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Kim M, Ahn SY, Kim T, Jung SH, Song GY, Yang DH, Lee JJ, Kim MY, Park JH, Shin MG, Ahn JS, Kim HJ, Kim DDH. Prognostic analysis according to European LeukemiaNet 2022 risk stratification for elderly patients with acute myeloid leukemia treated with decitabine. Hematology 2024; 29:2324417. [PMID: 38433437 DOI: 10.1080/16078454.2024.2324417] [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: 08/08/2023] [Accepted: 02/23/2024] [Indexed: 03/05/2024] Open
Abstract
OBJECTIVES This study aimed to evaluate the prognostic significance of the revised European LeukemiaNet (ELN)-2022 risk stratification model for 123 elderly acute myeloid leukemia (AML) patients treated with decitabine chemotherapy. RESULTS Based on the ELN-2022 risk stratification, 15 (12.2%), 51 (41.5%), and 57 (46.3%) patients were classified as having favorable, intermediate, and high-risk AML, respectively. In comparison with the ELN-2017 risk stratification, the ELN-2022 risk stratification re-assigned 26 (21.1%) and three (2.4%) patients to the adverse and favorable risk groups, respectively. Survival analysis revealed distinctive overall survival (OS) outcomes among the ELN-2022 risk groups (6-month OS rate: 73.3%, 52.9%, and 47.7% for favorable, intermediate, and adverse risk, respectively; P = 0.101), with a parallel trend observed in the event-free survival (EFS) (6-month EFS rate: 73.3%, 52.9%, and 45.6% for favorable, intermediate, and adverse risk, respectively; P = 0.049). Notably, both OS and EFS in the favorable risk group were significantly superior in comparison to that of the adverse risk group (OS: P = 0.040, EFS: P = 0.030). Although the ELN-2022 C-index (0.559) was greater than the ELN-2017 C-index (0.539), the result was not statistically significant (P = 0.059). Based on the event net reclassification index, we consistently observed significant improvements in the ELN-2022 risk stratification for overall survival (0.21 at 6 months). CONCLUSION In conclusion, the revised ELN-2022 risk stratification model may have improved the risk classification of elderly AML patients treated with hypomethylating agents compared to the ELN-2017 risk stratification model.
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Affiliation(s)
- Mihee Kim
- Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Jeollanam-do, Republic of Korea
| | - Seo-Yeon Ahn
- Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Jeollanam-do, Republic of Korea
| | - TaeHyung Kim
- Department of Computer Science, University of Toronto, Toronto, Canada
- The Donnelly Centre for Cellular and Biomolecular Research, University of Toronto, Toronto, Canada
| | - Sung-Hoon Jung
- Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Jeollanam-do, Republic of Korea
| | - Ga-Young Song
- Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Jeollanam-do, Republic of Korea
| | - Deok-Hwan Yang
- Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Jeollanam-do, Republic of Korea
| | - Je-Jung Lee
- Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Jeollanam-do, Republic of Korea
| | - Mi Yeon Kim
- Genomic Research Center for Hematopoietic Diseases, Chonnam National University Hwasun Hospital, Jeollanam-do, Republic of Korea
| | - Ju Heon Park
- Genomic Research Center for Hematopoietic Diseases, Chonnam National University Hwasun Hospital, Jeollanam-do, Republic of Korea
| | - Myung-Geun Shin
- Genomic Research Center for Hematopoietic Diseases, Chonnam National University Hwasun Hospital, Jeollanam-do, Republic of Korea
| | - Jae-Sook Ahn
- Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Jeollanam-do, Republic of Korea
- Genomic Research Center for Hematopoietic Diseases, Chonnam National University Hwasun Hospital, Jeollanam-do, Republic of Korea
| | - Hyeoung-Joon Kim
- Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Jeollanam-do, Republic of Korea
- Genomic Research Center for Hematopoietic Diseases, Chonnam National University Hwasun Hospital, Jeollanam-do, Republic of Korea
| | - Dennis Dong Hwan Kim
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
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Chen E, Jiao C, Yu J, Gong Y, Jin D, Ma X, Cui J, Wu Z, Zhou J, Wang H, Su B, Ge J. Assessment of 2022 European LeukemiaNet risk classification system in real-world cohort from China. Cancer Med 2023; 12:21615-21626. [PMID: 38098254 PMCID: PMC10757130 DOI: 10.1002/cam4.6696] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 10/09/2023] [Accepted: 10/26/2023] [Indexed: 12/31/2023] Open
Abstract
BACKGROUND The European LeukemiaNet (ELN) risk classification system for acute myeloid leukemia (AML) patients has been used worldwide. In 2022, the ELN risk classification system modified risk genes including CEBPA mutation status, myelodysplasia-related (MR) gene mutations and internal tandem duplications of FLT3 (FLT3-ITD). METHODS We include newly diagnosed de novo AML patients at our center from January 2017 to December 2021, regardless of the further treatment received. Clinical data and date of survival were included. Survival analysis were performed using the Kaplan-Meier method, and the log-rank test was used to compare survival between different risk groups. RESULTS We include 363 newly diagnosed de novo AML patients from 2017 to 2021 to assess the accuracy of the ELN risk classification system. Their survival results show that the ELN-2022 risk classification system is not superior to the ELN-2017 version; for patients with FLT3-ITD mutations but without FLT3 inhibitor treatment, their survival is similar to the ELN-2022 adverse risk group. The ELN-2022 risk classification system cannot accurately clarify ECOG performance status (PS) 2-4 patients, especially in the ELN-2022 favorable risk group. CONCLUSION The ELN-2022 risk stratification system may not be appropriate for patients unable to receive intensive therapy or FLT3 inhibitor; more real-world data is needed to straify patients with worse ECOG PS and inferior intensive therapy.
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Affiliation(s)
- Enbo Chen
- Department of HematologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
| | - Changqing Jiao
- Department of HematologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
| | - Jian Yu
- Department of HematologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
| | - Yu Gong
- Department of HematologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
- Department of HematologyChaoyang HospitalHuainanAnhuiChina
| | - Duo Jin
- Department of HematologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
- Department of HematologyTaihe County People's HospitalFuyangAnhuiChina
| | - Xiaoyu Ma
- Department of HematologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
| | - Jianling Cui
- Department of HematologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
| | - Zhonghui Wu
- Department of HematologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
| | - Junjie Zhou
- Department of HematologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
| | - Haixia Wang
- Department of HematologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
| | - Bobing Su
- Department of HematologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
| | - Jian Ge
- Department of HematologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
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Narlı Özdemir Z, Kılıçaslan NA, Yılmaz M, Eşkazan AE. Guidelines for the treatment of chronic myeloid leukemia from the NCCN and ELN: differences and similarities. Int J Hematol 2023; 117:3-15. [PMID: 36064839 DOI: 10.1007/s12185-022-03446-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 08/17/2022] [Revised: 08/25/2022] [Accepted: 08/25/2022] [Indexed: 01/07/2023]
Abstract
Patients diagnosed with chronic myeloid leukemia (CML) in chronic phase can now have a life expectancy comparable to that of the general population thanks to the use of tyrosine kinase inhibitor (TKI) therapies. Although most patients with CML require lifelong TKI therapy, it is possible for some patients to achieve treatment-free remission. These spectacular results have been made possible by the development of superior treatment modalities as well as clinicians' efforts in strictly adhering to clinical guidelines such as the National Comprehensive Cancer Network (NCCN) and European Leukemia Network (ELN). CML treatment recommendations reported in these guidelines are the result of years of selecting and incorporating the most reliable evidence. In this review, we provide a synopsis of the differences and similarities that exist between the NCCN and ELN guidelines.
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Affiliation(s)
- Zehra Narlı Özdemir
- Department of Hematology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | | | - Musa Yılmaz
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ahmet Emre Eşkazan
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Fatih, Istanbul, Turkey.
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Zini G, Barbagallo O, Scavone F, Béné MC. Digital morphology in hematology diagnosis and education: The experience of the European LeukemiaNet WP10. Int J Lab Hematol 2022; 44 Suppl 1:37-44. [PMID: 36074713 DOI: 10.1111/ijlh.13908] [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: 02/26/2022] [Accepted: 05/19/2022] [Indexed: 11/28/2022]
Abstract
Hematological diagnostics is based on increasingly precise techniques of cellular and molecular analysis. The correct interpretation of the blood and bone marrow smears observed under an optical microscope still represents a cornerstone. Precise quantitative and qualitative cytomorphological criteria have recently been codified by up-to-date guidelines for diagnosing hematopoietic neoplasms. Morphological analysis has found formidable support in digital reproduction techniques, which have simplified the circulation of images for educational or consultation purposes. From 2007 to 2019, the Working Group WP10 of European LeukemiaNet (ELN) used, in annual exercises, digital images to support training in cytomorphology and verify harmonization and comparability in the interpretation of blood and bone marrow smears. We describe the design, development, and results of this program, which had 741 participants in-person or remotely, to which 2055 questions were submitted regarding the interpretation of cytomorphological images. We initially used circulation and presentation of digital microphotographs and then introduced a virtual microscopy (VM). Virtual slides were obtained using a whole slide imaging technique, similar to the one largely used in histopathology, to produce digitized scans of consecutive microscopic fields and reassembles them to obtain a complete virtual smear by stitching. Participants were required to identify cells in labeled fields of view of the virtual slides to obtain a morphological diagnosis. This work has demonstrated substantial improvements in diagnostic accuracy and harmonization with the VM technique. Between-observer concordance increased from 62.5% to 83.0%. The integrity of the digitalized film image, which provides a general context for cell abnormalities, was the main factor for this outcome.
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Affiliation(s)
- Gina Zini
- Hematology, Catholic University of Sacred Heart, Rome, Italy.,Transfusion Service, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Ombretta Barbagallo
- Transfusion Service, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Fernando Scavone
- Transfusion Service, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Marie C Béné
- Hematology Biology, Nantes University Hospital and CRCINA, Nantes, France
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Zhang Y, Archer KJ. Bayesian variable selection for high-dimensional data with an ordinal response: identifying genes associated with prognostic risk group in acute myeloid leukemia. BMC Bioinformatics 2021; 22:539. [PMID: 34727888 PMCID: PMC8565083 DOI: 10.1186/s12859-021-04432-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/01/2021] [Accepted: 10/04/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Acute myeloid leukemia (AML) is a heterogeneous cancer of the blood, though specific recurring cytogenetic abnormalities in AML are strongly associated with attaining complete response after induction chemotherapy, remission duration, and survival. Therefore recurring cytogenetic abnormalities have been used to segregate patients into favorable, intermediate, and adverse prognostic risk groups. However, it is unclear how expression of genes is associated with these prognostic risk groups. We postulate that expression of genes monotonically associated with these prognostic risk groups may yield important insights into leukemogenesis. Therefore, in this paper we propose penalized Bayesian ordinal response models to predict prognostic risk group using gene expression data. We consider a double exponential prior, a spike-and-slab normal prior, a spike-and-slab double exponential prior, and a regression-based approach with variable inclusion indicators for modeling our high-dimensional ordinal response, prognostic risk group, and identify genes through hypothesis tests using Bayes factor. RESULTS Gene expression was ascertained using Affymetrix HG-U133Plus2.0 GeneChips for 97 favorable, 259 intermediate, and 97 adverse risk AML patients. When applying our penalized Bayesian ordinal response models, genes identified for model inclusion were consistent among the four different models. Additionally, the genes included in the models were biologically plausible, as most have been previously associated with either AML or other types of cancer. CONCLUSION These findings demonstrate that our proposed penalized Bayesian ordinal response models are useful for performing variable selection for high-dimensional genomic data and have the potential to identify genes relevantly associated with an ordinal phenotype.
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Affiliation(s)
| | - Kellie J Archer
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA.
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Yilmaz U, Eskazan AE. Moving on from 2013 to 2020 European LeukemiaNet recommendations for treating chronic myeloid leukemia: what has changed over the 7 years? Expert Rev Hematol 2020; 13:1035-1038. [PMID: 32814447 DOI: 10.1080/17474086.2020.1813564] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Umut Yilmaz
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa , Istanbul, Turkey
| | - Ahmet Emre Eskazan
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa , Istanbul, Turkey
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Jin P, Tan Y, Zhang W, Li J, Wang K. Prognostic alternative mRNA splicing signatures and associated splicing factors in acute myeloid leukemia. Neoplasia 2020; 22:447-457. [PMID: 32653835 PMCID: PMC7356271 DOI: 10.1016/j.neo.2020.06.004] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 12/22/2022] Open
Abstract
The dysregulation of alternative splicing (AS) has emerged as a mechanism of acute myeloid leukemia (AML). However, the prognostic impact of AS events remains under-explored in AML. Here we report the prognostic value of AS events and associated splicing factors based on three datasets of AML patients. We defined the landscape of AS events in AML and identified 7033 AS events associated with the survival of AML patients. Based on these events, we further developed a composite 15 AS event-based prognostic signature, which was independent of the cytogenetic risk stratification and patient age, and showed a better performance than known gene expression signatures. More importantly, our new signature markedly improved the European LeukemiaNet (ELN) risk classification, indicating a broad applicability in the clinical management of AML. Furthermore, the splicing-regulatory network established the correlations between prognostic AS events and associated splicing factors. The finding was validated by CRISPR-based data, which indicated that the increased expression of RBM39 contributed to the higher exon inclusion of SETD5 and conferred a poor outcome. Together, AS events may serve as a novel assortment of prognosticators for AML and could refine the ELN risk stratification. The splicing regulatory network provides clues regarding the splicing factor-mediated mechanisms of AML.
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Affiliation(s)
- Peng Jin
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yun Tan
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; Sino-French Research Center for Life Sciences and Genomics, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Zhang
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
| | - Junmin Li
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kankan Wang
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; Sino-French Research Center for Life Sciences and Genomics, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Takeuchi A, Imataki O, Kubo H, Kondo A, Seo K, Uemura M, Yamaoka G, Murao K, Takeuchi A. Diagnostic Value of Flow Cytometry Standardized Using the European LeukemiaNet for Myelodysplastic Syndrome. Acta Haematol 2019; 143:140-145. [PMID: 31330512 DOI: 10.1159/000501147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 02/04/2019] [Accepted: 05/24/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Myelodysplastic syndromes (MDS) and idiopathic cytopenia of undetermined significance (ICUS) are heterogeneous hematological disorders characterized by hematopoietic dysplasia and/or chromosomal aberrancy. OBJECTIVES This study aimed to evaluate the diagnostic value of flow cytometry standardized using the European LeukemiaNet (ELN) for MDS and ICUS by analyzing samples obtained from patients with cytopenia based on morphological examination, cytogenetic analysis, and flow cytometry. METHODS We retrospectively analyzed bone marrow samples aspirated from 253 consecutive patients (median age: 66 years [range: 1-92]) to identify the cause of cytopenia. RESULTS Sixty patients presented with MDS, and 16 with ICUS. MDS subtypes were distributed as follows: MDS with single-lineage dysplasia (n = 10); MDS with multi-lineage dysplasia (n = 10); MDS with ringed sideroblasts (n = 4); MDS with excess blasts-1 (n = 9); MDS with excess blasts-2 (n = 13), MDS unclassified (n = 5); 5q-syndrome (n = 6); and MDS/myeloproliferative neoplasms (n = 3). Four representative ELN indexes were used. Two or more ELN MDS indexes were in the abnormal range in 35 MDS cases (58.3%) and 4 ICUS cases (25.0%). CONCLUSIONS Morphological examination remains the standard for MDS diagnosis. Considering the low incidence of genetically proven ICUS (20.2-27.5%), the low sensitivity of ELN MDS indexes for ICUS is considered a valuable alternative.
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Affiliation(s)
- Akihiro Takeuchi
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
- Department of Clinical Laboratory, Kagawa University Hospital, Kagawa, Japan
| | - Osamu Imataki
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan,
| | - Hiroyuki Kubo
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Akihiro Kondo
- Department of Clinical Laboratory, Kagawa University Hospital, Kagawa, Japan
| | - Kayoko Seo
- Department of Clinical Laboratory, Kagawa University Hospital, Kagawa, Japan
| | - Makiko Uemura
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Genji Yamaoka
- Department of Clinical Laboratory, Kagawa University Hospital, Kagawa, Japan
| | - Koji Murao
- Department of Clinical Laboratory Medicine, Kagawa University, Kagawa, Japan
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Boddu PC, Kadia TM, Garcia-Manero G, Cortes J, Alfayez M, Borthakur G, Konopleva M, Jabbour EJ, Daver NG, DiNardo CD, Naqvi K, Yilmaz M, Short NJ, Pierce S, Kantarjian HM, Ravandi F. Validation of the 2017 European LeukemiaNet classification for acute myeloid leukemia with NPM1 and FLT3-internal tandem duplication genotypes. Cancer 2018; 125:1091-1100. [PMID: 30521114 DOI: 10.1002/cncr.31885] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [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: 06/13/2018] [Revised: 10/03/2018] [Accepted: 10/23/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND The revised 2017 European LeukemiaNet (ELN) classification (ELN-2017) of acute myeloid leukemia (AML) divides patients into 3 prognostic risk categories, with additional factors such as the fms-like tyrosine kinase 3 (FLT3)-internal tandem duplication (ITD) allele ratio (AR) considered for risk stratification. To the best of the authors' knowledge, the prognostic usefulness of ELN-2017 in comparison with ELN-2010 in younger patients with AML has not been validated to date. METHODS The authors performed a retrospective study on patients aged <60 years who received idarubicin plus cytarabine (IA)-based induction chemotherapy for newly diagnosed AML. RESULTS According to ELN-2017 criteria, the number of patients in the favorable (Fav), intermediate (Int), and adverse (Adv) risk categories was 192 patients (27%), 331 patients (46%), and 192 patients (27%), respectively. Overall survival probabilities at 5 years in the Fav, Int, and Adv groups were 57%, 37%, and 18%, respectively. In comparison, the 5-year overall survival probabilities in the Fav (169 patients), intermediate (IR)-1 (80 patients), IR-2 (306 patients), and Adv (160 patients) ELN-2010 categories were 59%, 32%, 40%, and 14%, respectively. Although ELN-2010 historically distinguishes prognosis into IR-1 and IR-2 categories in younger patients, this difference was nullified in the current study cohort. When comparing patients with a low FLT3-ITD AR with those with a high FLT3-ITD AR, no significant differences in survival were noted among patients with nucleophosmin 1 (NPM1)-mutated AML (P = .28) or wild-type NPM1 (P = .35), and in those treated with IA alone (P = .79) or those treated with IA and a FLT3 inhibitor (P = .10). CONCLUSIONS The ELN-2017 more accurately distinguishes prognosis in patients with newly diagnosed AML. The lack of prognostic significance for the FLT3-ITD AR needs further evaluation in different treatment settings.
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Affiliation(s)
- Prajwal C Boddu
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tapan M Kadia
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Jorge Cortes
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mansour Alfayez
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gautam Borthakur
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Marina Konopleva
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Elias J Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Naval G Daver
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Courtney D DiNardo
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kiran Naqvi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Musa Yilmaz
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nicholas J Short
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sherry Pierce
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hagop M Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Farhad Ravandi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Harada Y, Nagata Y, Kihara R, Ishikawa Y, Asou N, Ohtake S, Miyawaki S, Sakura T, Ozawa Y, Usui N, Kanamori H, Ito Y, Imai K, Suehiro Y, Kobayashi S, Kitamura K, Sakaida E, Onizuka M, Takeshita A, Ishida F, Suzushima H, Ishizawa K, Naoe T, Matsumura I, Miyazaki Y, Ogawa S, Kiyoi H; Japan Adult Leukemia Study Group JALSG. Prognostic analysis according to the 2017 ELN risk stratification by genetics in adult acute myeloid leukemia patients treated in the Japan Adult Leukemia Study Group (JALSG) AML201 study. Leuk Res 2018; 66:20-7. [PMID: 29360622 DOI: 10.1016/j.leukres.2018.01.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 12/19/2017] [Accepted: 01/14/2018] [Indexed: 01/24/2023]
Abstract
Many genetic alterations that are associated with the prognosis of acute myeloid leukemia (AML) have been identified, and several risk stratification systems based on the genetic status have been recommended. The European LeukemiaNet (ELN) first proposed the risk stratification system for AML in 2010 (ELN-2010), and recently published the revised system (ELN-2017). We validated the long-term prognosis and clinical characteristics of each ELN-2017 risk category in Japanese adult AML patients who were treated in the Japan Adult Leukemia Study Group (JALSG) AML-201 study. We demonstrated that the 3-risk category system of the ELN-2017 successfully discriminated the overall survival and complete remission rates in our cohort in comparison with the 4-risk category of the ELN-2010. However, there were still genetic categories in which stratification of patients into favorable or intermediate risk categories was controversial; the low allelic ratio of FLT3-ITD was not necessarily associated with a better prognosis in patients with FLT3-ITD, and cytogenetic abnormalities may affect the prognosis in patients with favorable genetic lesions such as NPM1 and CEBPA mutations. As many molecular targeting agents, such as FLT3 inhibitors, have been developed, we must continue to modify the genetic risk stratification system to match the progression of therapeutic strategies.
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Hemmati PG, Vuong LG, Terwey TH, Jehn CF, le Coutre P, Penack O, Na IK, Dörken B, Arnold R. Predictive significance of the European LeukemiaNet classification of genetic aberrations in patients with acute myeloid leukaemia undergoing allogeneic stem cell transplantation. Eur J Haematol 2016; 98:160-168. [PMID: 27706846 DOI: 10.1111/ejh.12815] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the predictive capacity of the European LeukemiaNet (ELN) classification of genetic risk in patients with acute myeloid leukaemia (AML) undergoing allogeneic stem cell transplantation (alloSCT). METHODS We retrospectively analysed 274 patients transplanted at our centre between 2004 and 2014. RESULTS The ELN grouping is comparable to the Southwest Oncology Group/Eastern Cooperative Oncology Group (SWOG/ECOG) stratification in predicting the outcome after alloSCT [overall P = 0.0064 for disease-free survival (DFS), overall P = 0.003 for relapse]. Patients with an intermediate-1 profile have a significantly elevated 5-yr relapse incidence as compared to favourable risk patients, that is 40% vs. 15%, [hazard ratio (HR) 2.58, P = 0.048]. An intermediate-1 risk profile is an independent predictor for relapse as determined by multivariate Cox regression analysis (HR 3.05, P = 0.023). In intermediate-1 patients, the presence of an FLT3 internal tandem duplication (FLT3-ITD) is associated with a significantly increased relapse incidence (P = 0.0323), and a lower DFS (P = 0.0465). FLT3-ITD is an independent predictor for overall survival, DFS and relapse incidence in the intermediate-1 subgroup. CONCLUSIONS The ELN stratification of genetic risk predicts the outcome of patients with AML undergoing alloSCT. Patients with an intermediate-1 profile have a high risk for treatment failure due to relapse, which prompts the development of alternative treatment strategies.
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Affiliation(s)
- Philipp G Hemmati
- Department of Hematology, Oncology and Tumor Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lam G Vuong
- Department of Hematology, Oncology and Tumor Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Theis H Terwey
- Department of Hematology, Oncology and Tumor Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian F Jehn
- Department of Hematology, Oncology and Tumor Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Philipp le Coutre
- Department of Hematology, Oncology and Tumor Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Olaf Penack
- Department of Hematology, Oncology and Tumor Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Il-Kang Na
- Department of Hematology, Oncology and Tumor Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Bernd Dörken
- Department of Hematology, Oncology and Tumor Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Renate Arnold
- Department of Hematology, Oncology and Tumor Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Oran B, Jimenez AM, De Lima M, Popat UR, Bassett R, Andersson B, Borthakur G, Bashir Q, Chen J, Ciurea SO, Jabbour E, Cortes J, Kebriaei P, Khouri IF, Qazilbash MH, Ravandi F, Rondon G, Lu X, Shpall EJ, Champlin RE. Age and Modified European LeukemiaNet Classification to Predict Transplant Outcomes: An Integrated Approach for Acute Myelogenous Leukemia Patients Undergoing Allogeneic Stem Cell Transplantation. Biol Blood Marrow Transplant 2015; 21:1405-1412. [PMID: 25840338 DOI: 10.1016/j.bbmt.2015.03.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 01/12/2015] [Accepted: 03/25/2015] [Indexed: 12/20/2022]
Abstract
We evaluated the prognostic significance of a modified European LeukemiaNet (ELN) classification for patients with acute myelogenous leukemia (AML) undergoing hematopoietic stem cell transplantation (HSCT) while in first complete remission (CR1). We analyzed 464 AML patients with matched related (n = 211, 45.5%), matched unrelated (n = 176, 37.9%), and mismatched donors (n = 77, 16.6%). Patients were classified into 4 modified ELN risk groups (favorable, intermediate-I, intermediate-II, and adverse) separately for 354 patients age < 60 years and 110 patients age ≥ 60 years. In this modified version of ELN classification, patients with normal cytogenetic were classified by FLT3-ITD mutational status: favorable risk if FLT3-ITDwild and intermediate-I if FLT3-ITDmut. The best outcomes occurred in the ELN favorable and intermediate-II groups in younger AML patients and in the favorable and intermediate-I groups in older AML patients. Older AML patients had worse transplant outcomes within each modified ELN risk group except intermediate-I when compared with younger patients; leukemia-free survival at 3 years was 67.8% versus 49.8% in favorable, 53.4% versus 50.7% in intermediate-I, 65.7% versus 20.2% in intermediate-II, and 44.6% versus 23.8% in adverse group younger and older patients, respectively. Among lesion-specific abnormalities, del5q/-5 and abnl(17p) had the worse transplant outcomes, with 3-year leukemia-free survival rates of 18.4% and 20% in younger CR1 patients. In conclusion, the modified ELN prognostic classification developed for chemotherapy outcomes also identifies prognostic groups for HSCT, which is useful for a selection of patients for post-transplant strategies to improve outcomes.
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Affiliation(s)
- Betül Oran
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Antonio M Jimenez
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Marcos De Lima
- University Hospitals and Case Western Reserve University, , Cleveland, OH
| | - Uday R Popat
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Roland Bassett
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Borje Andersson
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gautam Borthakur
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Qaiser Bashir
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Julianne Chen
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Stefan O Ciurea
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Elias Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jorge Cortes
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Partow Kebriaei
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Issa F Khouri
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Muzaffar H Qazilbash
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Farhad Ravandi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gabriela Rondon
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Xinyan Lu
- Department of Hematopathology; The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Elizabeth J Shpall
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Richard E Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
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Selmeczi A, Udvardy M, Illés A, Telek B, Kiss A, Batár P, Reményi G, Szász R, Ujj Z, Márton A, Ujfalusi A, Hevessy Z, Pinczés L, Bedekovics J, Rejtő L. [Treatment of acute myeloid leukemia -- a single center experience (2007-2013)]. Orv Hetil 2014; 155:653-8. [PMID: 24755447 DOI: 10.1556/oh.2014.29884] [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] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Mortality of acute myeloid leukemia is still 60-70% in young (<60 years) adults and 90% in elderly (≥60 years) patients. AIM The aim of the authors was to analyse the outcome of treatment in their patients with acute myeloid leukemia. METHOD From 2007 to 2013, 173 patients with acute myeloid leukemia were treated. Patients were classified according to the European LeukemiaNet prognostic guideline. Association between mortality and the type of acute myeloid leukemia (secondary or primary), dose of daunoblastin at induction of treatment, and the rate of minimal residual disease were investigated. RESULTS The 5-year survival probability was 25% in young adults and 2% in the elderly. The survival was significantly influenced by these prognostic factors. The 5-year survival rate was 50% in the young, favorable prognostic group. The 90 mg/m2 daunoblastin dose was found to be beneficial. Addition of bortezomib to the standard induction protocol had an additional beneficial effect. CONCLUSIONS The speed and depth of the response to induction therapy, and the initial white blood cell count had an apparent effect on survival.
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Affiliation(s)
- Anna Selmeczi
- Debreceni Egyetem, Klinikai Központ, Általános Orvostudományi Kar Belgyógyászati Intézet, Hematológiai Tanszék Debrecen Nagyerdei krt. 98. 4032
| | - Miklós Udvardy
- Debreceni Egyetem, Klinikai Központ, Általános Orvostudományi Kar Belgyógyászati Intézet, Hematológiai Tanszék Debrecen Nagyerdei krt. 98. 4032
| | - Arpád Illés
- Debreceni Egyetem, Klinikai Központ, Általános Orvostudományi Kar Belgyógyászati Intézet, Hematológiai Tanszék Debrecen Nagyerdei krt. 98. 4032
| | - Béla Telek
- Debreceni Egyetem, Klinikai Központ, Általános Orvostudományi Kar Belgyógyászati Intézet, Hematológiai Tanszék Debrecen Nagyerdei krt. 98. 4032
| | - Attila Kiss
- Debreceni Egyetem, Klinikai Központ, Általános Orvostudományi Kar Belgyógyászati Intézet, Hematológiai Tanszék Debrecen Nagyerdei krt. 98. 4032
| | - Péter Batár
- Debreceni Egyetem, Klinikai Központ, Általános Orvostudományi Kar Belgyógyászati Intézet, Hematológiai Tanszék Debrecen Nagyerdei krt. 98. 4032
| | - Gyula Reményi
- Debreceni Egyetem, Klinikai Központ, Általános Orvostudományi Kar Belgyógyászati Intézet, Hematológiai Tanszék Debrecen Nagyerdei krt. 98. 4032
| | - Róbert Szász
- Debreceni Egyetem, Klinikai Központ, Általános Orvostudományi Kar Belgyógyászati Intézet, Hematológiai Tanszék Debrecen Nagyerdei krt. 98. 4032
| | - Zsófia Ujj
- Debreceni Egyetem, Klinikai Központ, Általános Orvostudományi Kar Belgyógyászati Intézet, Hematológiai Tanszék Debrecen Nagyerdei krt. 98. 4032
| | - Adrienn Márton
- Debreceni Egyetem, Klinikai Központ, Általános Orvostudományi Kar Belgyógyászati Intézet, Hematológiai Tanszék Debrecen Nagyerdei krt. 98. 4032
| | - Anikó Ujfalusi
- Debreceni Egyetem, Klinikai Központ, Általános Orvostudományi Kar Gyermekgyógyászati Intézet, Klinikai Genetikai Központ Debrecen
| | - Zsuzsanna Hevessy
- Debreceni Egyetem, Klinikai Központ, Általános Orvostudományi Kar Laboratóriumi Medicina Intézet Debrecen
| | - László Pinczés
- Debreceni Egyetem, Klinikai Központ, Általános Orvostudományi Kar Belgyógyászati Intézet, Hematológiai Tanszék Debrecen Nagyerdei krt. 98. 4032
| | - Judit Bedekovics
- Debreceni Egyetem, Klinikai Központ, Általános Orvostudományi Kar Pathológiai Intézet Debrecen
| | - László Rejtő
- Debreceni Egyetem, Klinikai Központ, Általános Orvostudományi Kar Belgyógyászati Intézet, Hematológiai Tanszék Debrecen Nagyerdei krt. 98. 4032
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