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Calvo KR, Hickstein DD. The spectrum of GATA2 deficiency syndrome. Blood 2023; 141:1524-1532. [PMID: 36455197 PMCID: PMC10082373 DOI: 10.1182/blood.2022017764] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/22/2022] [Accepted: 11/26/2022] [Indexed: 12/04/2022] Open
Abstract
Inherited or de novo germ line heterozygous mutations in the gene encoding the transcription factor GATA2 lead to its deficiency. This results in a constellation of clinical features including nontuberculous mycobacterial, bacterial, fungal, and human papillomavirus infections, lymphedema, pulmonary alveolar proteinosis, and myelodysplasia. The onset, or even the presence, of disease is highly variable, even in kindreds with the identical mutation in GATA2. The clinical manifestations result from the loss of a multilineage progenitor that gives rise to B lymphocytes, monocytes, natural killer cells, and dendritic cells, leading to cytopenias of these lineages and subsequent infections. The bone marrow failure is typically characterized by hypocellularity. Dysplasia may either be absent or subtle but typically evolves into multilineage dysplasia with prominent dysmegakaryopoiesis, followed in some instances by progression to myeloid malignancies, specifically myelodysplastic syndrome, acute myelogenous leukemia, and chronic myelomonocytic leukemia. The latter 3 malignancies often occur in the setting of monosomy 7, trisomy 8, and acquired mutations in ASXL1 or in STAG2. Importantly, myeloid malignancy may represent the primary presentation of disease without recognition of other syndromic features. Allogeneic hematopoietic stem cell transplantation (HSCT) results in reversal of the phenotype. There remain important unanswered questions in GATA2 deficiency, including the following: (1) Why do some family members remain asymptomatic despite harboring deleterious mutations in GATA2? (2) What are the genetic changes that lead to myeloid progression? (3) What causes the apparent genetic anticipation? (4) What is the role of preemptive HSCT?
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Affiliation(s)
- Katherine R. Calvo
- Department of Laboratory Medicine, National Institutes of Health Clinical Center, Bethesda, MD
| | - Dennis D. Hickstein
- Immune Deficiency – Cellular Therapy Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
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Wang Y, Huang L, Hua Y, Liu H, Jiang H, Wang H, Zhang W, Fu R, Shao Z. Impact of iron overload by transfusion on survival and leukemia transformation of myelodysplastic syndromes in a single center of China. ACTA ACUST UNITED AC 2021; 26:874-880. [PMID: 34753406 DOI: 10.1080/16078454.2021.1989806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Myelodysplastic syndromes (MDS) are a heterogeneous group of diseases which are prone to progress into acute myeloid leukemia (AML). Iron overload (IOL) caused by transfusion occurred in most MDS patients. But how IOL influences MDS progression has not been clarified yet. METHODS Herein, we collected clinical data from 143 MDS patients to investigate the impacts of IOL on patients survival and AML transformation. RESULTS We found that median survival time, 3-year survival rate, leukemia-free survival (LFS) time were significantly shorter in patients with IOL than those with non-iron overload (NIOL) (P = 0.040; P = 0.044; P = 0.037). Besides, IOL was more likely to be found in higher-risk subgroups (assessed by IPSS and WPSS) of MDS patients which also promoted 2-year AML transformation. Furthermore, the serum ferritin (SF) was significantly correlated with the overall survival (OS) of MDS patients (r = -0.311, P < 0.05). The concentrations of both intracellular iron and reactive oxygen species (ROS) in CD34+ cells of bone marrow were higher in the IOL group than the NIOL group, respectively (P = 0.0426; P = 0.0185). Moreover, ROS level was closely correlated with the percentage of bone marrow blasts (r = 0.7200, P = 0.0370). Collectively, IOL threatened the survival of MDS patients and promoted AML transformation. CONCLUSION Elevated intracellular iron and ROS in CD34+ cells of bone marrow could accelerate the abnormal proliferation of blasts.
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Affiliation(s)
- Yihao Wang
- Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Lei Huang
- Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Yanni Hua
- Tianjin Medical University General Hospital, Tianjin, People's Republic of China.,Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Hui Liu
- Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Huijuan Jiang
- Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Huaquan Wang
- Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Wei Zhang
- Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Rong Fu
- Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Zonghong Shao
- Tianjin Medical University General Hospital, Tianjin, People's Republic of China
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3
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Yan X, Wang L, Jiang L, Luo Y, Lin P, Yang W, Ren Y, Ma L, Zhou X, Mei C, Ye L, Xu G, Xu W, Yang H, Lu C, Jin J, Tong H. Clinical significance of cytogenetic and molecular genetic abnormalities in 634 Chinese patients with myelodysplastic syndromes. Cancer Med 2021; 10:1759-1771. [PMID: 33609081 PMCID: PMC7940222 DOI: 10.1002/cam4.3786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/17/2021] [Accepted: 01/27/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To explore the relevance of cytogenetic or molecular genetic abnormalities to clinical variables, including clinical and laboratory characteristics and prognosis in Chinese patients with myelodysplastic syndromes (MDS). Methods A total of 634 consecutive patients diagnosed with MDS at The First Affiliated Hospital, Zhejiang University School of Medicine from June 2008 to May 2018 were retrospectively included in this study. All patients had evaluable cytogenetic analysis, and 425 patients had MDS‐related mutations sequencing. Results 38.6% of patients displayed abnormal karyotypes. The most common cytogenetic abnormality was +8 (31%). Sole +8 was related to female (p = 0.002), hemoglobin >10 g/dL (p = 0.03), and <60 years old (p = 0.046). TP53 mutations were associated with complex karyotype (CK) (p < 0.001). DNMT3A mutations correlated with ‐Y (p = 0.01) whereas NRAS mutations correlated with 20q‐ (p = 0.04). The overall survival (OS) was significantly inferior in patients with +8 compared with those with normal karyotype (NK) (p = 0.003). However, the OS of sole +8 and +8 with one additional karyotypic abnormality was not different from NK (p = 0.16), but +8 with two or more abnormalities had a significantly shorter OS than +8 and +8 with one additional karyotypic abnormality (p = 0.02). In multivariable analysis, ≥60 years old, marrow blasts ≥5% and TP53 mutations were independent predictors for poor OS (p < 0.05), whereas SF3B1 mutations indicated better prognosis. Male IDH1 and IDH2 mutations and marrow blasts ≥5% were independent risk factors for worse leukemia free survival (LFS) (p < 0.05). Conclusion In this population of Chinese patients, trisomy 8 is the most common karyotypic abnormality. Patients with +8 showed a poorer OS compared with patients with NK. Sole +8 and +8 with one additional karyotypic abnormality had similar OS with NK, whereas +8 with two or more abnormalities had a significantly shorter OS. DNMT3A mutations correlated with ‐Y and NRAS mutations correlated with 20q‐. TP53 mutations were associated with CK and had a poor OS. SF3B1 mutations indicated a favorable OS. IDH1 and IDH2 mutations independently indicated inferior LFS.
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Affiliation(s)
- Xuefen Yan
- Department of Hematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Myelodysplastic Syndromes Diagnosis and Therapy Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Department of Hematology, People's Hospital of Quzhou, Quzhou, Zhejiang, China
| | - Lu Wang
- Department of Hematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Myelodysplastic Syndromes Diagnosis and Therapy Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Lingxu Jiang
- Department of Hematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Myelodysplastic Syndromes Diagnosis and Therapy Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yingwan Luo
- Department of Hematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Myelodysplastic Syndromes Diagnosis and Therapy Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Peipei Lin
- Department of Radiotherapy, Taizhou Central Hospital (Taizhou University Hospital, Taizhou, Zhejiang, China
| | - Wenli Yang
- Department of Hematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Myelodysplastic Syndromes Diagnosis and Therapy Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yanling Ren
- Department of Hematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Myelodysplastic Syndromes Diagnosis and Therapy Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Liya Ma
- Department of Hematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Myelodysplastic Syndromes Diagnosis and Therapy Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xinping Zhou
- Department of Hematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Myelodysplastic Syndromes Diagnosis and Therapy Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Chen Mei
- Department of Hematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Myelodysplastic Syndromes Diagnosis and Therapy Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Li Ye
- Department of Hematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Myelodysplastic Syndromes Diagnosis and Therapy Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Gaixiang Xu
- Department of Hematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Myelodysplastic Syndromes Diagnosis and Therapy Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Weilai Xu
- Department of Hematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Myelodysplastic Syndromes Diagnosis and Therapy Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Haiyang Yang
- Department of Hematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Chenxi Lu
- Department of Hematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jie Jin
- Department of Hematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Hongyan Tong
- Department of Hematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Myelodysplastic Syndromes Diagnosis and Therapy Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Wang X, Liu W, Wang M, Fan T, Li Y, Guo X, Yang X, Wang H, Xiao H, Zhang S, Quan R, Liu C, Tang X, Lv Y, Chen Z, Li L, Xu Y, Ma R, Hu X. Cytogenetic characteristics of 665 patients with myelodysplastic syndrome in China: A single-center report. Oncol Lett 2020; 21:126. [PMID: 33552247 PMCID: PMC7798047 DOI: 10.3892/ol.2020.12387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 10/20/2020] [Indexed: 11/20/2022] Open
Abstract
The karyotype is highly important for diagnosis and prognosis in myelodysplastic syndrome (MDS). The objective of the present study was to investigate the cytogenetic characteristics of patients with MDS in China. The karyotypes of 665 Chinese patients with MDS were analyzed, and it was identified that 298 cases (298/665, 44.8%) had abnormal karyotypes. Among the 298 patients with abnormal karyotypes, the 75 patients with trisomy 8 (+8) constituted the most common subset (75/298, 25.2%). The incidence of abnormal karyotypes was significantly higher in patients who were ≥51 years old compared with those <51 years old, (54.8 vs. 34.7%, respectively; P<0.05). Based on World Health Organization (WHO) classification-based Prognostic Scoring System (WPSS) criteria, the incidence of poor-prognosis karyotypes was significantly higher (17.4 vs. 5.4%; P<0.05) in the older patient group, and based on the Revised International Prognostic Scoring System (IPSS-R) criteria, the incidence of poor-/very poor-prognosis karyotypes was also significantly higher (17.4 vs. 6.6%; P<0.05) in patients ≥51 years old compared with younger ones. Based on the WHO classification of MDS subtypes, the incidence of abnormal karyotypes in patients with high percentages of bone marrow (BM) blasts [excess blasts (EB)-I + EB-II, ≥5% blasts] was significantly higher than that in patients with low percentages of BM blasts (those with single lineage dysplasia + multilineage dysplasia, <5% blasts) (62.5 vs. 36.0%; P<0.05). The incidence of poor-prognosis karyotypes based on WPSS criteria was significantly higher in patients with high percentages of BM blasts than those with low percentages (22.0 vs. 6.9%, respectively; P<0.05), and the incidence of poor-/very poor-prognosis karyotypes based on IPSS-R criteria was also significantly higher (23.0 vs. 7.4%, respectively; P<0.05). These results demonstrate that +8 is the most common abnormal karyotype in Chinese patients with MDS. Age and the percentage of BM blasts are associated with the incidence of both abnormal karyotypes and karyotypes with poor prognosis. The results of cytogenetic abnormalities in this study will supplement the data on patients of MDS in China.
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Affiliation(s)
- Xueying Wang
- Graduate School, Beijing University of Chinese Medicine, Beijing 100029, P.R. China.,Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, P.R. China
| | - Weiyi Liu
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, P.R. China
| | - Mingjing Wang
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, P.R. China.,Graduate School, China Academy of Chinese Medical Sciences, Beijing 100700, P.R. China
| | - Teng Fan
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, P.R. China.,Graduate School, China Academy of Chinese Medical Sciences, Beijing 100700, P.R. China
| | - Yumeng Li
- Graduate School, Beijing University of Chinese Medicine, Beijing 100029, P.R. China.,Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, P.R. China
| | - Xiaoqing Guo
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, P.R. China
| | - Xiupeng Yang
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, P.R. China
| | - Hongzhi Wang
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, P.R. China
| | - Haiyan Xiao
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, P.R. China
| | - Shanshan Zhang
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, P.R. China
| | - Richeng Quan
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, P.R. China
| | - Chi Liu
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, P.R. China
| | - Xudong Tang
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, P.R. China
| | - Yan Lv
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, P.R. China
| | - Zhuo Chen
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, P.R. China
| | - Liu Li
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, P.R. China
| | - Yonggang Xu
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, P.R. China
| | - Rou Ma
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, P.R. China
| | - Xiaomei Hu
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, P.R. China
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5
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Maaroufi HE, Ababou M, Hammani A, Ahchouch S, Jennane S, Mahtat M, Mikdmae M, Messaoudi N, Doghmi K. [A monocentric study on the management of patients with myelodysplastic syndromes in Morocco]. Pan Afr Med J 2020; 37:300. [PMID: 33654519 PMCID: PMC7881929 DOI: 10.11604/pamj.2020.37.300.20972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 07/10/2020] [Indexed: 11/25/2022] Open
Abstract
We conducted a retrospective descriptive analytical study in the Department of Clinical Haematology at the Mohammed V Military Training Hospital in Rabat over a period of 10 years. This study included 76 patients diagnosed with myelodysplastic syndrome (MDS) between 2008 and 2018. The average number of cases per year was 7.6. Out of 76 patients, 57% were men and 43% were women. The average age of our study population was 65.75 ± 12.55. The average age was 66.88 ± 13.10. No cases of profession exposed to disease was reported. Ninety-seven point three percent of patients had primary myelodysplastic syndrome and only 2 or 2.7% had myelodysplastic syndrome secondary to chemotherapy. The average time between the first visit and the diagnosis of myelodysplastic syndrome was, on average, 33.6 days ± 51, with a median of 19 days. The IPSS prognostic score was: low risk in 37.4% of cases, intermediate risk 1 in 46.6% of cases, intermediate risk in 12% of cases and high risk in 4% of cases. Thus, 84% of patients had low-risk MDS and 16% had high-risk MDS. Regular monitoring of patients showed many complications such as bleeding in 13% of patients, infections in 8% of cases, secondary hemochromatosis as a result of iterative transfusions in 6.6% of patients and transformation to acute myeloid leukemia in 2.7% of patients. In our study, abstention was the therapeutic choice in 42.1% of patients, transfusion was recommended in 35.5% of patients: red cells in 70% of cases, platelet concentrates in 40% of cases, iron chelators in 25% of transfused patients and EPO in 27% of patients. azacitidine was prescribed in 18% of patients, 50% had low-risk MDS and 50% had high-risk MDS. Bone marrow transplant was the only curative treatment for MDS. It was performed in a single patient with high risk MDS.
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Affiliation(s)
- Hicham El Maaroufi
- Service d´Hématologie Clinique, Hôpital Militaire d´Instruction Mohammed V, Rabat, Maroc
| | - Mounir Ababou
- Service d´Hématologie Clinique, Hôpital Militaire d´Instruction Mohammed V, Rabat, Maroc
| | - Adnane Hammani
- Service d´Hématologie Clinique, Hôpital Militaire d´Instruction Mohammed V, Rabat, Maroc
| | - Siham Ahchouch
- Service d´Hématologie Clinique, Hôpital Militaire d´Instruction Mohammed V, Rabat, Maroc
| | - Salim Jennane
- Service d´Hématologie Clinique, Hôpital Militaire d´Instruction Mohammed V, Rabat, Maroc
| | - Mehdi Mahtat
- Service d´Hématologie Clinique, Hôpital Militaire d´Instruction Mohammed V, Rabat, Maroc
| | - Mohamed Mikdmae
- Service d´Hématologie Clinique, Hôpital Militaire d´Instruction Mohammed V, Rabat, Maroc
| | - Nezha Messaoudi
- Laboratoire d´Hématologie, Hôpital Militaire d´Instruction Mohammed V, Rabat, Maroc
| | - Kamal Doghmi
- Service d´Hématologie Clinique, Hôpital Militaire d´Instruction Mohammed V, Rabat, Maroc
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Martins F, Kruszewski M, Scarpelli I, Schoumans J, Spertini O, Lübbert M, Blum S. Characterization of myelodysplastic syndromes progressing to acute lymphoblastic leukemia. Ann Hematol 2020; 100:63-78. [PMID: 32556451 DOI: 10.1007/s00277-020-04114-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 06/01/2020] [Indexed: 12/17/2022]
Abstract
Myelodysplastic syndromes (MDS) are a heterogeneous group of diseases, with a variable probability of transformation into acute leukemia, which is, in the vast majority of cases, of myeloid lineage. Nevertheless, rare cases of acute lymphoblastic leukemia in patients with previously diagnosed MDS have been reported. We describe a series of 3 cases of MDS/CMML marked with evolution to acute lymphoblastic leukemia (ALL) and provide a comprehensive review of the 49 cases documented in the literature so far. These sporadic events have only been published as single-case reports or small series to date. Such atypical cases emphasize the possibility of major phenotypic switches arising at the leukemic stem cell (LSC) and/or early progenitor levels, as a consequence of epigenetic and genomic events driving these changes in the bone marrow niche.
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Affiliation(s)
- Filipe Martins
- Centre Hospitalier Universitaire Vaudois (CHUV), Hematology Service and Central laboratory, Oncology department, Rue du Bugnon 46, Lausanne, CH-1011, Switzerland. .,Service and Central Laboratory of Hematology, Department of Oncology and Department of Laboratory Medicine and Pathology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, Lausanne, CH-1011, Switzerland. .,School of Life Sciences, Laboratory of Virology and Genetics, Swiss Federal Institute of Technology Lausanne (EPFL), Station 19, CH-1015, Lausanne, Switzerland.
| | - Michael Kruszewski
- Internal Medicine 1, Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, University Hospital Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Ilaria Scarpelli
- Oncogenomic Laboratory, Hematology Service, Department of Laboratory Medicine and Pathology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, Lausanne, CH-1011, Switzerland
| | - Jacqueline Schoumans
- Oncogenomic Laboratory, Hematology Service, Department of Laboratory Medicine and Pathology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, Lausanne, CH-1011, Switzerland
| | - Olivier Spertini
- Service and Central Laboratory of Hematology, Department of Oncology and Department of Laboratory Medicine and Pathology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, Lausanne, CH-1011, Switzerland.,Oncogenomic Laboratory, Hematology Service, Department of Laboratory Medicine and Pathology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, Lausanne, CH-1011, Switzerland
| | - Michael Lübbert
- Internal Medicine 1, Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, University Hospital Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Sabine Blum
- Service and Central Laboratory of Hematology, Department of Oncology and Department of Laboratory Medicine and Pathology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, Lausanne, CH-1011, Switzerland.
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Yu Y, Zhang T, Bao X, Wang Q, Zhang L, Hong Y, Zeng Z, Shen H, Wu D, Pan J, Liu H, Chen S, Sun A. Combining gene variants with clinical characteristics improves outcome prediction in Chinese patients with myelodysplastic syndromes. Leuk Lymphoma 2019; 61:919-926. [PMID: 31842651 DOI: 10.1080/10428194.2019.1702177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Genetic variants have been identified in the majority of myelodysplastic syndromes (MDS) patients and have considerably influenced the diagnosis, classification, risk stratification and treatment of MDS. To explore the prognostic significance of genomic variants and build a new prognostic scoring model, we performed next-generation sequencing of 51 known genes in 499 Chinese patients with MDS. Ultimately, the TP53, GATA2, DNMT3A, age and the revised International Prognostic Scoring System (IPSS-R) risk stratification were included in a new Cox model and divided into three prognostic categories, and had a better prediction of overall survival. The C-index of the new prognostic scoring model (0.772) was clearly better than IPSS-R risk stratification (0.717), which was validated in 163 cases. Moreover, the new model was also suitable for the prediction of OS for patients undergoing allogeneic hematopoietic stem cell transplantation. The inclusion of genomic variants and age into the IPSS-R could improve prognostic algorithms for MDS patients.
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Affiliation(s)
- Yan Yu
- Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou, P.R. China.,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, P.R. China
| | - Tongtong Zhang
- Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou, P.R. China.,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, P.R. China
| | - Xiebing Bao
- Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou, P.R. China.,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, P.R. China
| | - Qinrong Wang
- Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou, P.R. China.,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, P.R. China
| | - Ling Zhang
- Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou, P.R. China.,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, P.R. China
| | - Yang Hong
- Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou, P.R. China.,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, P.R. China
| | - Zhao Zeng
- Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou, P.R. China.,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, P.R. China
| | - Hongjie Shen
- Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou, P.R. China.,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, P.R. China
| | - Depei Wu
- Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou, P.R. China.,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, P.R. China.,Institute of Blood and Marrow Transplantation, Soochow University, Suzhou, P.R. China.,Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Suzhou, P.R. China
| | - Jinlan Pan
- Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou, P.R. China.,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, P.R. China
| | - Hong Liu
- Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou, P.R. China.,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, P.R. China
| | - Suning Chen
- Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou, P.R. China.,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, P.R. China
| | - Aining Sun
- Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou, P.R. China.,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, P.R. China.,Institute of Blood and Marrow Transplantation, Soochow University, Suzhou, P.R. China
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8
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Ganster C, Müller-Thomas C, Haferlach C, Strupp C, Ogata K, Germing U, Hildebrandt B, Mallo M, Lübbert M, Müller C, Solé F, Götze KS, Vandenberghe P, Göhring G, Steinmetz T, Kröger N, Platzbecker U, Söling U, Raynaud S, Shirneshan K, Schanz J, Haase D. Comprehensive analysis of isolated der(1;7)(q10;p10) in a large international homogenous cohort of patients with myelodysplastic syndromes. Genes Chromosomes Cancer 2019; 58:689-697. [PMID: 30994215 DOI: 10.1002/gcc.22760] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 04/15/2019] [Accepted: 04/15/2019] [Indexed: 11/10/2022] Open
Abstract
The karyotype is a strong independent prognostic factor in myelodysplastic syndromes (MDS). Since the implementation of the new comprehensive cytogenetic scoring system for MDS, chromosome 7 anomalies are no longer generally assigned to poor risk features but are thoroughly separated. However, der(1;7)(q10;p10), hereinafter der(1;7), is merged into the group labeled "any other single" and belongs to the intermediate risk group, just by definition due to lack of adequate clinical data. The aim of our international collaborative was to clarify the "real" prognostic impact of der(1;7) on a homogenous and well-documented data base. We performed detailed analysis of 63 MDS patients with isolated der(1;7) constituting the largest cohort hitherto reported. Furthermore, clinical data are compared with those of patients with isolated del(7q) and isolated monosomy 7. Median overall survival (OS) of patients with der(1;7) is 26 months (hazard ratio (HR) 0.91 for del(7q) vs der(1;7) and 2.53 for monosomy 7 vs der(1;7)). The der(1;7) is associated with profound thrombocytopenia most probably causing the reduced OS which is in striking contrast to the low risk for AML transformation (HR 3.89 for del(7q) vs der(1;7) and 5.88 for monosomy 7 vs der(1;7)). Molecular karyotyping indicates that der(1;7) is generated in a single step during mitosis and that a chromosomal imbalance rather than a single disrupted gene accounts for malignancy. Thus, the current cytogenetic scoring system assigning isolated der(1;7) to the intermediate risk group is now confirmed by a sufficient data set.
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Affiliation(s)
- Christina Ganster
- Clinics of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Catharina Müller-Thomas
- Department of Hematology and Medical Oncology III, Technische Universität München, Munich, Germany
| | | | - Corinna Strupp
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine-Universität, Düsseldorf, Germany
| | - Kiyoyuki Ogata
- Metropolitan Research and Treatment Center for Blood Disorders (MRTC Japan), Tokyo, Japan
| | - Ulrich Germing
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine-Universität, Düsseldorf, Germany
| | - Barbara Hildebrandt
- Institute of Human Genetics and Anthropology, Heinrich-Heine-Universität, Düsseldorf, Germany
| | - Mar Mallo
- Josep Carreras Leukemia Research Institute (IJC), ICO-Hospital GermansTrias i Pujol, Universitat Autonòma de Barcelona, Barcelona, Spain
| | - Michael Lübbert
- Division of Hematology, Oncology and Stem Cell Transplantation, University of Freiburg, Freiburg, Germany
| | - Christel Müller
- Medical Clinic and Policlinic 1, Hematology and Cellular Therapy, Leipzig University Hospital, Leipzig, Germany
| | - Francesc Solé
- Josep Carreras Leukemia Research Institute (IJC), ICO-Hospital GermansTrias i Pujol, Universitat Autonòma de Barcelona, Barcelona, Spain
| | - Katharina S Götze
- Department of Hematology and Medical Oncology III, Technische Universität München, Munich, Germany
| | | | - Gudrun Göhring
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Tilman Steinmetz
- Onkologie Köln, Outpatient Clinic for Hematology and Oncology, Köln, Germany
| | - Nicolaus Kröger
- Department of Stem Cell Transplantation, University of Hamburg-Eppendorf, Hamburg, Germany
| | - Uwe Platzbecker
- Medical Clinic and Policlinic 1, Hematology and Cellular Therapy, Leipzig University Hospital, Leipzig, Germany
| | - Ulrike Söling
- Outpatient Clinic for Hematology and Oncology, Kassel, Germany
| | - Sophie Raynaud
- Département d'hématologie biologique, Hôpital Pasteur, Nice, France
| | - Katayoon Shirneshan
- Clinics of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Julie Schanz
- Clinics of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Detlef Haase
- Clinics of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen, Germany
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9
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[The clinical features, cytogenetic characteristics and survival analysis of 550 myelodysplastic syndromes in a single center]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2018; 37:864-869. [PMID: 27801317 PMCID: PMC7364886 DOI: 10.3760/cma.j.issn.0253-2727.2016.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
目的 回顾性分析550例初诊骨髓增生异常综合征(MDS)患者的临床特点、细胞遗传学特征和生存情况。 方法 收集患者基本信息,采用WHO(2008)标准进行分型,同时应用国际预后积分系统(IPSS)、基于WHO造血组织肿瘤分类的预后积分系统(WPSS)及修订版IPSS(IPSS-R)积分系统进行预后分层。 结果 550例MDS患者中位年龄57(12~89)岁,男女比为1.72∶1。血液学特点:外周血细胞三系可有不同程度减少或增加,中位HGB为72(22~154)g/L,中位PLT为52(3~587)×109/L,中位WBC为2.52(0.11~48.00)×109/L。细胞遗传学特征:251例(45.6%)检出克隆性染色体异常,复杂核型89例,占所有患者的16.2%。染色体异常类型主要以不平衡异常为主,三体或单体多见。最常见的克隆性异常是+8,占染色体异常患者的29.9%(75/251);其次为−7/del(7q)、del(5q)、del(20q)等。550例患者中位随访27(0.3~144)个月,采用IPSS、IPSS-R、WPSS分别对患者进行分组并比较各组生存,差异均有统计学意义(P<0.001)。其中IPSS-R分组中低危组中位OS期未达到,中危组中位OS期为44(95% CI 28~60)个月,高危组中位OS期为17(95% CI 13~21)个月,极高危组中位OS期为8(95% CI 5~11)个月(P <0.001)。 结论 该研究中纳入的MDS患者中位年龄57(12~89)岁,细胞遗传学异常类型与欧美报道有所差异,IPSS、IPSS-R和WPSS分层对于预测MDS患者的生存有重要意义。
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10
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Udayakumar AM, Fawaz N, Pathare A, Asraf S, Al-Huneini M, Al-Farsi K, Al-Kindi S, Al-Khabouri M. First Cytogenetic Profile of Omani Patients with de novo Myelodysplastic Syndromes: Comparison with data from Asia, Africa, Europe and North and South America. Sultan Qaboos Univ Med J 2017; 17:e286-e292. [PMID: 29062550 DOI: 10.18295/squmj.2017.17.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 12/01/2016] [Accepted: 04/06/2017] [Indexed: 11/16/2022] Open
Abstract
Clonal cytogenetic abnormalities have been reported among 30-80% of patients with myelodysplastic syndromes (MDS); however, 20-70% of patients with MDS show a normal karyotype that may nevertheless harbour a cryptic genetic alteration. Earlier reports have suggested that the distribution of specific chromosomal aberrations varies among Western and Asian countries, with geographical and ethnic differences in the frequency of specific chromosomal aberrations. This article compared the cytogenetic data of 36 adult Omani patients with MDS to previously reported data from other populations. Differences were noted between the percentages of clonal aberrations and the median age of Omani subjects at presentation in comparison to individuals of different ethnicities and from various geographical locations. To the best of the authors' knowledge, this is the first report to describe the cytogenetic data of patients with MDS from Oman.
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Affiliation(s)
- Achandira M Udayakumar
- Departments of Genetics, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman.,Department of Malignancy Cytogenetics & Molecular Pathology, Hammersmith Hospital, Imperial College Healthcare National Health Service Trust, London, UK
| | - Nagla Fawaz
- Departments of Genetics Haematology, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Anil Pathare
- Department of Haematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Shakila Asraf
- Department of Haematology, Sultan Qaboos University Hospital, Muscat, Oman
| | | | - Khalil Al-Farsi
- Department of Haematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Salam Al-Kindi
- Departments of Genetics Haematology, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
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11
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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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12
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Li X, Yang B, Wang L, Chen L, Luo X, Liu L. SPAG6 regulates cell apoptosis through the TRAIL signal pathway in myelodysplastic syndromes. Oncol Rep 2017; 37:2839-2846. [DOI: 10.3892/or.2017.5540] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 02/23/2017] [Indexed: 11/05/2022] Open
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13
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Molecular disease monitoring using circulating tumor DNA in myelodysplastic syndromes. Blood 2017; 129:1685-1690. [DOI: 10.1182/blood-2016-09-740308] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 01/13/2017] [Indexed: 12/25/2022] Open
Abstract
Key PointsCirculating tumor DNA can monitor disease and predict treatment failure by tracking driver mutations and karyotypic abnormalities in MDS.
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14
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Konuma T, Miyazaki Y, Uchida N, Ohashi K, Kondo T, Nakamae H, Takahashi S, Mori T, Ozawa Y, Kato C, Iwato K, Fukuda T, Ichinohe T, Atsuta Y, Ishiyama K. Outcomes of Allogeneic Hematopoietic Stem Cell Transplantation in Adult Patients with Myelodysplastic Syndrome Harboring Trisomy 8. Biol Blood Marrow Transplant 2016; 23:75-80. [PMID: 27777139 DOI: 10.1016/j.bbmt.2016.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 10/20/2016] [Indexed: 11/19/2022]
Abstract
Trisomy 8 (+8) is 1 of the most common cytogenetic abnormalities in adult patients with myelodysplastic syndrome (MDS). However, the outcome of allogeneic hematopoietic stem cell transplantation (HSCT) in adult patients with MDS harboring +8 remains unclear. To evaluate the outcome and prognostic factors in patients with MDS harboring +8 as the sole cytogenetic abnormality or in association with other abnormalities, we retrospectively analyzed the Japanese registration data of 381 adult patients with MDS harboring +8 treated with allogeneic HSCT between 1990 and 2013. With a median follow-up period of 53 months, the probability of overall survival and cumulative incidence of relapse at 4 years were 51% and 22%, respectively. In the multivariate analysis, age > 50 years, 2 or more additional cytogenetic abnormalities, and a high risk at the time of HSCT according to the FAB/WHO classification were significantly associated with a higher overall mortality. Nevertheless, no significant impact of the outcome was observed in patients with 1 cytogenetic abnormality in addition to +8. Although 221 patients (58%) had advanced MDS at the time of HSCT, allogeneic HSCT offered a curative option for adult patients with MDS harboring +8.
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Affiliation(s)
- Takaaki Konuma
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
| | - Yasushi Miyazaki
- Department of Hematology, Atomic Bomb Disease and Hibakusha Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Naoyuki Uchida
- Department of Hematology, Toranomon Hospital, Tokyo, Japan
| | - Kazuteru Ohashi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Tadakazu Kondo
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hirohisa Nakamae
- Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Satoshi Takahashi
- Division of Molecular Therapy, The Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Takehiko Mori
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yukiyasu Ozawa
- Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Chiaki Kato
- Department of Hematology, Meitetsu Hospital, Nagoya, Japan
| | - Koji Iwato
- Department of Hematology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Takahiro Fukuda
- Department of Hematopoietic Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan
| | - Tatsuo Ichinohe
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan; Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ken Ishiyama
- Department of Hematology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
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15
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Wang FX, Zhang WG, He AL, Cao XM, Chen YX, Zhao WH, Yang Y, Wang JL, Zhang PY, Gu LF. Effect of granulocyte colony-stimulating factor priming combined with low-dose cytarabine and homoharringtonine in higher risk myelodysplastic syndrome patients. Leuk Res 2016; 48:57-61. [PMID: 27497340 DOI: 10.1016/j.leukres.2016.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 07/14/2016] [Accepted: 07/21/2016] [Indexed: 11/26/2022]
Abstract
As sensitization of leukemia cells with granulocyte colony-stimulating factor (G-CSF) can enhance the cytotoxicity of chemotherapy in myeloid malignancies, a pilot study was conducted in order to evaluate the effect of G-CSF priming combined with low-dose chemotherapy in patients with higher risk myelodysplastic syndrome (MDS). The regimen, G-HA, consisted of cytarabine (Ara-C) 7.5mg/m(2)/12h by subcutaneous injection, days 1-14, homoharringtonine (HHT) 1.5mg/m(2)/day by intravenous continuous infusion, days 1-14, and G-CSF 150mg/m(2)/day by subcutaneous injection, days 0-14. 56 patients were enrolled, 34 patients (61%, 95% confidence interval: 51.44-70.56%) achieved complete remission (CR). Median duration of neutropenia was 7days (ranging from 2 to 16days). Grade 1-2 nonhematologic toxicities were documented, including nausea and vomiting (5%), liver function abnormality (5%), and heart function abnormality (2%). No central nervous system toxicity was found. Mortality within the first 4 weeks was 4%. The G-HA regimen is effective in remission induction for higher risk MDS patients and well tolerated due to the acceptable toxicity in maintenance therapy in the patients who cannot undergo Hematopoietic cell transplantation (HCT).
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Affiliation(s)
- Fang-Xia Wang
- Department of Hematology, The Second Hospital, Xi'an JiaoTong University, Xi'an 710004, PR China.
| | - Wang-Gang Zhang
- Department of Hematology, The Second Hospital, Xi'an JiaoTong University, Xi'an 710004, PR China
| | - Ai-Li He
- Department of Hematology, The Second Hospital, Xi'an JiaoTong University, Xi'an 710004, PR China
| | - Xin-Mei Cao
- Department of Hematology, The Second Hospital, Xi'an JiaoTong University, Xi'an 710004, PR China
| | - Yin-Xia Chen
- Department of Hematology, The Second Hospital, Xi'an JiaoTong University, Xi'an 710004, PR China
| | - Wan-Hong Zhao
- Department of Hematology, The Second Hospital, Xi'an JiaoTong University, Xi'an 710004, PR China
| | - Yun Yang
- Department of Hematology, The Second Hospital, Xi'an JiaoTong University, Xi'an 710004, PR China
| | - Jian-Li Wang
- Department of Hematology, The Second Hospital, Xi'an JiaoTong University, Xi'an 710004, PR China
| | - Peng-Yu Zhang
- Department of Hematology, The Second Hospital, Xi'an JiaoTong University, Xi'an 710004, PR China
| | - Liu-Fang Gu
- Department of Hematology, The Second Hospital, Xi'an JiaoTong University, Xi'an 710004, PR China
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16
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Petrova-Drus K, Hasserjian R, Pozdnyakova O, Dal Cin P, Mathew S, Margolskee E, Orazi A, Geyer JT. Clinicopathologic evaluation of cytopenic patients with isolated trisomy 8: a detailed comparison between idiopathic cytopenia of unknown significance and low-grade myelodysplastic syndrome. Leuk Lymphoma 2016; 58:569-577. [PMID: 27389864 DOI: 10.1080/10428194.2016.1203432] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The significance of an isolated trisomy 8 (+8) in the diagnosis of myelodysplastic syndrome (MDS) is not well established. It is common in MDS, but is not considered as an MDS-defining abnormality in the absence of morphologic dysplasia. We evaluated two groups of patients with isolated +8 and either low-grade MDS (LG-MDS) or idiopathic cytopenia of undetermined significance (ICUS). At presentation, ICUS patients had a lower platelet count (85.0 vs 163.5 × 109 cells/L; p = 0.02), while MDS patients had more frequent incidence of isolated anemia (64% vs 0%, p = 0.007). A subset (36%) of ICUS patients progressed to MDS or AML. These patients presented with more severe neutropenia (0.9 vs 3.1 × 103/μL, p = 0.01) and a trend toward a higher proportion (>50%) of +8 metaphases compared to those that did not progress (p = 0.05). Thus, ICUS patients with isolated +8 may progress to MDS and AML and deserve close clinical follow-up.
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Affiliation(s)
- Kseniya Petrova-Drus
- a Department of Pathology and Laboratory Medicine , New York Presbyterian Hospital - Weill Cornell Medicine , New York , NY , USA
| | - Robert Hasserjian
- b Department of Pathology , Massachusetts General Hospital , Boston , MA , USA
| | - Olga Pozdnyakova
- c Department of Pathology , Brigham and Women's Hospital , Boston , MA , USA
| | - Paola Dal Cin
- d Center of Advanced Molecular Diagnostics , Brigham & Women's Hospital , Boston , MA , USA
| | - Susan Mathew
- a Department of Pathology and Laboratory Medicine , New York Presbyterian Hospital - Weill Cornell Medicine , New York , NY , USA
| | - Elizabeth Margolskee
- a Department of Pathology and Laboratory Medicine , New York Presbyterian Hospital - Weill Cornell Medicine , New York , NY , USA
| | - Attilio Orazi
- a Department of Pathology and Laboratory Medicine , New York Presbyterian Hospital - Weill Cornell Medicine , New York , NY , USA
| | - Julia T Geyer
- a Department of Pathology and Laboratory Medicine , New York Presbyterian Hospital - Weill Cornell Medicine , New York , NY , USA
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17
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Laskowska J, Lewandowska-Bieniek J, Szczepanek J, Styczyński J, Tretyn A. Genomic and transcriptomic profiles and in vitro resistance to mitoxantrone and idarubicin in pediatric acute leukemias. J Gene Med 2016; 18:165-79. [PMID: 27280600 DOI: 10.1002/jgm.2889] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/06/2016] [Accepted: 06/06/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND A major problem in the treatment of leukemia is the development of drug resistance to chemotherapeutic agents. METHODS To determine the ex vivo drug resistance profile to anthracyclines, an 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-tetrazoliumbromide (MTT) cytotoxicity assay was performed on mononuclear cells obtained from 155 patients with acute lymphoblastic leukemia (ALL) or acute myeloblastic leukemia (AML). Gene expression profiles (for 51 patients with ALL and 16 with AML) were prepared on the basis of cRNA hybridization to oligonucleotide arrays of the human genome (Affymetrix). Hierarchical clustering, assignment location and biological function were investigated during the correlation analysis for identified probe sets. Comparative genomic hybridization (CGH) array profiles (34 patients with ALL and 12 with AML) were prepared on the basis of DNA hybridization to oligonucleotide arrays of the human genome (Agilent). The validation of the array results was performed by a quantitative reverse transcriptase polymerase chain reaction. RESULTS The collected expression and CGH microarray experiment results indicate that the ITGB2, SCL6A7, CASP1 and DUSP genes may comprise a resistance marker for acute leukemia cells correlated with anthracyclines. Moreover, there were also identified chromosome rearrangements associated with drug resistance, such as del5q32-35.3 and amp8p12-p11.21. Precise genes, as well as genome aberrations, might be classified as targets in therapy. CONCLUSIONS In AML, the resistance of blasts to idarubicin and mitoxantrone may reflect an impaired integrin pathway. In ALL, the development of resistance is caused by the inhibition of B and T cell activation. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Joanna Laskowska
- Department of Plant Physiology and Biotechnology, Nicolaus Copernicus University, Torun, Poland.,Centre for Modern Interdisciplinary Technologies, Nicolaus Copernicus University, Torun, Poland
| | | | - Joanna Szczepanek
- Department of Plant Physiology and Biotechnology, Nicolaus Copernicus University, Torun, Poland.,Centre for Modern Interdisciplinary Technologies, Nicolaus Copernicus University, Torun, Poland
| | - Jan Styczyński
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Andrzej Tretyn
- Department of Plant Physiology and Biotechnology, Nicolaus Copernicus University, Torun, Poland.,Centre for Modern Interdisciplinary Technologies, Nicolaus Copernicus University, Torun, Poland
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18
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Yue QF, Chen L, She XM, Hu B, Hu Y, Zou P, Liu XY. Clinical Prognostic Factors in 86 Chinese Patients with Primary Myelodysplastic Syndromes and Trisomy 8: A Single Institution Experience. Yonsei Med J 2016; 57:358-64. [PMID: 26847287 PMCID: PMC4740527 DOI: 10.3349/ymj.2016.57.2.358] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 12/01/2014] [Accepted: 01/08/2015] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The objective was to determine the characteristics and prognostic factors of 86 Chinese patients with trisomy 8 aberrations and compare the prognostic value of International Prognostic System (IPSS) and Revised IPSS (IPSS-R) in this cohort. MATERIALS AND METHODS A total of 86 cases diagnosed with primary myelodysplastic syndromes (MDS) with isolated tr8 or with tr8 and other additional cytogenetic aberrations diagnosed and treated at the Union Hospital, Tongji Medical College of Huazhong University of Science and Technology between July 2002 and March 2013 were reviewed. RESULTS The median survival of the entire group was 23.0 months, and acute myeloid leukemia (AML) developed in 43% (37/86) patients within the follow up time. The univariate analysis revealed that overall survival (OS) was correlated with age, thrombocytopenia, absolute neutrophil count, marrow blasts, cytogenetic status and red blood cell transfusion at diagnosis, and the multivariate analysis revealed that age, marrow blasts, cytogenetic status and transfusion dependence were independent parameters for the OS. The cytogenetic complexity and marrow blasts had the strongest impact on the AML transformation by multivariate analysis. Comparing the two prognostic systems, both two systems could successfully discriminate risk groups for survival. IPSS-R was more refined than IPSS for predicting OS, but had no advantage in predicting the risk of AML development. CONCLUSION This study confirmed the influence of clinical factors on the prognosis of 86 Chinese MDS patients with trisomy 8. In addition, IPSS-R can further refine prognostic discrimination in the IPSS risk categories.
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Affiliation(s)
- Qing Fang Yue
- Department of Medical Oncology, ShaanXi Provincial People's Hospital, Xi'an, Shaanxi, P.R. China
| | - Lei Chen
- Department of Hematology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Xiao Mei She
- Department of Hematology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Bin Hu
- Department of Hematology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Yu Hu
- Department of Hematology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Ping Zou
- Department of Hematology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Xin Yue Liu
- Department of Hematology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China.
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Genetics factors associated with myelodysplastic syndromes. Blood Cells Mol Dis 2015; 55:76-81. [PMID: 25976472 DOI: 10.1016/j.bcmd.2015.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 04/16/2015] [Indexed: 12/16/2022]
Abstract
The myelodysplastic syndromes (MDS) are a clinically and cytogenetically heterogeneous group of clonal diseases. Clonal chromosomal abnormalities are observed in 30-50% of patients with MDS. The deletions are among the most common alterations, and often involve the long arms of chromosomes 5, 7, 8, 13, and 20 and the short arms of chromosomes 12 and 17. The advent of new technologies for the detection of genetic abnormalities led to the description of a new set of recurrent mutations, leading to new insights into the pathophysiology of MDS. The recent recognition that genes involved in the regulation of histone function (EZH2, ASXL1, and UTX) and DNA methylation (DNMT3A, IDH1/IDH2, and TET2) are frequently mutated in MDS, has led to the proposal that there is an important link between genetic and epigenetic alterations in this disease. In fact, regulatory factors have also been considered as miR-143/miR-145, miR-146a, miR-125a and MiR-21. Somatic mutations may influence the clinical phenotype but are not included in current prognostic scoring systems. In recent years research has brought new insights into these diseases, but few of the findings are sufficiently robust to be incorporated into the clinical routine at this time. Thus, the aim of this study was to review the role of genetic factors involved in the diagnosis and development of the different phenotypes of MDS.
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Yan X, Wei J, Wang J, Ren Y, Zhou X, Mei C, Ye L, Xie L, Hu C, Jin J, Tong H. [Analysis of the karyotype abnormalities and its prognostic in 298 patients with myelodysplastic syndrome]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2015; 36:297-301. [PMID: 25916290 PMCID: PMC7342621 DOI: 10.3760/cma.j.issn.0253-2727.2015.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To investigate the relationship between cytogenetic markers with World Health Organization (WHO) classification, disease progress and prognosis in cases with primary myelodysplastic syndromes (MDS). METHODS 298 patients with de novo MDS from the first affiliated hospital of medical school, Zhejiang University were enrolled in the retrospective analysis of WHO classification, karyotype, and prognosis. Follow-up study was also conducted. RESULTS The WHO classifications at first diagnosis were as follows: refractory cytopenia with unilineage dysplasia (RCUD), 18 cases; refractory anemia with ring sideroblasts (RARS), 8 cases; refractory cytopenia with multiline dysplasia (RCMD), 104 cases; refractory anemia with excess blasts-1, 76 cases; refractory anemia with excess blasts-2, 85 cases; MDS unclassified (MDS-U), 5 cases involved; and single del (5q), 2 cases. 39.6% of MDS patients carried karyotypic abnormalities. Among them, the frequency of numerical abnormalities, structural abnormalities and the existence of composite abnormalities were 45, 31, and 42, respectively. The composite abnormalities were unbalanced translocations and complex chromosomal abnormalities. The incidence of both karyotypic abnormalities and complex chromosomal abnormalities in RAEB group was higher than that in non-RAEB group (P<0. 05). An analysis based on IPSS-R Scoring System showed that advanced risk stratification (except the low-risk group) gradually enhanced the incidence of karyotypic abnormalities (P<0.05). In addition, the probability of evolution to leukemia increased with the higher IPSS-R score (P<0.05). In RAEB group, the cases with +8 chromosome, accounting for 19.5% of karyotypic abnormalities, had worse prognosis than those with normal chromosomes. CONCLUSION Karyotype was identified with an independent risk factor in MDS patients. Therefore, the information on cytogenetic analysis was critical for diagnosis, prognosis and individual treatment. MDS patients presenting+8 chromosome, an intermediate risk factor, were associated with a poorer outcome compared to cases with normal chromosomes in RAEB group.
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Affiliation(s)
- Xuefen Yan
- MDS Center, 1st Affiliated Hospital College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Juying Wei
- MDS Center, 1st Affiliated Hospital College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Jinghan Wang
- MDS Center, 1st Affiliated Hospital College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Yanling Ren
- MDS Center, 1st Affiliated Hospital College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Xinping Zhou
- MDS Center, 1st Affiliated Hospital College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Chen Mei
- MDS Center, 1st Affiliated Hospital College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Li Ye
- MDS Center, 1st Affiliated Hospital College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Lili Xie
- MDS Center, 1st Affiliated Hospital College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Chao Hu
- MDS Center, 1st Affiliated Hospital College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Jie Jin
- MDS Center, 1st Affiliated Hospital College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Hongyan Tong
- MDS Center, 1st Affiliated Hospital College of Medicine, Zhejiang University, Hangzhou 310003, China
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Hosokawa K, Sugimori N, Katagiri T, Sasaki Y, Saito C, Seiki Y, Mochizuki K, Yamazaki H, Takami A, Nakao S. Increased glycosylphosphatidylinositol-anchored protein-deficient granulocytes define a benign subset of bone marrow failures in patients with trisomy 8. Eur J Haematol 2015; 95:230-8. [PMID: 25404431 DOI: 10.1111/ejh.12484] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2014] [Indexed: 01/23/2023]
Abstract
Trisomy 8 (+8), one of the most common chromosomal abnormalities found in patients with myelodysplastic syndromes (MDS), is occasionally seen in patients with otherwise typical aplastic anemia (AA). Although some studies have indicated that the presence of +8 is associated with the immune pathophysiology of bone marrow (BM) failure, its pathophysiology may be heterogeneous. We studied 53 patients (22 with AA and 31 with low-risk MDS) with +8 for the presence of increased glycosylphosphatidylinositol-anchored protein-deficient (GPI-AP(-) ) cells, their response to immunosuppressive therapy (IST), and their prognosis. A significant increase in the percentage of GPI-AP(-) cells was found in 14 (26%) of the 53 patients. Of the 26 patients who received IST, including nine with increased GPI-AP(-) cells and 17 without increased GPI-AP(-) cells, 14 (88% with increased GPI-AP(-) cells and 41% without increased GPI-AP(-) cells) improved. The overall and event-free survival rates of the +8 patients with and without increased GPI-AP(-) cells at 5 yr were 100% and 100% and 59% and 57%, respectively. Examining the peripheral blood for the presence of increased GPI-AP(-) cells may thus be helpful for choosing the optimal treatment for +8 patients with AA or low-risk MDS.
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Affiliation(s)
- Kohei Hosokawa
- Cellular Transplantation Biology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Naomi Sugimori
- Cellular Transplantation Biology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Takamasa Katagiri
- Clinical Laboratory Science, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Yumi Sasaki
- Cellular Transplantation Biology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Chizuru Saito
- Cellular Transplantation Biology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Yu Seiki
- Cellular Transplantation Biology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Kanako Mochizuki
- Cellular Transplantation Biology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Hirohito Yamazaki
- Cellular Transplantation Biology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Akiyoshi Takami
- Cellular Transplantation Biology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Shinji Nakao
- Cellular Transplantation Biology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
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Moons KGM, Altman DG, Reitsma JB, Ioannidis JPA, Macaskill P, Steyerberg EW, Vickers AJ, Ransohoff DF, Collins GS. Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD): explanation and elaboration. Ann Intern Med 2015; 162:W1-73. [PMID: 25560730 DOI: 10.7326/m14-0698] [Citation(s) in RCA: 2788] [Impact Index Per Article: 309.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The TRIPOD (Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis) Statement includes a 22-item checklist, which aims to improve the reporting of studies developing, validating, or updating a prediction model, whether for diagnostic or prognostic purposes. The TRIPOD Statement aims to improve the transparency of the reporting of a prediction model study regardless of the study methods used. This explanation and elaboration document describes the rationale; clarifies the meaning of each item; and discusses why transparent reporting is important, with a view to assessing risk of bias and clinical usefulness of the prediction model. Each checklist item of the TRIPOD Statement is explained in detail and accompanied by published examples of good reporting. The document also provides a valuable reference of issues to consider when designing, conducting, and analyzing prediction model studies. To aid the editorial process and help peer reviewers and, ultimately, readers and systematic reviewers of prediction model studies, it is recommended that authors include a completed checklist in their submission. The TRIPOD checklist can also be downloaded from www.tripod-statement.org.
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Duong VH, Komrokji RS, List AF. Update on the pharmacotherapy for myelodysplastic syndromes. Expert Opin Pharmacother 2014; 15:1811-25. [DOI: 10.1517/14656566.2014.937705] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Giagounidis A, Mufti GJ, Mittelman M, Sanz G, Platzbecker U, Muus P, Selleslag D, Beyne-Rauzy O, te Boekhorst P, del Cañizo C, Guerci-Bresler A, Nilsson L, Lübbert M, Quesnel B, Ganser A, Bowen D, Schlegelberger B, Göhring G, Fu T, Benettaib B, Hellström-Lindberg E, Fenaux P. Outcomes in RBC transfusion-dependent patients with Low-/Intermediate-1-risk myelodysplastic syndromes with isolated deletion 5q treated with lenalidomide: a subset analysis from the MDS-004 study. Eur J Haematol 2014; 93:429-38. [PMID: 24813620 PMCID: PMC4232868 DOI: 10.1111/ejh.12380] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2014] [Indexed: 11/30/2022]
Abstract
Objective A subset analysis of the randomised, phase 3, MDS-004 study to evaluate outcomes in patients with International Prognostic Scoring System (IPSS)-defined Low-/Intermediate (Int)-1-risk myelodysplastic syndromes (MDS) with isolated del(5q). Methods Patients received lenalidomide 10 mg/d (days 1–21; n = 47) or 5 mg/d (days 1–28; n = 43) on 28-d cycles or placebo (n = 45). From the placebo and lenalidomide 5 mg groups, 84% and 58% of patients, respectively, crossed over to lenalidomide 5 or 10 mg at 16 wk, respectively. Results Rates of red blood cell-transfusion independence (RBC-TI) ≥182 d were higher in the lenalidomide 10 mg (57.4%; P < 0.0001) and 5 mg (37.2%; P = 0.0001) groups vs. placebo (2.2%). Cytogenetic response rates (major + minor responses) were 56.8% (P < 0.0001), 23.1% (P = 0.0299) and 0%, respectively. Two-year cumulative risk of acute myeloid leukaemia progression was 12.6%, 17.4% and 16.7% in the lenalidomide 10 mg, 5 mg, and placebo groups, respectively. In a 6-month landmark analysis, overall survival was longer in lenalidomide-treated patients with RBC-TI ≥182 d vs. non-responders (P = 0.0072). The most common grade 3–4 adverse event was myelosuppression. Conclusions These data support the clinical benefits and acceptable safety profile of lenalidomide in transfusion-dependent patients with IPSS-defined Low-/Int-1-risk MDS with isolated del(5q).
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Kazama H, Teramura M, Kurihara S, Yoshinaga K, Kato T, Motoji T. Peroxiredoxin 2 expression is increased in neutrophils of patients with refractory cytopenia with multilineage dysplasia. Br J Haematol 2014; 166:720-8. [DOI: 10.1111/bjh.12954] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 03/31/2014] [Indexed: 01/13/2023]
Affiliation(s)
- Hiroshi Kazama
- Department of Haematology; Tokyo Women's Medical University; Tokyo Japan
| | - Masanao Teramura
- Department of Haematology; Tokyo Women's Medical University; Tokyo Japan
| | - Sachiko Kurihara
- Department of Haematology; Tokyo Women's Medical University; Tokyo Japan
| | - Kentaro Yoshinaga
- Department of Haematology; Tokyo Women's Medical University; Tokyo Japan
| | - Tomohiro Kato
- Clinical Proteomics and Molecular Medicine; St. Marianna University Graduate School of Medicine; Kanagawa Japan
| | - Toshiko Motoji
- Department of Haematology; Tokyo Women's Medical University; Tokyo Japan
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Abstract
Myelodysplastic syndromes are heterogeneous bone marrow diseases with a variable pathogenetic background. Cytomorphological alterations in peripheral blood films as well as bone marrow aspirates and histological findings in trephine biopsies result from cytogenetic and molecular abnormalities, epigenetic dysregulation and immune dysfunction and are key elements for setting the diagnosis of MDS. Whereas diagnosis can be made quite easily in advanced MDS this is much more difficult in early MDS, especially in cases with cytopenias or dysplasias of uncertain significance (ICUS and IDUS). Recommendations, illustrated by case reports for a stepwise annealing to the final diagnosis and exclusion of differential diagnoses are given. Furthermore, the problem of correct counting and identification of blasts is covered and features defining dysplasia in all three cell lineages are recapitulated thoroughly. Histopathology is not mandatory but has a distinct diagnostic and prognostic value especially in cases with hypoplasia or fibrosis and when the TP53 mutational status is of relevance. In up to 70% of patients with MDS clonal chromosome abnormalities can be identified which have a high impact on setting the correct diagnosis and estimation of prognosis. Incidence, type, molecular background and clinical relevance of distinct anomalies as well as cytogenetic subgroups are presented in detail and the development of the new cytogenetic prognostic scoring system as part of the IPSS-R is explained. The value of FISH-Analysis as a complementary tool for chromosome analysis in MDS is demonstrated with special emphasis on the possibility to perform frequent cytogenetic monitoring by CD34-FISH examination of peripheral blood. Finally the evolution of MDS-classification systems from FAB to WHO with a critical discussion of their shortcomings like degree of dysplasia, blast thresholds, inclusion/exclusion of CMML, and the lack of dynamic information is presented.
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Affiliation(s)
- Aristoteles Giagounidis
- Clinic for Oncology, Hematology and Palliative Medicine, Marien Hospital Düsseldorf, Rochusstr. 2, 40479 Düsseldorf, Germany.
| | - Detlef Haase
- University of Göttingen, Department of Hematology and Oncology, Robert-Koch-Str. 40, 37075 Göttingen, Germany.
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Padhi S, Varghese RG, Phansalkar MD, Sarangi R. Isolated deletion of the long arm of chromosome 20 [del(20q12)] in myelodysplastic syndrome: a case report and literature review. Singapore Med J 2013; 54:e185-9. [PMID: 24068064 DOI: 10.11622/smedj.2013119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Isolated deletion of the long arm of chromosome 20 [del(20q12)] is a rare abnormality in patients with de novo myelodysplastic syndrome. It is characterised by refractory thrombocytopenia, minimal haematological dysplasia and a lower risk for progression to acute myeloid leukaemia. Its distinction from chronic autoimmune thrombocytopenia, although clinically and morphologically difficult, is critical. We report a case of refractory cytopenia and unilineage dysplasia in an elderly woman with isolated del(20q12), identified via fluorescence in situ hybridisation analysis of her bone marrow. In order to avoid a misdiagnosis, we suggest that cytogenetic analysis be performed on all patients suspected to have myelodysplastic syndrome with predominant thrombocytopenic presentation.
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Affiliation(s)
- Somanath Padhi
- Pondicherry Institute of Medical Sciences, Ganapathychettykulam, Puducherry 605014, India.
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Sánchez-Castro J, Marco-Betés V, Gómez-Arbonés X, Arenillas L, Valcarcel D, Vallespí T, Costa D, Nomdedeu B, Jimenez MJ, Granada I, Grau J, Ardanaz MT, de la Serna J, Carbonell F, Cervera J, Sierra A, Luño E, Cervero CJ, Falantes J, Calasanz MJ, González-Porrás JR, Bailén A, Amigo ML, Sanz G, Solé F. Characterization and prognostic implication of 17 chromosome abnormalities in myelodysplastic syndrome. Leuk Res 2013; 37:769-76. [PMID: 23639672 DOI: 10.1016/j.leukres.2013.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 03/26/2013] [Accepted: 04/06/2013] [Indexed: 10/26/2022]
Abstract
The prognosis of chromosome 17 (chr17) abnormalities in patients with primary myelodysplastic syndrome (MDS) remains unclear. The revised International Prognostic Scoring System (IPSS-R) includes these abnormalities within the intermediate cytogenetic risk group. This study assessed the impact on overall survival (OS) and risk of acute myeloid leukemia transformation (AMLt) of chr17 abnormalities in 88 patients with primary MDS. We have compared this group with 1346 patients with primary MDS and abnormal karyotype without chr17 involved. The alterations of chr17 should be considered within group of poor prognosis. The different types of alterations of chromosome 17 behave different prognosis. The study confirms the intermediate prognostic impact of the i(17q), as stated in IPSS-R. The results of the study, however, provide valuable new information on the prognostic impact of alterations of chromosome 17 in complex karyotypes.
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Bernasconi P, Klersy C, Boni M, Cavigliano PM, Dambruoso I, Zappatore R. Validation of the new comprehensive cytogenetic scoring system (NCCSS) on 630 consecutive de novo MDS patients from a single institution. Am J Hematol 2013; 88:120-9. [PMID: 23349006 DOI: 10.1002/ajh.23369] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 11/15/2012] [Accepted: 11/18/2012] [Indexed: 11/05/2022]
Abstract
This study evaluated whether the NCCSS truly improves the prognostic stratification of 630 consecutive de novo MDS patients and established which cytogenetic grouping [NCCSS or International Prognostic Scoring System (IPSS)], when combined with the WHO classification, best predicted the clinical outcome of myelodysplastic syndromes (MDS). The frequency of chromosomal defects was 53.8%. Clinical parameters, including number of cytopenias, WHO classification, IPSS cytogenetic categories and scores, NCCSS were all relevant for overall survival (OS) and leukemia-free survival (LFS) and were included in six distinct multivariate models compared by the Akaike Information Criterion (AIC). The most effective model to predict OS included the number of cytopenias, the WHO classification and the NCCSS, whereas the model including the number of cytopenias, blast cell percentage and the NCCSS and the model including the number of cytopenias the WHO classification and the NCCSS were almost equally effective to predict LFS. In conclusion, the NCCS (i) improves the prognostic stratification of the good and poor IPSS cytogenetic categories by introducing the very good and the very poor categories; (ii) is still incomplete in establishing the prognostic relevance of rare/double defects, (ii) applied to patients who receive supportive treatment only identifies five different prognostic subgroups, but applied to patients treated with specific therapies reveals only a trend toward a significantly different OS and LFS when patients of the poor and intermediate cytogenetic categories are compared, (iii) combined with the WHO classification is much more effective than the IPSS in predicting MDS clinical outcome.
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Affiliation(s)
- Paolo Bernasconi
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo; University of Pavia; Italy
| | - Catherine Klersy
- Scientific Direction, Clinical Epidemiology and Biometry Unit; Fondazione IRCCS Policlinico San Matteo; Italy
| | - Marina Boni
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo; University of Pavia; Italy
| | - Paola Maria Cavigliano
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo; University of Pavia; Italy
| | - Irene Dambruoso
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo; University of Pavia; Italy
| | - Rita Zappatore
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo; University of Pavia; Italy
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Castelli R, Cassin R, Cannavò A, Cugno M. Immunomodulatory Drugs: New Options for the Treatment of Myelodysplastic Syndromes. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2013; 13:1-7. [DOI: 10.1016/j.clml.2012.09.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 09/24/2012] [Accepted: 09/26/2012] [Indexed: 10/27/2022]
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Expression of CXCR4 is an independent prognostic factor for overall survival and progression-free survival in patients with myelodysplastic syndrome. Med Oncol 2012; 30:341. [PMID: 23263827 DOI: 10.1007/s12032-012-0341-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 08/14/2012] [Indexed: 01/17/2023]
Abstract
CXCR4 is the receptor of stromal cell-derived factor (SDF-1) and is expressed in many types of cancer cells. It also plays an important role in metastasis of malignant disease. In this study, we detected the expression of CXCR4 in 81 patients with myelodysplastic syndrome (MDS) by flow cytometry. We categorized MDS patients into the high-expression group and low-expression group according to CXCR4 mean florescence intensity ration thresholds. We showed that the high-expression group had a shorter overall survival time and shorter relapse-free survival time compared with those of the low-expression group (21.6 ± 1.9 vs. 46.0 ± 1.6 months, 17.0 ± 1.9 vs. 42.5 ± 2.1 months, respectively, P < 0.05), and Cox regression showed that CXCR4 was an independent prognostic factor. We conclude that the expression of CXCR4 is a useful prognostic factor for patients with MDS.
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Epling-Burnette PK, McDaniel J, Wei S, List AF. Emerging immunosuppressive drugs in myelodysplastic syndromes. Expert Opin Emerg Drugs 2012; 17:519-41. [PMID: 23163589 DOI: 10.1517/14728214.2012.736487] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Myelodysplastic syndromes (MDS) are characterized by dysplastic morphologic features and ineffective hematopoiesis. Pathophysiological characteristics change over time making therapeutic development a major challenge. In early MDS, cytopenias arise or are exacerbated by humoral and cellular immune-mediators that suppress hematopoietic progenitor survival and alter the bone marrow microenvironment. AREAS COVERED In this review, current immunosuppressive regimens are described. To identify new therapies that may enhance immunosuppressive therapy (IST) response and identify pharmacodynamic biomarkers for patient selection, the inflammasome, cytokines, metabolic pathways and signaling events are described. EXPERT OPINION Agents with the potential to induce early, durable hematologic remissions are needed and many new immunosuppressive agents are available for investigation. An immune-mediated mechanism is likely to contribute to MDS early after diagnosis. New approaches that interfere with inflammatory pathways in the bone marrow microenvironment may move closer toward sustained disease control in MDS.
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Affiliation(s)
- Pearlie K Epling-Burnette
- H. Lee Moffitt Cancer Center & Research Institute, Immunology Department, SRB 23033, 12902 Magnolia Dr, Tampa, FL 33612, USA.
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Saumell S, Florensa L, Luño E, Sanzo C, Cañizo C, Hernández JM, Cervera J, Gallart MA, Carbonell F, Collado R, Arenillas L, Pedro C, Bargay J, Nomdedeu B, Xicoy B, Vallespí T, Raya JM, Belloch L, Sanz GF, Solé F. Prognostic value of trisomy 8 as a single anomaly and the influence of additional cytogenetic aberrations in primary myelodysplastic syndromes. Br J Haematol 2012; 159:311-21. [DOI: 10.1111/bjh.12035] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 07/16/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Sílvia Saumell
- Laboratori de Citologia Hematològica, Laboratori de Citogenètica Molecular, Serveis de Patologia i d'Hematologia Cl\xEDnica; Hospital del Mar; GRETHNE, IMIM (Hospital del Mar Research Institute); Barcelona Spain
- Department of Medicine; Medicine Faculty; Universitat Autònoma de Barcelona; Bellaterra Spain
| | - Lourdes Florensa
- Laboratori de Citologia Hematològica, Laboratori de Citogenètica Molecular, Serveis de Patologia i d'Hematologia Cl\xEDnica; Hospital del Mar; GRETHNE, IMIM (Hospital del Mar Research Institute); Barcelona Spain
| | - Elisa Luño
- Servicio de Hematología; Hospital Universitario Central de Asturias; Oviedo Spain
| | - Carmen Sanzo
- Servicio de Hematología; Hospital Universitario Central de Asturias; Oviedo Spain
| | - Consuelo Cañizo
- Servicio de Hematología; Hospital Universitario de Salamanca; Salamanca Spain
| | - Jesus M. Hernández
- Servicio de Hematología; Hospital Universitario de Salamanca; Salamanca Spain
| | - José Cervera
- Servicio de Hematología; Hospital Universitario La Fe; Valencia Spain
| | - Miguel A. Gallart
- Servei d'Hematología; Hospital Universitari Arnau de Vilanova; Lleida Spain
| | - Félix Carbonell
- Servicio de Hematología; Hospital General de Valencia; Valencia Spain
| | - Rosa Collado
- Servicio de Hematología; Hospital General de Valencia; Valencia Spain
| | - Leonor Arenillas
- Laboratori de Citologia Hematològica, Laboratori de Citogenètica Molecular, Serveis de Patologia i d'Hematologia Cl\xEDnica; Hospital del Mar; GRETHNE, IMIM (Hospital del Mar Research Institute); Barcelona Spain
| | - Carme Pedro
- Laboratori de Citologia Hematològica, Laboratori de Citogenètica Molecular, Serveis de Patologia i d'Hematologia Cl\xEDnica; Hospital del Mar; GRETHNE, IMIM (Hospital del Mar Research Institute); Barcelona Spain
| | - Joan Bargay
- Servicio de Hematología; Hospital Son Llàtzer; Mallorca Spain
| | - Benet Nomdedeu
- Servei d'Hematología; Hospital Clínic Barcelona; Barcelona Spain
| | - Blanca Xicoy
- Servei d'Hematología; Hospital Universitari Germans Trias i Pujol; Badalona Spain
| | - Teresa Vallespí
- Servei d'Hematología; Hospital Vall d'Hebron; Barcelona Spain
| | - José M. Raya
- Servicio de Hematología; Hospital Universitario de Canarias; La Laguna-Tenerife Spain
| | - Luis Belloch
- Servicio de Hematología; Hospital Universitario La Fe; Valencia Spain
| | - Guillermo F. Sanz
- Servicio de Hematología; Hospital Universitario La Fe; Valencia Spain
| | - Francesc Solé
- Laboratori de Citologia Hematològica, Laboratori de Citogenètica Molecular, Serveis de Patologia i d'Hematologia Cl\xEDnica; Hospital del Mar; GRETHNE, IMIM (Hospital del Mar Research Institute); Barcelona Spain
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Rohr SS, Pelloso LAF, Borgo ADS, de Rezende JG, Silva MRR, Yamamoto M, de Lourdes L F Chauffaille M. RARS with fibrosis and del(20q) transformed into ALL. Med Oncol 2012; 29:3570-3. [PMID: 22760793 DOI: 10.1007/s12032-012-0297-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 06/21/2012] [Indexed: 01/03/2023]
Abstract
Transformation of myelodysplastic syndrome (MDS) into acute myelogenous leukemia occurs in approximately 30 % of cases, while progression into acute lymphoblastic leukemia (ALL) is rare. We report on a 67-year-old man with the diagnosis of MDS, subtype refractory anemia with ring sideroblasts (RARS), karyotype 20q- , JAK-2 negative and grade III fibrosis on the bone marrow biopsy, who evolved into ALL 33 months after the diagnosis of MDS. RARS is one of the subtypes of MDS with most indolent course. Deletion of the long arm of chromosome 20 (20q-) is considered as good prognosis by the International Prognostic Scoring System, an important scoring system for predicting survival and evolution of MDS. Primary MDS with bone marrow fibrosis may represent a distinct clinicopathological and is supposed to have an unfavorable prognosis. The combined analysis of these features makes this rare report still more challenging and illustrates that biology of MDS is yet to be discovered.
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Affiliation(s)
- Sandra S Rohr
- Disciplina de Hematologia e Hemoterapia, UNIFESP-Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu, 740 -3.andar, São Paulo, SP, 04023-900, Brazil.
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Duong VH, Komrokji RS, List AF. Efficacy and safety of lenalidomide in patients with myelodysplastic syndrome with chromosome 5q deletion. Ther Adv Hematol 2012; 3:105-16. [PMID: 23556117 PMCID: PMC3573434 DOI: 10.1177/2040620711435659] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Myelodysplastic syndrome (MDS) with del(5q) is a unique hematopoietic stem cell disease that typically follows an indolent course and demonstrates particular sensitivity to lenalidomide, a second-generation immunomodulatory agent. Early trials demonstrated rapid and durable responses leading to US Food and Drug Administration (FDA) approval in 2005. Definitive confirmatory evidence from a large phase III trial was recently published. Other recent advances include a better understanding of the pathogenesis of disease including haplodeficiency of several candidate genes, and elucidation of the lenalidomide-specific effect on two phosphatases ultimately leading to p53 degradation in the erythroid progenitors and cell cycle arrest in earlier myeloid progenitors. In this review, we describe the pathogenesis of MDS with del(5q), summarize the major clinical studies establishing the activity of lenalidomide in this population, discuss commonly encountered adverse events, and shed light on practical uses of this agent in the clinic.
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36
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Schanz J, Tüchler H, Solé F, Mallo M, Luño E, Cervera J, Granada I, Hildebrandt B, Slovak ML, Ohyashiki K, Steidl C, Fonatsch C, Pfeilstöcker M, Nösslinger T, Valent P, Giagounidis A, Aul C, Lübbert M, Stauder R, Krieger O, Garcia-Manero G, Faderl S, Pierce S, Le Beau MM, Bennett JM, Greenberg P, Germing U, Haase D. New comprehensive cytogenetic scoring system for primary myelodysplastic syndromes (MDS) and oligoblastic acute myeloid leukemia after MDS derived from an international database merge. J Clin Oncol 2012; 30:820-9. [PMID: 22331955 PMCID: PMC4874200 DOI: 10.1200/jco.2011.35.6394] [Citation(s) in RCA: 473] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 12/05/2011] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The karyotype is a strong independent prognostic factor in myelodysplastic syndromes (MDS). Since the implementation of the International Prognostic Scoring System (IPSS) in 1997, knowledge concerning the prognostic impact of abnormalities has increased substantially. The present study proposes a new and comprehensive cytogenetic scoring system based on an international data collection of 2,902 patients. PATIENTS AND METHODS Patients were included from the German-Austrian MDS Study Group (n = 1,193), the International MDS Risk Analysis Workshop (n = 816), the Spanish Hematological Cytogenetics Working Group (n = 849), and the International Working Group on MDS Cytogenetics (n = 44) databases. Patients with primary MDS and oligoblastic acute myeloid leukemia (AML) after MDS treated with supportive care only were evaluated for overall survival (OS) and AML evolution. Internal validation by bootstrap analysis and external validation in an independent patient cohort were performed to confirm the results. RESULTS In total, 19 cytogenetic categories were defined, providing clear prognostic classification in 91% of all patients. The abnormalities were classified into five prognostic subgroups (P < .001): very good (median OS, 61 months; hazard ratio [HR], 0.5; n = 81); good (49 months; HR, 1.0 [reference category]; n = 1,809); intermediate (26 months; HR, 1.6; n = 529); poor (16 months; HR, 2.6; n = 148); and very poor (6 months; HR, 4.2; n = 187). The internal and external validations confirmed the results of the score. CONCLUSION In conclusion, these data should contribute to the ongoing efforts to update the IPSS by refining the cytogenetic risk categories.
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Affiliation(s)
- Julie Schanz
- Author affiliations appear at the end of this article
| | - Heinz Tüchler
- Author affiliations appear at the end of this article
| | - Francesc Solé
- Author affiliations appear at the end of this article
| | - Mar Mallo
- Author affiliations appear at the end of this article
| | - Elisa Luño
- Author affiliations appear at the end of this article
| | - José Cervera
- Author affiliations appear at the end of this article
| | | | | | | | | | | | | | | | | | - Peter Valent
- Author affiliations appear at the end of this article
| | | | - Carlo Aul
- Author affiliations appear at the end of this article
| | | | | | - Otto Krieger
- Author affiliations appear at the end of this article
| | | | - Stefan Faderl
- Author affiliations appear at the end of this article
| | - Sherry Pierce
- Author affiliations appear at the end of this article
| | | | | | | | | | - Detlef Haase
- Author affiliations appear at the end of this article
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Xiao Y, Wei J, Chen Y, Zhang K, Zhou J, Zhang Y. Trisomy 8 is the most frequent cytogenetic abnormality in de novo myelodysplastic syndrome in China. ACTA ACUST UNITED AC 2012; 35:100-6. [PMID: 22414973 DOI: 10.1159/000336815] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cytogenetic abnormalities have been detected in 40-60% of patients with de novo myelodysplastic syndrome (MDS). Some reports suggest that Asian and Western MDS patients have different cytogenetic features. PATIENTS AND METHODS We retrospectively analyzed 168 patients with de novo MDS and compared our results with other Chinese centers to investigate the prevalence and cytogenetic characteristics of MDS in China. RESULTS In our study, chromosome abnormalities were detected in 40.48% of patients (68/168). Although the median survival time did not differ between younger and older (≥60 years) patients (p = 0.969), survival curves based on International Prognostic Scoring System (IPSS) cytogenetic groups and WHO Classification-Based Prognostic Scoring System (WPSS) risk groups were significantly different (p < 0.001). Survival differences were observed between patients in the normal karyotype group, sole trisomy 8 group, and poor cytogenetic group according to IPSS (p < 0.001). In agreement with the results from 2 other large Chinese centers, trisomy 8 was the most detected cytogenetic abnormality, with a prevalence of 14.21%. CONCLUSION Trisomy 8, categorized as intermediate cytogenetic risk group in our study, is the most frequent cytogenetic abnormality in de novo MDS in China.
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Affiliation(s)
- Yi Xiao
- Department of Hematology, Tongji Hospital, Wuhan, China
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Gokce M, Bulus D, Bilginer Y, Gumruk F, Besbas N, Cetin M. Acute lymphoblastic leukaemia in a child with systemic lupus erythematosus. Lupus 2012; 21:910-3. [PMID: 22331193 DOI: 10.1177/0961203312436859] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Haematological involvement of systemic lupus erythematosus (SLE) - which ranges from the well-described haemolytic anaemia to macrophage activation syndrome - has a large impact on both morbidity and mortality. On the other hand, association between haematological malignities and SLE - in terms of pathophysiology and molecular genetics - is an obscure entity which has not been clarified evidently to date. Herein, we present a six-year-old female with the diagnosis of SLE who developed acute lymphoblastic leukaemia following a period of myelodysplasia. It could possibly be coincidental; however, persistent cytopenia, prominent dysplasia on bone marrow smears and azathioprine treatment may be considered as possible triggers for the development of leukaemia in the present case.
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Affiliation(s)
- M Gokce
- Pediatric Haematology Division, Hacettepe Medical Faculty, Ankara, Turkey
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Qu S, Xu Z, Zhang Y, Qin T, Zhang T, Cui R, Xiao Z. Impacts of cytogenetic categories in the Revised International Prognostic Scoring System on the prognosis of primary myelodysplastic syndromes: results of a single-center study. Leuk Lymphoma 2011; 53:940-6. [PMID: 22023524 DOI: 10.3109/10428194.2011.634049] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Recently, the Revised International Prognostic Scoring System (IPSS-R) has been developed for assessing the prognosis of primary myelodysplastic syndromes (MDS) and has shown satisfactory outcomes for prognostic stratification. In this new system, cytogenetics remains the key stratification parameter and karyotypic abnormalities are classified into five prognostic subgroups with more uncommon cytogenetic subsets. Using this system, we analyzed the cytogenetic features of 532 adult Chinese patients with primary MDS and assessed the impacts of the IPSS-R cytogenetic categories on the prognosis of the disease without intensive treatment. Here, we show that the cytogenetic features of this cohort of Chinese patients are different from those of previously reported Western populations with MDS. In our Chinese patients, trisomy 8 was the most common anomaly, and the incidence rate of del(5q) was lower than that in the Western population. In the IPSS-R cytogenetic subgroups, the median survival was 59 months for the good risk, 36 months for the intermediate risk, 15 months for the poor risk and 10 months for the very poor risk subgroups (p < 0.001). In conclusion, the IPSS-R can effectively stratify the prognosis of MDS based on cytogenetics, but the prognostic significances of some karyotypes in the IPSS-R still need to be confirmed by larger multicenter cooperative studies.
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Affiliation(s)
- Shiqiang Qu
- Chinese Academy of Medical Sciences, Tianjin, China
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40
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HLA-DR(negative), CD34(negative) hypergranular acute myeloid leukemia with trisomy 6 and del(5)(q22q33): case report and review of the literature. J Pediatr Hematol Oncol 2011; 33:e289-95. [PMID: 21768886 DOI: 10.1097/mph.0b013e31821503c8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We report a unique pediatric case of hypergranular acute myeloid leukemia with myelodysplasia-related changes. The patient presented with moderate leukocytosis with neutrophilia with left-shift maturation and dysplasia, anemia, and multiple sclerotic bone lesions. The bone marrow was hypercellular with a predominance of myeloblast cells and/or abnormal promyelocytes with hypergranular cytoplasm. Flow cytometric immunophenotyping showed that the leukemic cells were positive for CD13, CD33, and myeloperoxidase, and negative for HLA-DR and CD34. Morphology and immunophenotyping were highly suggestive of acute promyelocytic leukemia. The classic t(15;17) or other RARα rearrangements were not detected by cytogenetic or molecular assays, ruling out acute promyelocytic leukemia. Standard cytogenetic analysis showed that the karyotype of the predominant clone was 47,XY,+6 with evidence of clonal evolution to 47,XY,+6,del(5)(q22q33). A literature and database review showed that trisomy 6 is a rare occurrence in hematological malignancies and, to our knowledge, has never been reported in association with del(5)(q22q33) in a child presenting with hypergranular acute myeloid leukemia with myelodysplasia-related changes. We present a current review of the literature and summarize the clinical features of 57 cases of trisomy 6 as the primary chromosomal abnormality in hematological disease.
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Abstract
Use of appropriate methods to produce analysable metaphase spreads and high-quality fluorescence in situ hybridization (FISH) and array results is critical to successful cytogenetic analysis of haematological malignancies, but the analysis and reporting of the findings of these tests are equally important as it is the final report that clinicians rely upon to inform patient management. A methodical approach to reporting with the use of universally recognized nomenclature will ensure that the diagnostic and prognostic information is presented in a form that is interpretable by both clinicians and other cytogeneticists.
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42
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Huang J, Ding T, Yang M, Liu H, Sun X, Jin J. Antitumor activity and drug interactions of proteasome inhibitor Bortezomib in human high-risk myelodysplastic syndrome cells. Int J Hematol 2011; 93:482-493. [PMID: 21451957 DOI: 10.1007/s12185-011-0821-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 02/21/2011] [Accepted: 03/16/2011] [Indexed: 01/09/2023]
Abstract
The purpose of this study was to investigate the antitumor effects and drug interactions of the proteasome inhibitor Bortezomib against high-risk myelodysplastic syndrome (MDS) cells in vitro and in vivo. The high-risk MDS-derived MUTZ-1 cell line and bone marrow mononuclear cells from primary high-risk MDS patients were used to examine antitumor activity and drug interactions for Bortezomib. Apoptotic proteins, including caspase and Bcl-2 family members, as well as the protein FLIP, were studied. Phosphoinositide 3-kinase (PI3K)/Akt and MAPK signaling pathways were also examined. The PI3K inhibitor LY294002 was used to examine the involvement of the PI3K/Akt signaling pathway in the induction of apoptosis. Cytarabine (AraC) and daunorubicin (DNR) were used to test for synergistic effects between Bortezomib and chemotherapeutic agents. SCID mice xenografted with MUTZ-1 cells were used for in vivo study. We found that Bortezomib could induce growth arrest and apoptosis in high-risk MDS cells in vitro and in vivo. The mechanisms were related to decreased activation of the PI3K/Akt survival signaling pathway, but not the MAPK pathway, and involved inhibition of the NF-κB activity and downregulation of the Bcl-2/Bax and FLIPL/FLIPS ratios, triggering the activation of caspase cascades. This phenomenon was inhibited by the PI3K inhibitor LY294002. Bortezomib also acted synergistically with the chemotherapeutic agents AraC and DNR, which are associated with the inhibition of NF-κB activity. Our results demonstrate that Bortezomib can induce growth arrest and apoptosis of high-risk MDS cells and had a synergistic effect with two chemotherapeutic agents. Our findings provide new insights for the treatment of high-risk MDS, using either Bortezomib alone, or in combination with conventional antineoplastic agents.
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Affiliation(s)
- Jian Huang
- Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China.,Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China.,Key Lab of Hematology, Diagnose and Treatment, Hangzhou, Zhejiang, People's Republic of China.,Key Lab of Combined Muti-organ Transplantation, Ministry of Public Health, #79 Qingchun Road, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Ting Ding
- Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China.,Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China.,Key Lab of Hematology, Diagnose and Treatment, Hangzhou, Zhejiang, People's Republic of China.,Key Lab of Combined Muti-organ Transplantation, Ministry of Public Health, #79 Qingchun Road, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Min Yang
- Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China.,Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China.,Key Lab of Hematology, Diagnose and Treatment, Hangzhou, Zhejiang, People's Republic of China.,Key Lab of Combined Muti-organ Transplantation, Ministry of Public Health, #79 Qingchun Road, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Hui Liu
- Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China.,Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China.,Key Lab of Hematology, Diagnose and Treatment, Hangzhou, Zhejiang, People's Republic of China.,Key Lab of Combined Muti-organ Transplantation, Ministry of Public Health, #79 Qingchun Road, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Xin Sun
- Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China.,Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China.,Key Lab of Hematology, Diagnose and Treatment, Hangzhou, Zhejiang, People's Republic of China.,Key Lab of Combined Muti-organ Transplantation, Ministry of Public Health, #79 Qingchun Road, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Jie Jin
- Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China. .,Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China. .,Key Lab of Hematology, Diagnose and Treatment, Hangzhou, Zhejiang, People's Republic of China. .,Key Lab of Combined Muti-organ Transplantation, Ministry of Public Health, #79 Qingchun Road, Hangzhou, 310003, Zhejiang, People's Republic of China.
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Champlin R. Hematopoietic stem cell transplantation for treatment of myleodysplastic syndromes. Biol Blood Marrow Transplant 2011; 17:S6-8. [PMID: 21195312 DOI: 10.1016/j.bbmt.2010.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Allogeneic stem cell transplantation is a potentially curative treatment for myelodysplastic syndromes. Transplants are clearly indicated in patients with intermediate-2 and high risk disease; there is controversy regarding when transplantation should be performed in patients with low and intermediate-1 risk disease. Most patients with MDS are over age 65 and Medicare has recently provisionally approved transplants, but only when performed as part of a comparative clinical trial which still must be finalized. Nonmyeloablative preparative regimens allow treatment of older patients with MDS, and novel approaches are under evaluation to reduce the risk of relapse and treatment related morbidity and mortality.
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Affiliation(s)
- Richard Champlin
- University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA
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44
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Impact of adjunct cytogenetic abnormalities for prognostic stratification in patients with myelodysplastic syndrome and deletion 5q. Leukemia 2011; 25:110-20. [PMID: 20882045 DOI: 10.1038/leu.2010.231] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This cooperative study assessed prognostic factors for overall survival (OS) and risk of transformation to acute myeloid leukemia (AML) in 541 patients with de novo myelodysplastic syndrome (MDS) and deletion 5q. Additional chromosomal abnormalities were strongly related to different patients' characteristics. In multivariate analysis, the most important predictors of both OS and AML transformation risk were number of chromosomal abnormalities (P<0.001 for both outcomes), platelet count (P<0.001 and P=0.001, respectively) and proportion of bone marrow blasts (P<0.001 and P=0.016, respectively). The number of chromosomal abnormalities defined three risk categories for AML transformation (del(5q), del(5q)+1 and del(5q)+ ≥ 2 abnormalities) and two for OS (one group: del(5q) and del(5q)+1; and del(5q)+ ≥ 2 abnormalities, as the other one); with a median survival time of 58.0 and 6.8 months, respectively. Platelet count (P=0.001) and age (P=0.034) predicted OS in patients with '5q-syndrome'. This study demonstrates the importance of additional chromosomal abnormalities in MDS patients with deletion 5q, challenges the current '5q-syndrome' definition and constitutes a useful reference series to properly analyze the results of clinical trials in these patients.
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45
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Komrokji RS, Zhang L, Bennett JM. Myelodysplastic syndromes classification and risk stratification. Hematol Oncol Clin North Am 2010; 24:443-57. [PMID: 20359636 DOI: 10.1016/j.hoc.2010.02.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Myelodysplastic syndromes (MDS) are spectrum of bone marrow failure disorders that share a common pathologic feature: cytologic dysplasia. The classification of MDS reflects the understanding of the disease. It is hoped that in the future classification and risk stratification will be based on underlying pathobiology of different disease subsets and molecular signatures where the pathologic classification represents their phenotype. This article reviews MDS classification and risk stratification highlighting differences between the various systems.
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Affiliation(s)
- Rami S Komrokji
- H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA.
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46
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Wang SA, Jabbar K, Lu G, Chen SS, Galili N, Vega F, Jones D, Raza A, Kantarjian H, Garcia-Manero G, McDonnell TJ, Medeiros LJ. Trisomy 11 in myelodysplastic syndromes defines a unique group of disease with aggressive clinicopathologic features. Leukemia 2010; 24:740-7. [PMID: 20072149 DOI: 10.1038/leu.2009.289] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Trisomy 11 in myelodysplastic syndromes (MDS) is rare, with undefined clinical significance and is currently assigned to the International Prognostic Scoring System (IPSS) intermediate-risk group. Over a 15-year period, we identified 17 MDS patients with trisomy 11 either as a sole abnormality (n=10) or associated with one or two additional alterations (n=7), comprising 0.3% of all MDS cases reviewed. Of 16 patients with Bone Marrow material available for review, 14 (88%) patients presented with excess blasts, 69% patients evolved to acute myeloid leukemia (AML) in a 5-month median interval and the median survival was 14 months. For comparison, we studied 19 AML patients with trisomy 11 in a noncomplex karyotype, of which, a substantial subset of patients had morphologic dysplasia, and/or preexisting cytopenia(s)/MDS. Genomic DNA PCR showed MLL partial tandem duplication in 5 of 10 MDS and 7 of 11 AML patients. A review of literature identified 17 additional cases of MDS with trisomy 11, showing similar clinicopathologic features to our patients. Compared with our historical data comprising 1165 MDS patients, MDS patients with trisomy 11 had a significantly inferior survival to patients in the IPSS intermediate-risk cytogenetic group (P=0.0002), but comparable to the poor-risk group (P=0.97). We conclude that trisomy 11 in MDS correlates with clinical aggressiveness, may suggest an early/evolving AML with myelodysplasia-related changes and is best considered a high-risk cytogenetic abnormality in MDS prognostication.
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Affiliation(s)
- S A Wang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030-4009, USA.
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Does cytogenetic evolution have any prognostic relevance in myelodysplastic syndromes? A study on 153 patients from a single institution. Ann Hematol 2010; 89:545-51. [PMID: 20217086 DOI: 10.1007/s00277-010-0927-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Accepted: 02/11/2010] [Indexed: 10/19/2022]
Abstract
The present study was designed to establish the incidence of cytogenetic evolution (CE), defined as the acquisition of chromosomal defects during the course of MDS, in order to correlate it with the WHO classification and IPSS score, and to assess its impact on overall survival (OS) and risk of MDS/AML evolution (progression-free interval, PFI) by means of Cox models for time-dependent covariates. Adjustments for known risk factors were achieved by performing a bivariable analysis. The study was carried out in 153 MDS patients who were followed for a median period of 45.2 months. Disease progression occurred in 42.4% of patients after a 65.2-month median PFI, while CE occurred in 30.7% of patients. Our study shows that (1) CE was more common in advanced than in early MDS, and advanced MDS presented secondary chromosomal defects distinct from those of early MDS; (2) CE significantly affected OS and PFI independently of other prognostic variables; (3) del(7)(q31q34) was the only secondary chromosomal defect which significantly affected PFI; trisomy 8 had only a moderate influence.
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48
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Codispoti KET, Depalma L. Myelodysplastic syndrome in elderly patients: correlation of CBC with cytogenetic and FISH analysis. Int J Lab Hematol 2009; 32:443-8. [PMID: 20041967 DOI: 10.1111/j.1751-553x.2009.01210.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Unexplained anemia in the elderly could represent myelodysplastic syndrome (MDS). We assessed the utility of using a fluorescence in situ hybridization (FISH) panel for common chromosomal abnormalities seen in MDS. A total of 101 elderly outpatients with anemia of unknown etiology were evaluated. Complete blood count, bone marrow biopsy, conventional cytogenetic analysis (CC), and FISH panel were reviewed. A total of 21 (21%) of the 101 patients had MDS. A combination of CC and FISH identified chromosomal abnormalities in 17 (81%) of the patients with MDS. The remaining 4 (19%) were diagnosed with MDS based solely on morphologic criteria. Except in two cases, FISH did not reveal abnormalities not already detected by CC. Furthermore, MDS patients infrequently had isolated anemia (14%) as opposed to those without MDS (75%). A MDS FISH panel is not more sensitive than CC in elderly outpatients with unexplained anemia. MDS is more likely if in addition to anemia, leukopenia and/or thrombocytopenia are also present.
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Affiliation(s)
- K-E T Codispoti
- Department of Pathology, The George Washington University Medical Center, NW, Washington, DC, USA.
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49
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Cytogenetic features and prognosis analysis in Chinese patients with myelodysplastic syndrome: a multicenter study. Ann Hematol 2009; 89:535-44. [DOI: 10.1007/s00277-009-0861-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Accepted: 10/27/2009] [Indexed: 10/20/2022]
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50
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Affiliation(s)
- Ayalew Tefferi
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
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