1
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Severens JF, Karakaslar EO, van der Reijden BA, Sánchez-López E, van den Berg RR, Halkes CJM, van Balen P, Veelken H, Reinders MJT, Griffioen M, van den Akker EB. Mapping AML heterogeneity - multi-cohort transcriptomic analysis identifies novel clusters and divergent ex-vivo drug responses. Leukemia 2024; 38:751-761. [PMID: 38360865 DOI: 10.1038/s41375-024-02137-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 12/28/2023] [Accepted: 01/04/2024] [Indexed: 02/17/2024]
Abstract
Subtyping of acute myeloid leukaemia (AML) is predominantly based on recurrent genetic abnormalities, but recent literature indicates that transcriptomic phenotyping holds immense potential to further refine AML classification. Here we integrated five AML transcriptomic datasets with corresponding genetic information to provide an overview (n = 1224) of the transcriptomic AML landscape. Consensus clustering identified 17 robust patient clusters which improved identification of CEBPA-mutated patients with favourable outcomes, and uncovered transcriptomic subtypes for KMT2A rearrangements (2), NPM1 mutations (5), and AML with myelodysplasia-related changes (AML-MRC) (5). Transcriptomic subtypes of KMT2A, NPM1 and AML-MRC showed distinct mutational profiles, cell type differentiation arrests and immune properties, suggesting differences in underlying disease biology. Moreover, our transcriptomic clusters show differences in ex-vivo drug responses, even when corrected for differentiation arrest and superiorly capture differences in drug response compared to genetic classification. In conclusion, our findings underscore the importance of transcriptomics in AML subtyping and offer a basis for future research and personalised treatment strategies. Our transcriptomic compendium is publicly available and we supply an R package to project clusters to new transcriptomic studies.
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Affiliation(s)
- Jeppe F Severens
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
- Pattern Recognition & Bioinformatics, Delft University of Technology, Delft, The Netherlands
- Leiden Center for Computational Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - E Onur Karakaslar
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
- Pattern Recognition & Bioinformatics, Delft University of Technology, Delft, The Netherlands
- Leiden Center for Computational Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Bert A van der Reijden
- Laboratory of Hematology, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Elena Sánchez-López
- Leiden Center for Computational Oncology, Leiden University Medical Center, Leiden, The Netherlands
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, The Netherlands
| | - Redmar R van den Berg
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
- Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Peter van Balen
- Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hendrik Veelken
- Leiden Center for Computational Oncology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marcel J T Reinders
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
- Pattern Recognition & Bioinformatics, Delft University of Technology, Delft, The Netherlands
- Leiden Center for Computational Oncology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Marieke Griffioen
- Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Erik B van den Akker
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands.
- Pattern Recognition & Bioinformatics, Delft University of Technology, Delft, The Netherlands.
- Leiden Center for Computational Oncology, Leiden University Medical Center, Leiden, The Netherlands.
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2
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Rivera JC, Nuñez D, Millar E, Ramirez K, Chandía M, Aguayo C. Mutations in the bZip region of the CEBPA gene: A novel prognostic factor in patients with acute myeloid leukemia. Int J Lab Hematol 2023; 45:833-838. [PMID: 37621152 DOI: 10.1111/ijlh.14157] [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: 06/02/2023] [Accepted: 08/02/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Hematopoiesis, the process of blood cell formation involves on a complex network of transcription factors. Among them, the CCAAT-enhancer-binding protein alpha (CEBPA) plays a crucial role in maintaining the balance between myeloid proliferation and differentiation. Imbalances in this network can lead to disrupted differentiation and contribute to the development of malignant diseases. AIM Understanding of disease development and explore potential therapeutic strategies for hematological disorders associated CEPBA gen. MATERIALS AND METHODS The research involved a comprehensive analysis of CEBPA gene mutations in the context of acute myeloid leukemia (AML). This encompassed a thorough exploration of point mutations and double mutations in AML patients. RESULTS In the context of acute myeloid leukemia (AML), mutations in the CEBPA gene, especially point mutations, are frequently observed. A significant number of AML patients present with double mutations in CEBPA, which have been linked to a more favorable prognosis in terms of overall survival and event-free survival. These patients also tend to exhibit enhanced responsiveness to treatment. DISCUSSION Unraveling the intricate interplay of transcription factors, particularly CEBPA, holds significant implications for decoding the mechanisms governing hematopoiesis. This understanding offers a potential avenue for deciphering disease development and devising novel therapeutic strategies for hematological disorders. CONCLUSION The findings underscore that CEBPA mutations correlate with enhanced overall survival and event-free survival, with relevance to those presenting within the bZip framework. This knowledge may contribute to advancing personalized treatments for hematological conditions.
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Affiliation(s)
- Juan Carlos Rivera
- Department Medical Technology, Faculty of Medicine, University of Concepción, Concepción, Chile
| | - Daniel Nuñez
- Department Medical Technology, Faculty of Medicine, University of Concepción, Concepción, Chile
| | - Elizabet Millar
- Department Medical Technology, Faculty of Medicine, University of Concepción, Concepción, Chile
| | - Kimberly Ramirez
- Department Medical Technology, Faculty of Medicine, University of Concepción, Concepción, Chile
| | - Mauricio Chandía
- Flow Cytometry Laboratory, Pathological Anatomy Unit, Hospital Regional Clinical Dr. Guillermo Grant Benavente, Concepción, Chile
| | - Claudio Aguayo
- Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, University of Concepción, Concepción, Chile
- Group of Research and Innovation in Vascular Health (GRIVAS Health), Chillan, Chile
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3
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Zhao D, Zhou Q, Zarif M, Eladl E, Wei C, Atenafu EG, Schuh A, Tierens A, Yeung YWT, Minden MD, Chang H. AML with CEBPA mutations: A comparison of ICC and WHO-HAEM5 criteria in patients with 20% or more blasts. Leuk Res 2023; 134:107376. [PMID: 37690321 DOI: 10.1016/j.leukres.2023.107376] [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: 07/13/2023] [Revised: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 09/12/2023]
Abstract
AML with CEBPA mutation and AML with in-frame bZIP CEBPA mutations define favorable-risk disease entities in the proposed 5th edition of the World Health Organization Classification (WHO-HAEM5) and the International Consensus Classification (ICC), respectively. However, the impact of these new classifications on clinical practice remains unclear. We sought to assess the differences between the ICC and WHO-HAEM5 for AML with CEBPA mutation. 741 AML patients were retrospectively analyzed. Cox proportional-hazard regression was used to identify factors predictive of outcome. A validation cohort from the UK-NCRI clinical trials was used to confirm our findings. 81 (11%) AML patients had CEBPA mutations. 39 (48%) patients met WHO-HAEM5 criteria for AML with CEBPA mutation, among which 30 (77%) had biallelic CEBPA mutations and 9 (23%) had a single bZIP mutation. Among the 39 patients who met WHO-HAEM5 criteria, 25 (64%) also met ICC criteria. Compared to patients only meeting WHO-HAEM5 criteria, patients with in-frame bZIP CEBPA mutations (ie. meeting both WHO-HAEM5 and ICC criteria) were younger, had higher bone marrow blast percentages and CEBPA mutation burden, infrequently harboured 2022 ELN high-risk genetic features and co-mutations in other genes, and had superior outcomes. The associations in clinicopathological features and outcomes between the CEBPA-mutated groups were validated in the UK-NCRI cohort. Our study indicates that in-frame bZIP CEBPA mutations are the critical molecular aberrations associated with favorable outcomes in AML patients treated with curative intent chemotherapy. Compared to WHO-HAEM5, the ICC identifies a more homogenous group of CEBPA-mutated AML patients with favorable outcomes.
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Affiliation(s)
- Davidson Zhao
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Department of Laboratory Hematology, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
| | - Qianghua Zhou
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Department of Laboratory Hematology, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
| | - Mojgan Zarif
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Department of Laboratory Hematology, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
| | - Entsar Eladl
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Department of Laboratory Hematology, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
| | - Cuihong Wei
- Department of Clinical Laboratory Genetics, Genome Diagnostics & Cancer Cytogenetics, University Health Network, Toronto, ON, Canada
| | - Eshetu G Atenafu
- Department of Biostatistics, University Health Network, Toronto, ON, Canada
| | - Andre Schuh
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Anne Tierens
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Department of Laboratory Hematology, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
| | - Yu Wing Tony Yeung
- Department of Laboratory Medicine, St. Michael's Hospital, Toronto, ON, Canada
| | - Mark D Minden
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Hong Chang
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Department of Laboratory Hematology, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada.
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4
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Yuan J, He R, Alkhateeb HB. Sporadic and Familial Acute Myeloid Leukemia with CEBPA Mutations. Curr Hematol Malig Rep 2023; 18:121-129. [PMID: 37261703 PMCID: PMC10484814 DOI: 10.1007/s11899-023-00699-3] [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] [Accepted: 05/14/2023] [Indexed: 06/02/2023]
Abstract
PURPOSE OF REVIEW CCAAT enhancer binding protein A (CEBPA) gene mutation is one of the common genetic alterations in acute myeloid leukemia (AML), which can be associated with sporadic and familial AML. RECENT FINDINGS Due to the recent advances in molecular testing and the prognostic role of CEBPA mutation in AML, the definition for AML with CEBPA mutation (AML-CEBPA) has significantly changed. This review provides the rationale for the updates on classifications, and the impacts on laboratory evaluation and clinical management for sporadic and familial AML-CEBPA patients. In addition, minimal residual disease assessment post therapy to stratify disease risk and stem cell transplant in selected AML-CEBPA patients are discussed. Taken together, the recent progresses have shifted the definition, identification, and management of patients with AML-CEBPA.
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Affiliation(s)
- Ji Yuan
- Department of Laboratory Medicine and Pathology, Division of Hematopathology, Mayo Clinic, Rochester, MN USA
| | - Rong He
- Department of Laboratory Medicine and Pathology, Division of Hematopathology, Mayo Clinic, Rochester, MN USA
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5
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Tomizawa D, Tsujimoto SI. Risk-Stratified Therapy for Pediatric Acute Myeloid Leukemia. Cancers (Basel) 2023; 15:4171. [PMID: 37627199 PMCID: PMC10452723 DOI: 10.3390/cancers15164171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/08/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023] Open
Abstract
Acute Myeloid Leukemia (AML) is the second most common type of leukemia in children. Recent advances in high-resolution genomic profiling techniques have uncovered the mutational landscape of pediatric AML as distinct from adult AML. Overall survival rates of children with AML have dramatically improved in the past 40 years, currently reaching 70% to 80% in developed countries. This was accomplished by the intensification of conventional chemotherapy, improvement in risk stratification using leukemia-specific cytogenetics/molecular genetics and measurable residual disease, appropriate use of allogeneic hematopoietic stem cell transplantation, and improvement in supportive care. However, the principle therapeutic approach for pediatric AML has not changed substantially for decades and improvement in event-free survival is rather modest. Further refinements in risk stratification and the introduction of emerging novel therapies to contemporary therapy, through international collaboration, would be key solutions for further improvements in outcomes.
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Affiliation(s)
- Daisuke Tomizawa
- Division of Leukemia and Lymphoma, Children’s Cancer Center, National Center for Child Health and Development, Tokyo 157-8535, Japan
| | - Shin-Ichi Tsujimoto
- Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan;
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6
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Krizsán S, Péterffy B, Egyed B, Nagy T, Sebestyén E, Hegyi LL, Jakab Z, Erdélyi DJ, Müller J, Péter G, Csanádi K, Kállay K, Kriván G, Barna G, Bedics G, Haltrich I, Ottóffy G, Csernus K, Vojcek Á, Tiszlavicz LG, Gábor KM, Kelemen Á, Hauser P, Gaál Z, Szegedi I, Ujfalusi A, Kajtár B, Kiss C, Matolcsy A, Tímár B, Kovács G, Alpár D, Bödör C. Next-Generation Sequencing-Based Genomic Profiling of Children with Acute Myeloid Leukemia. J Mol Diagn 2023; 25:555-568. [PMID: 37088137 PMCID: PMC10435843 DOI: 10.1016/j.jmoldx.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 02/11/2023] [Accepted: 04/05/2023] [Indexed: 04/25/2023] Open
Abstract
Pediatric acute myeloid leukemia (AML) represents a major cause of childhood leukemic mortality, with only a limited number of studies investigating the molecular landscape of the disease. Here, we present an integrative analysis of cytogenetic and molecular profiles of 75 patients with pediatric AML from a multicentric, real-world patient cohort treated according to AML Berlin-Frankfurt-Münster protocols. Targeted next-generation sequencing of 54 genes revealed 17 genes that were recurrently mutated in >5% of patients. Considerable differences were observed in the mutational profiles compared with previous studies, as BCORL1, CUX1, KDM6A, PHF6, and STAG2 mutations were detected at a higher frequency than previously reported, whereas KIT, NRAS, and KRAS were less frequently mutated. Our study identified novel recurrent mutations at diagnosis in the BCORL1 gene in 9% of the patients. Tumor suppressor gene (PHF6, TP53, and WT1) mutations were found to be associated with induction failure and shorter event-free survival, suggesting important roles of these alterations in resistance to therapy and disease progression. Comparison of the mutational landscape at diagnosis and relapse revealed an enrichment of mutations in tumor suppressor genes (16.2% versus 44.4%) and transcription factors (35.1% versus 55.6%) at relapse. Our findings shed further light on the heterogeneity of pediatric AML and identify previously unappreciated alterations that may lead to improved molecular characterization and risk stratification of pediatric AML.
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Affiliation(s)
- Szilvia Krizsán
- HCEMM-SE Molecular Oncohematology Research Group, Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary; Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Borbála Péterffy
- HCEMM-SE Molecular Oncohematology Research Group, Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Bálint Egyed
- HCEMM-SE Molecular Oncohematology Research Group, Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary; Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Tibor Nagy
- HCEMM-SE Molecular Oncohematology Research Group, Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary; Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Endre Sebestyén
- HCEMM-SE Molecular Oncohematology Research Group, Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Lajos László Hegyi
- HCEMM-SE Molecular Oncohematology Research Group, Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Jakab
- Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Dániel J Erdélyi
- Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Judit Müller
- Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - György Péter
- Hemato-Oncology Unit, Heim Pal Children's Hospital, Budapest, Hungary
| | - Krisztina Csanádi
- Hemato-Oncology Unit, Heim Pal Children's Hospital, Budapest, Hungary
| | - Krisztián Kállay
- Division of Pediatric Hematology and Stem Cell Transplantation, Central Hospital of Southern Pest, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Gergely Kriván
- Division of Pediatric Hematology and Stem Cell Transplantation, Central Hospital of Southern Pest, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Gábor Barna
- HCEMM-SE Molecular Oncohematology Research Group, Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Gábor Bedics
- HCEMM-SE Molecular Oncohematology Research Group, Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Irén Haltrich
- Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Gábor Ottóffy
- Department of Pediatrics, University of Pécs Clinical Centre, Pécs, Hungary
| | - Katalin Csernus
- Department of Pediatrics, University of Pécs Clinical Centre, Pécs, Hungary
| | - Ágnes Vojcek
- Department of Pediatrics, University of Pécs Clinical Centre, Pécs, Hungary
| | - Lilla Györgyi Tiszlavicz
- Department of Pediatrics and Pediatric Health Care Center, University of Szeged, Szeged, Hungary
| | - Krisztina Mita Gábor
- Department of Pediatrics and Pediatric Health Care Center, University of Szeged, Szeged, Hungary
| | - Ágnes Kelemen
- Hemato-Oncology and Stem Cell Transplantation Unit, Velkey László Child's Health Center, Borsod-Abaúj-Zemplén County Central Hospital and University Teaching Hospital, Miskolc, Hungary
| | - Péter Hauser
- Hemato-Oncology and Stem Cell Transplantation Unit, Velkey László Child's Health Center, Borsod-Abaúj-Zemplén County Central Hospital and University Teaching Hospital, Miskolc, Hungary
| | - Zsuzsanna Gaál
- Department of Pediatric Hematology and Oncology, Institute of Pediatrics, University of Debrecen, Debrecen, Hungary
| | - István Szegedi
- Department of Pediatric Hematology and Oncology, Institute of Pediatrics, University of Debrecen, Debrecen, Hungary
| | - Anikó Ujfalusi
- Department of Laboratory Medicine, University of Debrecen, Debrecen, Hungary
| | - Béla Kajtár
- Department of Pathology, University of Pécs Clinical Centre, Pécs, Hungary
| | - Csongor Kiss
- Hemato-Oncology and Stem Cell Transplantation Unit, Velkey László Child's Health Center, Borsod-Abaúj-Zemplén County Central Hospital and University Teaching Hospital, Miskolc, Hungary
| | - András Matolcsy
- HCEMM-SE Molecular Oncohematology Research Group, Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary; Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Botond Tímár
- HCEMM-SE Molecular Oncohematology Research Group, Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Gábor Kovács
- Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Donát Alpár
- HCEMM-SE Molecular Oncohematology Research Group, Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Csaba Bödör
- HCEMM-SE Molecular Oncohematology Research Group, Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary.
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7
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Noort S, van Oosterwijk J, Ma J, Garfinkle EA, Nance S, Walsh M, Song G, Reinhardt D, Pigazzi M, Locatelli F, Hasle H, Abrahamsson J, Jarosova M, Kelaidi C, Polychronopoulou S, van den Heuvel-Eibrink MM, Fornerod M, Gruber TA, Zwaan CM. Analysis of rare driving events in pediatric acute myeloid leukemia. Haematologica 2022; 108:48-60. [PMID: 35899387 PMCID: PMC9827169 DOI: 10.3324/haematol.2021.280250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Indexed: 02/04/2023] Open
Abstract
Elucidating genetic aberrations in pediatric acute myeloid leukemia (AML) provides insight in biology and may impact on risk-group stratification and clinical outcome. This study aimed to detect such aberrations in a selected series of samples without known (cyto)genetic aberration using molecular profiling. A cohort of 161 patients was selected from various study groups: DCOG, BFM, SJCRH, NOPHO and AEIOP. Samples were analyzed using RNA sequencing (n=152), whole exome (n=135) and/or whole genome sequencing (n=100). In 70 of 156 patients (45%), of whom RNA sequencing or whole genome sequencing was available, rearrangements were detected, 22 of which were novel; five involving ERG rearrangements and four NPM1 rearrangements. ERG rearrangements showed self-renewal capacity in vitro, and a distinct gene expression pattern. Gene set enrichment analysis of this cluster showed upregulation of gene sets derived from Ewing sarcoma, which was confirmed comparing gene expression profiles of AML and Ewing sarcoma. Furthermore, NPM1-rearranged cases showed cytoplasmic NPM1 localization and revealed HOXA/B gene overexpression, as described for NPM1 mutated cases. Single-gene mutations as identified in adult AML were rare. Patients had a median of 24 coding mutations (range, 7-159). Novel recurrent mutations were detected in UBTF (n=10), a regulator of RNA transcription. In 75% of patients an aberration with a prognostic impact could be detected. Therefore, we suggest these techniques need to become standard of care in diagnostics.
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Affiliation(s)
- Sanne Noort
- Pediatric Oncology/Hematology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | | | - Jing Ma
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Stephanie Nance
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Michael Walsh
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Guangchun Song
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Dirk Reinhardt
- AML-BFM Study Group, Pediatric Hematology and Oncology, Essen, Germany
| | - Martina Pigazzi
- Women and Child Health Department, Hematology-Oncology Clinic and Lab, University of Padova, Padova, Italy
| | - Franco Locatelli
- Italian Association of Pediatric Hematology and Oncology, University of Pavia, Pavia, Italy
| | - Henrik Hasle
- Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Jonas Abrahamsson
- Nordic Society for Pediatric Hematology and Oncology, Department of Pediatrics, Institution for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marie Jarosova
- Center of Molecular Biology and Gene Therapy, Department of Internal Hematology and Oncology, Masaryk University Hospital, Brno, Czech Republic
| | - Charikleia Kelaidi
- Department of Pediatric Hematology and Oncology, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | - Sophia Polychronopoulou
- Department of Pediatric Hematology and Oncology, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | - Marry M. van den Heuvel-Eibrink
- Pediatric Oncology/Hematology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, the Netherlands,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Maarten Fornerod
- Department of Cell Biology, Erasmus MC, Rotterdam, the Netherlands
| | - Tanja A. Gruber
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - C. Michel Zwaan
- Pediatric Oncology/Hematology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, the Netherlands,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands,C. M. Zwaan
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8
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Lejman M, Dziatkiewicz I, Jurek M. Straight to the Point-The Novel Strategies to Cure Pediatric AML. Int J Mol Sci 2022; 23:ijms23041968. [PMID: 35216084 PMCID: PMC8878466 DOI: 10.3390/ijms23041968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 12/15/2022] Open
Abstract
Although the outcome has improved over the past decades, due to improved supportive care, a better understanding of risk factors, and intensified chemotherapy, pediatric acute myeloid leukemia remains a life-threatening disease, and overall survival (OS) remains near 70%. According to French-American-British (FAB) classification, AML is divided into eight subtypes (M0–M7), and each is characterized by a different pathogenesis and response to treatment. However, the curability of AML is due to the intensification of standard chemotherapy, more precise risk classification, improvements in supportive care, and the use of minimal residual disease to monitor response to therapy. The treatment of childhood AML continues to be based primarily on intensive, conventional chemotherapy. Therefore, it is essential to identify new, more precise molecules that are targeted to the specific abnormalities of each leukemia subtype. Here, we review abnormalities that are potential therapeutic targets for the treatment of AML in the pediatric population.
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Affiliation(s)
- Monika Lejman
- Laboratory of Genetic Diagnostics, II Faculty of Pediatrics, Medical University of Lublin, A. Gębali 6, 20-093 Lublin, Poland
- Correspondence:
| | - Izabela Dziatkiewicz
- Student Scientific Society, Laboratory of Genetic Diagnostics, II Faculty of Pediatrics, Medical University of Lublin, A. Gębali 6, 20-093 Lublin, Poland; (I.D.); (M.J.)
| | - Mateusz Jurek
- Student Scientific Society, Laboratory of Genetic Diagnostics, II Faculty of Pediatrics, Medical University of Lublin, A. Gębali 6, 20-093 Lublin, Poland; (I.D.); (M.J.)
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9
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Molina Garay C, Carrillo Sánchez K, Flores Lagunes LL, Jiménez Olivares M, Muñoz Rivas A, Villegas Torres BE, Flores Aguilar H, Núñez Enríquez JC, Jiménez Hernández E, Bekker Méndez VC, Torres Nava JR, Flores Lujano J, Martín Trejo JA, Mata Rocha M, Medina Sansón A, Espinoza Hernández LE, Peñaloza Gonzalez JG, Espinosa Elizondo RM, Flores Villegas LV, Amador Sanchez R, Pérez Saldívar ML, Sepúlveda Robles OA, Rosas Vargas H, Jiménez Morales S, Galindo Delgado P, Mejía Aranguré JM, Alaez Verson C. Mutational Landscape of CEBPA in Mexican Pediatric Acute Myeloid Leukemia Patients: Prognostic Implications. Front Pediatr 2022; 10:899742. [PMID: 35967564 PMCID: PMC9367218 DOI: 10.3389/fped.2022.899742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In Mexico, the incidence of acute myeloid leukemia (AML) has increased in the last few years. Mortality is higher than in developed countries, even though the same chemotherapy protocols are used. CCAAT Enhancer Binding Protein Alpha (CEBPA) mutations are recurrent in AML, influence prognosis, and help to define treatment strategies. CEBPA mutational profiles and their clinical implications have not been evaluated in Mexican pediatric AML patients. AIM OF THE STUDY To identify the mutational landscape of the CEBPA gene in pediatric patients with de novo AML and assess its influence on clinical features and overall survival (OS). MATERIALS AND METHODS DNA was extracted from bone marrow aspirates at diagnosis. Targeted massive parallel sequencing of CEBPA was performed in 80 patients. RESULTS CEBPA was mutated in 12.5% (10/80) of patients. Frameshifts at the N-terminal region were the most common mutations 57.14% (8/14). CEBPA biallelic (CEBPA BI) mutations were identified in five patients. M2 subtype was the most common in CEBPA positive patients (CEBPA POS) (p = 0.009); 50% of the CEBPA POS patients had a WBC count > 100,000 at diagnosis (p = 0.004). OS > 1 year was significantly better in CEBPA negative (CEBPA NEG) patients (p = 0.0001). CEBPA POS patients (either bi- or monoallelic) had a significantly lower OS (p = 0.002). Concurrent mutations in FLT3, CSF3R, and WT1 genes were found in CEBPA POS individuals. Their contribution to poor OS cannot be ruled out. CONCLUSION CEBPA mutational profiles in Mexican pediatric AML patients and their clinical implications were evaluated for the first time. The frequency of CEBPA POS was in the range reported for pediatric AML (4.5-15%). CEBPA mutations showed a negative impact on OS as opposed to the results of other studies.
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Affiliation(s)
- Carolina Molina Garay
- Laboratorio de Diagnóstico Genómico, Instituto Nacional de Medicina Genómica (INMEGEN), Mexico City, Mexico
| | - Karol Carrillo Sánchez
- Laboratorio de Diagnóstico Genómico, Instituto Nacional de Medicina Genómica (INMEGEN), Mexico City, Mexico
| | | | - Marco Jiménez Olivares
- Laboratorio de Diagnóstico Genómico, Instituto Nacional de Medicina Genómica (INMEGEN), Mexico City, Mexico
| | - Anallely Muñoz Rivas
- Laboratorio de Diagnóstico Genómico, Instituto Nacional de Medicina Genómica (INMEGEN), Mexico City, Mexico
| | | | | | - Juan Carlos Núñez Enríquez
- Unidad de Investigación Médica en Epidemiología Clínica, UMAE Hospital de Pediatría, Centro Médico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Elva Jiménez Hernández
- Servicio de Hematología Pediátrica, Hospital General "Gaudencio González Garza", Centro Médico Nacional (CMN) "La Raza", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Vilma Carolina Bekker Méndez
- Unidad de Investigación Médica en Inmunología e Infectología, Hospital de Infectología "Dr. Daniel Méndez Hernández", "La Raza", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - José Refugio Torres Nava
- Servicio de Oncología, Hospital Pediátrico de Moctezuma, Secretaria de Salud del D.F., Mexico City, Mexico
| | - Janet Flores Lujano
- Unidad de Investigación Médica en Epidemiología Clínica, UMAE Hospital de Pediatría, Centro Médico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Jorge Alfonso Martín Trejo
- Servicio de Hematología Pediátrica, UMAE Hospital de Pediatría, Centro Médico Nacional (CMN) "Siglo XXI", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Minerva Mata Rocha
- Unidad de Investigación Médica en Epidemiología Clínica, UMAE Hospital de Pediatría, Centro Médico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Aurora Medina Sansón
- Servicio de Hemato-Oncología, Hospital Infantil de México Federico Gómez, Secretaria de Salud (SSa), Mexico City, Mexico
| | - Laura Eugenia Espinoza Hernández
- Unidad de Investigación Médica en Epidemiología Clínica, UMAE Hospital de Pediatría, Centro Médico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | | | | | - Luz Victoria Flores Villegas
- Servicio de Hematología Pediátrica, Centro Médico Nacional (CMN) "20 de Noviembre", Instituto de Seguridad Social al Servicio de los Trabajadores del Estado (ISSSTE), Mexico City, Mexico
| | - Raquel Amador Sanchez
- Hospital General Regional No. 1 "Carlos McGregor Sánchez Navarro", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - María Luisa Pérez Saldívar
- Unidad de Investigación Médica en Epidemiología Clínica, UMAE Hospital de Pediatría, Centro Médico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Omar Alejandro Sepúlveda Robles
- Unidad de Investigación Médica en Genética Humana, UMAE Hospital de Pediatría, Centro Médico Nacional (CMN) "Siglo XXI", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Haydeé Rosas Vargas
- Unidad de Investigación Médica en Genética Humana, UMAE Hospital de Pediatría, Centro Médico Nacional (CMN) "Siglo XXI", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Silvia Jiménez Morales
- Laboratorio de Genómica del Cáncer, Instituto Nacional de Medicina Genómica (Inmegen), Mexico City, Mexico
| | | | - Juan Manuel Mejía Aranguré
- Laboratorio de Genómica del Cáncer, Instituto Nacional de Medicina Genómica (Inmegen), Mexico City, Mexico.,Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Carmen Alaez Verson
- Laboratorio de Diagnóstico Genómico, Instituto Nacional de Medicina Genómica (INMEGEN), Mexico City, Mexico
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10
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Liao XY, Fang JP, Zhou DH, Qiu KY. CEBPA are independent good prognostic factors in pediatric acute myeloid leukemia. Hematol Oncol 2021; 40:258-268. [PMID: 34816468 DOI: 10.1002/hon.2951] [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: 08/27/2021] [Revised: 11/08/2021] [Accepted: 11/18/2021] [Indexed: 11/12/2022]
Abstract
To evaluate the outcome and prognostic significance of CEBPA mutations among pediatric acute myeloid leukemia (AML) from TARGET dataset. A total of 1803 pediatric patients who were diagnosed with AML were classified into two groups based on the CEBPA status by using a retrospective cohort study method from September 1996 to December 2016. The incidence of CEBPA mutations was 18%. CEBPA mutations were significantly associated with elder age (p < 0.001), higher WBC (p = 0.004), higher proportion of peripheral blood blast (p < 0.001), normal karyotype (p < 0.001), low risk (p < 0.001) and higher complete remission induction rates (p < 0.05). Overall, CEBPA mutations patients had a significantly better 5-year EFS (p < 0.001) and OS (p < 0.001) compared to CEBPA wild-type patients, and this favorable impact was maintained even in the presence of FLT3/ITD mutations. Stem cell transplantation had no significant impact on the survival of patients with coexistence of CEBPA and FLT3/ITD mutations. Multivariate analysis demonstrated that mutated CEBPA were an independent favorable indicators of better outcome in terms of EFS (p = 0.007) and OS (p = 0.039). Our study demonstrate mutated CEBPA have an excellent outcome in pediatric AML patients. Furthermore, pediatric AML patients with coexistence of CEBPA and FLT3/ITD mutation appear to have favorable prognoses and might not required stem cell transplantation.
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Affiliation(s)
- Xiong-Yu Liao
- Children's Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jian-Pei Fang
- Children's Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Dun-Hua Zhou
- Children's Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Kun-Yin Qiu
- Children's Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
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11
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Mendoza H, Podoltsev NA, Siddon AJ. Laboratory evaluation and prognostication among adults and children with CEBPA-mutant acute myeloid leukemia. Int J Lab Hematol 2021; 43 Suppl 1:86-95. [PMID: 34288448 DOI: 10.1111/ijlh.13517] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 02/25/2021] [Indexed: 02/02/2023]
Abstract
CEBPA-mutant acute myeloid leukemia (AML) encompasses clinically and biologically distinct subtypes of AML in both adults and children. CEBPA-mutant AML may occur with monoallelic (moCEBPA) or biallelic (biCEBPA) mutations, which can be somatic or germline, with each entity impacting prognosis in unique ways. BiCEBPA AML is broadly associated with a favorable prognosis, but differences in the type and location of CEBPA mutations as well as the presence of additional leukemogenic mutations can lead to heterogeneity in survival. Concurrent FLT3-ITD mutations have a well-documented negative effect on survival in adult biCEBPA AML, whereas support for a negative prognostic effect of mutations in TET2, DNMT3A, WT1, CSF3R, ASXL1, and KIT is mixed. NPM1 and GATA2 mutations may have a positive prognostic impact. MoCEBPA AML has similar survival outcomes compared to AML with wild-type CEBPA, and risk stratification is determined by other cytogenetic and molecular findings. Germline CEBPA mutations may lead to familial biCEBPA AML after acquisition of second somatic CEBPA mutation, with variable penetrance and age. BiCEBPA AML in children is likely a favorable-risk diagnosis as it is in adults, but the role of a single CEBPA mutation and the impact of concurrent leukemogenic mutations are not clear in this population. Laboratory evaluation of the CEBPA gene includes PCR-based fragment-length analysis, Sanger sequencing, and next-generation sequencing. Phenotypic analysis using multiparameter flow cytometry can also provide additional data in evaluating CEBPA, helping to assess for the likelihood of mutation presence.
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Affiliation(s)
- Hadrian Mendoza
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Nikolai A Podoltsev
- Hematology Section, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Alexa J Siddon
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA.,Department of Pathology, Yale School of Medicine, New Haven, CT, USA
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12
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Abstract
The genetic basis for pediatric acute myeloid leukemia (AML) is highly heterogeneous, often involving the cooperative action of characteristic chromosomal rearrangements and somatic mutations in progrowth and antidifferentiation pathways that drive oncogenesis. Although some driver mutations are shared with adult AML, many genetic lesions are unique to pediatric patients, and their appropriate identification is essential for patient care. The increased understanding of these malignancies through broad genomic studies has begun to risk-stratify patients based on their combinations of genomic alterations, a trend that will enable precision medicine in this population.
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Affiliation(s)
- Bryan Krock
- Caris Life Sciences, 4610 South 44th Place, Phoenix, AZ, USA
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13
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Nie Y, Su L, Li W, Gao S. Novel insights of acute myeloid leukemia with CEBPA deregulation: Heterogeneity dissection and re-stratification. Crit Rev Oncol Hematol 2021; 163:103379. [PMID: 34087345 DOI: 10.1016/j.critrevonc.2021.103379] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 03/21/2021] [Accepted: 05/29/2021] [Indexed: 12/17/2022] Open
Abstract
Acute myeloid leukemia with bi-allelic CEBPA mutation was categorized as an independent disease entity with favorable prognosis, however, recent researches have revealed huge heterogeneity within this disease group, and for some patients, relapse remained a major cause of treatment failure. Further risk stratification is essentially needed. Here by reviewing the latest literature, we summarized the characteristics of CEBPA mutation profiles and clinical features, with a special intention of dissecting the heterogeneity within the seemingly homogeneous AML with bi-allelic CEBPA mutations. Specifically, non-classical CEBPA mutation, miscellaneous companion genetic aberrations and the presence of germline CEBPA mutation are three major sources of heterogeneity. Identifying these factors can help us predict patients at a higher risk of relapse, for whom aggressive treatment may be recommended. Novel therapeutic approaches regarding manipulating potentially druggable targets as well as the debate over post remission consolidation regimens has also been discussed.
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Affiliation(s)
- Yuanyuan Nie
- Department of Hematology, The First Hospital of Jilin University, Changchun, 130012, China
| | - Long Su
- Department of Hematology, The First Hospital of Jilin University, Changchun, 130012, China
| | - Wei Li
- Department of Hematology, The First Hospital of Jilin University, Changchun, 130012, China; Stem Cell and Cancer Center, The First Hospital of Jilin University, Changchun, 130012, China
| | - Sujun Gao
- Department of Hematology, The First Hospital of Jilin University, Changchun, 130012, China.
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14
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Patel BJ, Barot SV, Xie Y, Cook JR, Carraway HE, Hsi ED. Impact of next generation sequencing results on clinical management in patients with hematological disorders. Leuk Lymphoma 2021; 62:1702-1710. [PMID: 33533694 DOI: 10.1080/10428194.2021.1876860] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Application of next generation sequencing (NGS) has shed light on the molecular heterogeneity of hematological malignancies. NGS panels targeting recurrent mutations have become common in many large centers and commercial laboratories. However, its impact in clinical practice is unclear. We sought to characterize the use of NGS at a tertiary care center in an observational study of 343 patients with suspected hematological malignancies. We found that NGS changed or refined the clinical and pathologic diagnosis in 9% of patients and affected management decisions in 65% (including clinical trial eligibility, targeted therapy selection, and consideration for stem cell transplantation). This study emphasizes early incorporation of NGS in clinical practice while also highlighting the present limitations. As our understanding of these disorders increases and more clinically relevant genetic targets emerge, it will be important to refine the molecular testing strategy to deliver personalized medicine given the high cost associated with this technology.
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Affiliation(s)
- Bhumika J Patel
- Leukemia and Myeloid Disorders Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Translational Hematology and Oncology Research, Cleveland Clinic, Cleveland, OH, USA
| | - Shimoli V Barot
- Leukemia and Myeloid Disorders Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Translational Hematology and Oncology Research, Cleveland Clinic, Cleveland, OH, USA
| | - Yan Xie
- Department of Laboratory Medicine, Robert J. Tomsich Institute of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - James R Cook
- Department of Laboratory Medicine, Robert J. Tomsich Institute of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Hetty E Carraway
- Leukemia and Myeloid Disorders Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Translational Hematology and Oncology Research, Cleveland Clinic, Cleveland, OH, USA
| | - Eric D Hsi
- Department of Laboratory Medicine, Robert J. Tomsich Institute of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, OH, USA
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15
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Kimura Y, Iwanaga E, Iwanaga K, Endo S, Inoue Y, Tokunaga K, Nagahata Y, Masuda K, Kawamoto H, Matsuoka M. A regulatory element in the 3'-untranslated region of CEBPA is associated with myeloid/NK/T-cell leukemia. Eur J Haematol 2020; 106:327-339. [PMID: 33197296 DOI: 10.1111/ejh.13551] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/11/2020] [Accepted: 11/11/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES CCAAT/enhancer-binding protein α (CEBPA) is an essential transcription factor for myeloid differentiation. Not only mutation of the CEBPA gene, but also promoter methylation, which results in silencing of CEBPA, contributes to the pathogenesis of acute myeloid leukemia (AML). We sought for another differentially methylated region (DMR) that associates with the CEBPA silencing and disease phenotype. METHODS Using databases, we identified a conserved DMR in the CEBPA 3'-untranslated region (UTR). RESULTS Methylation-specific PCR analysis of 231 AML cases showed that hypermethylation of the 3'-UTR was associated with AML that had a myeloid/NK/T-cell phenotype and downregulated CEBPA. Most of these cases were of an immature phenotype with CD7/CD56 positivity. These cases were significantly associated with lower hemoglobin levels than the others. Furthermore, we discovered that the CEBPA 3'-UTR DMR can enhance transcription from the CEBPA native promoter. In vitro experiments identified IKZF1-binding sites in the 3'-UTR that are responsible for this increased transcription of CEBPA. CONCLUSIONS These results indicate that the CEBPA 3'-UTR DMR is a novel regulatory element of CEBPA related to myeloid/NK/T-cell lineage leukemogenesis. Transcriptional regulation of CEBPA by IKZF1 may provide a clue for understanding the fate determination of myeloid vs. NK/T-lymphoid progenitors.
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Affiliation(s)
- Yukiko Kimura
- Department of Hematology, Rheumatology and Infectious Diseases, Kumamoto University, Kumamoto, Japan
| | - Eisaku Iwanaga
- Department of Hematology, Rheumatology and Infectious Diseases, Kumamoto University, Kumamoto, Japan
| | - Kouta Iwanaga
- Department of Hematology, Rheumatology and Infectious Diseases, Kumamoto University, Kumamoto, Japan
| | - Shinya Endo
- Department of Hematology, Rheumatology and Infectious Diseases, Kumamoto University, Kumamoto, Japan
| | - Yoshitaka Inoue
- Department of Hematology, Rheumatology and Infectious Diseases, Kumamoto University, Kumamoto, Japan
| | - Kenji Tokunaga
- Department of Hematology, Rheumatology and Infectious Diseases, Kumamoto University, Kumamoto, Japan
| | - Yousuke Nagahata
- Laboratory of Immunology, Institute for Frontier Life and Medical Science, Kyoto University, Kyoto, Japan
| | - Kyoko Masuda
- Laboratory of Immunology, Institute for Frontier Life and Medical Science, Kyoto University, Kyoto, Japan
| | - Hiroshi Kawamoto
- Laboratory of Immunology, Institute for Frontier Life and Medical Science, Kyoto University, Kyoto, Japan
| | - Masao Matsuoka
- Department of Hematology, Rheumatology and Infectious Diseases, Kumamoto University, Kumamoto, Japan.,Laboratory of Virus Control, Institute for Frontier Life and Medical Sciences, Kyoto University, Kyoto, Japan
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16
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Shahid S, Shakeel M, Siddiqui S, Ahmed S, Sohail M, Khan IA, Abid A, Shamsi T. Novel Genetic Variations in Acute Myeloid Leukemia in Pakistani Population. Front Genet 2020; 11:560. [PMID: 32655615 PMCID: PMC7324646 DOI: 10.3389/fgene.2020.00560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 05/07/2020] [Indexed: 12/22/2022] Open
Abstract
Acute myeloid leukemia (AML) is a hematological malignancy characterized by clonal expansion of blast cells that exhibit great genetic heterogeneity. In this study, we describe the mutational landscape and its clinico-pathological significance in 26 myeloid neoplasm patients from a South Asian population (Pakistan) by using ultra-deep targeted next-generation DNA sequencing of 54 genes (∼5000×) and its subsequent bioinformatics analysis. The data analysis indicated novel non-silent somatic mutational events previously not reported in AML, including nine non-synonymous and one stop-gain mutations. Notably, two recurrent somatic non-synonymous mutations, i.e., STAG2 (causing p.L526F) and BCORL1 (p.A400V), were observed in three unrelated cases each. The BCOR was found to have three independent non-synonymous somatic mutations in three cases. Further, the SRSF2 with a protein truncating somatic mutation (p.Q88X) was observed for the first time in AML in this study. The prioritization of germline mutations with ClinVar, SIFT, Polyphen2, and Combined Annotation Dependent Depletion (CADD) highlighted 18 predicted deleterious/pathogenic mutations, including two recurrent deleterious mutations, i.e., a novel heterozygous non-synonymous SNV in GATA2 (p.T358P) and a frameshift insertion in NPM1 (p.L258fs), found in two unrelated cases each. The WT1 was observed with three independent potential detrimental germline mutations in three different cases. Collectively, non-silent somatic and/or germline mutations were observed in 23 (88.46%) of the cases (0.92 mutation per case). Furthermore, the pharmGKB database exploration showed a missense SNV rs1042522 in TP53, exhibiting decreased response to anti-cancer drugs, in 19 (73%) of the cases. This genomic profiling of AML provides deep insight into the disease pathophysiology. Identification of pharmacogenomics markers will help to adopt personalized approach for the management of AML patients in Pakistan.
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Affiliation(s)
- Saba Shahid
- Department of Genomics, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, Pakistan
| | - Muhammad Shakeel
- Jamil-ur-Rahman Center for Genome Research, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
| | - Saima Siddiqui
- Department of Hematology, National Institute of Blood Diseases and Bone Marrow Transplantation Karachi, Karachi, Pakistan
| | - Shariq Ahmed
- Department of Genomics, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, Pakistan
| | - Misha Sohail
- Department of Genomics, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, Pakistan
| | - Ishtiaq Ahmad Khan
- Jamil-ur-Rahman Center for Genome Research, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
| | - Aiysha Abid
- Centre for Human Genetics and Molecular Medicine, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
| | - Tahir Shamsi
- Department of Hematology, National Institute of Blood Diseases and Bone Marrow Transplantation Karachi, Karachi, Pakistan
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17
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Yu J, Li Y, Zhang D, Wan D, Jiang Z. Clinical implications of recurrent gene mutations in acute myeloid leukemia. Exp Hematol Oncol 2020; 9:4. [PMID: 32231866 PMCID: PMC7099827 DOI: 10.1186/s40164-020-00161-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 03/17/2020] [Indexed: 12/18/2022] Open
Abstract
Acute myeloid leukemia (AML) is a genetically heterogeneous clonal malignancy characterized by recurrent gene mutations. Genomic heterogeneity, patients’ individual variability, and recurrent gene mutations are the major obstacles among many factors that impact treatment efficacy of the AML patients. With the application of cost- and time-effective next-generation sequencing (NGS) technologies, an enormous diversity of genetic mutations has been identified. The recurrent gene mutations and their important roles in acute myeloid leukemia (AML) pathogenesis have been studied extensively. In this review, we summarize the recent development on the gene mutation in patients with AML.
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Affiliation(s)
- Jifeng Yu
- 1Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 Henan China.,2Academy of Medical and Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, 450052 Henan China
| | - Yingmei Li
- 1Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 Henan China
| | - Danfeng Zhang
- 1Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 Henan China
| | - Dingming Wan
- 1Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 Henan China
| | - Zhongxing Jiang
- 1Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 Henan China
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18
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Abstract
PURPOSE OF REVIEW Despite advances in therapy over the past decades, overall survival for children with acute myeloid leukemia (AML) has not exceeded 70%. In this review, we highlight recent insights into risk stratification for patients with pediatric AML and discuss data driving current and developing therapeutic approaches. RECENT FINDINGS Advances in cytogenetics and molecular profiling, as well as improvements in detection of minimal residual disease after induction therapy, have informed risk stratification, which now relies heavily on these elements. The treatment of childhood AML continues to be based primarily on intensive, conventional chemotherapy. However, recent trials focus on limiting treatment-related toxicity through the identification of low-risk subsets who can safely receive fewer cycles of chemotherapy, allocation of hematopoietic stem-cell transplant to only high-risk patients and optimization of infectious and cardioprotective supportive care. SUMMARY Further incorporation of genomic and molecular data in pediatric AML will allow for additional refinements in risk stratification to enable the tailoring of treatment intensity. These data will also dictate the incorporation of molecularly targeted therapeutics into frontline treatment in the hope of improving survival while decreasing treatment-related toxicity.
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19
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Gene mutational analysis by NGS and its clinical significance in patients with myelodysplastic syndrome and acute myeloid leukemia. Exp Hematol Oncol 2020; 9:2. [PMID: 31921515 PMCID: PMC6945703 DOI: 10.1186/s40164-019-0158-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 12/26/2019] [Indexed: 01/05/2023] Open
Abstract
Background In this study, we retrospectively summarized the differences of molecular gene mutations between MDS and AML patients, as well as the young and older age groups of MDS and AML patients. We also analyzed the response of newly diagnosed AML patients to standard DA or IA induction chemotherapy and the relationship between the chemotherapy outcome and the frequency of different gene mutation abnormalities. Methods NGS assay covering 43 genes was studied in 93 de novo MDS and 325 non-M3 AML patients. Bone marrow samples from all patients underwent gene mutational analysis by NGS. Results At least one non-synonymous gene mutation was detected in 279 AML patients (85.8%) and 85 MDS patients (91.4%). Contrary to 59 years and younger AML patients, there was a significantly higher incidence of gene mutation in 60 years and older AML patients (2.37 vs 1.94, p = 0.034). Gene mutation incidence in 60 years and older MDS patients increased, but no statistical significance was present (1.95 vs 1.64, p = 0.216). AML patients had a significantly higher gene mutation incidence compared with MDS-MLD patients (2.02 vs 1.63, p = 0.046). Gene mutation incidence was higher in patients with MDS-EB1/EB2 compared with patients with MDS-MLD but there was no statistical significance present (2.14 vs 1.63, p = 0.081). AML patients had significantly higher incidences of CEBPA, FLT3-ITD, DNMT3A, NPM1 and IDH1/2 gene mutations (p = 0.0043, 0.000, 0.030962, 0.002752, and 0.000628, respectively) and a lower incidence of TET2 and U2AF1 gene mutations (p = 0.000004 and 0.000, respectively) compared with MDS patients. Among the individual genes in different age groups, there were significantly higher incidences of RUNX1, IDH2, TP53 and SF3B1 gene mutations (p = 0.0478, 0.0028, 0.0024 and 0.005, respectively) as well as a trend of higher ASXL gene mutation (p = 0.057) in 60 years and older AML patients compared to 59 years and younger patients. There was no statistically significant difference in MDS patients with the different age groups and among the individual genes. Between AML patients and MDS patients among the different gene functional groups, AML patients had a significantly higher incidence of transcriptional deregulation (27.4% vs 15.1%, p = 0.014963), activated signalling (36.3% vs 10.8%, p = 0.000002) related gene mutations as well as a significantly lower incidence of RNA spliceosome (6.15% vs 60.1%, p = 0.000) related gene mutations. Furthermore, among the patients who received either IA or DA regimen for induction chemotherapy, patients with IA regimen had a significantly better CR rate than those with DA regimen (76.6% vs 57.1%, p = 0.0228). Conclusions Different gene mutations had been found in majority of MDS and AML patients. MDS and AML patients had different gene mutation patterns. AML patients with fewer or no gene mutations had a better chance of achieving CR when treated with IA and DA regimen induction chemotherapy.
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Ordoñez R, Martínez-Calle N, Agirre X, Prosper F. DNA Methylation of Enhancer Elements in Myeloid Neoplasms: Think Outside the Promoters? Cancers (Basel) 2019; 11:cancers11101424. [PMID: 31554341 PMCID: PMC6827153 DOI: 10.3390/cancers11101424] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 09/15/2019] [Accepted: 09/18/2019] [Indexed: 12/19/2022] Open
Abstract
Gene regulation through DNA methylation is a well described phenomenon that has a prominent role in physiological and pathological cell-states. This epigenetic modification is usually grouped in regions denominated CpG islands, which frequently co-localize with gene promoters, silencing the transcription of those genes. Recent genome-wide DNA methylation studies have challenged this paradigm, demonstrating that DNA methylation of regulatory regions outside promoters is able to influence cell-type specific gene expression programs under physiologic or pathologic conditions. Coupling genome-wide DNA methylation assays with histone mark annotation has allowed for the identification of specific epigenomic changes that affect enhancer regulatory regions, revealing an additional layer of complexity to the epigenetic regulation of gene expression. In this review, we summarize the novel evidence for the molecular and biological regulation of DNA methylation in enhancer regions and the dynamism of these changes contributing to the fine-tuning of gene expression. We also analyze the contribution of enhancer DNA methylation on the expression of relevant genes in acute myeloid leukemia and chronic myeloproliferative neoplasms. The characterization of the aberrant enhancer DNA methylation provides not only a novel pathogenic mechanism for different tumors but also highlights novel potential therapeutic targets for myeloid derived neoplasms.
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Affiliation(s)
- Raquel Ordoñez
- Área de Hemato-Oncología, Centro de Investigación Médica Aplicada, IDISNA, Universidad de Navarra, Avenida Pío XII-55, 31008 Pamplona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28029 Madrid, Spain
| | - Nicolás Martínez-Calle
- Área de Hemato-Oncología, Centro de Investigación Médica Aplicada, IDISNA, Universidad de Navarra, Avenida Pío XII-55, 31008 Pamplona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28029 Madrid, Spain
| | - Xabier Agirre
- Área de Hemato-Oncología, Centro de Investigación Médica Aplicada, IDISNA, Universidad de Navarra, Avenida Pío XII-55, 31008 Pamplona, Spain.
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28029 Madrid, Spain.
| | - Felipe Prosper
- Área de Hemato-Oncología, Centro de Investigación Médica Aplicada, IDISNA, Universidad de Navarra, Avenida Pío XII-55, 31008 Pamplona, Spain.
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28029 Madrid, Spain.
- Departamento de Hematología, Clínica Universidad de Navarra, Universidad de Navarra, Avenida Pío XII-36, 31008 Pamplona, Spain.
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Kim HS, Han E, Jang W, Kim M, Kim Y, Han K, Kim HJ, Cho B. Germline CEBPA mutations in Korean patients with acute myeloid leukemia. Leuk Res 2019; 76:84-86. [DOI: 10.1016/j.leukres.2018.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/19/2018] [Accepted: 12/10/2018] [Indexed: 10/27/2022]
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Cao XX, Cai H, Mao YY, Wu Q, Zhang L, Zhou DB, Li J. Next-generation sequencing-based genetic landscape and its clinical implications for Chinese acute myeloid leukemia patients. Cancer Cell Int 2018; 18:215. [PMID: 30598640 PMCID: PMC6303841 DOI: 10.1186/s12935-018-0716-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 12/18/2018] [Indexed: 11/13/2022] Open
Abstract
Background Acute myeloid leukemia (AML) is a clinically and biologically heterogeneous disease. The survival of older patients is generally poor. In the current study, we sought to investigate the differences in molecular gene mutations between younger and older AML patients, and to identify those newly diagnosed AML patients who are more likely to respond to standard cytarabine and daunorubicin induction chemotherapy. Methods We retrospectively evaluated 179 patients who were newly diagnosed with non-M3 AML. A next-generation sequencing assay covering 34 genes was used to investigate recurrently mutated genes. The mutational status of fusion genes was determined by real time PCR. Results The median age at diagnosis was 53 years (range 18–88 years). Sixty-eight patients were 60 years or older with a median age of 67 years (range 60–88 years). Eighteen patients (10.1%) carried t(8;21)(q22;q22.1) or RUNX1–RUNX1T1 gene fusion, and there was a significantly higher incidence in younger patients (p = 0.019). At least one non-synonymous gene mutation was detected in 159 patients (88.8%). The median number of gene mutations was two (range 0–6). The mean number of molecular gene mutations at diagnosis was higher in older patients than younger patients (2.5 vs 1.83, p = 0.003). Older patients had significantly higher incidences of ASXL1 (22.1% vs 13.5%, p = 0.025) and TP53 mutations (13.2% vs 3.6%, p = 0.034). In total, 78 patients received DA60 (daunorubicin 60 mg/m2 per day on days 1–3 and cytarabine 100 mg/m2 twice per day on days 1–7) as the induction therapy, and information was available on their response to induction treatment. Patients with RUNX1–RUNX1T1 gene fusion were significantly more likely to achieve complete remission (CR) after DA60 induction therapy (p = 0.026), as were patients without the ASXL1 mutation (p = 0.007). Conclusion Older AML patients had a lower incidence of favorable cytogenetics and higher frequencies and burdens of molecular mutations that are associated with poor prognosis compared to younger patients. Patients with RUNX1–RUNX1T1 gene fusion or without the ASXL1 gene mutation had a better chance of achieving CR when treated with cytarabine and daunorubicin induction chemotherapy.
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Affiliation(s)
- Xin-Xin Cao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1 Shuai Fu Yuan Hu Tong, Dongcheng District, Beijing, 100730 People's Republic of China
| | - Hao Cai
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1 Shuai Fu Yuan Hu Tong, Dongcheng District, Beijing, 100730 People's Republic of China
| | - Yue-Ying Mao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1 Shuai Fu Yuan Hu Tong, Dongcheng District, Beijing, 100730 People's Republic of China
| | - Qi Wu
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1 Shuai Fu Yuan Hu Tong, Dongcheng District, Beijing, 100730 People's Republic of China
| | - Lu Zhang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1 Shuai Fu Yuan Hu Tong, Dongcheng District, Beijing, 100730 People's Republic of China
| | - Dao-Bin Zhou
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1 Shuai Fu Yuan Hu Tong, Dongcheng District, Beijing, 100730 People's Republic of China
| | - Jian Li
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1 Shuai Fu Yuan Hu Tong, Dongcheng District, Beijing, 100730 People's Republic of China
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Arber DA. The 2016 WHO classification of acute myeloid leukemia: What the practicing clinician needs to know. Semin Hematol 2018; 56:90-95. [PMID: 30926096 DOI: 10.1053/j.seminhematol.2018.08.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/31/2018] [Accepted: 08/13/2018] [Indexed: 01/11/2023]
Abstract
In 2016 a revision of the World Health Organization (WHO) classification of acute myeloid leukemia (AML) was introduced that included changes to several disease categories. The WHO approach results in disease categories that are defined by a combination of clinical, morphologic, immunophenotypic, and genetic features in an attempt to define clinically relevant, biologic entities. This review summarizes the WHO approach as well as the priority of specific features for disease classification. Changes to specific categories, including AML with myelodysplasia-related changes, AML with mutated NPM1, AML with biallelic mutations of CEBPA and erythroleukemia are summarized. The importance of additional gene mutations as well as germline predisposition in AML is also reviewed.
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Affiliation(s)
- Daniel A Arber
- Department of Pathology, University of Chicago, Chicago, IL.
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Zhang M, Yin J, He Q, Zhang F, Huang H, Wu B, Wang X, Liu H, Yin H, Zeng Y, Gale RP, Wu D, Yin B. Chinese and Europeans with acute myeloid leukemia have discordant mutation topographies. Leuk Res 2018; 70:8-12. [PMID: 29727824 DOI: 10.1016/j.leukres.2018.04.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/10/2018] [Accepted: 04/15/2018] [Indexed: 11/19/2022]
Abstract
Although the topography of mutations in persons of predominately European-descent with acute myeloid leukemia (AML) is well-described this is less so in Asians. We studied AML-related mutations in 289 consecutive Chinese (mostly Han) with newly-diagnosed de novo AML. Full-length coding sequence of NPM1 and CEBPA, IDH1 and IDH2 hotspot mutations and WT1 mutations in exons 7 and 9 were analyzed by PCR as were correlations with clinical and laboratory variables. CEBPA mutations were detected in 20% of subjects (95% confidence interval [CI] 15, 25%), NPM1 mutations in 20% (15, 25%), IDH1 mutations in 4% (1, 6%), IDH2 mutations in 11% (7, 15%) and WT1 mutations in 6% (3, 9%). A comparison of these data with mutation frequencies in persons of predominately European-descent with AML indicates a higher frequency of CEBPA mutations, a similar frequency of IDH2 mutations and lower frequencies of NPM1, IDH1 and WT1 mutations. Our data indicate different topographies of AML-associated mutations in Chinese compared with persons of predominately European descent suggesting genetic background, life-style, environment and perhaps other variables may influence these differences.
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Affiliation(s)
- Min Zhang
- Department of Laboratory Medicine, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, Jiangsu Province, 214002, China
| | - Jiawei Yin
- Cyrus Tang Hematology Center, Jiangsu Institute of Hematology, First Affiliated Hospital, Soochow University, Suzhou, Jiangsu Province, 215123, China
| | - Qinghua He
- Department of Laboratory Medicine, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, Jiangsu Province, 214002, China
| | - Fan Zhang
- Cyrus Tang Hematology Center, Jiangsu Institute of Hematology, First Affiliated Hospital, Soochow University, Suzhou, Jiangsu Province, 215123, China
| | - Hongyu Huang
- Department of Laboratory Medicine, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, Jiangsu Province, 214002, China
| | - Biao Wu
- Department of Laboratory Medicine, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, Jiangsu Province, 214002, China
| | - Xuedong Wang
- Department of Medical Laboratory Science, The Fifth People's Hospital of Wuxi, The Medical School of Jiangnan University, Wuxi, Jiangsu, 214000, China
| | - Hong Liu
- First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, Suzhou, Jiangsu Province, 215006, China
| | - Hongchao Yin
- Department of Pathology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China
| | - Yan Zeng
- Department of Zoology, College of Life Sciences, Nanjing Agricultural University, Nanjing, Jiangsu, 210095, China
| | - Robert Peter Gale
- Haematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, SW7 2AZ, UK
| | - Depei Wu
- First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, Suzhou, Jiangsu Province, 215006, China
| | - Bin Yin
- Department of Laboratory Medicine, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, Jiangsu Province, 214002, China; Cyrus Tang Hematology Center, Jiangsu Institute of Hematology, First Affiliated Hospital, Soochow University, Suzhou, Jiangsu Province, 215123, China.
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Abstract
For several decades, we have known that epigenetic regulation is disrupted in cancer. Recently, an increasing body of data suggests epigenetics might be an intersection of current cancer research trends: next generation sequencing, immunology, metabolomics, and cell aging. The new emphasis on epigenetics is also related to the increasing production of drugs capable of interfering with epigenetic mechanisms and able to trigger clinical responses in even advanced phase patients. In this review, we will use myeloid malignancies as proof of concept examples of how epigenetic mechanisms can trigger or promote oncogenesis. We will also show how epigenetic mechanisms are related to genetic aberrations, and how they affect other systems, like immune response. Finally, we will show how we can try to influence the fate of cancer cells with epigenetic therapy.
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Affiliation(s)
- Maximilian Stahl
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Nathan Kohrman
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Steven D. Gore
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Tae Kon Kim
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Amer M. Zeidan
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Thomas Prebet
- Department of Internal Medicine, Section of Hematology, Yale Cancer Center at Yale University, New Haven, Connecticut, United States of America
- * E-mail:
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The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood 2016; 127:2391-405. [PMID: 27069254 DOI: 10.1182/blood-2016-03-643544] [Citation(s) in RCA: 6124] [Impact Index Per Article: 765.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 04/06/2016] [Indexed: 02/06/2023] Open
Abstract
The World Health Organization (WHO) classification of tumors of the hematopoietic and lymphoid tissues was last updated in 2008. Since then, there have been numerous advances in the identification of unique biomarkers associated with some myeloid neoplasms and acute leukemias, largely derived from gene expression analysis and next-generation sequencing that can significantly improve the diagnostic criteria as well as the prognostic relevance of entities currently included in the WHO classification and that also suggest new entities that should be added. Therefore, there is a clear need for a revision to the current classification. The revisions to the categories of myeloid neoplasms and acute leukemia will be published in a monograph in 2016 and reflect a consensus of opinion of hematopathologists, hematologists, oncologists, and geneticists. The 2016 edition represents a revision of the prior classification rather than an entirely new classification and attempts to incorporate new clinical, prognostic, morphologic, immunophenotypic, and genetic data that have emerged since the last edition. The major changes in the classification and their rationale are presented here.
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Gou H, Zhou J, Ye Y, Hu X, Shang M, Zhang J, Zhao Z, Peng W, Zhou Y, Zhou Y, Song X, Lu X, Ying B. The prevalence and clinical profiles of FLT3-ITD, FLT3-TKD, NPM1, C-KIT, DNMT3A, and CEBPA mutations in a cohort of patients with de novo acute myeloid leukemia from southwest China. Tumour Biol 2015; 37:7357-70. [PMID: 26676635 DOI: 10.1007/s13277-015-4601-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 12/07/2015] [Indexed: 02/05/2023] Open
Abstract
While a substantial amount of data on gene mutations related to acute myeloid leukemia (AML) prognosis from western and other populations have been reported, these studies largely describe one or two genes. Additionally, in southwest China, only insufficient data exist regarding FLT3-ITD, FLT3-TKD, NPM1, C-KIT, DNMT3A, and CEBPA mutations have been widely used in clinical settings. Therefore, a comprehensive study about these mutations of clinical importance in the prognosis of AML in western China is necessary. In a cohort of 255 patients with de novo AML, we retrospectively analyzed the prevalence of the six gene mutations, and then we assessed the results in conjunction with clinical characteristics and treatment responses. As for the frequencies of these mutations, the NPM1 mutation occurred most frequently (17.7 %; 42/237), followed by the CEBPA mutation (15.0 %; 19/127) and the FLT3-ITD mutation (10.2 %; 25/244). The frequencies of the FLT3-TKD, DNMT3A, and C-KIT mutations were 3.7 % (9/234), 4.0 % (9/225) and 4.2 % (10/238), respectively. These mutations were closely related to clinical characteristics including FAB classification, gender and age, hemogram, blasts (%), fusion genes, and immunophenotypes. Additionally, a higher complete remission (CR) rate was found in NPM1-mutated patients. The occurrence of these mutations is variable among different countries and regions worldwide, which may provide clues to the etiology of AML. Besides, we identified new clinical characteristics that advance our understanding of these mutations and further clarify the involvement of these mutations in the development of leukemia.
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Affiliation(s)
- Haimei Gou
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Juan Zhou
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Yuanxin Ye
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Xuejiao Hu
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Mengqiao Shang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Jingya Zhang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Zhenzhen Zhao
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Wu Peng
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Yanhong Zhou
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Yi Zhou
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Xingbo Song
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Xiaojun Lu
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, People's Republic of China.
| | - Binwu Ying
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, People's Republic of China.
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The multifaceted functions of C/EBPα in normal and malignant haematopoiesis. Leukemia 2015; 30:767-75. [PMID: 26601784 DOI: 10.1038/leu.2015.324] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 11/08/2015] [Accepted: 11/16/2015] [Indexed: 02/06/2023]
Abstract
The process of blood formation, haematopoiesis, depends upon a small number of haematopoietic stem cells (HSCs) that reside in the bone marrow. Differentiation of HSCs is characterised by decreased expression of genes associated with self-renewal accompanied by a stepwise activation of genes promoting differentiation. Lineage branching is further directed by groups of cooperating and counteracting genes forming complex networks of lineage-specific transcription factors. Imbalances in such networks can result in blockage of differentiation, lineage reprogramming and malignant transformation. CCAAT/enhancer-binding protein-α (C/EBPα) was originally identified 30 years ago as a transcription factor that binds both promoter and enhancer regions. Most of the early work focused on the role of C/EBPα in regulating transcriptional processes as well as on its functions in key differentiation processes during liver, adipogenic and haematopoietic development. Specifically, C/EBPα was shown to control differentiation by its ability to coordinate transcriptional output with cell cycle progression. Later, its role as an important tumour suppressor, mainly in acute myeloid leukaemia (AML), was recognised and has been the focus of intense studies by a number of investigators. More recent work has revisited the role of C/EBPα in normal haematopoiesis, especially its function in HSCs, and also started to provide more mechanistic insights into its role in normal and malignant haematopoiesis. In particular, the differential actions of C/EBPα isoforms, as well as its importance in chromatin remodelling and cellular reprogramming, are beginning to be elucidated. Finally, recent work has also shed light on the dichotomous function of C/EBPα in AML by demonstrating its ability to act as both a tumour suppressor and promoter. In the present review, we will summarise the current knowledge on the functions of C/EBPα during normal and malignant haematopoiesis with special emphasis on the recent work.
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Vinhas R, Tolmatcheva A, Canto R, Ribeiro P, Lourenço A, Sousa ABD, Baptista PV, Fernandes AR. A novel mutation in CEBPA gene in a patient with acute myeloid leukemia. Leuk Lymphoma 2015; 57:711-3. [PMID: 26419342 DOI: 10.3109/10428194.2015.1065979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Raquel Vinhas
- a UCIBIO, Departamento de Ciências da Vida, Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa , Caparica
| | - Anna Tolmatcheva
- a UCIBIO, Departamento de Ciências da Vida, Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa , Caparica
| | - Rafaela Canto
- a UCIBIO, Departamento de Ciências da Vida, Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa , Caparica
| | - Patrícia Ribeiro
- b Serviço de Hematologia, Hospital dos Capuchos (CHLC) , Lisboa , Portugal
| | - Alexandra Lourenço
- b Serviço de Hematologia, Hospital dos Capuchos (CHLC) , Lisboa , Portugal
| | | | - Pedro V Baptista
- a UCIBIO, Departamento de Ciências da Vida, Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa , Caparica
| | - Alexandra R Fernandes
- a UCIBIO, Departamento de Ciências da Vida, Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa , Caparica
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Ziai JM, Siddon AJ. Pathology Consultation on Gene Mutations in Acute Myeloid Leukemia. Am J Clin Pathol 2015; 144:539-54. [PMID: 26386075 DOI: 10.1309/ajcp77zfpuqgygwy] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES Acute myeloid leukemia (AML) is a rapidly fatal disease without the use of aggressive chemotherapy regimens. Cytogenetic and molecular studies are commonly used to classify types of AML based on prognosis, as well as to determine therapeutic regimens. METHODS Although there are several AML classifications determined by particular translocations, cytogenetically normal AML represents a molecularly, as well as clinically, heterogeneous group of diseases. Laboratory evaluation of AML will become increasingly important as new mutations with both prognostic and therapeutic implications are being recognized. Moreover, because many patients with AML are being treated more effectively, these mutations may become increasingly useful as markers of minimal residual disease, which can be interpreted in an individualized approach. RESULTS Current laboratory studies of gene mutations in AML include analysis of NPM1, FLT3, CEBPA, and KIT. In addition to these genes, many other genes are emerging as potentially useful in determining patients' prognosis, therapy, and disease course. CONCLUSIONS This article briefly reviews the current most clinically relevant gene mutations and their clinical and immunophenotypic features, prognostic information, and methods used for detection.
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Affiliation(s)
| | - Alexa J. Siddon
- Departments of Pathology, Yale School of Medicine, New Haven, CT
- Laboratory Medicine, Yale School of Medicine, New Haven, CT
- VA Connecticut Healthcare, West Haven, CT
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Zwaan CM, Kolb EA, Reinhardt D, Abrahamsson J, Adachi S, Aplenc R, De Bont ESJM, De Moerloose B, Dworzak M, Gibson BES, Hasle H, Leverger G, Locatelli F, Ragu C, Ribeiro RC, Rizzari C, Rubnitz JE, Smith OP, Sung L, Tomizawa D, van den Heuvel-Eibrink MM, Creutzig U, Kaspers GJL. Collaborative Efforts Driving Progress in Pediatric Acute Myeloid Leukemia. J Clin Oncol 2015; 33:2949-62. [PMID: 26304895 DOI: 10.1200/jco.2015.62.8289] [Citation(s) in RCA: 244] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Diagnosis, treatment, response monitoring, and outcome of pediatric acute myeloid leukemia (AML) have made enormous progress during the past decades. Because AML is a rare type of childhood cancer, with an incidence of approximately seven occurrences per 1 million children annually, national and international collaborative efforts have evolved. This overview describes these efforts and includes a summary of the history and contributions of each of the main collaborative pediatric AML groups worldwide. The focus is on translational and clinical research, which includes past, current, and future clinical trials. Separate sections concern acute promyelocytic leukemia, myeloid leukemia of Down syndrome, and relapsed AML. A plethora of novel antileukemic agents that have emerged, including new classes of drugs, are summarized as well. Finally, an important aspect of the treatment of pediatric AML--supportive care--and late effects are discussed. The future is bright, with a wide range of emerging innovative therapies and with more and more international collaboration that ultimately aim to cure all children with AML, with fewer adverse effects and without late effects.
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Affiliation(s)
- C Michel Zwaan
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Edward A Kolb
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Dirk Reinhardt
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Jonas Abrahamsson
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Souichi Adachi
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Richard Aplenc
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Eveline S J M De Bont
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Barbara De Moerloose
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Michael Dworzak
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Brenda E S Gibson
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Henrik Hasle
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Guy Leverger
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Franco Locatelli
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Christine Ragu
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Raul C Ribeiro
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Carmelo Rizzari
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Jeffrey E Rubnitz
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Owen P Smith
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Lillian Sung
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Daisuke Tomizawa
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Marry M van den Heuvel-Eibrink
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Ursula Creutzig
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Gertjan J L Kaspers
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
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Disease evolution and outcomes in familial AML with germline CEBPA mutations. Blood 2015; 126:1214-23. [PMID: 26162409 DOI: 10.1182/blood-2015-05-647172] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 07/01/2015] [Indexed: 12/26/2022] Open
Abstract
In-depth molecular investigation of familial leukemia has been limited by the rarity of recognized cases. This study examines the genetic events initiating leukemia and details the clinical progression of disease across multiple families harboring germ-line CEBPA mutations. Clinical data were collected from 10 CEBPA-mutated families, representing 24 members with acute myeloid leukemia (AML). Whole-exome (WES) and deep sequencing were performed to genetically profile tumors and define patterns of clonal evolution. Germline CEBPA mutations clustered within the N-terminal and were highly penetrant, with AML presenting at a median age of 24.5 years (range, 1.75-46 years). In all diagnostic tumors tested (n = 18), double CEBPA mutations (CEBPAdm) were detected, with acquired (somatic) mutations preferentially targeting the C-terminal. Somatic CEBPA mutations were unstable throughout the disease course, with different mutations identified at recurrence. Deep sequencing of diagnostic and relapse paired samples confirmed that relapse-associated CEBPA mutations were absent at diagnosis, suggesting recurrence was triggered by novel, independent clones. Integrated WES and deep sequencing subsequently revealed an entirely new complement of mutations at relapse, verifying the presentation of a de novo leukemic episode. The cumulative incidence of relapse in familial AML was 56% at 10 years (n = 11), and 3 patients experienced ≥3 disease episodes over a period of 17 to 20 years. Durable responses to secondary therapies were observed, with prolonged median survival after relapse (8 years) and long-term overall survival (10-year overall survival, 67%). Our data reveal that familial CEBPA-mutated AML exhibits a unique model of disease progression, associated with favorable long-term outcomes.
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CEBPA methylation and mutation in myelodysplastic syndrome. Med Oncol 2015; 32:192. [DOI: 10.1007/s12032-015-0605-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 03/26/2015] [Indexed: 12/30/2022]
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Kagita S, Uppalapati S, Gundeti S, Digumarti R. Correlation of C/EBPα expression with response and resistance to imatinib in chronic myeloid leukaemia. Jpn J Clin Oncol 2015; 45:749-54. [PMID: 25920395 DOI: 10.1093/jjco/hyv064] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 04/01/2015] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Altered differentiation is a common feature of haematopoietic malignancies with poor prognosis. CAAT/enhancer binding protein alpha (C/EBPα) is a key transcription factor that regulates myeloid differentiation. This study is aimed to know the prognostic value of CAAT/enhancer binding protein alpha expression and correlate its expression with response to imatinib therapy. METHODS We quantified the expression of C/EBPα gene in 126 chronic myeloid leukaemia samples (82 from newly diagnosed and 44 from imatinib-resistant patients) and 20 control samples. C/EBPα mRNA level was measured by real-time quantitative polymerase chain reaction using the ΔΔCT method. RESULTS C/EBPα expression level was significantly lower in the imatinib-resistant group than in the pretreatment and control group (P = 0.0398). Low CAAT/enhancer binding protein alpha levels in the imatinib-resistant group were significantly associated with advanced phase (P = 0.04), with more peripheral blasts (P = 0.0001), high BCR-ABL levels (P = 0.018) and T315I and P-loop mutations (P = 0.0002). In the pretreatment group, low expression showed association with high EUTOS risk score (P = 0.03) and possible partial cytogenetic response (P = 0.010). CONCLUSIONS Our results suggest that low expression of CAAT/enhancer binding protein alpha might have a role in the response to imatinib and progression of disease in patients with chronic myeloid leukaemia.
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Affiliation(s)
- Sailaja Kagita
- Department of Medical Oncology, Nizams Institute of Medical Sciences, Hyderabad, Andhra Pradesh
| | - Srihari Uppalapati
- Department of Medical Oncology, Nizams Institute of Medical Sciences, Hyderabad, Andhra Pradesh
| | - Sadasivudu Gundeti
- Department of Medical Oncology, Nizams Institute of Medical Sciences, Hyderabad, Andhra Pradesh
| | - Raghunadharao Digumarti
- Department of Medical Oncology, Nizams Institute of Medical Sciences, Hyderabad, Andhra Pradesh Homi Bhabha Cancer Hospital and Research Centre, Visakapatnam, Andhra Pradesh, India
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Bachas C, Schuurhuis GJ, Zwaan CM, van den Heuvel-Eibrink MM, den Boer ML, de Bont ESJM, Kwidama ZJ, Reinhardt D, Creutzig U, de Haas V, Kaspers GJL, Cloos J. Gene expression profiles associated with pediatric relapsed AML. PLoS One 2015; 10:e0121730. [PMID: 25849371 PMCID: PMC4388534 DOI: 10.1371/journal.pone.0121730] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 02/17/2015] [Indexed: 02/04/2023] Open
Abstract
Development of relapse remains a problem for further improvements in the survival of pediatric AML patients. While virtually all patients show a good response to initial treatment, more patients respond poorly when treated at relapse. The cellular characteristics of leukemic blast cells that allow survival of initial treatment, relapse development and subsequent resistance to salvage treatment remain largely elusive. Therefore, we studied if leukemic blasts at relapse biologically resemble their initial diagnosis counterparts. We performed microarray gene expression profiling on paired initial and relapse samples of 23 pediatric AML patients. In 11 out of 23 patients, gene expression profiles of initial and corresponding relapse samples end up in different clusters in unsupervised analysis, indicating altered gene expression profiles. In addition, shifts in type I/II mutational status were found in 5 of these 11 patients, while shifts were found in 3 of the remaining 12 patients. Although differentially expressed genes varied between patients, they were commonly related to hematopoietic differentiation, encompassed genes involved in chromatin remodeling and showed associations with similar transcription factors. The top five were CEBPA, GFI1, SATB1, KLF2 and TBP. In conclusion, the leukemic blasts at relapse are biologically different from their diagnosis counterparts. These differences may be exploited for further development of novel treatment strategies.
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Affiliation(s)
- Costa Bachas
- Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands
- Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | | | - C. Michel Zwaan
- Department of Pediatric Oncology/Hematology, Erasmus MC/Sophia Children’s Hospital, Rotterdam, The Netherlands
| | | | - Monique L. den Boer
- Department of Pediatric Oncology/Hematology, Erasmus MC/Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Eveline S. J. M. de Bont
- Division of Pediatric Oncology/Hematology, Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Zinia J. Kwidama
- Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Dirk Reinhardt
- AML-BFM Study Group, Department of Pediatric Hematology/ Oncology, Medical School Hannover, Hannover, Germany
| | - Ursula Creutzig
- AML-BFM Study Group, Department of Pediatric Hematology/ Oncology, Medical School Hannover, Hannover, Germany
| | - Valérie de Haas
- Dutch Childhood Oncology Group (DCOG), The Hague, The Netherlands
| | - Gertjan J. L. Kaspers
- Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands
- Dutch Childhood Oncology Group (DCOG), The Hague, The Netherlands
| | - Jacqueline Cloos
- Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands
- Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands
- * E-mail:
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37
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Sandahl JD, Kjeldsen E, Abrahamsson J, Ha SY, Heldrup J, Jahnukainen K, Jónsson ÓG, Lausen B, Palle J, Zeller B, Forestier E, Hasle H. The applicability of the WHO classification in paediatric AML. A NOPHO-AML study. Br J Haematol 2015; 169:859-67. [PMID: 25819835 DOI: 10.1111/bjh.13366] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 01/20/2015] [Indexed: 12/30/2022]
Abstract
The World Health Organization (WHO) classification of myeloid leukaemia was revised in 2008. It incorporates newly recognized entities and emphasizes the pivotal role of cytogenetic abnormalities. The aim of this study was to evaluate the usability of the WHO classification when applied to a large population-based paediatric acute myeloid leukaemia (AML) cohort. We included children diagnosed with de novo AML, 0-18 years of age from the Nordic countries and Hong Kong from 1993 to 2012. Data were retrieved from the Nordic Society for Paediatric Haematology and Oncology AML database and patients classified according to the WHO 2008 classification. A successful karyotype was available in 97% of the cases. AML with recurrent genetic abnormalities were present in 262 (41%) and 94 (15%) were classified as AML with myelodysplasia-related changes (AML-MDS). WHO classifies patients with monosomy 7 and del(7q) into one group. We found that -7 (n = 14) had significantly poorer outcome than del(7q) (n = 11); 5-year event-free survival 26% vs. 67%, (P = 0·02), and 5-year overall survival 51% vs. 90%, (P = 0·04). The largest group was the highly heterogeneous AML not otherwise specified (NOS) (n = 280) (44%). In conclusion, the WHO classification allocated 15% to AML-MDS, 44% to NOS and grouped together entities with clearly different outcome, therefore limiting the applicability of the current WHO classification in children with AML.
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Affiliation(s)
- Julie D Sandahl
- Department of Paediatrics, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Eigil Kjeldsen
- Cancer Cytogenetics Laboratory, Department of Haematology Aarhus University Hospital, Aarhus, Denmark
| | - Jonas Abrahamsson
- Institution for Clinical Sciences, Department of Paediatrics, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Shau-Yin Ha
- Department of Paediatrics, Queen Mary Hospital and Hong Kong Paediatric Haematology & Oncology Study Group (HKPHOSG), Hong Kong, China
| | - Jesper Heldrup
- Department of Paediatrics, University Hospital, Lund, Sweden
| | - Kirsi Jahnukainen
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Birgitte Lausen
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Josefine Palle
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Bernward Zeller
- Department of Paediatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Erik Forestier
- Department of Medical Biosciences, Clinical Genetics, Umeå University Hospital, Umeå, Sweden
| | - Henrik Hasle
- Department of Paediatrics, Aarhus University Hospital Skejby, Aarhus, Denmark
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38
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de Rooij JDE, van den Heuvel-Eibrink MM, Hermkens MCH, Verboon LJ, Arentsen-Peters STCJM, Fornerod M, Baruchel A, Stary J, Reinhardt D, de Haas V, Pieters R, Zwaan CM. BCOR and BCORL1 mutations in pediatric acute myeloid leukemia. Haematologica 2015; 100:e194-5. [PMID: 25596268 DOI: 10.3324/haematol.2014.117796] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Jasmijn D E de Rooij
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | - Malou C H Hermkens
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Lonneke J Verboon
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | - Maarten Fornerod
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | - Jan Stary
- Pediatric Hematology/Oncology, 2nd Medical School, Charles University, Prague, Czech Republic
| | - Dirk Reinhardt
- AML-BFM Study Group, Department of Pediatric Oncology/Hematology, Medical High School, Hannover, Germany
| | - Valerie de Haas
- Dutch Childhood Oncology Group (DCOG), The Hague, The Netherlands
| | - Rob Pieters
- Princess Máxima Center for Pediatric Oncology, Utrectht, The Netherlands
| | - C Michel Zwaan
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
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Abstract
Pediatric acute myeloid leukemia (AML) represents 15%-20% of all pediatric acute leukemias. Survival rates have increased over the past few decades to ~70%, due to improved supportive care, optimized risk stratification and intensified chemotherapy. In most children, AML presents as a de novo entity, but in a minority, it is a secondary malignancy. The diagnostic classification of pediatric AML includes a combination of morphology, cytochemistry, immunophenotyping and molecular genetics. Outcome is mainly dependent on the initial response to treatment and molecular and cytogenetic aberrations. Treatment consists of a combination of intensive anthracycline- and cytarabine-containing chemotherapy and stem cell transplantation in selected genetic high-risk cases or slow responders. In general, ~30% of all pediatric AML patients will suffer from relapse, whereas 5%-10% of the patients will die due to disease complications or the side-effects of the treatment. Targeted therapy may enhance anti-leukemic efficacy and minimize treatment-related morbidity and mortality, but requires detailed knowledge of the genetic abnormalities and aberrant pathways involved in leukemogenesis. These efforts towards future personalized therapy in a rare disease, such as pediatric AML, require intensive international collaboration in order to enhance the survival rates of pediatric AML, while aiming to reduce long-term toxicity.
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40
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de Rooij JDE, Zwaan CM, van den Heuvel-Eibrink M. Pediatric AML: From Biology to Clinical Management. J Clin Med 2015; 4:127-49. [PMID: 26237023 PMCID: PMC4470244 DOI: 10.3390/jcm4010127] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 11/28/2014] [Indexed: 12/25/2022] Open
Abstract
Pediatric acute myeloid leukemia (AML) represents 15%–20% of all pediatric acute leukemias. Survival rates have increased over the past few decades to ~70%, due to improved supportive care, optimized risk stratification and intensified chemotherapy. In most children, AML presents as a de novo entity, but in a minority, it is a secondary malignancy. The diagnostic classification of pediatric AML includes a combination of morphology, cytochemistry, immunophenotyping and molecular genetics. Outcome is mainly dependent on the initial response to treatment and molecular and cytogenetic aberrations. Treatment consists of a combination of intensive anthracycline- and cytarabine-containing chemotherapy and stem cell transplantation in selected genetic high-risk cases or slow responders. In general, ~30% of all pediatric AML patients will suffer from relapse, whereas 5%–10% of the patients will die due to disease complications or the side-effects of the treatment. Targeted therapy may enhance anti-leukemic efficacy and minimize treatment-related morbidity and mortality, but requires detailed knowledge of the genetic abnormalities and aberrant pathways involved in leukemogenesis. These efforts towards future personalized therapy in a rare disease, such as pediatric AML, require intensive international collaboration in order to enhance the survival rates of pediatric AML, while aiming to reduce long-term toxicity.
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Affiliation(s)
- Jasmijn D E de Rooij
- Department of Pediatric Oncology, Erasmus MC-Sophia Children's Hospital, 3015CN Rotterdam, The Netherlands.
| | - C Michel Zwaan
- Department of Pediatric Oncology, Erasmus MC-Sophia Children's Hospital, 3015CN Rotterdam, The Netherlands.
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Skvarova Kramarzova K, Fiser K, Mejstrikova E, Rejlova K, Zaliova M, Fornerod M, Drabkin HA, van den Heuvel-Eibrink MM, Stary J, Trka J, Starkova J. Homeobox gene expression in acute myeloid leukemia is linked to typical underlying molecular aberrations. J Hematol Oncol 2014; 7:94. [PMID: 25539595 PMCID: PMC4310032 DOI: 10.1186/s13045-014-0094-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 12/04/2014] [Indexed: 02/02/2023] Open
Abstract
Background Although distinct patterns of homeobox (HOX) gene expression have been described in defined cytogenetic and molecular subsets of patients with acute myeloid leukemia (AML), it is unknown whether these patterns are the direct result of transcriptional alterations or rather represent the differentiation stage of the leukemic cell. Method To address this question, we used qPCR to analyze mRNA expression of HOXA and HOXB genes in bone marrow (BM) samples of 46 patients with AML and sorted subpopulations of healthy BM cells. These various stages of myeloid differentiation represent matched counterparts of morphological subgroups of AML. To further study the transcriptional alterations of HOX genes in hematopoiesis, we also analyzed gene expression of epigenetic modifiers in the subpopluations of healthy BM and leukemic cells. Results Unsupervised hierarchical clustering divided the AMLs into five clusters characterized by the presence of prevalent molecular genetic aberrations. Notably, the impact of genotype on HOX gene expression was significantly more pronounced than that of the differentiation stage of the blasts. This driving role of molecular aberrations was best exemplified by the repressive effect of the PML-RARa fusion gene on HOX gene expression, regardless of the presence of the FLT3/ITD mutation. Furthermore, HOX gene expression was positively correlated with mRNA levels of histone demethylases (JMJD3 and UTX) and negatively correlated with gene expression of DNA methyltranferases. No such relationships were observed in subpopulations of healthy BM cells. Conclusion Our results demonstrate that specific molecular genetic aberrations, rather than differentiation per se, underlie the observed differences in HOX gene expression in AML. Moreover, the observed correlations between epigenetic modifiers and HOX ex pression that are specific to malignant hematopoiesis, suggest their potential causal relationships. Electronic supplementary material The online version of this article (doi:10.1186/s13045-014-0094-0) contains supplementary material, which is available to authorized users.
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42
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Matsuo H, Kajihara M, Tomizawa D, Watanabe T, Saito AM, Fujimoto J, Horibe K, Kodama K, Tokumasu M, Itoh H, Nakayama H, Kinoshita A, Taga T, Tawa A, Taki T, Tanaka S, Adachi S. Prognostic implications of CEBPA mutations in pediatric acute myeloid leukemia: a report from the Japanese Pediatric Leukemia/Lymphoma Study Group. Blood Cancer J 2014; 4:e226. [PMID: 25014773 PMCID: PMC4219441 DOI: 10.1038/bcj.2014.47] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 05/19/2014] [Indexed: 11/30/2022] Open
Abstract
CCAAT/enhancer-binding protein alpha (CEBPA) mutations are a favorable prognostic factor in adult acute myeloid leukemia (AML) patients; however, few studies have examined their significance in pediatric AML patients. Here we examined the CEBPA mutation status and clinical outcomes of pediatric AML patients treated in the AML-05 study. We found that 47 (14.9%) of the 315 evaluable patients harbored mutations in CEBPA; 26 cases (8.3%) harbored a single mutation (CEBPA-single) and 21 (6.7%) harbored double or triple mutations (CEBPA-double). After excluding core-binding factor-AML cases, patients harboring CEBPA mutations showed better overall survival (OS; P=0.048), but not event-free survival (EFS; P=0.051), than wild-type patients. Multivariate analysis identified CEBPA-single and CEBPA-double as independent favorable prognostic factors for EFS in the total cohort (hazard ratio (HR): 0.47 and 0.33; P=0.02 and 0.01, respectively). CEBPA-double was also an independent favorable prognostic factor for OS (HR: 0.30; P=0.04). CEBPA-double remained an independent favorable factor for EFS (HR: 0.28; P=0.04) in the normal karyotype cohort. These results suggest that CEBPA mutations, particularly CEBPA-double, are an independent favorable prognostic factor in pediatric AML patients, which will have important implications for risk-stratified therapy.
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Affiliation(s)
- H Matsuo
- Department of Human Health Sciences, Kyoto University, Kyoto, Japan
| | - M Kajihara
- Department of Human Health Sciences, Kyoto University, Kyoto, Japan
| | - D Tomizawa
- Department of Pediatrics, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - T Watanabe
- Department of Nutritional Science, Aichi Gakuin University, Aichi, Japan
| | - A M Saito
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Aichi, Japan
| | - J Fujimoto
- Clinical Research Center, National Center for Child Health and Development, Tokyo, Japan
| | - K Horibe
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Aichi, Japan
| | - K Kodama
- Department of Human Health Sciences, Kyoto University, Kyoto, Japan
| | - M Tokumasu
- Department of Pediatrics, Kyoto University, Kyoto, Japan
| | - H Itoh
- Department of Human Health Sciences, Kyoto University, Kyoto, Japan
| | - H Nakayama
- Department of Pediatrics, National Hospital Organization Fukuoka-Higashi Medical Center, Fukuoka, Japan
| | - A Kinoshita
- Department of Pediatrics, St Marianna University School of Medicine, Kanagawa, Japan
| | - T Taga
- Department of Pediatrics, Shiga University of Medical Science, Shiga, Japan
| | - A Tawa
- Department of Pediatrics, National Hospital Organization Osaka Medical Hospital, Osaka, Japan
| | - T Taki
- Department of Molecular Diagnostics and Therapeutics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - S Tanaka
- Department of Pharmacoepidemiology, Kyoto University, Kyoto, Japan
| | - S Adachi
- Department of Human Health Sciences, Kyoto University, Kyoto, Japan
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43
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Musialik E, Bujko M, Kober P, Grygorowicz MA, Libura M, Przestrzelska M, Juszczyński P, Borg K, Florek I, Jakóbczyk M, Baranowska A, Siedlecki JA. Comparison of promoter DNA methylation and expression levels of genes encoding CCAAT/enhancer binding proteins in AML patients. Leuk Res 2014; 38:850-6. [DOI: 10.1016/j.leukres.2014.04.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 04/22/2014] [Accepted: 04/27/2014] [Indexed: 11/28/2022]
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44
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Faulk K, Gore L, Cooper T. Overview of therapy and strategies for optimizing outcomes in de novo pediatric acute myeloid leukemia. Paediatr Drugs 2014; 16:213-27. [PMID: 24639021 DOI: 10.1007/s40272-014-0067-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Although acute myelogenous leukemia (AML) accounts for <20 % of leukemia in children, it is responsible for over half of all pediatric leukemia deaths. Improvement in event-free survival rates, now over 50 %, are due largely to intensification of chemotherapy, aggressive supportive care, development of risk stratification based on cytogenetic and molecular markers, and improved salvage regimens. Despite this improvement over the past few decades, the survival rates have recently plateaued, and further improvement will need to take into account advances in molecular characterization of AML, development of novel agents, and better understanding of host factors influencing toxicity and response to chemotherapy. This article reviews the epidemiology and biology trends in diagnosis and treatment of pediatric acute myelogenous leukemia.
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Affiliation(s)
- Kelly Faulk
- Department of Pediatrics, University of Colorado School of Medicine/Anschutz Medical Campus, Aurora, CO, USA
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45
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Schuster MB, Frank AK, Bagger FO, Rapin N, Vikesaa J, Porse BT. Lack of the p42 form of C/EBPα leads to spontaneous immortalization and lineage infidelity of committed myeloid progenitors. Exp Hematol 2013; 41:882-893.e16. [PMID: 23831605 DOI: 10.1016/j.exphem.2013.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 06/06/2013] [Indexed: 01/10/2023]
Abstract
Acute myeloid leukemia (AML) develops via a multistep process involving several genetic and epigenetic events, which ultimately leads to the formation of a heterogeneous population of malignant cells, of which only a small subpopulation termed the leukemia initiating cell (LIC) is able to sustain the leukemia. The identity of the LIC is highly diverse and ranges from populations resembling hematopoietic stem cells or multipotent progenitors (MPPs) to more committed myeloid progenitors, and the question still remains whether this is a direct consequence of which cells are targets of the final transforming events. In this study, we use premalignant cells from a Cebpa mutant AML model, in which the LIC population resembles granulocyte-macrophage progenitors (GMPs), to show that premalignant GMPs undergo spontaneous immortalization with a high clonal frequency when cultured in vitro, suggesting that these cells constitute the target of the final transforming events. Furthermore, we show that premalignant GMPs are characterized by a distinct T cell gene expression signature correlating with an increased potential for differentiation toward the T cell lineage. These findings have implications for our understanding of the transcriptional wiring in premalignant myeloid progenitors and how this contributes to the development of AML.
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Affiliation(s)
- Mikkel B Schuster
- The Finsen Laboratory, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Denmark; Biotech Research and Innovation Center, University of Copenhagen, Copenhagen, Denmark; Danish Stem Cell Center, Faculty of Health Sciences, University of Copenhagen, Denmark
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46
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E6AP, an E3 ubiquitin ligase negatively regulates granulopoiesis by targeting transcription factor C/EBPα for ubiquitin-mediated proteasome degradation. Cell Death Dis 2013; 4:e590. [PMID: 23598402 PMCID: PMC3641343 DOI: 10.1038/cddis.2013.120] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
CCAAT/enhancer-binding protein alpha (C/EBPα) is an important transcription factor involved in granulocytic differentiation. Here, for the first time we demonstrate that E6-associated protein (E6AP), an E3 ubiquitin ligase targets C/EBPα for ubiquitin-mediated proteasome degradation and thereby negatively modulates its functions. Wild-type E6AP promotes ubiquitin dependent proteasome degradation of C/EBPα, while catalytically inactive E6-associated protein having cysteine replaced with alanine at amino-acid position 843 (E6AP-C843A) rather stabilizes it. Further, these two proteins physically associate both in non-myeloid (overexpressed human embryonic kidney epithelium) and myeloid cells. We show that E6AP-mediated degradation of C/EBPα protein expression curtails its transactivation potential on its target genes. Noticeably, E6AP degrades both wild-type 42 kDa CCAAT-enhancer-binding protein alpha (p42C/EBPα) and mutant isoform 30 kDa CCAAT-enhancer-binding protein alpha (p30C/EBPα), this may explain perturbed p42C/EBPα/p30C/EBPα ratio often observed in acute myeloid leukemia (AML). We show that overexpression of catalytically inactive E6AP-C843A in C/EBPα inducible K562- p42C/EBPα-estrogen receptor (ER) cells inhibits β-estradiol (E2)-induced C/EBPα degradation leading to enhanced granulocytic differentiation. This enhanced granulocytic differentiation upon E2-induced activation of C/EBPα in C/EBPα stably transfected cells (β-estradiol inducible K562 cells stably expressing p42C/EBPα-ER (K562-C/EBPα-p42-ER)) was further substantiated by siE6AP-mediated knockdown of E6AP in both K562-C/EBPα-p42-ER and 32dcl3 (32D clone 3, a cell line widely used model for in vitro study of hematopoietic cell proliferation, differentiation, and apoptosis) cells. Taken together, our data suggest that E6AP targeted C/EBPα protein degradation may provide a possible explanation for both loss of expression and/or functional inactivation of C/EBPα often experienced in myeloid leukemia.
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47
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Fasan A, Alpermann T, Haferlach C, Grossmann V, Roller A, Kohlmann A, Eder C, Kern W, Haferlach T, Schnittger S. Frequency and prognostic impact of CEBPA proximal, distal and core promoter methylation in normal karyotype AML: a study on 623 cases. PLoS One 2013; 8:e54365. [PMID: 23383300 PMCID: PMC3562230 DOI: 10.1371/journal.pone.0054365] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 12/11/2012] [Indexed: 11/26/2022] Open
Abstract
The clinical impact of aberrant CEBPA promoter methylation (PM) in AML is controversially discussed. The aim of this study was to clarify the significance of aberrant CEBPA PM with regard to clinical features in a cohort of 623 cytogenetically normal (CN) de novo AML. 555 cases had wild-type CEBPA, 68 cases harbored CEBPA mutations. The distal promoter was methylated in 238/623 cases (38.2%), the core promoter in 8 of 326 cases (2.5%), whereas proximal PM was never detected. CEBPA PM and CEBPA mutations were mutually exclusive. CEBPA distal PM positive cases were characterized by reduced CEBPA mRNA expression levels and elevated white blood cell counts. CEBPA distal PM was less frequent in patients with mutations in FLT3, NPM1 and TET2 and more frequent in cases with RUNX1 and IDH2R140 mutations. Overall, no association of methylation to prognosis was seen. However CEBPA distal PM was associated with inferior outcome in cases with low FLT3-ITD ratio or TET2 mutations. A distinct gene expression profile of CEBPA distal PM positive cases compared to CEBPA mutated and CEBPA distal PM negative cases was observed. In conclusion, the presence of aberrant CEBPA PM is associated with distinct biological features but impact on outcome is weak.
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48
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49
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Abstract
Pediatric acute myeloid leukemia (AML) is currently associated with survival rates as high as 70%. However, many events still occur, side effects are significant, and late effects occur and can even be life-threatening. Thus, the treatment of pediatric AML still needs further improvement. While most study groups agree on several principles of AML treatment, many unanswered questions and even controversies remain, which will be the topic of this review. Relapsed AML, the most frequent event in children, will also be discussed. The controversies justify future clinical studies. Fortunately, biotechnical developments provide novel treatment targets and targeted drugs, and will enable minimal residual disease-driven tailored therapy. Moreover, a wide range of new drugs is being developed. International collaboration is required to perform randomized, or even single-arm clinical studies, in this setting of subgroup-directed therapy, and fortunately is being accomplished. Therefore, optimism is justified and the treatment of pediatric AML will continue to improve.
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Affiliation(s)
- Gertjan J L Kaspers
- Department of Pediatric Oncology/Hematology of the VU University Medical Center, De Boelelaan 1117, NL-1081, HV Amsterdam, The Netherlands.
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50
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Abstract
In acute myeloid leukemia (AML), aberrant expression and mutations of transcription factors have been correlated with disease outcome. In the present study, we performed expression and mutation screening of GATA2, which is an essential transcription factor for regulation of myeloid lineage determination, in de novo pediatric AML patients. GATA2 mutations were detected in 5 of 230 patients, representing a frequency of 2.2% overall and 9.8% in cytogenetically normal AML. GATA2 expression analysis demonstrated that in 155 of 237 diagnostic samples (65%), GATA2 expression was higher than in normal BM. In complete remission, normalization of GATA2 expression was observed, whereas GATA2 expression levels stayed high in patients with resistant disease. High GATA2 expression at diagnosis was an independent poor prognostic factor for overall survival (hazard ratio [HR] = 1.7, P = .045), event-free survival (HR = 2.1, P = .002), and disease-free survival (HR = 2.3, P = .004). The prognostic impact of GATA2 was particularly evident in specific AML subgroups. In patients with French-American-British M5 morphology, inv(16), or high WT1 expression, significant differences in survival were observed between patients with high versus normal GATA2 expression. We conclude that high GATA2 expression is a novel poor prognostic marker in pediatric AML, which may contribute to better risk-group stratification and risk-adapted therapy in the future.
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