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Zuna J, Hovorkova L, Krotka J, Koehrmann A, Bardini M, Winkowska L, Fronkova E, Alten J, Koehler R, Eckert C, Brizzolara L, Trkova M, Stuchly J, Zimmermann M, De Lorenzo P, Valsecchi MG, Conter V, Stary J, Schrappe M, Biondi A, Trka J, Zaliova M, Cazzaniga G, Cario G. Minimal residual disease in BCR::ABL1-positive acute lymphoblastic leukemia: different significance in typical ALL and in CML-like disease. Leukemia 2022; 36:2793-2801. [PMID: 35933523 DOI: 10.1038/s41375-022-01668-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 04/14/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 11/09/2022]
Abstract
Recently, we defined "CML-like" subtype of BCR::ABL1-positive acute lymphoblastic leukemia (ALL), resembling lymphoid blast crisis of chronic myeloid leukemia (CML). Here we retrospectively analyzed prognostic relevance of minimal residual disease (MRD) and other features in 147 children with BCR::ABL1-positive ALL (diagnosed I/2000-IV/2021, treated according to EsPhALL (n = 133) or other (n = 14) protocols), using DNA-based monitoring of BCR::ABL1 genomic breakpoint and clonal immunoglobulin/T-cell receptor gene rearrangements. Although overall prognosis of CML-like (n = 48) and typical ALL (n = 99) was similar (5-year-EFS 60% and 49%, respectively; 5-year-OS 75% and 73%, respectively), typical ALL presented more relapses while CML-like patients more often died in the first remission. Prognostic role of MRD was significant in the typical ALL (p = 0.0005 in multivariate analysis for EFS). In contrast, in CML-like patients MRD was not significant (p values > 0.2) and inapplicable for therapy adjustment. Moreover, in the typical ALL, risk-prediction could be further improved by considering initial hyperleukocytosis. Early distinguishing typical BCR::ABL1-positive ALL and CML-like patients is essential to enable optimal treatment approach in upcoming protocols. For the typical ALL, tyrosine-kinase inhibitors and concurrent chemotherapy with risk-directed intensity should be recommended; in the CML-like disease, no relevant prognostic feature applicable for therapy tailoring was found so far.
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Affiliation(s)
- Jan Zuna
- CLIP (Childhood Leukaemia Investigation Prague), Prague, Czech Republic.
- Department of Paediatric Haematology and Oncology, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
- University Hospital Motol, Prague, Czech Republic.
| | - Lenka Hovorkova
- CLIP (Childhood Leukaemia Investigation Prague), Prague, Czech Republic
- Department of Paediatric Haematology and Oncology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Justina Krotka
- CLIP (Childhood Leukaemia Investigation Prague), Prague, Czech Republic
- Department of Paediatric Haematology and Oncology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- University Hospital Motol, Prague, Czech Republic
| | - Amelie Koehrmann
- Pediatrics, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Michela Bardini
- Tettamanti Research Center, Pediatrics, University of Milano-Bicocca/Fondazione Tettamanti, Monza, Italy
| | - Lucie Winkowska
- CLIP (Childhood Leukaemia Investigation Prague), Prague, Czech Republic
- Department of Paediatric Haematology and Oncology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Eva Fronkova
- CLIP (Childhood Leukaemia Investigation Prague), Prague, Czech Republic
- Department of Paediatric Haematology and Oncology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- University Hospital Motol, Prague, Czech Republic
| | - Julia Alten
- Pediatrics, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Rolf Koehler
- Department of Human Genetics, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Lisa Brizzolara
- Tettamanti Research Center, Pediatrics, University of Milano-Bicocca/Fondazione Tettamanti, Monza, Italy
| | - Marie Trkova
- Centre for Medical Genetics and Reproductive Medicine GENNET, Prague, Czech Republic
| | - Jan Stuchly
- CLIP (Childhood Leukaemia Investigation Prague), Prague, Czech Republic
- Department of Paediatric Haematology and Oncology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Martin Zimmermann
- Department of Pediatric Hematology and Oncology, Medical School Hannover, Hannover, Germany
| | - Paola De Lorenzo
- EsPhALL Trial Data Center, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Maria Grazia Valsecchi
- EsPhALL Trial Data Center, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Valentino Conter
- Pediatric Hemato-Oncolgy, Fondazione MBBM/ASST-Monza, University of Milano-Bicocca, Monza, Italy
| | - Jan Stary
- Department of Paediatric Haematology and Oncology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- University Hospital Motol, Prague, Czech Republic
| | - Martin Schrappe
- Pediatrics, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Andrea Biondi
- Pediatric Hemato-Oncolgy, Fondazione MBBM/ASST-Monza, University of Milano-Bicocca, Monza, Italy
| | - Jan Trka
- CLIP (Childhood Leukaemia Investigation Prague), Prague, Czech Republic
- Department of Paediatric Haematology and Oncology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- University Hospital Motol, Prague, Czech Republic
| | - Marketa Zaliova
- CLIP (Childhood Leukaemia Investigation Prague), Prague, Czech Republic
- Department of Paediatric Haematology and Oncology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- University Hospital Motol, Prague, Czech Republic
| | - Giovanni Cazzaniga
- Tettamanti Research Center, Pediatrics, University of Milano-Bicocca/Fondazione Tettamanti, Monza, Italy
- Medical Genetics, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Gunnar Cario
- Pediatrics, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Dander E, Fallati A, Gulić T, Pagni F, Gaspari S, Silvestri D, Cricrì G, Bedini G, Portale F, Buracchi C, Starace R, Pasqualini F, D'Angiò M, Brizzolara L, Maglia O, Mantovani A, Garlanda C, Valsecchi MG, Locatelli F, Biondi A, Bottazzi B, Allavena P, D'Amico G. Monocyte-macrophage polarization and recruitment pathways in the tumour microenvironment of B-cell acute lymphoblastic leukaemia. Br J Haematol 2021; 193:1157-1171. [PMID: 33713428 DOI: 10.1111/bjh.17330] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 09/07/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 12/14/2022]
Abstract
B-cell acute lymphoblastic leukaemia (B-ALL) reprograms the surrounding bone marrow (BM) stroma to create a leukaemia-supportive niche. To elucidate the contribution of immune cells to the leukaemic microenvironment, we investigated the involvement of monocyte/macrophage compartments, as well as several recruitment pathways in B-ALL development. Immunohistochemistry analyses showed that CD68-expressing macrophages were increased in leukaemic BM biopsies, compared to controls and predominantly expressed the M2-like markers CD163 and CD206. Furthermore, the "non-classical" CD14+ CD16++ monocyte subset, expressing high CX3CR1 levels, was significantly increased in B-ALL patients' peripheral blood. CX3CL1 was shown to be significantly upregulated in leukaemic BM plasma, thus providing an altered migratory pathway possibly guiding NC monocyte recruitment into the BM. Additionally, the monocyte/macrophage chemoattractant chemokine ligand 2 (CCL2) strongly increased in leukaemic BM plasma, possibly because of the interaction of leukaemic cells with mesenchymal stromal cells and vascular cells and due to a stimulatory effect of leukaemia-related inflammatory mediators. C5a, a macrophage chemoattractant and M2-polarizing factor, further appeared to be upregulated in the leukaemic BM, possibly as an effect of PTX3 decrease, that could unleash complement cascade activation. Overall, deregulated monocyte/macrophage compartments are part of the extensive BM microenvironment remodelling at B-ALL diagnosis and could represent valuable targets for novel treatments to be coupled with classical chemotherapy.
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Affiliation(s)
- Erica Dander
- Centro Ricerca Tettamanti, Pediatric Dep, University of Milano-Bicocca, Fondazione MBBM, Monza, Italy
| | - Alessandra Fallati
- Centro Ricerca Tettamanti, Pediatric Dep, University of Milano-Bicocca, Fondazione MBBM, Monza, Italy
| | - Tamara Gulić
- IRCCS, Humanitas Clinical and Research Center, Rozzano (Mi), Italy
| | - Fabio Pagni
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Stefania Gaspari
- Department of Pediatric Hematology-Oncology, IRCCS Bambino Gesù Children's Hospital, Sapienza, University of Rome, Rome, Italy
| | - Daniela Silvestri
- Centro Ricerca Tettamanti, Pediatric Dep, University of Milano-Bicocca, Fondazione MBBM, Monza, Italy
| | - Giulia Cricrì
- Centro Ricerca Tettamanti, Pediatric Dep, University of Milano-Bicocca, Fondazione MBBM, Monza, Italy
| | - Gloria Bedini
- Centro Ricerca Tettamanti, Pediatric Dep, University of Milano-Bicocca, Fondazione MBBM, Monza, Italy
| | - Federica Portale
- Centro Ricerca Tettamanti, Pediatric Dep, University of Milano-Bicocca, Fondazione MBBM, Monza, Italy
| | - Chiara Buracchi
- Centro Ricerca Tettamanti, Pediatric Dep, University of Milano-Bicocca, Fondazione MBBM, Monza, Italy
| | - Rita Starace
- Centro Ricerca Tettamanti, Pediatric Dep, University of Milano-Bicocca, Fondazione MBBM, Monza, Italy
| | - Fabio Pasqualini
- IRCCS, Humanitas Clinical and Research Center, Rozzano (Mi), Italy
| | - Mariella D'Angiò
- Centro Ricerca Tettamanti, Pediatric Dep, University of Milano-Bicocca, Fondazione MBBM, Monza, Italy
| | - Lisa Brizzolara
- Centro Ricerca Tettamanti, Pediatric Dep, University of Milano-Bicocca, Fondazione MBBM, Monza, Italy
| | - Oscar Maglia
- Centro Ricerca Tettamanti, Pediatric Dep, University of Milano-Bicocca, Fondazione MBBM, Monza, Italy
| | - Alberto Mantovani
- IRCCS, Humanitas Clinical and Research Center, Rozzano (Mi), Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele - Milan, Italy.,The William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Cecilia Garlanda
- IRCCS, Humanitas Clinical and Research Center, Rozzano (Mi), Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele - Milan, Italy
| | - Maria Grazia Valsecchi
- Center of Bioinformatics, Biostatistics and Bioimaging, School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Franco Locatelli
- Department of Pediatric Hematology-Oncology, IRCCS Bambino Gesù Children's Hospital, Sapienza, University of Rome, Rome, Italy
| | - Andrea Biondi
- Centro Ricerca Tettamanti, Pediatric Dep, University of Milano-Bicocca, Fondazione MBBM, Monza, Italy
| | - Barbara Bottazzi
- IRCCS, Humanitas Clinical and Research Center, Rozzano (Mi), Italy
| | - Paola Allavena
- IRCCS, Humanitas Clinical and Research Center, Rozzano (Mi), Italy
| | - Giovanna D'Amico
- Centro Ricerca Tettamanti, Pediatric Dep, University of Milano-Bicocca, Fondazione MBBM, Monza, Italy
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