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Navrkalova V, Plevova K, Radova L, Porc J, Pal K, Malcikova J, Pavlova S, Doubek M, Panovska A, Kotaskova J, Pospisilova S. Integrative NGS testing reveals clonal dynamics of adverse genomic defects contributing to a natural progression in treatment-naïve CLL patients. Br J Haematol 2024; 204:240-249. [PMID: 38062779 DOI: 10.1111/bjh.19191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/17/2023] [Accepted: 10/25/2023] [Indexed: 01/11/2024]
Abstract
Large-scale next-generation sequencing (NGS) studies revealed extensive genetic heterogeneity, driving a highly variable clinical course of chronic lymphocytic leukaemia (CLL). The evolution of subclonal populations contributes to diverse therapy responses and disease refractoriness. Besides, the dynamics and impact of subpopulations before therapy initiation are not well understood. We examined changes in genomic defects in serial samples of 100 untreated CLL patients, spanning from indolent to aggressive disease. A comprehensive NGS panel LYNX, which provides targeted mutational analysis and genome-wide chromosomal defect assessment, was employed. We observed dynamic changes in the composition and/or proportion of genomic aberrations in most patients (62%). Clonal evolution of gene variants prevailed over the chromosomal alterations. Unsupervised clustering based on aberration dynamics revealed four groups of patients with different clinical behaviour. An adverse cluster was associated with fast progression and early therapy need, characterized by the expansion of TP53 defects, ATM mutations, and 18p- alongside dynamic SF3B1 mutations. Our results show that clonal evolution is active even without therapy pressure and that repeated genetic testing can be clinically relevant during long-term patient monitoring. Moreover, integrative NGS testing contributes to the consolidated evaluation of results and accurate assessment of individual patient prognosis.
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Affiliation(s)
- Veronika Navrkalova
- Department of Internal Medicine - Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Center of Molecular Medicine, CEITEC-Central European Institute of Technology, Masaryk University, Brno, Czech Republic
- Department of Medical Genetics and Genomics, Faculty of Medicine, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - Karla Plevova
- Department of Internal Medicine - Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Center of Molecular Medicine, CEITEC-Central European Institute of Technology, Masaryk University, Brno, Czech Republic
- Department of Medical Genetics and Genomics, Faculty of Medicine, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - Lenka Radova
- Center of Molecular Medicine, CEITEC-Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Jakub Porc
- Center of Molecular Medicine, CEITEC-Central European Institute of Technology, Masaryk University, Brno, Czech Republic
- Department of Medical Genetics and Genomics, Faculty of Medicine, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - Karol Pal
- Center of Molecular Medicine, CEITEC-Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Jitka Malcikova
- Department of Internal Medicine - Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Center of Molecular Medicine, CEITEC-Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Sarka Pavlova
- Department of Internal Medicine - Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Center of Molecular Medicine, CEITEC-Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Michael Doubek
- Department of Internal Medicine - Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Center of Molecular Medicine, CEITEC-Central European Institute of Technology, Masaryk University, Brno, Czech Republic
- Department of Medical Genetics and Genomics, Faculty of Medicine, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - Anna Panovska
- Department of Internal Medicine - Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jana Kotaskova
- Department of Internal Medicine - Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Center of Molecular Medicine, CEITEC-Central European Institute of Technology, Masaryk University, Brno, Czech Republic
- Department of Medical Genetics and Genomics, Faculty of Medicine, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - Sarka Pospisilova
- Department of Internal Medicine - Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Center of Molecular Medicine, CEITEC-Central European Institute of Technology, Masaryk University, Brno, Czech Republic
- Department of Medical Genetics and Genomics, Faculty of Medicine, Masaryk University and University Hospital Brno, Brno, Czech Republic
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Nguyen-Khac F, Balogh Z, Chauzeix J, Veronese L, Chapiro E. Cytogenetics in the management of chronic lymphocytic leukemia: Guidelines from the Groupe Francophone de Cytogénétique Hématologique (GFCH). Curr Res Transl Med 2023; 71:103410. [PMID: 38039634 DOI: 10.1016/j.retram.2023.103410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/14/2023] [Indexed: 12/03/2023]
Abstract
Chromosomal abnormalities are frequent in chronic lymphocytic leukemia (CLL), and most have prognostic value. In addition to the four well-known abnormalities (13q, 11q and 17p deletions, and trisomy 12), other recurrent aberrations have been linked to the disease outcome and/or drug resistance. Moreover, the complex karyotype has recently emerged as a prognostic marker for patients undergoing immunochemotherapy or targeted therapies. Here, we describe the main chromosomal abnormalities identified in CLL and related disorders (small lymphocytic lymphoma and monoclonal B-cell lymphocytosis) by reviewing the most recent literature and discussing their detection and clinical impact. Lastly, we provide technical guidelines and a strategy for the cytogenetic assessment of CLL.
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Affiliation(s)
- Florence Nguyen-Khac
- Centre de Recherche des Cordeliers, Sorbonne Université, Université Paris Cité, Inserm UMRS 1138, Drug Resistance in Hematological Malignancies Team, F-75006 Paris, France; Sorbonne Université, Paris, France; Service d'Hématologie Biologique, Bâtiment Pharmacie, 3e étage, Pitié-Salpêtrière/Charles Foix University Hospital, AP-HP, 83 Bd de l'Hôpital, Paris F-75013, France.
| | - Zsofia Balogh
- Département d'Innovation Thérapeutique et des Essais Précoces, Gustave Roussy, Villejuif, France
| | - Jasmine Chauzeix
- Service d'Hématologie biologique, CHU de Limoges - CRIBL, UMR CNRS 7276/INSERM 1262, Limoges, France
| | - Lauren Veronese
- Service de Cytogénétique Médicale, CHU Estaing, 1 place Lucie et Raymond Aubrac, Clermont-Ferrand 63003, France
| | - Elise Chapiro
- Centre de Recherche des Cordeliers, Sorbonne Université, Université Paris Cité, Inserm UMRS 1138, Drug Resistance in Hematological Malignancies Team, F-75006 Paris, France; Sorbonne Université, Paris, France; Service d'Hématologie Biologique, Bâtiment Pharmacie, 3e étage, Pitié-Salpêtrière/Charles Foix University Hospital, AP-HP, 83 Bd de l'Hôpital, Paris F-75013, France
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3
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The spectrum of chromosomal translocations in the Arab world: ethnic-specific chromosomal translocations and their relevance to diseases. Chromosoma 2022; 131:127-146. [PMID: 35907041 PMCID: PMC9470631 DOI: 10.1007/s00412-022-00775-2] [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: 03/24/2022] [Revised: 05/13/2022] [Accepted: 06/23/2022] [Indexed: 11/04/2022]
Abstract
Chromosomal translocations (CTs) are the most common type of structural chromosomal abnormalities in humans. CTs have been reported in several studies in the Arab world, but the frequency and spectrum of these translocations are not well characterized. The aim of this study is to conduct a systematic review to estimate the frequency and spectrum of CTs in the 22 Arab countries. Four literature databases were searched: PubMed, Science Direct, Scopus, and Web of Science, from the time of inception until July 2021. A combination of broad search terms was used to collect all possible CTs reported in the Arab world. In addition to the literature databases, all captured CTs were searched in three chromosomal rearrangement databases (Mitelman Database, CytoD 1.0 Database, and the Atlas of Genetics and Cytogenetics in Oncology and Hematology), along with PubMed and Google Scholar, to check whether the CTs are unique to the Arabs or shared between Arabs and non-Arabs. A total of 9,053 titles and abstracts were screened, of which 168 studies met our inclusion criteria, and 378 CTs were identified in 15 Arab countries, of which 57 CTs were unique to Arab patients. Approximately 89% of the identified CTs involved autosomal chromosomes. Three CTs, t(9;22), t(13;14), and t(14;18), showed the highest frequency, which were associated with hematological malignancies, recurrent pregnancy loss, and follicular lymphoma, respectively. Complex CTs were commonly reported among Arabs, with a total of 44 CTs, of which 12 were unique to Arabs. This is the first study to focus on the spectrum of CTs in the Arab world and compressively map the ethnic-specific CTs relevant to cancer. It seems that there is a distinctive genotype of Arabs with CTs, of which some manifested with unique clinical phenotypes. Although ethnic-specific CTs are highly relevant to disease mechanism, they are understudied and need to be thoroughly addressed.
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Devi A, Thielemans L, Ladikou EE, Nandra TK, Chevassut T. Lymphocytosis and chronic lymphocytic leukaemia: investigation and management. Clin Med (Lond) 2022; 22:225-229. [PMID: 35584829 DOI: 10.7861/clinmed.2022-0150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Lymphocytosis is a common blood-test finding. Establishing whether the cause of lymphocytosis is benign or malignant is key to managing patients appropriately. A lymphocytosis should always prompt clinical review including a thorough history, examination and appropriate preliminary investigations (blood tests, blood film). The majority of patients with chronic lymphocytic leukaemia (CLL) present incidentally due to a lymphocytosis found on routine blood tests. Patient outcomes vary considerably based on genetic pre-disposition and various prognostic markers (age, Binet or Rai staging, and B2-microglobulin). Although not curative, chemo-immunotherapy is an effective treatment strategy for the majority of CLL patients with progressive disease. More recently, novel oral therapies have been developed that target key signalling and apoptosis pathways and that are being used in relapse settings and as first-line treatments for certain patients.
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Affiliation(s)
- Amarpreet Devi
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | | | | | - Taran K Nandra
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Timothy Chevassut
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK and Brighton and Sussex Medical School, Falmer, UK
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Isik S, Gunden G, Gunduz E, Akay OM, Aslan A, Ozen H, Cilingir O, Erzurumluoglu Gokalp E, Kocagil S, Artan S, Gulbas Z, Durak Aras B. An Anomaly with Potential as a New Prognostic Marker in CLL with del(13q): Gain of 16p13.3. Cytogenet Genome Res 2021; 161:479-487. [PMID: 34915466 DOI: 10.1159/000520242] [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: 08/11/2021] [Accepted: 10/15/2021] [Indexed: 11/19/2022] Open
Abstract
Deletion 13q [del(13q)] is a favorable prognostic marker if it is detected as a sole abnormality in chronic lymphocytic leukemia (CLL). However the clinical courses of cases with isolated del(13q) are quite heterogeneous. In our study, we investigated copy number variations (CNVs), loss of heterozygosity (LOH), and the size of del(13q) in 30 CLL patients with isolated del(13q). We used CGH+SNP microarrays in order to understand the cause of this clinical heterogeneity. We detected del(13q) in 28/30 CLL cases. The size of the deletion varied from 0.34 to 28.81 Mb, and there was no clinical effect of the deletion size. We found new prognostic markers, especially the gain of 16p13.3. These markers have statistically significant associations with short time to first treatment and advanced disease stage. Detecting both CNVs and LOH at the same time is an advantageous feature of aCGH+SNP. However, it is very challenging for the array analysis to detect mosaic anomalies. Therefore, it is very important to confirm the results by FISH. In our study, we detected approximately 9% mosaic del(13q) by microarray. In addition, the gain of 16p13.3 may affect the disease prognosis in CLL. However, additional studies with more patients are needed to confirm these results.
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Affiliation(s)
- Sevgi Isik
- Department of Medical Genetics, Faculty of Medicine, University of Eskisehir Osmangazi, Eskisehir, Turkey
| | - Gulcin Gunden
- Department of Medical Genetics, Faculty of Medicine, University of Eskisehir Osmangazi, Eskisehir, Turkey
| | - Eren Gunduz
- Department of Hematology, Faculty of Medicine, University of Eskisehir Osmangazi, Eskisehir, Turkey
| | - Olga Meltem Akay
- Department of Hematology, Faculty of Medicine, University of Koc, Istanbul, Turkey
| | - Abdulvahap Aslan
- Department of Hematology, Private Umit Hospital, Eskisehir, Turkey
| | - Hulya Ozen
- Department of Biostatistics, Faculty of Medicine, University of Eskisehir Osmangazi, Eskisehir, Turkey
| | - Oguz Cilingir
- Department of Medical Genetics, Faculty of Medicine, University of Eskisehir Osmangazi, Eskisehir, Turkey
| | - Ebru Erzurumluoglu Gokalp
- Department of Medical Genetics, Faculty of Medicine, University of Eskisehir Osmangazi, Eskisehir, Turkey
| | - Sinem Kocagil
- Department of Medical Genetics, Faculty of Medicine, University of Eskisehir Osmangazi, Eskisehir, Turkey
| | - Sevilhan Artan
- Department of Medical Genetics, Faculty of Medicine, University of Eskisehir Osmangazi, Eskisehir, Turkey
| | - Zafer Gulbas
- Department of Hematology, Anadolu Medical Center, İzmit, Turkey
| | - Beyhan Durak Aras
- Department of Medical Genetics, Faculty of Medicine, University of Eskisehir Osmangazi, Eskisehir, Turkey.,Translational Medicine Research and Clinical Center, University of Eskisehir Osmangazi, Eskisehir, Turkey
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Zapatka M, Tausch E, Öztürk S, Yosifov DY, Seiffert M, Zenz T, Schneider C, Blöhdorn J, Döhner H, Mertens D, Lichter P, Stilgenbauer S. Clonal evolution in chronic lymphocytic leukemia is scant in relapsed but accelerated in refractory cases after chemo(immune)therapy. Haematologica 2021; 107:604-614. [PMID: 33691380 PMCID: PMC8883533 DOI: 10.3324/haematol.2020.265777] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Indexed: 11/20/2022] Open
Abstract
Clonal evolution is involved in the progression of chronic lymphocytic leukemia (CLL). In order to link evolutionary patterns to different disease courses, we performed a long-term longitudinal mutation profiling study of CLL patients. Tracking somatic mutations and their changes in allele frequency over time and assessing the underlying cancer cell fraction revealed highly distinct evolutionary patterns. Surprisingly, in long-term stable disease and in relapse after long-lasting clinical response to treatment, clonal shifts are minor. In contrast, in refractory disease major clonal shifts occur although there is little impact on leukemia cell counts. As this striking pattern in refractory cases is not linked to a strong contribution of known CLL driver genes, the evolution is mostly driven by treatment-induced selection of sub-clones, underlining the need for novel, non-genotoxic treatment regimens.
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Affiliation(s)
- Marc Zapatka
- Division of Molecular Genetics, German Cancer Research Center, Heidelberg, 69120, Germany
| | - Eugen Tausch
- Department of Internal Medicine III, Ulm University Hospital Ulm, 89081, Germany
| | - Selcen Öztürk
- Division of Molecular Genetics, German Cancer Research Center, Heidelberg, 69120, Germany
| | - Deyan Yordanov Yosifov
- Department of Internal Medicine III, Ulm University Hospital Ulm, 89081, Germany; Mechanisms of Leukemogenesis, German Cancer Research Center (DKFZ), Heidelberg, 69120, Germany
| | - Martina Seiffert
- Division of Molecular Genetics, German Cancer Research Center, Heidelberg, 69120, Germany
| | - Thorsten Zenz
- University Hospital and University of Zürich, 8091, Switzerland
| | - Christof Schneider
- Department of Internal Medicine III, Ulm University Hospital Ulm, 89081, Germany
| | - Johannes Blöhdorn
- Department of Internal Medicine III, Ulm University Hospital Ulm, 89081, Germany
| | - Hartmut Döhner
- Department of Internal Medicine III, Ulm University Hospital Ulm, 89081, Germany
| | - Daniel Mertens
- Department of Internal Medicine III, Ulm University Hospital Ulm, 89081, Germany; Mechanisms of Leukemogenesis, German Cancer Research Center (DKFZ), Heidelberg, 69120, Germany
| | - Peter Lichter
- Division of Molecular Genetics, German Cancer Research Center, Heidelberg, 69120, Germany.
| | - Stephan Stilgenbauer
- Department of Internal Medicine III, Ulm University Hospital Ulm, 89081, Germany.
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Hampel PJ, Parikh SA, Call TG. Incorporating molecular biomarkers into the continuum of care in chronic lymphocytic leukemia. Leuk Lymphoma 2021; 62:1289-1301. [PMID: 33410372 DOI: 10.1080/10428194.2020.1869966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Chronic lymphocytic leukemia (CLL) is a mature B-cell malignancy characterized by marked heterogeneity. Discoveries in disease biology over the past two decades have helped explain clinical variability and heralded the arrival of the targeted therapy era. In this article, we review improvements in risk stratification which have coincided with this progress, including individual biomarkers and their incorporation into prognostic models. Amidst an ever-expanding list of biomarkers, we seek to bring focus to the essential tests to improve patient care and counseling at particular times in the disease course, beginning with prognosis at diagnosis. The majority of patients do not require treatment at the time of diagnosis, making time-to-first-treatment a key initial prognostic concern. Prognostic and predictive biomarkers are then considered at subsequent major junctures, including at the time of treatment initiation, while on therapy, and at the time of relapse on novel agents.
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Affiliation(s)
- Paul J Hampel
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sameer A Parikh
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Timothy G Call
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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Durak Aras B, Isik S, Uskudar Teke H, Aslan A, Yavasoglu F, Gulbas Z, Demirkan F, Ozen H, Cilingir O, Inci NS, Gunden G, Bulduk T, Erzurumluoglu Gokalp E, Kocagil S, Artan S, Akay OM. Which prognostic marker is responsible for the clinical heterogeneity in CLL with 13q deletion? Mol Cytogenet 2021; 14:2. [PMID: 33407772 PMCID: PMC7788884 DOI: 10.1186/s13039-020-00522-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/09/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Deletion of 13q14 [del(13q)] is the most common cytogenetic change (50%) in chronic lymphoblastic leukemia (CLL), and it is a good prognostic factor if it is detected as a sole aberration by FISH. However, it is observed the clinical course of CLL cases with del(13q) are quite heterogeneous and the responsible for this clinical heterogeneity has not been established yet. Some investigators suggest type II deletion (include RB1 gene) is associated with more aggressive clinical course. Also, it is suggested that the deletion burden and the deletion type have a prognostic effect. In this study, we aimed to investigate the effect of RB1 gene deletion, deletion burden and deletion type on overall survival (OS), disease stage and time to first treatment (TTFT) in patients with isolated del(3q). Sixty eight cases, detected isolated del(13q) were included in the study. Also, RB1 deletion was analyzed from peripheral blood of them using FISH. RESULTS RB1 deletion was detected in 41% of patients, but there was no statistically significant difference between RB1 deletion and TTFT, stage and OS (p > 0.05). At same time, statistically significant difference was detected between high del(13q) (> 80%) and TTFT (p < 0.05). CONCLUSION The statistical analysis of our data regarding to the association between RB1 deletion and deletion type, TTFT, disease stage, and OS has not confirmed type II deletion or biallelic deletion cause poor prognosis. However, our data supports the deletion burden has a prognostic effect. More studies are needed to elucidate the cause of the clinical heterogeneity of CLL cases with del(13q).
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Affiliation(s)
- Beyhan Durak Aras
- Department of Medical Genetics, Faculty of Medicine, University of Eskisehir Osmangazi, Professor Dr. Nabi Avcı Street, No. 4, Eskisehir, Buyukdere, 26040, Turkey.
| | - Sevgi Isik
- Department of Medical Genetics, Faculty of Medicine, University of Eskisehir Osmangazi, Professor Dr. Nabi Avcı Street, No. 4, Eskisehir, Buyukdere, 26040, Turkey
| | - Hava Uskudar Teke
- Department of Hematology, Faculty of Medicine, University of Eskisehir Osmangazi, Eskisehir, Turkey
| | - Abdulvahap Aslan
- Department of Hematology, Private Umit Hospital, Eskisehir, Turkey
| | - Filiz Yavasoglu
- Department of Hematology, Faculty of Medicine, University of Afyonkarahisar Health Sciences, Afyon, Turkey
| | - Zafer Gulbas
- Department of Hematology, Anadolu Medical Center, Kocaeli, Turkey
| | - Fatih Demirkan
- Department of Oncology, Faculty of Medicine, University of Dokuz Eylul, Izmir, Turkey
| | - Hulya Ozen
- Department of Biostatistics, Faculty of Medicine, University of Eskisehir Osmangazi, Eskisehir, Turkey
| | - Oguz Cilingir
- Department of Medical Genetics, Faculty of Medicine, University of Eskisehir Osmangazi, Professor Dr. Nabi Avcı Street, No. 4, Eskisehir, Buyukdere, 26040, Turkey
| | - Nur Sena Inci
- Department of Medical Genetics, Faculty of Medicine, University of Eskisehir Osmangazi, Professor Dr. Nabi Avcı Street, No. 4, Eskisehir, Buyukdere, 26040, Turkey
| | - Gulcin Gunden
- Department of Medical Genetics, Faculty of Medicine, University of Eskisehir Osmangazi, Professor Dr. Nabi Avcı Street, No. 4, Eskisehir, Buyukdere, 26040, Turkey
| | - Tuba Bulduk
- Department of Hematology, Faculty of Medicine, University of Eskisehir Osmangazi, Eskisehir, Turkey
| | - Ebru Erzurumluoglu Gokalp
- Department of Medical Genetics, Faculty of Medicine, University of Eskisehir Osmangazi, Professor Dr. Nabi Avcı Street, No. 4, Eskisehir, Buyukdere, 26040, Turkey
| | - Sinem Kocagil
- Department of Medical Genetics, Faculty of Medicine, University of Eskisehir Osmangazi, Professor Dr. Nabi Avcı Street, No. 4, Eskisehir, Buyukdere, 26040, Turkey
| | - Sevilhan Artan
- Department of Medical Genetics, Faculty of Medicine, University of Eskisehir Osmangazi, Professor Dr. Nabi Avcı Street, No. 4, Eskisehir, Buyukdere, 26040, Turkey
| | - Olga Meltem Akay
- Department of Hematology, Faculty of Medicine, University of Koc, Istanbul, Turkey
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9
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Clonal dynamics in chronic lymphocytic leukemia. Blood Adv 2020; 3:3759-3769. [PMID: 31770443 DOI: 10.1182/bloodadvances.2019000367] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 08/20/2019] [Indexed: 12/28/2022] Open
Abstract
Chronic lymphocytic leukemia has a highly variable disease course across patients, thought to be driven by the vast inter- and intrapatient molecular heterogeneity described in several large-scale DNA-sequencing studies conducted over the past decade. Although the last 5 years have seen a dramatic shift in the therapeutic landscape for chronic lymphocytic leukemia, including the regulatory approval of several potent targeted agents (ie, idelalisib, ibrutinib, venetoclax), the vast majority of patients still inevitably experience disease recurrence or persistence. Recent genome-wide sequencing approaches have helped to identify subclonal populations within tumors that demonstrate a broad spectrum of somatic mutations, diverse levels of response to therapy, patterns of repopulation, and growth kinetics. Understanding the impact of genetic, epigenetic, and transcriptomic features on clonal growth dynamics and drug response will be an important step toward the selection and timing of therapy.
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10
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Treatment-naive CLL: lessons from phase 2 and phase 3 clinical trials. Blood 2020; 134:1796-1801. [PMID: 31751484 DOI: 10.1182/blood.2019001321] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 09/01/2019] [Indexed: 12/21/2022] Open
Abstract
The management of chronic lymphocytic leukemia (CLL) has undergone dramatic changes over the previous 2 decades with the introduction of multiple new therapies and new combinations. Management of the newly diagnosed asymptomatic patient has not significantly changed outside of the development of a number of prognostic factors and the CLL International Prognostic Index, which is helpful in discussions regarding prognosis and likelihood of requiring treatment. When therapy is required, initial treatment of most patients now includes either the Bruton tyrosine kinase inhibitor ibrutinib or the B-cell lymphoma 2 inhibitor venetoclax in combination with obinutuzumab. Current frontline trials are focused on the optimal sequencing or combination of targeted therapies. In this review, we will discuss the management of previously untreated CLL with an emphasis on the clinical trials that have formed the standard of care, as well as those newer studies that are likely to form the next generation of therapy.
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11
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Woyach JA. Treatment-naive CLL: lessons from phase 2 and phase 3 clinical trials. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2019; 2019:476-481. [PMID: 31808904 PMCID: PMC6913497 DOI: 10.1182/hematology.2019001321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The management of chronic lymphocytic leukemia (CLL) has undergone dramatic changes over the previous 2 decades with the introduction of multiple new therapies and new combinations. Management of the newly diagnosed asymptomatic patient has not significantly changed outside of the development of a number of prognostic factors and the CLL International Prognostic Index, which is helpful in discussions regarding prognosis and likelihood of requiring treatment. When therapy is required, initial treatment of most patients now includes either the Bruton tyrosine kinase inhibitor ibrutinib or the B-cell lymphoma 2 inhibitor venetoclax in combination with obinutuzumab. Current frontline trials are focused on the optimal sequencing or combination of targeted therapies. In this review, we will discuss the management of previously untreated CLL with an emphasis on the clinical trials that have formed the standard of care, as well as those newer studies that are likely to form the next generation of therapy.
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MESH Headings
- Adenine/analogs & derivatives
- Agammaglobulinaemia Tyrosine Kinase/antagonists & inhibitors
- Agammaglobulinaemia Tyrosine Kinase/genetics
- Aged
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bridged Bicyclo Compounds, Heterocyclic/therapeutic use
- Clinical Trials, Phase II as Topic
- Clinical Trials, Phase III as Topic
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Male
- Piperidines
- Proto-Oncogene Proteins c-bcl-2/antagonists & inhibitors
- Proto-Oncogene Proteins c-bcl-2/genetics
- Pyrazoles/therapeutic use
- Pyrimidines/therapeutic use
- Sulfonamides/therapeutic use
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Affiliation(s)
- Jennifer A Woyach
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH
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12
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Gutierrez C, Wu CJ. Clonal dynamics in chronic lymphocytic leukemia. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2019; 2019:466-475. [PMID: 31808879 PMCID: PMC6913465 DOI: 10.1182/hematology.2019000367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Chronic lymphocytic leukemia has a highly variable disease course across patients, thought to be driven by the vast inter- and intrapatient molecular heterogeneity described in several large-scale DNA-sequencing studies conducted over the past decade. Although the last 5 years have seen a dramatic shift in the therapeutic landscape for chronic lymphocytic leukemia, including the regulatory approval of several potent targeted agents (ie, idelalisib, ibrutinib, venetoclax), the vast majority of patients still inevitably experience disease recurrence or persistence. Recent genome-wide sequencing approaches have helped to identify subclonal populations within tumors that demonstrate a broad spectrum of somatic mutations, diverse levels of response to therapy, patterns of repopulation, and growth kinetics. Understanding the impact of genetic, epigenetic, and transcriptomic features on clonal growth dynamics and drug response will be an important step toward the selection and timing of therapy.
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MESH Headings
- Adenine/analogs & derivatives
- Bridged Bicyclo Compounds, Heterocyclic/therapeutic use
- Epigenesis, Genetic
- Gene Expression Regulation, Leukemic
- Genome-Wide Association Study
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Male
- Middle Aged
- Mutation
- Piperidines
- Purines/therapeutic use
- Pyrazoles/therapeutic use
- Pyrimidines/therapeutic use
- Quinazolinones/therapeutic use
- Sulfonamides/therapeutic use
- Transcriptome
- Whole Genome Sequencing
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Affiliation(s)
- Catherine Gutierrez
- Harvard Medical School, Boston, MA; and Dana-Farber Cancer Institute, Boston, MA
| | - Catherine J Wu
- Harvard Medical School, Boston, MA; and Dana-Farber Cancer Institute, Boston, MA
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13
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Autore F, Strati P, Innocenti I, Corrente F, Trentin L, Cortelezzi A, Visco C, Coscia M, Cuneo A, Gozzetti A, Mauro FR, Frustaci AM, Gentile M, Morabito F, Molica S, Falcucci P, D'Arena G, Murru R, Vincelli D, Efremov DG, Ferretti A, Rigolin GM, Vitale C, Tisi MC, Reda G, Visentin A, Sica S, Foà R, Ferrajoli A, Laurenti L. Elevated Lactate Dehydrogenase Has Prognostic Relevance in Treatment-Naïve Patients Affected by Chronic Lymphocytic Leukemia with Trisomy 12. Cancers (Basel) 2019; 11:cancers11070896. [PMID: 31248056 PMCID: PMC6678692 DOI: 10.3390/cancers11070896] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 06/16/2019] [Accepted: 06/18/2019] [Indexed: 12/14/2022] Open
Abstract
Chronic Lymphocytic Leukemia (CLL) patients with +12 have been reported to have specific clinical and biologic features. We performed an analysis of the association between demographic; clinical; laboratory; biologic features and outcome in CLL patients with +12 to identify parameters predictive of disease progression; time to treatment; and survival. The study included 487 treatment-naive CLL patients with +12 from 15 academic centers; diagnosed between January 2000 and July 2016; and 816 treatment-naïve patients with absence of Fluorescence In Situ Hybridization (FISH) abnormalities. A cohort of 250 patients with +12 CLL followed at a single US institution was used for external validation. In patients with +12; parameters associated with worse prognosis in the multivariate model were high Lactate DeHydrogenase (LDH) and β-2-microglobulin and unmutated immunoglobulin heavy-chain variable region gene (IGHV). CLL patients with +12 and high LDH levels showed a shorter Progression-Free-Survival (PFS) (30 months vs. 65 months; p < 0.001), Treatment-Free-Survival (TFS) (33 months vs. 69 months; p < 0.001), Overall Survival (OS) (131 months vs. 181 months; p < 0.001) and greater CLL-related mortality (29% vs. 11% at 10 years; p < 0.001) when compared with +12 CLL patients with normal LDH levels. The same differences were observed in the validation cohort. These data suggest that serum LDH levels can predict PFS; TFS; OS and CLL-specific survival in CLL patients with +12.
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Affiliation(s)
- Francesco Autore
- Institute of Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy.
| | - Paolo Strati
- Departments of Leukemia, MD Anderson Cancer Centre, 77030 Houston, USA.
| | - Idanna Innocenti
- Institute of Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy.
| | - Francesco Corrente
- Institute of Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy.
| | - Livio Trentin
- Hematology and Clinical Immunology Unit, Department of Medicine, Università di Padova, 35122 Padova, Italy.
| | - Agostino Cortelezzi
- Hematology Unit, IRCCS Ca' Granda Policlinico-Università degli Studi, 55031 Milano, Italy.
| | - Carlo Visco
- Division of Hematology, Ospedale San Bortolo di Vicenza, 36100 Vicenza, Italy.
| | - Marta Coscia
- Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126 Torino, Italy.
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, 10126 Torino, Italy.
| | - Antonio Cuneo
- Hematology section, Department of Medical Sciences, Azienda Ospedaliero Universitaria Arcispedale S. Anna, 44124 Ferrara, Italy.
| | - Alessandro Gozzetti
- Hematology Unit, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy.
| | | | | | - Massimo Gentile
- Biothecnology Research Unit, Azienda Ospedaliera di Cosenza, 87100 Cosenza, Italy.
| | - Fortunato Morabito
- Biothecnology Research Unit, Azienda Ospedaliera di Cosenza, 87100 Cosenza, Italy.
| | - Stefano Molica
- Department of Hematology-Oncology, Ospedale Pugliese-Ciacco, 88100 Catanzaro, Italy.
| | - Paolo Falcucci
- Division of Hematology, Ospedale Belcolle, 01100 Viterbo, Italy.
| | - Giovanni D'Arena
- Hematology and Stem cell Transplantation Unit, IRCCS Centro di Riferimento Oncologico della Basilicata, 85028 Rionero in Vulture, Italy.
| | - Roberta Murru
- Hematology and Stem Cell Transplantation Unit, Ospedale A. Businco, 09121 Cagliari, Italy.
| | - Donatella Vincelli
- Department of Hematology, Azienda Ospedaliera Bianchi-Melacrino-Morelli, 89124 Reggio Calabria, Italy.
| | - Dimitar G Efremov
- Molecular Hematology, International Centre for Genetic Engineering and Biotechnology, 34149 Trieste, Italy.
| | - Antonietta Ferretti
- Hematology division, Policlinico Umberto I, Università Sapienza, 00161 Roma, Italy.
| | - Gian Matteo Rigolin
- Hematology section, Department of Medical Sciences, Azienda Ospedaliero Universitaria Arcispedale S. Anna, 44124 Ferrara, Italy.
| | - Candida Vitale
- Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126 Torino, Italy.
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, 10126 Torino, Italy.
| | - Maria Chiara Tisi
- Division of Hematology, Ospedale San Bortolo di Vicenza, 36100 Vicenza, Italy.
| | - Gianluigi Reda
- Hematology Unit, IRCCS Ca' Granda Policlinico-Università degli Studi, 55031 Milano, Italy.
| | - Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, Università di Padova, 35122 Padova, Italy.
| | - Simona Sica
- Institute of Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy.
- Institute of Hematology, Università Cattolica del Sacro Cuore, 00168 Roma, Italy.
| | - Robin Foà
- Hematology division, Policlinico Umberto I, Università Sapienza, 00161 Roma, Italy.
| | | | - Luca Laurenti
- Institute of Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy.
- Institute of Hematology, Università Cattolica del Sacro Cuore, 00168 Roma, Italy.
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14
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Chin-Yee B, Sadikovic B, Chin-Yee IH. Genomic data in prognostic models-what is lost in translation? The case of deletion 17p and mutant TP53 in chronic lymphocytic leukaemia. Br J Haematol 2019; 188:652-660. [PMID: 30836431 DOI: 10.1111/bjh.15827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Genomic technologies are revolutionizing the practice of haematology-oncology, leading to improved disease detection, more accurate prognostication and targeted treatment decisions. These advances, however, have also introduced new clinical challenges, which include problems of prognostic underdetermination and its attendant risks of over- and undertreatment. Genomic data is generated from different technologies, from cytogenetics to next-generation sequencing, which are often interpreted interchangeably and in a binary fashion-as the presence or absence of a given chromosomal deletion or mutation-an oversimplification which may lead to mistaken prognosis. We discuss the clinical use of one such prognostic marker, represented by sequence and copy number alterations in TP53, located on chromosome 17p. Mutations in TP53 are strongly linked to poor prognosis in a variety of haematological malignancies, including chronic lymphocytic leukaemia (CLL). We review studies in CLL which utilize the 17p deletion or TP53 mutations for prognostic stratification with specific focus on the technologies used for detection, the thresholds established for clinical significance, and the clinical contexts in which these alterations are identified. The case of CLL illustrates issues arising from simplistic, binary interpretation of genetic testing and highlights the need to apply a critical lens when incorporating genomics into prognostic models.
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Affiliation(s)
| | - Bekim Sadikovic
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Ian H Chin-Yee
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,Department of Medicine, Division of Hematology, Western University, London, ON, Canada
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15
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Jurj A, Pop L, Petrushev B, Pasca S, Dima D, Frinc I, Deak D, Desmirean M, Trifa A, Fetica B, Gafencu G, Selicean S, Moisoiu V, Micu WT, Berce C, Sacu A, Moldovan A, Colita A, Bumbea H, Tanase A, Dascalescu A, Zdrenghea M, Stiufiuc R, Leopold N, Tetean R, Burzo E, Tomuleasa C, Berindan-Neagoe I. Exosome-carried microRNA-based signature as a cellular trigger for the evolution of chronic lymphocytic leukemia into Richter syndrome. Crit Rev Clin Lab Sci 2018; 55:501-515. [PMID: 30238808 DOI: 10.1080/10408363.2018.1499707] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Even if considered a cumulative and not a proliferative CD5+ B-cell neoplasm, chronic lymphocytic leukemia (CLL) has a proliferation rate higher than that recognized earlier, especially in the lymphoid tissues. Some patients with CLL develop a clinical syndrome entitled Richter syndrome (RS). Understanding CLL genetics and epigenetics may help to elucidate the molecular basics of the clinical heterogeneity of this type of malignancy. In the present project we aimed to identify a microRNA species that can predict the evolution of therapy-resistant CLL towards RS. In the first phase of our study, microRNA-19b was identified as a possible target, and in the second phase, we transfected three different CLL cell lines with microRNA-19b mimic and inhibitor and assessed the potential role on leukemia cells in vitro. The mechanism by which miR-19b acts were identified as the upregulation of Ki67 and downregulation of p53. This was further supported through RT-PCR and western blotting on CLL cell lines, as well as by next generation sequencing on two patients diagnosed with CLL that evolved into RS.
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Affiliation(s)
- Ancuta Jurj
- a Research Center for Functional Genomic, Biomedicine and Translational Medicine , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania
| | - Laura Pop
- a Research Center for Functional Genomic, Biomedicine and Translational Medicine , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania
| | - Bobe Petrushev
- b Department of Pathology , Ion Chiricuta Oncology Institute , Cluj Napoca , Romania
| | - Sergiu Pasca
- a Research Center for Functional Genomic, Biomedicine and Translational Medicine , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania
| | - Delia Dima
- c Department of Hematology , Ion Chiricuta Oncology Institute , Cluj Napoca , Romania
| | - Ioana Frinc
- c Department of Hematology , Ion Chiricuta Oncology Institute , Cluj Napoca , Romania
| | - Dalma Deak
- c Department of Hematology , Ion Chiricuta Oncology Institute , Cluj Napoca , Romania
| | - Minodora Desmirean
- d Department of Hematology , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania
| | - Adrian Trifa
- c Department of Hematology , Ion Chiricuta Oncology Institute , Cluj Napoca , Romania
| | - Bogdan Fetica
- b Department of Pathology , Ion Chiricuta Oncology Institute , Cluj Napoca , Romania
| | - Grigore Gafencu
- a Research Center for Functional Genomic, Biomedicine and Translational Medicine , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania
| | - Sonia Selicean
- a Research Center for Functional Genomic, Biomedicine and Translational Medicine , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania
| | - Vlad Moisoiu
- a Research Center for Functional Genomic, Biomedicine and Translational Medicine , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania
| | - Wilhelm-Thomas Micu
- a Research Center for Functional Genomic, Biomedicine and Translational Medicine , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania
| | - Cristian Berce
- e Center for Experimental Medicine , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania
| | - Alexandra Sacu
- d Department of Hematology , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania
| | - Alin Moldovan
- a Research Center for Functional Genomic, Biomedicine and Translational Medicine , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania.,f Department of Hematology , Carol Davilla University of Medicine and Pharmacy , Bucharest , Romania
| | - Andrei Colita
- g Department of Hematology , Coltea Hospital , Bucharest , Romania
| | - Horia Bumbea
- f Department of Hematology , Carol Davilla University of Medicine and Pharmacy , Bucharest , Romania.,h Department of Hematology , University Hospital , Bucharest , Romania
| | - Alina Tanase
- h Department of Hematology , University Hospital , Bucharest , Romania.,i Department of Hematology , Fundeni Clinical Hospital , Bucharest , Romania
| | - Angela Dascalescu
- j Department of Hematology , Grigore T. Popa University of Medicine and Pharmacy , Iasi , Romania.,k Department of Hematology , Regional Institute of Oncology , Iasi , Romania
| | - Mihnea Zdrenghea
- d Department of Hematology , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania
| | - Rares Stiufiuc
- d Department of Hematology , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania
| | - Nicolae Leopold
- l Department of Physics , Babes Bolyai University , Cluj Napoca , Romania
| | - Romulus Tetean
- l Department of Physics , Babes Bolyai University , Cluj Napoca , Romania
| | - Emil Burzo
- l Department of Physics , Babes Bolyai University , Cluj Napoca , Romania.,m Romanian Academy , Romania
| | - Ciprian Tomuleasa
- a Research Center for Functional Genomic, Biomedicine and Translational Medicine , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania.,c Department of Hematology , Ion Chiricuta Oncology Institute , Cluj Napoca , Romania
| | - Ioana Berindan-Neagoe
- a Research Center for Functional Genomic, Biomedicine and Translational Medicine , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania
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16
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Miao Y, Miao Y, Shi K, Sun Q, Zhao SS, Xia Y, Qin SC, Qiu HR, Yang H, Xu H, Zhu HY, Wu JZ, Wu W, Cao L, Wang L, Fan L, Xu W, Li JY. A higher percentage of cells with 13q deletion predicts worse outcome in Chinese patients with chronic lymphocytic leukemia carrying isolated 13q deletion. Ann Hematol 2018; 97:1663-1669. [PMID: 29736587 DOI: 10.1007/s00277-018-3359-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 04/28/2018] [Indexed: 01/05/2023]
Abstract
Previous studies showed that, in chronic lymphocytic leukemia (CLL) patients with isolated 13q deletion (13q-), those carrying higher percentage of leukemic cells with 13q- had more aggressive diseases. However, the prognostic value of the percentage of leukemic cells with 13q- in Chinese CLL patients with isolated 13q- remained to be determined. Using interphase fluorescence in situ hybridization (FISH), we identified 82 patients (25.4%) with isolated 13q deletion from a cohort of 323 untreated CLL patients. Among patients with isolated 13q deletion, cases of 13q- cells ≥ 80% (13q-H) had significantly shorter time to first treatment (TTT) than those of < 80% 13q- cells (13q-L) (median 11 vs. 92 months, p = 0.0016). A higher lymphocyte count (p = 0.0650) was associated with 13q-H, while other clinical, immunophenotypic, or molecular features did not differ between patients with 13q-H and 13q-L. Although 13q-H only showed marginal significance in multivariate analysis of TTT (hazards ratio 2.007; 95% confidence interval 0.975-4.129; p = 0.059), it helped refine the risk stratification based on Binet stage or immunoglobulin heavy chain variable gene (IGHV) status. In cases in Binet A or B stage, patients with 13q-H had a significantly shorter TTT (median TTT 18 months vs. undefined, p = 0.0101). And in IGHV mutated patients, 13q-H was also associated with reduced TTT (median TTT 13q-H. 18 months vs. 13q-L undefined, p = 0.0163). In conclusion, the prognosis of CLL patients with isolated 13q deletion was heterogeneous with 13q-H identifying patients with worse outcome.
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Affiliation(s)
- Yuqing Miao
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China.,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China.,Department of Hematology, The First People's Hospital of Yancheng, Yancheng, Jiangsu Province, China
| | - Yi Miao
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China.,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Ke Shi
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China.,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Qian Sun
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China.,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Si-Shu Zhao
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China.,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Yi Xia
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China.,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Shu-Chao Qin
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China.,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Hai-Rong Qiu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China.,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Hui Yang
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China.,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Hao Xu
- Department of Hematology, The First People's Hospital of Yancheng, Yancheng, Jiangsu Province, China
| | - Hua-Yuan Zhu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China.,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Jia-Zhu Wu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China.,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Wei Wu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China.,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Lei Cao
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China.,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Li Wang
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China.,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Lei Fan
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China.,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Wei Xu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China. .,Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China. .,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China.
| | - Jian-Yong Li
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China. .,Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China. .,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China.
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17
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18
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iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL. Blood 2018. [PMID: 29540348 DOI: 10.1182/blood-2017-09-806398] [Citation(s) in RCA: 959] [Impact Index Per Article: 159.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The previous edition of the consensus guidelines of the International Workshop on Chronic Lymphocytic Leukemia (iwCLL), published in 2008, has found broad acceptance by physicians and investigators caring for patients with CLL. Recent advances including the discovery of the genomic landscape of the disease, the development of genetic tests with prognostic relevance, and the detection of minimal residual disease (MRD), coupled with the increased availability of novel targeted agents with impressive efficacy, prompted an international panel to provide updated evidence- and expert opinion-based recommendations. These recommendations include a revised version of the iwCLL response criteria, an update on the use of MRD status for clinical evaluation, and recommendations regarding the assessment and prophylaxis of viral diseases during management of CLL.
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19
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Chapiro E, Lesty C, Gabillaud C, Durot E, Bouzy S, Armand M, Le Garff-Tavernier M, Bougacha N, Struski S, Bidet A, Laharanne E, Barin C, Veronese L, Prié N, Eclache V, Gaillard B, Michaux L, Lefebvre C, Gaillard JB, Terré C, Penther D, Bastard C, Nadal N, Fert-Ferrer S, Auger N, Godon C, Sutton L, Tournilhac O, Susin SA, Nguyen-Khac F. "Double-hit" chronic lymphocytic leukemia: An aggressive subgroup with 17p deletion and 8q24 gain. Am J Hematol 2018; 93:375-382. [PMID: 29194741 DOI: 10.1002/ajh.24990] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 11/21/2017] [Accepted: 11/27/2017] [Indexed: 01/21/2023]
Abstract
Chronic lymphocytic leukemia (CLL) with 17p deletion (17p-) is associated with a lack of response to standard treatment and thus the worst possible clinical outcome. Various chromosomal abnormalities (including unbalanced translocations, deletions, ring chromosomes and isochromosomes) result in the loss of 17p and one copy of the TP53 gene. The objective of the present study was to determine whether the type of chromosomal abnormality leading to 17p- and the additional aberrations influenced the prognosis in a series of 195 patients with 17p-CLL. Loss of 17p resulted primarily from an unbalanced translocation (70%) with several chromosome partners (the most frequent being chromosome 18q), followed by deletion 17p (23%), monosomy 17 (8%), isochromosome 17q [i(17q)] (5%) and a ring chromosome 17 (2%). In a univariate analysis, monosomy 17, a highly complex karyotype (≥5 abnormalities), and 8q24 gain were associated with poor treatment-free survival, and i(17q) (P = .04), unbalanced translocations (P = .03) and 8q24 gain (P = .001) were significantly associated with poor overall survival. In a multivariate analysis, 8q24 gain remained a significant predictor of poor overall survival. We conclude that 17p deletion and 8q24 gain have a synergistic impact on outcome, and so patients with this "double-hit" CLL have a particularly poor prognosis. Systematic, targeting screening for 8q24 gain should therefore be considered in cases of 17p- CLL.
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Affiliation(s)
- Elise Chapiro
- INSERM UMR_S 1138, Centre de Recherche des Cordeliers; Paris France
- Sorbonne Universités, UPMC Paris 6; Paris France
- Service d'Hématologie Biologique, Hôpital Pitié-Salpêtrière, AP-HP; Paris France
| | - Claude Lesty
- Sorbonne Universités, UPMC Paris 6; Paris France
- Service d'Hématologie Biologique, Hôpital Pitié-Salpêtrière, AP-HP; Paris France
| | - Clémentine Gabillaud
- Service d'Hématologie Biologique, Hôpital Pitié-Salpêtrière, AP-HP; Paris France
| | - Eric Durot
- Service d'Hématologie Clinique, CHU Reims; Reims France
| | - Simon Bouzy
- Service d'Hématologie Biologique, Hôpital Pitié-Salpêtrière, AP-HP; Paris France
| | - Marine Armand
- INSERM UMR_S 1138, Centre de Recherche des Cordeliers; Paris France
- Sorbonne Universités, UPMC Paris 6; Paris France
- Service d'Hématologie Biologique, Hôpital Pitié-Salpêtrière, AP-HP; Paris France
| | - Magali Le Garff-Tavernier
- INSERM UMR_S 1138, Centre de Recherche des Cordeliers; Paris France
- Service d'Hématologie Biologique, Hôpital Pitié-Salpêtrière, AP-HP; Paris France
| | - Nadia Bougacha
- INSERM UMR_S 1138, Centre de Recherche des Cordeliers; Paris France
- Sorbonne Universités, UPMC Paris 6; Paris France
| | - Stéphanie Struski
- Laboratoire de Cytogénétique, Institut Universitaire du Cancer de Toulouse; Toulouse France
| | - Audrey Bidet
- CHU Bordeaux, Service d'Hématologie biologique, F-33000; Bordeaux France
| | - Elodie Laharanne
- CHU Bordeaux, Service d'Hématologie biologique, F-33000; Bordeaux France
| | - Carole Barin
- Unité de Génétique, CHU Bretonneau; Tours France
| | - Lauren Veronese
- Laboratoire de Cytogénétique, CHU Estaing; Clermont-Ferrand France
| | - Nolwen Prié
- Laboratoire de Cytogénétique, CHU Estaing; Clermont-Ferrand France
| | - Virginie Eclache
- Laboratoire d'Hématologie, Hôpital Avicenne, AP-HP; Bobigny France
| | | | | | - Christine Lefebvre
- Laboratoire de Cytogénétique Onco-hématologique, CHU Grenoble; Grenoble France
| | | | - Christine Terré
- Centre Hospitalier de Versailles; Laboratoire de Cytogénétique; Versailles France
| | - Dominique Penther
- Laboratoire de Génétique Oncologique, centre de lutte contre le cancer Henri Becquerel; Rouen France
| | - Christian Bastard
- Laboratoire de Génétique Oncologique, centre de lutte contre le cancer Henri Becquerel; Rouen France
| | - Nathalie Nadal
- Service de génétique chromosomique et moléculaire, CHU Dijon; Dijon France
| | - Sandra Fert-Ferrer
- Centre Hospitalier Métropole Savoie; Laboratoire de Génétique Chromosomique; France, Chambéry
| | - Nathalie Auger
- Laboratoire de Cytogénétique, Institut Gustave Roussy; Villejuif France
| | - Catherine Godon
- Laboratoire de Cytogénétique Hématologique, CHU Nantes; Nantes France
| | - Laurent Sutton
- Centre Hospitalier Métropole Savoie; Service d'Hématologie Clinique; Chambéry France
| | | | - Santos A. Susin
- INSERM UMR_S 1138, Centre de Recherche des Cordeliers; Paris France
- Sorbonne Universités, UPMC Paris 6; Paris France
| | - Florence Nguyen-Khac
- INSERM UMR_S 1138, Centre de Recherche des Cordeliers; Paris France
- Sorbonne Universités, UPMC Paris 6; Paris France
- Service d'Hématologie Biologique, Hôpital Pitié-Salpêtrière, AP-HP; Paris France
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20
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Abur Ü, Oğur G, Akar ÖS, Altundağ E, Aymelek HS, Özatlı D, Turgut M. Impact of Fluorescent In Situ Hybridization Aberrations and CLLU1 Expression on the Prognosis of Chronic Lymphocytic Leukemia: Presentation of 156 Patients from Turkey. Turk J Haematol 2018; 35:61-65. [PMID: 29129824 PMCID: PMC5843776 DOI: 10.4274/tjh.2017.0112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE This study evaluates the impact of CLLU1 expression and fluorescent in situ hybridization (FISH) analysis of a group of Turkish chronic lymphocytic leukemia (CLL) patients. MATERIALS AND METHODS A total of 156 CLL patients were analyzed by FISH method; 47 of them were also evaluated for CLLU1 expression. Results were correlated with clinical parameters. RESULTS FISH aberrations were found in 62% of patients. These aberrations were del13q14 (67%), trisomy 12 (27%), del11q22 (19%), del17p (8%), and 14q32 rearrangements (20%). Overall del11q22 and del17p were associated with the highest mortality rates, shortest overall survival (OS), and highest need for medication. Homozygous del13q14, 14q32 rearrangements, and higher CLLU1 expression correlated with shorter OS. CONCLUSION Cytogenetics/FISH analysis is still indicated for routine evaluation of CLL. Special consideration is needed for the poor prognostic implications of del11q22, del17p, 14q32 rearrangements, and homozygous del13q14. The impact of CLLU1 expression is not yet clear and it requires more data before becoming routine in genetic testing in CLL patients.
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Affiliation(s)
- Ümmet Abur
- Ondokuz Mayıs University Faculty of Medicine, Department of Medical Genetics, Samsun, Turkey
| | - Gönül Oğur
- Ondokuz Mayıs University Faculty of Medicine, Department of Medical Genetics, Samsun, Turkey
| | - Ömer Salih Akar
- Ondokuz Mayıs University Faculty of Medicine, Department of Medical Genetics, Samsun, Turkey
| | - Engin Altundağ
- Ondokuz Mayıs University Faculty of Medicine, Department of Medical Genetics, Samsun, Turkey
| | - Huri Sema Aymelek
- Ondokuz Mayıs University Faculty of Medicine, Department of Medical Genetics, Samsun, Turkey
| | - Düzgün Özatlı
- Ondokuz Mayıs University Faculty of Medicine, Department of Hematology, Samsun, Turkey
| | - Mehmet Turgut
- Ondokuz Mayıs University Faculty of Medicine, Department of Hematology, Samsun, Turkey
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21
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Woyach JA. What is the optimal management of older CLL patients? Best Pract Res Clin Haematol 2018; 31:83-89. [PMID: 29452670 DOI: 10.1016/j.beha.2017.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 10/26/2017] [Indexed: 11/19/2022]
Abstract
CLL is the most common leukemia in older adults with a median age at diagnosis of 71. Therefore, management of patients with this disease must take into account the older age of most patients and consequences of this in terms of functional status and organ function. This review will discuss the management of CLL with regards to observation prior to the initiation of therapy, functional status, and initial treatment. We will discuss criteria for the initiation of therapy, and how initial therapy is different between older and younger patients. Finally, we will discuss specific therapies including chemoimmunotherapy and newer targeted therapies that are being used widely in the older patient population.
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MESH Headings
- Age Factors
- Aged
- Aged, 80 and over
- Humans
- Immunotherapy/methods
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
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Affiliation(s)
- Jennifer A Woyach
- The Ohio State University Division of Hematology, 445D Wiseman Hall CCC, 410 W 12th Ave, Columbus, OH 43210, USA.
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22
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Appleby N, O’Brien D, Quinn FM, Smyth L, Kelly J, Parker I, Scott K, Cahill MR, Crotty G, Enright H, Hennessy B, Hodgson A, Leahy M, O’Leary H, O’Dwyer M, Hayat A, Vandenberghe EA. Risk adjusted therapy in chronic lymphocytic leukemia: a phase II cancer trials Ireland (CTRIAL-IE [ICORG 07-01]) study of fludarabine, cyclophosphamide, and rituximab therapy evaluating response adapted, abbreviated frontline therapy with FCR in non-del(17p) CLL. Leuk Lymphoma 2017; 59:1338-1347. [DOI: 10.1080/10428194.2017.1376746] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Niamh Appleby
- Department of Haematology, St. James’s Hospital and Trinity College Dublin, Dublin, Ireland
| | - David O’Brien
- Department of Haematology, St. James’s Hospital and Trinity College Dublin, Dublin, Ireland
| | - Fiona M. Quinn
- Department of Cancer Molecular Diagnostics, St. James’s Hospital, Dublin, Ireland
| | - Liam Smyth
- Department of Haematology, St. James’s Hospital and Trinity College Dublin, Dublin, Ireland
| | - Johanna Kelly
- Department of Medical Genetics, Our Lady's Hospital for Children, Dublin, Ireland
| | | | | | - Mary R. Cahill
- Department of Haematology, Cork University Hospital, Cork, Ireland
| | - Gerard Crotty
- Department of Haematology, Midlands Regional Hospital, Tullamore, Ireland
| | - Helen Enright
- Department of Haematology, Adelaide, Meath and National Children’s Hospital, Dublin, Ireland
| | - Brian Hennessy
- Department of Haematology, University Hospital Waterford, Waterford, Ireland
| | - Andrew Hodgson
- Department of Haematology, Sligo Regional Hospital, Sligo, Ireland
| | - Maeve Leahy
- Department of Haematology, University Hospital Limerick, Limerick, Ireland
| | - Hilary O’Leary
- Department of Haematology, University Hospital Limerick, Limerick, Ireland
| | - Michael O’Dwyer
- Department of Haematology, University Hospital Galway, Galway, Ireland
| | - Amjad Hayat
- Department of Haematology, University Hospital Galway, Galway, Ireland
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23
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Huang SJ, Bergin K, Smith AC, Gerrie AS, Bruyere H, Dalal CB, Sugioka DK, Hrynchak M, Ramadan KM, Karsan A, Gillan TL, Toze CL. Clonal evolution as detected by interphase fluorescence in situ hybridization is associated with worse overall survival in a population-based analysis of patients with chronic lymphocytic leukemia in British Columbia, Canada. Cancer Genet 2017; 210:1-8. [PMID: 28212806 DOI: 10.1016/j.cancergen.2016.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 08/20/2016] [Accepted: 10/27/2016] [Indexed: 10/20/2022]
Abstract
This study evaluates prognostic markers as predictors of clonal evolution (CE) and assesses the impact of CE on overall survival (OS) in a population-based cohort of 159 consecutive eligible patients with chronic lymphocytic leukemia (CLL) obtained from the British Columbia Provincial CLL Database. CE was detected by interphase fluorescence in situ hybridization (FISH) in 34/159 patients (21%) with 65% of CE patients acquiring deletion 17p or 11q. CD38 positive status (≥30%) on flow cytometry predicted 2.7 times increased risk of high-risk CE (acquisition of deletion 17p or 11q) on multivariate analysis. Prior CLL therapy was not a significant predictor of CE. CE was associated with 4.1 times greater risk of death when analyzed as a time-dependent variable for OS after adjusting for age, lymphocyte count, and FISH timing. High-risk CE was associated with worse OS while acquisition of low/intermediate-risk abnormalities (trisomy 12, deletion 13q, and IGH translocation) had no difference in OS. Our study demonstrates the negative impact of CE detected by FISH on OS in this population-based cohort. These data provide support for repeating FISH testing during CLL follow-up as patients with high-risk CE have reduced survival and may require closer observation.
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Affiliation(s)
- Steven J Huang
- Division of Hematology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada; Pathology and Laboratory Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Krystal Bergin
- Division of Hematology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Adam C Smith
- Cancer Genetics Laboratory, Pathology and Laboratory Medicine, British Columbia Cancer Agency, University of British Columbia, Vancouver, BC, Canada; The Pelé Research Institute, Hospital Pequeno Prinicipe, Brazil
| | - Alina S Gerrie
- Division of Hematology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada; Leukemia/BMT Program of BC, Vancouver General Hospital and British Columbia Cancer Agency, University of British Columbia, Vancouver, BC, Canada
| | - Helene Bruyere
- Pathology and Laboratory Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Chinmay B Dalal
- Division of Hematology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | | | - Monica Hrynchak
- Cytogenetics Laboratory, Royal Columbian Hospital, New Westminster, BC, Canada
| | - Khaled M Ramadan
- Division of Hematology, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Aly Karsan
- Cancer Genetics Laboratory, Pathology and Laboratory Medicine, British Columbia Cancer Agency, University of British Columbia, Vancouver, BC, Canada
| | - Tanya L Gillan
- Pathology and Laboratory Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Cynthia L Toze
- Division of Hematology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada; Leukemia/BMT Program of BC, Vancouver General Hospital and British Columbia Cancer Agency, University of British Columbia, Vancouver, BC, Canada.
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24
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Abstract
The recent application of next-generation sequencing technologies lead to significant improvements in our understanding of genetic underpinnings of non-Hodgkin lymphomas with identification of an unexpectedly high number of novel mutation targets across the different B-cell lymphoma entities. These recently discovered molecular lesions are expected to have a major impact on development of novel biomarkers and targeted therapies as well as patient stratification based on the underlying genetic profile. This review will cover the major discoveries in B-cell lymphomas using next-generation sequencing technologies over the last few years, highlighting alterations associated with relapse and progression of these diseases.
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Affiliation(s)
- Csaba Bödör
- MTA-SE Lendulet Molecular Oncohematology Research Group, Budapest, Hungary.,1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Lilla Reiniger
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary. .,2nd Department of Pathology, MTA-SE NAP, Brain Metastasis Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary.
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25
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The mutational signature of chronic lymphocytic leukemia. Biochem J 2016; 473:3725-3740. [DOI: 10.1042/bcj20160256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 08/23/2016] [Indexed: 01/14/2023]
Abstract
Advances in next-generation sequencing technologies continue to unravel the cancer genome, identifying key biological pathways important for disease pathogenesis and clinically relevant genetic lesions. These studies have provided unprecedented resolution of the cancer genome, facilitating significant advances in the ability to detect many cancers, and predict patients who will develop an aggressive disease or respond poorly to treatment. The mature B-cell neoplasm chronic lymphocytic leukaemia remains at the forefront of these genomic analyses, largely due its protracted natural history and the accessibility to suitable material for study. We now possess a comprehensive view of the genomic copy number mutational landscape of the disease, as well as a detail description of clonal evolution, and the molecular mechanisms that drive the acquisition of genomic lesions and more broadly, genomic complexity. Here, recent genomic insights with associated biological and clinical implications will be reviewed.
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26
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Genetic evolution in chronic lymphocytic leukaemia. Best Pract Res Clin Haematol 2016; 29:67-78. [PMID: 27742073 DOI: 10.1016/j.beha.2016.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 06/30/2016] [Accepted: 08/04/2016] [Indexed: 11/21/2022]
Abstract
Next-generation sequencing provides a comprehensive understanding of the genomic, epigenomic and transcriptomic underpinnings of chronic lymphocytic leukaemia. Recent studies have uncovered new drivers, including mutations in non-coding regions, and signalling pathways whose role in cancer was previously unknown or poorly understood. Moreover, massive scale epigenomics and transcriptomics have supplied the foundations for the cellular origin of the disease. Some drivers could be targeted pharmacologically, and the ability to detect mutations present in minority subclones might even allow treatment before clonal selection occurs, thus preventing disease refractoriness. As our understanding broadens and ongoing technological innovation propels new achievements, we will certainly learn how to apply it in our daily practice.
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27
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Chen W, Miao Y, Wang R, Wu Y, Qiu H, Xu W, Li J, Fan L, Xu X. t(14;18)(q32;q21) in chronic lymphocytic leukemia patients: Report of two cases and a literature review. Oncol Lett 2016; 12:4351-4356. [PMID: 28105149 PMCID: PMC5228458 DOI: 10.3892/ol.2016.5258] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 07/20/2016] [Indexed: 11/06/2022] Open
Abstract
The chromosomal abnormality t(14;18)(q32;q21) is most commonly associated with germinal center-derived B-cell lymphomas, particularly follicular lymphoma (FL). Generally, it is considered a hallmark of FL. The t(14;18)(q32;q21) translocation is rare in chronic lymphocytic leukemia (CLL) and its prognostic significance remains unclear. In the present study, two cases of CLL with t(14;18)(q32;q21) were diagnosed using conventional cytogenetic analysis and fluorescence in situ hybridization. Both patients presented with leukemia and the morphological features and immunophenotypes were typical of CLL. Case 2 underwent a further lymph node biopsy, which established a diagnosis of CD5- CLL/small lymphocyte lymphoma. In addition to t(14;18)(q32;q21), trisomy 12 was identified in the same clone in Case 2. Both cases exhibited immunoglobulin heavy chain variable mutations, and heavy-chain variable region gene (VH) 4-39 and VH3-62 were used in Case 1 and Case 2, respectively. In addition, direct Sanger sequencing of exons 4-9 revealed that Case 2 harbored the tumor protein p53 mutation, c.829T>G. Both cases had indications for therapy. Case 1 responded well to chlorambucil treatment, and was still alive at the last follow-up. Conversely, Case 2 exhibited aggressive disease that appeared refractory to treatment, and eventually succumbed to the disease.
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Affiliation(s)
- Weifeng Chen
- Department of Hematology, The Affiliated Jiangyin Hospital of Southeast University Medical College, Jiangyin, Jiangsu 214400, P.R. China
| | - Yi Miao
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, Jiangsu 210029, P.R. China
| | - Rong Wang
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, Jiangsu 210029, P.R. China
| | - Yujie Wu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, Jiangsu 210029, P.R. China
| | - Hairong Qiu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, Jiangsu 210029, P.R. China
| | - Wei Xu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, Jiangsu 210029, P.R. China
| | - Jianyong Li
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, Jiangsu 210029, P.R. China
| | - Lei Fan
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, Jiangsu 210029, P.R. China
| | - Xin Xu
- Department of Hematology, The Affiliated Jiangyin Hospital of Southeast University Medical College, Jiangyin, Jiangsu 214400, P.R. China
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28
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TP53 dysfunction in CLL: Implications for prognosis and treatment. Best Pract Res Clin Haematol 2016; 29:90-99. [PMID: 27742075 DOI: 10.1016/j.beha.2016.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 07/26/2016] [Accepted: 08/04/2016] [Indexed: 02/01/2023]
Abstract
Despite the availability of novel targeted agents, TP53 defects remain the most important adverse prognostic factor in chronic lymphocytic leukemia (CLL). Detection of deletion of TP53 locus (17p deletion) by fluorescent in situ hybridization (FISH) has become standard and performed prior to every line of treatment as the incidence dramatically increases as relapses occur. As monoallelic mutations of TP53 equally affect outcome, novel methods are being developed to improve detection of TP53 defects and include next-generation sequencing (NGS) and functional assays. TP53 defects highly affect outcome of immunochemotherapy but also alter response durations of tyrosine kinase inhibitors. Although BCR-targeting agents and Bcl-2-inhibitos have achieved durable responses in some patients with TP53 defects, long-term follow-up is currently lacking. In this review biological and clinical consequences of TP53 dysfunction as well as applicability of currently available methods to detect TP53 defects are described. In addition, proposed novel therapeutic strategies specifically for patients with TP53 dysfunction are discussed. In summary, the only curative treatment option for TP53-defective CLL is still allogeneic hematopoietic stem cell transplantation. Other treatment strategies such as rationale combinations of agents with different (TP53 independent) targets, including kinase inhibitors and inhibitors of anti-apoptotic molecules but also immunomodulatory agents need to be further explored.
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29
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Gooden CE, Jones P, Bates R, Shallenberger WM, Surti U, Swerdlow SH, Roth CG. CD49d shows superior performance characteristics for flow cytometric prognostic testing in chronic lymphocytic leukemia/small lymphocytic lymphoma. CYTOMETRY PART B-CLINICAL CYTOMETRY 2016; 94:129-135. [PMID: 27221715 DOI: 10.1002/cyto.b.21384] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 05/16/2016] [Accepted: 05/23/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND CD49d is emerging as a powerful adverse prognostic marker in chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). However, flow cytometric testing for CD49d has not yet been widely adopted in the United States, in part due to the lack of establishment of its performance characteristics in the clinical setting, especially in comparison with the more common CLL/SLL prognostic markers CD38 and ZAP-70. METHODS CD49d expression levels in 124 CLL/SLL cases were assessed among peripheral blood (PB), bone marrow (BM), and lymph node (LN) specimens and correlated with available CD38 and ZAP-70 expression and cytogenetic findings. For 10 PB/BM specimens, the stability of CD49d, CD38, and ZAP-70 expression was assessed at <24 hours, 48 hours, 72 hours, and 96 hours. RESULTS 39% (28 of 71) PB, 56% (18 of 32) BM, and 71% (15 of 21) LN involved by CLL/SLL were CD49d+, using a ≥30% threshold. The mean for the CD49d+ cases was 2.8 standard deviations (SD) above the cutoff for positivity, compared with 1.7 SD for CD38 and 1.1 SD for ZAP-70. CD49d demonstrated the lowest mean SD (0.91) and coefficient of variation (CV) (8.0%) compared with CD38 (SD = 2.1, CV = 10.4%) and ZAP-70 (SD = 9.8, CV = 40.5%) in stability studies over a 96-hours time period. CD49d+ CLL/SLL correlated with trisomy 12 (P = 0.025) and lack of isolated deletion (13q) (P = 0.005). CD38+ CLL/SLL correlated with deletion (11q) (P = 0.025). ZAP-70 did not correlate with any underlying cytogenetic abnormality. CONCLUSIONS CD49d is a robust adverse prognostic marker in CLL/SLL with superior performance characteristics. © 2016 International Clinical Cytometry Society.
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Affiliation(s)
- Casey E Gooden
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Patricia Jones
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ruth Bates
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Wendy M Shallenberger
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Urvashi Surti
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Steven H Swerdlow
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Christine G Roth
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas
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30
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DE BRAEKELEER MARC, TOUS CORINE, GUÉGANIC NADIA, LE BRIS MARIEJOSÉE, BASINKO AUDREY, MOREL FRÉDÉRIC, DOUET-GUILBERT NATHALIE. Immunoglobulin gene translocations in chronic lymphocytic leukemia: A report of 35 patients and review of the literature. Mol Clin Oncol 2016; 4:682-694. [PMID: 27123263 PMCID: PMC4840758 DOI: 10.3892/mco.2016.793] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 02/09/2016] [Indexed: 12/20/2022] Open
Abstract
Chronic lymphocytic leukemia (CLL) represents the most common hematological malignancy in Western countries, with a highly heterogeneous clinical course and prognosis. Translocations involving the immunoglobulin (IG) genes are regularly identified. From 2000 to 2014, we identified an IG gene translocation in 18 of the 396 patients investigated at diagnosis (4.6%) and in 17 of the 275 analyzed during follow-up (6.2%). A total of 4 patients in whom the IG translocation was identified at follow-up did not carry the translocation at diagnosis. The IG heavy locus (IGH) was involved in 27 translocations (77.1%), the IG κ locus (IGK) in 1 (2.9%) and the IG λ locus (IGL) in 7 (20.0%). The chromosome band partners of the IG translocations were 18q21 in 16 cases (45.7%), 11q13 and 19q13 in 4 cases each (11.4% each), 8q24 in 3 cases (8.6%), 7q21 in 2 cases (5.7%), whereas 6 other bands were involved once (2.9% each). At present, 35 partner chromosomal bands have been described, but the partner gene has solely been identified in 10 translocations. CLL associated with IG gene translocations is characterized by atypical cell morphology, including plasmacytoid characteristics, and the propensity of being enriched in prolymphocytes. The IG heavy chain variable region (IGHV) mutational status varies between translocations, those with unmutated IGHV presumably involving cells at an earlier stage of B-cell lineage. All the partner genes thus far identified are involved in the control of cell proliferation and/or apoptosis. The translocated partner gene becomes transcriptionally deregulated as a consequence of its transposition into the IG locus. With the exception of t(14;18)(q32;q21) and its variants, prognosis appears to be poor for the other translocations. Therefore, searching for translocations involving not only IGH, but also IGL and IGK, by banding and molecular cytogenetics is required. Furthermore, it is important to identify the partner gene to ensure the patients receive the optimal treatment.
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Affiliation(s)
- MARC DE BRAEKELEER
- Faculty of Medicine and Health Sciences, University of Brest, Brest, France
- National Institute of Health and Medical Research (INSERM U1078), Brest, France
- Department of Cytogenetics and Reproductive Biology, Morvan Hospital, Regional University Hospital Center of Brest (CHRU), Brest, France
| | - CORINE TOUS
- Department of Cytogenetics and Reproductive Biology, Morvan Hospital, Regional University Hospital Center of Brest (CHRU), Brest, France
| | - NADIA GUÉGANIC
- Faculty of Medicine and Health Sciences, University of Brest, Brest, France
- National Institute of Health and Medical Research (INSERM U1078), Brest, France
| | - MARIE-JOSÉE LE BRIS
- Department of Cytogenetics and Reproductive Biology, Morvan Hospital, Regional University Hospital Center of Brest (CHRU), Brest, France
| | - AUDREY BASINKO
- National Institute of Health and Medical Research (INSERM U1078), Brest, France
- Department of Cytogenetics and Reproductive Biology, Morvan Hospital, Regional University Hospital Center of Brest (CHRU), Brest, France
| | - FRÉDÉRIC MOREL
- Faculty of Medicine and Health Sciences, University of Brest, Brest, France
- National Institute of Health and Medical Research (INSERM U1078), Brest, France
- Department of Cytogenetics and Reproductive Biology, Morvan Hospital, Regional University Hospital Center of Brest (CHRU), Brest, France
| | - NATHALIE DOUET-GUILBERT
- Faculty of Medicine and Health Sciences, University of Brest, Brest, France
- National Institute of Health and Medical Research (INSERM U1078), Brest, France
- Department of Cytogenetics and Reproductive Biology, Morvan Hospital, Regional University Hospital Center of Brest (CHRU), Brest, France
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31
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Amin NA, Seymour E, Saiya-Cork K, Parkin B, Shedden K, Malek SN. A Quantitative Analysis of Subclonal and Clonal Gene Mutations before and after Therapy in Chronic Lymphocytic Leukemia. Clin Cancer Res 2016; 22:4525-35. [PMID: 27060156 DOI: 10.1158/1078-0432.ccr-15-3103] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 04/05/2016] [Indexed: 01/31/2023]
Abstract
PURPOSE Chronic lymphocytic leukemia (CLL)-associated gene mutations that influence CLL cell fitness and chemotherapy resistance should increase in clonal representation when measured before therapy and at relapse. EXPERIMENTAL DESIGN To uncover mutations associated with CLL relapse, we have performed whole-exome sequencing in a discovery cohort of 61 relapsed CLL patients identifying 86 recurrently mutated genes. The variant allele fractions (VAF) of 19 genes with mutations in ≥3 of 61 cases were measured in 53 paired pre- and posttreatment CLL samples sorted to purity using panel-based deep resequencing or by droplet digital PCR. RESULTS We identify mutations in TP53 as the dominant subclonal gene driver of relapsed CLL often demonstrating substantial increases in VAFs. Subclonal mutations in SAMHD1 also recurrently demonstrated increased VAFs at relapse. Mutations in ATP10A, FAT3, FAM50A, and MGA, although infrequent, demonstrated enrichment in ≥2 cases each. In contrast, mutations in NOTCH1, SF3B1, POT1, FBXW7, MYD88, NXF1, XPO1, ZMYM3, or CHD2 were predominantly already clonal prior to therapy indicative of a pretreatment pathogenetic driver role in CLL. Quantitative analyses of clonal dynamics uncover rising, stable, and falling clones and subclones without clear evidence that gene mutations other than in TP53 and possibly SAMHD1 are frequently selected for at CLL relapse. CONCLUSIONS Data in aggregate support a provisional categorization of CLL-associated recurrently mutated genes into three classes (i) often subclonal before therapy and strongly enriched after therapy, or, (ii) mostly clonal before therapy or without further enrichments at relapse, or, (iii) subclonal before and after therapy and enriching only in sporadic cases. Clin Cancer Res; 22(17); 4525-35. ©2016 AACR.
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Affiliation(s)
- Nisar A Amin
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Erlene Seymour
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Kamlai Saiya-Cork
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Brian Parkin
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Kerby Shedden
- Division of Statistics, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Sami N Malek
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
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32
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Smolej L, Šimkovič M. Practical approach to management of chronic lymphocytic leukemia. Arch Med Sci 2016; 12:448-56. [PMID: 27186193 PMCID: PMC4848353 DOI: 10.5114/aoms.2016.55424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 10/11/2014] [Indexed: 11/17/2022] Open
Abstract
Revolutionary progress has recently changed the landscape of chronic lymphocytic leukemia (CLL). Powerful prognostic factors, especially p53 mutation and/or deletion and IGHV mutation status, have refined individual patient prognosis. Purine analogs and monoclonal antibodies paved the way from palliative treatment to chemoimmunotherapy capable of eradication of minimal residual disease and prolongation of survival. Obinutuzumab (GA-101) and ofatumumab have been recently approved for the treatment of comorbid patients. Bendamustine is available for first-line treatment of patients ineligible for fludarabine, cyclophosphamide, and rituximab (FCR). High-dose glucocorticoids combined with rituximab represent a promising option for refractory CLL; ofatumumab is approved for fludarabine- and alemtuzumab-refractory patients. Allogeneic stem cell transplantation is the only curative option but is feasible in a highly selected group of patients only. The novel small molecule inhibitors ibrutinib and idelalisib have been recently approved for relapsed/refractory CLL. This review provides practical advice for diagnosis, prognostication and treatment of CLL.
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Affiliation(s)
- Lukáš Smolej
- 4 Department of Internal Medicine - Hematology, University Hospital Hradec Králové and Charles University in Prague, Faculty of Medicine in Hradec Králové, Czech Republic
| | - Martin Šimkovič
- 4 Department of Internal Medicine - Hematology, University Hospital Hradec Králové and Charles University in Prague, Faculty of Medicine in Hradec Králové, Czech Republic
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33
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Tam CS, Seymour JF, Roberts AW. Progress in BCL2 inhibition for patients with chronic lymphocytic leukemia. Semin Oncol 2016; 43:274-9. [DOI: 10.1053/j.seminoncol.2016.02.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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34
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Baliakas P, Mattsson M, Stamatopoulos K, Rosenquist R. Prognostic indices in chronic lymphocytic leukaemia: where do we stand how do we proceed? J Intern Med 2016; 279:347-57. [PMID: 26709197 DOI: 10.1111/joim.12455] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The remarkable clinical heterogeneity in chronic lymphocytic leukaemia (CLL) has highlighted the need for prognostic and predictive algorithms that can be employed in clinical practice to assist patient management and therapy decisions. Over the last 20 years, this research field has been rewarding and many novel prognostic factors have been identified, especially at the molecular genetic level. Whilst detection of recurrent cytogenetic aberrations and determination of the immunoglobulin heavy variable gene somatic hypermutation status have an established role in outcome prediction, next-generation sequencing has recently revealed novel mutated genes with clinical relevance (e.g. NOTCH1, SF3B1 and BIRC3). Efforts have been made to combine variables into prognostic indices; however, none has been universally adopted. Although a unifying model for all groups of patients and in all situations is appealing, this may prove difficult to attain. Alternatively, focused efforts on patient subgroups in the same clinical context and at certain clinically relevant 'decision points', that is at diagnosis and at initiation of first-line or subsequent treatments, may provide a more accurate approach. In this review, we discuss the advantages and disadvantages as well as the clinical applicability of three recently proposed prognostic models, the MD Anderson nomogram, the integrated cytogenetic and mutational model and the CLL-international prognostic index. We also consider future directions taking into account novel aspects of the disease, such as the tumour microenvironment and the dynamics of (sub)clonal evolution. These aspects are particularly relevant in view of the increasing number of new targeted therapies that have recently emerged.
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Affiliation(s)
- P Baliakas
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - M Mattsson
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden.,Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - K Stamatopoulos
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden.,Institute of Applied Biosciences, Center of Research and Technology Hellas Center of Research and Technology Hellas (CERTH), Thessaloniki, Greece
| | - R Rosenquist
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
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35
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Van Dyke DL, Werner L, Rassenti LZ, Neuberg D, Ghia E, Heerema NA, Dal Cin P, Dell Aquila M, Sreekantaiah C, Greaves AW, Kipps TJ, Kay NE. The Dohner fluorescence in situ hybridization prognostic classification of chronic lymphocytic leukaemia (CLL): the CLL Research Consortium experience. Br J Haematol 2016; 173:105-13. [PMID: 26848054 PMCID: PMC4963001 DOI: 10.1111/bjh.13933] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 11/19/2015] [Indexed: 12/23/2022]
Abstract
This study revisited the Dohner prognostic hierarchy in a cohort of 1585 well-documented patients with chronic lymphocytic leukaemia. The duration of both time to first treatment (TTFT) and overall survival (OS) were significantly longer than observed previously, and this is at least partly due to improved therapeutic options. Deletion 13q remains the most favourable prognostic group with median TTFT and OS from fluorescence in situ hybridization (FISH) testing of 72 months and >12 years, respectively. Deletion 11q had the poorest median TTFT (22 months) and 17p deletion the poorest median OS (5 years). The percentages of abnormal nuclei were significantly associated with differential TTFT for the trisomy 12, 13q and 17p deletion cohorts but not for the 11q deletion cohort. From the date of the first FISH study, patients with >85% 13q deletion nuclei had a notably shorter TTFT (24 months). Patients with ≤20% 17p deletion nuclei had longer median TTFT and OS from the date of the first FISH study (44 months and 11 years), and were more likely to be IGHV mutated.
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MESH Headings
- Chromosome Deletion
- Chromosomes, Human/genetics
- Disease-Free Survival
- Female
- Follow-Up Studies
- Humans
- In Situ Hybridization, Fluorescence
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Male
- Survival Rate
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Affiliation(s)
- Daniel L. Van Dyke
- Departments of Laboratory Medicine and Pathology and Internal MedicineMayo ClinicRochesterMNUSA
| | - Lillian Werner
- Biostatistics and Computational BiologyDana‐Farber Cancer InstituteBostonMAUSA
| | - Laura Z. Rassenti
- Moores University of California San Diego Cancer CenterLa JollaCAUSA
| | - Donna Neuberg
- Biostatistics and Computational BiologyDana‐Farber Cancer InstituteBostonMAUSA
| | - Emanuella Ghia
- Moores University of California San Diego Cancer CenterLa JollaCAUSA
| | - Nyla A. Heerema
- Department of PathologyThe Ohio State UniversityColumbusOHUSA
| | - Paola Dal Cin
- Brigham and Women's HospitalHarvard Medical SchoolBostonMAUSA
| | - Marie Dell Aquila
- Moores University of California San Diego Cancer CenterLa JollaCAUSA
| | | | - Andrew W. Greaves
- Moores University of California San Diego Cancer CenterLa JollaCAUSA
| | - Thomas J. Kipps
- Moores University of California San Diego Cancer CenterLa JollaCAUSA
| | - Neil E. Kay
- Departments of Laboratory Medicine and Pathology and Internal MedicineMayo ClinicRochesterMNUSA
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37
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Mosaic 13q14 deletions in peripheral leukocytes of non-hematologic cancer cases and healthy controls. J Hum Genet 2016; 61:411-8. [PMID: 26763882 PMCID: PMC4880507 DOI: 10.1038/jhg.2015.166] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 12/07/2015] [Accepted: 12/10/2015] [Indexed: 01/07/2023]
Abstract
Loss of 13q14.3 is a chromosomal event found in approximately 50 percent of B-cell chronic lymphocytic leukemia (CLL) and monoclonal B-cell lymphocytosis (MBL) cases. Surveys of somatic alterations in solid tumors have shown sporadic 13q14.3 loss in many different tumor types, but not at high frequency in any specific tumor type. In our recent survey of the single nucleotide polymorphism (SNP) microarray data from 127,000 cancer free or solid tumor cases, we observed mosaic 13q14.3 loss as a common autosomal somatic large structural events (>2 Mb in size) in blood and buccal-derived DNA. Herein, we examined this region more closely investigating structural mosaic events <2 Mb using SNP microarray data in 46,254 non-hematologic cancer cases and 36,229 controls. We detected 60 individuals with 13q14.3 mosaic loss, one mosaic copy neutral uniparental disomy, and 13 individuals with homozygosity. While 13q14.3 loss size was variable, the minimally deleted region (MDR) (chr13:49,590,000-49,983,100; GRCh36) was comparable to what is classically reported in MBL and CLL. Breakpoint analysis of the estimated boundaries reveals enrichment for genes and open chromatin. The frequency of 13q14.3 loss significantly increases with increasing age (P-value=0.028), but was not significantly different between non-hematological cancer cases and controls (0.084% versus 0.058%; P-value=0.19). These findings suggest mosaic 13q14.3 losses accumulate with age. Individuals with detected mosaic 13q14.3 deletions may be early, undetected cases of MBL or CLL, but not necessarily all will develop MBL and CLL.
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38
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Grygalewicz B, Woroniecka R, Rygier J, Borkowska K, Rzepecka I, Łukasik M, Budziłowska A, Rymkiewicz G, Błachnio K, Nowakowska B, Bartnik M, Gos M, Pieńkowska-Grela B. Monoallelic and biallelic deletions of 13q14 in a group of CLL/SLL patients investigated by CGH Haematological Cancer and SNP array (8x60K). Mol Cytogenet 2016; 9:1. [PMID: 26740820 PMCID: PMC4702365 DOI: 10.1186/s13039-015-0212-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 12/30/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Deletion of 13q14 is the most common cytogenetic change in chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) and is detected in about 50 % of patients by fluorescence in situ hybridization (FISH), which can reveal presence of del(13)(q14) and mono- or biallelic deletion status without information about the size of the lost region. Array-comparative genomic hybridization (aCGH) and single nucleotide polymorphism (SNP) can detect submicroscopic copy number changes, loss of heterozygosity (LOH) and uniparental disomy (UPD) regions. The purpose of this study was detection of the size of del(13)(q14) deletion in our group of patients, comparing the size of the monoallelic and biallelic deletions, detection of LOH and UPD regions. RESULTS We have investigated 40 CLL/SLL patients by karyotype, FISH and CGH and SNP array. Mutational status was of immunoglobulin heavy-chain variable-region (IGVH) was also examined. The size of deletion ranged from 348,12 Kb to 38.97 Mb. Detected minimal deleted region comprised genes: TRIM13, miR-3613, KCNRG, DLEU2, miR-16-1, miR-15a, DLEU1. The RB1 deletions were detected in 41 % of cases. The average size in monoallelic 13q14 deletion group was 7,2 Mb while in biallelic group was 4,8 Mb. In two cases 13q14 deletions were located in the bigger UPD regions. CONCLUSIONS Our results indicate that bigger deletion including RB1 or presence of biallelic 13q14 deletion is not sufficient to be considered as adverse prognostic factor in CLL/SLL. CytoSure Haematological Cancer and SNP array (8x60k) can precisely detect recurrent copy number changes with known prognostic significance in CLL/SLL as well as other chromosomal imbalances. The big advantage of this array is simultaneous detection of LOH and UPD regions during the same test.
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Affiliation(s)
- Beata Grygalewicz
- />Cancer Genetic Laboratory, Pathology and Laboratory Diagnostics Department, Centre of Oncology, M. Skłodowska-Curie Memorial Institute, Warsaw, Poland
- />Department of Pathology and Laboratory Diagnostics, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, 15B Wawelska Str, 02-034, Warsaw, Poland
| | - Renata Woroniecka
- />Cancer Genetic Laboratory, Pathology and Laboratory Diagnostics Department, Centre of Oncology, M. Skłodowska-Curie Memorial Institute, Warsaw, Poland
| | - Jolanta Rygier
- />Cancer Genetic Laboratory, Pathology and Laboratory Diagnostics Department, Centre of Oncology, M. Skłodowska-Curie Memorial Institute, Warsaw, Poland
| | - Klaudia Borkowska
- />Cancer Genetic Laboratory, Pathology and Laboratory Diagnostics Department, Centre of Oncology, M. Skłodowska-Curie Memorial Institute, Warsaw, Poland
| | - Iwona Rzepecka
- />Cancer Genetic Laboratory, Pathology and Laboratory Diagnostics Department, Centre of Oncology, M. Skłodowska-Curie Memorial Institute, Warsaw, Poland
| | - Martyna Łukasik
- />Cancer Genetic Laboratory, Pathology and Laboratory Diagnostics Department, Centre of Oncology, M. Skłodowska-Curie Memorial Institute, Warsaw, Poland
| | - Agnieszka Budziłowska
- />Cancer Genetic Laboratory, Pathology and Laboratory Diagnostics Department, Centre of Oncology, M. Skłodowska-Curie Memorial Institute, Warsaw, Poland
| | - Grzegorz Rymkiewicz
- />Flow Cytometry Laboratory, Pathology and Laboratory Diagnostics Department, Centre of Oncology, M. Skłodowska-Curie Memorial Institute, Warsaw, Poland
| | - Katarzyna Błachnio
- />Flow Cytometry Laboratory, Pathology and Laboratory Diagnostics Department, Centre of Oncology, M. Skłodowska-Curie Memorial Institute, Warsaw, Poland
| | - Beata Nowakowska
- />Department of Medical Genetics, Mother and Child Institute, Warsaw, Poland
| | - Magdalena Bartnik
- />Department of Medical Genetics, Mother and Child Institute, Warsaw, Poland
| | - Monika Gos
- />Department of Medical Genetics, Mother and Child Institute, Warsaw, Poland
| | - Barbara Pieńkowska-Grela
- />Cancer Genetic Laboratory, Pathology and Laboratory Diagnostics Department, Centre of Oncology, M. Skłodowska-Curie Memorial Institute, Warsaw, Poland
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39
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Sutton LA, Rosenquist R. Deciphering the molecular landscape in chronic lymphocytic leukemia: time frame of disease evolution. Haematologica 2015; 100:7-16. [PMID: 25552678 DOI: 10.3324/haematol.2014.115923] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Dramatic advances in next generation sequencing technologies have provided a novel opportunity to understand the molecular genetics of chronic lymphocytic leukemia through the comprehensive detection of genetic lesions. While progress is being made in elucidating the clinical significance of recurrently mutated genes, layers of complexity have been added to our understanding of chronic lymphocytic leukemia pathogenesis in the guise of the molecular evolution and (sub)clonal architecture of the disease. As we prepare for an era of tailored therapy, we need to appreciate not only the effect mutations have on drug response but also the impact subclones containing specific mutations have at initial presentation, during therapy and upon relapse. Therefore, although the wealth of emerging genetic data has great potential in helping us devise strategies to improve the therapy and prognosis of patients, focused efforts will be required to follow disease evolution, particularly in the context of novel therapies, in order to translate this knowledge into clinical settings.
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Affiliation(s)
- Lesley-Ann Sutton
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Sweden
| | - Richard Rosenquist
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Sweden
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40
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Huang SJT, Gillan TL, Gerrie AS, Hrynchak M, Karsan A, Ramadan K, Smith AC, Toze CL, Bruyere H. Influence of clone and deletion size on outcome in chronic lymphocytic leukemia patients with an isolated deletion 13q in a population-based analysis in British Columbia, Canada. Genes Chromosomes Cancer 2015; 55:16-24. [PMID: 26391112 DOI: 10.1002/gcc.22294] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 08/05/2015] [Indexed: 01/22/2023] Open
Abstract
Deletion of the long arm of chromosome 13 (del(13q)) as the sole abnormality in chronic lymphocytic leukemia (CLL) portends a good prognosis; however, there is great outcome heterogeneity within this subgroup. The percentage of cells with a del(13q) (clone size) and the extent of the deletion are two factors that may affect outcome in CLL patients with isolated del(13q). We analyzed 248 CLL patients from the BC Provincial CLL database identified as having isolated del(13q) detected pretreatment by interphase fluorescence in situ hybridization to determine what impact clone and deletion size had on overall survival (OS) and treatment free survival (TFS). Patients with 60% or more of nuclei with a del(13q) had shorter TFS and shorter OS. A large deletion, encompassing the RB1 gene locus, was detected in half of the 90 cases with available specimens for testing, and there was no significant difference in OS and TFS between RB1-deleted and RB1-not-deleted cases. Further study in a larger sample size is required to determine the clinical interest of RB1 locus testing; however, clone size of del(13q) does predict TFS and OS and may better refine prognosis in this clinically heterogeneous population.
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Affiliation(s)
- Steven J T Huang
- Leukemia/BMT Program of BC, Vancouver General Hospital and British Columbia Cancer Agency, University of British Columbia, Vancouver, BC, Canada.,Pathology and Laboratory Medicine, Vancouver General Hospital University of British Columbia, Vancouver, BC, Canada
| | - Tanya L Gillan
- Pathology and Laboratory Medicine, Vancouver General Hospital University of British Columbia, Vancouver, BC, Canada
| | - Alina S Gerrie
- Leukemia/BMT Program of BC, Vancouver General Hospital and British Columbia Cancer Agency, University of British Columbia, Vancouver, BC, Canada
| | - Monica Hrynchak
- Department of Laboratory Medicine Molecular Cytogenetic Laboratory, Royal Columbian Hospital, University of British Columbia, New Westminster, BC, Canada
| | - Aly Karsan
- Pathology and Laboratory Medicine, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Khaled Ramadan
- Division of Hematology, St. Paul's Hospital University of British Columbia, Vancouver, BC, Canada
| | - Adam C Smith
- Instituto De Pesquisa Pelé Pequeno Príncipe, Curitiba, Brazil and the Dept. Of Pathology, University of British Columbia, Vancouver, Canada
| | - Cynthia L Toze
- Leukemia/BMT Program of BC, Vancouver General Hospital and British Columbia Cancer Agency, University of British Columbia, Vancouver, BC, Canada
| | - Helene Bruyere
- Pathology and Laboratory Medicine, Vancouver General Hospital University of British Columbia, Vancouver, BC, Canada
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41
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Mongini PKA, Gupta R, Boyle E, Nieto J, Lee H, Stein J, Bandovic J, Stankovic T, Barrientos J, Kolitz JE, Allen SL, Rai K, Chu CC, Chiorazzi N. TLR-9 and IL-15 Synergy Promotes the In Vitro Clonal Expansion of Chronic Lymphocytic Leukemia B Cells. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2015; 195:901-23. [PMID: 26136429 PMCID: PMC4505957 DOI: 10.4049/jimmunol.1403189] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 05/30/2015] [Indexed: 12/20/2022]
Abstract
Clinical progression of B cell chronic lymphocytic leukemia (B-CLL) reflects the clone's Ag receptor (BCR) and involves stroma-dependent B-CLL growth within lymphoid tissue. Uniformly elevated expression of TLR-9, occasional MYD88 mutations, and BCR specificity for DNA or Ags physically linked to DNA together suggest that TLR-9 signaling is important in driving B-CLL growth in patients. Nevertheless, reports of apoptosis after B-CLL exposure to CpG oligodeoxynucleotide (ODN) raised questions about a central role for TLR-9. Because normal memory B cells proliferate vigorously to ODN+IL-15, a cytokine found in stromal cells of bone marrow, lymph nodes, and spleen, we examined whether this was true for B-CLL cells. Through a CFSE-based assay for quantitatively monitoring in vitro clonal proliferation/survival, we show that IL-15 precludes TLR-9-induced apoptosis and permits significant B-CLL clonal expansion regardless of the clone's BCR mutation status. A robust response to ODN+IL-15 was positively linked to presence of chromosomal anomalies (trisomy-12 or ataxia telangiectasia mutated anomaly + del13q14) and negatively linked to a very high proportion of CD38(+) cells within the blood-derived B-CLL population. Furthermore, a clone's intrinsic potential for in vitro growth correlated directly with doubling time in blood, in the case of B-CLL with Ig H chain V region-unmutated BCR and <30% CD38(+) cells in blood. Finally, in vitro high-proliferator status was statistically linked to diminished patient survival. These findings, together with immunohistochemical evidence of apoptotic cells and IL-15-producing cells proximal to B-CLL pseudofollicles in patient spleens, suggest that collaborative ODN and IL-15 signaling may promote in vivo B-CLL growth.
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MESH Headings
- ADP-ribosyl Cyclase 1/metabolism
- Aged
- Aged, 80 and over
- Apoptosis/immunology
- Ataxia Telangiectasia Mutated Proteins/genetics
- B-Lymphocytes/immunology
- Cell Proliferation/genetics
- Cells, Cultured
- Chromosome Aberrations
- Female
- Humans
- Immunoglobulin Heavy Chains/genetics
- Interleukin-15/immunology
- Interleukin-15/pharmacology
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Male
- Membrane Glycoproteins/metabolism
- Middle Aged
- Myeloid Differentiation Factor 88/genetics
- Oligodeoxyribonucleotides/pharmacology
- Receptors, Antigen, B-Cell/immunology
- Signal Transduction/immunology
- Toll-Like Receptor 9/immunology
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Affiliation(s)
- Patricia K A Mongini
- The Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY 11030; Department of Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY 11549;
| | - Rashmi Gupta
- The Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY 11030
| | - Erin Boyle
- The Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY 11030
| | - Jennifer Nieto
- The Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY 11030
| | - Hyunjoo Lee
- The Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY 11030
| | - Joanna Stein
- The Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY 11030
| | - Jela Bandovic
- Department of Pathology, North Shore University Hospital-Long Island Jewish Medical Center, Manhasset, NY 11030
| | - Tatjana Stankovic
- School of Cancer Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - Jacqueline Barrientos
- Department of Medicine, North Shore University Hospital-Long Island Jewish Medical Center, Manhasset, NY; and
| | - Jonathan E Kolitz
- The Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY 11030; Department of Medicine, North Shore University Hospital-Long Island Jewish Medical Center, Manhasset, NY; and Department of Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY
| | - Steven L Allen
- The Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY 11030; Department of Medicine, North Shore University Hospital-Long Island Jewish Medical Center, Manhasset, NY; and Department of Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY
| | - Kanti Rai
- The Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY 11030; Department of Medicine, North Shore University Hospital-Long Island Jewish Medical Center, Manhasset, NY; and Department of Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY
| | - Charles C Chu
- The Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY 11030; Department of Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY 11549
| | - Nicholas Chiorazzi
- The Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY 11030; Department of Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY 11549; Department of Medicine, North Shore University Hospital-Long Island Jewish Medical Center, Manhasset, NY; and Department of Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY
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42
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Kostopoulos IV, Tsakiridou AA, Pavlidis D, Megalakaki A, Papadhimitriou SI. Familial chronic lymphocytic leukemia in two siblings with ATM/13q14 deletion and a similar pattern of clonal evolution. Blood Cancer J 2015; 5:e322. [PMID: 26140430 PMCID: PMC4526776 DOI: 10.1038/bcj.2015.50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- I V Kostopoulos
- Hematology Laboratory, ‘G. Gennimatas' Athens Regional General Hospital, Athens, Greece
| | - A A Tsakiridou
- Department of Hematology, ‘Metaxa' Piraeus Cancer Hospital, Piraeus, Greece
| | - D Pavlidis
- Hematology Laboratory, ‘G. Gennimatas' Athens Regional General Hospital, Athens, Greece
| | - A Megalakaki
- Department of Hematology, ‘Metaxa' Piraeus Cancer Hospital, Piraeus, Greece
| | - S I Papadhimitriou
- Hematology Laboratory, ‘G. Gennimatas' Athens Regional General Hospital, Athens, Greece
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43
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Delgado J, Pereira A, Villamor N, López-Guillermo A, Rozman C. Survival analysis in hematologic malignancies: recommendations for clinicians. Haematologica 2015; 99:1410-20. [PMID: 25176982 DOI: 10.3324/haematol.2013.100784] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The widespread availability of statistical packages has undoubtedly helped hematologists worldwide in the analysis of their data, but has also led to the inappropriate use of statistical methods. In this article, we review some basic concepts of survival analysis and also make recommendations about how and when to perform each particular test using SPSS, Stata and R. In particular, we describe a simple way of defining cut-off points for continuous variables and the appropriate and inappropriate uses of the Kaplan-Meier method and Cox proportional hazard regression models. We also provide practical advice on how to check the proportional hazards assumption and briefly review the role of relative survival and multiple imputation.
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Affiliation(s)
- Julio Delgado
- Department of Hematology, Hospital Clínic, IDIBAPS, Barcelona
| | - Arturo Pereira
- Hematopathology Unit, Hospital Clínic, IDIBAPS, Barcelona
| | - Neus Villamor
- Deparment of Hemostasis and Hemotherapy, Hospital Clínic, IDIBAPS, Barcelona
| | | | - Ciril Rozman
- Josep Carreras Leukemia Research Institute, Hospital Clínic, Barcelona, Spain
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44
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Tam CS, Stilgenbauer S. How best to manage patients with chronic lymphocytic leuekmia with 17p deletion and/orTP53mutation? Leuk Lymphoma 2015; 56:587-93. [DOI: 10.3109/10428194.2015.1011641] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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45
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Strati P, Abruzzo LV, Wierda WG, O'Brien S, Ferrajoli A, Keating MJ. Second cancers and Richter transformation are the leading causes of death in patients with trisomy 12 chronic lymphocytic leukemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 15:420-7. [PMID: 25800543 DOI: 10.1016/j.clml.2015.02.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 01/08/2015] [Accepted: 02/03/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Trisomy 12 (+12) is detected by fluorescence in-situ hybridization (FISH) analysis in up to 20% of patients with chronic lymphocytic leukemia (CLL). Patients with +12 are known to have unique features and to carry an intermediate prognosis. PATIENTS AND METHODS In order to better define this large group, we reviewed the characteristics of 250 untreated patients with +12. RESULTS When compared to 516 untreated patients negative for +12 by FISH, patients with +12 showed a higher incidence of thrombocytopenia, Richter transformation, and second malignant neoplasms (SMN), in addition to the expected increased rate of CD38 positivity and atypical immunophenotype. At a median follow-up of 51 months, 57% of patients needed first-line treatment; median time to first treatment was 38 months, and on multivariate analysis (MVA), it was found to be shorter in patients with advanced Rai stage, palpable splenomegaly, and deletion of 14q by conventional cytogenetic analysis. The overall response rate with first-line treatment was 94%. The median failure-free survival has not been reached, but on MVA, it was found to be shorter in patients whose disease responded in a manner other than complete remission or with FISH negativity for deletion 13q. The median overall survival for the entire group has not been reached, but MVA revealed it to be shorter in patients with an absolute lymphocyte count of > 30 × 10(9)/L or who developed SMN. Eighteen deaths have been observed so far, and Richter transformation and SMN were the leading causes of death (3 and 6, respectively). CONCLUSION Patients with +12 CLL show characteristic clinical and biologic features, and may benefit from increased surveillance for second cancers.
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Affiliation(s)
- Paolo Strati
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lynne V Abruzzo
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - William G Wierda
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Susan O'Brien
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Alessandra Ferrajoli
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael J Keating
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX.
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46
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Rodríguez D, Bretones G, Arango JR, Valdespino V, Campo E, Quesada V, López-Otín C. Molecular pathogenesis of CLL and its evolution. Int J Hematol 2015; 101:219-28. [PMID: 25630433 DOI: 10.1007/s12185-015-1733-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Accepted: 01/14/2015] [Indexed: 12/11/2022]
Abstract
In spite of being the most prevalent adult leukemia in Western countries, the molecular mechanisms driving the establishment and progression of chronic lymphocytic leukemia (CLL) remain largely unknown. In recent years, the use of next-generation sequencing techniques has uncovered new and, in some cases, unexpected driver genes with prognostic and therapeutic value. The mutational landscape of CLL is characterized by high-genetic and epigenetic heterogeneity, low mutation recurrence and a long tail of cases with undefined driver genes. On the other hand, the use of deep sequencing has also revealed high intra-tumor heterogeneity and provided a detailed picture of clonal evolution processes. This phenomenon, in which aberrant DNA methylation can also participate, appears to be tightly associated to poor outcomes and chemo-refractoriness, thus providing a new subject for therapeutic intervention. Hence, and having in mind the limitations derived from the CLL complexity thus described, the application of massively parallel sequencing studies has unveiled a wealth of information that is expected to substantially improve patient staging schemes and CLL clinical management.
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Affiliation(s)
- David Rodríguez
- Departamento de Bioquímica y Biología Molecular, Instituto Universitario de Oncología-IUOPA, Universidad de Oviedo, 33006, Oviedo, Spain
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47
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Zent CS, Burack WR. Mutations in chronic lymphocytic leukemia and how they affect therapy choice: focus on NOTCH1, SF3B1, and TP53. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2014; 2014:119-124. [PMID: 25696844 DOI: 10.1182/asheducation-2014.1.119] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Chronic lymphocytic leukemia (CLL) is characterized by a relatively small number of recurrent genetic defects. These can be evaluated by clinically available methods such as fluorescent in situ hybridization and targeted sequencing approaches to provide data that can be very helpful in prognostication and planning of treatment. Acquired defects in the p53 pathway, activating mutations of NOTCH1, and dysfunctional mutations of SF3B1 and BIRC3 identify patients with higher risk of progressive disease, poorer responses to conventional chemoimmunotherapy, and shorter survival. Risk stratification using these data can identify patients with aggressive CLL who require careful monitoring and are unlikely to have durable responses to chemoimmunotherapy at disease progression. Patients with defective DNA damage repair mechanisms because of p53 dysfunction should be considered for non-chemotherapy-based regimens including tyrosine kinase inhibitors, BCL2 inhibitors, monoclonal antibodies, and immunological therapies including allogeneic transplantation and chimeric antigen receptor-targeted T cells. Conversely, patients with no high-risk mutations can usually be monitored for a prolonged time and are likely to have durable responses to chemoimmunotherapy at disease progression. New technologies for genetic analysis such as targeted next-generation sequencing have the potential to make these analyses cheaper, faster, and more widely available. Comprehensive genetic analysis of patients both at diagnosis and before treatment for progressive disease could become an integral component of care for CLL.
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MESH Headings
- Clonal Evolution
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/physiopathology
- Mutation/genetics
- Receptor, Notch1/genetics
- Ribonucleoprotein, U2 Small Nuclear/genetics
- Tumor Suppressor Protein p53/genetics
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Affiliation(s)
- Clive S Zent
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | - W Richard Burack
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
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48
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Malcikova J, Stano-Kozubik K, Tichy B, Kantorova B, Pavlova S, Tom N, Radova L, Smardova J, Pardy F, Doubek M, Brychtova Y, Mraz M, Plevova K, Diviskova E, Oltova A, Mayer J, Pospisilova S, Trbusek M. Detailed analysis of therapy-driven clonal evolution of TP53 mutations in chronic lymphocytic leukemia. Leukemia 2014; 29:877-85. [PMID: 25287991 PMCID: PMC4396398 DOI: 10.1038/leu.2014.297] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 09/17/2014] [Accepted: 09/18/2014] [Indexed: 11/28/2022]
Abstract
In chronic lymphocytic leukemia (CLL), the worst prognosis is associated with TP53 defects with the affected patients being potentially directed to alternative treatment. Therapy administration was shown to drive the selection of new TP53 mutations in CLL. Using ultra-deep next-generation sequencing (NGS), we performed a detailed analysis of TP53 mutations' clonal evolution. We retrospectively analyzed samples that were assessed as TP53-wild-type (wt) by FASAY from 20 patients with a new TP53 mutation detected in relapse and 40 patients remaining TP53-wt in relapse. Minor TP53-mutated subclones were disclosed in 18/20 patients experiencing later mutation selection, while only one minor-clone mutation was observed in those patients remaining TP53-wt (n=40). We documented that (i) minor TP53 mutations may be present before therapy and may occur in any relapse; (ii) the majority of TP53-mutated minor clones expand to dominant clone under the selective pressure of chemotherapy, while persistence of minor-clone mutations is rare; (iii) multiple minor-clone TP53 mutations are common and may simultaneously expand. In conclusion, patients with minor-clone TP53 mutations carry a high risk of mutation selection by therapy. Deep sequencing can shift TP53 mutation identification to a period before therapy administration, which might be of particular importance for clinical trials.
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Affiliation(s)
- J Malcikova
- 1] Center of Molecular Medicine, Central European Institute of Technology, Masaryk University, Brno, Czech Republic [2] Department of Internal Medicine - Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - K Stano-Kozubik
- Center of Molecular Medicine, Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - B Tichy
- 1] Center of Molecular Medicine, Central European Institute of Technology, Masaryk University, Brno, Czech Republic [2] Department of Internal Medicine - Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - B Kantorova
- Center of Molecular Medicine, Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - S Pavlova
- 1] Center of Molecular Medicine, Central European Institute of Technology, Masaryk University, Brno, Czech Republic [2] Department of Internal Medicine - Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - N Tom
- 1] Center of Molecular Medicine, Central European Institute of Technology, Masaryk University, Brno, Czech Republic [2] Department of Internal Medicine - Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - L Radova
- Center of Molecular Medicine, Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - J Smardova
- Department of Pathology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - F Pardy
- Center of Molecular Medicine, Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - M Doubek
- 1] Center of Molecular Medicine, Central European Institute of Technology, Masaryk University, Brno, Czech Republic [2] Department of Internal Medicine - Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Y Brychtova
- Department of Internal Medicine - Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - M Mraz
- 1] Center of Molecular Medicine, Central European Institute of Technology, Masaryk University, Brno, Czech Republic [2] Department of Internal Medicine - Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - K Plevova
- 1] Center of Molecular Medicine, Central European Institute of Technology, Masaryk University, Brno, Czech Republic [2] Department of Internal Medicine - Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - E Diviskova
- Department of Internal Medicine - Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - A Oltova
- Department of Internal Medicine - Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - J Mayer
- 1] Center of Molecular Medicine, Central European Institute of Technology, Masaryk University, Brno, Czech Republic [2] Department of Internal Medicine - Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - S Pospisilova
- 1] Center of Molecular Medicine, Central European Institute of Technology, Masaryk University, Brno, Czech Republic [2] Department of Internal Medicine - Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - M Trbusek
- 1] Center of Molecular Medicine, Central European Institute of Technology, Masaryk University, Brno, Czech Republic [2] Department of Internal Medicine - Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Sutton LA, Rosenquist R. Clonal evolution in chronic lymphocytic leukemia: impact of subclonality on disease progression. Expert Rev Hematol 2014; 8:71-8. [PMID: 25345442 DOI: 10.1586/17474086.2015.972930] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In recent years, next-generation sequencing has unraveled the molecular landscape in chronic lymphocytic leukemia with the discovery of a number of recurrently mutated genes. Mutations in several of these genes, such as NOTCH1, SF3B1 and BIRC3, are linked to a more aggressive disease with early disease progression, short time-to-first-treatment and even chemorefractoriness. Although in its infancy, we have also begun to understand the complex dynamics of subclonal diversity and its impact on disease outcome. From pioneering studies, we know that certain genetic events are found in the majority of chronic lymphocytic leukemia cells and are considered as 'clonal driver mutations' (e.g., +12, 13q-), whereas others, present only in a fraction of the tumor, are deemed to be 'subclonal driver mutations' for example, TP53 and SF3B1. Over the coming years, we need to gain a deeper insight into the dynamics of this subclonal architecture to understand how, at an individual level, chronic lymphocytic leukemia patients should be followed, which will be particularly relevant as novel targeted therapies begin to emerge.
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Affiliation(s)
- Lesley-Ann Sutton
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, SE-751-85, Uppsala, Sweden
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50
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Chastain EC, Duncavage EJ. Clinical Prognostic Biomarkers in Chronic Lymphocytic Leukemia and Diffuse Large B-Cell Lymphoma. Arch Pathol Lab Med 2014; 139:602-7. [DOI: 10.5858/arpa.2014-0086-ra] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context
Diffuse large B-cell lymphoma and chronic lymphocytic leukemia are 2 of the most common B-cell lymphomas in adults. Both diffuse large B-cell lymphoma and chronic lymphocytic leukemia share heterogeneous outcomes, and the use of prognostic biomarkers to better stratify risk in these patients has now become commonplace.
Objective
To review chronic lymphocytic leukemia and diffuse large B-cell lymphoma biomarkers commonly used in the clinical laboratory, which can be divided into the following 3 main groups by testing methodology: chromosomal based (including fluorescence in situ hybridization and cytogenetics), expression based (including immunohistochemistry and flow cytometry), and DNA based (including gene sequencing for somatic mutations and IGVH mutational status).
Data Sources
Review of recent literature.
Conclusions
In chronic lymphocytic leukemia, important biomarkers include expression of CD38 and ZAP-70, IGVH mutational status, somatic mutations in TP53 and NOTCH1, and abnormalities in chromosomes 11, 12, 13q, and 17. In diffuse large B-cell lymphoma, important biomarkers include chromosomal rearrangement of BCL2, BCL6, and MYC and expression of CD5, BCL2, and CD43, as well as somatic mutations in TP53 and BCL6.
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Affiliation(s)
- Elizabeth C. Chastain
- From the Department of Pathology and Immunology, Washington University, St Louis, Missouri
| | - Eric J. Duncavage
- From the Department of Pathology and Immunology, Washington University, St Louis, Missouri
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