51
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Boissel N. How should we treat the AYA patient with newly diagnosed ALL? Best Pract Res Clin Haematol 2017; 30:175-183. [PMID: 29050690 DOI: 10.1016/j.beha.2017.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 07/31/2017] [Accepted: 07/31/2017] [Indexed: 01/19/2023]
Abstract
Adolescent and young adult (AYA) patients with acute lymphoblastic leukaemia (ALL) are recognized as a unique population with specific characteristics and needs. In adolescents aged 15-20 years old, the use of full paediatric protocols is supported by many comparative studies of paediatric and adult cooperative groups. In young adults, growing evidence suggests that paediatric-inspired approaches may also improve outcomes and lead to long-term survival rates of almost 70%. In the last decade, better knowledge of ALL oncogenic landscape, age distribution, and minimal residual disease prognostic impact have improved risk stratification. New targets have emerged mostly in the heterogeneous subgroup of Philadelphia-like ALL and will require both in-depth molecular investigations and specific evaluations in rare subgroups of ALL. The remaining gap with the excellent results reported in children has many other contributing factors that should not be underestimated including late or difficult access to care, or poor adherence to treatment.
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Affiliation(s)
- Nicolas Boissel
- Adolescent & Young Adult Hematology Unit, Saint-Louis Hospital, EA-3518, Paris 7 University, 1 avenue Claude Vellefaux, 75010, Paris, France.
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52
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Sapir T, Levy T, Kozer N, Shin I, Zamor V, Haffner-Krausz R, McGlade JC, Reiner O. Notch Activation by Shootin1 Opposing Activities on 2 Ubiquitin Ligases. Cereb Cortex 2017; 28:3115-3128. [DOI: 10.1093/cercor/bhx180] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 06/23/2017] [Indexed: 12/22/2022] Open
Affiliation(s)
- Tamar Sapir
- Department of Molecular Genetics, Weizmann Institute of Science, 234 Herzl St., Rehovot, Israel
| | - Talia Levy
- Department of Molecular Genetics, Weizmann Institute of Science, 234 Herzl St., Rehovot, Israel
| | - Noga Kozer
- Nancy and Stephen Grand Israel National Center for Personalized Medicine, Weizmann Institute of Science, 234 Herzl St., Rehovot, Israel
| | - Irina Shin
- Biological Services Unit, Weizmann Institute of Science, 234 Herzl St., Rehovot, Israel
| | - Vanessa Zamor
- Department of Molecular Genetics, Weizmann Institute of Science, 234 Herzl St., Rehovot, Israel
| | - Rebecca Haffner-Krausz
- Department of Veterinary Resources, Weizmann Institute of Science, 234 Herzl St., Rehovot, Israel
| | - Jane C McGlade
- The Arthur and Sonia Labatt Brain Tumour Research Centre and Program in Cell Biology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON,Canada
- Department of Medical Biophysics, University of Toronto, 610 University Avenue, Toronto, ON, Canada
| | - Orly Reiner
- Department of Molecular Genetics, Weizmann Institute of Science, 234 Herzl St., Rehovot, Israel
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53
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Adult T-type lymphoblastic lymphoma: Treatment advances and prognostic indicators. Exp Hematol 2017; 51:7-16. [DOI: 10.1016/j.exphem.2017.04.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/24/2017] [Accepted: 04/03/2017] [Indexed: 12/19/2022]
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54
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Liu RB, Guo JG, Liu TZ, Guo CC, Fan XX, Zhang X, Hu WH, Cai XY. Meta-analysis of the clinical characteristics and prognostic relevance of NOTCH1 and FBXW7 mutation in T-cell acute lymphoblastic leukemia. Oncotarget 2017; 8:66360-66370. [PMID: 29029518 PMCID: PMC5630418 DOI: 10.18632/oncotarget.18576] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 04/26/2017] [Indexed: 11/29/2022] Open
Abstract
The NOTCH1 signaling pathway is crucial for T-cell development, and NOTCH1 and/or FBXW7 mutations are frequently detected in T-cell acute lymphoblastic leukemia (T-ALL). We performed a systematic review and meta-analysis of 18 randomized controlled trials (RCTs) to assess the prognostic impact of mutations in the NOTCH1 pathway. After retrieving relevant articles from PubMed, EMBASE, and the Cochrane Library, we investigated overall survival (OS) and event-free survival (EFS) with hazard ratios (HRs) using fixed-effects or random-effects models and conducted subgroup analyses based on population and mutation status. NOTCH1/FBXW7 mutations correlated significantly with better prognosis (5-year EFS: HR, 0.57; 95% confidence interval [CI], 0.46 to 0.68; P < 0.001 and 5-year OS: HR, 0.61; 95% CI, 0.51 to 0.74; P < 0.001). The HR for 5-year EFS and OS with NOTCH1 mutations were 0.63 (95% CI, 0.53 to 0.75) and 0.76 (95% CI, 0.60 to 0.95), respectively; with FBXW7 mutations, they were 0.82 (95% CI, 0.60 to 1.11) and 0.79 (95% CI, 0.55 to 1.12), respectively. However, differences between children and adults showed no significance. We conclude that the presence of NOTCH1/FBXW7 mutations is an independent prognostic factor for 5-year EFS and 5-year OS.
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Affiliation(s)
- Rong-Bin Liu
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Molecular Diagnostics, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Jian-Gui Guo
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Department of Radiation Oncology, The First People's Hospital of Foshan, Foshan, China
| | - Tian-Ze Liu
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Cheng-Cheng Guo
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Neurosurgery, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Xin-Xiang Fan
- Department of Urology, Sun Yat-Sen Memorial Hospital, Guangzhou, China
| | - Xiao Zhang
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Molecular Diagnostics, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Wei-Han Hu
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Xiu-Yu Cai
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of VIP Region, Sun Yat-Sen University Cancer Center, Guangzhou, China
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55
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Tesio M, Trinquand A, Ballerini P, Hypolite G, Lhermitte L, Petit A, Ifrah N, Baruchel A, Dombret H, Macintyre E, Asnafi V. Age-related clinical and biological features of PTEN abnormalities in T-cell acute lymphoblastic leukaemia. Leukemia 2017; 31:2594-2600. [DOI: 10.1038/leu.2017.157] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 04/03/2017] [Accepted: 05/15/2017] [Indexed: 01/07/2023]
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56
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Management of adults with T-cell lymphoblastic leukemia. Blood 2017; 129:1134-1142. [DOI: 10.1182/blood-2016-07-692608] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 09/27/2016] [Indexed: 12/17/2022] Open
Abstract
Abstract
T-cell acute lymphoblastic leukemia (ALL) is a rare disease in adults with inferior survival outcomes compared with those seen in pediatric patients. Although potentially curable with ∼50% survival at 5 years, adult patients with relapsed disease have dismal outcomes with <10% of patients surviving long term. This review will discuss the diagnosis and management of adult patients with newly diagnosed T-cell ALL with an emphasis on the immunophenotypic and genetic analyses required to assign prognosis, risk stratify, and guide post-remission therapy. The evidence for the main components of complex T-cell ALL treatment regimens is described. The importance of monitoring minimal residual disease is emphasized, with a discussion of the different methods used. The results of hematopoietic cell transplantation are analyzed, and recommendations made about which patients should be considered for this intervention. The treatment of the adolescent and young adult group is delineated, and the role of using “pediatric-inspired” regimens in older adults considered. We also describe the current data and potential future options for the use of novel therapies, including nelarabine and γ-secretase inhibitors, in adult patients with T-cell ALL.
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57
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Acute lymphoblastic leukemia relapsing after first-line pediatric-inspired therapy: a retrospective GRAALL study. Blood Cancer J 2016; 6:e504. [PMID: 27935576 PMCID: PMC5223147 DOI: 10.1038/bcj.2016.111] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 10/06/2016] [Indexed: 01/16/2023] Open
Abstract
The outcome of adult patients with Philadelphia chromosome-negative acute lymphoblastic leukemia (Ph− ALL) relapsing after pediatric-inspired front-line therapy is ill known. Here 229 relapsing Ph− ALL younger adults (18–63 years) treated within the Group for Research on Adult Acute Lymphoblastic Leukemia (GRAALL)-2003/-2005 trials were considered. Salvage regimens consisted of potentially curative therapies in 194 cases, low-intensity therapies in 21, allogeneic stem cell transplant (allo-SCT) in 6 and best supportive care in 8. Overall, 77 patients received allo-SCT after relapse. The median follow-up was 3.1 years. A second complete remission (CR2) was achieved in 121 patients (53%). In multivariate analysis, only younger age <45 years (P=0.008) and CR1 duration ⩾18 months (P=0.009) predicted CR2. Overall survival (OS) at 2 and 5 years was 19.3% (14–24%) and 13.3% (8–18%), respectively. In CR2 patients, disease-free survival (DFS) at 2 and 5 years was 29.0% (21–38%) and 25% (17–33%). In multivariate analysis, CR1 duration ⩾18 months and allo-SCT after relapse were associated with longer DFS (P<0.009 and P=0.004, respectively) and longer OS (P=0.004 and P<0.0001, respectively). In conclusion, although younger adults relapsing after pediatric-inspired ALL therapies retain a poor outcome, some of them may be cured if CR1 duration ⩾18 months and if allo-SCT can be performed in CR2. New therapies are definitely needed for these patients.
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58
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Multi-center analysis of the effect of T-cell acute lymphoblastic leukemia subtype and minimal residual disease on allogeneic stem cell transplantation outcomes. Bone Marrow Transplant 2016; 52:20-27. [DOI: 10.1038/bmt.2016.194] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/24/2016] [Accepted: 06/10/2016] [Indexed: 11/08/2022]
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59
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Ho C, Kluk MJ. Molecular Pathology: Predictive, Prognostic, and Diagnostic Markers in Lymphoid Neoplasms. Surg Pathol Clin 2016; 9:489-521. [PMID: 27523974 DOI: 10.1016/j.path.2016.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Lymphoid neoplasms show great diversity in morphology, immunophenotypic profile, and postulated cells of origin, which also reflects the variety of genetic alterations within this group of tumors. This review discusses many of the currently known genetic alterations in selected mature B-cell and T-cell lymphoid neoplasms, and their significance as diagnostic, prognostic, and therapeutic markers. Given the rapidly increasing number of genetic alterations that have been described in this group of tumors, and that the clinical significance of many is still being studied, this is not an entirely exhaustive review of all of the genetic alterations that have been reported.
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Affiliation(s)
- Caleb Ho
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Michael J Kluk
- Department of Pathology, Weill Cornell Medical College, 525 East 68th Street, Mailbox #79, F-540, New York, NY 10065, USA.
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60
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Trinquand A, Dos Santos NR, Tran Quang C, Rocchetti F, Zaniboni B, Belhocine M, Da Costa de Jesus C, Lhermitte L, Tesio M, Dussiot M, Cosset FL, Verhoeyen E, Pflumio F, Ifrah N, Dombret H, Spicuglia S, Chatenoud L, Gross DA, Hermine O, Macintyre E, Ghysdael J, Asnafi V. Triggering the TCR Developmental Checkpoint Activates a Therapeutically Targetable Tumor Suppressive Pathway in T-cell Leukemia. Cancer Discov 2016; 6:972-85. [PMID: 27354269 DOI: 10.1158/2159-8290.cd-15-0675] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 06/24/2016] [Indexed: 11/16/2022]
Abstract
UNLABELLED Cancer onset and progression involves the accumulation of multiple oncogenic hits, which are thought to dominate or bypass the physiologic regulatory mechanisms in tissue development and homeostasis. We demonstrate in T-cell acute lymphoblastic leukemia (T-ALL) that, irrespective of the complex oncogenic abnormalities underlying tumor progression, experimentally induced, persistent T-cell receptor (TCR) signaling has antileukemic properties and enforces a molecular program resembling thymic negative selection, a major developmental event in normal T-cell development. Using mouse models of T-ALL, we show that induction of TCR signaling by high-affinity self-peptide/MHC or treatment with monoclonal antibodies to the CD3ε chain (anti-CD3) causes massive leukemic cell death. Importantly, anti-CD3 treatment hampered leukemogenesis in mice transplanted with either mouse- or patient-derived T-ALLs. These data provide a strong rationale for targeted therapy based on anti-CD3 treatment of patients with TCR-expressing T-ALL and demonstrate that endogenous developmental checkpoint pathways are amenable to therapeutic intervention in cancer cells. SIGNIFICANCE T-ALLs are aggressive malignant lymphoid proliferations of T-cell precursors characterized by high relapse rates and poor prognosis, calling for the search for novel therapeutic options. Here, we report that the lineage-specific TCR/CD3 developmental checkpoint controlling cell death in normal T-cell progenitors remains switchable to induce massive tumor cell apoptosis in T-ALL and is amenable to preclinical therapeutic intervention. Cancer Discov; 6(9); 972-85. ©2016 AACR.See related commentary by Lemonnier and Mak, p. 946This article is highlighted in the In This Issue feature, p. 932.
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Affiliation(s)
- Amélie Trinquand
- Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades (INEM), Institut national de recherche médicale (INSERM) U1151, and Laboratory of Onco-Hematology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker Enfants-Malades, Paris, France
| | - Nuno R Dos Santos
- Centre for Biomedical Research (CBMR), University of Algarve, Faro, Portugal. Institut Curie, PSL Research University, CNRS UMR 3348, Orsay, France
| | - Christine Tran Quang
- Institut Curie, PSL Research University, CNRS UMR 3348, Orsay, France. Université Paris Sud, Université Paris-Saclay, CNRS UMR 3348, Orsay, France
| | - Francesca Rocchetti
- Institut Curie, PSL Research University, CNRS UMR 3348, Orsay, France. Université Paris Sud, Université Paris-Saclay, CNRS UMR 3348, Orsay, France
| | - Benedetta Zaniboni
- Institut Curie, PSL Research University, CNRS UMR 3348, Orsay, France. Université Paris Sud, Université Paris-Saclay, CNRS UMR 3348, Orsay, France
| | - Mohamed Belhocine
- Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades (INEM), Institut national de recherche médicale (INSERM) U1151, and Laboratory of Onco-Hematology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker Enfants-Malades, Paris, France. Technological Advances for Genomics and Clinics (TAGC), INSERM U1090, Université de la Méditerranée, Marseille, France
| | - Cindy Da Costa de Jesus
- Institut Curie, PSL Research University, CNRS UMR 3348, Orsay, France. Université Paris Sud, Université Paris-Saclay, CNRS UMR 3348, Orsay, France
| | - Ludovic Lhermitte
- Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades (INEM), Institut national de recherche médicale (INSERM) U1151, and Laboratory of Onco-Hematology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker Enfants-Malades, Paris, France
| | - Melania Tesio
- Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades (INEM), Institut national de recherche médicale (INSERM) U1151, and Laboratory of Onco-Hematology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker Enfants-Malades, Paris, France
| | - Michael Dussiot
- INSERM UMR 1163 and CNRS ERL 8654, Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutic Implications, Laboratory of Excellence GR-Ex, Imagine Institute and Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - François-Loïc Cosset
- CIRI, EVIR Team, INSERM U1111, CNRS UMR 5308, Université de Lyon-1, ENS de Lyon, Lyon, France
| | - Els Verhoeyen
- CIRI, EVIR Team, INSERM U1111, CNRS UMR 5308, Université de Lyon-1, ENS de Lyon, Lyon, France. INSERM U1065, C3M, Equipe "Contrôle Métabolique des Morts Cellulaires," Nice, France
| | - Françoise Pflumio
- Laboratoire des Cellules Souches Hématopoïétiques et Leucémiques, UMR 967, INSERM, Commissariat à l'Energie Atomique, Université Paris Diderot, Université Paris 11, Institut de Radiobiologie Cellulaire et Moléculaire, équipe labellisée Ligue Nationale contre le Cancer, Fontenay-aux-Roses, France
| | - Norbert Ifrah
- PRES LUNAM, CHU Angers service des Maladies du Sang et INSERM U892, Angers, France
| | - Hervé Dombret
- Université Paris 7, Hôpital Saint-Louis, AP-HP, Department of Hematology and Institut Universitaire d'Hématologie, Paris, France
| | - Salvatore Spicuglia
- Technological Advances for Genomics and Clinics (TAGC), INSERM U1090, Université de la Méditerranée, Marseille, France
| | - Lucienne Chatenoud
- Institut Necker Enfants Malades, INSERM U1151, CNRS UMR 8253, Hôpital Necker-Enfants Malades, Paris, France, and Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | - David-Alexandre Gross
- Institut Necker Enfants Malades, INSERM U1151, CNRS UMR 8253, Hôpital Necker-Enfants Malades, Paris, France, and Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | - Olivier Hermine
- INSERM UMR 1163 and CNRS ERL 8654, Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutic Implications, Laboratory of Excellence GR-Ex, Imagine Institute and Paris Descartes University, Sorbonne Paris Cité, Paris, France. Department of Clinical Hematology, Hôpital Necker, Assistance publique hôpitaux de Paris, Paris, France
| | - Elizabeth Macintyre
- Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades (INEM), Institut national de recherche médicale (INSERM) U1151, and Laboratory of Onco-Hematology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker Enfants-Malades, Paris, France
| | - Jacques Ghysdael
- Institut Curie, PSL Research University, CNRS UMR 3348, Orsay, France. Université Paris Sud, Université Paris-Saclay, CNRS UMR 3348, Orsay, France.
| | - Vahid Asnafi
- Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades (INEM), Institut national de recherche médicale (INSERM) U1151, and Laboratory of Onco-Hematology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker Enfants-Malades, Paris, France.
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61
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Brammer JE, Khouri I, Marin D, Ledesma C, Rondon G, Ciurea SO, Nieto Y, Champlin RE, Hosing C, Kebriaei P. Stem cell transplantation outcomes in lymphoblastic lymphoma. Leuk Lymphoma 2016; 58:366-371. [DOI: 10.1080/10428194.2016.1193860] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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62
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Gianfelici V, Chiaretti S, Demeyer S, Di Giacomo F, Messina M, La Starza R, Peragine N, Paoloni F, Geerdens E, Pierini V, Elia L, Mancini M, De Propris MS, Apicella V, Gaidano G, Testi AM, Vitale A, Vignetti M, Mecucci C, Guarini A, Cools J, Foà R. RNA sequencing unravels the genetics of refractory/relapsed T-cell acute lymphoblastic leukemia. Prognostic and therapeutic implications. Haematologica 2016; 101:941-50. [PMID: 27151993 DOI: 10.3324/haematol.2015.139410] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 04/29/2016] [Indexed: 01/12/2023] Open
Abstract
Despite therapeutic improvements, a sizable number of patients with T-cell acute lymphoblastic leukemia still have a poor outcome. To unravel the genomic background associated with refractoriness, we evaluated the transcriptome of 19 cases of refractory/early relapsed T-cell acute lymphoblastic leukemia (discovery cohort) by performing RNA-sequencing on diagnostic material. The incidence and prognostic impact of the most frequently mutated pathways were validated by Sanger sequencing on genomic DNA from diagnostic samples of an independent cohort of 49 cases (validation cohort), including refractory, relapsed and responsive cases. Combined gene expression and fusion transcript analyses in the discovery cohort revealed the presence of known oncogenes and identified novel rearrangements inducing overexpression, as well as inactivation of tumor suppressor genes. Mutation analysis identified JAK/STAT and RAS/PTEN as the most commonly disrupted pathways in patients with chemorefractory disease or early relapse, frequently in association with NOTCH1/FBXW7 mutations. The analysis on the validation cohort documented a significantly higher risk of relapse, inferior overall survival, disease-free survival and event-free survival in patients with JAK/STAT or RAS/PTEN alterations. Conversely, a significantly better survival was observed in patients harboring only NOTCH1/FBXW7 mutations: this favorable prognostic effect was abrogated by the presence of concomitant mutations. Preliminary in vitro assays on primary cells demonstrated sensitivity to specific inhibitors. These data document the negative prognostic impact of JAK/STAT and RAS/PTEN mutations in T-cell acute lymphoblastic leukemia and suggest the potential clinical application of JAK and PI3K/mTOR inhibitors in patients harboring mutations in these pathways.
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Affiliation(s)
- Valentina Gianfelici
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Sabina Chiaretti
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Sofie Demeyer
- Center for Human Genetics, KU Leuven, Belgium Center for the Biology of Disease, VIB, Leuven, Belgium
| | - Filomena Di Giacomo
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy Department of Molecular Biotechnology and Health Science and Center for Experimental Research and Medical Studies (CeRMS), University of Turin, Italy
| | - Monica Messina
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Roberta La Starza
- Hematology and Bone Marrow Transplantation Unit, Department of Medicine, University of Perugia, Italy
| | - Nadia Peragine
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | | | - Ellen Geerdens
- Center for Human Genetics, KU Leuven, Belgium Center for the Biology of Disease, VIB, Leuven, Belgium
| | - Valentina Pierini
- Hematology and Bone Marrow Transplantation Unit, Department of Medicine, University of Perugia, Italy
| | - Loredana Elia
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Marco Mancini
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | | | - Valerio Apicella
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Anna Maria Testi
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Antonella Vitale
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Marco Vignetti
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy GIMEMA Data Center, Rome, Italy
| | - Cristina Mecucci
- Hematology and Bone Marrow Transplantation Unit, Department of Medicine, University of Perugia, Italy
| | - Anna Guarini
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Jan Cools
- Center for Human Genetics, KU Leuven, Belgium Center for the Biology of Disease, VIB, Leuven, Belgium
| | - Robin Foà
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
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63
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Lepretre S, Touzart A, Vermeulin T, Picquenot JM, Tanguy-Schmidt A, Salles G, Lamy T, Béné MC, Raffoux E, Huguet F, Chevallier P, Bologna S, Bouabdallah R, Benichou J, Brière J, Moreau A, Tallon-Simon V, Seris S, Graux C, Asnafi V, Ifrah N, Macintyre E, Dombret H. Pediatric-Like Acute Lymphoblastic Leukemia Therapy in Adults With Lymphoblastic Lymphoma: The GRAALL-LYSA LL03 Study. J Clin Oncol 2016; 34:572-80. [DOI: 10.1200/jco.2015.61.5385] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Purpose This study evaluated the efficacy of pediatric-like acute lymphoblastic leukemia (ALL) therapy in adults with lymphoblastic lymphoma (LL). Patients and Methods This was a prospective phase II study in adults 18 to 59 years old with previously untreated LL. Patients were treated with an adapted pediatric-like ALL protocol, which included a corticosteroid prephase, a five-drug induction reinforced by sequential cyclophosphamide administration, dose-dense consolidation, late intensification, CNS prophylaxis, and a 2-year maintenance phase. Treatment response was assessed by computed tomography and optional positron emission tomography. Allogeneic hematopoietic stem cell transplant was offered to selected patients in first complete remission (CR) or unconfirmed CR. Results The study enrolled 148 patients (131 with T-lineage LL [T-LL] and 17 with B-lineage LL [B-LL]). A total of 119 patients with T-LL (90.8%) and 13 with B-LL (76.5%) reached CR/unconfirmed CR, including 26 with T-LL and two with B-LL who needed a second induction salvage course. Relapse occurred in 34 patients with T-LL and four with B-LL. In patients with T-LL, 3-year event-free survival was 63.3% (95% CI, 54.2% to 71.0%), disease-free survival was 72.4% (95% CI, 63.0% to 79.7%), and overall survival was 69.2% (95% CI, 60.0% to 76.7%). Multivariate analysis identified serum lactate dehydrogenase level and the NOTCH1/FBXW7/RAS/PTEN oncogene (a four-gene oncogenetic classifier) status but not positron emission tomography or hematopoietic stem cell transplant as independent prognostic factors for outcome in T-LL. Conclusion In adults with LL, an intensive pediatric-like ALL treatment protocol was associated with a good response rate and outcome. In patients with T-LL, the four-gene oncogenetic classifier and lactate dehydrogenase level were independent prognostic indicators.
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Affiliation(s)
- Stéphane Lepretre
- Stéphane Lepretre, Valérie Tallon-Simon, and Stéphanie Seris, Institut National de la Santé et de la Recherche Médicale (INSERM) U918, University of Rouen, Centre de Lutte contre le Cancer de Haute-Normandie (CLCC) H. Becquerel; Thomas Vermeulin and Jacques Benichou, Centre Hospitalier Universitaire (CHU) Charles Nicolle and INSERM U657, University of Rouen; Jean-Michel Picquenot, CLCC H. Becquerel, Rouen; Aurore Touzart, Vahid Asnafi, and Elizabeth Macintyre, University Paris Descartes Sorbonne Cité,
| | - Aurore Touzart
- Stéphane Lepretre, Valérie Tallon-Simon, and Stéphanie Seris, Institut National de la Santé et de la Recherche Médicale (INSERM) U918, University of Rouen, Centre de Lutte contre le Cancer de Haute-Normandie (CLCC) H. Becquerel; Thomas Vermeulin and Jacques Benichou, Centre Hospitalier Universitaire (CHU) Charles Nicolle and INSERM U657, University of Rouen; Jean-Michel Picquenot, CLCC H. Becquerel, Rouen; Aurore Touzart, Vahid Asnafi, and Elizabeth Macintyre, University Paris Descartes Sorbonne Cité,
| | - Thomas Vermeulin
- Stéphane Lepretre, Valérie Tallon-Simon, and Stéphanie Seris, Institut National de la Santé et de la Recherche Médicale (INSERM) U918, University of Rouen, Centre de Lutte contre le Cancer de Haute-Normandie (CLCC) H. Becquerel; Thomas Vermeulin and Jacques Benichou, Centre Hospitalier Universitaire (CHU) Charles Nicolle and INSERM U657, University of Rouen; Jean-Michel Picquenot, CLCC H. Becquerel, Rouen; Aurore Touzart, Vahid Asnafi, and Elizabeth Macintyre, University Paris Descartes Sorbonne Cité,
| | - Jean-Michel Picquenot
- Stéphane Lepretre, Valérie Tallon-Simon, and Stéphanie Seris, Institut National de la Santé et de la Recherche Médicale (INSERM) U918, University of Rouen, Centre de Lutte contre le Cancer de Haute-Normandie (CLCC) H. Becquerel; Thomas Vermeulin and Jacques Benichou, Centre Hospitalier Universitaire (CHU) Charles Nicolle and INSERM U657, University of Rouen; Jean-Michel Picquenot, CLCC H. Becquerel, Rouen; Aurore Touzart, Vahid Asnafi, and Elizabeth Macintyre, University Paris Descartes Sorbonne Cité,
| | - Aline Tanguy-Schmidt
- Stéphane Lepretre, Valérie Tallon-Simon, and Stéphanie Seris, Institut National de la Santé et de la Recherche Médicale (INSERM) U918, University of Rouen, Centre de Lutte contre le Cancer de Haute-Normandie (CLCC) H. Becquerel; Thomas Vermeulin and Jacques Benichou, Centre Hospitalier Universitaire (CHU) Charles Nicolle and INSERM U657, University of Rouen; Jean-Michel Picquenot, CLCC H. Becquerel, Rouen; Aurore Touzart, Vahid Asnafi, and Elizabeth Macintyre, University Paris Descartes Sorbonne Cité,
| | - Gilles Salles
- Stéphane Lepretre, Valérie Tallon-Simon, and Stéphanie Seris, Institut National de la Santé et de la Recherche Médicale (INSERM) U918, University of Rouen, Centre de Lutte contre le Cancer de Haute-Normandie (CLCC) H. Becquerel; Thomas Vermeulin and Jacques Benichou, Centre Hospitalier Universitaire (CHU) Charles Nicolle and INSERM U657, University of Rouen; Jean-Michel Picquenot, CLCC H. Becquerel, Rouen; Aurore Touzart, Vahid Asnafi, and Elizabeth Macintyre, University Paris Descartes Sorbonne Cité,
| | - Thierry Lamy
- Stéphane Lepretre, Valérie Tallon-Simon, and Stéphanie Seris, Institut National de la Santé et de la Recherche Médicale (INSERM) U918, University of Rouen, Centre de Lutte contre le Cancer de Haute-Normandie (CLCC) H. Becquerel; Thomas Vermeulin and Jacques Benichou, Centre Hospitalier Universitaire (CHU) Charles Nicolle and INSERM U657, University of Rouen; Jean-Michel Picquenot, CLCC H. Becquerel, Rouen; Aurore Touzart, Vahid Asnafi, and Elizabeth Macintyre, University Paris Descartes Sorbonne Cité,
| | - Marie-Christine Béné
- Stéphane Lepretre, Valérie Tallon-Simon, and Stéphanie Seris, Institut National de la Santé et de la Recherche Médicale (INSERM) U918, University of Rouen, Centre de Lutte contre le Cancer de Haute-Normandie (CLCC) H. Becquerel; Thomas Vermeulin and Jacques Benichou, Centre Hospitalier Universitaire (CHU) Charles Nicolle and INSERM U657, University of Rouen; Jean-Michel Picquenot, CLCC H. Becquerel, Rouen; Aurore Touzart, Vahid Asnafi, and Elizabeth Macintyre, University Paris Descartes Sorbonne Cité,
| | - Emmanuel Raffoux
- Stéphane Lepretre, Valérie Tallon-Simon, and Stéphanie Seris, Institut National de la Santé et de la Recherche Médicale (INSERM) U918, University of Rouen, Centre de Lutte contre le Cancer de Haute-Normandie (CLCC) H. Becquerel; Thomas Vermeulin and Jacques Benichou, Centre Hospitalier Universitaire (CHU) Charles Nicolle and INSERM U657, University of Rouen; Jean-Michel Picquenot, CLCC H. Becquerel, Rouen; Aurore Touzart, Vahid Asnafi, and Elizabeth Macintyre, University Paris Descartes Sorbonne Cité,
| | - Françoise Huguet
- Stéphane Lepretre, Valérie Tallon-Simon, and Stéphanie Seris, Institut National de la Santé et de la Recherche Médicale (INSERM) U918, University of Rouen, Centre de Lutte contre le Cancer de Haute-Normandie (CLCC) H. Becquerel; Thomas Vermeulin and Jacques Benichou, Centre Hospitalier Universitaire (CHU) Charles Nicolle and INSERM U657, University of Rouen; Jean-Michel Picquenot, CLCC H. Becquerel, Rouen; Aurore Touzart, Vahid Asnafi, and Elizabeth Macintyre, University Paris Descartes Sorbonne Cité,
| | - Patrice Chevallier
- Stéphane Lepretre, Valérie Tallon-Simon, and Stéphanie Seris, Institut National de la Santé et de la Recherche Médicale (INSERM) U918, University of Rouen, Centre de Lutte contre le Cancer de Haute-Normandie (CLCC) H. Becquerel; Thomas Vermeulin and Jacques Benichou, Centre Hospitalier Universitaire (CHU) Charles Nicolle and INSERM U657, University of Rouen; Jean-Michel Picquenot, CLCC H. Becquerel, Rouen; Aurore Touzart, Vahid Asnafi, and Elizabeth Macintyre, University Paris Descartes Sorbonne Cité,
| | - Serge Bologna
- Stéphane Lepretre, Valérie Tallon-Simon, and Stéphanie Seris, Institut National de la Santé et de la Recherche Médicale (INSERM) U918, University of Rouen, Centre de Lutte contre le Cancer de Haute-Normandie (CLCC) H. Becquerel; Thomas Vermeulin and Jacques Benichou, Centre Hospitalier Universitaire (CHU) Charles Nicolle and INSERM U657, University of Rouen; Jean-Michel Picquenot, CLCC H. Becquerel, Rouen; Aurore Touzart, Vahid Asnafi, and Elizabeth Macintyre, University Paris Descartes Sorbonne Cité,
| | - Réda Bouabdallah
- Stéphane Lepretre, Valérie Tallon-Simon, and Stéphanie Seris, Institut National de la Santé et de la Recherche Médicale (INSERM) U918, University of Rouen, Centre de Lutte contre le Cancer de Haute-Normandie (CLCC) H. Becquerel; Thomas Vermeulin and Jacques Benichou, Centre Hospitalier Universitaire (CHU) Charles Nicolle and INSERM U657, University of Rouen; Jean-Michel Picquenot, CLCC H. Becquerel, Rouen; Aurore Touzart, Vahid Asnafi, and Elizabeth Macintyre, University Paris Descartes Sorbonne Cité,
| | - Jacques Benichou
- Stéphane Lepretre, Valérie Tallon-Simon, and Stéphanie Seris, Institut National de la Santé et de la Recherche Médicale (INSERM) U918, University of Rouen, Centre de Lutte contre le Cancer de Haute-Normandie (CLCC) H. Becquerel; Thomas Vermeulin and Jacques Benichou, Centre Hospitalier Universitaire (CHU) Charles Nicolle and INSERM U657, University of Rouen; Jean-Michel Picquenot, CLCC H. Becquerel, Rouen; Aurore Touzart, Vahid Asnafi, and Elizabeth Macintyre, University Paris Descartes Sorbonne Cité,
| | - Josette Brière
- Stéphane Lepretre, Valérie Tallon-Simon, and Stéphanie Seris, Institut National de la Santé et de la Recherche Médicale (INSERM) U918, University of Rouen, Centre de Lutte contre le Cancer de Haute-Normandie (CLCC) H. Becquerel; Thomas Vermeulin and Jacques Benichou, Centre Hospitalier Universitaire (CHU) Charles Nicolle and INSERM U657, University of Rouen; Jean-Michel Picquenot, CLCC H. Becquerel, Rouen; Aurore Touzart, Vahid Asnafi, and Elizabeth Macintyre, University Paris Descartes Sorbonne Cité,
| | - Anne Moreau
- Stéphane Lepretre, Valérie Tallon-Simon, and Stéphanie Seris, Institut National de la Santé et de la Recherche Médicale (INSERM) U918, University of Rouen, Centre de Lutte contre le Cancer de Haute-Normandie (CLCC) H. Becquerel; Thomas Vermeulin and Jacques Benichou, Centre Hospitalier Universitaire (CHU) Charles Nicolle and INSERM U657, University of Rouen; Jean-Michel Picquenot, CLCC H. Becquerel, Rouen; Aurore Touzart, Vahid Asnafi, and Elizabeth Macintyre, University Paris Descartes Sorbonne Cité,
| | - Valérie Tallon-Simon
- Stéphane Lepretre, Valérie Tallon-Simon, and Stéphanie Seris, Institut National de la Santé et de la Recherche Médicale (INSERM) U918, University of Rouen, Centre de Lutte contre le Cancer de Haute-Normandie (CLCC) H. Becquerel; Thomas Vermeulin and Jacques Benichou, Centre Hospitalier Universitaire (CHU) Charles Nicolle and INSERM U657, University of Rouen; Jean-Michel Picquenot, CLCC H. Becquerel, Rouen; Aurore Touzart, Vahid Asnafi, and Elizabeth Macintyre, University Paris Descartes Sorbonne Cité,
| | - Stéphanie Seris
- Stéphane Lepretre, Valérie Tallon-Simon, and Stéphanie Seris, Institut National de la Santé et de la Recherche Médicale (INSERM) U918, University of Rouen, Centre de Lutte contre le Cancer de Haute-Normandie (CLCC) H. Becquerel; Thomas Vermeulin and Jacques Benichou, Centre Hospitalier Universitaire (CHU) Charles Nicolle and INSERM U657, University of Rouen; Jean-Michel Picquenot, CLCC H. Becquerel, Rouen; Aurore Touzart, Vahid Asnafi, and Elizabeth Macintyre, University Paris Descartes Sorbonne Cité,
| | - Carlos Graux
- Stéphane Lepretre, Valérie Tallon-Simon, and Stéphanie Seris, Institut National de la Santé et de la Recherche Médicale (INSERM) U918, University of Rouen, Centre de Lutte contre le Cancer de Haute-Normandie (CLCC) H. Becquerel; Thomas Vermeulin and Jacques Benichou, Centre Hospitalier Universitaire (CHU) Charles Nicolle and INSERM U657, University of Rouen; Jean-Michel Picquenot, CLCC H. Becquerel, Rouen; Aurore Touzart, Vahid Asnafi, and Elizabeth Macintyre, University Paris Descartes Sorbonne Cité,
| | - Vahid Asnafi
- Stéphane Lepretre, Valérie Tallon-Simon, and Stéphanie Seris, Institut National de la Santé et de la Recherche Médicale (INSERM) U918, University of Rouen, Centre de Lutte contre le Cancer de Haute-Normandie (CLCC) H. Becquerel; Thomas Vermeulin and Jacques Benichou, Centre Hospitalier Universitaire (CHU) Charles Nicolle and INSERM U657, University of Rouen; Jean-Michel Picquenot, CLCC H. Becquerel, Rouen; Aurore Touzart, Vahid Asnafi, and Elizabeth Macintyre, University Paris Descartes Sorbonne Cité,
| | - Norbert Ifrah
- Stéphane Lepretre, Valérie Tallon-Simon, and Stéphanie Seris, Institut National de la Santé et de la Recherche Médicale (INSERM) U918, University of Rouen, Centre de Lutte contre le Cancer de Haute-Normandie (CLCC) H. Becquerel; Thomas Vermeulin and Jacques Benichou, Centre Hospitalier Universitaire (CHU) Charles Nicolle and INSERM U657, University of Rouen; Jean-Michel Picquenot, CLCC H. Becquerel, Rouen; Aurore Touzart, Vahid Asnafi, and Elizabeth Macintyre, University Paris Descartes Sorbonne Cité,
| | - Elizabeth Macintyre
- Stéphane Lepretre, Valérie Tallon-Simon, and Stéphanie Seris, Institut National de la Santé et de la Recherche Médicale (INSERM) U918, University of Rouen, Centre de Lutte contre le Cancer de Haute-Normandie (CLCC) H. Becquerel; Thomas Vermeulin and Jacques Benichou, Centre Hospitalier Universitaire (CHU) Charles Nicolle and INSERM U657, University of Rouen; Jean-Michel Picquenot, CLCC H. Becquerel, Rouen; Aurore Touzart, Vahid Asnafi, and Elizabeth Macintyre, University Paris Descartes Sorbonne Cité,
| | - Hervé Dombret
- Stéphane Lepretre, Valérie Tallon-Simon, and Stéphanie Seris, Institut National de la Santé et de la Recherche Médicale (INSERM) U918, University of Rouen, Centre de Lutte contre le Cancer de Haute-Normandie (CLCC) H. Becquerel; Thomas Vermeulin and Jacques Benichou, Centre Hospitalier Universitaire (CHU) Charles Nicolle and INSERM U657, University of Rouen; Jean-Michel Picquenot, CLCC H. Becquerel, Rouen; Aurore Touzart, Vahid Asnafi, and Elizabeth Macintyre, University Paris Descartes Sorbonne Cité,
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Jenkinson S, Kirkwood AA, Goulden N, Vora A, Linch DC, Gale RE. Impact of PTEN abnormalities on outcome in pediatric patients with T-cell acute lymphoblastic leukemia treated on the MRC UKALL2003 trial. Leukemia 2016; 30:39-47. [PMID: 26220040 PMCID: PMC4705426 DOI: 10.1038/leu.2015.206] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 06/29/2015] [Accepted: 07/22/2015] [Indexed: 12/21/2022]
Abstract
PTEN gene inactivation by mutation or deletion is common in pediatric T-cell acute lymphoblastic leukemia (T-ALL), but the impact on outcome is unclear, particularly in patients with NOTCH1/FBXW7 mutations. We screened samples from 145 patients treated on the MRC UKALL2003 trial for PTEN mutations using heteroduplex analysis and gene deletions using single nucleotide polymorphism arrays, and related genotype to response to therapy and long-term outcome. PTEN loss-of-function mutations/gene deletions were detected in 22% (PTEN(ABN)). Quantification of mutant level indicated that 67% of mutated cases harbored more than one mutant, with up to four mutants detected, consistent with the presence of multiple leukemic sub-clones. Overall, 41% of PTEN(ABN) cases were considered to have biallelic abnormalities (mutation and/or deletion) with complete loss of PTEN in a proportion of cells. In addition, 9% of cases had N- or K-RAS mutations. Neither PTEN nor RAS genotype significantly impacted on response to therapy or long-term outcome, irrespective of mutant level, and there was no evidence that they changed the highly favorable outcome of patients with double NOTCH1/FBXW7 mutations. These results indicate that, for pediatric patients treated according to current protocols, routine screening for PTEN or RAS abnormalities at diagnosis is not warranted to further refine risk stratification.
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Affiliation(s)
- S Jenkinson
- Department of Haematology, UCL Cancer Institute, London, UK
| | - A A Kirkwood
- Cancer Research UK & UCL Cancer Trials Centre, London, UK
| | - N Goulden
- Department of Haematology, Great Ormond Street Hospital, London, UK
| | - A Vora
- Department of Haematology, Sheffield Children's Hospital, Sheffield, UK
| | - D C Linch
- Department of Haematology, UCL Cancer Institute, London, UK
| | - R E Gale
- Department of Haematology, UCL Cancer Institute, London, UK
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65
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Abstract
Novel target discovery is warranted to improve treatment in adult T-cell acute lymphoblastic leukemia (T-ALL) patients. We provide a comprehensive study on mutations to enhance the understanding of therapeutic targets and studied 81 adult T-ALL patients. NOTCH1 exhibitedthe highest mutation rate (53%). Mutation frequencies of FBXW7 (10%), WT1 (10%), JAK3 (12%), PHF6 (11%), and BCL11B (10%) were in line with previous reports. We identified recurrent alterations in transcription factors DNM2, and RELN, the WNT pathway associated cadherin FAT1, and in epigenetic regulators (MLL2, EZH2). Interestingly, we discovered novel recurrent mutations in the DNA repair complex member HERC1, in NOTCH2, and in the splicing factor ZRSR2. A frequently affected pathway was the JAK/STAT pathway (18%) and a significant proportion of T-ALL patients harboured mutations in epigenetic regulators (33%), both predominantly found in the unfavourable subgroup of early T-ALL. Importantly, adult T-ALL patients not only showed a highly heterogeneous mutational spectrum, but also variable subclonal allele frequencies implicated in therapy resistance and evolution of relapse. In conclusion, we provide novel insights in genetic alterations of signalling pathways (e.g. druggable by γ-secretase inhibitors, JAK inhibitors or EZH2 inhibitors), present in over 80% of all adult T-ALL patients, that could guide novel therapeutic approaches.
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66
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Colomer-Lahiguera S, Strehl S. Complexity of NOTCH1 juxtamembrane insertion mutations in T-cell acute lymphoblastic leukemia. Leuk Lymphoma 2015; 57:1219-22. [PMID: 26292904 DOI: 10.3109/10428194.2015.1080366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Sara Colomer-Lahiguera
- a CCRI, Children's Cancer Research Institute, St. Anna Kinderkrebsforschung e.V. , Vienna , Austria
| | - Sabine Strehl
- a CCRI, Children's Cancer Research Institute, St. Anna Kinderkrebsforschung e.V. , Vienna , Austria
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67
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Fbw7 and its counteracting forces in stem cells and cancer: Oncoproteins in the balance. Semin Cancer Biol 2015; 36:52-61. [PMID: 26410034 DOI: 10.1016/j.semcancer.2015.09.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 09/10/2015] [Indexed: 12/14/2022]
Abstract
Fbw7 is well characterised as a stem cell regulator and tumour suppressor, powerfully positioned to control proliferation, differentiation and apoptosis by targeting key transcription factors for ubiquitination and destruction. Evidence in support of these roles continues to accumulate from in vitro studies, mouse models and human patient data. Here we summarise the latest of these findings, highlighting the tumour-suppressive role of Fbw7 in multiple tissues, and the rare circumstances where Fbw7 activity can be oncogenic. We discuss mechanisms that regulate ubiquitination by Fbw7, including ubiquitin-specific proteases such as USP28 that counteract Fbw7 activity and thereby stabilise oncoproteins. Deubiquitination of key Fbw7 substrates to prevent their destruction is beginning to be appreciated as an important pro-tumourigenic mechanism. As the ubiquitin-proteasome system represents a largely untapped field for drug development, the interplay between Fbw7 and its counterpart deubiquitinating enzymes in tumours is likely to attract increasing interest and influence future treatment strategies.
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68
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Genetic mutational profiling analysis of T cell acute lymphoblastic leukemia reveal mutant FBXW7 as a prognostic indicator for inferior survival. Ann Hematol 2015; 94:1817-28. [PMID: 26341754 DOI: 10.1007/s00277-015-2474-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 08/06/2015] [Indexed: 10/23/2022]
Abstract
T cell acute lymphoblastic leukemia (T-ALL) is an aggressive neoplasm for which there are currently no adequate biomarkers for developing risk-adapted therapeutic regimens to improve the treatment outcome. In this prospective study of 83 Chinese patients (54 children and 29 adults) with de novo T-ALL, we analyzed mutations in 11 T-ALL genes: NOTCH1, FBXW7, PHF6, PTEN, N-RAS, K-RAS, WT1, IL7R, PIK3CA, PIK3RA, and AKT1. NOTCH1 mutations were identified in 51.9 and 37.9 % of pediatric and adult patients, respectively, and these patients showed improved overall survival (OS) and event-free survival (EFS). The FBXW7 mutant was present in 25.9 and 6.9 % of pediatric and adult patients, respectively, and was associated with inferior OS and EFS in pediatric T-ALL. Multivariate analysis revealed that mutant FBXW7 was an independent prognostic indicator for inferior EFS (hazard ratio [HR] 4.38; 95 % confidence interval [CI] 1.15-16.71; p = 0.03) and tended to be associated with reduced OS (HR 2.81; 95 % CI 0.91-8.69; p = 0.074) in pediatric T-ALL. Mutant PHF6 was present in 13 and 20.7 % of our childhood and adult cohorts, respectively, while PTEN mutations were noted in 11.1 % of the pediatric patients. PTEN and NOTCH1 mutations were almost mutually exclusive, while IL7R and WT1 mutations were rare in pediatric T-ALL and PTPN11 and AKT1 mutations were infrequent in adult T-ALL. This study revealed differences in the mutational profiles of pediatric and adult T-ALL and suggests mutant FBXW7 as an independent prognostic indicator for inferior survival in pediatric T-ALL.
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69
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Hakeem A, Shiekh AA, Bhat GM, Lone AR. Prognostification of ALL by Cytogenetics. Indian J Hematol Blood Transfus 2015; 31:322-31. [PMID: 26085716 PMCID: PMC4465518 DOI: 10.1007/s12288-014-0483-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 11/20/2014] [Indexed: 10/24/2022] Open
Abstract
Cytogenetic abnormalities in chromosomal number and structure are common in pediatric ALL and some have prognostic significance. One interesting association between cytogenetic status and treatment response involves the metabolism of methotrexate. Hyperdiploid lymphoblasts accumulate increased amounts of MTX and MTX polyglutamates, and they have higher basal apoptotic rates compared with leukemic cells with lower ploidy and normal cells. These characteristics may contribute to the better outcomes observed for patients with hyperdiploid lymphoblasts. A number of recurrent chromosomal abnormalities have been shown to have prognostic significance, especially in B-precursor ALL. Some chromosomal abnormalities are associated with more favorable outcomes, such as high hyperdiploidy (51-65 chromosomes) and the ETV6-RUNX1 fusion. Others are associated with a poorer prognosis, including the Philadelphia chromosome [t(9;22)], rearrangements of the MLL gene (chromosome 11q23), and intrachromosomal amplification of the AML1 gene (iAMP21).
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Affiliation(s)
- Ansar Hakeem
- Department of Med Oncology, SKIMS SGR, Srinagar, 190011 J And K India
| | - Aejaz Aziz Shiekh
- Department of Med Oncology, SKIMS SGR, Srinagar, 190011 J And K India
| | - Gull Mohd. Bhat
- Department of Med Oncology, SKIMS SGR, Srinagar, 190011 J And K India
| | - A. R. Lone
- Department of Med Oncology, SKIMS SGR, Srinagar, 190011 J And K India
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Durinck K, Van Loocke W, Van der Meulen J, Van de Walle I, Ongenaert M, Rondou P, Wallaert A, de Bock CE, Van Roy N, Poppe B, Cools J, Soulier J, Taghon T, Speleman F, Van Vlierberghe P. Characterization of the genome-wide TLX1 binding profile in T-cell acute lymphoblastic leukemia. Leukemia 2015; 29:2317-27. [PMID: 26108691 DOI: 10.1038/leu.2015.162] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 05/15/2015] [Accepted: 06/09/2015] [Indexed: 01/27/2023]
Abstract
The TLX1 transcription factor is critically involved in the multi-step pathogenesis of T-cell acute lymphoblastic leukemia (T-ALL) and often cooperates with NOTCH1 activation during malignant T-cell transformation. However, the exact molecular mechanism by which these T-cell specific oncogenes cooperate during transformation remains to be established. Here, we used chromatin immunoprecipitation followed by sequencing to establish the genome-wide binding pattern of TLX1 in human T-ALL. This integrative genomics approach showed that ectopic TLX1 expression drives repression of T cell-specific enhancers and mediates an unexpected transcriptional antagonism with NOTCH1 at critical target genes, including IL7R and NOTCH3. These phenomena coordinately trigger a TLX1-driven pre-leukemic phenotype in human thymic precursor cells, reminiscent of the thymus regression observed in murine TLX1 tumor models, and create a strong genetic pressure for acquiring activating NOTCH1 mutations as a prerequisite for full leukemic transformation. In conclusion, our results uncover a functional antagonism between cooperative oncogenes during the earliest phases of tumor development and provide novel insights in the multi-step pathogenesis of TLX1-driven human leukemia.
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Affiliation(s)
- K Durinck
- Center for Medical Genetics, Department of Pediatrics and Genetics, Ghent University, Ghent, Belgium
| | - W Van Loocke
- Center for Medical Genetics, Department of Pediatrics and Genetics, Ghent University, Ghent, Belgium
| | - J Van der Meulen
- Center for Medical Genetics, Department of Pediatrics and Genetics, Ghent University, Ghent, Belgium
| | - I Van de Walle
- Department of Clinical Chemistry, Microbiology and Immunology, Ghent University, Ghent, Belgium
| | - M Ongenaert
- Center for Medical Genetics, Department of Pediatrics and Genetics, Ghent University, Ghent, Belgium
| | - P Rondou
- Center for Medical Genetics, Department of Pediatrics and Genetics, Ghent University, Ghent, Belgium
| | - A Wallaert
- Center for Medical Genetics, Department of Pediatrics and Genetics, Ghent University, Ghent, Belgium
| | - C E de Bock
- Laboratory for the Molecular Biology of Leukemia, Center for Human Genetics, KU Leuven and Center for the Biology of Disease, VIB, Leuven, Belgium
| | - N Van Roy
- Center for Medical Genetics, Department of Pediatrics and Genetics, Ghent University, Ghent, Belgium
| | - B Poppe
- Center for Medical Genetics, Department of Pediatrics and Genetics, Ghent University, Ghent, Belgium
| | - J Cools
- Laboratory for the Molecular Biology of Leukemia, Center for Human Genetics, KU Leuven and Center for the Biology of Disease, VIB, Leuven, Belgium
| | - J Soulier
- Genome Rearrangements and Cancer Laboratory, U944 INSERM, University Paris Diderot and Hematology Laboratory, Saint-Louis Hospital, Paris, France
| | - T Taghon
- Department of Clinical Chemistry, Microbiology and Immunology, Ghent University, Ghent, Belgium
| | - F Speleman
- Center for Medical Genetics, Department of Pediatrics and Genetics, Ghent University, Ghent, Belgium
| | - P Van Vlierberghe
- Center for Medical Genetics, Department of Pediatrics and Genetics, Ghent University, Ghent, Belgium
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71
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Effect of Initial Body Mass Index on Survival Outcome of Patients With Acute Leukemia: A Single-Center Retrospective Study. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 15 Suppl:S7-13. [DOI: 10.1016/j.clml.2015.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 02/03/2015] [Indexed: 11/18/2022]
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72
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How I treat T-cell acute lymphoblastic leukemia in adults. Blood 2015; 126:833-41. [PMID: 25966987 DOI: 10.1182/blood-2014-10-551895] [Citation(s) in RCA: 136] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 04/25/2015] [Indexed: 01/13/2023] Open
Abstract
T-cell immunophenotype of acute lymphoblastic leukemia (T-ALL) is an uncommon aggressive leukemia that can present with leukemic and/or lymphomatous manifestations. Molecular studies are enhancing our understanding of the pathogenesis of T-ALL, and the discovery of activating mutations of NOTCH1 and FBXW7 in a majority of patients has been a seminal observation. The use of pediatric intensive combination chemotherapy regimens in adolescents and young adults has significantly improved the outcome of patients with T-ALL. The use of nelarabine for relapsed and refractory T-ALL results in responses in a substantial minority of patients. Allogeneic hematopoietic cell transplantation (HCT) still plays a key role in patients with high-risk or relapsed/refractory disease. γ-Secretase inhibitors hold promise for the treatment of patients with NOTCH1 mutations, and the results of clinical trials with these agents are eagerly awaited. It is recommended that younger patients receive a pediatric-intensive regimen. Older and unfit patients can receive suitable multiagent chemotherapy and be allocated to HCT based on their response, risk factors, and comorbidities. Although advances in the treatment of T-ALL have lagged behind those of B-cell ALL, it is hoped that the molecular revolution will enhance our understanding of the pathogenesis and treatment of this aggressive lymphoid malignancy.
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73
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NOTCH1 Intracellular Domain Immunohistochemistry as a Diagnostic Tool to Distinguish T-Lymphoblastic Lymphoma From Thymoma. Am J Surg Pathol 2015; 39:565-72. [DOI: 10.1097/pas.0000000000000358] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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74
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Ho C, Rodig SJ. Immunohistochemical markers in lymphoid malignancies: Protein correlates of molecular alterations. Semin Diagn Pathol 2015; 32:381-91. [PMID: 25769206 DOI: 10.1053/j.semdp.2015.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Histomorphology, immunohistochemistry (IHC), and genetics are essential tools for the evaluation and classification of lymphoid malignancies. Advances in diagnostic techniques include the development of immunohistochemical assays that can serve as surrogates for genetic tests. We review the performance of a select subset of assays that detect the aberrant expression of onco-proteins secondary to chromosomal translocations (MYC; BCL2), somatic mutations (BRAF V600E; NOTCH1), and gene copy number gains (CD274 (encoding PD-L1); PDCD1LG2 (encoding PD-L2)) in fixed tissue biopsy sections. We discuss the limitations of IHC, but also its primary advantage over genetics; specifically, its ability to assess the final, common phenotypic consequences of a multitude of genetic and non-genetic events that influence protein expression. The information provided by IHC and genetic testing are thus intimately related; surgical pathologists will increasingly need to interpret and integrate the results of both to provide a comprehensive assessment of tumor biology and guide therapy.
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Affiliation(s)
- Caleb Ho
- Department of Pathology, Brigham and Women 's Hospital, Boston, Massachusetts
| | - Scott J Rodig
- Department of Pathology, Brigham and Women 's Hospital, Boston, Massachusetts.
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75
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NOTCH1 and FBXW7 mutations favor better outcome in pediatric South Indian T-cell acute lymphoblastic leukemia. J Pediatr Hematol Oncol 2015; 37:e23-30. [PMID: 25493453 DOI: 10.1097/mph.0000000000000290] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The NOTCH1 signaling pathway is essential for hematopoiesis and a critical regulatory step for T-cell proliferation and maturation. The E3 ubiquitin ligase FBXW7 controls NOTCH1 protein stability. Mutations in NOTCH1/FBXW7 activate NOTCH signaling and are of prognostic significance in patients with T-cell acute lymphoblastic leukemia (T-ALL). In this study we analyzed NOTCH1 and FBXW7 mutations in 50 South Indian T-ALL patients treated by a modified ALL BFM 95 regimen. The hot spot exons (HD-N, HD-C, TAD, and PEST) of NOTCH1 and exons 9 of the 10 of FBXW7 were polymerase chain reaction amplified and sequenced. In total, 20 of the 50 (40%) T-ALL patients revealed heterozygous mutations in the NOTCH1 domains, and a predominance of missense mutations in HD-N (70%) and PEST (15%) domains. FBXW7 mutations were detected in 5 of the 50 (10%) T-ALL patients. T-ALL patients with NOTCH1/FBXW7 mutations expressed higher protein level of NOTCH1 compared with patients without NOTCH1/FBXW7 mutations. Six of the mutations detected in NOTCH1 were not reported previously. When tested in a Dual Luciferase Renilla reporter assay some of these conferred increased NOTCH activity, suggesting that these are activating mutations. Importantly, 13 of the 20 (65%) NOTCH1/FBXW7-mutated T-ALL patients showed a good prednisone response (P=0.01) and a better clinical outcome compared with NOTCH1/FBXW7 nonmutated patients (P=0.03). These data suggest that NOTCH1/FBXW7 mutations are present in T-ALL patients from Southern India and may be useful biomarkers to predict prognosis in T-ALL.
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76
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Diagnosis and subclassification of acute lymphoblastic leukemia. Mediterr J Hematol Infect Dis 2014; 6:e2014073. [PMID: 25408859 PMCID: PMC4235437 DOI: 10.4084/mjhid.2014.073] [Citation(s) in RCA: 144] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 10/20/2014] [Indexed: 01/13/2023] Open
Abstract
Acute lymphoblastic leukemia (ALL) is a disseminated malignancy of B- or T-lymphoblasts which imposes a rapid and accurate diagnostic process to support an optimal risk-oriented therapy and thus increase the curability rate. The need for a precise diagnostic algorithm is underlined by the awareness that both ALL therapy and related success rates may vary greatly between ALL subsets, from standard chemotherapy in patients with standard-risk ALL, to allotransplantation (SCT) and targeted therapy in high-risk patients and cases expressing suitable biological targets, respectively. This review summarizes how best to identify ALL and the most relevant ALL subsets.
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77
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Chiaretti S, Gianfelici V, Ceglie G, Foà R. Genomic characterization of acute leukemias. Med Princ Pract 2014; 23:487-506. [PMID: 24968698 PMCID: PMC5586934 DOI: 10.1159/000362793] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 04/10/2014] [Indexed: 01/09/2023] Open
Abstract
Over the past two decades, hematologic malignancies have been extensively evaluated due to the introduction of powerful technologies, such as conventional karyotyping, FISH analysis, gene and microRNA expression profiling, array comparative genomic hybridization and SNP arrays, and next-generation sequencing (including whole-exome sequencing and RNA-seq). These analyses have allowed for the refinement of the mechanisms underlying the leukemic transformation in several oncohematologic disorders and, more importantly, they have permitted the definition of novel prognostic algorithms aimed at stratifying patients at the onset of disease and, consequently, treating them in the most appropriate manner. Furthermore, the identification of specific molecular markers is opening the door to targeted and personalized medicine. The most important findings on novel acquisitions in the context of acute lymphoblastic leukemia of both B and T lineage and de novo acute myeloid leukemia are described in this review.
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Affiliation(s)
- Sabina Chiaretti
- Division of Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
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78
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Gao C, Liu SG, Zhang RD, Li WJ, Zhao XX, Cui L, Wu MY, Zheng HY, Li ZG. NOTCH1 mutations are associated with favourable long-term prognosis in paediatric T-cell acute lymphoblastic leukaemia: a retrospective study of patients treated on BCH-2003 and CCLG-2008 protocol in China. Br J Haematol 2014; 166:221-8. [PMID: 24690100 DOI: 10.1111/bjh.12866] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 02/24/2014] [Indexed: 01/22/2023]
Abstract
Activating mutations of NOTCH1 are a common occurrence in T-cell acute lymphoblastic leukaemia (T-ALL), but its impact on T-ALL treatment is still controversial. In this study, the incidence, clinical features, and prognosis of 92 Chinese children with T-ALL treated using the Beijing Children's Hospital-2003 and Chinese Childhood Leukaemia Group-2008 protocols were analysed. NOTCH1 mutations were found in 42% of T-ALL patients and were not associated with clinical features, prednisone response, and minimal residual disease (MRD) at day 33 and 78. However, proline, glutamate, serine, threonine (PEST)/transactivation domain (TAD) mutations were associated with younger age (15/16 mutant vs. 48/76 wild-type, P = 0·018) and more central nervous system involvement (4/16 mutant vs. 3/76 wild-type, P = 0·016); while heterodimerization domain (HD) mutations were associated with KMT2A-MLLT1 (MLL-ENL; 4/30 mutant vs. 1/62 wild-type, P = 0·037). Furthermore, prognosis was better in patients with NOTCH1 mutations than in those with wild-type NOTCH1 (5-year event-free survival [EFS] 92·0 ± 4·5% vs. 64·0 ± 7·1%; P = 0·003). Long-term outcome was better in patients carrying HD mutations than in patients with wild-type HD (5-year EFS 89·7 ± 5·6% vs. 69·3 ± 6·2%; P = 0·034). NOTCH1 mutations and MRD at day 78 were independent prognostic factors. These findings indicate that NOTCH1 mutation predicts a favourable outcome in Chinese paediatric patients with T-ALL on the BCH-2003 and CCLG-2008 protocols, and may be considered a prognostic stratification factor.
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Affiliation(s)
- Chao Gao
- Beijing Key Laboratory of Paediatric Haematology Oncology, Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Paediatrics, Haematology and Oncology Centre, Beijing Children's Hospital, Capital Medical University, Beijing, China
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79
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[Acute lymphoblastic leukemia of T progenitors: from biology to clinics]. Med Clin (Barc) 2014; 144:223-9. [PMID: 24667111 DOI: 10.1016/j.medcli.2014.01.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 01/22/2014] [Accepted: 01/23/2014] [Indexed: 11/22/2022]
Abstract
Acute lymphoblastic leukemia (ALL) is the most common cancer in children and the main cause of morbidity among childhood blood disorders. There are 2 subtypes according to the affected lymphoid progenitor: B-ALL and T-ALL. The T-ALL is the less common and, although historically was associated with poor prognosis in both adults and children, at present, treatment outcomes do not differ significantly between the 2 types of ALL. The T-ALL subtype is the most complex and heterogeneous at the genetic level and currently the one with less new therapeutic alternatives available. This trend is changing thanks to the remarkable progress upon understanding its biology. This review summarizes the most recent and important biological findings in T-ALL and their possible therapeutic implications.
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80
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Ntziachristos P, Lim JS, Sage J, Aifantis I. From fly wings to targeted cancer therapies: a centennial for notch signaling. Cancer Cell 2014; 25:318-34. [PMID: 24651013 PMCID: PMC4040351 DOI: 10.1016/j.ccr.2014.02.018] [Citation(s) in RCA: 284] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 01/21/2014] [Accepted: 02/21/2014] [Indexed: 12/21/2022]
Abstract
Since Notch phenotypes in Drosophila melanogaster were first identified 100 years ago, Notch signaling has been extensively characterized as a regulator of cell-fate decisions in a variety of organisms and tissues. However, in the past 20 years, accumulating evidence has linked alterations in the Notch pathway to tumorigenesis. In this review, we discuss the protumorigenic and tumor-suppressive functions of Notch signaling, and dissect the molecular mechanisms that underlie these functions in hematopoietic cancers and solid tumors. Finally, we link these mechanisms and observations to possible therapeutic strategies targeting the Notch pathway in human cancers.
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Affiliation(s)
- Panagiotis Ntziachristos
- Howard Hughes Medical Institute and Department of Pathology, NYU School of Medicine, New York, NY 10016, USA; NYU Cancer Institute and Helen L. and Martin S. Kimmel Center for Stem Cell Biology, NYU School of Medicine, New York, NY 10016, USA
| | - Jing Shan Lim
- Departments of Pediatrics and Genetics, Stanford University, Stanford, CA 94305, USA
| | - Julien Sage
- Departments of Pediatrics and Genetics, Stanford University, Stanford, CA 94305, USA.
| | - Iannis Aifantis
- Howard Hughes Medical Institute and Department of Pathology, NYU School of Medicine, New York, NY 10016, USA; NYU Cancer Institute and Helen L. and Martin S. Kimmel Center for Stem Cell Biology, NYU School of Medicine, New York, NY 10016, USA.
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81
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Mühlbacher V, Zenger M, Schnittger S, Weissmann S, Kunze F, Kohlmann A, Bellos F, Kern W, Haferlach T, Haferlach C. Acute lymphoblastic leukemia with low hypodiploid/near triploid karyotype is a specific clinical entity and exhibits a very highTP53mutation frequency of 93%. Genes Chromosomes Cancer 2014; 53:524-36. [DOI: 10.1002/gcc.22163] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 02/26/2014] [Accepted: 02/26/2014] [Indexed: 12/24/2022] Open
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82
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Hales EC, Taub JW, Matherly LH. New insights into Notch1 regulation of the PI3K–AKT–mTOR1 signaling axis: Targeted therapy of γ-secretase inhibitor resistant T-cell acute lymphoblastic leukemia. Cell Signal 2014; 26:149-61. [DOI: 10.1016/j.cellsig.2013.09.021] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 09/30/2013] [Indexed: 02/01/2023]
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83
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Hernandez Tejada FN, Galvez Silva JR, Zweidler-McKay PA. The challenge of targeting notch in hematologic malignancies. Front Pediatr 2014; 2:54. [PMID: 24959528 PMCID: PMC4051192 DOI: 10.3389/fped.2014.00054] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 05/21/2014] [Indexed: 01/12/2023] Open
Abstract
Notch signaling can play oncogenic and tumor suppressor roles depending on cell type. Hematologic malignancies encompass a wide range of transformed cells, and consequently the roles of Notch are diverse in these diseases. For example Notch is a potent T-cell oncogene, with >50% of T-cell acute lymphoblastic leukemia (T-ALL) cases carry activating mutations in the Notch1 receptor. Targeting Notch signaling in T-ALL with gamma-secretase inhibitors, which prevent Notch receptor activation, has shown pre-clinical activity, and is under evaluation clinically. In contrast, Notch signaling inhibits acute myeloblastic leukemia growth and survival, and although targeting Notch signaling in AML with Notch activators appears to have pre-clinical activity, no Notch agonists are clinically available at this time. As such, despite accumulating evidence about the biology of Notch signaling in different hematologic cancers, which provide compelling clinical promise, we are only beginning to target this pathway clinically, either on or off. In this review, we will summarize the evidence for oncogenic and tumor suppressor roles of Notch in a wide range of leukemias and lymphomas, and describe therapeutic opportunities for now and the future.
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Affiliation(s)
| | - Jorge R Galvez Silva
- Department of Pediatrics, University of Texas M. D. Anderson Cancer Center , Houston, TX , USA
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84
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Zheng H, Wang X, Ma Y, Xu B, Chen S, Yang L, Wu X, Przybylski GK, Huang S, Ye T, Li Y. The TCR γδ repertoire and relative gene expression characteristics of T-ALL cases with biclonal malignant Vδ1 and Vδ2 T cells. DNA Cell Biol 2013; 33:49-56. [PMID: 24329526 DOI: 10.1089/dna.2013.2199] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Despite significant improvement in our understanding of T-cell acute lymphoblastic leukemia (T-ALL) biology and pathogenesis, many questions remain unanswered. In previous studies, we found a T-ALL case with two malignant T-cell clones with Vδ1Dδ2Dδ3Jδ1 and Vδ2Dδ3Jδ2 rearrangements. In this study, we further characterized T-ALL cases with two malignant clones containing Vδ1Dδ3Jδ1 and Vδ2Dδ1Jδ1 rearrangements using fine-tiling array comparative genomic hybridization, ligation-mediated polymerase chain reaction (LM-PCR), sequencing, and reverse transcription polymerase chain reaction (RT-PCR) analysis. We further analyzed the distribution and clonality of the T-cell receptor (TCR) Vγ and Vδ subfamily T cells in the two T-ALL cases by RT-PCR and GeneScan. Monoclonal Vδ1 and Vδ2 subfamilies were confirmed in both samples, the Vδ3 through Vδ7 subfamilies could not be detected in the T-ALL samples, whereas the oligoclonal Vδ8 subfamily could be identified. Based on the clinical finding that both of the T-ALL cases with two malignant T-cell clones had a poor outcome, we attempted to compare the expression pattern of genes related to T-cell activation and proliferation between cases with the malignant Vδ1 and Vδ2 T-cell clones and T-ALL cases with a mono-malignant Vα T-cell clone. We selected two T-ALL cases with VαJα rearrangements and analyzed the expression level of Notch1, TAL1, and the CARMA-BCL10-MALT-A20-NF-κB pathway genes by real-time PCR. A20 had significantly higher expression in the biclonal compared with the monoclonal T-ALL group (p=0.0354), and there was a trend toward higher expression for the other genes in the biclonal group with the exception of TAL1, although the differences were not statistically significant. In conclusion, we identified two T-ALL cases with biclonal malignant T-cell clones and described the characteristics of the biclonal T-ALL subtype and its gene expression pattern. Thus, our findings may improve the understanding of biclonal T-ALL.
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Affiliation(s)
- Haitao Zheng
- 1 Institute of Hematology, Jinan University , Guangzhou, People's Republic of China
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85
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Dalal BI, Al Mugairi A, Pi S, Lee SY, Khare NS, Pal J, Bryant A, Vakil AP, Lau S, Abou Mourad YR. Aberrant expression of CD13 identifies a subgroup of standard-risk adult acute lymphoblastic leukemia with inferior survival. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2013; 14:239-44. [PMID: 24411984 DOI: 10.1016/j.clml.2013.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 10/04/2013] [Accepted: 10/21/2013] [Indexed: 01/27/2023]
Abstract
BACKGROUND The standard-risk (SR) subgroup of acute lymphoblastic leukemia in adults (aALL) is a heterogeneous category, with a 20% to 40% relapse rate and a wide range of relapse-free survival (RFS) and overall survival (OS). There is a need to identify at the outset those patients with SR-aALL who are likely to have shorter RFS and OS, so they can be treated more aggressively. PATIENTS AND METHODS Flow cytometric data of 81 patients with SR-aALL treated with a standardized protocol were retrospectively analyzed. Thirty-two patients (40%) relapsed; the median RFS and OS were 12.5 months (range, 1-136 months) and 30 months (range, 3-235 months), respectively. Twenty-six patients survived ≥ 48 months. RESULTS Expression of myeloid antigen CD13, using the conventional ≥ 20% threshold and a lower ≥ 5% threshold, was seen in 17 (29%) of 59 and 29 (49%) of 59 patients, respectively, whereas dual expression of CD13 and CD33 was seen in 8 patients. CD13 positivity at ≥ 20% and ≥ 5% threshold was associated with a shorter RFS (P = .0158 and P < .0001, respectively) and OS (P = .0072 and P < .0001, respectively). Dual expression of CD13 (at ≥ 5% or ≥ 20% threshold) and CD33 was associated with inferior OS (P = .0038 and P = .0032, respectively) and RFS (P = .0705 and P = .2516, respectively). For ≥ 20% and ≥ 5% threshold of positivity, 16 of 42 and 28 of 42 who survived < 48 months were positive, compared with 1 of 17 and 1 of 17 who survived ≥ 48 months (P = .0133 and P < .0001, respectively). CONCLUSION Aberrant expression of CD13 in ≥ 5% of blasts of patients with SR-aALL is an adverse prognostic factor, delineating a subgroup of patients with SR-aALL that should be considered for more aggressive treatment.
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Affiliation(s)
- Bakul I Dalal
- Division of Laboratory Hematology, Vancouver General Hospital, Vancouver, BC, Canada.
| | - Areej Al Mugairi
- Division of Laboratory Hematology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Steven Pi
- Division of Laboratory Hematology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Soo Yeon Lee
- Division of Laboratory Hematology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Nikisha S Khare
- Division of Laboratory Hematology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Jason Pal
- Division of Laboratory Hematology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Adam Bryant
- Leukemia/Bone Marrow Transplant Program of British Columbia, BC Cancer Agency and University of British Columbia, Vancouver, BC, Canada
| | - Alok P Vakil
- Division of Laboratory Hematology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Sally Lau
- Leukemia/Bone Marrow Transplant Program of British Columbia, BC Cancer Agency and University of British Columbia, Vancouver, BC, Canada
| | - Yasser R Abou Mourad
- Leukemia/Bone Marrow Transplant Program of British Columbia, BC Cancer Agency and University of British Columbia, Vancouver, BC, Canada
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86
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Predictors of outcome in adults with BCR-ABL negative acute lymphoblastic leukemia treated with a pediatric-based regimen. Leuk Res 2013; 38:532-6. [PMID: 24444868 DOI: 10.1016/j.leukres.2013.10.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 09/10/2013] [Accepted: 10/25/2013] [Indexed: 01/24/2023]
Abstract
We retrospectively evaluated the outcome of 156 adults age 17-60 with BCR-ABL negative acute lymphoblastic leukemia treated with a pediatric-inspired protocol. The CR rate was 93%; 5-year overall survival (OS) and disease-free survival were 66% and 70%, respectively. Age <34 years and low presenting WBC were independent predictors of favorable OS (p<0.0001). The 5 year OS of patients age <34 and 34-60 presenting with a low WBC were 85% and 57%, respectively; the 5 year OS for those presenting with a high WBC were 57% and 30%, respectively. Cytogenetics and phenotype were not independent predictors of OS.
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87
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Trinquand A, Tanguy-Schmidt A, Ben Abdelali R, Lambert J, Beldjord K, Lengliné E, De Gunzburg N, Payet-Bornet D, Lhermitte L, Mossafa H, Lhéritier V, Bond J, Huguet F, Buzyn A, Leguay T, Cahn JY, Thomas X, Chalandon Y, Delannoy A, Bonmati C, Maury S, Nadel B, Macintyre E, Ifrah N, Dombret H, Asnafi V. Toward a NOTCH1/FBXW7/RAS/PTEN-based oncogenetic risk classification of adult T-cell acute lymphoblastic leukemia: a Group for Research in Adult Acute Lymphoblastic Leukemia study. J Clin Oncol 2013; 31:4333-42. [PMID: 24166518 DOI: 10.1200/jco.2012.48.5292] [Citation(s) in RCA: 169] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The Group for Research in Adult Acute Lymphoblastic Leukemia (GRAALL) recently reported a significantly better outcome in T-cell acute lymphoblastic leukemia (T-ALL) harboring NOTCH1 and/or FBXW7 (N/F) mutations compared with unmutated T-ALL. Despite this, one third of patients with N/F-mutated T-ALL experienced relapse. PATIENTS AND METHODS In a series of 212 adult T-ALLs included in the multicenter randomized GRAALL-2003 and -2005 trials, we searched for additional N/K-RAS mutations and PTEN defects (mutations and gene deletion). RESULTS N/F mutations were identified in 143 (67%) of 212 patients, and lack of N/F mutation was confirmed to be associated with a poor prognosis. K-RAS, N-RAS, and PTEN mutations/deletions were identified in three (1.6%) of 191, 17 (8.9%) of 191, and 21 (12%) of 175 patients, respectively. The favorable prognostic significance of N/F mutations was restricted to patients without RAS/PTEN abnormalities. These observations led us to propose a new T-ALL oncogenetic classifier defining low-risk patients as those with N/F mutation but no RAS/PTEN mutation (97 of 189 patients; 51%) and all other patients (49%; including 13% with N/F and RAS/PTEN mutations) as high-risk patients. In multivariable analysis, this oncogenetic classifier remained the only significant prognostic covariate (event-free survival: hazard ratio [HR], 3.2; 95% CI, 1.9 to 5.15; P < .001; and overall survival: HR, 3.2; 95% CI, 1.9 to 5.6; P < .001). CONCLUSION These data demonstrate that the presence of N/F mutations in the absence of RAS or PTEN abnormalities predicts good outcome in almost 50% of adult T-ALL. Conversely, the absence of N/F or presence of RAS/PTEN alterations identifies the remaining cohort of patients with poor prognosis.
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Affiliation(s)
- Amélie Trinquand
- Amélie Trinquand, Raouf Ben Abdelali, Etienne Lengliné, Noémie De Gunzburg, Ludovic Lhermitte, Jonathan Bond, Agnès Buzyn, Elizabeth Macintyre, and Vahid Asnafi, University Paris Descartes, Centre National de la Recherche Scientifique (CNRS) Unité Mixte de Recherche (UMR)-8147, and Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker-Enfants Malades; Jérôme Lambert, UMR-S-717, Hôpital Saint-Louis, AP-HP; Kheira Beldjord, Etienne Lengliné, and Hervé Dombret, University Paris 7, Hôpital Saint-Louis, AP-HP, and Institut Universitaire d'Hématologie, EA3518, Paris; Aline Tanguy-Schmidt and Norbert Ifrah, Pôle de Recherche et d'Enseignement Supérieur L'Université Nantes Angers Le Mans, Centre Hospitalier Universitaire Angers Service des Maladies du Sang et L'Institut National de la Santé et de la Recherche Médicale (INSERM) U892, Angers; Dominique Payet-Bornet and Bertrand Nadel, Center of Immunology of Marseille Luminy, Aix-Marseille University, INSERM U1104 and Centre National de la Recherche Scientifique (CNRS) UMR-7280, Marseille; Hossein Mossafa, Laboratoire Cerba, Cergy-Pontoise; Véronique Lhéritier and Xavier Thomas, Centre Hospitalier Lyon Sud, Lyon; Françoise Huguet, Hôpital Purpan, Toulouse; Thibaud Leguay, Centre Hospitalier du Haut Lévêque, Pessac; Jean-Yves Cahn, UMR-5525 CNRS-Université Joseph Fourier, Grenoble; Caroline Bonmati, Centre Hospitalier Régional Hôpital de Brabois, Vandoeuvre Les Nancy; Sebastien Maury, Hôpital Henry Mondor, Creteil, France; Yves Chalandon, University Hospital of Geneva, Geneva, Switzerland; and André Delannoy, Hopital de Jolimont, La Louviere, Belgium
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88
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Tosello V, Ferrando AA. The NOTCH signaling pathway: role in the pathogenesis of T-cell acute lymphoblastic leukemia and implication for therapy. Ther Adv Hematol 2013; 4:199-210. [PMID: 23730497 DOI: 10.1177/2040620712471368] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
T-cell acute lymphoblastic leukemia/lymphoma (T-ALL) is characterized by aberrant activation of NOTCH1 in over 60% of T-ALL cases. The high prevalence of activating NOTCH1 mutations highlights the critical role of NOTCH signaling in the pathogenesis of this disease and has prompted the development of therapeutic approaches targeting the NOTCH signaling pathway. Small molecule gamma secretase inhibitors (GSIs) can effectively inhibit oncogenic NOTCH1 and are in clinical testing for the treatment of T-ALL. Treatment with GSIs and glucocorticoids are strongly synergistic and may overcome the gastrointestinal toxicity associated with systemic inhibition of the NOTCH pathway. In addition, emerging new anti-NOTCH1 therapies include selective inhibition of NOTCH1 with anti-NOTCH1 antibodies and stapled peptides targeting the NOTCH transcriptional complex in the nucleus.
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89
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Prognostic relevance of integrated genetic profiling in adult T-cell acute lymphoblastic leukemia. Blood 2013; 122:74-82. [PMID: 23687089 DOI: 10.1182/blood-2013-03-491092] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Adult T-cell acute lymphoblastic leukemia (T-ALL) is an aggressive hematologic tumor associated with poor outcome. In this study, we analyzed the prognostic relevance of genetic alterations, immunophenotypic markers, and microarray gene expression signatures in a panel of 53 adult T-ALL patients treated in the Eastern Cooperative Oncology Group E2993 clinical trial. An early immature gene expression signature, the absence of bi-allelic TCRG deletion, CD13 surface expression, heterozygous deletions of the short arm of chromosome 17, and mutations in IDH1/IDH2 and DNMT3A genes are associated with poor prognosis in this series. In contrast, expression of CD8 or CD62L, homozygous deletion of CDKN2A/CDKN2B, NOTCH1 and/or FBXW7 mutations, and mutations or deletions in the BCL11B tumor suppressor gene were associated with improved overall survival. Importantly, the prognostic relevance of CD13 expression and homozygous CDKN2A/CDKN2B deletions was restricted to cortical and mature T-ALLs. Conversely, mutations in IDH1/IDH2 and DNMT3A were specifically associated with poor outcome in early immature adult T-ALLs. This trial was registered at www.clinicaltrials.gov as #NCT00002514.
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90
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Sugita F, Maki K, Nakamura Y, Sasaki K, Mitani K. Overexpression of MIR9 indicates poor prognosis in acute lymphoblastic leukemia. Leuk Lymphoma 2013; 55:78-86. [PMID: 23547834 DOI: 10.3109/10428194.2013.790023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Aberrant expression of MIR9 predicts a poor prognosis in acute myelogenous leukemia. To evaluate its clinical significance in acute lymphoblastic leukemia, we analyzed expression levels of MIR9 in bone marrow samples from patients with acute lymphoblastic leukemia and compared them to those in normal bone marrow cells. Approximately 20% of them showed higher expression compared with controls. There was a tendency that patients who showed overexpression of MIR9 underwent worse clinical courses, but without statistical significance. However, when the analyses were restricted to patients who did not receive a stem cell transplant, overexpression of MIR9 was significantly associated with worse overall survival. Interestingly, exaggerated MIR9 expression and higher white blood cell count at presentation were independent unfavorable prognostic factors in all patients for overall survival by multivariate analysis. The presence of higher MIR9 expression could be a useful indicator for treatment stratification.
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Affiliation(s)
- Fusako Sugita
- Department of Hematology and Oncology, Dokkyo Medical University School of Medicine , Tochigi , Japan
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91
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Forcade E, Leguay T, Vey N, Baruchel A, Delaunay J, Robin M, Socié G, Dombret H, Peffault de Latour R, Raffoux E. Nelarabine for T cell acute lymphoblastic leukemia relapsing after allogeneic hematopoietic stem cell transplantation: an opportunity to improve survival. Biol Blood Marrow Transplant 2013; 19:1124-6. [PMID: 23648236 DOI: 10.1016/j.bbmt.2013.04.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Accepted: 04/06/2013] [Indexed: 11/30/2022]
Abstract
T-ALL relapsing after allogeneic stem cell transplantation is unusual but classically associated with poor outcome. Recently, encouraging results have been reported with Nelarabine in relapse or refractory cases. On behalf of the Group of Research in Adult ALL (GRAALL), we conducted a retrospective analysis of patients receiving Nelarabine following relapse after transplantation. Eleven patients received Nelarabine as salvage therapy in this situation. Most of them were transplanted in first Complete Remission (CR), and received a myeloablative conditioning regimen in 7 cases. Relapse occurred with a median time of 199 days. Nelarabine was given at 1.5 g/m(2)/day (Day 1, D3, D5) alone (N = 5) or in association (N = 6). The overall hematological response rate was 81%. Neurologic toxicity represents the main adverse event (N = 4), mainly grade I-II. Event free survival and overall survival at 1 year were 70 and 90% respectively. Nelarabine is a valuable option for salvage therapy in T-cell acute lymphoblastic leukemia relapsing after transplantation.
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Affiliation(s)
- Edouard Forcade
- Service d'Hématologie clinique et de Thérapie cellulaire, Bordeaux, Pessac, France.
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92
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Sionov RV. MicroRNAs and Glucocorticoid-Induced Apoptosis in Lymphoid Malignancies. ISRN HEMATOLOGY 2013; 2013:348212. [PMID: 23431463 PMCID: PMC3569899 DOI: 10.1155/2013/348212] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Accepted: 11/14/2012] [Indexed: 12/20/2022]
Abstract
The initial response of lymphoid malignancies to glucocorticoids (GCs) is a critical parameter predicting successful treatment. Although being known as a strong inducer of apoptosis in lymphoid cells for almost a century, the signaling pathways regulating the susceptibility of the cells to GCs are only partly revealed. There is still a need to develop clinical tests that can predict the outcome of GC therapy. In this paper, I discuss important parameters modulating the pro-apoptotic effects of GCs, with a specific emphasis on the microRNA world comprised of small players with big impacts. The journey through the multifaceted complexity of GC-induced apoptosis brings forth explanations for the differential treatment response and raises potential strategies for overcoming drug resistance.
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Affiliation(s)
- Ronit Vogt Sionov
- The Department of Biochemistry and Molecular Biology, The Institute for Medical Research-Israel-Canada, Hadassah Medical School, The Hebrew University of Jerusalem, Ein-Kerem, 91120 Jerusalem, Israel
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93
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Huh HJ, Lee SH, Yoo KH, Sung KW, Koo HH, Jang JH, Kim K, Kim SJ, Kim WS, Jung CW, Lee KO, Kim SH, Kim HJ. Gene mutation profiles and prognostic implications in Korean patients with T-lymphoblastic leukemia. Ann Hematol 2013; 92:635-44. [PMID: 23354995 DOI: 10.1007/s00277-012-1664-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 12/17/2012] [Indexed: 11/29/2022]
Abstract
Genetic alterations implicated in the leukemogenesis of T cell acute lymphoblastic leukemia (T-ALL) have been identified in recent years. In this study, we investigated gene mutation profiles and prognostic implications in a series of Korean T-ALL patients. The study patients were 29 Korean patients with T-ALL; 13 adults (45 %) and 16 children (55 %; male-to-female ratio, 25:4). Clinical, hematologic, and cytogenetic findings were reviewed. We performed mutation analyses for NOTCH1, FBXW7, PHF6, and IL7R genes and survival analyses according to the mutational status. Gene mutations were identified in 66 % of the patients in our series (19/29). Eighteen patients (62 %) had NOTCH1/FBXW7 mutations. Sixteen patients (55 %) had NOTCH1 mutations including nine novel mutations, and eight patients (28 %) had known FBXW7 mutations. Eight patients (28 %; six males and two females) had PHF6 mutations including four novel mutations. Three patients (10 %) had IL7R mutations, which were all novel in-frame insertion or deletion-insertions. The gene mutation profile combined with cytogenetics and FISH study for the p16 gene detected genetic aberrations in 90 % of patients (26/29). There was no significant difference in the frequency of gene mutations between the pediatric and adult patients with T-ALL. Survival analyses suggested a favorable prognostic implication of NOTCH1 mutations in adult T-ALL. Gene mutation studies for NOTCH1, FBXW7, PHF6, and IL7R could detect genetic alterations in a majority of Korean T-ALL patients with novel mutations. We observed similar mutation profiles between adult and pediatric T-ALL, and a favorable prognostic implication of NOTCH1 mutations in adult T-ALL.
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Affiliation(s)
- Hee Jae Huh
- Department of Laboratory Medicine & Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, South Korea
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94
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Bandapalli OR, Zimmermann M, Kox C, Stanulla M, Schrappe M, Ludwig WD, Koehler R, Muckenthaler MU, Kulozik AE. NOTCH1 activation clinically antagonizes the unfavorable effect of PTEN inactivation in BFM-treated children with precursor T-cell acute lymphoblastic leukemia. Haematologica 2013; 98:928-36. [PMID: 23349303 DOI: 10.3324/haematol.2012.073585] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Despite improvements in treatment results for pediatric T-cell acute lymphoblastic leukemia, approximately 20% of patients relapse with dismal prognosis. PTEN inactivation and NOTCH1 activation are known frequent leukemogenic events but their effect on outcome is still controversial. We analyzed the effect of PTEN inactivation and its interaction with NOTCH1 activation on treatment response and long-term outcome in 301 ALL-BFM treated children with T-cell acute lymphoblastic leukemia. We identified PTEN mutations in 52 of 301 (17.3%) of patients. In univariate analyses this was significantly associated with increased resistance to induction chemotherapy and a trend towards poor long-term outcome. By contrast, patients with inactivating PTEN and activating NOTCH1 mutations showed marked sensitivity to induction treatment and excellent long-term outcome, which was similar to patients with NOTCH1 mutations only, and more favorable than in patients with PTEN mutations only. Notably, in the subgroup of patients with a prednisone- and minimal residual disease (MRD)-response based medium risk profile, PTEN-mutations without co-existing NOTCH1-mutations represented an MRD-independent highly significant high-risk biomarker. Mutations of PTEN highly significantly indicate a poor prognosis in T-ALL patients who have been stratified to the medium risk group of the BFM-protocol. This effect is clinically neutralized by NOTCH1 mutations. Although these results have not yet been explained by an obvious molecular mechanism, they contribute to the development of new molecularly defined stratification algorithms. Furthermore, these data have unexpected potential implications for the development of NOTCH1 inhibitors in the treatment of T-cell acute lymphoblastic leukemia in general, and in those with a combination of PTEN and NOTCH1 mutations in particular.
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Affiliation(s)
- Obul R Bandapalli
- Department of Pediatric Oncology, Hematology and Immunology, University of Heidelberg, Heidelberg, Germany
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95
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Neumann M, Coskun E, Fransecky L, Mochmann LH, Bartram I, Farhadi Sartangi N, Heesch S, Gökbuget N, Schwartz S, Brandts C, Schlee C, Haas R, Dührsen U, Griesshammer M, Döhner H, Ehninger G, Burmeister T, Blau O, Thiel E, Hoelzer D, Hofmann WK, Baldus CD. FLT3 mutations in early T-cell precursor ALL characterize a stem cell like leukemia and imply the clinical use of tyrosine kinase inhibitors. PLoS One 2013; 8:e53190. [PMID: 23359050 PMCID: PMC3554732 DOI: 10.1371/journal.pone.0053190] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 11/29/2012] [Indexed: 01/08/2023] Open
Abstract
Early T-cell precursor acute lymphoblastic leukemia (ETP-ALL) has been identified as high-risk subgroup of acute T-lymphoblastic leukemia (T-ALL) with a high rate of FLT3-mutations in adults. To unravel the underlying pathomechanisms and the clinical course we assessed molecular alterations and clinical characteristics in a large cohort of ETP-ALL (n = 68) in comparison to non-ETP T-ALL adult patients. Interestingly, we found a high rate of FLT3-mutations in ETP-ALL samples (n = 24, 35%). Furthermore, FLT3 mutated ETP-ALL was characterized by a specific immunophenotype (CD2+/CD5-/CD13+/CD33-), a distinct gene expression pattern (aberrant expression of IGFBP7, WT1, GATA3) and mutational status (absence of NOTCH1 mutations and a low frequency, 21%, of clonal TCR rearrangements). The observed low GATA3 expression and high WT1 expression in combination with lack of NOTCH1 mutations and a low rate of TCR rearrangements point to a leukemic transformation at the pluripotent prothymocyte stage in FLT3 mutated ETP-ALL. The clinical outcome in ETP-ALL patients was poor, but encouraging in those patients with allogeneic stem cell transplantation (3-year OS: 74%). To further explore the efficacy of targeted therapies, we demonstrate that T-ALL cell lines transfected with FLT3 expression constructs were particularly sensitive to tyrosine kinase inhibitors. In conclusion, FLT3 mutated ETP-ALL defines a molecular distinct stem cell like leukemic subtype. These data warrant clinical studies with the implementation of FLT3 inhibitors in addition to early allogeneic stem cell transplantation for this high risk subgroup.
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Affiliation(s)
- Martin Neumann
- Charité, University Hospital Berlin, Campus Benjamin Franklin, Department of Hematology and Oncology, Berlin, Germany
| | - Ebru Coskun
- Charité, University Hospital Berlin, Campus Benjamin Franklin, Department of Hematology and Oncology, Berlin, Germany
| | - Lars Fransecky
- Charité, University Hospital Berlin, Campus Benjamin Franklin, Department of Hematology and Oncology, Berlin, Germany
| | - Liliana H. Mochmann
- Charité, University Hospital Berlin, Campus Benjamin Franklin, Department of Hematology and Oncology, Berlin, Germany
| | - Isabelle Bartram
- Charité, University Hospital Berlin, Campus Benjamin Franklin, Department of Hematology and Oncology, Berlin, Germany
| | - Nasrin Farhadi Sartangi
- Charité, University Hospital Berlin, Campus Benjamin Franklin, Department of Hematology and Oncology, Berlin, Germany
| | - Sandra Heesch
- Charité, University Hospital Berlin, Campus Benjamin Franklin, Department of Hematology and Oncology, Berlin, Germany
| | - Nicola Gökbuget
- Goethe University Hospital, Department of Medicine II, Hematology and Oncology, Frankfurt/Main, Germany
| | - Stefan Schwartz
- Charité, University Hospital Berlin, Campus Benjamin Franklin, Department of Hematology and Oncology, Berlin, Germany
| | - Christian Brandts
- Goethe University Hospital, Department of Medicine II, Hematology and Oncology, Frankfurt/Main, Germany
| | - Cornelia Schlee
- Charité, University Hospital Berlin, Campus Benjamin Franklin, Department of Hematology and Oncology, Berlin, Germany
| | - Rainer Haas
- Department of Hematology and Oncology, University of Düsseldorf, Düsseldorf, Germany
| | - Ulrich Dührsen
- Department of Hematology and Oncology, University of Essen, Essen, Germany
| | | | - Hartmut Döhner
- Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | - Gerhard Ehninger
- Department of Hematology and Oncology, University of Dresden, Dresden, Germany
| | - Thomas Burmeister
- Charité, University Hospital Berlin, Campus Benjamin Franklin, Department of Hematology and Oncology, Berlin, Germany
| | - Olga Blau
- Charité, University Hospital Berlin, Campus Benjamin Franklin, Department of Hematology and Oncology, Berlin, Germany
| | - Eckhard Thiel
- Charité, University Hospital Berlin, Campus Benjamin Franklin, Department of Hematology and Oncology, Berlin, Germany
| | - Dieter Hoelzer
- Goethe University Hospital, Department of Medicine II, Hematology and Oncology, Frankfurt/Main, Germany
| | - Wolf-Karsten Hofmann
- University Hospital Mannheim, Department of Hematology and Oncology, Mannheim, Germany
| | - Claudia D. Baldus
- Charité, University Hospital Berlin, Campus Benjamin Franklin, Department of Hematology and Oncology, Berlin, Germany
- * E-mail:
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96
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Grossmann V, Haferlach C, Weissmann S, Roller A, Schindela S, Poetzinger F, Stadler K, Bellos F, Kern W, Haferlach T, Schnittger S, Kohlmann A. The molecular profile of adult T-cell acute lymphoblastic leukemia: mutations in RUNX1 and DNMT3A are associated with poor prognosis in T-ALL. Genes Chromosomes Cancer 2013; 52:410-22. [PMID: 23341344 DOI: 10.1002/gcc.22039] [Citation(s) in RCA: 121] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 11/02/2012] [Accepted: 11/20/2012] [Indexed: 12/15/2022] Open
Abstract
T-cell acute lymphoblastic leukemia (T-ALL) is an aggressive and heterogeneous disease. The diagnosis is predominantly based on immunophenotyping. In addition to known cytogenetic abnormalities molecular mutations were recently identified. Here, 90 adult T-ALL cases were investigated for mutations in NOTCH1, FBXW7, PHF6, CDKN2A, DNMT3A, FLT3, PTEN, and RUNX1 using 454 next-generation amplicon sequencing and melting curve analyses. These data were further complemented by FISH, chromosome banding, array CGH, and CDKN2B promoter methylation analyses. NOTCH1 was the most frequently mutated gene with a 71.1% frequency followed by FBXW7 (18.9%), PHF6 (39.5%), DNMT3A (17.8%), RUNX1 (15.5%), PTEN (10.0%), CDKN2A (4.4%), FLT3-ITD (2.2%), and FLT3-TKD (1.1%). In total, 84/90 (93.3%) cases harbored at least one mutation. Combining these data with CDKN2A/B deletions and CDKN2B methylation status, we detected minimum one aberration in 89/90 (98.9%) patients. Survival analyses revealed the subtype as defined by the immunophenotype as the strongest independent prognostic factor. When restricting the survival analysis to the early T-ALL subtype, a strong association of RUNX1 (P = 0.027) and DNMT3A (P = 0.005) mutations with shorter overall survival was observed. In conclusion, RUNX1 and DNMT3A are frequently mutated in T-ALL and are associated with poor prognosis in early T-ALL.
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Affiliation(s)
- Vera Grossmann
- MLL Munich Leukemia Laboratory, Max-Lebsche-Platz 31, 81377 Munich, Germany.
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97
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Malyukova A, Brown S, Papa R, O'Brien R, Giles J, Trahair TN, Dalla Pozza L, Sutton R, Liu T, Haber M, Norris MD, Lock RB, Sangfelt O, Marshall GM. FBXW7 regulates glucocorticoid response in T-cell acute lymphoblastic leukaemia by targeting the glucocorticoid receptor for degradation. Leukemia 2012; 27:1053-62. [PMID: 23228967 DOI: 10.1038/leu.2012.361] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Loss of function mutation in FBXW7, an E3 ubiquitin ligase, is associated with good prognosis and early glucocorticoid treatment response in childhood T-cell acute lymphoblastic leukemia (T-ALL) by unknown mechanisms. Here, we show that FBXW7 targets the glucocorticoid receptor α (GRα) for ubiquitylation and proteasomal degradation in a manner dependent on glycogen synthase kinase 3 β-mediated phsophorylation. FBXW7 inactivation caused elevated GRα levels, and enhanced the transcriptional response to glucocorticoids. There was significant enhancement of GR transcriptional responses in FBXW7-deficient cell lines and primary T-ALL samples, in particular, for those pro-apoptotic regulatory proteins, BIM and PUMA. Reduced FBXW7 expression or function promoted glucocorticoid sensitivity, but not sensitivity to other chemotherapeutic agents used in T-ALL. Moreover, this was a general feature of different cancer cell types. Taken together, our work defines GRα as a novel FBXW7 substrate and demonstrates that favorable patient prognosis in T-ALL is associated with FBXW7 mutations due to enhanced GRα levels and steroid sensitivity. These findings suggest that inactivation of FBXW7, a putative tumor suppressor protein, may create a synthetic lethal state in the presence of specific anticancer therapies.
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Affiliation(s)
- A Malyukova
- Children's Cancer Institute Australia for Medical Research, Lowy Cancer Research Centre, University of New South Wales, Sydney, NSW, Australia.
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98
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99
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Abstract
Abstract
Significant improvements have been made in the treatment of acute lymphoblastic leukemia (ALL) during the past 2 decades, and measurement of submicroscopic (minimal) levels of residual disease (MRD) is increasingly used to monitor treatment efficacy. For a better comparability of MRD data, there are ongoing efforts to standardize MRD quantification using real-time quantitative PCR of clonal immunoglobulin and T-cell receptor gene rearrangements, real-time quantitative-based detection of fusion gene transcripts or breakpoints, and multiparameter flow cytometric immunophenotyping. Several studies have demonstrated that MRD assessment in childhood and adult ALL significantly correlates with clinical outcome. MRD detection is particularly useful for evaluation of treatment response, but also for early assessment of an impending relapse. Therefore, MRD has gained a prominent position in many ALL treatment studies as a tool for tailoring therapy with growing evidence that MRD supersedes most conventional stratification criteria at least for Ph-negative ALL. Most study protocols on adult ALL follow a 2-step approach with a first classic pretherapeutic and a second MRD-based risk stratification. Here we discuss whether and how MRD is ready to be used as main decisive marker and whether pretherapeutic factors and MRD are really competing or complementary tools to individualize treatment.
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100
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Shepherd C, Banerjee L, Cheung CW, Mansour MR, Jenkinson S, Gale RE, Khwaja A. PI3K/mTOR inhibition upregulates NOTCH-MYC signalling leading to an impaired cytotoxic response. Leukemia 2012; 27:650-60. [PMID: 23038273 DOI: 10.1038/leu.2012.285] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PI3K, mTOR and NOTCH pathways are frequently dysregulated in T-cell acute lymphoblastic leukaemia (T-ALL). Blockade of PI3K and mTOR with the dual inhibitor PI-103 decreased proliferation in all 15 T-ALL cell lines tested, inducing cell death in three. Combined PI3K/mTOR/NOTCH inhibition (with a γ-secretase inhibitor (GSI)) led to enhanced cell-cycle arrest and to subsequent cell death in 7/11 remaining NOTCH mutant cell lines. Commitment to cell death occurred within 48-72 h and was maximal when PI3K, mTOR and NOTCH activities were inhibited. PI-103 addition led to upregulation of c-MYC, which was blocked by coincubation with a GSI, indicating that PI3K/mTOR inhibition resulted in activation of the NOTCH-MYC pathway. Microarray studies showed a global increase in NOTCH target gene expression upon PI3K/mTOR inhibition. NOTCH-MYC-induced resistance to PI3K/mTOR inhibition was supported by synergistic cell death induction by PI-103 and a small molecule c-MYC inhibitor, and by reduction of the cytotoxic effect of PI-103+GSI by c-MYC overexpression. These results show that drugs targeting PI3K/mTOR can upregulate NOTCH-MYC activity, have implications for the use of PI3K inhibitors for the treatment of other malignancies with activated NOTCH, and provide a rational basis for the use of drug combinations that target both the pathways.
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Affiliation(s)
- C Shepherd
- Department of Haematology, University College, London, UK
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