1
|
Groh M, Fenwarth L, Labro M, Boudry A, Fournier E, Wemeau M, Marceau-Renaut A, Daltro de Oliveira R, Abraham J, Barry M, Blanche P, Bodard Q, Braun T, Chebrek S, Decamp M, Durel CA, Forcade E, Gerfaud-Valentin M, Golfier C, Gourguechon C, Grardel N, Kosmider O, Martis N, Melboucy Belkhir S, Merabet F, Michon A, Moreau S, Morice C, Néel A, Nicolini FE, Pascal L, Pasquier F, Pieragostini A, Roche-Lestienne C, Rousselot P, Terriou L, Thiebaut-Bertrand A, Viallard JF, Preudhomme C, Kahn JE, Lefevre G, Duployez N. Involvement of the JAK-STAT pathway in the molecular landscape of tyrosine kinase fusion-negative hypereosinophilic syndromes: A nationwide CEREO study. Am J Hematol 2024; 99:1108-1118. [PMID: 38563187 DOI: 10.1002/ajh.27306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 03/11/2024] [Indexed: 04/04/2024]
Abstract
We investigated using a custom NGS panel of 149 genes the mutational landscape of 64 consecutive adult patients with tyrosine kinase fusion-negative hypereosinophilia (HE)/hypereosinophilic syndrome (HES) harboring features suggestive of myeloid neoplasm. At least one mutation was reported in 50/64 (78%) patients (compared to 8/44 (18%) patients with idiopathic HE/HES/HEUS used as controls; p < .001). Thirty-five patients (54%) had at least one mutation involving the JAK-STAT pathway, including STAT5B (n = 18, among which the hotspot N642H, n = 13), JAK1 (indels in exon 13, n = 5; V658F/L, n = 2), and JAK2 (V617F, n = 6; indels in exon 13, n = 2). Other previously undescribed somatic mutations were also found in JAK2, JAK1, STAT5B, and STAT5A, including three patients who shared the same STAT5A V707fs mutation and features consistent with primary polycythemia. Nearly all JAK-STAT mutations were preceded by (or associated with) myelodysplasia-related gene mutations, especially in RNA-splicing genes or chromatin modifiers. In multivariate analysis, neurologic involvement (hazard ratio [HR] 4.95 [1.87-13.13]; p = .001), anemia (HR 5.50 [2.24-13.49]; p < .001), and the presence of a high-risk mutation (as per the molecular international prognosis scoring system: HR 6.87 [2.39-19.72]; p < .001) were independently associated with impaired overall survival. While corticosteroids were ineffective in all treated JAK-STAT-mutated patients, ruxolitinib showed positive hematological responses including in STAT5A-mutated patients. These findings emphasize the usefulness of NGS for the workup of tyrosine kinase fusion-negative HE/HES patients and support the use of JAK inhibitors in this setting. Updated classifications could consider patients with JAK-STAT mutations and eosinophilia as a new "gene mutated-entity" that could be differentiated from CEL, NOS, and idiopathic HES.
Collapse
Affiliation(s)
- Matthieu Groh
- Department of Internal Medicine, French National Reference Center for Hypereosinophilic syndromes (CEREO), Hôpital Foch, Suresnes, France
- University of Lille, INSERM 1286 INFINITE, CHU de Lille, Lille, France
| | - Laurène Fenwarth
- Laboratoire d'Hématologie, Centre de Biologie Pathologie Génétique, CHU Lille, Lille, France
| | - Mathilde Labro
- Département de Statistiques, Délégation de la recherche clinique et de l'innovation, Hôpital Foch, Suresnes, France
| | - Augustin Boudry
- Laboratoire d'Hématologie, Centre de Biologie Pathologie Génétique, CHU Lille, Lille, France
| | - Elise Fournier
- Laboratoire d'Hématologie, Centre de Biologie Pathologie Génétique, CHU Lille, Lille, France
| | - Mathieu Wemeau
- Département d'Hématologie, CH de Roubaix, Roubaix, France
| | - Alice Marceau-Renaut
- Laboratoire d'Hématologie, Centre de Biologie Pathologie Génétique, CHU Lille, Lille, France
| | | | - Julie Abraham
- Service d'Hématologie Clinique et Thérapie Cellulaire, CHU Limoges, Limoges, France
| | - Marly Barry
- Département d'Hématologie, CH de Boulogne-sur-Mer, Boulogne-sur-Mer, France
| | - Philippe Blanche
- Département de Médecine Interne, Hôpital Cochin, AP-HP, Paris, France
| | - Quentin Bodard
- Département de Médecine Interne, CH d'Angoulême, Angoulême, France
| | - Thorsten Braun
- Département d'Hématologie, Hôpital Avicenne, AP-HP, Paris, France
| | - Safia Chebrek
- Département d'Hématologie, CH d'Avignon, Avignon, France
| | | | - Cécile-Audrey Durel
- Département de Médecine Interne, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Edouard Forcade
- Département d'Hématologie, CHU de Bordeaux, Bordeaux, France
| | - Mathieu Gerfaud-Valentin
- Département de Médecine Interne, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Camille Golfier
- Département d'Hématologie, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Clément Gourguechon
- Département d'Hématologie Clinique et Thérapie Cellulaire, CHU Amiens-Picardie, Amiens, France
| | - Nathalie Grardel
- Laboratoire d'Hématologie, Centre de Biologie Pathologie Génétique, CHU Lille, Lille, France
| | - Olivier Kosmider
- Service d'Hématologie Biologique, Centre-Université de Paris, Hôpital Cochin, AP-HP, Paris, France
| | - Nihal Martis
- Département de Médecine Interne, CHU de Nice, Université Côte d'Azur, Nice, France
| | | | - Fatiha Merabet
- Département d'Hématologie, CH de Versailles, Le Chesnay, France
| | - Adrien Michon
- Département de Médecine Interne, Hôpital Européen Georges-Pompidou, AP-HP, Paris, France
| | - Stéphane Moreau
- Service d'Hématologie Clinique et Thérapie Cellulaire, CHU Limoges, Limoges, France
| | | | - Antoine Néel
- Service de Médecine Interne, CHU de Nantes, Nantes, France
| | - Franck E Nicolini
- Département d'Hématologie, INSERM U 1052, CRCL, Centre Léon Bérard, Lyon, France
| | - Laurent Pascal
- Département d'Hématologie, Hôpital St Vincent de Paul, Lille, France
| | - Florence Pasquier
- Département d'Hématologie, Gustave Roussy Cancer Campus, Villejuif, France
| | | | | | | | - Louis Terriou
- Université de Lille, CHU Lille, Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Lille, France
| | | | | | - Claude Preudhomme
- Laboratoire d'Hématologie, Centre de Biologie Pathologie Génétique, CHU Lille, Lille, France
| | - Jean-Emmanuel Kahn
- Department of Internal Medicine, Université Paris-Saclay, CHU Ambroise Paré, Boulogne Billancourt Cedex, France
- INSERM UMR1173, Université de Versailles St-Quentin-en-Yvelines, Infection et Inflammation, Montigny-le-Bretonneux, France
| | - Guillaume Lefevre
- University of Lille, INSERM 1286 INFINITE, CHU de Lille, Lille, France
- Laboratoire d'immunologie, CHU Lille, Lille, France
| | - Nicolas Duployez
- Laboratoire d'Hématologie, Centre de Biologie Pathologie Génétique, CHU Lille, Lille, France
| |
Collapse
|