1
|
Shanmuganathan N, Wadham C, Shahrin N, Feng J, Thomson D, Wang P, Saunders V, Kok CH, King RM, Kenyon RR, Lin M, Pagani IS, Ross DM, Yong ASM, Grigg AP, Mills AK, Schwarer AP, Braley J, Altamura H, Yeung DT, Scott HS, Schreiber AW, Hughes TP, Branford S. Impact of additional genetic abnormalities at diagnosis of chronic myeloid leukemia for first-line imatinib-treated patients receiving proactive treatment intervention. Haematologica 2023; 108:2380-2395. [PMID: 36951160 PMCID: PMC10483360 DOI: 10.3324/haematol.2022.282184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/06/2022] [Accepted: 03/16/2023] [Indexed: 03/24/2023] Open
Abstract
The BCR::ABL1 gene fusion initiates chronic myeloid leukemia (CML); however, evidence has accumulated from studies of highly selected cohorts that variants in other cancer-related genes are associated with treatment failure. Nevertheless, the true incidence and impact of additional genetic abnormalities (AGA) at diagnosis of chronic phase (CP)-CML is unknown. We sought to determine whether AGA at diagnosis in a consecutive imatinib-treated cohort of 210 patients enrolled in the TIDEL-II trial influenced outcome despite a highly proactive treatment intervention strategy. Survival outcomes including overall survival, progression-free survival, failure-free survival, and BCR::ABL1 kinase domain mutation acquisition were evaluated. Molecular outcomes were measured at a central laboratory and included major molecular response (MMR, BCR::ABL1 ≤0.1%IS), MR4 (BCR::ABL1 ≤0.01%IS), and MR4.5 (BCR::ABL1 ≤0.0032%IS). AGA included variants in known cancer genes and novel rearrangements involving the formation of the Philadelphia chromosome. Clinical outcomes and molecular response were assessed based on the patient's genetic profile and other baseline factors. AGA were identified in 31% of patients. Potentially pathogenic variants in cancer-related genes were detected in 16% of patients at diagnosis (including gene fusions and deletions) and structural rearrangements involving the Philadelphia chromosome (Ph-associated rearrangements) were detected in 18%. Multivariable analysis demonstrated that the combined genetic abnormalities plus the EUTOS long-term survival clinical risk score were independent predictors of lower molecular response rates and higher treatment failure. Despite a highly proactive treatment intervention strategy, first-line imatinib-treated patients with AGA had poorer response rates. These data provide evidence for the incorporation of genomically-based risk assessment for CML.
Collapse
MESH Headings
- Humans
- Imatinib Mesylate/therapeutic use
- Antineoplastic Agents/therapeutic use
- Philadelphia Chromosome
- Fusion Proteins, bcr-abl/genetics
- Fusion Proteins, bcr-abl/metabolism
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myeloid, Chronic-Phase/drug therapy
- Protein Kinase Inhibitors/therapeutic use
Collapse
Affiliation(s)
- Naranie Shanmuganathan
- Department of Hematology, Royal Adelaide Hospital and SA Pathology, Adelaide, Australia; Department of Genetics and Molecular Pathology, SA Pathology, Adelaide, Australia; Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, Australia; Precision Cancer Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia; Clinical and Health Sciences, University of South Australia, Adelaide, Australia; Adelaide Medical School, University of Adelaide, Adelaide, Australia; Australasian Leukemia and Lymphoma Group (ALLG).
| | - Carol Wadham
- Department of Genetics and Molecular Pathology, SA Pathology, Adelaide, Australia; Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, Australia; Clinical and Health Sciences, University of South Australia, Adelaide
| | - NurHezrin Shahrin
- Department of Genetics and Molecular Pathology, SA Pathology, Adelaide, Australia; Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide
| | - Jinghua Feng
- Clinical and Health Sciences, University of South Australia, Adelaide, Australia; Australian Cancer Research Foundation Genomics Facility, Centre for Cancer Biology, SA Pathology, Adelaide
| | - Daniel Thomson
- Department of Genetics and Molecular Pathology, SA Pathology, Adelaide, Australia; Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide
| | - Paul Wang
- Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, Australia; Australian Cancer Research Foundation Genomics Facility, Centre for Cancer Biology, SA Pathology, Adelaide
| | - Verity Saunders
- Precision Cancer Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide
| | - Chung Hoow Kok
- Precision Cancer Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia; Clinical and Health Sciences, University of South Australia, Adelaide, Australia; Adelaide Medical School, University of Adelaide, Adelaide
| | - Rob M King
- Australian Cancer Research Foundation Genomics Facility, Centre for Cancer Biology, SA Pathology, Adelaide
| | - Rosalie R Kenyon
- Australian Cancer Research Foundation Genomics Facility, Centre for Cancer Biology, SA Pathology, Adelaide
| | - Ming Lin
- Australian Cancer Research Foundation Genomics Facility, Centre for Cancer Biology, SA Pathology, Adelaide
| | - Ilaria S Pagani
- Precision Cancer Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia; Adelaide Medical School, University of Adelaide, Adelaide, Australia; Australasian Leukemia and Lymphoma Group (ALLG)
| | - David M Ross
- Department of Hematology, Royal Adelaide Hospital and SA Pathology, Adelaide, Australia; Department of Genetics and Molecular Pathology, SA Pathology, Adelaide, Australia; Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, Australia; Precision Cancer Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia; Australasian Leukemia and Lymphoma Group (ALLG); Department of Hematology, Flinders University and Medical Centre, Adelaide
| | - Agnes S M Yong
- Precision Cancer Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia; Adelaide Medical School, University of Adelaide, Adelaide, Australia; Australasian Leukemia and Lymphoma Group (ALLG); The University of Western Australia Medical School, Western Australia
| | - Andrew P Grigg
- Australasian Leukemia and Lymphoma Group (ALLG); Department of Clinical Hematology, Austin Hospital and University of Melbourne, Melbourne
| | - Anthony K Mills
- Australasian Leukemia and Lymphoma Group (ALLG); Department of Hematology, Princess Alexandra Hospital, Brisbane
| | - Anthony P Schwarer
- Australasian Leukemia and Lymphoma Group (ALLG); Department of Hematology, Box Hill Hospital, Melbourne
| | - Jodi Braley
- Department of Genetics and Molecular Pathology, SA Pathology, Adelaide
| | - Haley Altamura
- Department of Genetics and Molecular Pathology, SA Pathology, Adelaide
| | - David T Yeung
- Department of Hematology, Royal Adelaide Hospital and SA Pathology, Adelaide, Australia; Precision Cancer Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia; Clinical and Health Sciences, University of South Australia, Adelaide, Australia; Adelaide Medical School, University of Adelaide, Adelaide, Australia; Australasian Leukemia and Lymphoma Group (ALLG)
| | - Hamish S Scott
- Department of Genetics and Molecular Pathology, SA Pathology, Adelaide, Australia; Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, Australia; Clinical and Health Sciences, University of South Australia, Adelaide, Australia; Adelaide Medical School, University of Adelaide, Adelaide, Australia; Australian Cancer Research Foundation Genomics Facility, Centre for Cancer Biology, SA Pathology, Adelaide
| | - Andreas W Schreiber
- Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, Australia; Australian Cancer Research Foundation Genomics Facility, Centre for Cancer Biology, SA Pathology, Adelaide, Australia; School of Biological Sciences, University of Adelaide, Adelaide
| | - Timothy P Hughes
- Department of Hematology, Royal Adelaide Hospital and SA Pathology, Adelaide, Australia; Precision Cancer Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia; Adelaide Medical School, University of Adelaide, Adelaide, Australia; Australasian Leukemia and Lymphoma Group (ALLG)
| | - Susan Branford
- Department of Genetics and Molecular Pathology, SA Pathology, Adelaide, Australia; Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, Australia; Precision Cancer Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia; Clinical and Health Sciences, University of South Australia, Adelaide, Australia; Adelaide Medical School, University of Adelaide, Adelaide
| |
Collapse
|
3
|
Pagani IS, Dang P, Saunders VA, Grose R, Shanmuganathan N, Kok CH, Carne L, Rwodzi Z, Watts S, McLean J, Braley J, Altamura H, Yeung DT, Branford S, Yong ASM, White DL, Hughes TP, Ross DM. Lineage of measurable residual disease in patients with chronic myeloid leukemia in treatment-free remission. Leukemia 2019; 34:1052-1061. [PMID: 31768016 DOI: 10.1038/s41375-019-0647-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/14/2019] [Accepted: 11/03/2019] [Indexed: 11/09/2022]
Abstract
Approximately half of patients with chronic myeloid leukemia (CML) in sustained deep molecular response who discontinue tyrosine kinase inhibitors (TKIs) remain in treatment-free remission (TFR). Some of these patients have measurable residual disease (MRD) by BCR-ABL1 mRNA testing, and most have detectable BCR-ABL1 DNA by highly sensitive methods. We used fluorescence-activated cell sorting and BCR-ABL1 DNA PCR to investigate the lineage of residual CML cells in TFR. Twenty patients in TFR for >1 year provided blood for sorting into granulocytes, monocytes, B cells, T cells, and NK cells. MRD was identified predominantly in the lymphoid compartment and never in granulocytes. B cells were more often BCR-ABL1 positive than T cells (18 vs 11/20 patients) and at higher levels (median 10-4.9 vs 10-5.7; P = 0.014). In 13 CML patients studied at diagnosis lymphocytes expressing BCR-ABL1 mRNA comprised a small proportion of total leukocytes. These data improve our understanding of TFR biology, since it is now clear that MRD in the blood of TFR patients need not imply the persistence of multipotent CML cells. Lineage-specific assessment of MRD could be explored as a means to improve the prediction of TFR.
Collapse
Affiliation(s)
- Ilaria S Pagani
- Cancer Program, Precision Medicine Theme, South Australian Health & Medical Research Institute, Adelaide, SA, Australia.,School of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.,Australasian Leukaemia and Lymphoma Group, Melbourne, VIC, Australia
| | - Phuong Dang
- Cancer Program, Precision Medicine Theme, South Australian Health & Medical Research Institute, Adelaide, SA, Australia
| | - Verity A Saunders
- Cancer Program, Precision Medicine Theme, South Australian Health & Medical Research Institute, Adelaide, SA, Australia
| | - Randall Grose
- Cancer Program, Precision Medicine Theme, South Australian Health & Medical Research Institute, Adelaide, SA, Australia
| | - Naranie Shanmuganathan
- Cancer Program, Precision Medicine Theme, South Australian Health & Medical Research Institute, Adelaide, SA, Australia.,School of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.,Australasian Leukaemia and Lymphoma Group, Melbourne, VIC, Australia.,Department of Haematology and Bone Marrow Transplantation, Royal Adelaide Hospital, Adelaide, SA, Australia.,Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, SA, Australia.,Genetic and Molecular Pathology, SA Pathology, Adelaide, SA, Australia
| | - Chung H Kok
- Cancer Program, Precision Medicine Theme, South Australian Health & Medical Research Institute, Adelaide, SA, Australia.,School of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Lisa Carne
- Department of Haematology and Bone Marrow Transplantation, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Zandy Rwodzi
- Department of Haematology and Bone Marrow Transplantation, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Sophie Watts
- Cancer Program, Precision Medicine Theme, South Australian Health & Medical Research Institute, Adelaide, SA, Australia
| | - Jennifer McLean
- Cancer Program, Precision Medicine Theme, South Australian Health & Medical Research Institute, Adelaide, SA, Australia
| | - Jodi Braley
- Genetic and Molecular Pathology, SA Pathology, Adelaide, SA, Australia
| | - Haley Altamura
- Genetic and Molecular Pathology, SA Pathology, Adelaide, SA, Australia
| | - David T Yeung
- Cancer Program, Precision Medicine Theme, South Australian Health & Medical Research Institute, Adelaide, SA, Australia.,School of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.,Australasian Leukaemia and Lymphoma Group, Melbourne, VIC, Australia.,Department of Haematology and Bone Marrow Transplantation, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Susan Branford
- School of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.,Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, SA, Australia.,Genetic and Molecular Pathology, SA Pathology, Adelaide, SA, Australia.,School of Biological Sciences, Faculty of Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Agnes S M Yong
- Cancer Program, Precision Medicine Theme, South Australian Health & Medical Research Institute, Adelaide, SA, Australia.,School of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.,Australasian Leukaemia and Lymphoma Group, Melbourne, VIC, Australia
| | - Deborah L White
- Cancer Program, Precision Medicine Theme, South Australian Health & Medical Research Institute, Adelaide, SA, Australia.,School of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.,Australasian Leukaemia and Lymphoma Group, Melbourne, VIC, Australia.,Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, SA, Australia.,School of Biological Sciences, Faculty of Sciences, University of Adelaide, Adelaide, SA, Australia.,School of Paediatrics, Faculty of Health Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Timothy P Hughes
- Cancer Program, Precision Medicine Theme, South Australian Health & Medical Research Institute, Adelaide, SA, Australia.,School of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.,Australasian Leukaemia and Lymphoma Group, Melbourne, VIC, Australia.,Department of Haematology and Bone Marrow Transplantation, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - David M Ross
- Cancer Program, Precision Medicine Theme, South Australian Health & Medical Research Institute, Adelaide, SA, Australia. .,School of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia. .,Australasian Leukaemia and Lymphoma Group, Melbourne, VIC, Australia. .,Department of Haematology and Bone Marrow Transplantation, Royal Adelaide Hospital, Adelaide, SA, Australia. .,Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, SA, Australia. .,Department of Haematology and Genetic Pathology, Flinders University and Medical Centre, Adelaide, SA, Australia.
| |
Collapse
|