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Danishevich A, Chegodar A, Bodunova N, Konovalov F, Nefedova M, Kremneva N, Kurbanov N, Bilyalov A, Nikolaev S, Khatkov I, Dudina G. Myelodysplastic Syndrome: Clinical Characteristics and Significance of Preclinically Detecting Biallelic Mutations in the TET2 Gene. Life (Basel) 2024; 14:637. [PMID: 38792657 PMCID: PMC11122331 DOI: 10.3390/life14050637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 05/03/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
Myelodysplastic syndrome (MDS) is a clonal disease derived from hematopoietic stem cells, characterized by ineffective hematopoiesis (resulting in peripheral blood cytopenia) and an increased risk of transformation into acute myeloid leukemia. MDS is caused by a complex combination of genetic mutations resulting in a heterogeneous genotype. Genetic studies have identified a set of aberrations that play a central role in the pathogenesis of MDS. In this article, we present a clinical case of MDS transformation into acute myeloid leukemia in the context of two cell lines exhibiting morphological, immunophenotypic, and dysmyelopoiesis markers and the presence of two heterozygous mutations in the TET2 gene.
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Affiliation(s)
| | - Anzhelika Chegodar
- The Loginov Moscow Clinical Scientific Center, 111123 Moscow, Russia (S.N.)
| | - Natalia Bodunova
- The Loginov Moscow Clinical Scientific Center, 111123 Moscow, Russia (S.N.)
| | - Fedor Konovalov
- Independent Clinical Bioinformatics Laboratory, 123181 Moscow, Russia
| | - Maria Nefedova
- Independent Clinical Bioinformatics Laboratory, 123181 Moscow, Russia
| | - Natalya Kremneva
- The Loginov Moscow Clinical Scientific Center, 111123 Moscow, Russia (S.N.)
| | - Nizhat Kurbanov
- The Loginov Moscow Clinical Scientific Center, 111123 Moscow, Russia (S.N.)
| | - Airat Bilyalov
- The Loginov Moscow Clinical Scientific Center, 111123 Moscow, Russia (S.N.)
- Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia
| | - Sergey Nikolaev
- The Loginov Moscow Clinical Scientific Center, 111123 Moscow, Russia (S.N.)
| | - Igor Khatkov
- The Loginov Moscow Clinical Scientific Center, 111123 Moscow, Russia (S.N.)
| | - Galina Dudina
- The Loginov Moscow Clinical Scientific Center, 111123 Moscow, Russia (S.N.)
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2
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Pereira MP, Herrity E, Kim DDH. TP53-mutated acute myeloid leukemia and myelodysplastic syndrome: biology, treatment challenges, and upcoming approaches. Ann Hematol 2024; 103:1049-1067. [PMID: 37770618 DOI: 10.1007/s00277-023-05462-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/17/2023] [Indexed: 09/30/2023]
Abstract
Improved understanding of TP53 biology and the clinicopathological features of TP53-mutated myeloid neoplasms has led to the recognition of TP53-mutated acute myeloid leukemia/myelodysplastic syndrome (TP53m AML/MDS) as a unique entity, characterized by dismal outcomes following conventional therapies. Several clinical trials have investigated combinations of emerging therapies for these patients with the poorest molecular prognosis among myeloid neoplasms. Although some emerging therapies have shown improvement in overall response rates, this has not translated into better overall survival, hence the notion that p53 remains an elusive target. New therapeutic strategies, including novel targeted therapies, immune checkpoint inhibitors, and monoclonal antibodies, represent a shift away from cytotoxic and hypomethylating-based therapies, towards approaches combining non-immune and novel immune therapeutic strategies. The triple combination of azacitidine and venetoclax with either magrolimab or eprenetapopt have demonstrated safety in early trials, with phase III trials currently underway, and promising interim clinical results. This review compiles background on TP53 biology, available and emerging therapies along with their mechanisms of action for the TP53m disease entity, current treatment challenges, and recently published data and status of ongoing clinical trials for TP53m AML/MDS.
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Affiliation(s)
- Mariana Pinto Pereira
- Hans Messner Allogeneic Blood and Marrow Transplantation Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, M5G2M9, Toronto, ON, Canada
| | - Elizabeth Herrity
- Hans Messner Allogeneic Blood and Marrow Transplantation Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, M5G2M9, Toronto, ON, Canada
| | - Dennis D H Kim
- Hans Messner Allogeneic Blood and Marrow Transplantation Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, M5G2M9, Toronto, ON, Canada.
- Leukemia Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
- Department of Hematology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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3
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Zheng B, Yi K, Zhang Y, Pang T, Zhou J, He J, Lan H, Xian H, Li R. Multi-omics analysis of multiple myeloma patients with differential response to first-line treatment. Clin Exp Med 2023; 23:3833-3846. [PMID: 37515690 DOI: 10.1007/s10238-023-01148-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/20/2023] [Indexed: 07/31/2023]
Abstract
The genome backgrounds of multiple myeloma (MM) would affect the efficacy of specific treatment. However, the mutational and transcriptional landscapes in MM patients with differential response to first-line treatment remains unclear. We collected paired whole-exome sequencing (WES) and transcriptomic data of over 200 MM cases from MMRF-COMPASS project. R package, maftools was applied to analyze the somatic mutations and mutational signatures across MM samples. Differential expressed genes (DEG) was calculated using R package, DESeq2. The feature selection of the predictive model was determined by LASSO regression. In silico analysis revealed newly discovered recurrent mutated genes such as TTN, MUC16. TP53 mutation was observed more frequent in nonCR (complete remission) group with poor prognosis. DNA repair-associated mutational signatures were enriched in CR patients. Transcriptomic profiling showed that the activity of NF-kappa B and TGF-β pathways was suppressed in CR patients. A transcriptome-based response predictive model was constructed and showed promising predictive accuracy in MM patients receiving first-line treatment. Our study delineated distinctive mutational and transcriptional landscapes in MM patients with differential response to first-line treatment. Furthermore, we constructed a 20-gene predictive model which showed promising accuracy in predicting treatment response in newly diagnosed MM patients.
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Affiliation(s)
- Bo Zheng
- Nuclear Radiation Injury Protection and Treatment Department, Navy Medical Center of PLA, Naval Medical University, Huaihai West Road No. 338, Shanghai, 200050, China.
| | - Ke Yi
- Nuclear Radiation Injury Protection and Treatment Department, Navy Medical Center of PLA, Naval Medical University, Huaihai West Road No. 338, Shanghai, 200050, China
| | - Yajun Zhang
- Nuclear Radiation Injury Protection and Treatment Department, Navy Medical Center of PLA, Naval Medical University, Huaihai West Road No. 338, Shanghai, 200050, China
| | - Tongfang Pang
- Nuclear Radiation Injury Protection and Treatment Department, Navy Medical Center of PLA, Naval Medical University, Huaihai West Road No. 338, Shanghai, 200050, China
| | - Jieyi Zhou
- Nuclear Radiation Injury Protection and Treatment Department, Navy Medical Center of PLA, Naval Medical University, Huaihai West Road No. 338, Shanghai, 200050, China
| | - Jie He
- Nuclear Radiation Injury Protection and Treatment Department, Navy Medical Center of PLA, Naval Medical University, Huaihai West Road No. 338, Shanghai, 200050, China
| | - Hongyan Lan
- Nuclear Radiation Injury Protection and Treatment Department, Navy Medical Center of PLA, Naval Medical University, Huaihai West Road No. 338, Shanghai, 200050, China
| | - Hongming Xian
- Nuclear Radiation Injury Protection and Treatment Department, Navy Medical Center of PLA, Naval Medical University, Huaihai West Road No. 338, Shanghai, 200050, China
| | - Rong Li
- Nuclear Radiation Injury Protection and Treatment Department, Navy Medical Center of PLA, Naval Medical University, Huaihai West Road No. 338, Shanghai, 200050, China.
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4
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Acha P, Mallo M, Solé F. Myelodysplastic Syndromes with Isolated del(5q): Value of Molecular Alterations for Diagnostic and Prognostic Assessment. Cancers (Basel) 2022; 14:cancers14225531. [PMID: 36428627 PMCID: PMC9688702 DOI: 10.3390/cancers14225531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/30/2022] [Accepted: 11/07/2022] [Indexed: 11/12/2022] Open
Abstract
Myelodysplastic syndromes (MDS) are a group of clonal hematological neoplasms characterized by ineffective hematopoiesis in one or more bone marrow cell lineages. Consequently, patients present with variable degrees of cytopenia and dysplasia. These characteristics constitute the basis for the World Health Organization (WHO) classification criteria of MDS, among other parameters, for the current prognostic scoring system. Although nearly half of newly diagnosed patients present a cytogenetic alteration, and almost 90% of them harbor at least one somatic mutation, MDS with isolated del(5q) constitutes the only subtype clearly defined by a cytogenetic alteration. The results of several clinical studies and the advances of new technologies have allowed a better understanding of the biological basis of this disease. Therefore, since the first report of the "5q- syndrome" in 1974, changes and refinements have been made in the definition and the characteristics of the patients with MDS and del(5q). Moreover, specific genetic alterations have been found to be associated with the prognosis and response to treatments. The aim of this review is to summarize the current knowledge of the molecular background of MDS with isolated del(5q), focusing on the clinical and prognostic relevance of cytogenetic alterations and somatic mutations.
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Affiliation(s)
- Pamela Acha
- MDS Group, Institut de Recerca Contra la Leucèmia Josep Carreras, ICO-Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, 08916 Badalona, Spain
| | - Mar Mallo
- MDS Group, Institut de Recerca Contra la Leucèmia Josep Carreras, ICO-Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, 08916 Badalona, Spain
- Microarrays Unit, Institut de Recerca Contra la Leucèmia Josep Carreras, ICO-Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, 08916 Badalona, Spain
| | - Francesc Solé
- MDS Group, Institut de Recerca Contra la Leucèmia Josep Carreras, ICO-Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, 08916 Badalona, Spain
- Microarrays Unit, Institut de Recerca Contra la Leucèmia Josep Carreras, ICO-Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, 08916 Badalona, Spain
- Correspondence: ; Tel.: +34-93-557-2806
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Distinct clonal identities of B-ALLs arising after lenolidomide therapy for multiple myeloma. Blood Adv 2022; 7:236-245. [PMID: 36251745 PMCID: PMC9860439 DOI: 10.1182/bloodadvances.2022007496] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 01/29/2023] Open
Abstract
Patients with multiple myeloma (MM) who are treated with lenalidomide rarely develop a secondary B-cell acute lymphoblastic leukemia (B-ALL). The clonal and biological relationship between these sequential malignancies is not yet clear. We identified 17 patients with MM treated with lenalidomide, who subsequently developed B-ALL. Patient samples were evaluated through sequencing, cytogenetics/fluorescence in situ hybridization (FISH), immunohistochemical (IHC) staining, and immunoglobulin heavy chain (IgH) clonality assessment. Samples were assessed for shared mutations and recurrently mutated genes. Through whole exome sequencing and cytogenetics/FISH analysis of 7 paired samples (MM vs matched B-ALL), no mutational overlap between samples was observed. Unique dominant IgH clonotypes between the tumors were observed in 5 paired MM/B-ALL samples. Across all 17 B-ALL samples, 14 (83%) had a TP53 variant detected. Three MM samples with sufficient sequencing depth (>500×) revealed rare cells (average of 0.6% variant allele frequency, or 1.2% of cells) with the same TP53 variant identified in the subsequent B-ALL sample. A lack of mutational overlap between MM and B-ALL samples shows that B-ALL developed as a second malignancy arising from a founding population of cells that likely represented unrelated clonal hematopoiesis caused by a TP53 mutation. The recurrent variants in TP53 in the B-ALL samples suggest a common path for malignant transformation that may be similar to that of TP53-mutant, treatment-related acute myeloid leukemia. The presence of rare cells containing TP53 variants in bone marrow at the initiation of lenalidomide treatment suggests that cellular populations containing TP53 variants expand in the presence of lenalidomide to increase the likelihood of B-ALL development.
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6
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Kontandreopoulou CN, Kalopisis K, Viniou NA, Diamantopoulos P. The genetics of myelodysplastic syndromes and the opportunities for tailored treatments. Front Oncol 2022; 12:989483. [PMID: 36338673 PMCID: PMC9630842 DOI: 10.3389/fonc.2022.989483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/14/2022] [Indexed: 11/17/2022] Open
Abstract
Genomic instability, microenvironmental aberrations, and somatic mutations contribute to the phenotype of myelodysplastic syndrome and the risk for transformation to AML. Genes involved in RNA splicing, DNA methylation, histone modification, the cohesin complex, transcription, DNA damage response pathway, signal transduction and other pathways constitute recurrent mutational targets in MDS. RNA-splicing and DNA methylation mutations seem to occur early and are reported as driver mutations in over 50% of MDS patients. The improved understanding of the molecular landscape of MDS has led to better disease and risk classification, leading to novel therapeutic opportunities. Based on these findings, novel agents are currently under preclinical and clinical development and expected to improve the clinical outcome of patients with MDS in the upcoming years. This review provides a comprehensive update of the normal gene function as well as the impact of mutations in the pathogenesis, deregulation, diagnosis, and prognosis of MDS, focuses on the most recent advances of the genetic basis of myelodysplastic syndromes and their clinical relevance, and the latest targeted therapeutic approaches including investigational and approved agents for MDS.
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7
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Gurnari C, Piciocchi A, Soddu S, Bonanni F, Scalzulli E, Niscola P, Di Veroli A, Piccioni AL, Piedimonte M, Maiorana G, Salutari P, Cicconi L, Santopietro M, Gumenyuk S, Sarlo C, Fenu S, Tafuri A, Latagliata R, Fianchi L, Criscuolo M, Maciejewski JP, Maurillo L, Buccisano F, Breccia M, Voso MT. Myelodysplastic syndromes with del(5q): A real-life study of determinants of long-term outcomes and response to lenalidomide. Blood Cancer J 2022; 12:132. [PMID: 36071048 PMCID: PMC9452671 DOI: 10.1038/s41408-022-00724-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/18/2022] [Accepted: 08/22/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Carmelo Gurnari
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.,Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.,GROM-L (Gruppo Romano-Laziale MDS), Rome, Italy
| | - Alfonso Piciocchi
- Italian Group for Adult Hematologic Diseases (GIMEMA) Foundation, Rome, Italy
| | - Stefano Soddu
- Italian Group for Adult Hematologic Diseases (GIMEMA) Foundation, Rome, Italy
| | - Fabrizio Bonanni
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.,GROM-L (Gruppo Romano-Laziale MDS), Rome, Italy
| | - Emilia Scalzulli
- GROM-L (Gruppo Romano-Laziale MDS), Rome, Italy.,Department of Translational and Precision Medicine-Az., Policlinico Umberto I-Sapienza University, Rome, Italy
| | - Pasquale Niscola
- GROM-L (Gruppo Romano-Laziale MDS), Rome, Italy.,Hematology Unit, Sant'Eugenio Hospital, Rome, Italy
| | - Ambra Di Veroli
- GROM-L (Gruppo Romano-Laziale MDS), Rome, Italy.,Belcolle Hospital, Viterbo, Italy
| | - Anna Lina Piccioni
- GROM-L (Gruppo Romano-Laziale MDS), Rome, Italy.,Hematology Dep, Az. Osp., San Giovanni-Addolorata, Rome, Italy
| | - Monica Piedimonte
- GROM-L (Gruppo Romano-Laziale MDS), Rome, Italy.,Hematology, "Sant'Andrea" Hospital-Sapienza, University of Rome, Rome, Italy
| | - Gianluca Maiorana
- GROM-L (Gruppo Romano-Laziale MDS), Rome, Italy.,Hematology, "Sant'Andrea" Hospital-Sapienza, University of Rome, Rome, Italy
| | | | - Laura Cicconi
- GROM-L (Gruppo Romano-Laziale MDS), Rome, Italy.,Hematology, ASL Roma 1, Rome, Italy
| | - Michelina Santopietro
- GROM-L (Gruppo Romano-Laziale MDS), Rome, Italy.,Hematology and Hematopoietic Stem Cells Transplant Unit, AO San Camillo-Forlanini, Rome, Italy
| | - Svitlana Gumenyuk
- GROM-L (Gruppo Romano-Laziale MDS), Rome, Italy.,Hematology Unit, Department of Research and Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Chiara Sarlo
- GROM-L (Gruppo Romano-Laziale MDS), Rome, Italy.,Hematology and Stem Cell Transplantation Unit, University Campus Bio-Medico, Rome, Italy
| | - Susanna Fenu
- GROM-L (Gruppo Romano-Laziale MDS), Rome, Italy.,Hematology Dep, Az. Osp., San Giovanni-Addolorata, Rome, Italy
| | - Agostino Tafuri
- GROM-L (Gruppo Romano-Laziale MDS), Rome, Italy.,Hematology, "Sant'Andrea" Hospital-Sapienza, University of Rome, Rome, Italy
| | - Roberto Latagliata
- GROM-L (Gruppo Romano-Laziale MDS), Rome, Italy.,Belcolle Hospital, Viterbo, Italy
| | - Luana Fianchi
- GROM-L (Gruppo Romano-Laziale MDS), Rome, Italy.,Department of Hematology, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Roma, Italy
| | - Marianna Criscuolo
- GROM-L (Gruppo Romano-Laziale MDS), Rome, Italy.,Department of Hematology, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Roma, Italy
| | - Jaroslaw P Maciejewski
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Luca Maurillo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.,GROM-L (Gruppo Romano-Laziale MDS), Rome, Italy
| | - Francesco Buccisano
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.,GROM-L (Gruppo Romano-Laziale MDS), Rome, Italy
| | - Massimo Breccia
- GROM-L (Gruppo Romano-Laziale MDS), Rome, Italy.,Department of Translational and Precision Medicine-Az., Policlinico Umberto I-Sapienza University, Rome, Italy
| | - Maria Teresa Voso
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy. .,GROM-L (Gruppo Romano-Laziale MDS), Rome, Italy. .,Santa Lucia Foundation, IRCCS, Neuro-Oncohematology, Rome, Italy.
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8
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Dissecting TET2 Regulatory Networks in Blood Differentiation and Cancer. Cancers (Basel) 2022; 14:cancers14030830. [PMID: 35159097 PMCID: PMC8834528 DOI: 10.3390/cancers14030830] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 12/11/2022] Open
Abstract
Simple Summary Bone marrow disorders such as leukemia and myelodysplastic syndromes are characterized by abnormal healthy blood cells production and function. Uncontrolled growth and impaired differentiation of white blood cells hinder the correct development of healthy cells in the bone marrow. One of the most frequent alterations that appear to initiate this deregulation and persist in leukemia patients are mutations in epigenetic regulators such as TET2. This review summarizes the latest molecular findings regarding TET2 functions in hematopoietic cells and their potential implications in blood cancer origin and evolution. Our goal was to encompass and interlink up-to-date discoveries of the convoluted TET2 functional network to provide a more precise overview of the leukemic burden of this protein. Abstract Cytosine methylation (5mC) of CpG is the major epigenetic modification of mammalian DNA, playing essential roles during development and cancer. Although DNA methylation is generally associated with transcriptional repression, its role in gene regulation during cell fate decisions remains poorly understood. DNA demethylation can be either passive or active when initiated by TET dioxygenases. During active demethylation, transcription factors (TFs) recruit TET enzymes (TET1, 2, and 3) to specific gene regulatory regions to first catalyze the oxidation of 5mC to 5-hydroxymethylcytosine (5hmC) and subsequently to higher oxidized cytosine derivatives. Only TET2 is frequently mutated in the hematopoietic system from the three TET family members. These mutations initially lead to the hematopoietic stem cells (HSCs) compartment expansion, eventually evolving to give rise to a wide range of blood malignancies. This review focuses on recent advances in characterizing the main TET2-mediated molecular mechanisms that activate aberrant transcriptional programs in blood cancer onset and development. In addition, we discuss some of the key outstanding questions in the field.
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What Are the Prospects for Treating TP53 Mutated Myelodysplastic Syndromes and Acute Myeloid Leukemia? Cancer J 2022; 28:51-61. [DOI: 10.1097/ppo.0000000000000569] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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10
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Jiang Y, Gao SJ, Soubise B, Douet-Guilbert N, Liu ZL, Troadec MB. TP53 in Myelodysplastic Syndromes. Cancers (Basel) 2021; 13:cancers13215392. [PMID: 34771553 PMCID: PMC8582368 DOI: 10.3390/cancers13215392] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/18/2021] [Accepted: 10/21/2021] [Indexed: 01/03/2023] Open
Abstract
Simple Summary The importance of gene variants in the prognosis of myelodysplastic syndromes (MDSs) has been repeatedly reported in recent years. Especially, TP53 mutations are independently associated with a higher risk category, resistance to conventional therapies, rapid transformation to leukemia, and a poor outcome. In the review, we discuss the features of monoallelic and biallelic TP53 mutations within MDS, the carcinogenic mechanisms, and the predictive value of TP53 variants in current standard treatments including hypomethylating agents, allogeneic hematopoietic stem cell transplantation, and lenalidomide, as well as the latest progress in TP53-targeted therapy strategies in MDS. Abstract Myelodysplastic syndromes (MDSs) are heterogeneous for their morphology, clinical characteristics, survival of patients, and evolution to acute myeloid leukemia. Different prognostic scoring systems including the International Prognostic Scoring System (IPSS), the Revised IPSS, the WHO Typed Prognostic Scoring System, and the Lower-Risk Prognostic Scoring System have been introduced for categorizing the highly variable clinical outcomes. However, not considered by current MDS prognosis classification systems, gene variants have been identified for their contribution to the clinical heterogeneity of the disease and their impact on the prognosis. Notably, TP53 mutation is independently associated with a higher risk category, resistance to conventional therapies, rapid transformation to leukemia, and a poor outcome. Herein, we discuss the features of monoallelic and biallelic TP53 mutations within MDS, their corresponding carcinogenic mechanisms, their predictive value in current standard treatments including hypomethylating agents, allogeneic hematopoietic stem cell transplantation, and lenalidomide, together with the latest progress in TP53-targeted therapy strategies, especially MDS clinical trial data.
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Affiliation(s)
- Yan Jiang
- Department of Hematology, The First Hospital of Jilin University, Changchun 130021, China; (Y.J.); (S.-J.G.)
- Univ Brest, Inserm, EFS, UMR 1078, GGB, F-29200 Brest, France; (B.S.); (N.D.-G.)
| | - Su-Jun Gao
- Department of Hematology, The First Hospital of Jilin University, Changchun 130021, China; (Y.J.); (S.-J.G.)
| | - Benoit Soubise
- Univ Brest, Inserm, EFS, UMR 1078, GGB, F-29200 Brest, France; (B.S.); (N.D.-G.)
| | - Nathalie Douet-Guilbert
- Univ Brest, Inserm, EFS, UMR 1078, GGB, F-29200 Brest, France; (B.S.); (N.D.-G.)
- CHRU Brest, Service de Génétique, Laboratoire de Génétique Chromosomique, F-29200 Brest, France
| | - Zi-Ling Liu
- Cancer Center, The First Hospital of Jilin University, Changchun 130021, China
- Correspondence: (Z.-L.L.); (M.-B.T.); Tel.: +86-139-43-00-16-00 (Z.-L.L.); +33-2-98-01-64-55 (M.-B.T.)
| | - Marie-Bérengère Troadec
- Univ Brest, Inserm, EFS, UMR 1078, GGB, F-29200 Brest, France; (B.S.); (N.D.-G.)
- CHRU Brest, Service de Génétique, Laboratoire de Génétique Chromosomique, F-29200 Brest, France
- Correspondence: (Z.-L.L.); (M.-B.T.); Tel.: +86-139-43-00-16-00 (Z.-L.L.); +33-2-98-01-64-55 (M.-B.T.)
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11
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Palacios-Berraquero ML, Alfonso-Piérola A. Current Therapy of the Patients with MDS: Walking towards Personalized Therapy. J Clin Med 2021; 10:jcm10102107. [PMID: 34068316 PMCID: PMC8153316 DOI: 10.3390/jcm10102107] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/29/2021] [Accepted: 05/07/2021] [Indexed: 12/13/2022] Open
Abstract
Myelodysplastic syndromes (MDS) are characterized by ineffective hematopoiesis, dysplasia and peripheral cytopenias. Nowadays, MDS therapy is selected based on risk. The goals of therapy are different in low-risk and high-risk patients. In low-risk MDS, the goal is to decrease transfusion needs and to increase the quality of life. Currently, available drugs for newly diagnosed low-risk MDS include growth factor support, lenalidomide and immunosuppressive therapy. Additionally, luspatercept has recently been added to treat patients with MDS with ring sideroblasts, who are not candidates or have lost the response to erythropoiesis-stimulating agents. Treatment of high-risk patients is aimed to improve survival. To date, the only currently approved treatments are hypomethylating agents and allogeneic stem cell transplantation. However, the future for MDS patients is promising. In recent years, we are witnessing the emergence of multiple treatment combinations based on hypomethylating agents (pevonedistat, magrolimab, eprenetapopt, venetoclax) that have proven to be effective in MDS, even those with high-risk factors. Furthermore, the approval in the US of an oral hypomethylating agent opens the door to exclusively oral combinations for these patients and their consequent impact on the quality of life of these patients. Relapsed and refractory patients remain an unmet clinical need. We need more drugs and clinical trials for this profile of patients who have a dismal prognosis.
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12
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Hughes CFM, Gallipoli P, Agarwal R. Design, implementation and clinical utility of next generation sequencing in myeloid malignancies: acute myeloid leukaemia and myelodysplastic syndrome. Pathology 2021; 53:328-338. [PMID: 33676768 DOI: 10.1016/j.pathol.2021.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 12/25/2022]
Abstract
Next generation sequencing (NGS) based technology has contributed enormously to our understanding of the biology of myeloid malignancies including acute myeloid leukaemia (AML) and myelodysplastic syndrome (MDS). Assessment of clinically important mutations by NGS is a powerful tool to define diagnosis, determine prognostic risk, monitor measurable residual disease and uncover predictive mutational markers/therapeutic targets, and is now a routine component in the workup and monitoring of haematological disorders. There are many technical challenges in the design, implementation, analysis and reporting of NGS based results, and expert interpretation is essential. It is vital to distinguish relevant somatic disease associated mutations from those that are known polymorphisms, rare germline variants and clonal haematopoiesis of indeterminate potential (CHIP) associated variants. This review highlights and addresses the technical and biological challenges that should be considered before the implementation of NGS based testing in diagnostic laboratories and seeks to outline the essential and expanding role NGS plays in myeloid malignancies. Broad aspects of NGS panel design and reporting including inherent technological, biological and economic considerations are covered, following which the utility of NGS based testing in AML and MDS are discussed. In current practice, patient care is now strongly shaped by the results of NGS assessment and is considered a vital piece of the puzzle for clinicians as they manage these complex haematological disorders.
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Affiliation(s)
| | - Paolo Gallipoli
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
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Analysis of Intratumoral Heterogeneity in Myelodysplastic Syndromes with Isolated del(5q) Using a Single Cell Approach. Cancers (Basel) 2021; 13:cancers13040841. [PMID: 33671317 PMCID: PMC7922695 DOI: 10.3390/cancers13040841] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/09/2021] [Accepted: 02/14/2021] [Indexed: 01/10/2023] Open
Abstract
Simple Summary Myelodysplastic syndromes (MDS) are a heterogeneous group of clonal hematopoietic stem cell malignancies characterized by ineffective differentiation of one or more bone marrow cell lineages. Only 50% of patients with de novo MDS will be found to have cytogenetic abnormalities, of which del(5q) is the most common. In 10% of MDS cases, del(5q) is found as a sole abnormality. In this work, a single cell approach was used to analyze intratumoral heterogeneity in four patients with MDS with isolated del(5q). We were able to observe that an ancestral event in one patient can appear as a secondary hit in another one, thus reflecting the high intratumoral heterogeneity in MDS with isolated del(5q) and the importance of patient-specific molecular characterization. Abstract Myelodysplastic syndromes (MDS) are a heterogeneous group of hematological diseases. Among them, the most well characterized subtype is MDS with isolated chromosome 5q deletion (MDS del(5q)), which is the only one defined by a cytogenetic abnormality that makes these patients candidates to be treated with lenalidomide. During the last decade, single cell (SC) analysis has emerged as a powerful tool to decipher clonal architecture and to further understand cancer and other diseases at higher resolution level compared to bulk sequencing techniques. In this study, a SC approach was used to analyze intratumoral heterogeneity in four patients with MDS del(5q). Single CD34+CD117+CD45+CD19- bone marrow hematopoietic stem progenitor cells were isolated using the C1 system (Fluidigm) from diagnosis or before receiving any treatment and from available follow-up samples. Selected somatic alterations were further analyzed in SC by high-throughput qPCR (Biomark HD, Fluidigm) using specific TaqMan assays. A median of 175 cells per sample were analyzed. Inferred clonal architectures were relatively simple and either linear or branching. Similar to previous studies based on bulk sequencing to infer clonal architecture, we were able to observe that an ancestral event in one patient can appear as a secondary hit in another one, thus reflecting the high intratumoral heterogeneity in MDS del(5q) and the importance of patient-specific molecular characterization.
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Daw S, Law S. Quercetin induces autophagy in myelodysplastic bone marrow including hematopoietic stem/progenitor compartment. ENVIRONMENTAL TOXICOLOGY 2021; 36:149-167. [PMID: 32902906 DOI: 10.1002/tox.23020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 08/11/2020] [Accepted: 08/16/2020] [Indexed: 06/11/2023]
Abstract
Myelodysplastic syndrome (MDS) is regarded as a spectrum of bone marrow failure disorders that share hemato-pathological state of cellular dysplasia and cytopenia. The modern treatment of cancers like chemotherapy and radiation therapy sometimes severely pounce on the basic hematopoietic stem/progenitor cellular (HSPC) compartment which gradually disclose the clinical symptoms of MDS. The present study involves flowcytometric protein expression analysis of insulin growth factor receptor (IGFR), PI3K-Akt-mTOR pathway, the autophagy related proteins (ATG's), the status of antioxidative molecules SOD2 and SDF1 and apoptosis profiling in ethyl-nitroso-urea induced myelodysplasia. The redox status that is, reactive oxygen species was estimated with dihydroetidium and the status of mitochondria and lysosomes were checked by Janus green B and neutral red staining respectively, pre and post quercetin treatment in MDS bone marrow. The results revealed the activated IGFR/PI3K/Akt axis in MDS bone marrow but unconventionally both p-mTOR and autophagy (p-ATG1, p-AT6, ATG7, ATG12) was downregulated. Interestingly, post quercetin treatment an upregulation of basal autophagocytosis, reversal of oxidative damage and proper functionality of mitochondria and lysosome was recorded. Taken together, the study hinted that the PI3K-Akt-mTOR pathway does not rule over the process of autophagocytosis in HSPC's of MDS bone marrow and the isoflavanoid quercetin remarkably restored autophagocytosis and hematopoietic oxidative status toward normalcy during the progression of myelodysplasia.
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Affiliation(s)
- Suchismita Daw
- Stem Cell Research and Application Unit, Department of Biochemistry and Medical Biotechnology, Calcutta School of Tropical Medicine, Kolkata, West Bengal, India
| | - Sujata Law
- Stem Cell Research and Application Unit, Department of Biochemistry and Medical Biotechnology, Calcutta School of Tropical Medicine, Kolkata, West Bengal, India
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Ronaghy A, Yang RK, Khoury JD, Kanagal-Shamanna R. Clinical Applications of Chromosomal Microarray Testing in Myeloid Malignancies. Curr Hematol Malig Rep 2020; 15:194-202. [PMID: 32382988 DOI: 10.1007/s11899-020-00578-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW Knowledge of both somatic mutations and copy number aberrations are important for the understanding of cancer pathogenesis and management of myeloid neoplasms. The currently available standard of care technologies for copy number assessment such as conventional karyotype and FISH are either limited by low resolution or restriction to targeted assessment. RECENT FINDINGS Chromosomal microarray (CMA) is effective in characterization of chromosomal and gene aberrations of diagnostic, prognostic, and therapeutic significance at a higher resolution than conventional karyotyping. These results are complementary to NGS mutation studies. Copy-neutral loss of heterozygosity (CN-LOH), which is prognostic in AML, is currently only identified by CMA. Yet, despite the widespread availability, CMA testing is not routinely performed in diagnostic laboratories due to lack of knowledge on best-testing practices for clinical work-up of myeloid neoplasms. In this review, we provide an overview of the clinical significance of CMA in acute myeloid leukemia (AML), myelodysplastic syndromes (MDS), and myelodysplastic/myeloproliferative neoplasms (MDS/MPN). We will also elaborate the specific clinical scenarios where CMA can provide additional information essential for management and could potentially alter treatment. Chromosomal microarray (CMA) is an effective technology for characterizing chromosomal copy number changes and copy-neutral loss of heterozygosity of diagnostic, prognostic, and therapeutic significance at a high resolution in myeloid malignancies.
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MESH Headings
- Chromosome Aberrations
- Chromosomes, Human
- Comparative Genomic Hybridization
- DNA Copy Number Variations
- Genetic Predisposition to Disease
- High-Throughput Nucleotide Sequencing
- Humans
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myelomonocytic, Chronic/diagnosis
- Leukemia, Myelomonocytic, Chronic/genetics
- Loss of Heterozygosity
- Microarray Analysis
- Myelodysplastic Syndromes/diagnosis
- Myelodysplastic Syndromes/genetics
- Polymorphism, Single Nucleotide
- Predictive Value of Tests
- Prognosis
- Reproducibility of Results
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Affiliation(s)
- Arash Ronaghy
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 072, Houston, TX, 77030, USA
| | - Richard K Yang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 072, Houston, TX, 77030, USA
| | - Joseph D Khoury
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 072, Houston, TX, 77030, USA
| | - Rashmi Kanagal-Shamanna
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 072, Houston, TX, 77030, USA.
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Garcia‐Manero G, Chien KS, Montalban‐Bravo G. Myelodysplastic syndromes: 2021 update on diagnosis, risk stratification and management. Am J Hematol 2020; 95:1399-1420. [PMID: 32744763 DOI: 10.1002/ajh.25950] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 07/30/2020] [Accepted: 07/30/2020] [Indexed: 12/12/2022]
Abstract
DISEASE OVERVIEW The myelodysplastic syndromes (MDS) are a very heterogeneous group of myeloid disorders characterized by peripheral blood cytopenias and increased risk of transformation to acute myelogenous leukemia (AML). Myelodysplastic syndromes occur more frequently in older males and in individuals with prior exposure to cytotoxic therapy. DIAGNOSIS Diagnosis of MDS is based on morphological evidence of dysplasia upon visual examination of a bone marrow aspirate and biopsy. Information obtained from additional studies such as karyotype, flow cytometry and molecular genetics is usually complementary and may help refine diagnosis. RISK-STRATIFICATION Prognosis of patients with MDS can be calculated using a number of scoring systems. In general, all these scoring systems include analysis of peripheral cytopenias, percentage of blasts in the bone marrow and cytogenetic characteristics. The most commonly accepted system is the Revised International Prognostic Scoring System (IPSS-R). Somatic mutations can help define prognosis and therapy. RISK-ADAPTED THERAPY Therapy is selected based on risk, transfusion needs, percent of bone marrow blasts, cytogenetic and mutational profiles, comorbidities, potential for allogeneic stem cell transplantation (alloSCT) and prior exposure to hypomethylating agents (HMA). Goals of therapy are different in lower-risk patients than in higher-risk individuals and in those with HMA failure. In lower-risk MDS, the goal is to decrease transfusion needs and transformation to higher risk disease or AML, as well as to improve survival. In higher-risk disease, the goal is to prolong survival. In 2020, we witnessed an explosion of new agents and investigational approaches. Current available therapies include growth factor support, lenalidomide, HMAs, intensive chemotherapy and alloSCT. Novel therapeutics approved in 2020 are luspatercept and the oral HMA ASTX727. At the present time, there are no approved interventions for patients with progressive or refractory disease particularly after HMA-based therapy. Options include participation in a clinical trial, cytarabine-based therapy or alloSCT.
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Affiliation(s)
- Guillermo Garcia‐Manero
- Section of MDS, Department of Leukemia University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Kelly S. Chien
- Section of MDS, Department of Leukemia University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Guillermo Montalban‐Bravo
- Section of MDS, Department of Leukemia University of Texas MD Anderson Cancer Center Houston Texas USA
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Identification of Lenalidomide Sensitivity and Resistance Mechanisms in Non-Del(5q) Myelodysplastic Syndromes. Int J Mol Sci 2020; 21:ijms21093323. [PMID: 32397113 PMCID: PMC7246771 DOI: 10.3390/ijms21093323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 12/24/2022] Open
Abstract
Whereas lenalidomide is an effective therapy for del(5q) MDS patients, a minority of non-del(5q) MDS patients achieve hematologic improvement with lenalidomide. We used computational biology modeling and digital drug simulation to examine genomic data from 56 non-del(5q) MDS patients treated with lenalidomide, and then matched treatment response with molecular pathways. The computer inferred genomic abnormalities associating with lenalidomide treatment response in non-del(5q) MDS to include trisomy 8, del(20q), or RUNX1 loss of function mutations. Genomic abnormalities associating with lenalidomide resistance in non-del(5q) MDS patients included mutations in SF3B1, TET2, WNT3A amplification, MCL1 amplification, and/or PSEN2 amplification. These results may inform protocols for determining appropriateness of lenalidomide in non-del(5q) MDS.
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19
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Acute myeloid leukemia with isolated del(5q) is associated with IDH1/IDH2 mutations and better prognosis when compared to acute myeloid leukemia with complex karyotype including del(5q). Mod Pathol 2020; 33:566-575. [PMID: 31685963 DOI: 10.1038/s41379-019-0396-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/30/2019] [Accepted: 09/30/2019] [Indexed: 11/09/2022]
Abstract
Myelodysplastic syndrome with isolated del(5q) is a well-recognized entity with a relatively favorable prognosis. Isolated del(5q) in acute myeloid leukemia is rare and acute myeloid leukemia cases with isolated del(5q) are not well characterized. Del(5q) has been shown to be a poor prognostic marker in acute myeloid leukemia based on multivariable analysis in large cohort studies, which contained mostly cases with del(5q) in the context of multiple chromosomal abnormalities. To further characterize acute myeloid leukemia with isolated del(5q), clinicopathologic characterization including mutation analysis was performed. During a 10-year period, we identified 12 cases of acute myeloid leukemia with isolated del(5q), 7 cases of acute myeloid leukemia with del(5q) plus one additional chromosome abnormality not involving chromosome 7, as well as two control groups composed of 124 cases of acute myeloid leukemia with complex karyotype including del(5q), and 40 cases of myelodysplastic syndrome with isolated del(5q). At diagnosis, cases of acute myeloid leukemia with isolated del(5q) had higher platelet counts (p = 0.044), hemoglobin (p = 0.011), and mean corpuscular volume (p = 0.017) compared with cases of acute myeloid leukemia with complex karyotype including del(5q). Acute myeloid leukemia with isolated del(5q) was less likely therapy-related (p = 0.037), more likely to have IDH1/IDH2 mutations (p = 0.009), and less likely to have TP53 mutations (p = 0.005) when compared to acute myeloid leukemia with complex karyotype including del(5q). Acute myeloid leukemia with isolated del(5q) also showed longer overall survival than acute myeloid leukemia with complex karyotype cases including del(5q) (p = 0.004). In summary, acute myeloid leukemia with isolated del(5q) appeared to show some distinct clinicopathologic and genomic features as compared to cases of acute myeloid leukemia with complex karyotype including del(5q).
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Evolving therapies for lower-risk myelodysplastic syndromes. Ann Hematol 2020; 99:677-692. [PMID: 32078008 DOI: 10.1007/s00277-020-03963-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 02/10/2020] [Indexed: 12/16/2022]
Abstract
The development in the therapeutic landscape of myelodysplastic syndromes (MDS) has substantially lagged behind other hematologic malignancies with no new drug approvals for MDS for 13 years since the approval of decitabine in the United States in 2006. While therapeutic concepts for MDS patients continue to be primarily defined by clinical-pathologic risk stratification tools such as the International Prognostic Scoring System (IPSS) and its revised version IPSS-R, our understanding of the genetic landscape and the molecular pathogenesis of MDS has greatly evolved over the last decade. It is expected that the therapeutic approach to MDS patients will become increasingly individualized based on prognostic and predictive genetic features and other biomarkers. Herein, we review the current treatment of lower-risk MDS patients and discuss promising agents in advanced clinical testing for the treatment of symptomatic anemia in lower-risk MDS patients such as luspatercept and imetelstat. Lastly, we review the clinical development of new agents and the implications of the wider availability of mutational analysis for the management of individual MDS patients.
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Gorshein E, Weber UM, Gore S. Higher-risk myelodysplastic syndromes with del(5q): does the del(5q) matter? Expert Rev Hematol 2020; 13:233-239. [PMID: 32067540 DOI: 10.1080/17474086.2020.1730806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Introduction: Myelodysplastic Syndrome (MDS) represents a group of cancers characterized by abnormal blood cell formation and maturation, leading to various degrees of cytopenias and potential transformation to acute myeloid leukemia. Deletion of the long arm of chromosome 5 (del(5q)) is the most common clonal chromosomal anomaly in MDS, yet the population in this disease subtype is quite heterogeneous. This manuscript analyzes literature on high-risk MDS with del(5q) abnormalities.Areas covered: The paper will review outcomes with lenalidomide among high-risk MDS patients with del(5q). It will discuss the implications of harboring TP53 gene mutations, and share the data for allogeneic hematopoietic stem cell transplantations in this setting. Finally, the report evaluates the risk of disease progression in these patients.Expert commentary: Improved characterization of MDS has enhanced our understanding of patients with anomalies involving del(5q). Emerging literature is exploring combination therapy beyond lenalidomide, and next-generation sequencing may identify secondary mutations that could be an additional avenue for treatment.
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Affiliation(s)
- Elan Gorshein
- Yale School of Medicine, Division of Hematology, New Haven, CT, USA
| | - Urs M Weber
- Yale School of Medicine, Internal Medicine Residency Program, New Haven, CT, USA
| | - Steven Gore
- Yale School of Medicine, Division of Hematology, New Haven, CT, USA
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23
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Sangiorgio VFI, Geyer JT, Margolskee E, Al-Kawaaz M, Mathew S, Tam W, Orazi A. Myeloid neoplasms with isolated del(5q) and JAK2 V617F mutation: a "grey zone" combination of myelodysplastic and myeloproliferative features? Haematologica 2019; 105:e276-e279. [PMID: 31558664 DOI: 10.3324/haematol.2019.227686] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Valentina F I Sangiorgio
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY, USA .,University of Milan, Milan, Italy
| | - Julia T Geyer
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY, USA
| | - Elizabeth Margolskee
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY, USA
| | - Mustafa Al-Kawaaz
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY, USA
| | - Susan Mathew
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY, USA
| | - Wayne Tam
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY, USA
| | - Attilio Orazi
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY, USA
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Youn M, Huang H, Chen C, Kam S, Wilkes MC, Chae HD, Sridhar KJ, Greenberg PL, Glader B, Narla A, Lin S, Sakamoto KM. MMP9 inhibition increases erythropoiesis in RPS14-deficient del(5q) MDS models through suppression of TGF-β pathways. Blood Adv 2019; 3:2751-2763. [PMID: 31540902 PMCID: PMC6759738 DOI: 10.1182/bloodadvances.2019000537] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/23/2019] [Indexed: 12/11/2022] Open
Abstract
The del(5q) myelodysplastic syndrome (MDS) is a distinct subtype of MDS, associated with deletion of the ribosomal protein S14 (RPS14) gene that results in macrocytic anemia. This study sought to identify novel targets for the treatment of patients with del(5q) MDS by performing an in vivo drug screen using an rps14-deficient zebrafish model. From this, we identified the secreted gelatinase matrix metalloproteinase 9 (MMP9). MMP9 inhibitors significantly improved the erythroid defect in rps14-deficient zebrafish. Similarly, treatment with MMP9 inhibitors increased the number of colony forming unit-erythroid colonies and the CD71+ erythroid population from RPS14 knockdown human BMCD34+ cells. Importantly, we found that MMP9 expression is upregulated in RPS14-deficient cells by monocyte chemoattractant protein 1. Double knockdown of MMP9 and RPS14 increased the CD71+ population compared with RPS14 single knockdown, suggesting that increased expression of MMP9 contributes to the erythroid defect observed in RPS14-deficient cells. In addition, transforming growth factor β (TGF-β) signaling is activated in RPS14 knockdown cells, and treatment with SB431542, a TGF-β inhibitor, improved the defective erythroid development of RPS14-deficient models. We found that recombinant MMP9 treatment decreases the CD71+ population through increased SMAD2/3 phosphorylation, suggesting that MMP9 directly activates TGF-β signaling in RPS14-deficient cells. Finally, we confirmed that MMP9 inhibitors reduce SMAD2/3 phosphorylation in RPS14-deficient cells to rescue the erythroid defect. In summary, these study results support a novel role for MMP9 in the pathogenesis of del(5q) MDS and the potential for the clinical use of MMP9 inhibitors in the treatment of patients with del(5q) MDS.
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Affiliation(s)
- Minyoung Youn
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Haigen Huang
- Department of Molecular, Cell and Developmental Biology, University of California Los Angeles, Los Angeles, CA; and
| | - Cheng Chen
- Department of Molecular, Cell and Developmental Biology, University of California Los Angeles, Los Angeles, CA; and
| | - Sharon Kam
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Mark C Wilkes
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Hee-Don Chae
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | | | | | - Bertil Glader
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Anupama Narla
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Shuo Lin
- Department of Molecular, Cell and Developmental Biology, University of California Los Angeles, Los Angeles, CA; and
| | - Kathleen M Sakamoto
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
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Abstract
PURPOSE OF REVIEW Anaemia is a common haematological presentation in patients with bone marrow failure, yet a challenging condition to treat. As anaemia has a direct impact on the patient's symptoms, managing anaemia in the common bone marrow failure conditions, such as myelodysplastic syndrome will help to improve the quality of life. This review discusses the available treatment options and the benefit of improving the haemoglobin level. RECENT FINDINGS Managing anaemia effectively has shown to improve the patient outcome, yet treatment option remain limited. Recently, activin inhibitors such as Luspatercept have shown to be effective in patients' refractory to ESAs and further clinical trials are ongoing to explore this further. SUMMARY Transfusion still remains the mainstay of treatment in patients not suitable, lost response or refractory to erythropoiesis-stimulating agents (ESAs). Majority of these patients are not suitable for definite treatment options such as bone marrow transplantation. The aim of treatment remains improving the quality of life and newer therapeutic options may offer better and more sustained response.
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Chronic graft-versus-host disease could ameliorate the impact of adverse somatic mutations in patients with myelodysplastic syndromes and hematopoietic stem cell transplantation. Ann Hematol 2019; 98:2151-2162. [DOI: 10.1007/s00277-019-03751-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 06/27/2019] [Indexed: 11/28/2022]
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Fuchs O. Treatment of Lymphoid and Myeloid Malignancies by Immunomodulatory Drugs. Cardiovasc Hematol Disord Drug Targets 2019; 19:51-78. [PMID: 29788898 DOI: 10.2174/1871529x18666180522073855] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 05/05/2018] [Accepted: 05/14/2018] [Indexed: 06/08/2023]
Abstract
Thalidomide and its derivatives (lenalidomide, pomalidomide, avadomide, iberdomide hydrochoride, CC-885 and CC-90009) form the family of immunomodulatory drugs (IMiDs). Lenalidomide (CC5013, Revlimid®) was approved by the US FDA and the EMA for the treatment of multiple myeloma (MM) patients, low or intermediate-1 risk transfusion-dependent myelodysplastic syndrome (MDS) with chromosome 5q deletion [del(5q)] and relapsed and/or refractory mantle cell lymphoma following bortezomib. Lenalidomide has also been studied in clinical trials and has shown promising activity in chronic lymphocytic leukemia (CLL) and non-Hodgkin lymphoma (NHL). Lenalidomide has anti-inflammatory effects and inhibits angiogenesis. Pomalidomide (CC4047, Imnovid® [EU], Pomalyst® [USA]) was approved for advanced MM insensitive to bortezomib and lenalidomide. Other IMiDs are in phases 1 and 2 of clinical trials. Cereblon (CRBN) seems to have an important role in IMiDs action in both lymphoid and myeloid hematological malignancies. Cereblon acts as the substrate receptor of a cullin-4 really interesting new gene (RING) E3 ubiquitin ligase CRL4CRBN. This E3 ubiquitin ligase in the absence of lenalidomide ubiquitinates CRBN itself and the other components of CRL4CRBN complex. Presence of lenalidomide changes specificity of CRL4CRBN which ubiquitinates two transcription factors, IKZF1 (Ikaros) and IKZF3 (Aiolos), and casein kinase 1α (CK1α) and marks them for degradation in proteasomes. Both these transcription factors (IKZF1 and IKZF3) stimulate proliferation of MM cells and inhibit T cells. Low CRBN level was connected with insensitivity of MM cells to lenalidomide. Lenalidomide decreases expression of protein argonaute-2, which binds to cereblon. Argonaute-2 seems to be an important drug target against IMiDs resistance in MM cells. Lenalidomide decreases also basigin and monocarboxylate transporter 1 in MM cells. MM cells with low expression of Ikaros, Aiolos and basigin are more sensitive to lenalidomide treatment. The CK1α gene (CSNK1A1) is located on 5q32 in commonly deleted region (CDR) in del(5q) MDS. Inhibition of CK1α sensitizes del(5q) MDS cells to lenalidomide. CK1α mediates also survival of malignant plasma cells in MM. Though, inhibition of CK1α is a potential novel therapy not only in del(5q) MDS but also in MM. High level of full length CRBN mRNA in mononuclear cells of bone marrow and of peripheral blood seems to be necessary for successful therapy of del(5q) MDS with lenalidomide. While transfusion independence (TI) after lenalidomide treatment is more than 60% in MDS patients with del(5q), only 25% TI and substantially shorter duration of response with occurrence of neutropenia and thrombocytopenia were achieved in lower risk MDS patients with normal karyotype treated with lenalidomide. Shortage of the biomarkers for lenalidomide response in these MDS patients is the main problem up to now.
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Affiliation(s)
- Ota Fuchs
- Institute of Hematology and Blood Transfusion, U Nemocnice 1, 128 20 Prague 2, Czech Republic
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Fink EC, McConkey M, Adams DN, Haldar SD, Kennedy JA, Guirguis AA, Udeshi ND, Mani DR, Chen M, Liddicoat B, Svinkina T, Nguyen AT, Carr SA, Ebert BL. Crbn I391V is sufficient to confer in vivo sensitivity to thalidomide and its derivatives in mice. Blood 2018; 132:1535-1544. [PMID: 30064974 PMCID: PMC6172563 DOI: 10.1182/blood-2018-05-852798] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 07/21/2018] [Indexed: 12/11/2022] Open
Abstract
Thalidomide and its derivatives, lenalidomide and pomalidomide, are clinically effective treatments for multiple myeloma and myelodysplastic syndrome with del(5q). These molecules lack activity in murine models, limiting investigation of their therapeutic activity or toxicity in vivo. Here, we report the development of a mouse model that is sensitive to thalidomide derivatives because of a single amino acid change in the direct target of thalidomide derivatives, cereblon (Crbn). In human cells, thalidomide and its analogs bind CRBN and recruit protein targets to the CRL4CRBN E3 ubiquitin ligase, resulting in their ubiquitination and subsequent degradation by the proteasome. We show that mice with a single I391V amino acid change in Crbn exhibit thalidomide-induced degradation of drug targets previously identified in human cells, including Ikaros (Ikzf1), Aiolos (Ikzf3), Zfp91, and casein kinase 1a1 (Ck1α), both in vitro and in vivo. We use the Crbn I391V model to demonstrate that the in vivo therapeutic activity of lenalidomide in del(5q) myelodysplastic syndrome can be explained by heterozygous expression of Ck1α in del(5q) cells. We found that lenalidomide acts on hematopoietic stem cells with heterozygous expression of Ck1α and inactivation of Trp53 causes lenalidomide resistance. We further demonstrate that Crbn I391V is sufficient to confer thalidomide-induced fetal loss in mice, capturing a major toxicity of this class of drugs. Further study of the Crbn I391V model will provide valuable insights into the in vivo efficacy and toxicity of this class of drugs.
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Affiliation(s)
- Emma C Fink
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Department of Hematology, Division of Medicine, Brigham and Women's Hospital, Boston, MA
- Cancer Program, Broad Institute, Cambridge, MA
| | - Marie McConkey
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Department of Hematology, Division of Medicine, Brigham and Women's Hospital, Boston, MA
- Cancer Program, Broad Institute, Cambridge, MA
| | - Dylan N Adams
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Department of Hematology, Division of Medicine, Brigham and Women's Hospital, Boston, MA
- Cancer Program, Broad Institute, Cambridge, MA
| | - Saurav D Haldar
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Department of Hematology, Division of Medicine, Brigham and Women's Hospital, Boston, MA
- Cancer Program, Broad Institute, Cambridge, MA
| | - James A Kennedy
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Department of Hematology, Division of Medicine, Brigham and Women's Hospital, Boston, MA
- Cancer Program, Broad Institute, Cambridge, MA
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada; and
| | - Andrew A Guirguis
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Department of Hematology, Division of Medicine, Brigham and Women's Hospital, Boston, MA
- Cancer Program, Broad Institute, Cambridge, MA
| | | | - D R Mani
- Proteomics Platform, Broad Institute, Cambridge, MA
| | - Michelle Chen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Department of Hematology, Division of Medicine, Brigham and Women's Hospital, Boston, MA
- Cancer Program, Broad Institute, Cambridge, MA
| | - Brian Liddicoat
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Department of Hematology, Division of Medicine, Brigham and Women's Hospital, Boston, MA
- Cancer Program, Broad Institute, Cambridge, MA
| | | | - Andrew T Nguyen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Department of Hematology, Division of Medicine, Brigham and Women's Hospital, Boston, MA
- Cancer Program, Broad Institute, Cambridge, MA
| | | | - Benjamin L Ebert
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Department of Hematology, Division of Medicine, Brigham and Women's Hospital, Boston, MA
- Cancer Program, Broad Institute, Cambridge, MA
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SOHO State of the Art and Next Questions: Management of Myelodysplastic Syndromes With Deletion 5q. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:629-635. [DOI: 10.1016/j.clml.2018.07.293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 07/25/2018] [Indexed: 12/17/2022]
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Diagnostic algorithm for lower-risk myelodysplastic syndromes. Leukemia 2018; 32:1679-1696. [PMID: 29946191 DOI: 10.1038/s41375-018-0173-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/20/2018] [Accepted: 04/05/2018] [Indexed: 01/01/2023]
Abstract
Rapid advances over the past decade have uncovered the heterogeneous genomic and immunologic landscape of myelodysplastic syndromes (MDS). This has led to notable improvements in the accuracy and timing of diagnosis and prognostication of MDS, as well as the identification of possible novel targets for therapeutic intervention. For the practicing clinician, however, this increase in genomic, epigenomic, and immunologic knowledge needs consideration in a "real-world" context to aid diagnostic specificity. Although the 2016 revision to the World Health Organization classification for MDS is comprehensive and timely, certain limitations still exist for day-to-day clinical practice. In this review, we describe an up-to-date diagnostic approach to patients with suspected lower-risk MDS, including hypoplastic MDS, and demonstrate the requirement for an "integrated" diagnostic approach. Moreover, in the era of rapid access to massive parallel sequencing platforms for mutational screening, we suggest which patients should undergo such analyses, when such screening should be performed, and how those data should be interpreted. This is particularly relevant given the recent findings describing age-related clonal hematopoiesis.
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Arcioni F, Roncadori A, Di Battista V, Tura S, Covezzoli A, Cundari S, Mecucci C. Lenalidomide treatment of myelodysplastic syndromes with chromosome 5q deletion: Results from the National Registry of the Italian Drug Agency. Eur J Haematol 2018; 101:78-85. [PMID: 29569278 DOI: 10.1111/ejh.13067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The most typical cytogenetic aberration in myelodysplastic syndromes is del(5q), which, when isolated, is associated with refractory anaemia and good prognosis. Based on high rates of erythroid response and transfusion independence, Lenalidomide (LEN) became the standard treatment. This multi-centre study was designed to supplement Italian Registry data on LEN by addressing prescription, administration appropriateness, haematological and cytogenetic responses and disease evolution. METHODS MORE study was an observational, non-interventional, multi-centre, retrospective and prospective study. Cases were recruited from 45 Haematological Centres throughout Italy. Data were collected from the Italian National Registry for Lenalidomide administration and supplemented by a MORE data form. RESULTS Data from 190/213 patients were analysed. In all, 149 had been diagnosed by conventional cytogenetics (GROUP A) and 41 only by FISH (GROUP B). Overall erythroid response was obtained in 92.8% of cases. Overall cytogenetic remission was achieved in 22.6% of cases. Disease progression occurred in 15.6% of cases. Clonal cytogenetic evolution characterised progression to AML but not to higher risk MDS. CONCLUSIONS Erythroid response to Lenalidomide was similar in MDS with isolated del(5q) and with del(5q) plus one anomaly. Progression to AML or higher risk MDS showed different cytogenetic features.
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Affiliation(s)
- Francesco Arcioni
- Department of Medicine, Institute of Hematology and Center for Hemato-Oncology Research (C.R.E.O.), University of Perugia, Perugia, Italy
| | | | - Valeria Di Battista
- Department of Medicine, Institute of Hematology and Center for Hemato-Oncology Research (C.R.E.O.), University of Perugia, Perugia, Italy
| | | | | | | | - Cristina Mecucci
- Department of Medicine, Institute of Hematology and Center for Hemato-Oncology Research (C.R.E.O.), University of Perugia, Perugia, Italy
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A decade of progress in myelodysplastic syndrome with chromosome 5q deletion. Leukemia 2018; 32:1493-1499. [DOI: 10.1038/s41375-018-0029-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 12/28/2017] [Accepted: 01/05/2018] [Indexed: 12/26/2022]
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Montalban-Bravo G, Garcia-Manero G. Myelodysplastic syndromes: 2018 update on diagnosis, risk-stratification and management. Am J Hematol 2018; 93:129-147. [PMID: 29214694 DOI: 10.1002/ajh.24930] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 10/02/2017] [Indexed: 12/12/2022]
Abstract
DISEASE OVERVIEW The myelodysplastic syndromes (MDS) are a very heterogeneous group of myeloid disorders characterized by peripheral blood cytopenias and increased risk of transformation to acute myelogenous leukemia (AML). MDS occurs more frequently in older males and in individuals with prior exposure to cytotoxic therapy. DIAGNOSIS Diagnosis of MDS is based on morphological evidence of dysplasia upon visual examination of a bone marrow aspirate and biopsy. Information obtained from additional studies such as karyotype, flow cytometry or molecular genetics is usually complementary and may help refine diagnosis. RISK-STRATIFICATION Prognosis of patients with MDS can be calculated using a number of scoring systems. In general, all these scoring systems include analysis of peripheral cytopenias, percentage of blasts in the bone marrow and cytogenetic characteristics. The most commonly used system is probably the International Prognostic Scoring System (IPSS). IPSS is now replaced by the revised IPSS-R score. Although not systematically incorporated into new validated prognostic systems, somatic mutations can help define prognosis and should be considered as new prognostic factors. RISK-ADAPTED THERAPY Therapy is selected based on risk, transfusion needs, percent of bone marrow blasts and cytogenetic and mutational profiles. Goals of therapy are different in lower risk patients than in higher risk. In lower risk, the goal is to decrease transfusion needs and transformation to higher risk disease or AML, as well as to improve survival. In higher risk, the goal is to prolong survival. Current available therapies include growth factor support, lenalidomide, hypomethylating agents, intensive chemotherapy and allogeneic stem cell transplantation. The use of lenalidomide has significant clinical activity in patients with lower risk disease, anemia and a chromosome 5 alteration. 5-azacitidine and decitabine have activity in both lower and higher-risk MDS. 5-azacitidine has been shown to improve survival in higher risk MDS. A number of new molecular lesions have been described in MDS that may serve as new therapeutic targets or aid in the selection of currently available agents. Additional supportive care measures may include the use of prophylactic antibiotics and iron chelation. MANAGEMENT OF PROGRESSIVE OR REFRACTORY DISEASE At the present time there are no approved interventions for patients with progressive or refractory disease particularly after hypomethylating based therapy. Options include participation in a clinical trial or cytarabine based therapy and stem cell transplantation.
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Hong M, He G. The 2016 Revision to the World Health Organization Classification of Myelodysplastic Syndromes. J Transl Int Med 2017; 5:139-143. [PMID: 29085786 DOI: 10.1515/jtim-2017-0002] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Ming Hong
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, Jiangsu Province, China
| | - Guangsheng He
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, Jiangsu Province, China
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Sallman DA, Tanaka TN, List A, Bejar R. SOHO State of the Art Update and Next Questions: Biology and Treatment of Myelodysplastic Syndromes. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:613-620. [PMID: 29025689 DOI: 10.1016/j.clml.2017.09.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 09/19/2017] [Indexed: 11/17/2022]
Abstract
Myelodysplastic syndromes (MDS) are a heterogeneous group of myeloid neoplasms characterized by clonal hematopoiesis leading to bone marrow dysplasia and cytopenias. Recently, significant advancements have been made in understanding the pathogenic mechanisms of this disease. In particular, how a wide array of somatic mutations can induce a common clinical phenotype has been investigated. Specifically, activation of innate immune signaling (i.e. myeloid derived suppressor cells) and the NLRP3 inflammasome in hematopoietic stem/progenitor cells play a central role in the biology of MDS, leading to pyroptotic cell death and clonal expansion. Additionally, deciphering the molecular drivers of MDS using next-generation sequencing has rapidly expanded our understanding of MDS with profound implications for prognosis, treatment decisions, and future clinical investigations. Together, unraveling of the role of innate immunity/pyroptosis in the clinical phenotype of MDS patients and comprehensive molecular characterization has identified novel therapeutic strategies that offer significant promise.
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Affiliation(s)
- David A Sallman
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Tiffany N Tanaka
- Moores Cancer Center, University of California, San Diego, La Jolla, CA
| | - Alan List
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
| | - Rafael Bejar
- Moores Cancer Center, University of California, San Diego, La Jolla, CA
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Talati C, Sallman D, List A. Lenalidomide: Myelodysplastic syndromes with del(5q) and beyond. Semin Hematol 2017; 54:159-166. [PMID: 28958290 DOI: 10.1053/j.seminhematol.2017.06.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 06/19/2017] [Indexed: 01/18/2023]
Abstract
Myelodysplastic syndrome (MDS) with deletion 5q (del(5q)) is a distinct clinical and pathological disease subset that is exquisitely sensitive to lenalidomide for the treatment of red blood cell transfusion-dependent anemia. Although lenalidomide has erythropoeitic promoting activity in MDS without del(5q) (non-del(5q) MDS), the frequency of response to treatment is lower and relates to biologically separate drug effects. In del(5q) MDS, lenalidomide suppresses the malignant clone to restore effective erythropoiesis by virtue of synthetic lethality, arising from cereblon-dependent degradation of haplodeficient proteins encoded within the commonly deleted region of the chromosome 5q deletion. In contrast, in non-del(5q) MDS, lenalidomide restores effective erythropoiesis via enhancement of erythropoietin (EPO) receptor-initiated transcriptional response arising from the assembly of signaling-competent receptor complexes within membrane lipid raft domains. Recently, large phase III clinical studies have explored the role of lenalidomide, alone and in combination with, erythropoiesis-stimulating agents showing additive improvement in erythroid responses. Herein, we will describe the mechanisms of lenalidomide action in MDS and pivotal clinical studies testing the benefit of lenalidomide in both del(5q) and non-del(5q) MDS. Furthermore, we discuss evidence-based strategies to incorporate lenalidomide into the treatment algorithm for patients with MDS.
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Affiliation(s)
- Chetasi Talati
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - David Sallman
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL.
| | - Alan List
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
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Meggendorfer M, Haferlach C, Kern W, Haferlach T. Molecular analysis of myelodysplastic syndrome with isolated deletion of the long arm of chromosome 5 reveals a specific spectrum of molecular mutations with prognostic impact: a study on 123 patients and 27 genes. Haematologica 2017. [PMID: 28642303 PMCID: PMC5685225 DOI: 10.3324/haematol.2017.166173] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The only cytogenetic aberration defining a myelodysplastic syndrome subtype is the deletion of the long arm of chromosome 5, which, along with morphological features, leads to the diagnosis of myelodysplastic syndrome with isolated deletion of the long arm of chromosome 5. These patients show a good prognosis and respond to treatment such as lenalidomide, but some cases progress to acute myeloid leukemia; however, the molecular mutation pattern is rarely characterized. Therefore, we investigated a large cohort of 123 myelodysplastic syndrome patients with isolated deletion of the long arm of chromosome 5, diagnosed following the World Health Organization classifications 2008 and 2016, by sequencing 27 genes. A great proportion of patients showed no or only one mutation. Only seven genes showed mutation frequencies >5% (SF3B1, DNMT3A, TP53, TET2, CSNK1A1, ASXL1, JAK2). However, the pattern of recurrently mutated genes was comparable to other myelodysplastic syndrome subtypes by comparison to a reference cohort, except that of TP53 which was significantly more often mutated in myelodysplastic syndrome with isolated deletion of the long arm of chromosome 5. As expected, SF3B1 was frequently mutated and correlated with ring sider-oblasts, while JAK2 mutations correlated with elevated platelet counts. Surprisingly, SF3B1 mutations led to significantly worse prognosis within cases with isolated deletion of the long arm of chromosome 5, but showed a comparable outcome to other myelodysplastic syndrome subtypes with SF3B1 mutation. However, addressing genetic stability in follow-up cases might suggest different genetic mechanisms for progression to secondary acute myeloid leukemia compared to overall myelodysplastic syndrome patients.
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Drusbosky L, Medina C, Martuscello R, Hawkins KE, Chang M, Lamba JK, Vali S, Kumar A, Singh NK, Abbasi T, Sekeres MA, Mallo M, Sole F, Bejar R, Cogle CR. Computational drug treatment simulations on projections of dysregulated protein networks derived from the myelodysplastic mutanome match clinical response in patients. Leuk Res 2017; 52:1-7. [DOI: 10.1016/j.leukres.2016.11.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 11/02/2016] [Accepted: 11/04/2016] [Indexed: 01/19/2023]
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Palau A, Mallo M, Palomo L, Rodríguez-Hernández I, Diesch J, Campos D, Granada I, Juncà J, Drexler HG, Solé F, Buschbeck M. Immunophenotypic, cytogenetic, and mutational characterization of cell lines derived from myelodysplastic syndrome patients after progression to acute myeloid leukemia. Genes Chromosomes Cancer 2016; 56:243-252. [PMID: 27750403 DOI: 10.1002/gcc.22430] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 10/13/2016] [Accepted: 10/13/2016] [Indexed: 02/06/2023] Open
Abstract
Leukemia cell lines have been widely used in the hematology field to unravel mechanistic insights and to test new therapeutic strategies. Myelodysplastic syndromes (MDS) comprise a heterogeneous group of diseases that are characterized by ineffective hematopoiesis and frequent progress to acute myeloid leukemia (AML). A few cell lines have been established from MDS patients after progression to AML but their characterization is incomplete. Here we provide a detailed description of the immunophenotypic profile of the MDS-derived cell lines SKK-1, SKM-1, F-36P; and MOLM-13. Specifically, we analyzed a comprehensive panel of markers that are currently applied in the diagnostic routine for myeloid disorders. To provide high-resolution genetic data comprising copy number alterations and losses of heterozygosity we performed whole genome single nucleotide polymorphism-based arrays and included the cell line OHN-GM that harbors the frequent chromosome arm 5q deletion. Furthermore, we assessed the mutational status of 83 disease-relevant genes. Our results provide a resource to the MDS and AML field that allows researchers to choose the best-matching cell line for their functional studies. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Anna Palau
- Josep Carreras Leukaemia Research Institute, Campus ICO - Germans Trias i Pujol, Badalona, Spain
| | - Mar Mallo
- Josep Carreras Leukaemia Research Institute, Campus ICO - Germans Trias i Pujol, Badalona, Spain
| | - Laura Palomo
- Josep Carreras Leukaemia Research Institute, Campus ICO - Germans Trias i Pujol, Badalona, Spain
| | - Ines Rodríguez-Hernández
- Clinical Hematology Department, ICO-Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Jeannine Diesch
- Josep Carreras Leukaemia Research Institute, Campus ICO - Germans Trias i Pujol, Badalona, Spain
| | - Diana Campos
- Clinical Hematology Department, ICO-Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Isabel Granada
- Clinical Hematology Department, ICO-Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Jordi Juncà
- Clinical Hematology Department, ICO-Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Hans G Drexler
- Department of Human and Animal Cell Lines, Leibniz-Institute DSMZ, German Collection of Microorganisms and Cell Cultures, Braunschweig, Germany
| | - Francesc Solé
- Josep Carreras Leukaemia Research Institute, Campus ICO - Germans Trias i Pujol, Badalona, Spain
| | - Marcus Buschbeck
- Josep Carreras Leukaemia Research Institute, Campus ICO - Germans Trias i Pujol, Badalona, Spain
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Lian XY, Zhang ZH, Deng ZQ, He PF, Yao DM, Xu ZJ, Wen XM, Yang L, Lin J, Qian J. Efficacy and Safety of Lenalidomide for Treatment of Low-/Intermediate-1-Risk Myelodysplastic Syndromes with or without 5q Deletion: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0165948. [PMID: 27824902 PMCID: PMC5100926 DOI: 10.1371/journal.pone.0165948] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 10/20/2016] [Indexed: 01/22/2023] Open
Abstract
Background Lenalidomide could effectively induce red blood cell (RBC) transfusion independence (TI) in patients with lower-risk (Low/Intermediate-1) myelodysplastic syndrome (MDS) with or without 5q deletion. However whether lenalidomide ultimately improves the overall survival (OS) of lower-risk MDS patients and reduces the progression to AML remains controversial. Method A meta-analysis was conducted to examine the efficacy and safety of lenalidomide in the treatment of lower-risk MDS. Efficacy was assessed according to erythroid hematologic response (HI-E), cytogenetic response (CyR), OS and AML progression. Safety was evaluated based on the occurrence rates of grades 3–4 adverse events (AEs). Results Seventeen studies were included consisting of a total of 2160 patients. The analysis indicated that the overall rate of HI-E was 58% with 95% confidence interval (CI) of 43–74%. The pooled estimates for the rates of CyR, complete CyR, and partial CyR were 44% (95% CI 19–68%), 21% (95% CI 13–30%) and 23% (95% CI 15–32%), respectively. The patients with 5q deletion had significantly higher rate of HI-E and CyR than those without 5q deletion (P = 0.002 and 0.001, respectively). The incidences of grades 3–4 neutropenia, thrombocytopenia, leukopenia, anemia, deep vein thrombosis, diarrhea, fatigue and rash were 51% (95% CI 30–73%), 31% (95% CI 20–42%), 9% (95% CI 5–13%), 7% (95% CI 2–12%), 3% (95% CI 2–5%), 3% (95% CI 1–5%), 2% (95% CI 1–4%) and 2% (95% CI 1–3%), respectively. Lenalidomide significantly improved OS (HR: 0.62, 95% CI 0.47–0.83, P = 0.001) and lowered the risk of AML progression in del(5q) patients (RR: 0.61, 95% CI 0.41–0.91, P = 0.014). Conclusions In spite of the AEs, lenalidomide could be effectively and safely used for the treatment of lower-risk MDS patients with or without 5q deletion.
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Affiliation(s)
- Xin-yue Lian
- Department of Hematology, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, People’s Republic of China
| | - Zhi-hui Zhang
- Department of Hematology, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, People’s Republic of China
| | - Zhao-qun Deng
- Laboratory Center, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, People’s Republic of China
| | - Pin-fang He
- Laboratory Center, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, People’s Republic of China
| | - Dong-ming Yao
- Laboratory Center, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, People’s Republic of China
| | - Zi-jun Xu
- Laboratory Center, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, People’s Republic of China
| | - Xiang-mei Wen
- Laboratory Center, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, People’s Republic of China
| | - Lei Yang
- Laboratory Center, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, People’s Republic of China
| | - Jiang Lin
- Laboratory Center, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, People’s Republic of China
- * E-mail: (JQ); (JL)
| | - Jun Qian
- Department of Hematology, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, People’s Republic of China
- * E-mail: (JQ); (JL)
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Gidaro A, Deliliers GL, Gallipoli P, Arquati M, Wu MA, Castelli R. Laboratory and clinical risk assessment to treat myelodysplatic syndromes. ACTA ACUST UNITED AC 2016; 54:1411-26. [DOI: 10.1515/cclm-2015-0789] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 11/11/2015] [Indexed: 12/11/2022]
Abstract
Abstract
Myelodisplastic syndromes (MDS) are heterogeneous myeloid disorders characterized by peripheral cytopenias and increased risk of transformation into acute myelogenous leukemia (AML). MDS are generally suspected in the presence of cytopenia on routine analysis and the evaluation of bone marrow cells morphology and cellularity leads to correct diagnosis of MDS. The incidence of MDS is approximately five cases per 100,000 people per year in the general population, but it increases up to 50 cases per 100,000 people per year after 60 years of age. Typically MDS affect the elderly, with a median age at diagnosis of 65–70 years. Here the current therapeutic approaches for MDS are evaluated by searching the PubMed database. Establishing the prognosis in MDS patients is a key element of therapy. In fact an accurate estimate of prognosis drives decisions about the choice and timing of the therapeutic options. Therapy is selected based on prognostic risk assessment, cytogenetic pattern, transfusion needs and biological characteristics of the disease, comorbidities and clinical condition of the patients. In lower-risk patients the goals of therapy are different from those in higher-risk patients. In lower-risk patients, the aim of therapy is to reduce transfusion needs and transformation to higher risk disease or AML, improving the quality of life and survival. In higher-risk patients, the main goal of therapy is to prolong survival and to reduce the risk of AML transformation. Current therapies include growth factor support, lenalidomide, immunomodulatory and hypomethylating agents, intensive chemotherapy, and allogenic stem cell transplantation. The challenge when dealing with MDS patients is to select the optimal treatment by balancing efficacy and toxicity.
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Zeidan AM, Stahl M, Komrokji R. Emerging biological therapies for the treatment of myelodysplastic syndromes. Expert Opin Emerg Drugs 2016; 21:283-300. [DOI: 10.1080/14728214.2016.1220534] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Mutations of myelodysplastic syndromes (MDS): An update. MUTATION RESEARCH-REVIEWS IN MUTATION RESEARCH 2016; 769:47-62. [DOI: 10.1016/j.mrrev.2016.04.009] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 04/11/2016] [Indexed: 01/08/2023]
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He R, Wiktor AE, Durnick DK, Kurtin PJ, Van Dyke DL, Tefferi A, Patnaik MS, Ketterling RP, Hanson CA. Bone Marrow Conventional Karyotyping and Fluorescence In Situ Hybridization: Defining an Effective Utilization Strategy for Evaluation of Myelodysplastic Syndromes. Am J Clin Pathol 2016; 146:86-94. [PMID: 27353768 DOI: 10.1093/ajcp/aqw077] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES The current standard of practice for evaluation of myelodysplastic syndromes (MDS) includes peripheral blood and bone marrow morphology review and conventional karyotyping. Karyotype provides a global view of the chromosome complement while fluorescence in situ hybridization (FISH) targets specific abnormalities. The aim of this study was to determine if an MDS-FISH panel would add value beyond karyotype in MDS workup. METHODS We studied 505 patients who were evaluated for a possible MDS and had concurrent bone marrow examination, karyotyping, and MDS-FISH performed. RESULTS In total, 462 cases had adequate karyotyping (≥20 metaphases) and showed excellent concordance (96%, 445/462) between karyotyping and MDS-FISH. Additional FISH abnormalities had no impact on diagnosis and minimal impact on the cytogenetic prognostic scoring in the myeloid neoplasm cases (2%, 4/206). The concordance rate dropped to 82% (32/39) in the group with insufficient karyotyping (<20 metaphases), and additional FISH findings in this subgroup had no impact on the diagnosis but altered the cytogenetic prognostic scoring in 10% (2/20) of myeloid neoplasm cases. CONCLUSIONS In the evaluation of a possible MDS, FISH rarely provides additional value when karyotype is adequate. We propose a value-based, cost-effective algorithmic approach for conventional karyotyping and FISH testing in routine MDS workup.
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Affiliation(s)
- Rong He
- From the Divisions of Hematopathology
| | | | | | | | | | - Ayalew Tefferi
- Hematology, Mayo Clinic College of Medicine, Rochester, MN
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The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood 2016; 127:2391-405. [PMID: 27069254 DOI: 10.1182/blood-2016-03-643544] [Citation(s) in RCA: 6117] [Impact Index Per Article: 764.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 04/06/2016] [Indexed: 02/06/2023] Open
Abstract
The World Health Organization (WHO) classification of tumors of the hematopoietic and lymphoid tissues was last updated in 2008. Since then, there have been numerous advances in the identification of unique biomarkers associated with some myeloid neoplasms and acute leukemias, largely derived from gene expression analysis and next-generation sequencing that can significantly improve the diagnostic criteria as well as the prognostic relevance of entities currently included in the WHO classification and that also suggest new entities that should be added. Therefore, there is a clear need for a revision to the current classification. The revisions to the categories of myeloid neoplasms and acute leukemia will be published in a monograph in 2016 and reflect a consensus of opinion of hematopathologists, hematologists, oncologists, and geneticists. The 2016 edition represents a revision of the prior classification rather than an entirely new classification and attempts to incorporate new clinical, prognostic, morphologic, immunophenotypic, and genetic data that have emerged since the last edition. The major changes in the classification and their rationale are presented here.
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Palomo L, Xicoy B, Garcia O, Mallo M, Ademà V, Cabezón M, Arnan M, Pomares H, José Larrayoz M, José Calasanz M, Maciejewski JP, Huang D, Shih LY, Ogawa S, Cervera J, Such E, Coll R, Grau J, Solé F, Zamora L. Impact of SNP array karyotyping on the diagnosis and the outcome of chronic myelomonocytic leukemia with low risk cytogenetic features or no metaphases. Am J Hematol 2016; 91:185-92. [PMID: 26509444 DOI: 10.1002/ajh.24227] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 10/14/2015] [Accepted: 10/26/2015] [Indexed: 12/26/2022]
Abstract
Chronic myelomonocytic leukemia (CMML) is a clonal hematopoietic disorder with heterogeneous clinical, morphological and genetic characteristics. Clonal cytogenetic abnormalities are found in 20-30% of patients with CMML. Patients with low risk cytogenetic features (normal karyotype and isolated loss of Y chromosome) account for ∼80% of CMML patients and often fall into the low risk categories of CMML prognostic scores. We hypothesized that single nucleotide polymorphism arrays (SNP-A) karyotyping could detect cryptic chromosomal alterations with prognostic impact in these subgroup of patients. SNP-A were performed at diagnosis in 128 CMML patients with low risk karyotypes or uninformative results for conventional G-banding cytogenetics (CC). Copy number alterations (CNAs) and regions of copy number neutral loss of heterozygosity (CNN-LOH) were detected in 67% of patients. Recurrent CNAs included gains in regions 8p12 and 21q22 as well as losses in 10q21.1 and 12p13.2. Interstitial CNN-LOHs were recurrently detected in the following regions: 4q24-4q35, 7q32.1-7q36.3, and 11q13.3-11q25. Statistical analysis showed that some of the alterations detected by SNP-A associated with the patients' outcome. A shortened overall survival (OS) and progression free survival (PFS) was observed in cases where the affected size of the genome (considering CNAs and CNN-LOHs) was >11 Mb. In addition, presence of interstitial CNN-LOH was predictive of poor OS. Presence of CNAs (≥1) associated with poorer OS and PFS in the patients with myeloproliferative CMML. Overall, SNP-A analysis increased the diagnostic yield in patients with low risk cytogenetic features or uninformative CC and added prognostic value to this subset of patients.
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Affiliation(s)
- Laura Palomo
- MDS Research Group, Institut De Recerca Contra La Leucèmia Josep Carreras; ICO-Hospital Germans Trias I Pujol, Universitat Autònoma De Barcelona; Badalona Spain
- Departament De Bioquímica I Biologia Molecular, Universitat Autònoma De Barcelona; Spain
| | - Blanca Xicoy
- Hematology Service, ICO-Hospital Germans Trias I Pujol, Institut De Recerca Contra La Leucèmia Josep Carreras; Universitat Autònoma De Barcelona; Badalona Spain
| | - Olga Garcia
- Hematology Service, ICO-Hospital Germans Trias I Pujol, Institut De Recerca Contra La Leucèmia Josep Carreras; Universitat Autònoma De Barcelona; Badalona Spain
| | - Mar Mallo
- MDS Research Group, Institut De Recerca Contra La Leucèmia Josep Carreras; ICO-Hospital Germans Trias I Pujol, Universitat Autònoma De Barcelona; Badalona Spain
| | - Vera Ademà
- MDS Research Group, Institut De Recerca Contra La Leucèmia Josep Carreras; ICO-Hospital Germans Trias I Pujol, Universitat Autònoma De Barcelona; Badalona Spain
| | - Marta Cabezón
- Hematology Service, ICO-Hospital Germans Trias I Pujol, Institut De Recerca Contra La Leucèmia Josep Carreras; Universitat Autònoma De Barcelona; Badalona Spain
| | - Montse Arnan
- Hematology Service, ICO-Hospital Duran I Reynals; Barcelona Spain
| | - Helena Pomares
- Hematology Service, ICO-Hospital Duran I Reynals; Barcelona Spain
| | - María José Larrayoz
- CIMA LAB Diagnostics, Department of Biochemistry and Genetics; University of Navarra, Instituto De Investigación Sanitaria De Navarra; Pamplona Spain
| | - María José Calasanz
- CIMA LAB Diagnostics, Department of Biochemistry and Genetics; University of Navarra, Instituto De Investigación Sanitaria De Navarra; Pamplona Spain
| | - Jaroslaw P. Maciejewski
- Department of Translational Hematology and Oncology Research; Taussing Cancer Institute, Cleveland Clinic; Cleveland Ohio
| | - Dayong Huang
- Department of Translational Hematology and Oncology Research; Taussing Cancer Institute, Cleveland Clinic; Cleveland Ohio
| | - Lee-Yung Shih
- Division of Hematology; Chang Gung Memorial Hospital-Linkou, Chang Gung University; Taiwan City Taiwan
| | - Seishi Ogawa
- Department of Pathology and Tumor Biology, Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Jose Cervera
- Hematology Department; Hospital Universitario La Fe; Valencia Spain
| | - Esperanza Such
- Hematology Department; Hospital Universitario La Fe; Valencia Spain
| | - Rosa Coll
- Hematology Service, ICO Girona Hospital Josep Trueta; Girona Spain
| | - Javier Grau
- Hematology Service, ICO-Hospital Germans Trias I Pujol, Institut De Recerca Contra La Leucèmia Josep Carreras; Universitat Autònoma De Barcelona; Badalona Spain
| | - Francesc Solé
- MDS Research Group, Institut De Recerca Contra La Leucèmia Josep Carreras; ICO-Hospital Germans Trias I Pujol, Universitat Autònoma De Barcelona; Badalona Spain
| | - Lurdes Zamora
- Hematology Service, ICO-Hospital Germans Trias I Pujol, Institut De Recerca Contra La Leucèmia Josep Carreras; Universitat Autònoma De Barcelona; Badalona Spain
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Greenberg PL, Stone RM, Bejar R, Bennett JM, Bloomfield CD, Borate U, De Castro CM, Deeg HJ, DeZern AE, Fathi AT, Frankfurt O, Gaensler K, Garcia-Manero G, Griffiths EA, Head D, Klimek V, Komrokji R, Kujawski LA, Maness LJ, O'Donnell MR, Pollyea DA, Scott B, Shami PJ, Stein BL, Westervelt P, Wheeler B, Shead DA, Smith C. Myelodysplastic syndromes, version 2.2015. J Natl Compr Canc Netw 2015; 13:261-72. [PMID: 25736003 DOI: 10.6004/jnccn.2015.0038] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The NCCN Guidelines for Myelodysplastic Syndromes (MDS) comprise a heterogeneous group of myeloid disorders with a highly variable disease course that depends largely on risk factors. Risk evaluation is therefore a critical component of decision-making in the treatment of MDS. The development of newer treatments and the refinement of current treatment modalities are designed to improve patient outcomes and reduce side effects. These NCCN Guidelines Insights focus on the recent updates to the guidelines, which include the incorporation of a revised prognostic scoring system, addition of molecular abnormalities associated with MDS, and refinement of treatment options involving a discussion of cost of care.
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Affiliation(s)
- Peter L Greenberg
- From Stanford Cancer Institute; Dana-Farber/Brigham and Women's Cancer Center; UC San Diego Moores Cancer Center; University of Rochester Medical Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; University of Alabama at Birmingham Comprehensive Cancer Center; Duke Cancer Institute; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Massachusetts General Hospital Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; UCSF Helen Diller Family Comprehensive Cancer Center; The University of Texas MD Anderson Cancer Center; Roswell Park Cancer Institute; Vanderbilt-Ingram Cancer Center; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; University of Michigan Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center; City of Hope Comprehensive Cancer Center; University of Colorado Cancer Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; and National Comprehensive Cancer Network
| | - Richard M Stone
- From Stanford Cancer Institute; Dana-Farber/Brigham and Women's Cancer Center; UC San Diego Moores Cancer Center; University of Rochester Medical Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; University of Alabama at Birmingham Comprehensive Cancer Center; Duke Cancer Institute; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Massachusetts General Hospital Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; UCSF Helen Diller Family Comprehensive Cancer Center; The University of Texas MD Anderson Cancer Center; Roswell Park Cancer Institute; Vanderbilt-Ingram Cancer Center; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; University of Michigan Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center; City of Hope Comprehensive Cancer Center; University of Colorado Cancer Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; and National Comprehensive Cancer Network
| | - Rafael Bejar
- From Stanford Cancer Institute; Dana-Farber/Brigham and Women's Cancer Center; UC San Diego Moores Cancer Center; University of Rochester Medical Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; University of Alabama at Birmingham Comprehensive Cancer Center; Duke Cancer Institute; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Massachusetts General Hospital Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; UCSF Helen Diller Family Comprehensive Cancer Center; The University of Texas MD Anderson Cancer Center; Roswell Park Cancer Institute; Vanderbilt-Ingram Cancer Center; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; University of Michigan Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center; City of Hope Comprehensive Cancer Center; University of Colorado Cancer Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; and National Comprehensive Cancer Network
| | - John M Bennett
- From Stanford Cancer Institute; Dana-Farber/Brigham and Women's Cancer Center; UC San Diego Moores Cancer Center; University of Rochester Medical Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; University of Alabama at Birmingham Comprehensive Cancer Center; Duke Cancer Institute; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Massachusetts General Hospital Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; UCSF Helen Diller Family Comprehensive Cancer Center; The University of Texas MD Anderson Cancer Center; Roswell Park Cancer Institute; Vanderbilt-Ingram Cancer Center; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; University of Michigan Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center; City of Hope Comprehensive Cancer Center; University of Colorado Cancer Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; and National Comprehensive Cancer Network
| | - Clara D Bloomfield
- From Stanford Cancer Institute; Dana-Farber/Brigham and Women's Cancer Center; UC San Diego Moores Cancer Center; University of Rochester Medical Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; University of Alabama at Birmingham Comprehensive Cancer Center; Duke Cancer Institute; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Massachusetts General Hospital Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; UCSF Helen Diller Family Comprehensive Cancer Center; The University of Texas MD Anderson Cancer Center; Roswell Park Cancer Institute; Vanderbilt-Ingram Cancer Center; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; University of Michigan Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center; City of Hope Comprehensive Cancer Center; University of Colorado Cancer Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; and National Comprehensive Cancer Network
| | - Uma Borate
- From Stanford Cancer Institute; Dana-Farber/Brigham and Women's Cancer Center; UC San Diego Moores Cancer Center; University of Rochester Medical Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; University of Alabama at Birmingham Comprehensive Cancer Center; Duke Cancer Institute; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Massachusetts General Hospital Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; UCSF Helen Diller Family Comprehensive Cancer Center; The University of Texas MD Anderson Cancer Center; Roswell Park Cancer Institute; Vanderbilt-Ingram Cancer Center; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; University of Michigan Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center; City of Hope Comprehensive Cancer Center; University of Colorado Cancer Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; and National Comprehensive Cancer Network
| | - Carlos M De Castro
- From Stanford Cancer Institute; Dana-Farber/Brigham and Women's Cancer Center; UC San Diego Moores Cancer Center; University of Rochester Medical Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; University of Alabama at Birmingham Comprehensive Cancer Center; Duke Cancer Institute; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Massachusetts General Hospital Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; UCSF Helen Diller Family Comprehensive Cancer Center; The University of Texas MD Anderson Cancer Center; Roswell Park Cancer Institute; Vanderbilt-Ingram Cancer Center; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; University of Michigan Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center; City of Hope Comprehensive Cancer Center; University of Colorado Cancer Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; and National Comprehensive Cancer Network
| | - H Joachim Deeg
- From Stanford Cancer Institute; Dana-Farber/Brigham and Women's Cancer Center; UC San Diego Moores Cancer Center; University of Rochester Medical Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; University of Alabama at Birmingham Comprehensive Cancer Center; Duke Cancer Institute; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Massachusetts General Hospital Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; UCSF Helen Diller Family Comprehensive Cancer Center; The University of Texas MD Anderson Cancer Center; Roswell Park Cancer Institute; Vanderbilt-Ingram Cancer Center; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; University of Michigan Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center; City of Hope Comprehensive Cancer Center; University of Colorado Cancer Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; and National Comprehensive Cancer Network
| | - Amy E DeZern
- From Stanford Cancer Institute; Dana-Farber/Brigham and Women's Cancer Center; UC San Diego Moores Cancer Center; University of Rochester Medical Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; University of Alabama at Birmingham Comprehensive Cancer Center; Duke Cancer Institute; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Massachusetts General Hospital Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; UCSF Helen Diller Family Comprehensive Cancer Center; The University of Texas MD Anderson Cancer Center; Roswell Park Cancer Institute; Vanderbilt-Ingram Cancer Center; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; University of Michigan Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center; City of Hope Comprehensive Cancer Center; University of Colorado Cancer Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; and National Comprehensive Cancer Network
| | - Amir T Fathi
- From Stanford Cancer Institute; Dana-Farber/Brigham and Women's Cancer Center; UC San Diego Moores Cancer Center; University of Rochester Medical Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; University of Alabama at Birmingham Comprehensive Cancer Center; Duke Cancer Institute; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Massachusetts General Hospital Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; UCSF Helen Diller Family Comprehensive Cancer Center; The University of Texas MD Anderson Cancer Center; Roswell Park Cancer Institute; Vanderbilt-Ingram Cancer Center; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; University of Michigan Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center; City of Hope Comprehensive Cancer Center; University of Colorado Cancer Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; and National Comprehensive Cancer Network
| | - Olga Frankfurt
- From Stanford Cancer Institute; Dana-Farber/Brigham and Women's Cancer Center; UC San Diego Moores Cancer Center; University of Rochester Medical Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; University of Alabama at Birmingham Comprehensive Cancer Center; Duke Cancer Institute; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Massachusetts General Hospital Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; UCSF Helen Diller Family Comprehensive Cancer Center; The University of Texas MD Anderson Cancer Center; Roswell Park Cancer Institute; Vanderbilt-Ingram Cancer Center; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; University of Michigan Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center; City of Hope Comprehensive Cancer Center; University of Colorado Cancer Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; and National Comprehensive Cancer Network
| | - Karin Gaensler
- From Stanford Cancer Institute; Dana-Farber/Brigham and Women's Cancer Center; UC San Diego Moores Cancer Center; University of Rochester Medical Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; University of Alabama at Birmingham Comprehensive Cancer Center; Duke Cancer Institute; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Massachusetts General Hospital Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; UCSF Helen Diller Family Comprehensive Cancer Center; The University of Texas MD Anderson Cancer Center; Roswell Park Cancer Institute; Vanderbilt-Ingram Cancer Center; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; University of Michigan Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center; City of Hope Comprehensive Cancer Center; University of Colorado Cancer Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; and National Comprehensive Cancer Network
| | - Guillermo Garcia-Manero
- From Stanford Cancer Institute; Dana-Farber/Brigham and Women's Cancer Center; UC San Diego Moores Cancer Center; University of Rochester Medical Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; University of Alabama at Birmingham Comprehensive Cancer Center; Duke Cancer Institute; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Massachusetts General Hospital Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; UCSF Helen Diller Family Comprehensive Cancer Center; The University of Texas MD Anderson Cancer Center; Roswell Park Cancer Institute; Vanderbilt-Ingram Cancer Center; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; University of Michigan Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center; City of Hope Comprehensive Cancer Center; University of Colorado Cancer Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; and National Comprehensive Cancer Network
| | - Elizabeth A Griffiths
- From Stanford Cancer Institute; Dana-Farber/Brigham and Women's Cancer Center; UC San Diego Moores Cancer Center; University of Rochester Medical Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; University of Alabama at Birmingham Comprehensive Cancer Center; Duke Cancer Institute; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Massachusetts General Hospital Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; UCSF Helen Diller Family Comprehensive Cancer Center; The University of Texas MD Anderson Cancer Center; Roswell Park Cancer Institute; Vanderbilt-Ingram Cancer Center; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; University of Michigan Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center; City of Hope Comprehensive Cancer Center; University of Colorado Cancer Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; and National Comprehensive Cancer Network
| | - David Head
- From Stanford Cancer Institute; Dana-Farber/Brigham and Women's Cancer Center; UC San Diego Moores Cancer Center; University of Rochester Medical Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; University of Alabama at Birmingham Comprehensive Cancer Center; Duke Cancer Institute; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Massachusetts General Hospital Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; UCSF Helen Diller Family Comprehensive Cancer Center; The University of Texas MD Anderson Cancer Center; Roswell Park Cancer Institute; Vanderbilt-Ingram Cancer Center; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; University of Michigan Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center; City of Hope Comprehensive Cancer Center; University of Colorado Cancer Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; and National Comprehensive Cancer Network
| | - Virginia Klimek
- From Stanford Cancer Institute; Dana-Farber/Brigham and Women's Cancer Center; UC San Diego Moores Cancer Center; University of Rochester Medical Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; University of Alabama at Birmingham Comprehensive Cancer Center; Duke Cancer Institute; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Massachusetts General Hospital Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; UCSF Helen Diller Family Comprehensive Cancer Center; The University of Texas MD Anderson Cancer Center; Roswell Park Cancer Institute; Vanderbilt-Ingram Cancer Center; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; University of Michigan Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center; City of Hope Comprehensive Cancer Center; University of Colorado Cancer Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; and National Comprehensive Cancer Network
| | - Rami Komrokji
- From Stanford Cancer Institute; Dana-Farber/Brigham and Women's Cancer Center; UC San Diego Moores Cancer Center; University of Rochester Medical Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; University of Alabama at Birmingham Comprehensive Cancer Center; Duke Cancer Institute; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Massachusetts General Hospital Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; UCSF Helen Diller Family Comprehensive Cancer Center; The University of Texas MD Anderson Cancer Center; Roswell Park Cancer Institute; Vanderbilt-Ingram Cancer Center; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; University of Michigan Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center; City of Hope Comprehensive Cancer Center; University of Colorado Cancer Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; and National Comprehensive Cancer Network
| | - Lisa A Kujawski
- From Stanford Cancer Institute; Dana-Farber/Brigham and Women's Cancer Center; UC San Diego Moores Cancer Center; University of Rochester Medical Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; University of Alabama at Birmingham Comprehensive Cancer Center; Duke Cancer Institute; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Massachusetts General Hospital Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; UCSF Helen Diller Family Comprehensive Cancer Center; The University of Texas MD Anderson Cancer Center; Roswell Park Cancer Institute; Vanderbilt-Ingram Cancer Center; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; University of Michigan Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center; City of Hope Comprehensive Cancer Center; University of Colorado Cancer Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; and National Comprehensive Cancer Network
| | - Lori J Maness
- From Stanford Cancer Institute; Dana-Farber/Brigham and Women's Cancer Center; UC San Diego Moores Cancer Center; University of Rochester Medical Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; University of Alabama at Birmingham Comprehensive Cancer Center; Duke Cancer Institute; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Massachusetts General Hospital Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; UCSF Helen Diller Family Comprehensive Cancer Center; The University of Texas MD Anderson Cancer Center; Roswell Park Cancer Institute; Vanderbilt-Ingram Cancer Center; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; University of Michigan Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center; City of Hope Comprehensive Cancer Center; University of Colorado Cancer Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; and National Comprehensive Cancer Network
| | - Margaret R O'Donnell
- From Stanford Cancer Institute; Dana-Farber/Brigham and Women's Cancer Center; UC San Diego Moores Cancer Center; University of Rochester Medical Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; University of Alabama at Birmingham Comprehensive Cancer Center; Duke Cancer Institute; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Massachusetts General Hospital Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; UCSF Helen Diller Family Comprehensive Cancer Center; The University of Texas MD Anderson Cancer Center; Roswell Park Cancer Institute; Vanderbilt-Ingram Cancer Center; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; University of Michigan Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center; City of Hope Comprehensive Cancer Center; University of Colorado Cancer Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; and National Comprehensive Cancer Network
| | - Daniel A Pollyea
- From Stanford Cancer Institute; Dana-Farber/Brigham and Women's Cancer Center; UC San Diego Moores Cancer Center; University of Rochester Medical Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; University of Alabama at Birmingham Comprehensive Cancer Center; Duke Cancer Institute; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Massachusetts General Hospital Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; UCSF Helen Diller Family Comprehensive Cancer Center; The University of Texas MD Anderson Cancer Center; Roswell Park Cancer Institute; Vanderbilt-Ingram Cancer Center; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; University of Michigan Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center; City of Hope Comprehensive Cancer Center; University of Colorado Cancer Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; and National Comprehensive Cancer Network
| | - Bart Scott
- From Stanford Cancer Institute; Dana-Farber/Brigham and Women's Cancer Center; UC San Diego Moores Cancer Center; University of Rochester Medical Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; University of Alabama at Birmingham Comprehensive Cancer Center; Duke Cancer Institute; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Massachusetts General Hospital Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; UCSF Helen Diller Family Comprehensive Cancer Center; The University of Texas MD Anderson Cancer Center; Roswell Park Cancer Institute; Vanderbilt-Ingram Cancer Center; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; University of Michigan Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center; City of Hope Comprehensive Cancer Center; University of Colorado Cancer Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; and National Comprehensive Cancer Network
| | - Paul J Shami
- From Stanford Cancer Institute; Dana-Farber/Brigham and Women's Cancer Center; UC San Diego Moores Cancer Center; University of Rochester Medical Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; University of Alabama at Birmingham Comprehensive Cancer Center; Duke Cancer Institute; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Massachusetts General Hospital Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; UCSF Helen Diller Family Comprehensive Cancer Center; The University of Texas MD Anderson Cancer Center; Roswell Park Cancer Institute; Vanderbilt-Ingram Cancer Center; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; University of Michigan Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center; City of Hope Comprehensive Cancer Center; University of Colorado Cancer Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; and National Comprehensive Cancer Network
| | - Brady L Stein
- From Stanford Cancer Institute; Dana-Farber/Brigham and Women's Cancer Center; UC San Diego Moores Cancer Center; University of Rochester Medical Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; University of Alabama at Birmingham Comprehensive Cancer Center; Duke Cancer Institute; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Massachusetts General Hospital Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; UCSF Helen Diller Family Comprehensive Cancer Center; The University of Texas MD Anderson Cancer Center; Roswell Park Cancer Institute; Vanderbilt-Ingram Cancer Center; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; University of Michigan Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center; City of Hope Comprehensive Cancer Center; University of Colorado Cancer Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; and National Comprehensive Cancer Network
| | - Peter Westervelt
- From Stanford Cancer Institute; Dana-Farber/Brigham and Women's Cancer Center; UC San Diego Moores Cancer Center; University of Rochester Medical Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; University of Alabama at Birmingham Comprehensive Cancer Center; Duke Cancer Institute; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Massachusetts General Hospital Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; UCSF Helen Diller Family Comprehensive Cancer Center; The University of Texas MD Anderson Cancer Center; Roswell Park Cancer Institute; Vanderbilt-Ingram Cancer Center; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; University of Michigan Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center; City of Hope Comprehensive Cancer Center; University of Colorado Cancer Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; and National Comprehensive Cancer Network
| | - Benton Wheeler
- From Stanford Cancer Institute; Dana-Farber/Brigham and Women's Cancer Center; UC San Diego Moores Cancer Center; University of Rochester Medical Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; University of Alabama at Birmingham Comprehensive Cancer Center; Duke Cancer Institute; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Massachusetts General Hospital Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; UCSF Helen Diller Family Comprehensive Cancer Center; The University of Texas MD Anderson Cancer Center; Roswell Park Cancer Institute; Vanderbilt-Ingram Cancer Center; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; University of Michigan Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center; City of Hope Comprehensive Cancer Center; University of Colorado Cancer Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; and National Comprehensive Cancer Network
| | - Dorothy A Shead
- From Stanford Cancer Institute; Dana-Farber/Brigham and Women's Cancer Center; UC San Diego Moores Cancer Center; University of Rochester Medical Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; University of Alabama at Birmingham Comprehensive Cancer Center; Duke Cancer Institute; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Massachusetts General Hospital Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; UCSF Helen Diller Family Comprehensive Cancer Center; The University of Texas MD Anderson Cancer Center; Roswell Park Cancer Institute; Vanderbilt-Ingram Cancer Center; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; University of Michigan Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center; City of Hope Comprehensive Cancer Center; University of Colorado Cancer Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; and National Comprehensive Cancer Network
| | - Courtney Smith
- From Stanford Cancer Institute; Dana-Farber/Brigham and Women's Cancer Center; UC San Diego Moores Cancer Center; University of Rochester Medical Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; University of Alabama at Birmingham Comprehensive Cancer Center; Duke Cancer Institute; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Massachusetts General Hospital Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; UCSF Helen Diller Family Comprehensive Cancer Center; The University of Texas MD Anderson Cancer Center; Roswell Park Cancer Institute; Vanderbilt-Ingram Cancer Center; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; University of Michigan Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center; City of Hope Comprehensive Cancer Center; University of Colorado Cancer Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; and National Comprehensive Cancer Network
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48
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Platzbecker U, Fenaux P. Personalized medicine in myelodysplastic syndromes: wishful thinking or already clinical reality? Haematologica 2015; 100:568-71. [PMID: 25944636 DOI: 10.3324/haematol.2015.126813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Uwe Platzbecker
- Universitätsklinikum "Carl-Gustav-Carus", Medizinische Klinik I, Technische Universität Dresden, Dresden, Germany
| | - Pierre Fenaux
- Service d'Hématologie Sénior, Hopital Saint Louis, Assistance Publique-Hôpitaux de Paris et Université Paris 7, France
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49
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Ganster C, Shirneshan K, Salinas-Riester G, Braulke F, Schanz J, Platzbecker U, Haase D. Influence of total genomic alteration and chromosomal fragmentation on response to a combination of azacitidine and lenalidomide in a cohort of patients with very high risk MDS. Leuk Res 2015; 39:1079-87. [PMID: 26278198 DOI: 10.1016/j.leukres.2015.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 06/16/2015] [Accepted: 06/19/2015] [Indexed: 11/16/2022]
Abstract
We genetically analyzed a group of high risk MDS/AML patients treated by a combination of azacitidine and lenalidomide. In our cohort, the extent of genetic rearrangements was associated with outcome and response to treatment. The size of total genomic aberrations as defined by molecular karyotyping (SNP-array analysis) was a predictive marker for overall survival. TP53 mutations were associated with therapy refractoriness only if accompanied by heavily rearranged chromosomes. This study suggests a potential value of molecular karyotyping as a method to objectivate comprehensively the extent of genetic alterations in high risk patients with complex karyotypes, especially if the clinical value of the size of total genomic aberrations and the fragmentation status of single chromosomes could be evaluated in larger therapy trials.
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Affiliation(s)
- Christina Ganster
- Department of Hematology and Medical Oncology, University Hospital, University Göttingen, Göttingen, Germany.
| | - Katayoon Shirneshan
- Department of Hematology and Medical Oncology, University Hospital, University Göttingen, Göttingen, Germany
| | | | - Friederike Braulke
- Department of Hematology and Medical Oncology, University Hospital, University Göttingen, Göttingen, Germany
| | - Julie Schanz
- Department of Hematology and Medical Oncology, University Hospital, University Göttingen, Göttingen, Germany
| | - Uwe Platzbecker
- Medical Clinic and Polyclinic I, University Hospital, Technical University Dresden, Dresden, Germany
| | - Detlef Haase
- Department of Hematology and Medical Oncology, University Hospital, University Göttingen, Göttingen, Germany
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50
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Bally C, Renneville A, Preudhomme C, Legrand M, Adès L, de Thé H, Fenaux P, Lehmann-Che J. Comparison of TP53 mutations screening by functional assay of separated allele in yeast and next-generation sequencing in myelodysplastic syndromes. Leuk Res 2015; 39:S0145-2126(15)30344-1. [PMID: 26271412 DOI: 10.1016/j.leukres.2015.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 06/03/2015] [Accepted: 07/02/2015] [Indexed: 11/15/2022]
Abstract
TP53 mutations are major prognostic factors in many hematological malignancies including acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS). Next-generation sequencing (NGS) has improved the detection of such mutations by identifying small mutated clones but functional method like FASAY (functional assay of separated allele in yeast) may prove interesting. We compared the detection of TP53 mutations by FASAY and NGS in 91 patients with AML or MDS. By FASAY, 91% of assays were evaluable and 47 patients (57%) had a functional and 36 (43%) a non-functional p53 protein. FASAY could not conclude in 8 cases (9%), mainly because of poor RNA quality. No TP53 mutation was found using NGS in 50 cases (55%), and at least one mutation was detected in 41 cases (45%). The p53 status was concordant between FASAY and NGS in 95% (79/83) of cases. The four discordances included mutations detected by FASAY only in two cases, and by NGS only in two cases. Mutations not detected by NGS consisted of insertions in intronic regions, which were not analyzed by this assay. Mutations not detected by FASAY were mutations for which the percentage of mutated allele was less than 10%, including one mutation reported as non-deleterious in the IARC database. Overall, our data suggest that FASAY is an effective and reliable method to detect TP53 mutations in AML and MDS, which allows the assessment of the protein functionality, contrary to a sequencing approach.
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Affiliation(s)
- Cécile Bally
- Hematology Clinical Unit, Hospital Saint Louis, AP-HP, Paris, France
| | | | | | - M Legrand
- Molecular Oncology Unit, Department of Biochemistry, Hospital Saint Louis, AP-HP, Paris, France
| | - Lionel Adès
- Hematology Clinical Unit, Hospital Saint Louis, AP-HP, Paris, France
| | - Hugues de Thé
- Molecular Oncology Unit, Department of Biochemistry, Hospital Saint Louis, AP-HP, Paris, France; Univ Paris Diderot, Sorbonne Paris Cité, CNRS UMR7212/INSERM U944, Paris, France
| | - Pierre Fenaux
- Hematology Clinical Unit, Hospital Saint Louis, AP-HP, Paris, France
| | - Jacqueline Lehmann-Che
- Molecular Oncology Unit, Department of Biochemistry, Hospital Saint Louis, AP-HP, Paris, France; Univ Paris Diderot, Sorbonne Paris Cité, CNRS UMR7212/INSERM U944, Paris, France.
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