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Jia X, Liao N, Yu S, Li H, Liu H, Zhang H, Xu J, Yao Y, He H, Yu G, Liu Q, Zhang Y, Shi P. Impact of measurable residual disease in combination with CD19 on postremission therapy choices for adult t(8;21) acute myeloid leukemia in first complete remission. Cancer Med 2024; 13:e7074. [PMID: 38457215 PMCID: PMC10922018 DOI: 10.1002/cam4.7074] [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: 10/08/2023] [Revised: 02/08/2024] [Accepted: 02/20/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND The post-remission therapy (PRT) choices for adult t(8;21) acute myeloid leukemia (AML) in first complete remission (CR1) need to be further explored. AIMS We aimed to investigate the impact of measurable residual disease (MRD) combined with CD19 on PRT choices for adult t(8;21) AML in CR1. METHODS A total of 150 t(8;21) AML patients were enrolled, including 67 underwent chemotherapy (CMT) and 83 allogeneic hematopoietic stem cell transplantation (allo-SCT) as PRT in CR1. Subgroup analyses were performed according to MRD level after three cycles of chemotherapy combined with CD19 expression. RESULTS Multivariate analysis indicated MRDhigh after three courses of treatment (HR, 0.14 [95% CI, 0.03-0.66]; p = 0.013) and CD19 negativity (HR, 0.14 [95% CI, 0.02-0.96]; p = 0.045) were risk factors for relapse, while allo-SCT was protective factor for relapse (HR, 0.34 [95% CI, 0.15-0.75]; p = 0.008). Grouped by MRD after three courses of chemotherapy, allo-SCT had lower CIR (p < 0.001) and better OS (p = 0.003) than CMT for MRDhigh patients, CMT showed a higher CIR (35.99% vs. 15.34%, p = 0.100) but comparable OS (p = 0.588) than allo-SCT for MRDlow patients. Grouped by CD19 expression, allo-SCT demonstrated lower CIR (p < 0.001) and better OS (p = 0.002) than CMT for CD19- patients. CMT had a higher CIR (41.37% vs. 10.48%, p = 0.007) but comparable OS (p = 0.147) than allo-SCT for CD19+ patients. Grouped by MRD combined with CD19, MRDhigh /CD19+ subsets were identified out of CD19+ patients benefiting from allo-SCT with lower CIR (p = 0.002) and superior OS (p = 0.020) than CMT. CMT preserved comparable CIR (p = 0.939) and OS (p = 0.658) with allo-SCT for MRDlow /CD19+ patients. MRDlow /CD19- subsets were also identified from MRDlow patients requiring allo-SCT with lower CIR (p < 0.001) and superior OS (p = 0.008) than CMT. Allo-SCT maintained lower CIR (p < 0.001) and superior OS (p = 0.008) than CMT for MRDhigh /CD19- patients. CONCLUSIONS MRD combined with CD19 might optimize PRT choices for adult t(8;21) AML patients in CR1.
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Affiliation(s)
- Xi Jia
- Department of Hematology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
- Clinical Medical Research Center of Hematological Diseases of Guangdong ProvinceGuangzhouChina
| | - Naying Liao
- Department of Hematology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
- Clinical Medical Research Center of Hematological Diseases of Guangdong ProvinceGuangzhouChina
| | - Sijian Yu
- Department of Hematology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
- Clinical Medical Research Center of Hematological Diseases of Guangdong ProvinceGuangzhouChina
| | - Huan Li
- Department of Hematology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
- Clinical Medical Research Center of Hematological Diseases of Guangdong ProvinceGuangzhouChina
| | - Hui Liu
- Department of Hematology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
- Clinical Medical Research Center of Hematological Diseases of Guangdong ProvinceGuangzhouChina
| | - Haiyan Zhang
- Department of Hematology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
- Clinical Medical Research Center of Hematological Diseases of Guangdong ProvinceGuangzhouChina
| | - Jun Xu
- Department of Hematology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
- Clinical Medical Research Center of Hematological Diseases of Guangdong ProvinceGuangzhouChina
| | - Yunqian Yao
- Department of Hematology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
- Clinical Medical Research Center of Hematological Diseases of Guangdong ProvinceGuangzhouChina
| | - Han He
- Department of Hematology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
- Clinical Medical Research Center of Hematological Diseases of Guangdong ProvinceGuangzhouChina
| | - Guopan Yu
- Department of Hematology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
- Clinical Medical Research Center of Hematological Diseases of Guangdong ProvinceGuangzhouChina
| | - Qifa Liu
- Department of Hematology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
- Clinical Medical Research Center of Hematological Diseases of Guangdong ProvinceGuangzhouChina
| | - Yu Zhang
- Department of Hematology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
- Clinical Medical Research Center of Hematological Diseases of Guangdong ProvinceGuangzhouChina
| | - Pengcheng Shi
- Department of Hematology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
- Clinical Medical Research Center of Hematological Diseases of Guangdong ProvinceGuangzhouChina
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Lucas F, Hergott CB. Advances in Acute Myeloid Leukemia Classification, Prognostication and Monitoring by Flow Cytometry. Clin Lab Med 2023; 43:377-398. [PMID: 37481318 DOI: 10.1016/j.cll.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
Although final classification of acute myeloid leukemia (AML) integrates morphologic, cytogenetic, and molecular data, flow cytometry remains an essential component of modern AML diagnostics. Here, we review the current role of flow cytometry in the classification, prognostication, and monitoring of AML. We cover immunophenotypic features of key genetically defined AML subtypes and their effects on biological and clinical behaviors, review clinically tractable strategies to differentiate leukemias with ambiguous immunophenotypes more accurately and discuss key principles of standardization for measurable residual disease monitoring. These advances underscore flow cytometry's continued growth as a powerful diagnostic, management, and discovery tool.
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Affiliation(s)
- Fabienne Lucas
- Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Christopher B Hergott
- Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
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Shang L, Cai X, Sun W, Cheng Q, Mi Y. Time point-dependent concordance and prognostic significance of flow cytometry and real time quantitative PCR for measurable/minimal residual disease detection in acute myeloid leukemia with t(8;21)(q22;q22.1). CYTOMETRY PART B-CLINICAL CYTOMETRY 2021; 102:34-43. [PMID: 34232569 DOI: 10.1002/cyto.b.22028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 06/23/2021] [Accepted: 06/29/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Flow cytometry (FCM) and PCR are reliable methods for assessing minimal residual disease (MRD) in acute myeloid leukemia with t(8;21)(q22;q22.1). The aim of this study was to analyze the concordant rate of these two methods and their prognostic significance. METHODS PCR and FCM were simultaneously used for MRD analysis at four different time points on 450 BM samples from 124 patients with AML with t(8;21)(q22;q22.1). The four monitoring time points included post-induction (first), after the first consolidation (second) and the second consolidation (third), and at the end of chemotherapy or before Allo/Auto stem cell transplantation (fourth). RESULTS The concordant rates of the two methods were 33.06%, 25.81%, 49.59%, and 75.31%, respectively, and the main discordant cases were FCM-/PCR+ cases. At all monitoring time points, the MRD level ≥ 10-4 by FCM indicated a poor 3-year Relapse-Free Survival (RFS) (p < 0.001). More than 2-log MRD reduction by PCR after induction and more than 3-log reduction by PCR after the first consolidation remained the significant predictors of better RFS (p < 0.001). After the second consolidation, the negative MRD by PCR (<10-5) was also associated with improved RFS (p = 0.002). A > 1-log increase in PCR can effectively predict recurrence after molecular remission (p < 0.001). In the multivariate analysis, MRD≥0.01% by. FCM and less than 2-log MRD reduction by PCR after induction remained the significant predictors of poor RFS (p < 0.05). CONCLUSIONS FCM+ always indicates a poor prognosis. Sequential monitoring by PCR is of significance for evaluating prognosis. Our findings suggest a complementary role of two analyses in optimizing risk stratification in clinical practice.
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Affiliation(s)
- Lei Shang
- Department of Pathology and Lab Medicine, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Xiaojin Cai
- Department of Pathology and Lab Medicine, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Wanchen Sun
- Department of Pathology and Lab Medicine, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Qingnian Cheng
- Department of Pathology and Lab Medicine, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Yingchang Mi
- Department of Leukemia, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
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4
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Marashi-Sabouni Z, Vayne C, Ibrahim-Kosta M, Guidon C, Loundou A, Guery EA, Morange PE, Camoin-Jau L. Clinical validation of immunoassay HemosIL® AcuStar HIT-IgG (PF4-H) in the diagnosis of Heparin-induced thrombocytopenia. J Thromb Thrombolysis 2021; 52:601-609. [PMID: 33386560 DOI: 10.1007/s11239-020-02349-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 11/25/2022]
Abstract
Heparin induced thrombocytopenia (HIT) is a life and limb-threatening complication of heparin exposure. The misdiagnosis of this disease can have major consequences on the patients. The objective of this study was to evaluate a diagnostic strategy that combines the 4Ts score with the result of HemosIL® AcuStar HIT-IgG (PF4-H) to confirm the diagnosis of HIT. Citrated plasmas from 1300 patients with suspicion of HIT were analyzed with a fully automated quantitative chemiluminescent immunoassay (HemosIL® AcuStar HIT-IgG (PF4/H)). If the IgG anti-PF4/H antibodies were positive (cut-off, 1 U/mL), HIT diagnosis was confirmed using functional tests. In total, 1300 samples of consecutive patients were enrolled, 94 (7.2%) of which gave positive results in HemosIL® AcuStar-IgG. HIT was diagnosed in 65 out of these patients, corresponding to a prevalence of 5%. Using ROC curve analysis, patients were divided into three groups according to their titer of antibodies. Higher values of the IgG (PF4-H) were associated with increased probability of HIT, and the diagnostic specificity was greatly increased using the combination of a 4Ts score > 3 and a positive titer ≥ 3.25 U/mL. Importantly, the diagnostic specificity is 100% when the titer is > 12.40 U/mL. We demonstrated that higher values of Anti PF4/H Antibodies were associated with a high probability of having HIT. A titer of HemosIL® IgG (PF4-H) > 12.40 U/mL has a specificity of 100% which should no require a functional test to confirm the diagnosis of HIT.
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Affiliation(s)
- Zeina Marashi-Sabouni
- Laboratoire d'Hématologie, La Timone Hospital, APHM, Boulevard Jean- Moulin, 13005, Marseille, France
| | - Caroline Vayne
- Service d'Hématologie Hémostase, Hôpital Trousseau, CHU de Tours, 37044, Tours, France
- EA7501 GICC, Université de Tours, Tours, France
| | - Manal Ibrahim-Kosta
- Laboratoire d'Hématologie, La Timone Hospital, APHM, Boulevard Jean- Moulin, 13005, Marseille, France
- Aix Marseille Univ, INSERM, INRAE, C2VN, Marseille, France
| | - Catherine Guidon
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, Marseille, France
| | - Anderson Loundou
- Biostatistic and Public Health Department, La Timone Hospital, Marseille, France
| | - Eve Anne Guery
- Service d'Hématologie Hémostase, Hôpital Trousseau, CHU de Tours, 37044, Tours, France
| | - Pierre-Emmanuel Morange
- Laboratoire d'Hématologie, La Timone Hospital, APHM, Boulevard Jean- Moulin, 13005, Marseille, France
- Aix Marseille Univ, INSERM, INRAE, C2VN, Marseille, France
| | - Laurence Camoin-Jau
- Laboratoire d'Hématologie, La Timone Hospital, APHM, Boulevard Jean- Moulin, 13005, Marseille, France.
- Aix Marseille Univ, IRD, APHM, MEPHI, IHU Méditerranée Infection, Marseille, France.
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Wang B, Yang B, Ling Y, Zhang J, Hua X, Gu W, Yan F. Role of CD19 and specific KIT-D816 on risk stratification refinement in t(8;21) acute myeloid leukemia induced with different cytarabine intensities. Cancer Med 2020; 10:1091-1102. [PMID: 33382538 PMCID: PMC7897948 DOI: 10.1002/cam4.3705] [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: 08/15/2020] [Revised: 11/22/2020] [Accepted: 12/07/2020] [Indexed: 12/23/2022] Open
Abstract
High‐dose cytarabine (Ara‐C) has been reported with increased treatment‐related mortality, whereas few data are available concerning intermediate‐dose Ara‐C for induction of acute myeloid leukemia (AML) with t(8;21) translocation. We retrospectively analyzed factors impacting complete remission (CR), event‐free survival (EFS), cumulative incidence of relapse (CIR), and overall survival (OS) in 197 adults with t(8;21) AML, of whom 107 cases were induced with intermediate‐dose and 90 with standard‐dose Ara‐C (as part of 3 + 7 protocol). After a single induction course, the overall CR rate was 87.6% (170/194), with a significant difference between the standard‐dose (83/105, 79.0%) and intermediate‐dose (87/89, 97.8%) groups (p < 0.001). Rather than general KITmut, the specific KIT‐D816 independently led to a lower probability of achieving CR (HR = 3.29 [1.18–9.24], p = 0.023), worse EFS (HR = 3.53 [1.82–6.84], p < 0.001), and OS (HR = 5.45 [1.77–16.84], p = 0.003) in the standard‐dose group, but not in the intermediate‐dose group. CD19(+) represented the only independent factor predicting lower CIR both in the standard‐dose group (HR = 0.32 [0.10–1.00], p = 0.050) and in the intermediate‐dose group (HR = 0.11 [0.03–0.40], p = 0.001). When combined, KIT(+) plus CD19(−) conferred the most increased relapse risk (3‐year CIR 60%; SE 0.12). Specific KIT‐D816, instead of general KITmut, may be incorporated in prognostication model for t(8;21) AML. Combination of CD19 with KIT provides a more definite risk stratification profile for t(8;21) AML.
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Affiliation(s)
- Biao Wang
- Department of Hematology, Changzhou First People's Hospital, Changzhou, China
| | - Bin Yang
- Department of Hematology, Changzhou First People's Hospital, Changzhou, China
| | - Yun Ling
- Department of Hematology, Changzhou First People's Hospital, Changzhou, China
| | - Jihong Zhang
- Blood Research Laboratory, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiaoying Hua
- Department of Hematology, Changzhou First People's Hospital, Changzhou, China
| | - Weiying Gu
- Department of Hematology, Changzhou First People's Hospital, Changzhou, China
| | - Feng Yan
- Department of Hematology, Changzhou First People's Hospital, Changzhou, China
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6
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Zhou Z, Ye C, Wang J, Zhang NR. Surface protein imputation from single cell transcriptomes by deep neural networks. Nat Commun 2020; 11:651. [PMID: 32005835 PMCID: PMC6994606 DOI: 10.1038/s41467-020-14391-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 12/18/2019] [Indexed: 01/10/2023] Open
Abstract
While single cell RNA sequencing (scRNA-seq) is invaluable for studying cell populations, cell-surface proteins are often integral markers of cellular function and serve as primary targets for therapeutic intervention. Here we propose a transfer learning framework, single cell Transcriptome to Protein prediction with deep neural network (cTP-net), to impute surface protein abundances from scRNA-seq data by learning from existing single-cell multi-omic resources.
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Affiliation(s)
- Zilu Zhou
- Graduate Group in Genomics and Computational Biology, University of Pennsylvania, Philadelphia, PA, USA
- Department of Statistics, University of Pennsylvania, Philadelphia, PA, USA
| | - Chengzhong Ye
- School of Medicine, Tsinghua University, Beijing, China
| | - Jingshu Wang
- Department of Statistics, The University of Chicago, Chicago, IL, USA
| | - Nancy R Zhang
- Department of Statistics, University of Pennsylvania, Philadelphia, PA, USA.
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7
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Bain BJ, Béné MC. Morphological and Immunophenotypic Clues to the WHO Categories of Acute Myeloid Leukaemia. Acta Haematol 2019; 141:232-244. [PMID: 30965338 DOI: 10.1159/000496097] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 12/08/2018] [Indexed: 01/08/2023]
Abstract
Diagnosis and classification of acute myeloid leukaemia (AML) require cytogenetic and molecular genetic investigation. However, while these evaluations are pending, morphology supplemented by immunophenotyping can provide clues to the diagnosis of specific cytogenetic/genetic categories of AML. Most importantly, acute promyelocytic leukaemia can be diagnosed with a high degree of certainty. However, provisional identification of cases associated with t(8; 21), inv(16), t(1; 22), and NPM1 mutation may also be possible. In addition, transient abnormal myelopoiesis of Down's syndrome can generally be diagnosed morphologically.
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MESH Headings
- Chromosome Inversion
- Chromosomes, Human/genetics
- Down Syndrome/genetics
- Humans
- Leukemia, Promyelocytic, Acute/classification
- Leukemia, Promyelocytic, Acute/diagnosis
- Leukemia, Promyelocytic, Acute/genetics
- Leukemia, Promyelocytic, Acute/therapy
- Myelopoiesis/genetics
- Neoplasm Proteins/genetics
- Nuclear Proteins/genetics
- Nucleophosmin
- Translocation, Genetic
- World Health Organization
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Affiliation(s)
- Barbara J Bain
- Department of Haematology, St Mary's Hospital, London, United Kingdom,
| | - Marie C Béné
- Hematology Biology, Nantes University Hospital, Nantes, France
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