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Naumann N, Rudelius M, Lübke J, Christen D, Bresser J, Sotlar K, Metzgeroth G, Fabarius A, Hofmann WK, Panse J, Horny HP, Cross NCP, Reiter A, Schwaab J. Poor Applicability of Currently Available Prognostic Scoring Systems for Prediction of Outcome in KIT D816V-Negative Advanced Systemic Mastocytosis. Cancers (Basel) 2024; 16:593. [PMID: 38339343 PMCID: PMC10854835 DOI: 10.3390/cancers16030593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
Within our nationwide registry, we identified a KIT D816V mutation (KIT D816Vpos.) in 280/299 (94%) patients with advanced systemic mastocytosis (AdvSM). Age, cytopenias and the presence of additional somatic mutations confer inferior overall survival (OS). However, little is known about the characteristics of KIT D816V-negative (D816Vneg.) AdvSM. In 19 D816Vneg. patients, a combination of clinical, morphological and genetic features revealed three subgroups: (a) KIT D816H- or Y-positive SM (KIT D816H/Ypos., n = 7), predominantly presenting as mast cell leukemia (MCL; 6/7 patients), (b) MCL with negative KIT sequencing (KITneg. MCL, n = 7) and (c) KITneg. SM with associated hematologic neoplasm (KITneg. SM-AHN, n = 5). Although >70% of patients in the two MCL cohorts (KIT D816H/Ypos. and KITneg.) were classified as low/intermediate risk according to prognostic scoring systems (PSS), treatment response was poor and median OS was shorter than in a KIT D816Vpos. MCL control cohort (n = 29; 1.7 vs. 0.9 vs. 2.6 years; p < 0.04). The KITneg. SM-AHN phenotype was dominated by the heterogeneous AHN (low mast cell burden, presence of additional mutations) with a better median OS of 4.5 years. We conclude that (i) in MCL, negativity for D816V is a relevant prognostic factor and (ii) PSS fail to correctly classify D816Vneg. patients.
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Affiliation(s)
- Nicole Naumann
- Hematology and Oncology, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (N.N.)
| | - Martina Rudelius
- Institute of Pathology, Ludwig-Maximilian-University, 80337 Munich, Germany
| | - Johannes Lübke
- Hematology and Oncology, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (N.N.)
| | - Deborah Christen
- Department of Oncology, Haematology, Haemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany
- Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), 52074 Aachen, Germany
| | - Jakob Bresser
- Hematology and Oncology, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (N.N.)
| | - Karl Sotlar
- Institute of Pathology, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Georgia Metzgeroth
- Hematology and Oncology, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (N.N.)
| | - Alice Fabarius
- Hematology and Oncology, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (N.N.)
| | - Wolf-Karsten Hofmann
- Hematology and Oncology, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (N.N.)
| | - Jens Panse
- Department of Oncology, Haematology, Haemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany
- Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), 52074 Aachen, Germany
| | - Hans-Peter Horny
- Institute of Pathology, Ludwig-Maximilian-University, 80337 Munich, Germany
| | - Nicholas C. P. Cross
- Wessex Genomics Laboratory Service, Salisbury SP2 8BJ, UK
- Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK
| | - Andreas Reiter
- Hematology and Oncology, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (N.N.)
| | - Juliana Schwaab
- Hematology and Oncology, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (N.N.)
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2
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McLornan DP, Godfrey AL, Green A, Frewin R, Arami S, Brady J, Butt NM, Cargo C, Ewing J, Francis S, Garg M, Harrison C, Innes A, Khan A, Knapper S, Lambert J, Mead A, McGregor A, Neelakantan P, Psaila B, Somervaille TCP, Woodley C, Nangalia J, Cross NCP, McMullin MF. Diagnosis and evaluation of prognosis of myelofibrosis: A British Society for Haematology Guideline. Br J Haematol 2024; 204:127-135. [PMID: 37932932 DOI: 10.1111/bjh.19164] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/02/2023] [Accepted: 10/08/2023] [Indexed: 11/08/2023]
Affiliation(s)
- Donal P McLornan
- Department of Haematology, University College London Hospitals, London, UK
| | - Anna L Godfrey
- Haematopathology and Oncology Diagnostics Service, Department of Haematology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Anna Green
- Department of Histopathology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Rebecca Frewin
- Department of Haematology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Siamak Arami
- Department of Haematology, London Northwest Healthcare University NHS Trust, London, UK
| | - Jessica Brady
- Department of Clinical Oncology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Nauman M Butt
- Department of Haematology, The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - Catherine Cargo
- Department of Haematology, Leeds Teaching Hospitals NHS Foundation Trust, Leeds, UK
| | - Joanne Ewing
- Department of Haematology, University Hospitals Birmingham Trust, Birmingham, UK
| | - Sebastian Francis
- Department of Haematology, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
| | - Mamta Garg
- Department of Haematology, University Hospitals Leicester NHS Trust, Leicester, UK
| | - Claire Harrison
- Department of Haematology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Andrew Innes
- Department of Haematology, Imperial College, London, UK
| | - Alesia Khan
- Department of Haematology, Leeds Teaching Hospitals NHS Foundation Trust, Leeds, UK
| | - Steve Knapper
- Department of Haematology, Cardiff University, Cardiff, UK
| | - Jonathan Lambert
- Department of Haematology, University College London Hospitals, London, UK
| | - Adam Mead
- MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
- Department of Haematology, Churchill Hospital, Oxford University NHS Trust, Oxford, UK
| | - Andrew McGregor
- Department of Haematology, Freeman Hospital, Newcastle upon Tyne, UK
| | - Pratap Neelakantan
- Department of Haematology, Royal Berkshire NHS Foundation Trust, Berkshire, UK
| | - Bethan Psaila
- MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
- Department of Haematology, Churchill Hospital, Oxford University NHS Trust, Oxford, UK
| | - Tim C P Somervaille
- Cancer Research UK Manchester Institute and The Christie NHS Foundation Trust, Manchester, UK
| | - Claire Woodley
- Department of Haematology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Jyoti Nangalia
- Wellcome Sanger Institute, University of Cambridge, Cambridge, UK
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3
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McLornan DP, Psaila B, Ewing J, Innes A, Arami S, Brady J, Butt NM, Cargo C, Cross NCP, Francis S, Frewin R, Garg M, Godfrey AL, Green A, Khan A, Knapper S, Lambert J, McGregor A, McMullin MF, Nangalia J, Neelakantan P, Woodley C, Mead A, Somervaille TCP, Harrison CN. The management of myelofibrosis: A British Society for Haematology Guideline. Br J Haematol 2024; 204:136-150. [PMID: 38037886 DOI: 10.1111/bjh.19186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/03/2023] [Accepted: 10/20/2023] [Indexed: 12/02/2023]
Affiliation(s)
- Donal P McLornan
- Department of Haematology, University College London Hospitals, London, UK
| | - Bethan Psaila
- MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
- Department of Haematology, Churchill Hospital, Oxford University NHS Trust, Oxford, UK
| | - Joanne Ewing
- Department of Haematology, University Hospitals Birmingham Trust, London, UK
| | - Andrew Innes
- Department of Haematology, Imperial College, London, UK
| | - Siamak Arami
- Department of Haematology, London Northwest Healthcare University NHS Trust, London, UK
| | - Jessica Brady
- Department of Clinical Oncology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Nauman M Butt
- Department of Haematology, The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - Catherine Cargo
- Department of Haematology, Leeds Teaching Hospitals NHS Foundation Trust, Leeds, UK
| | | | - Sebastian Francis
- Department of Haematology, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
| | - Rebecca Frewin
- Department of Haematology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Mamta Garg
- Department of Haematology, University Hospitals Leicester NHS Trust, Leicester, UK
| | - Anna L Godfrey
- Haematopathology & Oncology Diagnostics Service, Department of Haematology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Anna Green
- Department of Histopathology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Alesia Khan
- Department of Haematology, Leeds Teaching Hospitals NHS Foundation Trust, Leeds, UK
| | - Steve Knapper
- Department of Haematology, Cardiff University, Cardiff, UK
| | - Jonathan Lambert
- Department of Haematology, University College London Hospitals, London, UK
| | | | | | - Jyoti Nangalia
- Wellcome Sanger Institute, University of Cambridge, Cambridge, UK
| | - Pratap Neelakantan
- Department of Haematology, Royal Berkshire NHS Foundation Trust, London, UK
| | - Claire Woodley
- Department of Haematology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Adam Mead
- MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
- Department of Haematology, Churchill Hospital, Oxford University NHS Trust, Oxford, UK
| | - Tim C P Somervaille
- Cancer Research UK Manchester Institute & The Christie NHS Foundation Trust, Manchester, UK
| | - Claire N Harrison
- Department of Haematology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
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4
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Carreño-Tarragona G, Álvarez-Larrán A, Hernández-Boluda JC, Ayala R, Cross NCP. Should we move to a genomic classification of neutrophilic myeloid neoplasms? Blood Adv 2023; 7:6705-6706. [PMID: 37672387 PMCID: PMC10641471 DOI: 10.1182/bloodadvances.2023011103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/26/2023] [Accepted: 09/02/2023] [Indexed: 09/08/2023] Open
Affiliation(s)
- Gonzalo Carreño-Tarragona
- Department of Hematology, Hospital Universitario 12 de Octubre, I+12, CNIO, Complutense University, CIBERONC, Madrid, Spain
| | | | | | - Rosa Ayala
- Department of Hematology, Hospital Universitario 12 de Octubre, I+12, CNIO, Complutense University, CIBERONC, Madrid, Spain
| | - Nicholas C. P. Cross
- Wessex Genomic Laboratory Service, Salisbury, United Kingdom
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
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5
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Cross NCP, Ernst T, Branford S, Cayuela JM, Deininger M, Fabarius A, Kim DDH, Machova Polakova K, Radich JP, Hehlmann R, Hochhaus A, Apperley JF, Soverini S. European LeukemiaNet laboratory recommendations for the diagnosis and management of chronic myeloid leukemia. Leukemia 2023; 37:2150-2167. [PMID: 37794101 PMCID: PMC10624636 DOI: 10.1038/s41375-023-02048-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/13/2023] [Accepted: 09/20/2023] [Indexed: 10/06/2023]
Abstract
From the laboratory perspective, effective management of patients with chronic myeloid leukemia (CML) requires accurate diagnosis, assessment of prognostic markers, sequential assessment of levels of residual disease and investigation of possible reasons for resistance, relapse or progression. Our scientific and clinical knowledge underpinning these requirements continues to evolve, as do laboratory methods and technologies. The European LeukemiaNet convened an expert panel to critically consider the current status of genetic laboratory approaches to help diagnose and manage CML patients. Our recommendations focus on current best practice and highlight the strengths and pitfalls of commonly used laboratory tests.
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Affiliation(s)
| | - Thomas Ernst
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Susan Branford
- Centre for Cancer Biology and SA Pathology, Adelaide, SA, Australia
| | - Jean-Michel Cayuela
- Laboratory of Hematology, University Hospital Saint-Louis, AP-HP and EA3518, Université Paris Cité, Paris, France
| | | | - Alice Fabarius
- III. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - Dennis Dong Hwan Kim
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | | | | | - Rüdiger Hehlmann
- III. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
- ELN Foundation, Weinheim, Germany
| | - Andreas Hochhaus
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Jane F Apperley
- Centre for Haematology, Imperial College London, London, UK
- Department of Clinical Haematology, Imperial College Healthcare NHS Trust, London, UK
| | - Simona Soverini
- Department of Medical and Surgical Sciences, Institute of Hematology "Lorenzo e Ariosto Seràgnoli", University of Bologna, Bologna, Italy
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6
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Metzgeroth G, Steiner L, Naumann N, Lübke J, Kreil S, Fabarius A, Haferlach C, Haferlach T, Hofmann WK, Cross NCP, Schwaab J, Reiter A. Myeloid/lymphoid neoplasms with eosinophilia and tyrosine kinase gene fusions: reevaluation of the defining characteristics in a registry-based cohort. Leukemia 2023; 37:1860-1867. [PMID: 37454239 PMCID: PMC10457188 DOI: 10.1038/s41375-023-01958-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 05/18/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Abstract
In a registry-based analysis of 135 patients with "myeloid/lymphoid neoplasms with eosinophilia and tyrosine kinase gene fusions" (MLN-TK; FIP1L1::PDGFRA, n = 78; PDGFRB, diverse fusions, n = 26; FGFR1, diverse, n = 9; JAK2, diverse, n = 11; ETV6::ABL1, n = 11), we sought to evaluate the disease-defining characteristics. In 81/135 (60%) evaluable patients, hypereosinophilia (>1.5 × 109/l) was observed in 40/44 (91%) FIP1L1::PDGFRA and 7/7 (100%) ETV6::ABL1 positive patients but only in 13/30 (43%) patients with PDGFRB, FGFR1, and JAK2 fusion genes while 9/30 (30%) patients had no eosinophilia. Monocytosis >1 × 109/l was identified in 27/81 (33%) patients, most frequently in association with hypereosinophilia (23/27, 85%). Overall, a blast phase (BP) was diagnosed in 38/135 (28%) patients (myeloid, 61%; lymphoid, 39%), which was at extramedullary sites in 18 (47%) patients. The comparison between patients with PDGFRA/PDGFRB vs. FGFR1, JAK2, and ETV6::ABL1 fusion genes revealed a similar occurrence of primary BP (17/104, 16% vs. 8/31 26%, p = 0.32), a lower frequency (5/87, 6% vs. 8/23, 35%, p = 0.003) of and a later progression (median 87 vs. 19 months, p = 0.053) into secondary BP, and a better overall survival from diagnosis of BP (17.1 vs. 1.7 years, p < 0.0008). We conclude that hypereosinophilia with or without monocytosis and various phenotypes of BP occur at variable frequencies in MLN-TK.
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Affiliation(s)
- Georgia Metzgeroth
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Laurenz Steiner
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Nicole Naumann
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Johannes Lübke
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Sebastian Kreil
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Alice Fabarius
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | | | | | - Wolf-Karsten Hofmann
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Nicholas C P Cross
- Wessex Regional Genetics Laboratory, Salisbury, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Juliana Schwaab
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Andreas Reiter
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany.
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7
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Carreño-Tarragona G, Álvarez-Larrán A, Harrison C, Martínez-Ávila JC, Hernández-Boluda JC, Ferrer-Marín F, Radia DH, Mora E, Francis S, González-Martínez T, Goddard K, Pérez-Encinas M, Narayanan S, Raya JM, Singh V, Gutiérrez X, Toth P, Amat-Martínez P, Mcilwaine L, Alobaidi M, Mayani K, McGregor A, Stuckey R, Psaila B, Segura A, Alvares C, Davidson K, Osorio S, Cutting R, Sweeney CP, Rufián L, Moreno L, Cuenca I, Smith J, Morales ML, Gil-Manso R, Koutsavlis I, Wang L, Mead AJ, Rozman M, Martínez-López J, Ayala R, Cross NCP. CNL and aCML should be considered as a single entity based on molecular profiles and outcomes. Blood Adv 2023; 7:1672-1681. [PMID: 36375042 PMCID: PMC10182308 DOI: 10.1182/bloodadvances.2022008204] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/13/2022] [Accepted: 09/27/2022] [Indexed: 01/11/2023] Open
Abstract
Chronic neutrophilic leukemia (CNL) and atypical chronic myeloid leukemia (aCML) are rare myeloid disorders that are challenging with regard to diagnosis and clinical management. To study the similarities and differences between these disorders, we undertook a multicenter international study of one of the largest case series (CNL, n = 24; aCML, n = 37 cases, respectively), focusing on the clinical and mutational profiles (n = 53 with molecular data) of these diseases. We found no differences in clinical presentations or outcomes of both entities. As previously described, both CNL and aCML share a complex mutational profile with mutations in genes involved in epigenetic regulation, splicing, and signaling pathways. Apart from CSF3R, only EZH2 and TET2 were differentially mutated between them. The molecular profiles support the notion of CNL and aCML being a continuum of the same disease that may fit best within the myelodysplastic/myeloproliferative neoplasms. We identified 4 high-risk mutated genes, specifically CEBPA (β = 2.26, hazard ratio [HR] = 9.54, P = .003), EZH2 (β = 1.12, HR = 3.062, P = .009), NRAS (β = 1.29, HR = 3.63, P = .048), and U2AF1 (β = 1.75, HR = 5.74, P = .013) using multivariate analysis. Our findings underscore the relevance of molecular-risk classification in CNL/aCML as well as the importance of CSF3R mutations in these diseases.
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MESH Headings
- Humans
- Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative/diagnosis
- Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative/genetics
- Leukemia, Neutrophilic, Chronic/diagnosis
- Leukemia, Neutrophilic, Chronic/genetics
- Epigenesis, Genetic
- Myelodysplastic-Myeloproliferative Diseases/genetics
- Mutation
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Affiliation(s)
- Gonzalo Carreño-Tarragona
- Hematology Department, Hospital Universitario 12 de Octubre, I+12, Centro Nacional de Investigaciones Oncológicas, Complutense University, Centro de Investigación Biomédica en Red de Oncología, Madrid, Spain
| | | | - Claire Harrison
- Hematology Department, Guy’s and St. Thomas NHS Foundation Trust, London, United Kingdom
| | - José Carlos Martínez-Ávila
- Agricultural Economics, Statistics and Business Management Department, Escuela Técnica Superior de Ingeniería Agrónomica, Alimentaria y Biosistemas, Universidad Politécnica de Madrid, Madrid, Spain
| | | | - Francisca Ferrer-Marín
- Hematology Department, Hospital Morales Meseguer, Centro de Investigación Biomédica en Red de Enfermedades Raras, Universidad Católica San Antonio de Murcia, Murcia, Spain
| | - Deepti H. Radia
- Hematology Department, Guy’s and St. Thomas NHS Foundation Trust, London, United Kingdom
| | - Elvira Mora
- Hematology Department, Hospital Universitario La Fe, Valencia, Spain
| | - Sebastian Francis
- Hematology Department, Sheffield Hospital, Sheffield, United Kingdom
| | | | - Kathryn Goddard
- Hematology Department, Rotherham Hospital, Rotherham, United Kingdom
| | - Manuel Pérez-Encinas
- Hematology Department, Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - Srinivasan Narayanan
- Hematology Department, University Hospital Southampton, Southampton, United Kingdom
| | - José María Raya
- Hematology Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - Vikram Singh
- The Clatterbridge Cancer Centre, Liverpool, United Kingdom
| | - Xabier Gutiérrez
- Hematology Department, Hospital Universitario 12 de Octubre, I+12, Centro Nacional de Investigaciones Oncológicas, Complutense University, Centro de Investigación Biomédica en Red de Oncología, Madrid, Spain
| | - Peter Toth
- Hematology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | | | - Louisa Mcilwaine
- Hematology Department, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Magda Alobaidi
- Department of Haematology, Chelsea and Westminster NHS Trust West Middlesex Hospital, London, United Kingdom
| | - Karan Mayani
- Hematology Department, Hospital General de La Palma, Santa Cruz de Tenerife, Spain
| | - Andrew McGregor
- Department of Haematology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Ruth Stuckey
- Hematology Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Bethan Psaila
- MRC Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
- Department of Haematology, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Adrián Segura
- Hematology Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Caroline Alvares
- Hematology Department, University Hospital of Wales, Cardiff, United Kingdom
| | - Kerri Davidson
- Hematology Department, Kirkcaldy Hospital, Fife, Scotland
| | - Santiago Osorio
- Hematology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Robert Cutting
- Hematology Department, Doncaster Hospital, Doncaster, Yorkshire, England
| | - Caroline P. Sweeney
- Hematology Department, Vale of Leven Hospital, Alexandria, West Dunbartonshire, Scotland
| | - Laura Rufián
- Hematology Department, Hospital Universitario 12 de Octubre, I+12, Centro Nacional de Investigaciones Oncológicas, Complutense University, Centro de Investigación Biomédica en Red de Oncología, Madrid, Spain
| | - Laura Moreno
- Hematology Department, Hospital Universitario 12 de Octubre, I+12, Centro Nacional de Investigaciones Oncológicas, Complutense University, Centro de Investigación Biomédica en Red de Oncología, Madrid, Spain
| | - Isabel Cuenca
- Hematology Department, Hospital Universitario 12 de Octubre, I+12, Centro Nacional de Investigaciones Oncológicas, Complutense University, Centro de Investigación Biomédica en Red de Oncología, Madrid, Spain
| | - Jeffery Smith
- The Clatterbridge Cancer Centre, Liverpool, United Kingdom
| | - María Luz Morales
- Hematology Department, Hospital Universitario 12 de Octubre, I+12, Centro Nacional de Investigaciones Oncológicas, Complutense University, Centro de Investigación Biomédica en Red de Oncología, Madrid, Spain
| | - Rodrigo Gil-Manso
- Hematology Department, Hospital Universitario 12 de Octubre, I+12, Centro Nacional de Investigaciones Oncológicas, Complutense University, Centro de Investigación Biomédica en Red de Oncología, Madrid, Spain
| | - Ioannis Koutsavlis
- Hematology Department, Western General Hospital, Edinburgh, United Kingdom
| | - Lihui Wang
- Haemato-Oncology Diagnostic Service, Liverpool Clinical Laboratories, Liverpool University Hospital, Liverpool, United Kingdom
| | - Adam J. Mead
- Medical Research Council (MRC) Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, NIHR Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - María Rozman
- Hemopathology Unit, Hospital Clínic, Barcelona, Spain
| | - Joaquín Martínez-López
- Hematology Department, Hospital Universitario 12 de Octubre, I+12, Centro Nacional de Investigaciones Oncológicas, Complutense University, Centro de Investigación Biomédica en Red de Oncología, Madrid, Spain
| | - Rosa Ayala
- Hematology Department, Hospital Universitario 12 de Octubre, I+12, Centro Nacional de Investigaciones Oncológicas, Complutense University, Centro de Investigación Biomédica en Red de Oncología, Madrid, Spain
| | - Nicholas C. P. Cross
- Wessex Regional Genetics Laboratory, Salisbury, United Kingdom
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
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8
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Lübke J, Naumann N, Metzgeroth G, Kreil S, Brand T, Horny HP, Sotlar K, Cross NCP, Fabarius A, Valent P, Hofmann WK, Reiter A, Schwaab J. Response and resistance to cladribine in patients with advanced systemic mastocytosis: a registry-based analysis. Ann Hematol 2023:10.1007/s00277-023-05180-y. [PMID: 37012462 DOI: 10.1007/s00277-023-05180-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/13/2023] [Indexed: 04/05/2023]
Abstract
We sought to evaluate the efficacy of the purine analogue cladribine in 79 patients with advanced systemic mastocytosis (AdvSM) using data from the 'German Registry on Disorders of Eosinophils and Mast Cells (GREM)'. The overall response rate according to modified Valent criteria (46 evaluable patients) for first- (1L) and second-line (2L) cladribine treatment was 41% (12/29) and 35% (6/17, P = 0.690), respectively, and the median overall survival (OS, all patients evaluable) was 1.9 years (n = 48) and 1.2 years (n = 31; P = 0.311). Univariate and multivariable analyses of baseline and on-treatment parameters identified diagnosis of mast cell leukemia (hazard ratio [HR] 3.5, 95% confidence interval [CI, 1.3-9.1], P = 0.012), eosinophilia ≥ 1.5 × 109/L (HR 2.9 [CI 1.4-6.2], P = 0.006) and < 3 cycles of cladribine (HR 0.4 [CI 0.2-0.8], P = 0.008) as independent adverse prognostic parameters for OS. There was no impact of other laboratory (anemia, thrombocytopenia, serum tryptase) or genetic markers (mutations in SRSF2, ASXL1 or RUNX1) on OS. In consequence, none of the recently established prognostic scoring systems (MARS, IPSM, MAPS or GPSM) was predictive for OS. Modified Valent criteria were superior to a single factor-based response assessment (HR 2.9 [CI 1.3-6.6], P = 0.026). In conclusion, cladribine is effective in 1L and 2L treatment of AdvSM. Mast cell leukemia, eosinophilia, application of < 3 cycles and a lack of response are adverse prognostic markers.
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Affiliation(s)
- Johannes Lübke
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Nicole Naumann
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Georgia Metzgeroth
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Sebastian Kreil
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Timo Brand
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Hans-Peter Horny
- Department of Pathology, Ludwig-Maximilians-University, Munich, Germany
| | - Karl Sotlar
- Department of Pathology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | | | - Alice Fabarius
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Peter Valent
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Wolf-Karsten Hofmann
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Andreas Reiter
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany.
| | - Juliana Schwaab
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
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9
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Moyo TK, Mendler JH, Itzykson R, Kishtagari A, Solary E, Seegmiller AC, Gerds AT, Ayers GD, Dezern AE, Nazha A, Valent P, van de Loosdrecht AA, Onida F, Pleyer L, Cirici BX, Tibes R, Geissler K, Komrokji RS, Zhang J, Germing U, Steensma DP, Wiseman DH, Pfeilstöecker M, Elena C, Cross NCP, Kiladjian JJ, Luebbert M, Mesa RA, Montalban-Bravo G, Sanz GF, Platzbecker U, Patnaik MM, Padron E, Santini V, Fenaux P, Savona MR. The ABNL-MARRO 001 study: a phase 1–2 study of randomly allocated active myeloid target compound combinations in MDS/MPN overlap syndromes. BMC Cancer 2022; 22:1013. [PMID: 36153475 PMCID: PMC9509596 DOI: 10.1186/s12885-022-10073-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 09/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background Myelodysplastic/myeloproliferative neoplasms (MDS/MPN) comprise several rare hematologic malignancies with shared concomitant dysplastic and proliferative clinicopathologic features of bone marrow failure and propensity of acute leukemic transformation, and have significant impact on patient quality of life. The only approved disease-modifying therapies for any of the MDS/MPN are DNA methyltransferase inhibitors (DNMTi) for patients with dysplastic CMML, and still, outcomes are generally poor, making this an important area of unmet clinical need. Due to both the rarity and the heterogeneous nature of MDS/MPN, they have been challenging to study in dedicated prospective studies. Thus, refining first-line treatment strategies has been difficult, and optimal salvage treatments following DNMTi failure have also not been rigorously studied. ABNL-MARRO (A Basket study of Novel therapy for untreated MDS/MPN and Relapsed/Refractory Overlap Syndromes) is an international cooperation that leverages the expertise of the MDS/MPN International Working Group (IWG) and provides the framework for collaborative studies to advance treatment of MDS/MPN and to explore clinical and pathologic markers of disease severity, prognosis, and treatment response. Methods ABNL MARRO 001 (AM-001) is an open label, randomly allocated phase 1/2 study that will test novel treatment combinations in MDS/MPNs, beginning with the novel targeted agent itacitinib, a selective JAK1 inhibitor, combined with ASTX727, a fixed dose oral combination of the DNMTi decitabine and the cytidine deaminase inhibitor cedazuridine to improve decitabine bioavailability. Discussion Beyond the primary objectives of the study to evaluate the safety and efficacy of novel treatment combinations in MDS/MPN, the study will (i) Establish the ABNL MARRO infrastructure for future prospective studies, (ii) Forge innovative scientific research that will improve our understanding of pathogenetic mechanisms of disease, and (iii) Inform the clinical application of diagnostic criteria, risk stratification and prognostication tools, as well as response assessments in this heterogeneous patient population. Trial registration This trial was registered with ClinicalTrials.gov on August 19, 2019 (Registration No. NCT04061421).
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10
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Salmon M, White HE, Zizkova H, Gottschalk A, Motlova E, Cerveira N, Colomer D, Coriu D, Franke GN, Gottardi E, Izzo B, Jurcek T, Lion T, Schäfer V, Venturi C, Vigneri P, Zawada M, Zuna J, Hovorkova L, Koblihova J, Klamova H, Markova MS, Srbova D, Benesova A, Polivkova V, Zackova D, Mayer J, Roeder I, Glauche I, Ernst T, Hochhaus A, Polakova KM, Cross NCP. Impact of BCR::ABL1 transcript type on RT-qPCR amplification performance and molecular response to therapy. Leukemia 2022; 36:1879-1886. [PMID: 35676453 PMCID: PMC9252903 DOI: 10.1038/s41375-022-01612-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/28/2022] [Revised: 05/16/2022] [Accepted: 05/20/2022] [Indexed: 12/03/2022]
Abstract
Several studies have reported that chronic myeloid leukaemia (CML) patients expressing e14a2 BCR::ABL1 have a faster molecular response to therapy compared to patients expressing e13a2. To explore the reason for this difference we undertook a detailed technical comparison of the commonly used Europe Against Cancer (EAC) BCR::ABL1 reverse transcriptase quantitative polymerase chain reaction (RT-qPCR) assay in European Treatment and Outcome Study (EUTOS) reference laboratories (n = 10). We found the amplification ratio of the e13a2 amplicon was 38% greater than e14a2 (p = 0.015), and the amplification efficiency was 2% greater (P = 0.17). This subtle difference led to measurable transcript-type dependent variation in estimates of residual disease which could be corrected by (i) taking the qPCR amplification efficiency into account, (ii) using alternative RT-qPCR approaches or (iii) droplet digital PCR (ddPCR), a technique which is relatively insensitive to differences in amplification kinetics. In CML patients, higher levels of BCR::ABL1/GUSB were identified at diagnosis for patients expressing e13a2 (n = 67) compared to e14a2 (n = 78) when analysed by RT-qPCR (P = 0.0005) but not ddPCR (P = 0.5). These data indicate that widely used RT-qPCR assays result in subtly different estimates of disease depending on BCR::ABL1 transcript type; these differences are small but may need to be considered for optimal patient management.
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Affiliation(s)
- Matthew Salmon
- Faculty of Medicine, University of Southampton, Southampton, UK.,Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury, UK
| | - Helen E White
- Faculty of Medicine, University of Southampton, Southampton, UK.,Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury, UK
| | - Hana Zizkova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Andrea Gottschalk
- Institute for Medical Informatics and Biometry (IMB), Carl Gustav Carus Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Eliska Motlova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Nuno Cerveira
- Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Dolors Colomer
- Pathology Department, Hospital Clinic, Institut d' Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERONC, Barcelona, Spain
| | - Daniel Coriu
- Fundeni Clinical Institute, Hematology Department, Bucharest, Romania.,Hematology Department, Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Georg N Franke
- University of Leipzig Medical Center, Department for Hematology, Cellular Therapies and Hemostaseology, Leipzig, Germany
| | - Enrico Gottardi
- Laboratory of Chemical and Clinical Analysis "Area 3" A.O.U San Luigi Gonzaga-Orbassano, Turin, Italy
| | - Barbara Izzo
- Department of Molecular Medicine and Medical Biotechnology University 'Federico II' and CEINGE - Advanced Biotechnologies, Naples, Italy
| | - Tomas Jurcek
- Center of Molecular Biology and Gene Therapy, Internal Hematology and Oncology Clinic, Faculty Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Thomas Lion
- Labdia Labordiagnostik / St. Anna Children´s Cancer Research Institute (CCRI), Vienna, Austria
| | - Vivien Schäfer
- Abteilung Hämatologie/Onkologie, Klinik für Innere Medizin II, University of Jena, Jena, Germany
| | - Claudia Venturi
- IRCSS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - Paolo Vigneri
- University of Catania, Department of Clinical and Experimental Medicine, Center of Experimental Oncology and Hematology, Catania, Italy
| | | | - Jan Zuna
- CLIP, Dept. of Paediatric Haematology and Oncology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Lenka Hovorkova
- CLIP, Dept. of Paediatric Haematology and Oncology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Jitka Koblihova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Hana Klamova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | | | - Dana Srbova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Adela Benesova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Vaclava Polivkova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Daniela Zackova
- Internal Hematology and Oncology Clinic, Faculty Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiri Mayer
- Internal Hematology and Oncology Clinic, Faculty Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ingo Roeder
- Institute for Medical Informatics and Biometry (IMB), Carl Gustav Carus Faculty of Medicine, TU Dresden, Dresden, Germany.,National Center for Tumor Diseases (NCT), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany. Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
| | - Ingmar Glauche
- Institute for Medical Informatics and Biometry (IMB), Carl Gustav Carus Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Thomas Ernst
- Abteilung Hämatologie/Onkologie, Klinik für Innere Medizin II, University of Jena, Jena, Germany
| | - Andreas Hochhaus
- Abteilung Hämatologie/Onkologie, Klinik für Innere Medizin II, University of Jena, Jena, Germany
| | | | - Nicholas C P Cross
- Faculty of Medicine, University of Southampton, Southampton, UK. .,Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury, UK.
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11
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Catherwood MA, Wren D, Chiecchio L, Cavalieri D, Donaldson D, Lawless S, ElHassadi E, Hayat A, Cahill MR, O’Shea D, Sargent J, Stewart P, Maurya M, Quinn J, Murphy P, de Castro DG, Mills K, Cross NCP, Forconi F, Iyengar S, Schuh A, Thornton P. TP53 Mutations Identified Using NGS Comprise the Overwhelming Majority of TP53 Disruptions in CLL: Results From a Multicentre Study. Front Oncol 2022; 12:909615. [PMID: 35837095 PMCID: PMC9273895 DOI: 10.3389/fonc.2022.909615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/24/2022] [Indexed: 11/18/2022] Open
Abstract
Limited data exists to show the correlation of (tumour protein 53) TP53 mutation detected by Next generation sequencing (NGS) and the presence/absence of deletions of 17p13 detected by FISH. The study which is the largest series to date includes 2332 CLL patients referred for analysis of del(17p) by FISH and TP53 mutations by NGS before treatment. Using a 10% variant allele frequency (VAF) threshold, cases were segregated into high burden mutations (≥10%) and low burden mutations (<10%). TP53 aberrations (17p [del(17p)] and/or TP53 mutation) were detected in 320/2332 patients (13.7%). Using NGS analysis, 429 TP53 mutations were identified in 303 patients (13%). Of these 238 (79%) and 65 (21%) were cases with high burden and low burden mutations respectively. In our cohort, 2012 cases did not demonstrate a TP53 aberration (86.3%). A total of 159 cases showed TP53 mutations in the absence of del(17p) (49/159 with low burden TP53 mutations) and 144 cases had both TP53 mutation and del(17p) (16/144 with low burden mutations). Only 17/2332 (0.7%) cases demonstrated del(17p) with no TP53 mutation. Validated NGS protocols should be used in clinical decision making to avoid missing low-burden TP53 mutations and can detect the vast majority of TP53 aberrations.
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Affiliation(s)
- Mark A. Catherwood
- Haematology Department, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Dorte Wren
- The Royal Marsden Hospital and the Institute of Cancer Research, Biomedical Research Centre, London, United Kingdom
| | - Laura Chiecchio
- Wessex Regional Genetics Laboratory, Salisbury National Health Service (NHS) Foundation Trust, Salisbury, United Kingdom
| | - Doriane Cavalieri
- Oxford Molecular Diagnostics Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - David Donaldson
- Haematology Department, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Sarah Lawless
- Haematology Department, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Ezzat ElHassadi
- Department of Haematology, University Hospital Waterford, Waterford, Ireland
| | - Amjad Hayat
- Department of Haematology, University Hospital Galway, Galway, Ireland
| | - Mary R. Cahill
- Department of Haematology, Cork University Hospital, Cork, Ireland
| | - Derville O’Shea
- Department of Haematology, Cork University Hospital, Cork, Ireland
| | - Jeremy Sargent
- Department of Haematology, Our Lady of Lourdes Hospital, Queens University Belfast, Drogheda, Ireland
| | - Peter Stewart
- Centre for Cancer Research and Cell Biology (CCRCB), Queen’s University Belfast, Belfast, United Kingdom
| | - Manisha Maurya
- Centre for Cancer Research and Cell Biology (CCRCB), Queen’s University Belfast, Belfast, United Kingdom
| | - John Quinn
- Department of Haematology, Beaumont Hospital, Dublin, Ireland
| | - Philip Murphy
- Department of Haematology, Beaumont Hospital, Dublin, Ireland
| | - David Gonzalez de Castro
- Centre for Cancer Research and Cell Biology (CCRCB), Queen’s University Belfast, Belfast, United Kingdom
| | - Ken Mills
- Centre for Cancer Research and Cell Biology (CCRCB), Queen’s University Belfast, Belfast, United Kingdom
| | - Nicholas C. P. Cross
- Wessex Regional Genetics Laboratory, Salisbury National Health Service (NHS) Foundation Trust, Salisbury, United Kingdom
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Francesco Forconi
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Sunil Iyengar
- The Royal Marsden Hospital and the Institute of Cancer Research, Biomedical Research Centre, London, United Kingdom
| | - Anna Schuh
- Oxford Molecular Diagnostics Centre, Oxford University Hospitals, Oxford, United Kingdom
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12
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White HE, Salmon M, Albano F, Andersen CSA, Balabanov S, Balatzenko G, Barbany G, Cayuela JM, Cerveira N, Cochaux P, Colomer D, Coriu D, Diamond J, Dietz C, Dulucq S, Engvall M, Franke GN, Gineikiene-Valentine E, Gniot M, Gómez-Casares MT, Gottardi E, Hayden C, Hayette S, Hedblom A, Ilea A, Izzo B, Jiménez-Velasco A, Jurcek T, Kairisto V, Langabeer SE, Lion T, Meggyesi N, Mešanović S, Mihok L, Mitterbauer-Hohendanner G, Moeckel S, Naumann N, Nibourel O, Oppliger Leibundgut E, Panayiotidis P, Podgornik H, Pott C, Rapado I, Rose SJ, Schäfer V, Touloumenidou T, Veigaard C, Venniker-Punt B, Venturi C, Vigneri P, Vorkinn I, Wilkinson E, Zadro R, Zawada M, Zizkova H, Müller MC, Saussele S, Ernst T, Machova Polakova K, Hochhaus A, Cross NCP. Standardization of molecular monitoring of CML: results and recommendations from the European treatment and outcome study. Leukemia 2022; 36:1834-1842. [PMID: 35614319 PMCID: PMC9252906 DOI: 10.1038/s41375-022-01607-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 03/05/2022] [Revised: 05/06/2022] [Accepted: 05/12/2022] [Indexed: 11/17/2022]
Abstract
Standardized monitoring of BCR::ABL1 mRNA levels is essential for the management of chronic myeloid leukemia (CML) patients. From 2016 to 2021 the European Treatment and Outcome Study for CML (EUTOS) explored the use of secondary, lyophilized cell-based BCR::ABL1 reference panels traceable to the World Health Organization primary reference material to standardize and validate local laboratory tests. Panels were used to assign and validate conversion factors (CFs) to the International Scale and assess the ability of laboratories to assess deep molecular response (DMR). The study also explored aspects of internal quality control. The percentage of EUTOS reference laboratories (n = 50) with CFs validated as optimal or satisfactory increased from 67.5% to 97.6% and 36.4% to 91.7% for ABL1 and GUSB, respectively, during the study period and 98% of laboratories were able to detect MR4.5 in most samples. Laboratories with unvalidated CFs had a higher coefficient of variation for BCR::ABL1IS and some laboratories had a limit of blank greater than zero which could affect the accurate reporting of DMR. Our study indicates that secondary reference panels can be used effectively to obtain and validate CFs in a manner equivalent to sample exchange and can also be used to monitor additional aspects of quality assurance.
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Affiliation(s)
- Helen E White
- Faculty of Medicine, University of Southampton, Southampton, UK.,Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury, UK
| | - Matthew Salmon
- Faculty of Medicine, University of Southampton, Southampton, UK.,Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury, UK
| | - Francesco Albano
- Department of Emergency and Organ Transplantation (D.E.T.O.)-Hematology and Stem Cell Transplantation Unit, University of Bari "Aldo Moro", Bari, Italy
| | | | - Stefan Balabanov
- Department of Medical Oncology and Hematology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Gueorgui Balatzenko
- Laboratory of Medical Genetics National Specialized Hospital for Active Treatment of Hematological Diseases, Sofia, Bulgaria
| | - Gisela Barbany
- Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Jean-Michel Cayuela
- Laboratory of Hematology, University Hospital Saint-Louis, Université de Paris, Paris, France
| | - Nuno Cerveira
- Department of Genetics and Research Centre, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Pascale Cochaux
- Department of Molecular Hemato-Oncology, LHUB-ULB, Brussels, Belgium
| | - Dolors Colomer
- Pathology Department, Hospital Clinic, Institut d' Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERONC, Barcelona, Spain
| | - Daniel Coriu
- Fundeni Clinical Institute, Hematology Department, Bucharest, Romania.,Hematology Department, Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Joana Diamond
- Laboratório de Hemato-Oncologia-LHO Instituto Português de Oncologia Francisco Gentil, Lisbon, Portugal
| | - Christian Dietz
- Institute for Hematology and Oncology (IHO GmbH), Mannheim, Germany
| | - Stéphanie Dulucq
- University Hospital of Bordeaux, Laboratory of Hematology, Haut Lévêque Hospital, Pessac, France
| | - Marie Engvall
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Georg N Franke
- University of Leipzig Medical Center, Department for Hematology, Cellular Therapies and Hemostaseology, Leipzig, Germany
| | | | - Michal Gniot
- Poznan University of Medical Sciences, Department of Hematology and Bone Marrow Transplantation, Poznan, Poland
| | - María Teresa Gómez-Casares
- Hematology Department, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Enrico Gottardi
- Laboratory of Chemical and Clinical Analysis "Area 3" A.O.U San Luigi Gonzaga-Orbassano, Turin, Italy
| | - Chloe Hayden
- SIHMDS Hosted by Imperial College Healthcare NHS Trust at Hammersmith Hospital, London, UK
| | - Sandrine Hayette
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d'Hématologie Biologique, Pierre-Bénite, France
| | - Andreas Hedblom
- Section of Molecular Diagnostics, Clinical Genetics, Region Skåne, Lund, Sweden
| | - Anca Ilea
- Ritus Biotec Laboratory, Codlea-Brasov, Romania.,Transilvania University, Brasov, Romania
| | - Barbara Izzo
- Department of Molecular Medicine and Medical Biotechnology University 'Federico II' and CEINGE-Advanced Biotechnologies, Naples, Italy
| | | | - Tomas Jurcek
- Department of Internal Medicine-Hematology and Oncology, University Hospital Brno, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Veli Kairisto
- Department of Genomics, Turku University Hospital Laboratories, Turku, Finland
| | | | - Thomas Lion
- Labdia Labordiagnostik/St. Anna Children´s Cancer Research Institute (CCRI), Vienna, Austria
| | - Nora Meggyesi
- Laboratory of Molecular Genetics, Central Hospital of Southern Pest National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Semir Mešanović
- Pathology Department, University Clinical Center Tuzla, Policlinic for Laboratory Diagnostics, Tuzla, Bosnia and Herzegovina
| | - Luboslav Mihok
- Department of Medical Genetics, National Cancer Institute, Bratislava, Slovakia
| | | | | | - Nicole Naumann
- III. Medizinische Klinik, Universitätsmedizin Mannheim, Mannheim, Germany
| | | | | | - Panayiotis Panayiotidis
- Haematology Research Laboratory, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Helena Podgornik
- Department of Haematology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - Christiane Pott
- Second Medical Department, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Inmaculada Rapado
- Hematology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Imas12, 28041, Madrid, Spain.,Hematological Malignancies Clinical Research Unit, CNIO, 28029, Madrid, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto Carlos III, 28029, Madrid, Spain
| | - Susan J Rose
- West Midlands Regional Genetics Laboratory, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Vivien Schäfer
- Abteilung Hämatologie/Onkologie, Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Tasoula Touloumenidou
- Molecular Diagnostics Laboratory, Hematology Department and HCT Unit, George Papanicolaou General Hospital, Thessaloniki, Greece
| | - Christopher Veigaard
- HemoDiagnostic Laboratory, Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Claudia Venturi
- IRCSS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - Paolo Vigneri
- Department of Clinical and Experimental Medicine, Center of Experimental Oncology and Hematology, University of Catania, Catania, Italy
| | - Ingvild Vorkinn
- Molecular Hemapathology, Oslo University Hospital, Oslo, Norway
| | - Elizabeth Wilkinson
- Haematological Malignancy Diagnostic Service, Leeds Teaching Hospitals, Leeds, UK
| | - Renata Zadro
- University Hospital Center Zagreb, Zagreb, Croatia
| | | | - Hana Zizkova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Martin C Müller
- Institute for Hematology and Oncology (IHO GmbH), Mannheim, Germany
| | - Susanne Saussele
- III. Medizinische Klinik, Universitätsmedizin Mannheim, Mannheim, Germany
| | - Thomas Ernst
- Abteilung Hämatologie/Onkologie, Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | | | - Andreas Hochhaus
- Abteilung Hämatologie/Onkologie, Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Nicholas C P Cross
- Faculty of Medicine, University of Southampton, Southampton, UK. .,Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury, UK.
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13
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Lübke J, Schwaab J, Naumann N, Horny HP, Weiß C, Metzgeroth G, Kreil S, Cross NCP, Sotlar K, Fabarius A, Hofmann WK, Valent P, Gotlib J, Jawhar M, Reiter A. Superior Efficacy of Midostaurin Over Cladribine in Advanced Systemic Mastocytosis: A Registry-Based Analysis. J Clin Oncol 2022; 40:1783-1794. [PMID: 35235417 DOI: 10.1200/jco.21.01849] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE On the basis of data from the German Registry on Disorders of Eosinophils and Mast Cells, we compared the efficacy of midostaurin and cladribine in patients with advanced systemic mastocytosis (AdvSM). PATIENTS AND METHODS Patients with AdvSM (n = 139) were treated with midostaurin only (n = 63, 45%), cladribine only (n = 23, 17%), or sequentially (midostaurin-cladribine, n = 30, 57%; cladribine-midostaurin, n = 23, 43%). Prognosis was assessed through the Mutation-Adjusted Risk Score (MARS). Besides the comparison of efficacy between midostaurin and cladribine on response (eg, organ dysfunction, bone marrow mast cell [MC] infiltration, and tryptase), overall survival (OS), and leukemia-free survival, we focused on the impact of treatment on involved non-MC lineages, for example, monocytes or eosinophils, and the KIT D816V expressed allele burden. RESULTS Midostaurin only was superior to cladribine only with effects from responses on MC and non-MC lineages conferring on a significantly improved OS (median 4.2 v 1.9 years, P = .033) and leukemia-free survival (2.7 v 1.3 years, P = .044) on the basis of a propensity score-weighted analysis of parameters included in MARS. Midostaurin compensated the inferior efficacy of cladribine in first- and second-line treatment. On midostaurin in any line, response of eosinophilia did not improve its baseline adverse prognostic impact, whereas response of monocytosis proved to be a positive on-treatment parameter. Multivariable analysis allowed to establish three risk categories (low/intermediate/high) through the combination of MARS and the reduction of the KIT D816V expressed allele burden of ≥ 25% at month 6 (median OS not reached v 3.0 years v 1.0 year; P < .001). CONCLUSION In this registry-based analysis, midostaurin revealed superior efficacy over cladribine in patients with AdvSM. In midostaurin-treated patients, the combination of baseline MARS and molecular response provided a compelling three-tier risk categorization (MARSv2.0) for OS.
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Affiliation(s)
- Johannes Lübke
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Juliana Schwaab
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Nicole Naumann
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Hans-Peter Horny
- Department of Pathology, Ludwig-Maximilians-University, Munich, Germany
| | - Christel Weiß
- Department of Medical Statistics and Biomathematics, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Georgia Metzgeroth
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Sebastian Kreil
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Nicholas C P Cross
- Wessex Regional Genetics Laboratory, Salisbury, United Kingdom.,University of Southampton, Southampton, United Kingdom
| | - Karl Sotlar
- Department of Pathology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Alice Fabarius
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Wolf-Karsten Hofmann
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Peter Valent
- Division of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Jason Gotlib
- Hematology Division, Stanford University School of Medicine/Stanford Cancer Institute, Stanford, CA
| | - Mohamad Jawhar
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Andreas Reiter
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
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14
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Dawoud AAZ, Gilbert RD, Tapper WJ, Cross NCP. Clonal myelopoiesis promotes adverse outcomes in chronic kidney disease. Leukemia 2022; 36:507-515. [PMID: 34413458 PMCID: PMC8807385 DOI: 10.1038/s41375-021-01382-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 07/29/2021] [Accepted: 08/02/2021] [Indexed: 12/18/2022]
Abstract
We sought to determine the relationship between age-related clonal hematopoiesis (CH) and chronic kidney disease (CKD). CH, defined as mosaic chromosome abnormalities (mCA) and/or driver mutations was identified in 5449 (2.9%) eligible UK Biobank participants (n = 190,487 median age = 58 years). CH was negatively associated with glomerular filtration rate estimated from cystatin-C (eGFR.cys; β = -0.75, P = 2.37 × 10-4), but not with eGFR estimated from creatinine, and was specifically associated with CKD defined by eGFR.cys < 60 (OR = 1.02, P = 8.44 × 10-8). In participants without prevalent myeloid neoplasms, eGFR.cys was associated with myeloid mCA (n = 148, β = -3.36, P = 0.01) and somatic driver mutations (n = 3241, β = -1.08, P = 6.25 × 10-5) associated with myeloid neoplasia (myeloid CH), specifically mutations in CBL, TET2, JAK2, PPM1D and GNB1 but not DNMT3A or ASXL1. In participants with no history of cardiovascular disease or myeloid neoplasms, myeloid CH increased the risk of adverse outcomes in CKD (HR = 1.6, P = 0.002) compared to those without myeloid CH. Mendelian randomisation analysis provided suggestive evidence for a causal relationship between CH and CKD (P = 0.03). We conclude that CH, and specifically myeloid CH, is associated with CKD defined by eGFR.cys. Myeloid CH promotes adverse outcomes in CKD, highlighting the importance of the interaction between intrinsic and extrinsic factors to define the health risk associated with CH.
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Affiliation(s)
| | - Rodney D Gilbert
- Faculty of Medicine, University of Southampton, Southampton, UK
- Southampton Children's Hospital, Southampton, UK
| | | | - Nicholas C P Cross
- Faculty of Medicine, University of Southampton, Southampton, UK.
- Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury, UK.
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15
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Bruford EA, Antonescu CR, Carroll AJ, Chinnaiyan A, Cree IA, Cross NCP, Dalgleish R, Gale RP, Harrison CJ, Hastings RJ, Huret JL, Johansson B, Le Beau M, Mecucci C, Mertens F, Verhaak R, Mitelman F. HUGO Gene Nomenclature Committee (HGNC) recommendations for the designation of gene fusions. Leukemia 2021; 35:3040-3043. [PMID: 34615987 PMCID: PMC8550944 DOI: 10.1038/s41375-021-01436-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 09/10/2021] [Accepted: 09/21/2021] [Indexed: 11/30/2022]
Abstract
Gene fusions have been discussed in the scientific literature since they were first detected in cancer cells in the early 1980s. There is currently no standardized way to denote the genes involved in fusions, but in the majority of publications the gene symbols in question are listed either separated by a hyphen (-) or by a forward slash (/). Both types of designation suffer from important shortcomings. HGNC has worked with the scientific community to determine a new, instantly recognizable and unique separator-a double colon (::)-to be used in the description of fusion genes, and advocates its usage in all databases and articles describing gene fusions.
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Affiliation(s)
- Elspeth A Bruford
- HUGO Gene Nomenclature Committee (HGNC), European Molecular Biology Laboratory, European Bioinformatics Institute, Wellcome Genome Campus, Hinxton, UK.
- Department of Haematology, University of Cambridge School of Clinical Medicine, Cambridge, UK.
| | - Cristina R Antonescu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew J Carroll
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Arul Chinnaiyan
- University of Michigan Medical School, Ann Arbor, MI, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
| | - Ian A Cree
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Nicholas C P Cross
- Faculty of Medicine, University of Southampton, Southampton, UK
- Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury, Wiltshire, UK
| | - Raymond Dalgleish
- Department of Genetics and Genome Biology, University of Leicester, Leicester, UK
| | - Robert Peter Gale
- Centre for Haematology Research, Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Christine J Harrison
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
| | - Rosalind J Hastings
- The Women's Centre, John Radcliffe Hospital, Oxford University Hospitals Foundation Trust, Oxford, UK
| | | | - Bertil Johansson
- Division of Clinical Genetics, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Michelle Le Beau
- Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA
| | - Cristina Mecucci
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Fredrik Mertens
- Division of Clinical Genetics, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Roel Verhaak
- Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
- Department of Neurosurgery, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Felix Mitelman
- Division of Clinical Genetics, Department of Laboratory Medicine, Lund University, Lund, Sweden
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16
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Cross NCP, Godfrey AL, Cargo C, Garg M, Mead AJ. The use of genetic tests to diagnose and manage patients with myeloproliferative and myeloproliferative/myelodysplastic neoplasms, and related disorders. Br J Haematol 2021; 195:338-351. [PMID: 34409596 DOI: 10.1111/bjh.17766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 07/28/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Nicholas C P Cross
- Wessex Regional Genetics Laboratory, Salisbury District Hospital, Salisbury, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Anna L Godfrey
- Haematopathology & Oncology Diagnostics Service, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Catherine Cargo
- Haematological Malignancy Diagnostic Service, Leeds Cancer Centre, St James's University Hospital, Leeds, UK
| | - Mamta Garg
- Leicester Royal Infirmary, Infirmary Square, Leicester, UK
| | - Adam J Mead
- MRC Molecular Haematology Unit, NIHR Oxford Biomedical Research Centre, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
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17
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Gale RP, Hochhaus A, Cross NCP, Harrison CJ. HGNC nomenclature for fusion genes. Leukemia 2021; 35:3039. [PMID: 34611300 DOI: 10.1038/s41375-021-01437-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 09/16/2021] [Accepted: 09/21/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Robert Peter Gale
- Centre for Haematology Research, Department of Immunology and Inflammation, Imperial College London, London, UK.
| | - Andreas Hochhaus
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena, Jena, Germany
| | - Nicholas C P Cross
- Wessex Regional Genetics Laboratory, Salisbury, United Kingdom and Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Christine J Harrison
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Newcastle-upon-Tyne, England
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18
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Lafferty N, Salmon M, Cross NCP, Singer I, Cooney A, Jayaprakash R. Chronic Eosinophilic Leukaemia Associated with JAK2 Exon 13 Insertion/Deletion Mutations. Acta Haematol 2021; 145:201-206. [PMID: 34515041 DOI: 10.1159/000518737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 07/27/2021] [Indexed: 01/31/2023]
Abstract
Chronic eosinophilic leukaemia, not otherwise specified (CEL, NOS), is a diagnosis of exclusion made in cases in which there is clonal eosinophilia but an absence of genetic aberrations that define other disease subtypes. There is a need for further characterization of these cases in order to inform risk stratification and management. The importance of JAK2 mutations in myeloproliferative neoplasms (MPN) as a whole is well established, although their role specifically in eosinophilic disorders is less clear, with only a minority of cases demonstrating JAK2 abnormalities. Here, we report 2 cases with an exon 13 insertion-deletion (indel) mutation in JAK2: one with CEL-NOS and the second with an unspecified eosinophilic disorder. JAK2 indels were not detected in a screen of suspected MPN cases (n = 592) without eosinophilia that tested negative for common MPN driver mutations. Our findings thus provide further evidence for a specific association between this rare mutation and clonal eosinophilic disorders.
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Affiliation(s)
- Nicholas Lafferty
- Department of Haematology, University Hospitals Dorset, Poole, United Kingdom
| | - Matthew Salmon
- Wessex Regional Genetics Laboratory, Salisbury, United Kingdom
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Nicholas C P Cross
- Wessex Regional Genetics Laboratory, Salisbury, United Kingdom
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Iain Singer
- Department of Haematology, University Hospital Monklands, Airdrie, United Kingdom
| | - Aaron Cooney
- Department of Haematology, University Hospitals Dorset, Poole, United Kingdom
| | - Ram Jayaprakash
- Department of Haematology, University Hospitals Dorset, Poole, United Kingdom
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19
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Naumann N, Lübke J, Shomali W, Reiter L, Horny HP, Jawhar M, Dangelo V, Fabarius A, Metzgeroth G, Kreil S, Sotlar K, Oni C, Harrison C, Hofmann WK, Cross NCP, Valent P, Radia D, Gotlib J, Reiter A, Schwaab J. Clinical and histopathological features of myeloid neoplasms with concurrent Janus kinase 2 (JAK2) V617F and KIT proto-oncogene, receptor tyrosine kinase (KIT) D816V mutations. Br J Haematol 2021; 194:344-354. [PMID: 34060083 DOI: 10.1111/bjh.17567] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/22/2021] [Accepted: 04/29/2021] [Indexed: 01/23/2023]
Abstract
We report on 45 patients with myeloid neoplasms and concurrent Janus kinase 2 (JAK2) V617F and KIT proto-oncogene, receptor tyrosine kinase (KIT) D816V (JAK2pos . /KITpos . ) mutations, which are individually identified in >60% of patients with classical myeloproliferative neoplasms (MPN) and >90% of patients with systemic mastocytosis (SM) respectively. In SM, the concurrent presence of a clonal non-mast cell neoplasm [SM with associated haematological neoplasm (SM-AHN)] usually constitutes a distinct subtype associated with poor survival. All 45 patients presented with a heterogeneous combination of clinical/morphological features typical of the individual disorders (e.g. leuco-/erythro-/thrombocytosis and elevated lactate dehydrogenase for MPN; elevated serum tryptase and alkaline phosphatase for SM). Overlapping features identified in 70% of patients included splenomegaly, cytopenia(s), bone marrow fibrosis and additional somatic mutations. Molecular dissection revealed discordant development of variant allele frequency for both mutations and absence of concurrently positive single-cell derived colonies, indicating disease evolution in two independent clones rather than monoclonal disease in >60% of patients examined. Overall survival of JAK2pos . /KITpos . patients without additional somatic high-risk mutations [HRM, e.g. in serine and arginine-rich splicing factor 2 (SRSF2), additional sex combs like-1 (ASXL1) or Runt-related transcription factor 1 (RUNX1)] at 5 years was 77%, indicating that the mutual impact of JAK2 V617F and KIT D816V on prognosis is fundamentally different from the adverse impact of additional HRM in the individual disorders.
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Affiliation(s)
- Nicole Naumann
- Haematology and Oncology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Johannes Lübke
- Haematology and Oncology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - William Shomali
- Division of Hematology, Stanford Cancer Institute/Stanford University School of Medicine, Stanford, CA, USA
| | - Lukas Reiter
- Haematology and Oncology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Hans-Peter Horny
- Institute of Pathology, Ludwig-Maximilian-University, Munich, Germany
| | - Mohamad Jawhar
- Haematology and Oncology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Vito Dangelo
- Haematology and Oncology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Alice Fabarius
- Haematology and Oncology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Georgia Metzgeroth
- Haematology and Oncology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sebastian Kreil
- Haematology and Oncology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Karl Sotlar
- Institute of Pathology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Claire Oni
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Claire Harrison
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Wolf-Karsten Hofmann
- Haematology and Oncology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Nicholas C P Cross
- Wessex Regional Genetics Laboratory, Salisbury, UK.,School of Medicine, University of Southampton, Southampton, UK
| | - Peter Valent
- Department of Internal Medicine I, Division of Haematology and Ludwig Boltzmann Institute for Haematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Deepti Radia
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jason Gotlib
- Division of Hematology, Stanford Cancer Institute/Stanford University School of Medicine, Stanford, CA, USA
| | - Andreas Reiter
- Haematology and Oncology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Juliana Schwaab
- Haematology and Oncology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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20
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Galatà G, García-Montero AC, Kristensen T, Dawoud AAZ, Muñoz-González JI, Meggendorfer M, Guglielmelli P, Hoade Y, Alvarez-Twose I, Gieger C, Strauch K, Ferrucci L, Tanaka T, Bandinelli S, Schnurr TM, Haferlach T, Broesby-Olsen S, Vestergaard H, Møller MB, Bindslev-Jensen C, Vannucchi AM, Orfao A, Radia D, Reiter A, Chase AJ, Cross NCP, Tapper WJ. Genome-wide association study identifies novel susceptibility loci for KIT D816V positive mastocytosis. Am J Hum Genet 2021; 108:284-294. [PMID: 33421400 DOI: 10.1016/j.ajhg.2020.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/07/2020] [Indexed: 12/18/2022] Open
Abstract
Mastocytosis is a rare myeloid neoplasm characterized by uncontrolled expansion of mast cells, driven in >80% of affected individuals by acquisition of the KIT D816V mutation. To explore the hypothesis that inherited variation predisposes to mastocytosis, we performed a two-stage genome-wide association study, analyzing 1,035 individuals with KIT D816V positive disease and 17,960 healthy control individuals from five European populations. After quality control, we tested 592,007 SNPs at stage 1 and 75 SNPs at stage 2 for association by using logistic regression and performed a fixed effects meta-analysis to combine evidence across the two stages. From the meta-analysis, we identified three intergenic SNPs associated with mastocytosis that achieved genome-wide significance without heterogeneity between cohorts: rs4616402 (pmeta = 1.37 × 10-15, OR = 1.52), rs4662380 (pmeta = 2.11 × 10-12, OR = 1.46), and rs13077541 (pmeta = 2.10 × 10-9, OR = 1.33). Expression quantitative trait analyses demonstrated that rs4616402 is associated with the expression of CEBPA (peQTL = 2.3 × 10-14), a gene encoding a transcription factor known to play a critical role in myelopoiesis. The role of the other two SNPs is less clear: rs4662380 is associated with expression of the long non-coding RNA gene TEX41 (peQTL = 2.55 × 10-11), whereas rs13077541 is associated with the expression of TBL1XR1, which encodes transducin (β)-like 1 X-linked receptor 1 (peQTL = 5.70 × 10-8). In individuals with available data and non-advanced disease, rs4616402 was associated with age at presentation (p = 0.009; beta = 4.41; n = 422). Additional focused analysis identified suggestive associations between mastocytosis and genetic variation at TERT, TPSAB1/TPSB2, and IL13. These findings demonstrate that multiple germline variants predispose to KIT D816V positive mastocytosis and provide novel avenues for functional investigation.
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Affiliation(s)
- Gabriella Galatà
- School of Medicine, University of Southampton, Southampton SO17 1BJ, UK
| | - Andrés C García-Montero
- Institute of Biomedical Research of Salamanca, Salamanca 37007, Spain; Servicio de Citometría, Departamento de Medicina, CIBERONC, and Instituto de Biología Molecular y Celular del Cáncer, CSIC/Universidad de Salamanca, Salamanca 37007, Spain
| | - Thomas Kristensen
- Department of Pathology, Odense University Hospital, 5000 Odense, Denmark; Mastocytosis Centre Odense University Hospital, 5000 Odense, Denmark
| | - Ahmed A Z Dawoud
- School of Medicine, University of Southampton, Southampton SO17 1BJ, UK
| | - Javier I Muñoz-González
- Institute of Biomedical Research of Salamanca, Salamanca 37007, Spain; Servicio de Citometría, Departamento de Medicina, CIBERONC, and Instituto de Biología Molecular y Celular del Cáncer, CSIC/Universidad de Salamanca, Salamanca 37007, Spain
| | | | - Paola Guglielmelli
- Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Università Degli Studi di Firenze, 50134 Firenze, Italy
| | - Yvette Hoade
- School of Medicine, University of Southampton, Southampton SO17 1BJ, UK
| | - Ivan Alvarez-Twose
- Instituto de Mastocitosis de Castilla La Mancha, Hospital Virgen del Valle, 45071 Toledo, Spain
| | - Christian Gieger
- Institute of Genetic Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, 85764 Neuherberg, Germany; German Centre for Cardiovascular Research Partner Site Munich Heart Alliance, 80802 Munich, Germany; Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, Germany Research Center for Environmental Health, 85764 Neuherberg, Germany; German Center for Diabetes Research, 85764 Neuherberg, Germany
| | - Konstantin Strauch
- Institute of Genetic Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, 85764 Neuherberg, Germany; Chair of Genetic Epidemiology, IBE, Faculty of Medicine, LMU Munich, 80539 Munich, Germany; Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University, 55131 Mainz, Germany
| | - Luigi Ferrucci
- Longitudinal study section, Translation Gerontology Branch, National Institute on Aging, Baltimore, MD 21224, USA
| | - Toshiko Tanaka
- Longitudinal study section, Translation Gerontology Branch, National Institute on Aging, Baltimore, MD 21224, USA
| | | | - Theresia M Schnurr
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | | | - Sigurd Broesby-Olsen
- Mastocytosis Centre Odense University Hospital, 5000 Odense, Denmark; Department of Dermatology and Allergy Centre, Odense University Hospital, 5000 Odense, Denmark; Odense Research Center for Anaphylaxis, Odense University Hospital, 5000 Odense, Denmark
| | - Hanne Vestergaard
- Mastocytosis Centre Odense University Hospital, 5000 Odense, Denmark; Department of Hematology, Odense University Hospital, 5000 Odense, Denmark
| | - Michael Boe Møller
- Department of Pathology, Odense University Hospital, 5000 Odense, Denmark; Mastocytosis Centre Odense University Hospital, 5000 Odense, Denmark
| | - Carsten Bindslev-Jensen
- Mastocytosis Centre Odense University Hospital, 5000 Odense, Denmark; Department of Dermatology and Allergy Centre, Odense University Hospital, 5000 Odense, Denmark; Odense Research Center for Anaphylaxis, Odense University Hospital, 5000 Odense, Denmark
| | - Alessandro M Vannucchi
- Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Università Degli Studi di Firenze, 50134 Firenze, Italy
| | - Alberto Orfao
- Institute of Biomedical Research of Salamanca, Salamanca 37007, Spain; Servicio de Citometría, Departamento de Medicina, CIBERONC, and Instituto de Biología Molecular y Celular del Cáncer, CSIC/Universidad de Salamanca, Salamanca 37007, Spain
| | - Deepti Radia
- Department of Clinical Haematology, Guy's and St Thomas' NHS Hospitals, London SE1 9RT, UK
| | - Andreas Reiter
- University Hospital Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Andrew J Chase
- School of Medicine, University of Southampton, Southampton SO17 1BJ, UK; Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury SP2 8BJ, UK
| | - Nicholas C P Cross
- School of Medicine, University of Southampton, Southampton SO17 1BJ, UK; Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury SP2 8BJ, UK.
| | - William J Tapper
- School of Medicine, University of Southampton, Southampton SO17 1BJ, UK
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21
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Milojkovic D, Cross NCP, Ali S, Byrne J, Campbell G, Dignan FL, Drummond M, Huntly B, Marshall S, McMullin MF, Neelakantan P, Raghavan M, Sivakumaran M, Tighe J, Wandroo F, Willis F, Glen F, Fildes L, Collington SJ, Ryan J, Clark RE, Mead AJ. Real-world tyrosine kinase inhibitor treatment pathways, monitoring patterns and responses in patients with chronic myeloid leukaemia in the United Kingdom: the UK TARGET CML study. Br J Haematol 2021; 192:62-74. [PMID: 32449159 DOI: 10.1111/bjh.16733] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/18/2020] [Indexed: 10/24/2022]
Abstract
Management of chronic myeloid leukaemia (CML) has recently undergone dramatic changes, prompting the European LeukemiaNet (ELN) to issue recommendations in 2013; however, it remains unclear whether real-world CML management is consistent with these goals. We report results of UK TARGET CML, a retrospective observational study of 257 patients with chronic-phase CML who had been prescribed a first-line TKI between 2013 and 2017, most of whom received first-line imatinib (n = 203). Although 44% of patients required ≥1 change of TKI, these real-world data revealed that molecular assessments were frequently missed, 23% of patients with ELN-defined treatment failure did not switch TKI, and kinase domain mutation analysis was performed in only 49% of patients who switched TKI for resistance. Major molecular response (MMR; BCR-ABL1IS ≤0·1%) and deep molecular response (DMR; BCR-ABL1IS ≤0·01%) were observed in 50% and 29%, respectively, of patients treated with first-line imatinib, and 63% and 54%, respectively, receiving a second-generation TKI first line. MMR and DMR were also observed in 77% and 44% of evaluable patients with ≥13 months follow-up, receiving a second-generation TKI second line. We found little evidence that cardiovascular risk factors were considered during TKI management. These findings highlight key areas for improvement in providing optimal care to patients with CML.
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Affiliation(s)
| | | | - Sahra Ali
- Castle Hill Hospital, Hull and East Yorkshire Hospitals NHS Trust, Cottingham, UK
| | - Jenny Byrne
- Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Gavin Campbell
- Colchester Hospital University NHS Foundation Trust, Colchester, UK
| | - Fiona L Dignan
- Manchester Royal Infirmary, Manchester University Hospitals Foundation Trust, Manchester, UK
| | | | - Brian Huntly
- Addenbrookes, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Scott Marshall
- Sunderland Royal Hospital, City Hospitals Sunderland NHS Foundation Trust, Sunderland, UK
| | | | | | - Manoj Raghavan
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Jane Tighe
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - Farooq Wandroo
- Sandwells District General Hospital, Sandwells and West Birmingham Hospitals NHS Trust, West Bromwich, UK
| | - Fenella Willis
- St George's University Hospitals NHS Foundation Trust, London, UK
| | | | | | | | | | | | - Adam J Mead
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
- MRC Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, Oxford, UK
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22
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Steele L, Hill K, Cross NCP, Cooper HL. Possible transmission of Laugier-Hunziker syndrome by allogeneic peripheral blood stem cell transplantation. Clin Exp Dermatol 2020; 46:400-402. [PMID: 33217072 DOI: 10.1111/ced.14418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/22/2020] [Accepted: 07/28/2020] [Indexed: 11/30/2022]
Affiliation(s)
- L Steele
- Department of Dermatology, Portsmouth Hospitals NHS Trust, Portsmouth, Hampshire, UK.,Centre for Cell Biology and Cutaneous Research, Blizard Institute, Queen Mary University of London, London, UK
| | - K Hill
- Department of Haematology, University Hospital Southampton, Southampton, Hampshire, UK
| | - N C P Cross
- Wessex Regional Genetics Laboratory, Salisbury District Hospital, Salisbury, Wiltshire, UK
| | - H L Cooper
- Department of Dermatology, Portsmouth Hospitals NHS Trust, Portsmouth, Hampshire, UK
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23
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Smith G, Apperley J, Milojkovic D, Cross NCP, Foroni L, Byrne J, Goringe A, Rao A, Khorashad J, de Lavallade H, Mead AJ, Osborne W, Plummer C, Jones G, Copland M. A British Society for Haematology Guideline on the diagnosis and management of chronic myeloid leukaemia. Br J Haematol 2020; 191:171-193. [PMID: 32734668 DOI: 10.1111/bjh.16971] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/22/2020] [Indexed: 12/20/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Adam J Mead
- MRC Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Wendy Osborne
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Chris Plummer
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Gail Jones
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
- BSH Haemato-Oncology Task Force representative
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24
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Abstract
Chronic myeloid leukemia (CML) is defined for many years as BCR-ABL1 positive disease, but older publications refer to a poor prognosis, clinically heterogeneous entity termed 'BCR-ABL1 negative CML' constituting about 5% of CML cases. Apart from very rare CML cases with cytogenetically cryptic, atypical variant BCR-ABL1 fusions that had been inadvertently missed during the diagnostic work up, most of these cases would now be classified as a subtype of myelodysplastic/myeloproliferative neoplasm (MDS/MPN), such as atypical CML (aCML), chronic myelomonocytic leukemia (CMML), or chronic neutrophilic leukemia (CNL). A minority would be classified as systemic mastocytosis with associated hematological neoplasm (SM-AHN), myeloid/lymphoid neoplasms associated with eosinophilia and rearrangement of PDGFRA, PDGFRB, FGFR1 or with PCM1-JAK2 (MLN-eo), or chronic eosinophilic leukemia not otherwise specified (CEL-NOS).1.
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Affiliation(s)
- Nicholas C P Cross
- University of Southampton, Southampton, UK; Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury, UK.
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25
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Machova Polakova K, Zizkova H, Zuna J, Motlova E, Hovorkova L, Gottschalk A, Glauche I, Koblihova J, Pecherkova P, Klamova H, Stastna Markova M, Srbova D, Benesova A, Polivkova V, Jurcek T, Zackova D, Mayer J, Ernst T, Mahon FX, Saussele S, Roeder I, Cross NCP, Hochhaus A. Analysis of chronic myeloid leukaemia during deep molecular response by genomic PCR: a traffic light stratification model with impact on treatment-free remission. Leukemia 2020; 34:2113-2124. [PMID: 32472084 DOI: 10.1038/s41375-020-0882-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 01/06/2020] [Revised: 05/14/2020] [Accepted: 05/19/2020] [Indexed: 12/12/2022]
Abstract
This work investigated patient-specific genomic BCR-ABL1 fusions as markers of measurable residual disease (MRD) in chronic myeloid leukaemia, with a focus on relevance to treatment-free remission (TFR) after achievement of deep molecular response (DMR) on tyrosine kinase inhibitor (TKI) therapy. DNA and mRNA BCR-ABL1 measurements by qPCR were compared in 2189 samples (129 patients) and by digital PCR in 1279 sample (62 patients). A high correlation was found at levels of disease above MR4, but there was a poor correlation for samples during DMR. A combination of DNA and RNA MRD measurements resulted in a better prediction of molecular relapse-free survival (MRFS) after TKI stop (n = 17) or scheduled interruption (n = 25). At 18 months after treatment cessation, patients with stopped or interrupted TKI therapy who were DNA negative/RNA negative during DMR maintenance (green group) had an MRFS of 80% and 100%, respectively, compared with those who were DNA positive/RNA negative (MRFS = 57% and 67%, respectively; yellow group) or DNA positive/RNA positive (MRFS = 20% for both cohorts; red group). Thus, we propose a "traffic light" stratification as a TFR predictor based on DNA and mRNA BCR-ABL1 measurements during DMR maintenance before TKI cessation.
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MESH Headings
- Adult
- Aged
- Female
- Fusion Proteins, bcr-abl/genetics
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/mortality
- Male
- Middle Aged
- Neoplasm, Residual
- Polymerase Chain Reaction/methods
- Protein Kinase Inhibitors/therapeutic use
- Protein-Tyrosine Kinases/antagonists & inhibitors
- RNA, Messenger/analysis
- Remission Induction
- Withholding Treatment
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Affiliation(s)
- Katerina Machova Polakova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic.
- Institute of Pathological Physiology, First Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Hana Zizkova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Jan Zuna
- CLIP, Department of Paediatric Haematology and Oncology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Eliska Motlova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Lenka Hovorkova
- CLIP, Department of Paediatric Haematology and Oncology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Andrea Gottschalk
- Institute for Medical Informatics and Biometry (IMB), Carl Gustav Carus Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Ingmar Glauche
- Institute for Medical Informatics and Biometry (IMB), Carl Gustav Carus Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Jitka Koblihova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Pavla Pecherkova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Hana Klamova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
- Institute of Clinical and Experimental Hematology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marketa Stastna Markova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
- Institute of Clinical and Experimental Hematology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Dana Srbova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Adela Benesova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Vaclava Polivkova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Tomas Jurcek
- Center of Molecular Biology and Gene Therapy, Internal Hematology and Oncology Clinic, Faculty Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Daniela Zackova
- Internal Hematology and Oncology Clinic, Faculty Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiri Mayer
- Internal Hematology and Oncology Clinic, Faculty Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Thomas Ernst
- Abteilung Hämatologie/Onkologie, Klinik für Innere Medizin II, University of Jena, Jena, Germany
| | - Francois X Mahon
- BERGONIE Institute BORDEAUX, INSERM U1218 University of Bordeaux, Bordeaux, France
| | - Susanne Saussele
- Department of Haematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Ingo Roeder
- Institute for Medical Informatics and Biometry (IMB), Carl Gustav Carus Faculty of Medicine, TU Dresden, Dresden, Germany
- National Center for Tumor Diseases (NCT), Partner Site Dresden, Dresden, Germany
| | - Nicholas C P Cross
- Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury and Faculty of Medicine, University of Southampton, Southampton, UK
| | - Andreas Hochhaus
- Abteilung Hämatologie/Onkologie, Klinik für Innere Medizin II, University of Jena, Jena, Germany
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26
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Abstract
Our understanding of the significance of epigenetic dysregulation in the pathogenesis of myeloid malignancies has greatly advanced in the past decade. Enhancer of Zeste Homolog 2 (EZH2) is the catalytic core component of the Polycomb Repressive Complex 2 (PRC2), which is responsible for gene silencing through trimethylation of H3K27. EZH2 dysregulation is highly tumorigenic and has been observed in various cancers, with EZH2 acting as an oncogene or a tumor-suppressor depending on cellular context. While loss-of-function mutations of EZH2 frequently affect patients with myelodysplastic/myeloproliferative neoplasms, myelodysplastic syndrome and myelofibrosis, cases of chronic myeloid leukemia (CML) seem to be largely characterized by EZH2 overexpression. A variety of other factors frequently aberrant in myeloid leukemia can affect PRC2 function and disease pathogenesis, including Additional Sex Combs Like 1 (ASXL1) and splicing gene mutations. As the genetic background of myeloid malignancies is largely heterogeneous, it is not surprising that EZH2 mutations act in conjunction with other aberrations. Since EZH2 mutations are considered to be early events in disease pathogenesis, they are of therapeutic interest to researchers, though targeting of EZH2 loss-of-function does present unique challenges. Preliminary research indicates that combined tyrosine kinase inhibitor (TKI) and EZH2 inhibitor therapy may provide a strategy to eliminate the residual disease burden in CML to allow patients to remain in treatment-free remission.
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Affiliation(s)
- Jenny Rinke
- Klinik für Innere Medizin II, Universitätsklinikum Jena, 07743 Jena, Germany; (J.R.); (A.H.)
| | - Andrew Chase
- School of Medicine, University of Southampton, Southampton SO17 1BJ, UK; (A.C.); (N.C.P.C.)
- Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury SP2 8BJ, UK
| | - Nicholas C. P. Cross
- School of Medicine, University of Southampton, Southampton SO17 1BJ, UK; (A.C.); (N.C.P.C.)
- Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury SP2 8BJ, UK
| | - Andreas Hochhaus
- Klinik für Innere Medizin II, Universitätsklinikum Jena, 07743 Jena, Germany; (J.R.); (A.H.)
| | - Thomas Ernst
- Klinik für Innere Medizin II, Universitätsklinikum Jena, 07743 Jena, Germany; (J.R.); (A.H.)
- Correspondence: ; Tel.: +49-3641-9324201; Fax: +49-3641-9324202
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27
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Schwaab J, Naumann N, Luebke J, Jawhar M, Somervaille TCP, Williams MS, Frewin R, Jost PJ, Lichtenegger FS, La Rosée P, Storch N, Haferlach T, Horny HP, Fabarius A, Haferlach C, Burchert A, Hofmann WK, Cross NCP, Hochhaus A, Reiter A, Metzgeroth G. Response to tyrosine kinase inhibitors in myeloid neoplasms associated with PCM1-JAK2, BCR-JAK2 and ETV6-ABL1 fusion genes. Am J Hematol 2020; 95:824-833. [PMID: 32279331 DOI: 10.1002/ajh.25825] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/03/2020] [Accepted: 04/05/2020] [Indexed: 12/16/2022]
Abstract
We report on 18 patients with myeloid neoplasms and associated tyrosine kinase (TK) fusion genes on treatment with the TK inhibitors (TKI) ruxolitinib (PCM1-JAK2, n = 8; BCR-JAK2, n = 1) and imatinib, nilotinib or dasatinib (ETV6-ABL1, n = 9). On ruxolitinib (median 24 months, range 2-36 months), a complete hematologic response (CHR) and complete cytogenetic response (CCR) was achieved by five of nine and two of nine patients, respectively. However, ruxolitinib was stopped in eight of nine patients because of primary resistance (n = 3), progression (n = 3) or planned allogeneic stem cell transplantation (allo SCT, n = 2). At a median of 36 months (range 4-78 months) from diagnosis, five of nine patients are alive: four of six patients after allo SCT and one patient who remains on ruxolitinib. In ETV6-ABL1 positive patients, a durable CHR was achieved by four of nine patients (imatinib with one of five, nilotinib with two of three, dasatinib with one of one). Because of inadequate efficacy (lack of hematological and/or cytogenetic/molecular response), six of nine patients (imatinib, n = 5; nilotinib, n = 1) were switched to nilotinib or dasatinib. At a median of 23 months (range 3-60 months) from diagnosis, five of nine patients are in CCR or complete molecular response (nilotinib, n = 2; dasatinib, n = 2; allo SCT, n = 1) while two of nine patients have died. We conclude that (a) responses on ruxolitinib may only be transient in the majority of JAK2 fusion gene positive patients with allo SCT being an important early treatment option, and (b) nilotinib or dasatinib may be more effective than imatinib to induce durable complete remissions in ETV6-ABL1 positive patients.
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Affiliation(s)
- Juliana Schwaab
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Nicole Naumann
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Johannes Luebke
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Mohamad Jawhar
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Tim C P Somervaille
- Department of Haematology, The Christie NHS Foundation Trust, Manchester, UK
- Cancer Research UK Manchester Institute, Manchester, UK
| | - Mark S Williams
- Department of Haematology, The Christie NHS Foundation Trust, Manchester, UK
- Cancer Research UK Manchester Institute, Manchester, UK
| | - Rebecca Frewin
- Department of Pathology, Gloucester Royal Hospital, Gloucester, UK
| | - Philipp J Jost
- III. Medical Department, Hematology and Oncology, Klinikum rechts der Isar, Technical University Munich, Munchen, Bayern, Germany
| | | | - Paul La Rosée
- Klinik für Innere Medizin II, Schwarzwald-Baar-Klinikum, Villingen-Schwenningen, Germany
| | - Nicola Storch
- Department of Hematology and Oncology, St. Vincenz Medical Centre, Limburg, Germany
| | | | | | - Alice Fabarius
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Andreas Burchert
- Department of Hematology, Oncology and Immunology, Philipps University Marburg, and University Medical Center Giessen and Marburg, Marburg, Germany
| | - Wolf-Karsten Hofmann
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Nicholas C P Cross
- Faculty of Medicine, University of Southampton, Southampton, UK
- Wessex Regional Genetics Laboratory, Salisbury, UK
| | - Andreas Hochhaus
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Andreas Reiter
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Georgia Metzgeroth
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
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28
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Dawoud AAZ, Tapper WJ, Cross NCP. Clonal myelopoiesis in the UK Biobank cohort: ASXL1 mutations are strongly associated with smoking. Leukemia 2020; 34:2660-2672. [PMID: 32518416 DOI: 10.1038/s41375-020-0896-8] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/19/2020] [Accepted: 05/26/2020] [Indexed: 12/13/2022]
Abstract
We sought to determine the significance of myeloid clonal hematopoiesis (CH) in the UK Biobank cohort (n = 502,524, median age = 58 years). Utilizing SNP array (n = 486,941) and whole exome sequencing data (n = 49,956), we identified 1166 participants with myeloid CH, defined by myeloid-associated mosaic chromosome abnormalities (mCA) and/or likely somatic driver mutations in DNMT3A, TET2, ASXL1, JAK2, SRSF2, or PPM1D. Myeloid CH increased by 1.1-fold per annum (myeloid mCA, P = 1.57 × 10-38; driver mutations, P = 5.89 × 10-47). Genome-wide association analysis identified two distinct signals within TERT that predisposed to myeloid CH, plus a weaker signal corresponding to the JAK2 46/1 haplotype. Specific subtypes of myeloid CH were associated with several blood features and clinical phenotypes, including TET2 mutations and chronic obstructive pulmonary disease. Smoking history was significantly associated with myeloid CH: 53% of myeloid CH cases were smokers compared to 44% of controls (P = 3.38 × 10-6), a difference principally due to current (OR = 1.10; P = 6.14 × 10-6) rather than past smoking (P = 0.08). Breakdown of CH by specific mutation type revealed that ASXL1 loss of function mutations were most strongly associated with current smoking status (OR = 1.07; P = 1.92 × 10-5), and the only abnormality associated with past smoking (OR = 1.04; P = 0.0026). We suggest that the inflammatory environment induced by smoking may promote the outgrowth of ASXL1-mutant clones.
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Affiliation(s)
| | | | - Nicholas C P Cross
- Faculty of Medicine, University of Southampton, Southampton, UK. .,Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury, UK.
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29
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Schwaab J, Cabral do O Hartmann N, Naumann N, Jawhar M, Weiß C, Metzgeroth G, Schmid A, Lübke J, Reiter L, Fabarius A, Cross NCP, Sotlar K, Valent P, Kluin-Nelemans HC, Hofmann WK, Horny HP, Panse J, Reiter A. Importance of Adequate Diagnostic Workup for Correct Diagnosis of Advanced Systemic Mastocytosis. J Allergy Clin Immunol Pract 2020; 8:3121-3127.e1. [PMID: 32422371 DOI: 10.1016/j.jaip.2020.05.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Little is known about the epidemiology of advanced systemic mastocytosis (advSM). OBJECTIVES To investigate epidemiologic features and diagnostic pitfalls of advSM in Germany. METHODS Therefore, 140 patients from a single German reference center of the European Competence Network on Mastocytosis between 2003 and 2018 were analyzed. RESULTS The patients' median age was 68 years (range, 26-86 years), and male versus female ratio was 2:1. An elevated serum tryptase, a KIT D816 mutation, and additional somatic mutations, for example, in SRSF2, ASXL1, or RUNX1, were identified in 95%, 91%, and 74% of patients, respectively. Median overall survival was 3.5 years (range, 0.03-14.3 years; male vs female 2.6 vs 4.2 years; P = .02). Two categories of misdiagnoses were identified in 51 of 140 (36%) patients: First, systemic mastocytosis (SM) was overlooked in 28 of 140 (20%) patients primarily diagnosed with various subtypes of myeloid neoplasms. Second, 23 of 140 (16%) patients were diagnosed with supposed progression from indolent SM to advSM; however, combination of an elevated KIT D816V variant allele frequency in peripheral blood (n = 22), monocytosis (n = 9), eosinophilia (n = 6), and/or mutations in SRSF2, ASXL1, or RUNX1 (n = 10) suggest that distinct signs of potential advSM were overlooked in virtually all patients. Based on locally diagnosed patients in an area of 2.5 million inhabitants, but obviously without considering more, yet unrecognized cases, the incidence and prevalence of advSM is at least 0.8 and 5.2, respectively, per 1 million inhabitants. CONCLUSIONS Adequate analyses of tryptase levels, bone marrow morphology, and genetics in patients with myeloid neoplasms or SM would help to prevent the significant underdiagnosis of advSM.
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Affiliation(s)
- Juliana Schwaab
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Nicole Cabral do O Hartmann
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Nicole Naumann
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Mohamad Jawhar
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Christel Weiß
- Department of Medical Statistics and Biomathematics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Georgia Metzgeroth
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Alicia Schmid
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Johannes Lübke
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Lukas Reiter
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Alice Fabarius
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Nicholas C P Cross
- Wessex Regional Genetics Laboratory, Salisbury, and Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Karl Sotlar
- University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Peter Valent
- Department of Internal Medicine I, Division of Hematology and Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Hanneke C Kluin-Nelemans
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Wolf-Karsten Hofmann
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Hans-Peter Horny
- Department of Pathology, Ludwig-Maximilians-University, Munich, Germany
| | - Jens Panse
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Andreas Reiter
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany.
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30
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Chase A, Score J, Lin F, Bryant C, Waghorn K, Yapp S, Carreno-Tarragona G, Aranaz P, Villasante A, Ernst T, Cross NCP. Mutational mechanisms of EZH2 inactivation in myeloid neoplasms. Leukemia 2020; 34:3206-3214. [PMID: 32322039 PMCID: PMC7610374 DOI: 10.1038/s41375-020-0816-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 09/05/2019] [Revised: 03/20/2020] [Accepted: 03/26/2020] [Indexed: 12/18/2022]
Abstract
EZH2, a component of the polycomb repressive complex 2, catalyses the trimethylation of histone H3 lysine 27, a chromatin mark associated with transcriptional repression. EZH2 loss-of-function mutations are seen in myeloid neoplasms and are associated with an adverse prognosis. Missense mutations in the SET/CXC domain abrogate catalytic activity as assessed by in vitro histone methylation assays, but missense mutations clustering in the conserved DI and DII regions retain activity. To understand the role of DI and DII mutations, we initially developed a cell-based histone methylation assay to test activity in a cellular context. Murine induced pluripotent stem cells lacking EZH2 were transiently transfected with wild type or mutant EZH2 (n=15) and any resulting histone methylation was measured by flow cytometry. All DI mutations (n=5) resulted in complete or partial loss of methylation activity whilst 5/6 DII mutations retained activity. Next, we assessed the possibility of splicing abnormalities induced by exon 8 mutations (encoding DII) using RT-PCR from primary patient samples and mini-gene assays. Exon 8 mutations resulted in skipping of exon 8 and an out-of-frame transcript. We have therefore shown that mutations within regions encoding EZH2 domains DI and DII are pathogenic by loss of function and exon skipping, respectively.
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Affiliation(s)
- Andrew Chase
- Faculty of Medicine, University of Southampton, Southampton, UK. .,Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury, UK.
| | - Joannah Score
- Faculty of Medicine, University of Southampton, Southampton, UK.,Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury, UK
| | - Feng Lin
- Faculty of Medicine, University of Southampton, Southampton, UK.,Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury, UK
| | - Catherine Bryant
- Faculty of Medicine, University of Southampton, Southampton, UK.,Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury, UK
| | - Katherine Waghorn
- Faculty of Medicine, University of Southampton, Southampton, UK.,Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury, UK
| | - Sarah Yapp
- Faculty of Medicine, University of Southampton, Southampton, UK.,Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury, UK
| | | | - Paula Aranaz
- Centre for Nutrition Research, University of Navarra, Pamplona, Spain
| | - Aranzazu Villasante
- Institute for Bioengineering of Catalonia (IBEC), Barcelona, Spain.,Department of Electronics and Biomedical Engineering, University of Barcelona, Barcelona, Spain
| | - Thomas Ernst
- Abteilung Hämatologie/Onkologie, Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Nicholas C P Cross
- Faculty of Medicine, University of Southampton, Southampton, UK.,Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury, UK
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31
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Patel AB, Franzini A, Leroy E, Kim SJ, Pomicter AD, Genet L, Xiao M, Yan D, Ahmann JM, Agarwal AM, Clair P, Addada J, Lambert J, Salmon M, Gleich GJ, Cross NCP, Constantinescu SN, O'Hare T, Prchal JT, Deininger MW. JAK2 ex13InDel drives oncogenic transformation and is associated with chronic eosinophilic leukemia and polycythemia vera. Blood 2019; 134:2388-2398. [PMID: 31697804 PMCID: PMC6933291 DOI: 10.1182/blood.2019001385] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 10/01/2019] [Indexed: 02/06/2023] Open
Abstract
The V617F mutation in the JH2 domain of Janus kinase 2 (JAK2) is an oncogenic driver in several myeloproliferative neoplasms (MPNs), including essential thrombocythemia, myelofibrosis, and polycythemia vera (PV). Other mutations in JAK2 have been identified in MPNs, most notably exon 12 mutations in PV. Here, we describe a novel recurrent mutation characterized by a common 4-amino-acid deletion and variable 1-amino-acid insertion (Leu583-Ala586DelInsSer/Gln/Pro) within the JH2 domain of JAK2. All 4 affected patients had eosinophilia, and both patients with Leu583-Ala586DelInsSer fulfilled diagnostic criteria of both PV and chronic eosinophilic leukemia (CEL). Computational and functional studies revealed that Leu583-Ala586DelInsSer (herein referred to as JAK2ex13InDel) deregulates JAK2 through a mechanism similar to JAK2V617F, activates signal transducer and activator of transcription 5 and extracellular signal-regulated kinase, and transforms parental Ba/F3 cells to growth factor independence. In contrast to JAK2V617F, JAK2ex13InDel does not require an exogenous homodimeric type 1 cytokine receptor to transform Ba/F3 cells and is capable of activating β common chain family cytokine receptor (interleukin-3 receptor [IL-3R], IL-5R, and granulocyte-macrophage colony stimulating factor receptor) signaling in the absence of ligand, with the maximum effect observed for IL-5R, consistent with the clinical phenotype of eosinophilia. Recognizing this new PV/CEL-overlap MPN has significant clinical implications, as both PV and CEL patients are at high risk for thrombosis, and concomitant cytoreduction of red cells, neutrophils, and eosinophils may be required for prevention of thromboembolic events. Targeted next-generation sequencing for genes recurrently mutated in myeloid malignancies in patients with unexplained eosinophilia may reveal additional cases of Leu583-Ala586DelInsSer/Gln/Pro, allowing for complete characterization of this unique MPN.
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Affiliation(s)
- Ami B Patel
- Division of Hematology and Hematologic Malignancies, The University of Utah, Salt Lake City, UT
- Huntsman Cancer Institute, The University of Utah, Salt Lake City, UT
| | - Anca Franzini
- Huntsman Cancer Institute, The University of Utah, Salt Lake City, UT
| | - Emilie Leroy
- Ludwig Cancer Research Brussels and de Duve Institute, Université Catholique de Louvain, Brussels, Belgium
- WELBIO (Walloon Excellence in Life Sciences and Biotechnology), Brussels, Belgium
| | - Soo Jin Kim
- Huntsman Cancer Institute, The University of Utah, Salt Lake City, UT
| | | | - Lidvine Genet
- Ludwig Cancer Research Brussels and de Duve Institute, Université Catholique de Louvain, Brussels, Belgium
- WELBIO (Walloon Excellence in Life Sciences and Biotechnology), Brussels, Belgium
| | - Michael Xiao
- Department of Biochemistry, The University of Utah School of Medicine, Salt Lake City, UT
| | - Dongqing Yan
- Huntsman Cancer Institute, The University of Utah, Salt Lake City, UT
| | - Jonathan M Ahmann
- Huntsman Cancer Institute, The University of Utah, Salt Lake City, UT
| | - Archana M Agarwal
- Division of Clinical Pathology, Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT
| | - Phillip Clair
- Division of Hematology and Hematologic Malignancies, The University of Utah, Salt Lake City, UT
| | - Juanah Addada
- Department of Haematology, Royal Derby Hospital, Derby, United Kingdom
| | - Jonathan Lambert
- Department of Clinical Haematology, University College London Hospitals, London, United Kingdom
| | - Matthew Salmon
- Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury, United Kingdom
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Gerald J Gleich
- Department of Dermatology and
- Department of Medicine, The University of Utah, Salt Lake City, UT; and
| | - Nicholas C P Cross
- Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury, United Kingdom
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Stefan N Constantinescu
- Ludwig Cancer Research Brussels and de Duve Institute, Université Catholique de Louvain, Brussels, Belgium
- WELBIO (Walloon Excellence in Life Sciences and Biotechnology), Brussels, Belgium
| | - Thomas O'Hare
- Division of Hematology and Hematologic Malignancies, The University of Utah, Salt Lake City, UT
- Huntsman Cancer Institute, The University of Utah, Salt Lake City, UT
| | - Josef T Prchal
- Division of Hematology and Hematologic Malignancies, The University of Utah, Salt Lake City, UT
- Veteran Administration Medical Center, Salt Lake City, UT
| | - Michael W Deininger
- Division of Hematology and Hematologic Malignancies, The University of Utah, Salt Lake City, UT
- Huntsman Cancer Institute, The University of Utah, Salt Lake City, UT
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32
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Jawhar M, Schwaab J, Álvarez-Twose I, Shoumariyeh K, Naumann N, Lübke J, Perkins C, Muñoz-González JI, Meggendorfer M, Kennedy V, Metzgeroth G, Fabarius A, Pfeifer D, Sotlar K, Horny HP, von Bubnoff N, Haferlach T, Cross NCP, Hofmann WK, Sperr WR, García-Montero AC, Valent P, Gotlib J, Orfao A, Reiter A. MARS: Mutation-Adjusted Risk Score for Advanced Systemic Mastocytosis. J Clin Oncol 2019; 37:2846-2856. [PMID: 31509472 PMCID: PMC6823885 DOI: 10.1200/jco.19.00640] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [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] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To develop a risk score for patients with advanced systemic mastocytosis (AdvSM) that integrates clinical and mutation characteristics. PATIENTS AND METHODS The study included 383 patients with AdvSM from the German Registry on Disorders of Eosinophils and Mast Cells (training set; n = 231) and several centers for mastocytosis in the United States and Europe, all within the European Competence Network on Mastocytosis (validation set; n = 152). A Cox multivariable model was used to select variables that were predictive of overall survival (OS). RESULTS In multivariable analysis, the following risk factors were identified as being associated with OS: age greater than 60 years, anemia (hemoglobin < 10 g/dL), thrombocytopenia (platelets < 100 × 109/L), presence of one high molecular risk gene mutation (ie, in SRSF2, ASXL1, and/or RUNX1), and presence of two or more high molecular risk gene mutations. By assigning hazard ratio–weighted points to these variables, the following three risk categories were defined: low risk (median OS, not reached), intermediate risk (median OS, 3.9 years; 95% CI, 2.1 to 5.7 years), and high risk (median OS, 1.9 years; 95% CI, 1.3 to 2.6 years; P < .001). The mutation-adjusted risk score (MARS) was independent of the WHO classification and was confirmed in the independent validation set. During a median follow-up time of 2.2 years (range, 0 to 23 years), 63 (16%) of 383 patients experienced a leukemic transformation to secondary mast cell leukemia (32%) or secondary acute myeloid leukemia (68%). The MARS was also predictive for leukemia-free survival (P < .001). CONCLUSION The MARS is a validated, five-parameter, WHO-independent prognostic score that defines three risk groups among patients with AdvSM and may improve up-front treatment stratification for these rare hematologic neoplasms.
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Affiliation(s)
- Mohamad Jawhar
- University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Juliana Schwaab
- University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Iván Álvarez-Twose
- Spanish Network on Mastocytosis, Toledo and Salamanca, Spain.,Virgen del Valle Hospital, Toledo, Spain
| | | | - Nicole Naumann
- University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Johannes Lübke
- University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Cecelia Perkins
- Stanford University School of Medicine/Stanford Cancer Institute, Stanford, CA
| | - Javier I Muñoz-González
- Spanish Network on Mastocytosis, Toledo and Salamanca, Spain.,University of Salamanca and Biomedical Research Institute of Salamanca, Salamanca, Spain
| | | | - Vanessa Kennedy
- Stanford University School of Medicine/Stanford Cancer Institute, Stanford, CA
| | | | - Alice Fabarius
- University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Karl Sotlar
- Paracelsus Medical University of Salzburg, Salzburg, Austria
| | | | | | | | - Nicholas C P Cross
- Wessex Regional Genetics Laboratory, Salisbury, United Kingdom.,University of Southampton, Southampton, United Kingdom
| | | | | | - Andrés C García-Montero
- Spanish Network on Mastocytosis, Toledo and Salamanca, Spain.,University of Salamanca and Biomedical Research Institute of Salamanca, Salamanca, Spain
| | | | - Jason Gotlib
- Stanford University School of Medicine/Stanford Cancer Institute, Stanford, CA
| | - Alberto Orfao
- Spanish Network on Mastocytosis, Toledo and Salamanca, Spain.,University of Salamanca and Biomedical Research Institute of Salamanca, Salamanca, Spain
| | - Andreas Reiter
- University Hospital Mannheim, Heidelberg University, Mannheim, Germany
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33
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Levavi H, Tripodi J, Marcellino B, Mascarenhas J, Jones AV, Cross NCP, Gruenstein D, Najfeld V. A Novel t(1;9)(p36;p24.1) JAK2 Translocation and Review of the Literature. Acta Haematol 2019; 142:105-112. [PMID: 31063994 DOI: 10.1159/000498945] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 02/10/2019] [Indexed: 11/19/2022]
Abstract
The JAK2V617F point mutation has been implicated in the pathogenesis of the vast majority of myeloproliferative neoplasms (MPNs), but translocations involving JAK2 have increasingly been identified in patients with JAK2V617F-negativeMPNs. Here, we present a case of a patient diagnosed with JAK2V617F-negativepolycythemia vera (PV) that transformed to the MPN-blast phase. Cytogenetic and FISH analysis revealed a novel translocation of t(1;9)(p36;p24.1), causing a PEX14-JAK2 gene fusion product. The t(1;9)(p36;p24.1) represents a new addition to the list of known translocations involving JAK2that have been identified in hematologic malignancies. Although the prognostic and treatment implications of JAK2 translocations in MPNs have not been elucidated, positive outcomes have been described in case reports describing the use of JAK inhibitors in these patients. Further research into the role of JAK2 translocations in the pathogenesis and outcomes of hematologic malignancies is warranted.
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Affiliation(s)
- Hannah Levavi
- Departments of Medicine and Pathology, Tumor Cytogenomics, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | | | - Bridget Marcellino
- Departments of Medicine and Pathology, Tumor Cytogenomics, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - John Mascarenhas
- Departments of Medicine and Pathology, Tumor Cytogenomics, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Amy V Jones
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Nicholas C P Cross
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Diana Gruenstein
- Departments of Medicine and Pathology, Tumor Cytogenomics, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Vesna Najfeld
- Departments of Medicine and Pathology, Tumor Cytogenomics, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA,
- Tisch Cancer Institute, New York, New York, USA,
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34
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Jawhar M, Döhner K, Kreil S, Schwaab J, Shoumariyeh K, Meggendorfer M, Span LLF, Fuhrmann S, Naumann N, Horny HP, Sotlar K, Kubuschok B, von Bubnoff N, Spiekermann K, Heuser M, Metzgeroth G, Fabarius A, Klein S, Hofmann WK, Kluin-Nelemans HC, Haferlach T, Döhner H, Cross NCP, Sperr WR, Valent P, Reiter A. KIT D816 mutated/CBF-negative acute myeloid leukemia: a poor-risk subtype associated with systemic mastocytosis. Leukemia 2019; 33:1124-1134. [PMID: 30635631 PMCID: PMC6756067 DOI: 10.1038/s41375-018-0346-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/02/2018] [Accepted: 11/06/2018] [Indexed: 01/07/2023]
Abstract
KIT D816 mutations (KIT D816mut) are strongly associated with systemic mastocytosis (SM) but are also detectable in acute myeloid leukemia (AML), where they represent an adverse prognostic factor in combination with core binding factor (CBF) fusion genes. Here, we evaluated the clinical and molecular features of KIT D816mut/CBF-negative (CBFneg) AML, a previously uncharacterized combination. All KIT D816mut/CBFneg cases (n = 40) had histologically proven SM with associated AML (SM-AML). Molecular analyses revealed at least one additional somatic mutation (median, n = 3) beside KIT D816 (e.g., SRSF2, 38%; ASXL1, 31%; RUNX1, 34%) in 32/32 (100%) patients. Secondary AML evolved in 29/40 (73%) patients from SM ± associated myeloid neoplasm. Longitudinal molecular and cytogenetic analyses revealed the acquisition of new mutations and/or karyotype evolution in 15/16 (94%) patients at the time of SM-AML. Median overall survival (OS) was 5.4 months. A screen of two independent AML databases (AMLdatabases) revealed remarkable similarities between KIT D816mut/CBFneg SM-AML and KIT D816mut/CBFneg AMLdatabases (n = 69) with regard to KIT D816mut variant allele frequency, mutation profile, aberrant karyotype, and OS suggesting underlying SM in a significant proportion of AMLdatabases patients. Bone marrow histology and reclassification as SM-AML has important clinical implications regarding prognosis and potential inclusion of KIT inhibitors in treatment concepts.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Alleles
- Biomarkers
- Bone Marrow/pathology
- Core Binding Factors/genetics
- Cytogenetic Analysis
- Female
- Gene Frequency
- High-Throughput Nucleotide Sequencing
- Humans
- In Situ Hybridization, Fluorescence
- Kaplan-Meier Estimate
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/mortality
- Leukemia, Myeloid, Acute/therapy
- Male
- Mastocytosis, Systemic/genetics
- Mastocytosis, Systemic/metabolism
- Mastocytosis, Systemic/pathology
- Middle Aged
- Mutation
- Proto-Oncogene Proteins c-kit/genetics
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Affiliation(s)
- Mohamad Jawhar
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Konstanze Döhner
- Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany
| | - Sebastian Kreil
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Juliana Schwaab
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Khalid Shoumariyeh
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg, Freiburg, Germany
| | | | - Lambert L F Span
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan Fuhrmann
- Department of Hematology and Oncology, HELIOS Hospital, Berlin, Germany
| | - Nicole Naumann
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Hans-Peter Horny
- Institute of Pathology, Ludwig-Maximilians-University, Munich, Germany
| | - Karl Sotlar
- Institute of Pathology, Medical University of Salzburg, Salzburg, Austria
| | - Boris Kubuschok
- Department of Internal Medicine I, José-Carreras Centrum for Immuno- and Gene Therapy, University of Saarland Medical School, Homburg/Saar, Germany
| | - Nikolas von Bubnoff
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg, Freiburg, Germany
| | | | - Michael Heuser
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Georgia Metzgeroth
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Alice Fabarius
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefan Klein
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Wolf-Karsten Hofmann
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Hanneke C Kluin-Nelemans
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Hartmut Döhner
- Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany
| | - Nicholas C P Cross
- Wessex Regional Genetics Laboratory, Salisbury, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Wolfgang R Sperr
- Department of Internal Medicine I, Division of Hematology and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria
| | - Peter Valent
- Department of Internal Medicine I, Division of Hematology and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria
| | - Andreas Reiter
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany.
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35
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Lübke J, Naumann N, Kluger S, Schwaab J, Metzgeroth G, Evans E, Gardino AK, Lengauer C, Hofmann WK, Fabarius A, Cross NCP, Reiter A, Jawhar M. Inhibitory effects of midostaurin and avapritinib on myeloid progenitors derived from patients with KIT D816V positive advanced systemic mastocytosis. Leukemia 2019; 33:1195-1205. [PMID: 30911112 PMCID: PMC6756065 DOI: 10.1038/s41375-019-0450-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [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: 01/09/2019] [Revised: 03/08/2019] [Accepted: 03/08/2019] [Indexed: 02/03/2023]
Abstract
Advanced systemic mastocytosis (advSM) is characterized by the presence of an acquired KIT D816V mutation in >90% of patients. In the majority of patients, KIT D816V is not only detected in mast cells but also in other hematopoietic lineages. We sought to investigate the effects of the KIT-inhibitors midostaurin and avapritinib on single-cell-derived myeloid progenitor cells using granulocyte-macrophage colony-forming-units of patients with KIT D816V positive advSM. Colonies obtained prior to treatment were incubated in vitro with midostaurin (n = 10) or avapritinib (n = 11) and showed a marked reduction (≥50%) of KIT D816V positive colonies in 3/10 (30%) and 7/11 (64%) patient samples, respectively. Three of those 7 (43%) avapritinib responders were resistant to midostaurin in both, in vitro and in vivo. Colonies from four patients with high-risk molecular profile and aggressive clinical course were resistant to both drugs. The in vitro activity of midostaurin strongly correlated with clinical and molecular responses, e.g., relative reduction of KIT D816V allele burden and the proportion of KIT D816V positive colonies obtained after six months midostaurin-treatment in vivo. We conclude that the colony inhibition assay provides useful information for prediction of responses on midostaurin and that avapritinib has a superior in vitro activity compared to midostaurin.
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Affiliation(s)
- Johannes Lübke
- Department of Hematology and Oncology, University Medical Centre Mannheim, Mannheim, Germany
| | - Nicole Naumann
- Department of Hematology and Oncology, University Medical Centre Mannheim, Mannheim, Germany
| | - Sebastian Kluger
- Department of Hematology and Oncology, University Medical Centre Mannheim, Mannheim, Germany
| | - Juliana Schwaab
- Department of Hematology and Oncology, University Medical Centre Mannheim, Mannheim, Germany
| | - Georgia Metzgeroth
- Department of Hematology and Oncology, University Medical Centre Mannheim, Mannheim, Germany
| | - Erica Evans
- Blueprint Medicines Corporation, Cambridge, MA, USA
| | | | | | - Wolf-Karsten Hofmann
- Department of Hematology and Oncology, University Medical Centre Mannheim, Mannheim, Germany
| | - Alice Fabarius
- Department of Hematology and Oncology, University Medical Centre Mannheim, Mannheim, Germany
| | - Nicholas C P Cross
- Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury, UK.,Faculty of Medicine, University of Southampton, Southampton, UK
| | - Andreas Reiter
- Department of Hematology and Oncology, University Medical Centre Mannheim, Mannheim, Germany.
| | - Mohamad Jawhar
- Department of Hematology and Oncology, University Medical Centre Mannheim, Mannheim, Germany
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36
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Cross NCP, Hoade Y, Tapper WJ, Carreno-Tarragona G, Fanelli T, Jawhar M, Naumann N, Pieniak I, Lübke J, Ali S, Bhuller K, Burgstaller S, Cargo C, Cavenagh J, Duncombe AS, Das-Gupta E, Evans P, Forsyth P, George P, Grimley C, Jack F, Munro L, Mehra V, Patel K, Rismani A, Sciuccati G, Thomas-Dewing R, Thornton P, Virchis A, Watt S, Wallis L, Whiteway A, Zegocki K, Bain BJ, Reiter A, Chase A. Recurrent activating STAT5B N642H mutation in myeloid neoplasms with eosinophilia. Leukemia 2018; 33:415-425. [PMID: 30573779 PMCID: PMC6365490 DOI: 10.1038/s41375-018-0342-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 09/24/2018] [Indexed: 01/16/2023]
Abstract
Determining the underlying cause of persistent eosinophilia is important for effective clinical management but remains a diagnostic challenge in many cases. We identified STAT5B N642H, an established oncogenic mutation, in 27/1715 (1.6%) cases referred for investigation of eosinophilia. Of the 27 mutated cases, a working diagnosis of hypereosinophilic syndrome (HES; n = 7) or a myeloid neoplasm with eosinophilia (n = 20) had been made prior to the detection of STAT5B N642H. Myeloid panel analysis identified a median of 2 additional mutated genes (range 0–4) with 4 cases having STAT5B N642H as a sole abnormality. STAT5B N642H was absent in cultured T cells of 4/4 positive cases. Individuals with SF3B1 mutations (9/27; 33%) or STAT5B N642H as a sole abnormality had a markedly better overall survival compared to cases with other additional mutations (median 65 months vs. 14 months; hazard ratio = 8.1; P < 0.001). The overall survival of STAT5B-mutated HES cases was only 30 months, suggesting that these cases should be reclassified as chronic eosinophilic leukemia, not otherwise specified (CEL-NOS). The finding of STAT5B N642H as a recurrent mutation in myeloid neoplasia with eosinophilia provides a new diagnostic and prognostic marker as well as a potential target for therapy.
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Affiliation(s)
- Nicholas C P Cross
- Faculty of Medicine, University of Southampton, Southampton, UK. .,Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury, UK.
| | - Yvette Hoade
- Faculty of Medicine, University of Southampton, Southampton, UK.,Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury, UK
| | | | - Gonzalo Carreno-Tarragona
- Faculty of Medicine, University of Southampton, Southampton, UK.,Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury, UK
| | - Tiziana Fanelli
- Center Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, University of Florence, Firenze, Italy
| | - Mohamad Jawhar
- University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Nicole Naumann
- University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Iwo Pieniak
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Johannes Lübke
- University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Sahra Ali
- Hull & East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Kaljit Bhuller
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | | | | | | | - Emma Das-Gupta
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Paul Evans
- HMDS, St. James's University Hospital, Leeds, UK
| | | | - Philip George
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | | | | | | | - Kavita Patel
- Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Ali Rismani
- Whittington Health & University College London Hospitals, London, UK
| | | | | | | | - Andres Virchis
- Royal Free London, Barnet Hospital, Wellhouse Lane, Barnet, UK
| | - Simon Watt
- Manchester University NHS FT, Manchester, UK
| | | | | | | | | | - Andreas Reiter
- University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Andrew Chase
- Faculty of Medicine, University of Southampton, Southampton, UK.,Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury, UK
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37
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Cross NCP, White HE, Evans PAS, Hancock J, Copland M, Milojkovic D, Mason J, Craine S, Mead AJ. Consensus on BCR-ABL1 reporting in chronic myeloid leukaemia in the UK. Br J Haematol 2018; 182:777-788. [PMID: 30125955 PMCID: PMC6175193 DOI: 10.1111/bjh.15542] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
For patients with chronic myeloid leukaemia (CML), treatment guidelines recommend monitoring response to treatment with tyrosine kinase inhibitors (TKIs) by testing the BCR‐ABL1 fusion gene transcript level using reverse transcriptase quantitative polymerase chain reaction. Despite recent efforts to standardise protocols for BCR‐ABL1 testing, some variability remains among laboratories in the UK regarding the techniques used and the approach to reporting results. This increases the risk of misinterpretation of results by both clinicians and patients. An expert panel met to discuss current issues surrounding BCR‐ABL1 testing in the UK and to develop guidance for laboratories, with emphasis on the optimal approach to reporting laboratory results. Topics included the minimum required information to include in the laboratory report, units of measurement, test sensitivity and BCR‐ABL1 transcript variants. To aid communication between laboratories and clinics, standard forms were generated that could be used by (i) clinics when submitting samples to laboratories, and (ii) laboratories when reporting results to clinics. Standardising the way in which BCR‐ABL1 test results are reported from laboratories to clinics should help to improve communication, interpretation of results and patient care.
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Affiliation(s)
- Nicholas C P Cross
- University of Southampton, Southampton, UK.,Salisbury NHS Foundation Trust, Salisbury, UK
| | | | | | - Jeremy Hancock
- Bristol Genetics Laboratory, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Mhairi Copland
- Paul O'Gorman Leukaemia Research Centre, Institute of Cancer Sciences, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Dragana Milojkovic
- Hammersmith Hospital - Imperial College Healthcare NHS Trust, London, UK
| | - Joanne Mason
- West Midlands Regional Genetics Laboratory, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | | | - Adam J Mead
- Oxford NIHR Biomedical Research Centre, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
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38
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Khoder A, Al Obaidi M, Babb A, Liu C, Cross NCP, Bain BJ. Chronic neutrophilic leukemia. Am J Hematol 2018; 93:841-842. [PMID: 29473201 DOI: 10.1002/ajh.25073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 02/20/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Ahmad Khoder
- Department of HaematologyWest Middlesex University HospitalIsleworth MiddlesexTW7 6AF United Kingdom
| | - Magda Al Obaidi
- Department of HaematologyWest Middlesex University HospitalIsleworth MiddlesexTW7 6AF United Kingdom
| | - Anna Babb
- Department of HaematologyWest Middlesex University HospitalIsleworth MiddlesexTW7 6AF United Kingdom
| | - Christine Liu
- Department of HaematologyWest Middlesex University HospitalIsleworth MiddlesexTW7 6AF United Kingdom
| | - Nicholas C. P. Cross
- Wessex Regional Genetics LaboratorySalisbury District HospitalSalisbury WiltshireSP2 8BJ United Kingdom
| | - Barbara J. Bain
- Centre for Haematology, St Mary's Hospital Campus of Imperial College London, St Mary's HospitalLondonW2 1NY United Kingdom
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39
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Catherwood MA, Graham A, Cuthbert RJG, Garrec C, Gardie B, Girodon F, Laird S, Cross NCP, McMullin MF. Absence of CALR Mutations in Idiopathic Erythrocytosis Patients with Low Serum Erythropoietin Levels. Acta Haematol 2018; 139:217-219. [PMID: 29847812 DOI: 10.1159/000489006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 03/30/2018] [Indexed: 01/05/2023]
Affiliation(s)
- Mark A Catherwood
- Clinical Haematology, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Amy Graham
- Clinical Haematology, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Robert J G Cuthbert
- Clinical Haematology, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Celine Garrec
- Ecole Pratique des Hautes Etudes (EPHE), PSL Research University, Paris, France
- INSERM U892, CNRS 6299, Université de Nantes, Nantes, France
| | - Betty Gardie
- Ecole Pratique des Hautes Etudes (EPHE), PSL Research University, Paris, France
- INSERM U892, CNRS 6299, Université de Nantes, Nantes, France
| | - François Girodon
- Service d'Hématologie Biologique CHU Dijon, Dijon, France
- INSERM, UMR866, University of Burgundy Franche-Comté, Dijon, France
| | - Sophie Laird
- Wessex Regional Genetics Laboratory, Salisbury, United Kingdom
| | | | - Mary Frances McMullin
- Clinical Haematology, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom
- Centre for Medical Education (CME), Queen's University Belfast, Belfast, United Kingdom
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40
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Naumann N, Jawhar M, Schwaab J, Kluger S, Lübke J, Metzgeroth G, Popp HD, Khaled N, Horny HP, Sotlar K, Valent P, Haferlach C, Göhring G, Schlegelberger B, Meggendorfer M, Hofmann WK, Cross NCP, Reiter A, Fabarius A. Incidence and prognostic impact of cytogenetic aberrations in patients with systemic mastocytosis. Genes Chromosomes Cancer 2018; 57:252-259. [PMID: 29341334 DOI: 10.1002/gcc.22526] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/14/2018] [Accepted: 01/15/2018] [Indexed: 12/22/2022] Open
Abstract
The clinical behavior of systemic mastocytosis (SM) is strongly associated with activating mutations in KIT (D816V in >80% of cases), with the severity of the phenotype influenced by additional somatic mutations, for example, in SRSF2, ASXL1, or RUNX1. Complex molecular profiles are frequently associated with the presence of an associated hematologic neoplasm (AHN) and an unfavorable clinical outcome. However, little is known about the incidence and prognostic impact of cytogenetic aberrations. We analyzed cytogenetic and molecular characteristics of 109 patients (KIT D816V+, n = 102, 94%) with indolent (ISM, n = 26) and advanced SM (n = 83) with (n = 73, 88%) or without AHN. An aberrant karyotype was identified in SM-AHN (16/73, 22%) patients only. In patients with an aberrant karyotype, additional somatic mutations were identified in 12/16 (75%) patients. Seven of 10 (70%) patients with a poor-risk karyotype, for example, monosomy 7 or complex karyotype, and 1/6 (17%) patients with a good-risk karyotype progressed to secondary acute myeloid leukemia (n = 7) or mast cell leukemia (n = 1) within a median of 40 months (range 2-190, P = .04). In advanced SM, the median overall survival (OS) of poor-risk karyotype patients was significantly shorter than in good-risk/normal karyotype patients (4 vs 39 months; hazard ratio 11.7, 95% CI 5.0-27.3; P < .0001). Additionally, the shortened OS in patients with poor-risk karyotype was independent from the mutation status. In summary, a poor-risk karyotype is an independent prognostic variable in advanced SM. Cytogenetic and molecular analyses should be routinely performed in all patients with advanced SM ± AHN because these investigations greatly support prognostication and treatment decisions.
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Affiliation(s)
- Nicole Naumann
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Heidelberg, Germany
| | - Mohamad Jawhar
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Heidelberg, Germany
| | - Juliana Schwaab
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Heidelberg, Germany
| | - Sebastian Kluger
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Heidelberg, Germany
| | - Johannes Lübke
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Heidelberg, Germany
| | - Georgia Metzgeroth
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Heidelberg, Germany
| | - Henning D Popp
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Heidelberg, Germany
| | - Nada Khaled
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Heidelberg, Germany
| | - Hans-Peter Horny
- Institute of Pathology, Ludwig-Maximilians-University, Munich, Germany
| | - Karl Sotlar
- University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Peter Valent
- Department of Internal Medicine I, Division of Hematology and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria
| | | | - Gudrun Göhring
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | | | | | - Wolf-Karsten Hofmann
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Heidelberg, Germany
| | - Nicholas C P Cross
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,Wessex Regional Genetics Laboratory, Salisbury, United Kingdom
| | - Andreas Reiter
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Heidelberg, Germany
| | - Alice Fabarius
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Heidelberg, Germany
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41
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Hoade Y, Metzgeroth G, Schwaab J, Reiter A, Cross NCP. Routine Screening for KIT M541L Is Not Warranted in the Diagnostic Work-Up of Patients with Hypereosinophilia. Acta Haematol 2018; 139:71-73. [PMID: 29393093 DOI: 10.1159/000485959] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 11/30/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Yvette Hoade
- Wessex Regional Genetics Laboratory, Salisbury, UK
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42
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Ghazzawi M, Mehra V, Knut M, Brown L, Tapper W, Chase A, de Lavallade H, Cross NCP. A Novel PCM1-PDGFRB Fusion in a Patient with a Chronic Myeloproliferative Neoplasm and an ins(8;5). Acta Haematol 2017; 138:198-200. [PMID: 29169164 DOI: 10.1159/000484077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 10/09/2017] [Indexed: 11/19/2022]
MESH Headings
- Antineoplastic Agents/therapeutic use
- Autoantigens/chemistry
- Autoantigens/genetics
- Cell Cycle Proteins/chemistry
- Cell Cycle Proteins/genetics
- Chromosomes, Human, Pair 5/genetics
- Chromosomes, Human, Pair 8/genetics
- Humans
- Hypereosinophilic Syndrome/drug therapy
- Hypereosinophilic Syndrome/genetics
- Imatinib Mesylate/therapeutic use
- Leukemia, Myelomonocytic, Chronic/drug therapy
- Leukemia, Myelomonocytic, Chronic/genetics
- Male
- Middle Aged
- Mutagenesis, Insertional
- Oncogene Proteins, Fusion/chemistry
- Oncogene Proteins, Fusion/genetics
- Protein Kinase Inhibitors/therapeutic use
- RNA, Neoplasm/genetics
- Receptor, Platelet-Derived Growth Factor beta/chemistry
- Receptor, Platelet-Derived Growth Factor beta/genetics
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Affiliation(s)
- Muna Ghazzawi
- Faculty of Medicine, University of Southampton, Southampton, UK
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43
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Harrison CN, Mead AJ, Panchal A, Fox S, Yap C, Gbandi E, Houlton A, Alimam S, Ewing J, Wood M, Chen F, Coppell J, Panoskaltsis N, Knapper S, Ali S, Hamblin A, Scherber R, Dueck AC, Cross NCP, Mesa R, McMullin MF. Ruxolitinib vs best available therapy for ET intolerant or resistant to hydroxycarbamide. Blood 2017; 130:1889-1897. [PMID: 29074595 PMCID: PMC6410531 DOI: 10.1182/blood-2017-05-785790] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 07/24/2017] [Indexed: 01/11/2023] Open
Abstract
Treatments for high-risk essential thrombocythemia (ET) address thrombocytosis, disease-related symptoms, as well as risks of thrombosis, hemorrhage, transformation to myelofibrosis, and leukemia. Patients resistant/intolerant to hydroxycarbamide (HC) have a poor outlook. MAJIC (ISRCTN61925716) is a randomized phase 2 trial of ruxolitinib (JAK1/2 inhibitor) vs best available therapy (BAT) in ET and polycythemia vera patients resistant or intolerant to HC. Here, findings of MAJIC-ET are reported, where the modified intention-to-treat population included 58 and 52 patients randomized to receive ruxolitinib or BAT, respectively. There was no evidence of improvement in complete response within 1 year reported in 27 (46.6%) patients treated with ruxolitinib vs 23 (44.2%) with BAT (P = .40). At 2 years, rates of thrombosis, hemorrhage, and transformation were not significantly different; however, some disease-related symptoms improved in patients receiving ruxolitinib relative to BAT. Molecular responses were uncommon; there were 2 complete molecular responses (CMR) and 1 partial molecular response in CALR-positive ruxolitinib-treated patients. Transformation to myelofibrosis occurred in 1 CMR patient, presumably because of the emergence of a different clone, raising questions about the relevance of CMR in ET patients. Grade 3 and 4 anemia occurred in 19% and 0% of ruxolitinib vs 0% (both grades) in the BAT arm, and grade 3 and 4 thrombocytopenia in 5.2% and 1.7% of ruxolitinib vs 0% (both grades) of BAT-treated patients. Rates of discontinuation or treatment switching did not differ between the 2 trial arms. The MAJIC-ET trial suggests that ruxolitinib is not superior to current second-line treatments for ET. This trial was registered at www.isrctn.com as #ISRCTN61925716.
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Affiliation(s)
| | - Adam J Mead
- Weatherall Institute of Molecular Medicine, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Anesh Panchal
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Sonia Fox
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Christina Yap
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Emmanouela Gbandi
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Aimee Houlton
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Samah Alimam
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Joanne Ewing
- Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - Marion Wood
- Colchester Hospital University NHS Foundation Trust, Colchester, United Kingdom
| | - Frederick Chen
- Centre for Clinical Hematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Jason Coppell
- Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
| | - Nicki Panoskaltsis
- Department of Hematology, London North West Healthcare NHS Trust, London, United Kingdom
| | - Steven Knapper
- Department of Hematology, Cardiff University, Cardiff, United Kingdom
| | - Sahra Ali
- Castle Hill Hospital, Hull, United Kingdom
| | - Angela Hamblin
- NIHR Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Robyn Scherber
- Department of Hematology and Oncology, Oregon Health and Sciences University, Portland, OR
- Mayo Clinic, Phoenix, AZ
| | - Amylou C Dueck
- Division of Health Sciences Research, Mayo Clinic, Scottsdale, AZ
| | - Nicholas C P Cross
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom; and
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44
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Jawhar M, Naumann N, Knut M, Score J, Ghazzawi M, Schneider B, Kreuzer KA, Hallek M, Drexler HG, Chacko J, Wallis L, Fabarius A, Metzgeroth G, Hofmann WK, Chase A, Tapper W, Reiter A, Cross NCP. Cytogenetically cryptic ZMYM2-FLT3 and DIAPH1-PDGFRB gene fusions in myeloid neoplasms with eosinophilia. Leukemia 2017; 31:2271-2273. [PMID: 28751768 PMCID: PMC5630086 DOI: 10.1038/leu.2017.240] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- M Jawhar
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - N Naumann
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - M Knut
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - J Score
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - M Ghazzawi
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - B Schneider
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - K-A Kreuzer
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - M Hallek
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - H G Drexler
- Department of Human and Animal Cell Lines, Leibniz-Institute DSMZ, German Collection of Microorganisms and Cell Cultures, Braunschweig, Germany
| | - J Chacko
- Department of Haematology, Royal Bournemouth Hospital, Bournemouth, UK
| | - L Wallis
- Department of Haematology, Royal Bournemouth Hospital, Bournemouth, UK
| | - A Fabarius
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - G Metzgeroth
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - W-K Hofmann
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - A Chase
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - W Tapper
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - A Reiter
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - N C P Cross
- Faculty of Medicine, University of Southampton, Southampton, UK
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45
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Hochhaus A, Mahon FX, le Coutre P, Petrov L, Janssen JJWM, Cross NCP, Rea D, Castagnetti F, Hellmann A, Rosti G, Gattermann N, Coronel MLP, Gutierrez MAE, Garcia-Gutierrez V, Vincenzi B, Dezzani L, Giles FJ. Nilotinib first-line therapy in patients with Philadelphia chromosome-negative/BCR-ABL-positive chronic myeloid leukemia in chronic phase: ENEST1st sub-analysis. J Cancer Res Clin Oncol 2017; 143:1225-1233. [PMID: 28224300 PMCID: PMC5486575 DOI: 10.1007/s00432-017-2359-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 01/27/2017] [Indexed: 01/06/2023]
Abstract
PURPOSE The ENEST1st sub-analysis presents data based on Philadelphia chromosome (Ph) status, i.e., Ph+ and Ph-/BCR-ABL1 + chronic myeloid leukemia. METHODS Patients received nilotinib 300 mg twice daily, up to 24 months. RESULTS At screening, 983 patients were identified as Ph+ and 30 patients as Ph-/BCR-ABL + based on cytogenetic and RT-PCR assessment; 76 patients had unknown karyotype (excluded from this sub-analysis). In the Ph-/BCR-ABL1 + subgroup, no additional chromosomal aberrations were reported. In the Ph+ subgroup, 952 patients had safety and molecular assessments. In the Ph-/BCR-ABL1 + subgroup, 30 patients had safety assessments and 28 were followed up for molecular assessments. At 18 months, the molecular response (MR) 4 rate [MR4; BCR-ABL1 ≤0.01% on International Scale (IS)] was similar in the Ph-/BCR-ABL1+ (39.3%) and Ph+ subgroups (38.1%). By 24 months, the cumulative rates of major molecular response (BCR-ABL1IS ≤0.1%;), MR4, and MR4.5 (BCR-ABL1IS ≤0.0032%) were 85.7, 60.7, and 50.0%, respectively, in the Ph-/BCR-ABL1 + subgroup, and 80.3, 54.7, and 38.3%, respectively, in the Ph+ subgroup. In both Ph-/BCR-ABL1 + and Ph+ subgroups, rash (20 and 22%), pruritus (16.7 and 16.7%), nasopharyngitis (13.3 and 10.4%), fatigue (10 and 14.2%), headache (10 and 15.8%), and nausea (6.7 vs 11.4%) were frequent non-hematologic adverse events, whereas hypophosphatemia (23.3 and 6.8%), anemia (10 and 6.5%), and thrombocytopenia (3.3 and 10.2%) were the common hematologic/biochemical laboratory events. CONCLUSION Based on similar molecular response and safety results in both subgroups, we conclude that Ph-/BCR-ABL1 + patients benefit from nilotinib in the same way as Ph+ patients.
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Affiliation(s)
- Andreas Hochhaus
- Abteilung Hämatologie/Onkologie, Klinik für Innere Medizin II, Universitätsklinikum Jena, Am Klinikum 1, 07740, Jena, Germany.
| | - Franҫois-Xavier Mahon
- Laboratoire Hématopoïèse Leucémique et Cible Thérapeutique, Université Victor Ségalen, Bordeaux, France
| | | | | | - Jeroen J W M Janssen
- Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Delphine Rea
- Adult Hematology Department, Hôpital Saint-Louis, APHP, Paris, France
| | - Fausto Castagnetti
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology "L. & A. Seràgnoli", "S Orsola-Malpighi" University Hospital, University of Bologna, Bologna, Italy
| | - Andrzej Hellmann
- Department of Hematology, Medical University of Gdańsk, Gdańsk, Poland
| | - Gianantonio Rosti
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology "L. & A. Seràgnoli", "S Orsola-Malpighi" University Hospital, University of Bologna, Bologna, Italy
| | - Norbert Gattermann
- Department of Hematology, Oncology, and Clinical Immunology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | | | | | | | | | | | - Francis J Giles
- Division of Hematology Oncology, Developmental Therapeutics Program, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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46
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Rinke J, Müller JP, Blaess MF, Chase A, Meggendorfer M, Schäfer V, Winkelmann N, Haferlach C, Cross NCP, Hochhaus A, Ernst T. Molecular characterization of EZH2 mutant patients with myelodysplastic/myeloproliferative neoplasms. Leukemia 2017. [DOI: 10.1038/leu.2017.190] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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47
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Silver RT, Barel AC, Lascu E, Ritchie EK, Roboz GJ, Christos PJ, Orazi A, Hassane DC, Tam W, Cross NCP. The effect of initial molecular profile on response to recombinant interferon-α (rIFNα) treatment in early myelofibrosis. Cancer 2017; 123:2680-2687. [DOI: 10.1002/cncr.30679] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 01/11/2017] [Accepted: 01/12/2017] [Indexed: 01/24/2023]
Affiliation(s)
- Richard T. Silver
- Richard T Silver, MD Myeloproliferative Neoplasms Center, Division of Hematology-Medical Oncology; Weill Cornell Medicine; New York New York
| | - Ariella C. Barel
- Richard T Silver, MD Myeloproliferative Neoplasms Center, Division of Hematology-Medical Oncology; Weill Cornell Medicine; New York New York
| | - Elena Lascu
- Richard T Silver, MD Myeloproliferative Neoplasms Center, Division of Hematology-Medical Oncology; Weill Cornell Medicine; New York New York
| | - Ellen K. Ritchie
- Richard T Silver, MD Myeloproliferative Neoplasms Center, Division of Hematology-Medical Oncology; Weill Cornell Medicine; New York New York
| | - Gail J. Roboz
- Richard T Silver, MD Myeloproliferative Neoplasms Center, Division of Hematology-Medical Oncology; Weill Cornell Medicine; New York New York
| | - Paul J. Christos
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research; Weill Cornell Medicine; New York New York
| | - Attilio Orazi
- Department of Pathology and Laboratory Medicine; Weill Cornell Medicine; New York New York
| | - Duane C. Hassane
- Institute for Computational Biomedicine, Division of Hematology and Medical Oncology, Department of Medicine; Weill Cornell Medicine; New York New York
| | - Wayne Tam
- Department of Pathology and Laboratory Medicine; Weill Cornell Medicine; New York New York
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48
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Silver RT, Krichevsky S, Gjoni S, Cross NCP. Evaluation of serum erythropoietin values as defined by 2016 World Health Organization criteria for the diagnosis of polycythemia vera. Leuk Lymphoma 2017; 58:2768-2769. [DOI: 10.1080/10428194.2017.1300892] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Richard T. Silver
- Division of Hematology/Medical Oncology, Myeloproliferative Neoplasm Center, Weill Cornell Medicine, New York, NY, USA
| | - Spencer Krichevsky
- Division of Hematology/Medical Oncology, Myeloproliferative Neoplasm Center, Weill Cornell Medicine, New York, NY, USA
| | - Stefani Gjoni
- Division of Hematology/Medical Oncology, Myeloproliferative Neoplasm Center, Weill Cornell Medicine, New York, NY, USA
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49
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Gunawan AS, McLornan DP, Wilkins B, Waghorn K, Hoade Y, Cross NCP, Harrison CN. Ruxolitinib, a potent JAK1/JAK2 inhibitor, induces temporary reductions in the allelic burden of concurrent CSF3R mutations in chronic neutrophilic leukemia. Haematologica 2017; 102:e238-e240. [PMID: 28302714 DOI: 10.3324/haematol.2017.163790] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
| | | | | | - Katherine Waghorn
- Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust and Faculty of Medicine, University of Southampton, UK
| | - Yvette Hoade
- Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust and Faculty of Medicine, University of Southampton, UK
| | - Nicholas C P Cross
- Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust and Faculty of Medicine, University of Southampton, UK
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50
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Scott S, Travis D, Whitby L, Bainbridge J, Cross NCP, Barnett D. Measurement ofBCR-ABL1by RT-qPCR in chronic myeloid leukaemia: findings from an International EQA Programme. Br J Haematol 2017; 177:414-422. [DOI: 10.1111/bjh.14557] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 11/19/2016] [Indexed: 01/21/2023]
Affiliation(s)
- Stuart Scott
- UKNEQAS for Leucocyte Immunophenotyping; Sheffield Teaching Hospitals; Sheffield UK
| | - Debbie Travis
- UKNEQAS for Leucocyte Immunophenotyping; Sheffield Teaching Hospitals; Sheffield UK
| | - Liam Whitby
- UKNEQAS for Leucocyte Immunophenotyping; Sheffield Teaching Hospitals; Sheffield UK
| | - John Bainbridge
- Biostatistics Center; Duke Human Vaccine Institute; Duke University Medical Center; Durham NC USA
| | - Nicholas C. P. Cross
- Wessex Regional Genetics Laboratory; Salisbury District Hospital; Salisbury UK
- Faculty of Medicine; University of Southampton; Southampton UK
| | - David Barnett
- UKNEQAS for Leucocyte Immunophenotyping; Sheffield Teaching Hospitals; Sheffield UK
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