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Modvig S, Madsen HO, Siitonen SM, Rosthøj S, Tierens A, Juvonen V, Osnes LTN, Vålerhaugen H, Hultdin M, Thörn I, Matuzeviciene R, Stoskus M, Marincevic M, Fogelstrand L, Lilleorg A, Toft N, Jónsson OG, Pruunsild K, Vaitkeviciene G, Vettenranta K, Lund B, Abrahamsson J, Schmiegelow K, Marquart HV. Minimal residual disease quantification by flow cytometry provides reliable risk stratification in T-cell acute lymphoblastic leukemia. Leukemia 2019; 33:1324-1336. [PMID: 30552401 DOI: 10.1038/s41375-018-0307-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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: 09/04/2018] [Revised: 10/26/2018] [Accepted: 10/31/2018] [Indexed: 01/22/2023]
Abstract
Minimal residual disease (MRD) measured by PCR of clonal IgH/TCR rearrangements predicts relapse in T-cell acute lymphoblastic leukemia (T-ALL) and serves as risk stratification tool. Since 10% of patients have no suitable PCR-marker, we evaluated flowcytometry (FCM)-based MRD for risk stratification. We included 274 T-ALL patients treated in the NOPHO-ALL2008 protocol. MRD was measured by six-color FCM and real-time quantitative PCR. Day 29 PCR-MRD (cut-off 10-3) was used for risk stratification. At diagnosis, 93% had an FCM-marker for MRD monitoring, 84% a PCR-marker, and 99.3% (272/274) had a marker when combining the two. Adjusted for age and WBC, the hazard ratio for relapse was 3.55 (95% CI 1.4-9.0, p = 0.008) for day 29 FCM-MRD ≥ 10-3 and 5.6 (95% CI 2.0-16, p = 0.001) for PCR-MRD ≥ 10-3 compared with MRD < 10-3. Patients stratified to intermediate-risk therapy on day 29 with MRD 10-4-<10-3 had a 5-year event-free survival similar to intermediate-risk patients with MRD < 10-4 or undetectable, regardless of method for monitoring. Patients with day 15 FCM-MRD < 10-4 had a cumulative incidence of relapse of 2.3% (95% CI 0-6.8, n = 59). Thus, FCM-MRD allows early identification of patients eligible for reduced intensity therapy, but this needs further studies. In conclusion, FCM-MRD provides reliable risk prediction for T-ALL and can be used for stratification when no PCR-marker is available.
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Affiliation(s)
- S Modvig
- Department of Clinical Immunology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - H O Madsen
- Department of Clinical Immunology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - S M Siitonen
- Helsinki University Ctrl. Hospital, Helsinki, Finland
| | - S Rosthøj
- Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - A Tierens
- Laboratory Medicine Program, University Health Network and University of Toronto, Toronto, ON, Canada
- Department of Pathology, University Hospital of Oslo, Oslo, Norway
| | - V Juvonen
- Department of Clinical Chemistry and Laboratory Division, University of Turku and Turku University Hospital, Turku, Finland
| | - L T N Osnes
- Department of Immunology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - H Vålerhaugen
- Department of Pathology, Laboratory of Molecular Pathology, Oslo University Hospital, Oslo, Norway
| | - M Hultdin
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | - I Thörn
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - R Matuzeviciene
- Department of Physiology, Biochemistry, Microbiology and Laboratory Medicine, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Centre of Laboratory Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - M Stoskus
- Hematology, Oncology and Transfusion Medicine Centre, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - M Marincevic
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - L Fogelstrand
- Department of Clinical Chemistry, Sahlgrenska University Hospital, and Department of Clinical Chemistry and Transfusion Medicine, Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - A Lilleorg
- Department of Clinical Immunology, North Estonia Medical Centre, Tallinn, Estonia
| | - N Toft
- Department of Hematology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - O G Jónsson
- Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland
| | - K Pruunsild
- Tallinn Children's Hospital, Tallinn, Estonia
| | - G Vaitkeviciene
- Children's Hospital, Affiliate of Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania
| | - K Vettenranta
- Department of Pediatrics, Helsinki University Children's Hospital and University of Helsinki, Helsinki, Finland
| | - B Lund
- Department of Pediatrics, St. Olavs University Hospital and Department of Clinical and Molecular Medicine, NTNU, Trondheim, Norway
| | - J Abrahamsson
- Institution of Clinical Sciences, Department of Pediatrics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - K Schmiegelow
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- The Institute of Clinical medicine, The Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - H V Marquart
- Department of Clinical Immunology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
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Møllgaard M, Degn M, Sellebjerg F, Frederiksen JL, Modvig S. Cerebrospinal fluid chitinase-3-like 2 and chitotriosidase are potential prognostic biomarkers in early multiple sclerosis. Eur J Neurol 2016; 23:898-905. [PMID: 26872061 DOI: 10.1111/ene.12960] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [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: 09/29/2015] [Accepted: 12/04/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE The role of chitinases and chitinase-like proteins in multiple sclerosis (MS) is currently unknown; however, cerebrospinal fluid (CSF) levels of chitinase 3-like 1 (CHI3L1) predict prognosis in early MS. Whether this applies to other chitinases and chitinase-like proteins is yet to be established. Our objective was to investigate the potential of chitinase 3-like 2 (CHI3L2) and chitotriosidase as prognostic biomarkers in optic neuritis (ON) as the first demyelinating episode and to evaluate the ability of CHI3L2 to predict long-term MS risk and disability. METHODS In a prospective cohort of 73 patients with ON as a first demyelinating episode and 26 age-matched healthy controls levels of CHI3L2 and chitotriosidase in CSF were explored by enzyme-linked immunosorbent assay. Associations with magnetic resonance imaging white matter lesions, CSF oligoclonal bands, immunoglobulin G index and leukocyte count were investigated. Long-term MS risk and disability (Expanded Disability Status Scale, Multiple Sclerosis Functional Composite components) were examined in a retrospective cohort of 78 patients with ON as the first demyelinating episode (mean follow-up 14 years). The predictive ability of CHI3L2 was compared with CHI3L1. RESULTS Cerebrospinal fluid levels of CHI3L2 and chitotriosidase were significantly elevated in patients with ON and were associated with MS risk measures. CHI3L2 levels predicted MS development after ON (hazard ratio 1.95, P = 0.00039, Cox regression) and cognitive impairment by the Paced Auditory Serial Addition Test (P = 0.0357, linear regression) at follow-up. In a multivariate analysis of MS risk, CHI3L2 performed better than CHI3L1. CONCLUSIONS CHI3L2 and chitotriosidase are promising biomarkers in patients with a first demyelinating episode. Our findings thus support a role for these proteins as biomarkers in early MS.
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Affiliation(s)
- M Møllgaard
- MS Clinic, Department of Neurology, Rigshospitalet Glostrup, Copenhagen, Denmark
| | - M Degn
- MS Clinic, Department of Neurology, Rigshospitalet Glostrup, Copenhagen, Denmark.,Department of Diagnostics, Rigshospitalet Glostrup, Copenhagen, Denmark
| | - F Sellebjerg
- Danish MS Research Centre, Department of Neurology, Rigshospitalet, Copenhagen, Denmark
| | - J L Frederiksen
- MS Clinic, Department of Neurology, Rigshospitalet Glostrup, Copenhagen, Denmark
| | - S Modvig
- MS Clinic, Department of Neurology, Rigshospitalet Glostrup, Copenhagen, Denmark.,Department of Clinical Immunology, Rigshospitalet, Copenhagen, Denmark
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Modvig S, Degn M, Sander B, Horwitz H, Wanscher B, Sellebjerg F, Frederiksen JL. Cerebrospinal fluid neurofilament light chain levels predict visual outcome after optic neuritis. Mult Scler 2015; 22:590-8. [DOI: 10.1177/1352458515599074] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 06/26/2015] [Indexed: 12/31/2022]
Abstract
Background: Optic neuritis is a good model for multiple sclerosis relapse, but currently no tests can accurately predict visual outcome. Objective: The purpose of this study was to examine whether cerebrospinal fluid (CSF) biomarkers of tissue damage and remodelling (neurofilament light chain (NF-L), myelin basic protein, osteopontin and chitinase-3-like-1) predict visual outcome after optic neuritis. Methods: We included 47 patients with optic neuritis as a first demyelinating episode. Patients underwent visual tests, optical coherence tomography (OCT), magnetic resonance imaging (MRI) and lumbar puncture. Biomarkers were measured in CSF by enzyme-linked immunosorbent assay (ELISA). Patients were followed up six months after onset and this included visual tests and OCT. Outcome measures were inter-ocular differences in low contrast visual acuity (LCVA), retinal nerve fibre layer (RNFL) and ganglion cell layer+inner plexiform layer (GC-IPL) thicknesses. Results: CSF NF-L levels at onset predicted inter-ocular differences in follow-up LCVA (β=13.8, p=0.0008), RNFL (β=5.6, p=0.0004) and GC-IPL (β=4.0, p=0.0008). The acute-phase GC-IPL thickness also predicted follow-up LCVA (β=12.9, p=0.0021 for NF-L, β=−1.1, p=0.0150 for GC-IPL). Complete/incomplete remission was determined based on LCVA from 30 healthy controls. NF-L had a positive predictive value of 91% and an area under the curve (AUC) of 0.79 for incomplete remission. Conclusion: CSF NF-L is a promising biomarker of visual outcome after optic neuritis. This could aid neuroprotective/regenerative medical advancements.
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Affiliation(s)
- S Modvig
- The MS Clinic, Department of neurology, Glostrup Hospital, University of Copenhagen, Denmark/Department of Clinical Immunology, Rigshospitalet, University of Copenhagen, Denmark
| | - M Degn
- The MS Clinic, Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark/Department of Diagnostics, Glostrup Hospital, University of Copenhagen, Denmark
| | - B Sander
- Department of Ophthalmology, Glostrup Hospital, University of Copenhagen, Denmark
| | - H Horwitz
- The MS Clinic, Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark/Department of Clinical Pharmacology, Bispebjerg Hospital, University of Copenhagen, Denmark
| | - B Wanscher
- Department of Clinical Neurophysiology, Glostrup Hospital, University of Copenhagen, Denmark
| | - F Sellebjerg
- Danish MS Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
| | - JL Frederiksen
- The MS Clinic, Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark
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Modvig S, Degn M, Roed H, Sørensen TL, Larsson HBW, Langkilde AR, Frederiksen JL, Sellebjerg F. Cerebrospinal fluid levels of chitinase 3-like 1 and neurofilament light chain predict multiple sclerosis development and disability after optic neuritis. Mult Scler 2015; 21:1761-70. [PMID: 25698172 DOI: 10.1177/1352458515574148] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [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: 10/10/2014] [Accepted: 01/31/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Cerebrospinal fluid (CSF) biomarkers have been suggested to predict multiple sclerosis (MS) after clinically isolated syndromes, but studies investigating long-term prognosis are needed. OBJECTIVE To assess the predictive ability of CSF biomarkers with regard to MS development and long-term disability after optic neuritis (ON). METHODS Eighty-six patients with ON as a first demyelinating event were included retrospectively. Magnetic resonance imaging (MRI), CSF leukocytes, immunoglobulin G index and oligoclonal bands were registered. CSF levels of chitinase-3-like-1, osteopontin, neurofilament light-chain, myelin basic protein, CCL2, CXCL10, CXCL13 and matrix metalloproteinase-9 were measured by enzyme-linked immunosorbent assay. Patients were followed up after 13.6 (range 9.6-19.4) years and 81.4% were examined, including Expanded Disability Status Scale and MS functional composite evaluation. 18.6% were interviewed by phone. Cox regression, multiple regression and Spearman correlation analyses were used. RESULTS Forty-six (53.5%) developed clinically definite MS (CDMS) during follow-up. In a multivariate model MRI (p=0.0001), chitinase 3-like 1 (p=0.0033) and age (p=0.0194) combined predicted CDMS best. Neurofilament light-chain predicted long-term disability by the multiple sclerosis severity scale (p=0.0111) and nine-hole-peg-test (p=0.0202). Chitinase-3-like-1 predicted long-term cognitive impairment by the paced auditory serial addition test (p=0.0150). CONCLUSION Neurofilament light-chain and chitinase-3-like-1 were significant predictors of long-term physical and cognitive disability. Furthermore, chitinase-3-like-1 predicted CDMS development. Thus, these molecules hold promise as clinically valuable biomarkers after ON as a first demyelinating event.
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Affiliation(s)
- S Modvig
- The MS Clinic, Department of Neurology, Copenhagen University Hospital Glostrup, Glostrup, Denmark
| | - M Degn
- The MS Clinic, Department of Neurology, Copenhagen University Hospital Glostrup, Glostrup, Denmark
| | - H Roed
- Holbaek municipal eye clinic, Denmark
| | - T L Sørensen
- Clinical Eye Research Unit, Department of Ophthalmology, Copenhagen University Hospital Roskilde and The Faculty of Health Sciences, University of Copenhagen, Denmark
| | - H B W Larsson
- Functional Imaging Unit, Department of Diagnostics, Copenhagen University Hospital Glostrup, Glostrup, Denmark
| | - A R Langkilde
- Department of Neuroradiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - J L Frederiksen
- The MS Clinic, Department of Neurology, Copenhagen University Hospital Glostrup, Glostrup, Denmark
| | - F Sellebjerg
- Danish MS Research Centre, Department of Neurology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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