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Gianfaldoni G, Mannelli F, Intermesoli T, Bencini S, Giupponi D, Farina G, Cutini I, Bonetti MI, Masciulli A, Audisio E, Ferrero D, Pavoni C, Scattolin AM, Bosi A, Rambaldi A, Bassan R. Early peripheral clearance of leukemia-associated immunophenotypes in AML: centralized analysis of a randomized trial. Blood Adv 2020; 4:301-311. [PMID: 31978214 PMCID: PMC6988394 DOI: 10.1182/bloodadvances.2019000406] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 12/20/2019] [Indexed: 12/15/2022] Open
Abstract
Although genetics is a relevant risk factor in acute myeloid leukemia (AML), it can be minimally informative and/or not readily available for the early identification of patients at risk for treatment failure. In a randomized trial comparing standard vs high-dose induction (ClinicalTrials.gov #NCT00495287), we studied early peripheral blast cell clearance (PBC) as a rapid predictive assay of chemotherapy response to determine whether it correlates with the achievement of complete remission (CR), as well as postremission outcome, according to induction intensity. Individual leukemia-associated immunophenotypes (LAIPs) identified pretherapy by flow cytometry were validated and quantified centrally after 3 days of treatment, expressing PBC on a logarithmic scale as the ratio of absolute LAIP+ cells on day 1 and day 4. Of 178 patients, 151 (84.8%) were evaluable. Patients in CR exhibited significantly higher median PBC (2.3 log) compared with chemoresistant patients (1.0 log; P < .0001). PBC < 1.0 predicted the worst outcome (CR, 28%). With 1.5 log established as the most accurate cutoff predicting CR, 87.5% of patients with PBC >1.5 (PBChigh, n = 96) and 43.6% of patients with PBC ≤1.5 (PBClow, n = 55) achieved CR after single-course induction (P < .0001). CR and PBChigh rates were increased in patients randomized to the high-dose induction arm (P = .04) and correlated strongly with genetic/cytogenetic risk. In multivariate analysis, PBC retained significant predictive power for CR, relapse risk, and survival. Thus, PBC analysis can provide a very early prediction of outcome, correlates with treatment intensity and disease subset, and may support studies of customized AML therapy.
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Affiliation(s)
- Giacomo Gianfaldoni
- Struttura Organizzativa Dipartimentale (SOD) Ematologia, Università di Firenze, and
| | - Francesco Mannelli
- Struttura Organizzativa Dipartimentale (SOD) Ematologia, Università di Firenze, and
- Centro Ricerca e Innovazione Malattie Mieloproliferative, Azienda Ospedaliero-Universitaria (AOU) Careggi, Florence, Italy
| | - Tamara Intermesoli
- Unità Strutturale Complessa di Ematologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Sara Bencini
- Struttura Organizzativa Dipartimentale (SOD) Ematologia, Università di Firenze, and
- Centro Diagnostico di Citofluorimetria e Immunoterapia, AOU Careggi, Florence, Italy
| | - Damiano Giupponi
- Unità Strutturale Complessa di Ematologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Giorgio Farina
- Unità Operativa Laboratorio Analisi-Citofluorimetria, Ospedale dell'Angelo, Mestre-Venezia, Italy
| | - Ilaria Cutini
- Struttura Organizzativa Dipartimentale (SOD) Ematologia, Università di Firenze, and
- SOD Terapie Cellulari e Medicina Trasfusionale, AOU Careggi, Florence, Italy
| | - Maria Ida Bonetti
- Struttura Organizzativa Dipartimentale (SOD) Ematologia, Università di Firenze, and
| | - Arianna Masciulli
- Unità Strutturale Complessa di Ematologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Ernesta Audisio
- Struttura Complessa di Ematologia, Ospedale Molinette, Turin, Italy
| | - Dario Ferrero
- Divisione di Ematologia, Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Turin, Italy; and
| | - Chiara Pavoni
- Unità Strutturale Complessa di Ematologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | | | - Alberto Bosi
- Struttura Organizzativa Dipartimentale (SOD) Ematologia, Università di Firenze, and
| | - Alessandro Rambaldi
- Unità Strutturale Complessa di Ematologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Renato Bassan
- Unità Operativa di Ematologia, Ospedale dell'Angelo, Mestre-Venezia, Italy
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Mannelli F, Ponziani V, Bencini S, Bonetti MI, Benelli M, Cutini I, Gianfaldoni G, Scappini B, Pancani F, Piccini M, Rondelli T, Caporale R, Gelli AMG, Peruzzi B, Chiarini M, Borlenghi E, Spinelli O, Giupponi D, Zanghì P, Bassan R, Rambaldi A, Rossi G, Bosi A. CEBPA-double-mutated acute myeloid leukemia displays a unique phenotypic profile: a reliable screening method and insight into biological features. Haematologica 2016; 102:529-540. [PMID: 28250006 PMCID: PMC5394975 DOI: 10.3324/haematol.2016.151910] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 10/28/2016] [Indexed: 11/09/2022] Open
Abstract
Mutations in CCAAT/enhancer binding protein α (CEBPA) occur in 5-10% of cases of acute myeloid leukemia. CEBPA-double-mutated cases usually bear biallelic N- and C-terminal mutations and are associated with a favorable clinical outcome. Identification of CEBPA mutants is challenging because of the variety of mutations, intrinsic characteristics of the gene and technical issues. Several screening methods (fragment-length analysis, gene expression array) have been proposed especially for large-scale clinical use; although efficient, they are limited by specific concerns. We investigated the phenotypic profile of blast and maturing bone marrow cell compartments at diagnosis in 251 cases of acute myeloid leukemia. In this cohort, 16 (6.4%) patients had two CEBPA mutations, whereas ten (4.0%) had a single mutation. First, we highlighted that the CEBPA-double-mutated subset displays recurrent phenotypic abnormalities in all cell compartments. By mutational analysis after cell sorting, we demonstrated that this common phenotypic signature depends on CEBPA-double-mutated multi-lineage involvement. From a multidimensional study of phenotypic data, we developed a classifier including ten core and widely available parameters. The selected markers on blasts (CD34, CD117, CD7, CD15, CD65), neutrophil (SSC, CD64), monocytic (CD14, CD64) and erythroid (CD117) compartments were able to cluster CEBPA-double-mutated cases. In a validation set of 259 AML cases from three independent centers, our classifier showed excellent performance with 100% specificity and 100% sensitivity. We have, therefore, established a reliable screening method, based upon multidimensional analysis of widely available phenotypic parameters. This method provides early results and is suitable for large-scale detection of CEBPA-double-mutated status, allowing gene sequencing to be focused in selected cases.
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Affiliation(s)
- Francesco Mannelli
- Unità Funzionale di Ematologia, Università degli Studi, AOU Careggi, Firenze, Italy .,Istituto Toscano Tumori, Firenze, Italy
| | - Vanessa Ponziani
- Unità Funzionale di Ematologia, Università degli Studi, AOU Careggi, Firenze, Italy.,Istituto Toscano Tumori, Firenze, Italy
| | - Sara Bencini
- Unità Funzionale di Ematologia, Università degli Studi, AOU Careggi, Firenze, Italy.,Istituto Toscano Tumori, Firenze, Italy
| | - Maria Ida Bonetti
- Unità Funzionale di Ematologia, Università degli Studi, AOU Careggi, Firenze, Italy.,Istituto Toscano Tumori, Firenze, Italy
| | | | - Ilaria Cutini
- Unità Funzionale di Ematologia, Università degli Studi, AOU Careggi, Firenze, Italy.,Istituto Toscano Tumori, Firenze, Italy
| | - Giacomo Gianfaldoni
- Unità Funzionale di Ematologia, Università degli Studi, AOU Careggi, Firenze, Italy.,Istituto Toscano Tumori, Firenze, Italy
| | - Barbara Scappini
- Unità Funzionale di Ematologia, Università degli Studi, AOU Careggi, Firenze, Italy.,Istituto Toscano Tumori, Firenze, Italy
| | - Fabiana Pancani
- Unità Funzionale di Ematologia, Università degli Studi, AOU Careggi, Firenze, Italy.,Istituto Toscano Tumori, Firenze, Italy
| | - Matteo Piccini
- Unità Funzionale di Ematologia, Università degli Studi, AOU Careggi, Firenze, Italy.,Istituto Toscano Tumori, Firenze, Italy
| | - Tommaso Rondelli
- SOD Laboratorio Centrale, Settore Citometria Clinica, AOU Careggi, Firenze, Italy
| | - Roberto Caporale
- SOD Laboratorio Centrale, Settore Citometria Clinica, AOU Careggi, Firenze, Italy
| | | | - Benedetta Peruzzi
- SOD Laboratorio Centrale, Settore Citometria Clinica, AOU Careggi, Firenze, Italy
| | - Marco Chiarini
- Centro di Ricerca Emato-Oncologica AIL (CREA), Spedali Civili, Brescia, Italy
| | | | - Orietta Spinelli
- Unità Strutturale Complessa di Ematologia, Ospedali Riuniti, Bergamo, Italy
| | - Damiano Giupponi
- Unità Strutturale Complessa di Ematologia, Ospedali Riuniti, Bergamo, Italy
| | - Pamela Zanghì
- Unità Strutturale Complessa di Ematologia, Ospedali Riuniti, Bergamo, Italy
| | - Renato Bassan
- Divisione di Ematologia, Ospedale dell'Angelo & Ospedale SS. Giovanni e Paolo, Mestre-Venezia, Italy
| | | | | | - Alberto Bosi
- Unità Funzionale di Ematologia, Università degli Studi, AOU Careggi, Firenze, Italy.,Istituto Toscano Tumori, Firenze, Italy
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