytogenetic Analysis
- Epidural Neoplasms/diagnosis
- Epidural Neoplasms/diagnostic imaging
- Epidural Neoplasms/genetics
- Humans
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/genetics
- Male
- Radiography
- Remission Induction
- Sarcoma, Myeloid/diagnosis
- Sarcoma, Myeloid/diagnostic imaging
- Sarcoma, Myeloid/genetics
- Translocation, Genetic
- Trisomy
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Affiliation(s)
- S Somjee
- Department of Pediatric Hematology-Oncology, LSU Health Sciences Center & Childrens Hospital, New Orleans, LA 70118, USA
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21
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Yang LV, Nicholson RH, Kaplan J, Galy A, Li L. Hemogen is a novel nuclear factor specifically expressed in mouse hematopoietic development and its human homologue EDAG maps to chromosome 9q22, a region containing breakpoints of hematological neoplasms. Mech Dev 2001; 104:105-11. [PMID: 11404085 DOI: 10.1016/s0925-4773(01)00376-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We cloned a novel murine gene, designated Hemogen (hemopoietic gene), which was sequentially expressed in active hematopoietic sites and downregulated in the process of blood cell differentiation. Hemogen transcripts were specifically detected in blood islands, primitive blood cells and fetal liver during embryogenesis, and then remained in bone marrow and spleen in adult mice. Immunostaining demonstrated that Hemogen was a nuclear protein. We also identified a human homologue of Hemogen, named EDAG, which was mapped to chromosome 9q22, a leukemia breakpoint. Like Hemogen, EDAG exhibited specific expression in hematopoietic tissues and cells. Taken together, these data are consistent with Hemogen and EDAG playing an important role in hematopoietic development and neoplasms.
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Affiliation(s)
- L V Yang
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI 48201, USA
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22
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Abstract
The prognosis between subgroups of patients with acute myeloid leukaemia (AML) may range considerably. Haematological, genetic and clinical analysis has provided possibilities for defining the heterogeneity of prognosis. This furnishes clinically relevant insights into the probability of treatment response and survival in individual cases of AML and it provides a lead in treatment management.
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Affiliation(s)
- B Löwenberg
- Erasmus University and University Hospital Rotterdam, Rotterdam, 3000 CA, The Netherlands
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23
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24
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Sarriera JE, Albitar M, Estrov Z, Gidel C, Aboul-Nasr R, Manshouri T, Kornblau S, Chang KS, Kantarjian H, Estey E. Comparison of outcome in acute myelogenous leukemia patients with translocation (8;21) found by standard cytogenetic analysis and patients with AML1/ETO fusion transcript found only by PCR testing. Leukemia 2001; 15:57-61. [PMID: 11243400 DOI: 10.1038/sj.leu.2401951] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Patients with normal-karyotype acute myelogenous leukemia (NKAML) may have undetected genetic abnormalities that could affect prognosis. Screening for known AML-specific genetic abnormalities using the reverse transcription polymerase chain reaction (RT-PCR) may help in arriving at a more definitive prognosis. To test this hypothesis, 104 patients without translocation (8;21) and inversion(16), as shown by standard cytogenetic (SC) analysis, were screened for these two genetic abnormalities using RT-PCR. Western blot analysis for the AML1/ETO fusion protein and fluorescent in situ hybridization (FISH) analysis for t(8;21) were performed in patients for whom we had samples. The characteristics and outcome after high-dose cytarabine containing treatments in five patients with t(8;21) shown by RT-PCR alone were then compared to 21 patients with t(8;21) detected using SC analysis. Eight of the 104 patients had masked t(8;21) and none had masked inv(16), as shown by RT-PCR. Five of 54 patients with NKAML had a detectable AML1/ETO fusion RNA transcript. Western blot analysis showed the AML1/ETO fusion protein in four of the seven patients for whom we had samples among the eight with masked t(8;21) shown by RT-PCR. All patients with t(8;21) shown by RT-PCR had negative FISH results. Ninety percent (n=19) of the patients with t(8;21) shown by SC analysis and 40% (n= 2) of the patients with t(8;21) shown by RT-PCR alone achieved a complete remission (P value 0.03). These data suggest that the outcome of NKAML patients with t(8;21) shown by RT-PCR is not equivalent to patients with t(8;21) by SC studies.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Chromosomes, Human, Pair 21
- Chromosomes, Human, Pair 8
- Core Binding Factor Alpha 2 Subunit
- Cytogenetics/methods
- Humans
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/pathology
- Leukemia, Myeloid, Acute/physiopathology
- Middle Aged
- Oncogene Proteins, Fusion/analysis
- Oncogene Proteins, Fusion/genetics
- Polymerase Chain Reaction/methods
- Prognosis
- RUNX1 Translocation Partner 1 Protein
- Transcription Factors/analysis
- Transcription Factors/genetics
- Translocation, Genetic
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Affiliation(s)
- J E Sarriera
- Department of Hematology, The University of Texas MD Anderson Cancer Center, Houston 77030, USA
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25
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Schoch C, Haferlach T, Haase D, Fonatsch C, Löffler H, Schlegelberger B, Staib P, Sauerland MC, Heinecke A, Büchner T, Hiddemann W. Patients with de novo acute myeloid leukaemia and complex karyotype aberrations show a poor prognosis despite intensive treatment: a study of 90 patients. Br J Haematol 2001; 112:118-26. [PMID: 11167792 DOI: 10.1046/j.1365-2141.2001.02511.x] [Citation(s) in RCA: 140] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The clinical significance of complex chromosome aberrations for adults with acute myeloid leukaemia (AML) was assessed in 920 patients with de novo AML who were karyotyped and treated within the German AML Cooperative Group (AMLCG) trials. Complex chromosome aberrations were defined as three or more numerical and/or structural chromosome aberrations excluding translocations t(8;21)(q22;q22), t(15;17)(q22;q11-q12) and inv(16)(p13q22). Complex chromosome anomalies were detected in 10% of all cases with a significantly higher incidence in patients > or = 60 years of age (17.8% vs. 7.8%, P < 0.0001). Clinical follow-up data were available for 90 patients. Forty-five patients were < 60 years of age and were randomly assigned to double induction therapy with either TAD-TAD [thioguanine, daunorubicin, cytosine arabinoside (AraC)] or TAD-HAM (high-dose AraC, mitoxantrone). Twenty-one patients achieved complete remission (CR) (47%), 20 patients (44%) were non-responders and 9% of patients died during aplasia (early death). The median overall survival (OS) was 7 months and the OS rate at 3 years was 12%. Patients receiving TAD-HAM showed a significantly higher CR rate than patients receiving TAD-TAD (56% vs. 23%, P = 0.04). Median event-free survival was less than 1 month in the TAD-TAD group and 2 months in the TAD-HAM group, respectively (P = 0.04), with a median OS of 4.5 months vs. 7.6 months (P = 0.13) and an OS after 3 years of 7.6% vs. 19.6%. Forty-five patients were > or = 60 years of age: 28 of these patient were treated for induction using one or two TAD courses and 17 cases received TAD-HAM with an age-adjusted reduction of the AraC dose. The CR rate was 44%, 38% were non-responders and 18% experienced early death. The median OS was 8 months and the OS rate at 3 years was 6%. In conclusion, complex chromosome aberrations in de novo AML predicted a dismal outcome, even when patients were treated with intensive chemotherapy. Patients under the age of 60 years with complex aberrant karyotypes may benefit from HAM treatment during induction. However, long-term survival rates are low and alternative treatment strategies for remission induction and consolidation are urgently needed.
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Affiliation(s)
- C Schoch
- Department of Internal Medicine III, University Hospital Grosshadern, Ludwig-Maximilians-University, Munich, Germany.
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26
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Brendel C, Neubauer A. Characteristics and analysis of normal and leukemic stem cells: current concepts and future directions. Leukemia 2000; 14:1711-7. [PMID: 11021745 DOI: 10.1038/sj.leu.2401907] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Acute myeloid leukemias (AML) are considered to be clonal disorders involving early hematopoietic progenitor cells. The recent advances in characterization of early stem cells give rise to the question whether it is possible to distinguish healthy progenitors from cells of the leukemic clone in leukemia patients. Differences and similarities in phenotype, genotype and biology are described for leukemic cells and normal hematological progenitors. Recent new insights into human stem cell development offer the perspective that distinction between benign and malignant progenitors might be possible in the future at a very early stage of maturation.
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Affiliation(s)
- C Brendel
- Department of Hematology/Oncology/Immunology at the Universitätsklinikum of the Philipps-Universität Marburg, Germany
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27
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McGhee EM, Cohen NR, Wolf JL, Ledesma CT, Cotter PD. Monosomy 16 as the sole abnormality in myeloid malignancies. CANCER GENETICS AND CYTOGENETICS 2000; 118:163-6. [PMID: 10748300 DOI: 10.1016/s0165-4608(99)00194-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The majority of acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) patients reported with chromosome 16 abnormalities had the inv(16)(p13q22) or t(16;16)(p13;q22) rearrangements, which were associated with a favorable prognosis. In contrast, del(16)(q22) was reported less commonly but was associated with a less favorable prognosis. We describe an 80-year-old woman who presented with MDS (refractory anemia). Chromosome analysis from bone marrow aspirate cultures showed monosomy 16 as the sole cytogenetic abnormality. Comparison of this patient with previously reported cases of monosomy 16 showed that this uncommon abnormality was associated with myeloid disorders. Monosomy 16 patients, similar to del(16)(q22) patients, tended to be elderly, presented with MDS or AML, and had a poor prognosis. The similarity in clinical course for del(16)(q22) and monosomy 16 patients suggests that the phenotype in both groups resulted from loss of important gene(s) on 16q, as distinct from the fusion gene product identified in the inv(16) and t(16;16) rearrangements.
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Affiliation(s)
- E M McGhee
- Department of Pediatrics, Division of Medical Genetics, University of California at San Francisco, San Francisco, CA, USA
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28
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Paulien S, Busson-Le Coniat M, Berger R. Acute megakaryocytic leukaemia with acquired polysomy 21 and translocation t(1;21). ANNALES DE GENETIQUE 2000; 43:99-104. [PMID: 10998452 DOI: 10.1016/s0003-3995(00)01019-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Cytogenetic study of a young child with acute megakaryocytic leukaemia (AML-M7) has shown a karyotype with 49-50 chromosomes with one and two acquired extra chromosomes 21. Fluorescence in situ hybridization detected a minor clone with translocation t(1;21) and loss of a part of chromosome band 1p36. Trisomy and polysomy 21 are not uncommon in AML-M7. A more systematic search for chromosome 21 rearrangements in AML-M7 using FISH techniques is proposed.
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Affiliation(s)
- S Paulien
- Institut de biologie et biochimie appliquée (IBBA), Université de Caen, Esplanade de la Paix, 14032 cedex, Caen, France
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29
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MESH Headings
- Antineoplastic Agents/therapeutic use
- Bone Marrow Transplantation
- Core Binding Factor Alpha 2 Subunit
- DNA-Binding Proteins/genetics
- Hematopoietic Cell Growth Factors/therapeutic use
- Humans
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/therapy
- Leukemia, Myelomonocytic, Acute/diagnosis
- Leukemia, Myelomonocytic, Acute/genetics
- Leukemia, Myelomonocytic, Acute/therapy
- Prognosis
- Proto-Oncogene Proteins
- Recurrence
- Remission Induction
- Transcription Factor AP-2
- Transcription Factors/genetics
- Translocation, Genetic
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Affiliation(s)
- B Löwenberg
- Department of Hematology, Erasmus University and University Hospital Rotterdam, The Netherlands
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30
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Ma SK, Wan TS, Au WY, Chan LC. Trisomy 5 in two cases of acute monocytic leukemia with hyperdiploid clones. Leuk Res 1998; 22:961-4. [PMID: 9766757 DOI: 10.1016/s0145-2126(98)00095-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although numerical chromosomal aberrations are commonly seen in acute myeloid leukemia (AML), trisomy 5 (+ 5) is very rarely detected. We report two patients, both of whom suffered from acute monocytic leukemia, in which + 5 was found in hyperdiploid clones. A review of the English literature shows 17 additional cases of AML with + 5 in at least one of the abnormal clones, making a total of 19 such cases including ours. Trisomy 5 has been reported in all FAB subtypes of AML except acute promyelocytic leukemia. In the 19 cases identified in this report, + 5 was found in association with other numerical changes (four cases), structural changes (five cases) or both (eight cases). Trisomy 5 as a sole karyotypic abnormality was exceedingly rare (two cases). Its biologic and prognostic significance remains to be determined.
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Affiliation(s)
- S K Ma
- Department of Pathology, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
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31
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Lemez P, Michalová K, Zemanová Z, Marinov I, Trpáková A, Moravcová J, Jelínek J. Three cases of near-tetraploid acute myeloid leukemias originating in pluripotent myeloid progenitors. Leuk Res 1998; 22:581-8. [PMID: 9680107 DOI: 10.1016/s0145-2126(97)00177-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
We report three cases of acute myeloid leukemia (AML) with a near-tetraploid karyotype in most metaphases while lacking chromosomal abnormalities typical for AML. All patients, 63, 72 and 81 years old, were female. In two cases, AML was diagnosed 5-7 months after a cytopenic period while the third patient had a secondary AML after therapy for a pleural tumor. Leukemic blasts were classified as AML M0, AML M1 and AML without further specification. Two patients died on the 18th and 52nd day after the start of cytotoxic chemotherapy, the third patient refused chemotherapy and died 22 days after the diagnosis. The three patients may represent a distinct AML category with the following features: (1) the near-tetraploid karyotype in most bone marrow metaphases examined at diagnosis of AML; (2) the presence of very large myeloid blasts in the bone marrow and dysplastic changes in erythroid and/or megakaryocytic lineages pointing to the origin of AML in pluripotent myeloid progenitor cells; (3) the expression of the CD34 antigen; (4) the low growth of granulocyte-macrophage colony forming cells in culture; and (5) the presence of a preleukemic phase, a higher age and a poor prognosis.
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Affiliation(s)
- P Lemez
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
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32
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Pernice F, Musolino C, Mazza G, Puglisi D, Squadrito G, Frisina N, Squadrito G. Translocation (5;10)(q13;q26) in acute monoblastic leukemia. CANCER GENETICS AND CYTOGENETICS 1998; 101:152-5. [PMID: 9494619 DOI: 10.1016/s0165-4608(97)00264-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We report a case of acute monoblastic leukemia [French-American-British (FAB) M5a] observed in a 38-year-old man and associated at diagnosis with a t(5;10)(q13;q26) found in cells from a bone marrow culture. The patient survived only 2 months after diagnosis. t(5;10) as a solitary chromosome abnormality has not been previously reported in M5a, and, in the case that we describe, it appears to be correlated with a poor prognosis.
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Affiliation(s)
- F Pernice
- Cattedra e Divisione di Medicina Interna, Università degli Studi di Messina, Italy
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33
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Rennie IG. The Ashton Lecture. Uveal melanoma: the past, the present and the future. Eye (Lond) 1998; 11 ( Pt 2):255-64. [PMID: 9349422 DOI: 10.1038/eye.1997.61] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- I G Rennie
- Department of Ophthalmology and Orthoptics, University of Sheffield, Royal Hallamshire Hospital, UK
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34
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Legrand O, Perrot JY, Simonin G, Baudard M, Cadiou M, Blanc C, Ramond S, Viguié F, Marie JP, Zittoun R. Adult biphenotypic acute leukaemia: an entity with poor prognosis which is related to unfavourable cytogenetics and P-glycoprotein over-expression. Br J Haematol 1998; 100:147-55. [PMID: 9450804 DOI: 10.1046/j.1365-2141.1998.00523.x] [Citation(s) in RCA: 109] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Biphenotypic acute leukaemia (BAL) patients represented 8% of the 287 de novo consecutive adult acute leukaemias (23 BAL, 230 acute myeloid leukaemia (AML) and 34 acute lymphoblastic leukaemia (ALL)) referred to our department during the last 4-year period. Of these 23 BAL patients, 14 patients showed myeloid morphology and nine cases lymphoid morphology according to FAB criteria. There were no differences between lymphoid and myeloid BAL according to clinical and biological presentation and treatment outcome. We confirm the poor prognosis of BAL when compared to AML or ALL seen during the same period of time, in terms of complete remission (47%, 62% and 82% respectively, BAL v AML, NS and BAL v ALL, P = 0.006) and 4-year overall survival (8.1%, 25.8% and 23.8% respectively, BAL v AML, P = 0.05 and BAL v ALL, P = 0.003). Comparing adult BAL patients with AML patients, we found an increase in poor prognostic factors: CD34+ phenotype (82% v 60% respectively, P = 0.03), unfavourable karyotype (60% v 20%, P < 0.0001) and Pgp over-expression by RT-PCR (0.705 v 0.107, P < 0.0001) and flow cytometry (0.824 v 0.391, P = 0.0001). MRP and LRP were not found to be poor prognostic factors. Comparing BAL patients with ALL patients, we found also an increase in poor prognostic factors: age (51 v 39, P = 0.003) and CD34+ phenotype (82% v 50%, P = 0.02). We conclude that BAL patients need a more aggressive treatment procedure, including high-dose AraC or the use of Pgp modulators for first-line therapy.
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Affiliation(s)
- O Legrand
- Service d'Hématologie Clinique, Laboratoire de Culture et Cinétique Cellulaire, Hôpital Hôtel-Dieu, Paris, France
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35
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Pedersen B. MDS and AML with trisomy 8 as the sole chromosome aberration show different sex ratios and prognostic profiles: a study of 115 published cases. Am J Hematol 1997; 56:224-9. [PMID: 9395183 DOI: 10.1002/(sici)1096-8652(199712)56:4<224::aid-ajh5>3.0.co;2-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A number of chromosome aberrations occur nonrandomly as the sole aberration in malignant and premalignant hematological disorders. They imply very different prognoses. For most of them the survival consequences have been established. For trisomy 8, which is the most frequent numerical aberration in myeloid disorders, the prognostic implications have not been investigated. In order to clarify survival in patients with trisomy 8 as the sole aberration, the literature was searched for such cases. In 115 patients survival data were available. In 103 (89.6%), a myeloid disorder had been diagnosed. Acute myeloid leukemia (AML) or a myelodysplastic syndrome (MDS) occurred in 100 cases (87.0%). The median survival was found to be 17.1 months. On multivariate survival analysis (Cox), age above 60 and a leukemic diagnosis were found to be independent adverse prognostic indicators. MDS patients survived significantly longer (median 21 months) than AML patients (median 15 months). In MDS age and in AML the trisomy 8 clonal size was an independent prognostic factor. An unexpected observation was a clear male preponderance in trisomy 8 MDS (about two-thirds of cases). In trisomy 8 AML an approximate 1:1 ratio was found. Browsing of Mitelman's catalog confirmed these ratios.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Child
- Child, Preschool
- Chromosome Aberrations/genetics
- Chromosomes, Human, Pair 8
- Female
- Humans
- Infant
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/mortality
- Leukemia, Myeloid, Acute/pathology
- Male
- Middle Aged
- Myelodysplastic Syndromes/genetics
- Myelodysplastic Syndromes/mortality
- Myelodysplastic Syndromes/pathology
- Prognosis
- Retrospective Studies
- Sex Ratio
- Survival Analysis
- Trisomy/genetics
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Affiliation(s)
- B Pedersen
- Danish Cancer Society, Department of Cytogenetics, Aarhus C
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36
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Quaglino D, Furia N, Di Leonardo G, Limoncelli P, Campitelli A. Therapeutic management of hematological malignancies in elderly patients. Biological and clinical considerations. Part 1. Myelodysplasias and the acute leukemias. AGING (MILAN, ITALY) 1997; 9:231-40. [PMID: 9359934 DOI: 10.1007/bf03341826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The different therapeutic options that may be employed in the treatment of elderly patients with acute leukemias and myelodysplastic states are considered following an analysis of certain biological features, that have been investigated by cytochemical, cytogenetic and cytokinetic techniques, immunophenotyping, and studies on G-6-PD isoenzymes. These studies imply that in the elderly the pattern of hematological malignancies and the lack of response to conventional treatment derive from intrinsic biological differences between these pathological states in older and younger patients. Treatment in elderly patients has ranged from palliative treatment to intensive chemotherapy, often with disappointing results in both cases. Palliative treatment does not induce remissions, and median survival is short. On the other hand, elderly patients do not tolerate well both induction and post-remission therapy due to the degree of toxicity and the effects of drug-induced pancytopenia. In this scenario, in vitro drug-sensitivity testing and karyotyping assume increasing importance, because they may predict which patients are likely to benefit from intensive therapy. In both acute leukemias and myelodysplasias, treatment ideally should be designed case by case, according to the hematological, clinical and biological features.
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Affiliation(s)
- D Quaglino
- Department of Internal Medicine, University of L'Aquila, Italy
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37
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Abstract
Developments in supportive care, new regimens for induction of remission and consolidation therapy, and bone-marrow transplantation have improved the outlook for patients with acute leukaemia. The outlook, though, is influenced by age and factors related to the biology of the disease. In acute myeloid leukaemia age is such an important factor that it determines approach to therapy. Overcoming resistance to chemotherapy is an area that needs much attention.
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Affiliation(s)
- A K Burnett
- Department of Haematology, University of Wales College of Medicine, Cardiff, UK
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Fruchart C, Lenormand B, Bastard C, Boulet D, Lesesve JF, Callat MP, Stamatoullas A, Monconduit M, Tilly H. Correlation between CD34 expression and chromosomal abnormalities but not clinical outcome in acute myeloid leukemia. Am J Hematol 1996; 53:175-80. [PMID: 8895688 DOI: 10.1002/(sici)1096-8652(199611)53:3<175::aid-ajh5>3.0.co;2-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The hemopoietic stem cell marker CD34 has been reported to be a useful predictor of treatment outcome in acute myeloid leukemia (AML). Previous data suggested that CD34 expression may be associated with other poor prognosis factors in AML such as undifferentiated leukemia, secondary AML (SAML), and clonal abnormalities involving chromosome 5 and 7. In order to analyze the correlations between the clinicopathologic features, cytogenetic and CD34 expression in AML, we retrospectively investigated 99 patients with newly diagnosed AML: 85 with de novo disease and 14 with secondary AML (SAML). Eighty-six patients who received the same induction chemotherapy were available for clinical outcome. Defining a case as positive when > or = 20% of bone marrow cells collected at diagnosis expressed the CD34 antigen, forty-five patients were included in the CD34 positive group. Ninety patients had adequate cytogenetic analysis. Thirty-two patients (72%) with CD34 positive AML exhibited an abnormal karyotype whereas 15 patients (28%) with CD34 negative AML had abnormal metaphases (P < 0.01). Monosomy 7/7q- or monosomy 5/5q- occurred in 10 patients and 8 of them expressed the CD34 antigen (P < 0.05). All patients with t(8;21) which is considered as a favorable factor in AML had levels of CD34 >/= 20% (P < 0.05). We did not find any association between CD34 expression and attainment of complete remission, overall survival, or disease-free survival. In conclusion, the variations of CD34 expression in AML are correlated with cytogenetic abnormalities associated both with poor and favorable outcome. The evaluation of the correlations between CD34 antigen and clinical outcome in AML should take into account the results of pretreatment karyotype.
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MESH Headings
- Acute Disease
- Adult
- Aged
- Aged, 80 and over
- Antigens, CD34/biosynthesis
- Antigens, Neoplasm/biosynthesis
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bone Marrow/pathology
- Chromosome Aberrations
- Chromosomes, Human, Pair 5
- Chromosomes, Human, Pair 7
- Disease-Free Survival
- Female
- Hematopoietic Stem Cells/metabolism
- Hematopoietic Stem Cells/ultrastructure
- Humans
- Karyotyping
- Leukemia, Myeloid/drug therapy
- Leukemia, Myeloid/genetics
- Leukemia, Myeloid/mortality
- Leukemia, Myeloid/pathology
- Life Tables
- Male
- Middle Aged
- Monosomy
- Neoplastic Stem Cells/metabolism
- Neoplastic Stem Cells/ultrastructure
- Prognosis
- Remission Induction
- Retrospective Studies
- Survival Analysis
- Treatment Outcome
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Affiliation(s)
- C Fruchart
- Service d'Hematologie, Centre Henri Becquerel, Rouen, France
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39
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Amiel A, Elis A, Manor Y, Tangi I, Fejgin M, Lishner M. Fluorescent in situ hybridization (FISH) for the detection of trisomy 8 in acute myeloblastic leukemia. Leuk Lymphoma 1996; 23:603-7. [PMID: 9031092 DOI: 10.3109/10428199609054870] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The karyotype of acute myeloid leukemia (AML) blasts has a major prognostic importance. However conventional cytogenetic studies of AML patients may fail to reveal chromosome abnormalities. Trisomy 8 is a common numerical abnormality in all AML subtypes. We evaluated the role of fluorescent in situ hybridization (FISH) in the detection of trisomy 8 in de-novo AML, and compared the results to chromosome analysis in some patients. Cytogenetic studies were performed in 9 of 12 patients. In three patients no metaphases were obtained. Of the remaining six, trisomy 8 was only detected in the metaphases of 1 patient. In contrast, 4 patients showed +8 with FISH and one had a borderline value. We conclude that FISH is a rapid and sensitive method to detect numerical aberrations in AML. In the future larger prospective studies should explore the biological and clinical application of the FISH method in different hematological malignancies.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Chromosomes, Human, Pair 8
- DNA Probes
- DNA, Neoplasm/analysis
- DNA, Neoplasm/genetics
- DNA, Satellite/analysis
- DNA, Satellite/genetics
- Evaluation Studies as Topic
- Female
- Humans
- In Situ Hybridization, Fluorescence
- Leukemia, Myeloid, Acute/genetics
- Male
- Middle Aged
- Trisomy
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Affiliation(s)
- A Amiel
- Department of Medicine, Meir Hospital, Kfar Saba, Israel
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40
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Abstract
There are two major classes of genes implicated in human tumorigenesis, the oncogenes and the tumour suppressor genes. In haematological malignancies most emphasis has been placed upon the recurring translocations in which the juxtaposition of two gene sequences has resulted in the activation of an oncogene. Chromosomal loss rather than translocation is the most frequent karyotypic abnormality in the myelodysplastic syndromes, a heterogeneous group of clonal malignant blood disorders characterised by dyshaematopoiesis and/or impaired maturation of haemopoietic cells with frequent evolution to acute leukaemia. Recent attention has focused on the loss of genetic material as a result of chromosomal monosomy or deletion in the myelodysplastic syndromes. The most frequently reported deletions in these myeloid syndromes are of chromosomes 5, 20 and 7. Deletions of chromosomes 11, 12, and 13, although more rarely observed, are also characteristics of the myelodysplastic syndromes. It is probable that the deleted chromosomal bands give the location for as yet unidentified myeloid specific tumour suppressor loci and there is considerable interest in the cloning of these genes. This review discusses the three most frequently observed deletions in MDS; 7q deletion, 5q deletion and 20q deletion taking into account recent evidence on the respective critical regions of gene loss and the role of candidate genes.
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Affiliation(s)
- J Boultwood
- Department of Haematology, John Radcliffe Hospital, Headington, Oxford, UK
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41
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Pedersen B, Ellegaard J. A factor encoded by 7q31 suppresses expansion of the 7q- clone and delays cytogenetic progression. CANCER GENETICS AND CYTOGENETICS 1994; 78:181-8. [PMID: 7828151 DOI: 10.1016/0165-4608(94)90088-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Deletion of part of chromosome 7q (7q-) is a consistent aberration in human acute leukemias and myelodysplasias, especially in patients with a history of genotoxic exposure. The deletion is usually associated with a short survival. Loss of a number of different 7q segments has been described, but still it is not known whether different deletions imply differences in survival. We have investigated the possible importance of loss of different segments in 77 7q- patients studied with high-resolution banding. Thirty-six were examined in our laboratory and 41 were published cases. We found that when the 7q- marker contained the 7q31 band, the 7q- clone was smaller than when the band had been lost (p = 0.011), and the patients survived longer (p = 0.004). Further, karyotypes with complex aberrations were less frequent (p = 0.012). These results indicate that genetic information in 7q31 delays cytogenetic and clinical progression of myeloid disease with 7q-. Our results do not tell, however, whether this is due to direct tumor suppressor activity of a 7q31 gene or due to a more indirect effect.
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Affiliation(s)
- B Pedersen
- Danish Cancer Society Department of Cytogenetics, Aarhus
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42
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Lemez P, Jelínek J, Michalová K, Koubek K, Schwarz J, Malasková V, Rypácková B, Jirásek A, Brezinová J, Hrabánek J. Near-tetraploid poorly differentiated acute myeloid leukemia M0 diagnosed by short-term cultures with a phorbol ester TPA. Leuk Res 1994; 18:493-7. [PMID: 8022200 DOI: 10.1016/0145-2126(94)90087-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Leukemic blasts of two patients with acute leukemia exhibited similar characteristics. They were heterogeneous in size with a diameter of 14-30 microns in smears and unclassifiable by morphological, cytochemical, immunophenotypic and ultrastructural examinations. Cytogenetic examinations of both revealed a near-tetraploid karyotype. Blasts from both patients differentiated into macrophages in cultures with 10 ng/ml 12-O-tetradecanoylphorbol-13-acetate (TPA) which is a feature specific for myeloid blasts and the cases were thus classified as poorly differentiated acute myeloid leukemias (AML M0). Near-tetraploid poorly differentiated acute myeloid leukemias M0 seem to be a special category of AML in the morphologic, immunologic and cytogenetic (MIC) classification. The presence of very large blasts in the heterogeneous blast population in acute unclassified leukemias could be a morphological sign of near-tetraploid leukemias AML M0.
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Affiliation(s)
- P Lemez
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
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43
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Hamamoto K, Hashimoto-Ninomiya A, Kishimoto Y, Kimura T, Fujitake H, Yasunaga K, Horiike S. Unbalanced 1;7 translocation in myelodysplastic syndrome following treatment of acute myeloblastic leukemia with an 8;21 translocation. CANCER GENETICS AND CYTOGENETICS 1994; 74:35-9. [PMID: 8194045 DOI: 10.1016/0165-4608(94)90026-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The chromosome der(1;7)(q10;p10) consists of the short arm of chromosome 7 and the long arm of chromosome 1, and is a common abnormality in treatment-related leukemia and myelodysplastic syndrome. Here we describe a 39-year-old Japanese man with acute myeloblastic leukemia (FAB-M2) exhibiting t(8;21)(q22;q22). He entered complete remission after induction therapy, and intensification therapy including alkylating agents was subsequently continued for 3 years. The patient then developed pancytopenia; bone marrow aspiration revealed myelodysplastic syndrome exhibiting the der (1;7) chromosome. To our knowledge, this is the first reported case of such an abnormality in myelodysplastic syndrome secondary to acute myeloblastic leukemia with the 8;21 translocation.
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MESH Headings
- Adult
- Anemia, Refractory, with Excess of Blasts/chemically induced
- Anemia, Refractory, with Excess of Blasts/genetics
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Chromosomes, Human, Pair 1
- Chromosomes, Human, Pair 21
- Chromosomes, Human, Pair 7
- Chromosomes, Human, Pair 8
- Humans
- Karyotyping
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/genetics
- Male
- Translocation, Genetic
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Affiliation(s)
- K Hamamoto
- First Department of Internal Medicine, Kansai Medical University, Osaka, Japan
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44
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Abstract
Interstitial deletion of the long arm of chromosome 9 (9q-) is an uncommon karyotypic abnormality in acute myeloid leukemia (AML). We report a case of acute myeloid leukemia, M6 according to the FAB criteria, in which 9q- was the sole karyotypic abnormality. From our own experience and that in the literature, interstitial 9q- seems to be associated with two specific morphologic/cytogenetic categories: AML M2 and t(8;21)(q22;q22)/trisomy 21; and as the sole karyotypic aberration in AML M1/M2(M6) with dyserythropoiesis. Examination of the published karyotypes shows that 9q13 to 9q21 is the commonest deleted segment, suggesting that this region may carry genes important in leukemogenesis.
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Affiliation(s)
- Y L Kwong
- University Department of Medicine, Queen Mary Hospital, Hong Kong
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45
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Juliusson G, Gahrton G. Cytogenetics in CLL and related disorders. BAILLIERE'S CLINICAL HAEMATOLOGY 1993; 6:821-48. [PMID: 8038492 DOI: 10.1016/s0950-3536(05)80178-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Chromosome analysis of more than 1200 patients with chronic lymphocytic leukaemia reported to the International Working Party on Chromosomes in CLL and in the literature is analysed. Clonal chromosomal abnormalities are found in about half of the patients, and one third of those with clonal aberrations have trisomy 12, with or without additional changes. The most common structural abnormalities involve the long arm of chromosome 13, usually as deletions involving 13q14, the site of the retinoblastoma gene. Other recurrent abnormalities are deletions of the long arms of chromosome 11 and 6. 14q+ markers are frequent in patients at advanced stage, but are almost always within complex abnormalities. The number of clonal abnormalities in the CLL cells has a strong prognostic impact. Trisomy 12 as a single abnormality is an adverse prognostic sign, whereas patients with 13q abnormalities generally do comparatively well. Lymphoid leukaemia with monoclonal immunoglobulin secretion frequently involves clonal chromosomal abnormalities, and the type of change is similar to that seen in true CLL. In B cell prolymphocytic leukaemia, t(11;14) is a common finding, together with trisomy 12. T cell prolymphocytic leukaemia is characterized by an inversion of the long arm of chromosome 14, with breaks at q11 and q32, and trisomy of 8q, whereas large granular lymphocytic leukaemia has shown no consistent abnormality. Hairy cell leukaemia seems to involve a specific set of non-random chromosome abnormalities, such as inv(5)9.
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MESH Headings
- Chromosome Aberrations
- Chromosomes, Human/ultrastructure
- Humans
- Leukemia, Hairy Cell/genetics
- Leukemia, Hairy Cell/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Lymphoma, Non-Hodgkin/genetics
- Lymphoma, Non-Hodgkin/pathology
- Lymphoproliferative Disorders/genetics
- Lymphoproliferative Disorders/pathology
- Oncogenes
- Philadelphia Chromosome
- Prognosis
- Survival Rate
- Translocation, Genetic
- Waldenstrom Macroglobulinemia/genetics
- Waldenstrom Macroglobulinemia/pathology
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Affiliation(s)
- G Juliusson
- Department of Medicine, Karolinska Institute, Huddinge Hospital, Sweden
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46
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Abstract
Therapy-related myelodysplastic syndrome (tMDS) and acute nonlymphocytic leukemia (tANLL) are known late complications of cytotoxic drug therapy for hematologic malignancies, solid tumors, and nonmalignant conditions. The alkylating agents are often the causative agents, but a few reports have implicated cisplatin as an etiologic agent. Cisplatin has a significant impact on the treatment of a number of malignant neoplasms, including testicular and ovarian cancer, and is a part of several clinical trials for squamous cell carcinoma of the head and neck region. Given its increasing use, a complication as significant as tMDS is potentially important. In this article, the authors describe the case of a patient who had myelodysplastic syndrome develop after successful treatment for laryngeal cancer with cisplatin. The treatment included cisplatin in combination with 5-fluorouracil, followed by radiation therapy. The authors also present a review of articles in the literature regarding tMDS and tANLL occurrence after treatment with cisplatin-containing regimens. The authors conclude that cisplatin can be a leukemogenic agent. The drug may potentiate the leukemogenic effects of other alkylating agents and drugs that inhibit topoisomerase II action.
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Affiliation(s)
- R Cheruku
- Department of Internal Medicine, Scott & White Hospital and Clinic, Temple, TX 76508
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47
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Nacheva E, Kearney L, Bower M, Chaplin T, Douek E, Das S, Young BD. In situ hybridisation analysis of a homogeneously staining region at 11q23-24 in an acute myeloid leukaemia (M5) using yeast artificial chromosomes. Genes Chromosomes Cancer 1993; 7:123-7. [PMID: 7687863 DOI: 10.1002/gcc.2870070302] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
An example of a homogeneously staining region (hsr), occurring in an acute myeloid leukaemia (M5) on chromosome 11 in the region of bands q23-q24, has been analysed. In situ hybridisation using yeast artificial chromosome (YAC) DNA demonstrated that the amplification did not include the CD3 gene cluster and did not affect the human trithorax gene known to be disrupted by translocations at 11q23. In contrast, the amplification was shown to include the sequence D11S543 which has been previously mapped to chromosome band 11q24. High resolution analysis using confocal microscopy allowed the individual amplicons to be visualised, and it was shown that the hsr consisted of an 8-fold amplification of the region surrounding the probe D11S543. From previous estimates of human chromosome size it was possible to calculate that the hsr was composed of amplicons approximately 10 megabases in length. It was concluded that the region amplified did not extend as far as the translocation breakpoints occurring at 11q23 in acute leukaemias.
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Affiliation(s)
- E Nacheva
- University of Cambridge, Department of Haematology, England
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48
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49
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Abstract
Recommendations for the treatment of ANLL in general, and in pediatrics more specifically, are still conflicting. Overall, a child diagnosed with ANLL has a 35-50% of remaining alive long term, without disease. Induction chemotherapy with cytarabine and daunorubicin will achieve remission in about 80% of children with ANLL. So far, intensifying induction chemotherapy by adding more agents has not changed this result significantly. Major changes in induction chemotherapy may come from either new chemotherapeutic agents or biological agents that hasten bone marrow recovery after treatment. Such an approach might allow more dose-intensive drug administration without increased toxicity. Another question that is slowly being answered with the ongoing trials is the one concerning maintenance. So far, all the pediatric trials that have tried to shorten the maintenance therapy of this disease were able to do so without jeopardizing the final outcome. The final optimal minimal duration of therapy has yet to be established. The best therapy for a patient who has achieved a remission is still the most difficult question regarding the treatment of this disease. So far, allogeneic BMT has yielded the best results, with a disease-free interval varying between 55 and 65%. However, one-third of these patients have chronic GvHD and, therefore, a somewhat diminished quality of life. As preparative regimens and marrow purging protocols evolve, the results of autologous bone marrow transplantation seem to be improving, with disease-free intervals of 35-50% reported.
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Affiliation(s)
- F Boulad
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York 10021
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50
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Affiliation(s)
- P R Johnson
- Department of Clinical Haematology, Manchester Royal Infirmary
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