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Tembhare PR, Narula G, Khanka T, Ghogale S, Chatterjee G, Patkar NV, Prasad M, Badrinath Y, Deshpande N, Gudapati P, Verma S, Sanyal M, Kunjachan F, Mangang G, Gujral S, Banavali S, Subramanian PG. Post-induction Measurable Residual Disease Using Multicolor Flow Cytometry Is Strongly Predictive of Inferior Clinical Outcome in the Real-Life Management of Childhood T-Cell Acute Lymphoblastic Leukemia: A Study of 256 Patients. Front Oncol 2020; 10:577. [PMID: 32391267 PMCID: PMC7193086 DOI: 10.3389/fonc.2020.00577] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 03/30/2020] [Indexed: 01/21/2023] Open
Abstract
Background: Measurable/minimal residual disease (MRD) status is suggested as a powerful indicator of clinical-outcome in T-cell lymphoblastic leukemia/lymphoma (T-ALL). Contrary to B-cell ALL, reports on T-ALL MRD are limited and mostly based on molecular methods, mainly from developed countries. Multicolor flow cytometry (MFC)-based T-ALL studies are very few. Clinically relevant cut-off levels and ideal time-point for MRD assessment are still inconclusive. In view of lack of T-ALL MRD data from the developing world, we evaluated the prognostic value of MFC-based post-induction (PI)-MRD assessment in T-ALL in the context of standard practice. Methods: We included 256 childhood-T-ALL patients (age < 15 years) treated with a modified-MCP841 protocol, which uses high-dose cytarabine during consolidation, as a part of standard hospital practice. MRD was studied using 10-color 11-antibody MFC with any level of detectable disease being considered positive. Post-induction (PI)-MRD was available in all patients, and post-consolidation (PC) MRD was available mostly in PI-MRD-positive patients (n = 88). Results: Three years cumulative-incidence-of-relapse (3years-CIR) in PI-MRD-positive patients was inferior to negative patients (46.3% vs. 18.4%). The median relapse-free-survival (RFS), event-free-survival (EFS) and overall-survival (OS) with hazard ratio (HR) of PI-MRD-positive patients were 21.4 months vs not reached (p < 0.0001, HR-4.7), 21.6 months vs. not-reached (p = 0.0003, HR-2.01) and 37.3 months vs. not reached (p = 0.026, HR-1.64) respectively. RFS, EFS and OS of patients with PI-MRD<0.01% (n = 17) were as inferior as PI-MRD ≥ 0.01% in comparison with MRD-negative patients with HR of 4.7 (p < 0.0001), 2.45 (p = 0.0003), and 2.5 (p = 0.029), respectively. Three-years-CIR of patients with hyperleukocytosis (≥100 × 109/L) was also higher (50.5 vs. 27.6%) with inferior RFS, EFS, and OS. Among PI-MRD-positive patients, 3years-CIR, RFS, EFS, and OS of PC-MRD-positive were also inferior to that of negative patients. On multivariate analysis any-level detectable PI-MRD and hyperleukocytosis remained independently associated with inferior RFS, EFS, and OS. A combination of PI-MRD-positive status and hyperleukocytosis identified the patients with the worst clinical outcomes. Conclusion: Detectable PI-MRD using MFC was found to be the strong predictive factor of inferior clinical outcome in T-ALL patients. The combination of PI-MRD status and hyperleukocytosis provides the most influential tool for the management of T-ALL in resource constrained settings from developing world.
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Affiliation(s)
- Prashant R. Tembhare
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Gaurav Narula
- Department of Pediatric Oncology, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Twinkle Khanka
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Sitaram Ghogale
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Gaurav Chatterjee
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Nikhil V. Patkar
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Maya Prasad
- Department of Pediatric Oncology, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Yajamanam Badrinath
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Nilesh Deshpande
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Pratyusha Gudapati
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Shefali Verma
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Mahima Sanyal
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Florence Kunjachan
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Gunit Mangang
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Sumeet Gujral
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Shripad Banavali
- Department of Pediatric Oncology, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Papagudi G. Subramanian
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
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Pedrosa F, Coustan-Smith E, Zhou Y, Cheng C, Pedrosa A, Lins MM, Pedrosa M, Lucena-Silva N, Ramos AMDL, Vinhas E, Rivera GK, Campana D, Ribeiro RC. Reduced-dose intensity therapy for pediatric lymphoblastic leukemia: long-term results of the Recife RELLA05 pilot study. Blood 2020; 135:1458-1466. [PMID: 32027741 PMCID: PMC7180080 DOI: 10.1182/blood.2019004215] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 01/28/2020] [Indexed: 12/22/2022] Open
Abstract
Treatment-related mortality is common among children with acute lymphoblastic leukemia (ALL) treated in poor-resource settings. We applied a simplified flow cytometric assay to identify patients with precursor B-cell ALL (B-ALL) at very low risk (VLR) of relapse and treated them with a reduced-intensity treatment plan (RELLA05). VLR criteria include favorable presenting features (age ≥ 1 and < 10 years), white blood cell count of <50 ×109/L, lack of extramedullary leukemia, and minimal residual disease level of <0.01% on remission induction day 19. Except for 2 doses of daunorubicin, treatment of patients with VLR B-ALL consisted of a combination of agents with relatively low myelotoxicity profiles, including corticosteroids, vincristine, L-asparaginase, methotrexate, and 6-mercaptopurine. Cyclophosphamide, systemic cytarabine, and central nervous system radiotherapy were not used. Of 454 patients with ALL treated at the Instituto de Medicina Integral Professor Fernando Figueira in Recife, Brazil, between December 2005 and June 2015, 101 were classified as having VLR B-ALL. There were no cases of death resulting from toxicity or treatment abandonment during remission induction. At a median follow-up of 6.6 years, there were 8 major adverse events: 6 relapses, 1 treatment-related death (from septicemia) during remission, and 1 secondary myeloid leukemia. The estimated 5-year event-free and overall survival rates were 92.0% ± 3.9% and 96.0% ± 2.8%, respectively. The 5-year cumulative risk of relapse was 4.24% ± 2.0%. The treatment was well tolerated. Episodes of neutropenia were of short duration. Patients with B-ALL selected by a combination of presenting features and degree of early response can be successfully treated with a mildly myelosuppressive chemotherapy regimen.
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Affiliation(s)
- Francisco Pedrosa
- Department of Pediatric Oncology, Real Hospital Português, Recife, Brazil
| | - Elaine Coustan-Smith
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yinmei Zhou
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - Cheng Cheng
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - Arli Pedrosa
- Department of Pediatric Oncology, Real Hospital Português, Recife, Brazil
| | | | - Marcia Pedrosa
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brazil; and
| | - Norma Lucena-Silva
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brazil; and
| | | | - Ester Vinhas
- Department of Pediatric Oncology, Real Hospital Português, Recife, Brazil
| | | | - Dario Campana
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Raul C Ribeiro
- Department of Global Pediatric Medicine
- Department of Oncology, and
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN
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53
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Ariffin H, Ab Rahman S, Leong SH, Chiew EKH, Lin HP, Quah TC, Yeoh AEJ. Malaysia-Singapore (MASPORE) leukaemia study group: From common history to successful collaboration. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2020. [DOI: 10.1016/j.phoj.2020.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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54
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Li Z, Jiang N, Lim EH, Chin WHN, Lu Y, Chiew KH, Kham SKY, Yang W, Quah TC, Lin HP, Tan AM, Ariffin H, Yang JJ, Yeoh AEJ. Identifying IGH disease clones for MRD monitoring in childhood B-cell acute lymphoblastic leukemia using RNA-Seq. Leukemia 2020; 34:2418-2429. [PMID: 32099036 DOI: 10.1038/s41375-020-0774-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 02/07/2020] [Accepted: 02/13/2020] [Indexed: 12/19/2022]
Abstract
Identifying patient-specific clonal IGH/TCR junctional sequences is critical for minimal residual disease (MRD) monitoring. Conventionally these junctional sequences are identified using laborious Sanger sequencing of excised heteroduplex bands. We found that the IGH is highly expressed in our diagnostic B-cell acute lymphoblastic leukemia (B-ALL) samples using RNA-Seq. Therefore, we used RNA-Seq to identify IGH disease clone sequences in 258 childhood B-ALL samples for MRD monitoring. The amount of background IGH rearrangements uncovered by RNA-Seq followed the Zipf's law with IGH disease clones easily identified as outliers. Four hundred and ninety-seven IGH disease clones (median 2, range 0-7 clones/patient) are identified in 90.3% of patients. High hyperdiploid patients have the most IGH disease clones (median 3) while DUX4 subtype has the least (median 1) due to the rearrangements involving the IGH locus. In all, 90.8% of IGH disease clones found by Sanger sequencing are also identified by RNA-Seq. In addition, RNA-Seq identified 43% more IGH disease clones. In 69 patients lacking sensitive IGH targets, targeted NGS IGH MRD showed high correlation (R = 0.93; P = 1.3 × 10-14), better relapse prediction than conventional RQ-PCR MRD using non-IGH targets. In conclusion, RNA-Seq can identify patient-specific clonal IGH junctional sequences for MRD monitoring, adding to its usefulness for molecular diagnosis in childhood B-ALL.
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Affiliation(s)
- Zhenhua Li
- VIVA-NUS Centre for Translational Research in Acute Leukaemia, Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nan Jiang
- VIVA-NUS Centre for Translational Research in Acute Leukaemia, Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Evelyn Huizi Lim
- VIVA-NUS Centre for Translational Research in Acute Leukaemia, Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Winnie Hui Ni Chin
- VIVA-NUS Centre for Translational Research in Acute Leukaemia, Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yi Lu
- VIVA-NUS Centre for Translational Research in Acute Leukaemia, Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kean Hui Chiew
- VIVA-NUS Centre for Translational Research in Acute Leukaemia, Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shirley Kow Yin Kham
- VIVA-NUS Centre for Translational Research in Acute Leukaemia, Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wentao Yang
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Thuan Chong Quah
- VIVA-NUS Centre for Translational Research in Acute Leukaemia, Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Viva-University Children's Cancer Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
| | - Hai Peng Lin
- Subang Jaya Medical Centre, Subang Jaya, Malaysia
| | - Ah Moy Tan
- Department of Paediatrics, KK Women's & Children's Hospital, Singapore, Singapore
| | - Hany Ariffin
- University of Malaya Cancer Research Institute, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jun J Yang
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Allen Eng-Juh Yeoh
- VIVA-NUS Centre for Translational Research in Acute Leukaemia, Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. .,Viva-University Children's Cancer Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore. .,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore.
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55
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Kruse A, Abdel-Azim N, Kim HN, Ruan Y, Phan V, Ogana H, Wang W, Lee R, Gang EJ, Khazal S, Kim YM. Minimal Residual Disease Detection in Acute Lymphoblastic Leukemia. Int J Mol Sci 2020; 21:E1054. [PMID: 32033444 PMCID: PMC7037356 DOI: 10.3390/ijms21031054] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/30/2020] [Accepted: 02/03/2020] [Indexed: 02/04/2023] Open
Abstract
Minimal residual disease (MRD) refers to a chemotherapy/radiotherapy-surviving leukemia cell population that gives rise to relapse of the disease. The detection of MRD is critical for predicting the outcome and for selecting the intensity of further treatment strategies. The development of various new diagnostic platforms, including next-generation sequencing (NGS), has introduced significant advances in the sensitivity of MRD diagnostics. Here, we review current methods to diagnose MRD through phenotypic marker patterns or differential gene patterns through analysis by flow cytometry (FCM), polymerase chain reaction (PCR), real-time quantitative polymerase chain reaction (RQ-PCR), reverse transcription polymerase chain reaction (RT-PCR) or NGS. Future advances in clinical procedures will be molded by practical feasibility and patient needs regarding greater diagnostic sensitivity.
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Affiliation(s)
- Aaron Kruse
- Children’s Hospital Los Angeles, University of Southern California, 4650 Sunset Boulevard, MS #57, Los Angeles, CA 90027, USA; (A.K.); (N.A.-A.); (H.N.K.); (Y.R.); (V.P.); (H.O.); (W.W.); (R.L.); (E.J.G.)
| | - Nour Abdel-Azim
- Children’s Hospital Los Angeles, University of Southern California, 4650 Sunset Boulevard, MS #57, Los Angeles, CA 90027, USA; (A.K.); (N.A.-A.); (H.N.K.); (Y.R.); (V.P.); (H.O.); (W.W.); (R.L.); (E.J.G.)
| | - Hye Na Kim
- Children’s Hospital Los Angeles, University of Southern California, 4650 Sunset Boulevard, MS #57, Los Angeles, CA 90027, USA; (A.K.); (N.A.-A.); (H.N.K.); (Y.R.); (V.P.); (H.O.); (W.W.); (R.L.); (E.J.G.)
| | - Yongsheng Ruan
- Children’s Hospital Los Angeles, University of Southern California, 4650 Sunset Boulevard, MS #57, Los Angeles, CA 90027, USA; (A.K.); (N.A.-A.); (H.N.K.); (Y.R.); (V.P.); (H.O.); (W.W.); (R.L.); (E.J.G.)
| | - Valerie Phan
- Children’s Hospital Los Angeles, University of Southern California, 4650 Sunset Boulevard, MS #57, Los Angeles, CA 90027, USA; (A.K.); (N.A.-A.); (H.N.K.); (Y.R.); (V.P.); (H.O.); (W.W.); (R.L.); (E.J.G.)
| | - Heather Ogana
- Children’s Hospital Los Angeles, University of Southern California, 4650 Sunset Boulevard, MS #57, Los Angeles, CA 90027, USA; (A.K.); (N.A.-A.); (H.N.K.); (Y.R.); (V.P.); (H.O.); (W.W.); (R.L.); (E.J.G.)
| | - William Wang
- Children’s Hospital Los Angeles, University of Southern California, 4650 Sunset Boulevard, MS #57, Los Angeles, CA 90027, USA; (A.K.); (N.A.-A.); (H.N.K.); (Y.R.); (V.P.); (H.O.); (W.W.); (R.L.); (E.J.G.)
| | - Rachel Lee
- Children’s Hospital Los Angeles, University of Southern California, 4650 Sunset Boulevard, MS #57, Los Angeles, CA 90027, USA; (A.K.); (N.A.-A.); (H.N.K.); (Y.R.); (V.P.); (H.O.); (W.W.); (R.L.); (E.J.G.)
| | - Eun Ji Gang
- Children’s Hospital Los Angeles, University of Southern California, 4650 Sunset Boulevard, MS #57, Los Angeles, CA 90027, USA; (A.K.); (N.A.-A.); (H.N.K.); (Y.R.); (V.P.); (H.O.); (W.W.); (R.L.); (E.J.G.)
| | - Sajad Khazal
- Department of Pediatrics Patient Care, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Yong-Mi Kim
- Children’s Hospital Los Angeles, University of Southern California, 4650 Sunset Boulevard, MS #57, Los Angeles, CA 90027, USA; (A.K.); (N.A.-A.); (H.N.K.); (Y.R.); (V.P.); (H.O.); (W.W.); (R.L.); (E.J.G.)
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Hendricks CL, Buldeo S, Pillay D, Naidoo A, Thejpal R, Rapiti N, Neethling B, Goga Y, van Staaden H. Comparing morphology, flow cytometry and molecular genetics in the assessment of minimal residual disease in children with B-acute lymphoblastic leukaemia (B-ALL). SOUTH AFRICAN JOURNAL OF ONCOLOGY 2019. [DOI: 10.4102/sajo.v3i0.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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57
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Jovanovska A, Martinova K, Kocheva S, Trajkova-Antevska Z, Coneska-Jovanova B, Panovska-Stavridis I, Stankovikj S, Trajkova S, Dimovski A. Clinical Significance of Minimal Residual Disease at the End of Remission Induction Therapy in Childhood Acute Lymphoblastic Leukemia. Open Access Maced J Med Sci 2019; 7:2818-2823. [PMID: 31844443 PMCID: PMC6901875 DOI: 10.3889/oamjms.2019.752] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 08/04/2019] [Accepted: 08/05/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Detection of minimal residual disease (MRD) in the early phase of therapy is the most powerful predictor of relapse risk in children with acute lymphoblastic leukaemia (ALL). AIM We aimed to determine the significance of MRD at the end of remission induction therapy in the prediction of treatment outcome in children with ALL. METHODS Sixty-four consecutive patients aged 1-14 years with newly diagnosed ALL were enrolled in this study from January 2010 to October 2017. All patients were treated according to the ALL IC BFM 2002 protocol. MRD was detected at the end of remission induction therapy (day 33) by multiparameter 6-colour flow cytometry performed on bone marrow specimens with a sensitivity of 0.01%. RESULTS Overall, 42.2% of patients had detectable MRD on day 33 of therapy. MRD measurements were not significantly related to presenting characteristics but were associated with a poorer blast clearance on day 8 and 15 of remission induction therapy. Patients with negative MRD status on day 33 had a 5-year event-free survival of 94.6% compared with 76.1% for those with positive MRD status (P = 0.044). CONCLUSION MRD levels at the end of remission induction therapy measured by multiparameter flow cytometry have clinical significance in childhood ALL. High levels of MRD are strongly related to poor treatment outcome.
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Affiliation(s)
- Aleksandra Jovanovska
- Department of Hematology and Oncology, University Clinic for Children`s Diseases, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Kata Martinova
- Department of Hematology and Oncology, University Clinic for Children`s Diseases, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Svetlana Kocheva
- Department of Hematology and Oncology, University Clinic for Children`s Diseases, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Zorica Trajkova-Antevska
- Department of Hematology and Oncology, University Clinic for Children`s Diseases, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | | | - Irina Panovska-Stavridis
- University Clinic for Hematology, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Svetlana Stankovikj
- University Clinic for Hematology, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Sanja Trajkova
- University Clinic for Hematology, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Aleksandar Dimovski
- Faculty of Pharmacy, Ss Cyril and Methodius University of Skopje, Skopje, Skopje, Republic of Macedonia
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Zhao X, Liu Y, Xu L, Wang Y, Zhang X, Chen H, Chen Y, Han W, Sun Y, Yan C, Mo X, Wang Y, Fan Q, Wang X, Liu K, Huang X, Chang Y. Minimal residual disease status determined by multiparametric flow cytometry pretransplantation predicts the outcome of patients with ALL receiving unmanipulated haploidentical allografts. Am J Hematol 2019; 94:512-521. [PMID: 30680765 DOI: 10.1002/ajh.25417] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 12/28/2018] [Accepted: 01/22/2019] [Indexed: 12/11/2022]
Abstract
This study evaluated the effects of pretransplantation minimal residual disease (pre-MRD) on outcomes of patients with acute lymphoblastic leukemia (ALL) who underwent unmanipulated haploidentical stem cell transplantation (haplo-SCT). A retrospective study including 543 patients with ALL was performed. MRD was determined using multiparametric flow cytometry. Both in the entire cohort of patients and in subgroup cases with T-ALL or B-ALL, patients with positive pre-MRD had a higher incidence of relapse (CIR) than those with negative pre-MRD in MSDT settings (P < 0.01 for all). Landmark analysis at 6 months showed that MRD positivity was significantly and independently associated with inferior rates of relapse (HR, 1.908; P = 0.007), leukemia-free survival (LFS) (HR, 1.559; P = 0.038), and OS (HR, 1.545; P = 0.049). The levels of pre-MRD according to a logarithmic scale were also associated with leukemia relapse, LFS, and OS, except that cases with MRD <0.01% experienced comparable CIR and LFS to those with negative pre-MRD. A risk score for CIR was developed using the variables pre-MRD, disease status, and immunophenotype of ALL. The CIR was 14%, 26%, and 59% for subjects with scores of 0, 1, and 2-3, respectively (P < 0.001). Three-year LFS was 75%, 64%, and 42%, respectively (P < 0.001). Multivariate analysis confirmed the association of the risk score with CIR and LFS. The results indicate that positive pre-MRD, except for low level one (MRD < 0.01%), is associated with poor outcomes in patients with ALL who underwent unmanipulated haplo-SCT.
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Affiliation(s)
- Xiao‐Su Zhao
- Peking University People's Hospital & Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell TransplantationPeking University People's Hospital & Peking University Institute of Hematology Beijing China
- Peking‐Tsinghua Center for Life Sciences Beijing China
| | - Yan‐Rong Liu
- Peking University People's Hospital & Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell TransplantationPeking University People's Hospital & Peking University Institute of Hematology Beijing China
| | - Lan‐Ping Xu
- Peking University People's Hospital & Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell TransplantationPeking University People's Hospital & Peking University Institute of Hematology Beijing China
| | - Yu Wang
- Peking University People's Hospital & Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell TransplantationPeking University People's Hospital & Peking University Institute of Hematology Beijing China
- Peking‐Tsinghua Center for Life Sciences Beijing China
| | - Xiao‐Hui Zhang
- Peking University People's Hospital & Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell TransplantationPeking University People's Hospital & Peking University Institute of Hematology Beijing China
- Peking‐Tsinghua Center for Life Sciences Beijing China
| | - Huan Chen
- Peking University People's Hospital & Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell TransplantationPeking University People's Hospital & Peking University Institute of Hematology Beijing China
| | - Yu‐Hong Chen
- Peking University People's Hospital & Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell TransplantationPeking University People's Hospital & Peking University Institute of Hematology Beijing China
| | - Wei Han
- Peking University People's Hospital & Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell TransplantationPeking University People's Hospital & Peking University Institute of Hematology Beijing China
| | - Yu‐Qian Sun
- Peking University People's Hospital & Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell TransplantationPeking University People's Hospital & Peking University Institute of Hematology Beijing China
| | - Chen‐Hua Yan
- Peking University People's Hospital & Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell TransplantationPeking University People's Hospital & Peking University Institute of Hematology Beijing China
| | - Xiao‐Dong Mo
- Peking University People's Hospital & Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell TransplantationPeking University People's Hospital & Peking University Institute of Hematology Beijing China
| | - Ya‐Zhe Wang
- Peking University People's Hospital & Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell TransplantationPeking University People's Hospital & Peking University Institute of Hematology Beijing China
| | - Qiao‐Zhen Fan
- Peking University People's Hospital & Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell TransplantationPeking University People's Hospital & Peking University Institute of Hematology Beijing China
| | - Xin‐Yu Wang
- Peking University People's Hospital & Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell TransplantationPeking University People's Hospital & Peking University Institute of Hematology Beijing China
| | - Kai‐Yan Liu
- Peking University People's Hospital & Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell TransplantationPeking University People's Hospital & Peking University Institute of Hematology Beijing China
| | - Xiao‐Jun Huang
- Peking University People's Hospital & Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell TransplantationPeking University People's Hospital & Peking University Institute of Hematology Beijing China
- Collaborative Innovation Center of HematologyPeking University Beijing China
| | - Ying‐Jun Chang
- Peking University People's Hospital & Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell TransplantationPeking University People's Hospital & Peking University Institute of Hematology Beijing China
- Collaborative Innovation Center of HematologyPeking University Beijing China
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Teachey DT, Pui CH. Comparative features and outcomes between paediatric T-cell and B-cell acute lymphoblastic leukaemia. Lancet Oncol 2019; 20:e142-e154. [PMID: 30842058 PMCID: PMC9233195 DOI: 10.1016/s1470-2045(19)30031-2] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 12/24/2018] [Accepted: 01/02/2019] [Indexed: 01/01/2023]
Abstract
Contemporary paediatric clinical trials have improved 5-year event-free survival above 85% and 5-year overall survival above 90% in B-cell acute lymphoblastic leukaemia (ALL) in many study groups, whilst outcomes for T-cell ALL are still lagging behind by 5-10% in most studies. Several factors have contributed to this discrepant outcome. First, patients with T-cell ALL are generally older than those with B-cell ALL and, therefore, have poorer tolerance to chemotherapy, especially dexamethasone and asparaginase, and have increased risk of extramedullary relapse. Second, a higher proportion of patients with B-cell ALL have favourable genetic subtypes (eg, ETV6-RUNX1 and high hyperdiploidy), which confer a superior outcome compared with favourable subtypes of T-cell ALL. Third, T-cell ALL blasts are generally more resistant to conventional chemotherapeutic drugs than are B-cell ALL blasts. Finally, patients with B-cell ALL are more amendable to available targeted therapies, such as Philadelphia chromosome-positive and some Philadelphia chromosome-like ALL cases to ABL-class tyrosine kinase inhibitors, and CD19-positive and CD22-postive B-cell ALL cases to a variety of immunotherapies. Several novel treatments under investigation might narrow the gap in survival between T-cell ALL and B-cell ALL, although novel treatment options for T-cell ALL are limited.
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Affiliation(s)
- David T Teachey
- Hematology and Oncology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ching-Hon Pui
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA.
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Heikamp EB, Pui CH. Next-Generation Evaluation and Treatment of Pediatric Acute Lymphoblastic Leukemia. J Pediatr 2018; 203:14-24.e2. [PMID: 30213460 PMCID: PMC6261438 DOI: 10.1016/j.jpeds.2018.07.039] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 06/25/2018] [Accepted: 07/11/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Emily B Heikamp
- Department of Pediatrics, Section of Pediatric Hematology-Oncology, Baylor College of Medicine, Houston, TX; Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, TX.
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN; Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN; Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, TN
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Chin TF, Ibrahim K, Thirunavakarasu T, Azanan MS, Oh L, Lum SH, Yap TY, Ariffin H. Nonclonal Chromosomal Aberrations in Childhood Leukemia Survivors. Fetal Pediatr Pathol 2018; 37:243-253. [PMID: 30273079 DOI: 10.1080/15513815.2018.1492054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Survivors of childhood cancer are at risk of developing a second malignancy. One possible mechanism for neoplastic transformation of cells is through induction of persistent genomic instability. This study aims to seek evidence of chromosomal instability in long-term childhood leukemia survivors (CLS) in one of the largest pediatric academic oncology centers in South East Asia. METHODS 50 asymptomatic (subjects have remained leukemia-free since treatment cessation) CLS and 50 healthy controls were recruited in this cross-sectional study. Of 50 CLS, 44 had acute lymphoblastic leukemia and 6 had acute myeloid leukemia. G-banded karyotyping was performed on unstimulated peripheral blood leukocytes of all subjects. RESULTS CLS had significantly higher occurrence of karyotypic abnormalities compared to controls. Five CLS harbored six nonclonal abnormalities (mostly aneuploidy) while none were found in controls. CONCLUSION Subpopulations with nonclonal chromosomal aberrations were present in peripheral blood leukocytes of our cohort of childhood leukemia long-term survivors.
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Affiliation(s)
- Tong Foh Chin
- a Department of Paediatrics, Faculty of Medicine , University of Malaya , Kuala Lumpur , Malaysia.,b Department of Paediatrics , University of Malaya Medical Centre , Kuala Lumpur , Malaysia
| | - Kamariah Ibrahim
- c Department of Biomedical Science, Faculty of Medicine , University of Malaya , Kuala Lumpur , Malaysia
| | - Tharshanadevasheri Thirunavakarasu
- a Department of Paediatrics, Faculty of Medicine , University of Malaya , Kuala Lumpur , Malaysia.,b Department of Paediatrics , University of Malaya Medical Centre , Kuala Lumpur , Malaysia
| | - Mohamad Shafiq Azanan
- a Department of Paediatrics, Faculty of Medicine , University of Malaya , Kuala Lumpur , Malaysia.,b Department of Paediatrics , University of Malaya Medical Centre , Kuala Lumpur , Malaysia
| | - Lixian Oh
- a Department of Paediatrics, Faculty of Medicine , University of Malaya , Kuala Lumpur , Malaysia.,b Department of Paediatrics , University of Malaya Medical Centre , Kuala Lumpur , Malaysia
| | - Su Han Lum
- a Department of Paediatrics, Faculty of Medicine , University of Malaya , Kuala Lumpur , Malaysia
| | - Tsiao Yi Yap
- a Department of Paediatrics, Faculty of Medicine , University of Malaya , Kuala Lumpur , Malaysia
| | - Hany Ariffin
- a Department of Paediatrics, Faculty of Medicine , University of Malaya , Kuala Lumpur , Malaysia.,b Department of Paediatrics , University of Malaya Medical Centre , Kuala Lumpur , Malaysia
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Yeoh AEJ, Lu Y, Chin WHN, Chiew EKH, Lim EH, Li Z, Kham SKY, Chan YH, Abdullah WA, Lin HP, Chan LL, Lam JCM, Tan PL, Quah TC, Tan AM, Ariffin H. Intensifying Treatment of Childhood B-Lymphoblastic Leukemia With IKZF1 Deletion Reduces Relapse and Improves Overall Survival: Results of Malaysia-Singapore ALL 2010 Study. J Clin Oncol 2018; 36:2726-2735. [PMID: 30044693 DOI: 10.1200/jco.2018.78.3050] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Purpose Although IKZF1 deletion ( IKZF1del) confers a higher risk of relapse in childhood B-cell acute lymphoblastic leukemia (B-ALL), it is uncertain whether treatment intensification will reverse this risk and improve outcomes. The Malaysia-Singapore ALL 2010 study (MS2010) prospectively upgraded the risk assignment of patients with IKZF1del to the next highest level and added imatinib to the treatment of all patients with BCR- ABL1 fusion. Patients and Methods In total, 823 patients with B-ALL treated in the Malyasia-Singapore ALL 2003 study (MS2003; n = 507) and MS2010 (n = 316) were screened for IKZF1del using the multiplex ligation-dependent probe amplification assay. The impact of IKZF1del on the 5-year cumulative incidence of relapse (CIR) was compared between the two studies. Results Patient characteristics were similar in both cohorts, including IKZF1del frequencies (59 of 410 [14.4%] v 50 of 275 [18.2%]; P = .2). In MS2003, where IKZF1del was not used in risk assignment, IKZF1del conferred a significantly higher 5-year CIR (30.4% v 8.1%; P = 8.7 × 10-7), particularly in the intermediate-risk group who lacked high-risk features (25.0% v 7.5%; P = .01). For patients with BCR-ABL1-negative disease, IKZF1del conferred a higher 5-year CIR (20.5% v 8.0%; P = .01). In MS2010, the 5-year CIR of patients with IKZF1del significantly decreased to 13.5% ( P = .05) and no longer showed a significant difference in patients with BCR-ABL1-negative disease (11.4% v 4.4%; P = .09). The 5-year overall survival for patients with IKZF1del improved from 69.6% in MS2003 to 91.6% in MS2010 ( P = .007). Conclusion Intensifying therapy for childhood B-ALL with IKZF1del significantly reduced the risk of relapse and improved overall survival. Incorporating IKZF1del screening significantly improved treatment outcomes in contemporary ALL therapy.
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Affiliation(s)
- Allen Eng Juh Yeoh
- Allen Eng Juh Yeoh, Yi Lu, Winnie Hui Ni Chin, Edwynn Kean Hui Chiew, Evelyn Huizi Lim, Zhenhua Li, Shirley Kow Yin Kham, Yiong Huak Chan, Poh Lin Tan, and Thuan Chong Quah, National University of Singapore; Allen Eng Juh Yeoh, Edwynn Kean Hui Chiew, Poh Lin Tan, and Thuan Chong Quah, National University Health System; Joyce Ching Mei Lam and Ah Moy Tan, KK Women's & Children's Hospital, Singapore; Wan Ariffin Abdullah and Hany Ariffin, University of Malaya, Kuala Lumpur; and Hai Peng Lin and Lee Lee Chan, Sime Darby Medical Centre Subang Jaya, Subang Jaya, Malaysia
| | - Yi Lu
- Allen Eng Juh Yeoh, Yi Lu, Winnie Hui Ni Chin, Edwynn Kean Hui Chiew, Evelyn Huizi Lim, Zhenhua Li, Shirley Kow Yin Kham, Yiong Huak Chan, Poh Lin Tan, and Thuan Chong Quah, National University of Singapore; Allen Eng Juh Yeoh, Edwynn Kean Hui Chiew, Poh Lin Tan, and Thuan Chong Quah, National University Health System; Joyce Ching Mei Lam and Ah Moy Tan, KK Women's & Children's Hospital, Singapore; Wan Ariffin Abdullah and Hany Ariffin, University of Malaya, Kuala Lumpur; and Hai Peng Lin and Lee Lee Chan, Sime Darby Medical Centre Subang Jaya, Subang Jaya, Malaysia
| | - Winnie Hui Ni Chin
- Allen Eng Juh Yeoh, Yi Lu, Winnie Hui Ni Chin, Edwynn Kean Hui Chiew, Evelyn Huizi Lim, Zhenhua Li, Shirley Kow Yin Kham, Yiong Huak Chan, Poh Lin Tan, and Thuan Chong Quah, National University of Singapore; Allen Eng Juh Yeoh, Edwynn Kean Hui Chiew, Poh Lin Tan, and Thuan Chong Quah, National University Health System; Joyce Ching Mei Lam and Ah Moy Tan, KK Women's & Children's Hospital, Singapore; Wan Ariffin Abdullah and Hany Ariffin, University of Malaya, Kuala Lumpur; and Hai Peng Lin and Lee Lee Chan, Sime Darby Medical Centre Subang Jaya, Subang Jaya, Malaysia
| | - Edwynn Kean Hui Chiew
- Allen Eng Juh Yeoh, Yi Lu, Winnie Hui Ni Chin, Edwynn Kean Hui Chiew, Evelyn Huizi Lim, Zhenhua Li, Shirley Kow Yin Kham, Yiong Huak Chan, Poh Lin Tan, and Thuan Chong Quah, National University of Singapore; Allen Eng Juh Yeoh, Edwynn Kean Hui Chiew, Poh Lin Tan, and Thuan Chong Quah, National University Health System; Joyce Ching Mei Lam and Ah Moy Tan, KK Women's & Children's Hospital, Singapore; Wan Ariffin Abdullah and Hany Ariffin, University of Malaya, Kuala Lumpur; and Hai Peng Lin and Lee Lee Chan, Sime Darby Medical Centre Subang Jaya, Subang Jaya, Malaysia
| | - Evelyn Huizi Lim
- Allen Eng Juh Yeoh, Yi Lu, Winnie Hui Ni Chin, Edwynn Kean Hui Chiew, Evelyn Huizi Lim, Zhenhua Li, Shirley Kow Yin Kham, Yiong Huak Chan, Poh Lin Tan, and Thuan Chong Quah, National University of Singapore; Allen Eng Juh Yeoh, Edwynn Kean Hui Chiew, Poh Lin Tan, and Thuan Chong Quah, National University Health System; Joyce Ching Mei Lam and Ah Moy Tan, KK Women's & Children's Hospital, Singapore; Wan Ariffin Abdullah and Hany Ariffin, University of Malaya, Kuala Lumpur; and Hai Peng Lin and Lee Lee Chan, Sime Darby Medical Centre Subang Jaya, Subang Jaya, Malaysia
| | - Zhenhua Li
- Allen Eng Juh Yeoh, Yi Lu, Winnie Hui Ni Chin, Edwynn Kean Hui Chiew, Evelyn Huizi Lim, Zhenhua Li, Shirley Kow Yin Kham, Yiong Huak Chan, Poh Lin Tan, and Thuan Chong Quah, National University of Singapore; Allen Eng Juh Yeoh, Edwynn Kean Hui Chiew, Poh Lin Tan, and Thuan Chong Quah, National University Health System; Joyce Ching Mei Lam and Ah Moy Tan, KK Women's & Children's Hospital, Singapore; Wan Ariffin Abdullah and Hany Ariffin, University of Malaya, Kuala Lumpur; and Hai Peng Lin and Lee Lee Chan, Sime Darby Medical Centre Subang Jaya, Subang Jaya, Malaysia
| | - Shirley Kow Yin Kham
- Allen Eng Juh Yeoh, Yi Lu, Winnie Hui Ni Chin, Edwynn Kean Hui Chiew, Evelyn Huizi Lim, Zhenhua Li, Shirley Kow Yin Kham, Yiong Huak Chan, Poh Lin Tan, and Thuan Chong Quah, National University of Singapore; Allen Eng Juh Yeoh, Edwynn Kean Hui Chiew, Poh Lin Tan, and Thuan Chong Quah, National University Health System; Joyce Ching Mei Lam and Ah Moy Tan, KK Women's & Children's Hospital, Singapore; Wan Ariffin Abdullah and Hany Ariffin, University of Malaya, Kuala Lumpur; and Hai Peng Lin and Lee Lee Chan, Sime Darby Medical Centre Subang Jaya, Subang Jaya, Malaysia
| | - Yiong Huak Chan
- Allen Eng Juh Yeoh, Yi Lu, Winnie Hui Ni Chin, Edwynn Kean Hui Chiew, Evelyn Huizi Lim, Zhenhua Li, Shirley Kow Yin Kham, Yiong Huak Chan, Poh Lin Tan, and Thuan Chong Quah, National University of Singapore; Allen Eng Juh Yeoh, Edwynn Kean Hui Chiew, Poh Lin Tan, and Thuan Chong Quah, National University Health System; Joyce Ching Mei Lam and Ah Moy Tan, KK Women's & Children's Hospital, Singapore; Wan Ariffin Abdullah and Hany Ariffin, University of Malaya, Kuala Lumpur; and Hai Peng Lin and Lee Lee Chan, Sime Darby Medical Centre Subang Jaya, Subang Jaya, Malaysia
| | - Wan Ariffin Abdullah
- Allen Eng Juh Yeoh, Yi Lu, Winnie Hui Ni Chin, Edwynn Kean Hui Chiew, Evelyn Huizi Lim, Zhenhua Li, Shirley Kow Yin Kham, Yiong Huak Chan, Poh Lin Tan, and Thuan Chong Quah, National University of Singapore; Allen Eng Juh Yeoh, Edwynn Kean Hui Chiew, Poh Lin Tan, and Thuan Chong Quah, National University Health System; Joyce Ching Mei Lam and Ah Moy Tan, KK Women's & Children's Hospital, Singapore; Wan Ariffin Abdullah and Hany Ariffin, University of Malaya, Kuala Lumpur; and Hai Peng Lin and Lee Lee Chan, Sime Darby Medical Centre Subang Jaya, Subang Jaya, Malaysia
| | - Hai Peng Lin
- Allen Eng Juh Yeoh, Yi Lu, Winnie Hui Ni Chin, Edwynn Kean Hui Chiew, Evelyn Huizi Lim, Zhenhua Li, Shirley Kow Yin Kham, Yiong Huak Chan, Poh Lin Tan, and Thuan Chong Quah, National University of Singapore; Allen Eng Juh Yeoh, Edwynn Kean Hui Chiew, Poh Lin Tan, and Thuan Chong Quah, National University Health System; Joyce Ching Mei Lam and Ah Moy Tan, KK Women's & Children's Hospital, Singapore; Wan Ariffin Abdullah and Hany Ariffin, University of Malaya, Kuala Lumpur; and Hai Peng Lin and Lee Lee Chan, Sime Darby Medical Centre Subang Jaya, Subang Jaya, Malaysia
| | - Lee Lee Chan
- Allen Eng Juh Yeoh, Yi Lu, Winnie Hui Ni Chin, Edwynn Kean Hui Chiew, Evelyn Huizi Lim, Zhenhua Li, Shirley Kow Yin Kham, Yiong Huak Chan, Poh Lin Tan, and Thuan Chong Quah, National University of Singapore; Allen Eng Juh Yeoh, Edwynn Kean Hui Chiew, Poh Lin Tan, and Thuan Chong Quah, National University Health System; Joyce Ching Mei Lam and Ah Moy Tan, KK Women's & Children's Hospital, Singapore; Wan Ariffin Abdullah and Hany Ariffin, University of Malaya, Kuala Lumpur; and Hai Peng Lin and Lee Lee Chan, Sime Darby Medical Centre Subang Jaya, Subang Jaya, Malaysia
| | - Joyce Ching Mei Lam
- Allen Eng Juh Yeoh, Yi Lu, Winnie Hui Ni Chin, Edwynn Kean Hui Chiew, Evelyn Huizi Lim, Zhenhua Li, Shirley Kow Yin Kham, Yiong Huak Chan, Poh Lin Tan, and Thuan Chong Quah, National University of Singapore; Allen Eng Juh Yeoh, Edwynn Kean Hui Chiew, Poh Lin Tan, and Thuan Chong Quah, National University Health System; Joyce Ching Mei Lam and Ah Moy Tan, KK Women's & Children's Hospital, Singapore; Wan Ariffin Abdullah and Hany Ariffin, University of Malaya, Kuala Lumpur; and Hai Peng Lin and Lee Lee Chan, Sime Darby Medical Centre Subang Jaya, Subang Jaya, Malaysia
| | - Poh Lin Tan
- Allen Eng Juh Yeoh, Yi Lu, Winnie Hui Ni Chin, Edwynn Kean Hui Chiew, Evelyn Huizi Lim, Zhenhua Li, Shirley Kow Yin Kham, Yiong Huak Chan, Poh Lin Tan, and Thuan Chong Quah, National University of Singapore; Allen Eng Juh Yeoh, Edwynn Kean Hui Chiew, Poh Lin Tan, and Thuan Chong Quah, National University Health System; Joyce Ching Mei Lam and Ah Moy Tan, KK Women's & Children's Hospital, Singapore; Wan Ariffin Abdullah and Hany Ariffin, University of Malaya, Kuala Lumpur; and Hai Peng Lin and Lee Lee Chan, Sime Darby Medical Centre Subang Jaya, Subang Jaya, Malaysia
| | - Thuan Chong Quah
- Allen Eng Juh Yeoh, Yi Lu, Winnie Hui Ni Chin, Edwynn Kean Hui Chiew, Evelyn Huizi Lim, Zhenhua Li, Shirley Kow Yin Kham, Yiong Huak Chan, Poh Lin Tan, and Thuan Chong Quah, National University of Singapore; Allen Eng Juh Yeoh, Edwynn Kean Hui Chiew, Poh Lin Tan, and Thuan Chong Quah, National University Health System; Joyce Ching Mei Lam and Ah Moy Tan, KK Women's & Children's Hospital, Singapore; Wan Ariffin Abdullah and Hany Ariffin, University of Malaya, Kuala Lumpur; and Hai Peng Lin and Lee Lee Chan, Sime Darby Medical Centre Subang Jaya, Subang Jaya, Malaysia
| | - Ah Moy Tan
- Allen Eng Juh Yeoh, Yi Lu, Winnie Hui Ni Chin, Edwynn Kean Hui Chiew, Evelyn Huizi Lim, Zhenhua Li, Shirley Kow Yin Kham, Yiong Huak Chan, Poh Lin Tan, and Thuan Chong Quah, National University of Singapore; Allen Eng Juh Yeoh, Edwynn Kean Hui Chiew, Poh Lin Tan, and Thuan Chong Quah, National University Health System; Joyce Ching Mei Lam and Ah Moy Tan, KK Women's & Children's Hospital, Singapore; Wan Ariffin Abdullah and Hany Ariffin, University of Malaya, Kuala Lumpur; and Hai Peng Lin and Lee Lee Chan, Sime Darby Medical Centre Subang Jaya, Subang Jaya, Malaysia
| | - Hany Ariffin
- Allen Eng Juh Yeoh, Yi Lu, Winnie Hui Ni Chin, Edwynn Kean Hui Chiew, Evelyn Huizi Lim, Zhenhua Li, Shirley Kow Yin Kham, Yiong Huak Chan, Poh Lin Tan, and Thuan Chong Quah, National University of Singapore; Allen Eng Juh Yeoh, Edwynn Kean Hui Chiew, Poh Lin Tan, and Thuan Chong Quah, National University Health System; Joyce Ching Mei Lam and Ah Moy Tan, KK Women's & Children's Hospital, Singapore; Wan Ariffin Abdullah and Hany Ariffin, University of Malaya, Kuala Lumpur; and Hai Peng Lin and Lee Lee Chan, Sime Darby Medical Centre Subang Jaya, Subang Jaya, Malaysia
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Pui CH, Yang JJ, Bhakta N, Rodriguez-Galindo C. Global efforts toward the cure of childhood acute lymphoblastic leukaemia. THE LANCET. CHILD & ADOLESCENT HEALTH 2018; 2:440-454. [PMID: 30169285 PMCID: PMC6467529 DOI: 10.1016/s2352-4642(18)30066-x] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 01/31/2018] [Accepted: 02/13/2018] [Indexed: 12/18/2022]
Abstract
Improvements in risk-directed treatment and supportive care, together with increased reliance on both national and international collaborative studies, have made childhood acute lymphoblastic leukaemia (ALL) one of the most curable human cancers. Next-generation sequencing studies of leukaemia cells and the host germline provide new opportunities for precision medicine and thus potential improvements in the cure rate and quality of life of patients. Efforts are underway to assess the global impact of childhood ALL and develop initiatives that can meet the long-term challenge of providing quality care to children with this disease worldwide and improving cure rates globally. This ambitious task will rely on increased collaborative research and international networking so that the therapeutic gains in high-income countries can be translated to patients in low-income and middle-income countries. Ultimately, the greatest obstacle to overcome will be to fully understand leukaemogenesis, enabling measures to decrease the risk of leukaemia development and thus close the last major gap in offering a cure to any child who might have the disease.
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Affiliation(s)
- Ching-Hon Pui
- Department of Oncology, St Jude Children's Research Hospital, University of Tennessee Health Science Center, Memphis, TN, USA.
| | - Jun J Yang
- Department of Pharmaceutical Science, St Jude Children's Research Hospital, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Nickhill Bhakta
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Carlos Rodriguez-Galindo
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, University of Tennessee Health Science Center, Memphis, TN, USA
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Yeoh AEJ, Li Z, Dong D, Lu Y, Jiang N, Trka J, Tan AM, Lin HP, Quah TC, Ariffin H, Wong L. Effective Response Metric: a novel tool to predict relapse in childhood acute lymphoblastic leukaemia using time-series gene expression profiling. Br J Haematol 2018; 181:653-663. [PMID: 29808917 DOI: 10.1111/bjh.15252] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 03/01/2018] [Indexed: 01/08/2023]
Abstract
Accurate risk assignment in childhood acute lymphoblastic leukaemia is essential to avoid under- or over-treatment. We hypothesized that time-series gene expression profiles (GEPs) of bone marrow samples during remission-induction therapy can measure the response and be used for relapse prediction. We computed the time-series changes from diagnosis to Day 8 of remission-induction, termed Effective Response Metric (ERM-D8) and tested its ability to predict relapse against contemporary risk assignment methods, including National Cancer Institutes (NCI) criteria, genetics and minimal residual disease (MRD). ERM-D8 was trained on a set of 131 patients and validated on an independent set of 79 patients. In the independent blinded test set, unfavourable ERM-D8 patients had >3-fold increased risk of relapse compared to favourable ERM-D8 (5-year cumulative incidence of relapse 38·1% vs. 10·6%; P = 2·5 × 10-3 ). ERM-D8 remained predictive of relapse [P = 0·05; Hazard ratio 4·09, 95% confidence interval (CI) 1·03-16·23] after adjusting for NCI criteria, genetics, Day 8 peripheral response and Day 33 MRD. ERM-D8 improved risk stratification in favourable genetics subgroups (P = 0·01) and Day 33 MRD positive patients (P = 1·7 × 10-3 ). We conclude that our novel metric - ERM-D8 - based on time-series GEP after 8 days of remission-induction therapy can independently predict relapse even after adjusting for NCI risk, genetics, Day 8 peripheral blood response and MRD.
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Affiliation(s)
- Allen E-J Yeoh
- Centre for Translational Research in Acute Leukaemia, Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Viva-University Children's Cancer Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Zhenhua Li
- Centre for Translational Research in Acute Leukaemia, Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Viva-University Children's Cancer Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore
| | - Difeng Dong
- School of Computing, National University of Singapore, Singapore
| | - Yi Lu
- Centre for Translational Research in Acute Leukaemia, Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Viva-University Children's Cancer Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore
| | - Nan Jiang
- Centre for Translational Research in Acute Leukaemia, Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Viva-University Children's Cancer Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore
| | - Jan Trka
- 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ah Moy Tan
- Department of Paediatrics, KK Women's & Children's Hospital, Singapore
| | - Hai Peng Lin
- Sime Darby Medical Centre, Subang Jaya, Malaysia
| | - Thuan Chong Quah
- Centre for Translational Research in Acute Leukaemia, Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Viva-University Children's Cancer Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore
| | - Hany Ariffin
- Faculty of Medicine, University of Malaya Cancer Research Institute, University of Malaya, Kuala Lumpur, Malaysia
| | - Limsoon Wong
- School of Computing, National University of Singapore, Singapore
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Preclinical evaluation of NUDT15-guided thiopurine therapy and its effects on toxicity and antileukemic efficacy. Blood 2018; 131:2466-2474. [PMID: 29572377 DOI: 10.1182/blood-2017-11-815506] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 03/14/2018] [Indexed: 01/18/2023] Open
Abstract
Thiopurines (eg, 6-mercaptopurine [MP]) are highly efficacious antileukemic agents, but they are also associated with dose-limiting toxicities. Recent studies by us and others have identified inherited NUDT15 deficiency as a novel genetic cause of thiopurine toxicity, and there is a strong rationale for NUDT15-guided dose individualization to preemptively mitigate adverse effects of these drugs. Using CRISPR-Cas9 genome editing, we established a Nudt15-/- mouse model to evaluate the effectiveness of this strategy in vivo. Across MP dosages, Nudt15-/- mice experienced severe leukopenia, rapid weight loss, earlier death resulting from toxicity, and more bone marrow hypocellularity compared with wild-type mice. Nudt15-/- mice also showed excessive accumulation of a thiopurine active metabolite (ie, DNA-incorporated thioguanine nucleotides [DNA-TG]) in an MP dose-dependent fashion, as a plausible cause of increased toxicity. MP dose reduction effectively normalized systemic exposure to DNA-TG in Nudt15-/- mice and largely eliminated Nudt15 deficiency-mediated toxicity. In 95 children with acute lymphoblastic leukemia, MP dose adjustment also directly led to alteration in DNA-TG levels, the effects of which were proportional to the degree of NUDT15 deficiency. Using leukemia-bearing mice with concordant Nudt15 genotype in leukemia and host, we also confirmed that therapeutic efficacy was preserved in Nudt15-/- mice receiving a reduced MP dose compared with Nudt15+/+ counterparts exposed to a standard dose. In conclusion, we demonstrated that NUDT15 genotype-guided MP dose individualization can preemptively mitigate toxicity without compromising therapeutic efficacy.
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Schrappe M, Bleckmann K, Zimmermann M, Biondi A, Möricke A, Locatelli F, Cario G, Rizzari C, Attarbaschi A, Valsecchi MG, Bartram CR, Barisone E, Niggli F, Niemeyer C, Testi AM, Mann G, Ziino O, Schäfer B, Panzer-Grümayer R, Beier R, Parasole R, Göhring G, Ludwig WD, Casale F, Schlegel PG, Basso G, Conter V. Reduced-Intensity Delayed Intensification in Standard-Risk Pediatric Acute Lymphoblastic Leukemia Defined by Undetectable Minimal Residual Disease: Results of an International Randomized Trial (AIEOP-BFM ALL 2000). J Clin Oncol 2017; 36:244-253. [PMID: 29148893 DOI: 10.1200/jco.2017.74.4946] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Delayed intensification (DI) is an integral part of treatment of childhood acute lymphoblastic leukemia (ALL), but it is associated with relevant toxicity. Therefore, standard-risk patients of trial AIEOP-BFM ALL 2000 (Combination Chemotherapy Based on Risk of Relapse in Treating Young Patients With ALL) were investigated with the specific aim to reduce treatment intensity. Patients and Methods Between July 2000 and July 2006, 1,164 patients (1 to 17 years of age) with standard-risk ALL (defined as the absence of high-risk cytogenetics and undetectable minimal residual disease on days 33 and 78) were randomly assigned to either experimental reduced-intensity DI (protocol III; P-III) or standard DI (protocol II; P-II). Cumulative drug doses of P-III were reduced by 30% for dexamethasone and 50% for vincristine, doxorubicin, and cyclophosphamide, which shortened the treatment duration from 49 to 29 days. The study aimed at noninferiority of reduced-intensity P-III; analyses were performed according to treatment given. Results For P-III and P-II, respectively, the 8-year rate of disease-free survival (± SE) was 89.2 ± 1.3% and 92.3 ± 1.2% ( P = .04); cumulative incidence of relapse, 8.7 ± 1.2% and 6.4 ± 1.1% ( P = .09); and overall survival, 96.1 ± 0.8% and 98.0 ± 0.6% ( P = .06). Patients with ETV6-RUNX1-positive ALL and patients 1 to 6 years of age performed equally well in both arms. The incidence of death during remission was comparable, which indicates equivalent toxicity. The 8-year cumulative incidence rate of secondary malignancies was 1.3 ± 0.5% and 0.6 ± 0.4% for P-III and P-II, respectively ( P = .37). Conclusion Although the criteria used for the standard-risk definition in this trial identified patients with exceptionally good prognosis, reduction of chemotherapy was not successful mainly because of an increased rate of relapse. The data suggest that treatment reduction is feasible in specific subgroups, which underlines the biologic heterogeneity of this cohort selected according to treatment response.
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Affiliation(s)
- Martin Schrappe
- Martin Schrappe, Kirsten Bleckmann, Anja Möricke, and Gunnar Cario, University Hospital Schleswig-Holstein, Campus Kiel, Kiel; Martin Zimmermann and Gudrun Göhring, Hannover Medical School, Hannover; Claus R. Bartram, Institute of Human Genetics, Ruprecht-Karls University, Heidelberg; Charlotte Niemeyer, University of Freiburg, Freiburg; Rita Beier, University Hospital, Essen; Wolf-Dieter Ludwig, HELIOS Medical Center Berlin-Buch, Berlin; Paul-Gerhardt Schlegel, University of Würzburg, Würzburg, Germany; Andrea Biondi, Carmelo Rizzari, Maria Grazia Valsecchi, and Valentino Conter, University of Milano-Bicocca; Andrea Biondi, Carmelo Rizzari, and Valentino Conter, Ospedale San Gerardo, Monza; Franco Locatelli, University of Pavia and Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Pediatrico Bambino Gesù; Anna Maria Testi, University La Sapienza, Rome; Elena Barisone, Regina Margherita Children's Hospital, Turin; Ottavio Ziino, Azienda di Rilievo Nazionale ad Alta Specializzazione Ospedali Civico Di Cristina, Palermo; Rosanna Parasole, Santobono-Pausilipon Children's Hospital; Fiorina Casale, University of Naples, Naples; Giuseppe Basso, University of Padova, Padova, Italy; Andishe Attarbaschi, Georg Mann, and Renate Panzer-Grümayer, St Anna Children's Hospital and Medical University of Vienna, Vienna, Austria; and Felix Niggli and Beat Schäfer, University Hospital Zürich, Zürich, Switzerland
| | - Kirsten Bleckmann
- Martin Schrappe, Kirsten Bleckmann, Anja Möricke, and Gunnar Cario, University Hospital Schleswig-Holstein, Campus Kiel, Kiel; Martin Zimmermann and Gudrun Göhring, Hannover Medical School, Hannover; Claus R. Bartram, Institute of Human Genetics, Ruprecht-Karls University, Heidelberg; Charlotte Niemeyer, University of Freiburg, Freiburg; Rita Beier, University Hospital, Essen; Wolf-Dieter Ludwig, HELIOS Medical Center Berlin-Buch, Berlin; Paul-Gerhardt Schlegel, University of Würzburg, Würzburg, Germany; Andrea Biondi, Carmelo Rizzari, Maria Grazia Valsecchi, and Valentino Conter, University of Milano-Bicocca; Andrea Biondi, Carmelo Rizzari, and Valentino Conter, Ospedale San Gerardo, Monza; Franco Locatelli, University of Pavia and Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Pediatrico Bambino Gesù; Anna Maria Testi, University La Sapienza, Rome; Elena Barisone, Regina Margherita Children's Hospital, Turin; Ottavio Ziino, Azienda di Rilievo Nazionale ad Alta Specializzazione Ospedali Civico Di Cristina, Palermo; Rosanna Parasole, Santobono-Pausilipon Children's Hospital; Fiorina Casale, University of Naples, Naples; Giuseppe Basso, University of Padova, Padova, Italy; Andishe Attarbaschi, Georg Mann, and Renate Panzer-Grümayer, St Anna Children's Hospital and Medical University of Vienna, Vienna, Austria; and Felix Niggli and Beat Schäfer, University Hospital Zürich, Zürich, Switzerland
| | - Martin Zimmermann
- Martin Schrappe, Kirsten Bleckmann, Anja Möricke, and Gunnar Cario, University Hospital Schleswig-Holstein, Campus Kiel, Kiel; Martin Zimmermann and Gudrun Göhring, Hannover Medical School, Hannover; Claus R. Bartram, Institute of Human Genetics, Ruprecht-Karls University, Heidelberg; Charlotte Niemeyer, University of Freiburg, Freiburg; Rita Beier, University Hospital, Essen; Wolf-Dieter Ludwig, HELIOS Medical Center Berlin-Buch, Berlin; Paul-Gerhardt Schlegel, University of Würzburg, Würzburg, Germany; Andrea Biondi, Carmelo Rizzari, Maria Grazia Valsecchi, and Valentino Conter, University of Milano-Bicocca; Andrea Biondi, Carmelo Rizzari, and Valentino Conter, Ospedale San Gerardo, Monza; Franco Locatelli, University of Pavia and Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Pediatrico Bambino Gesù; Anna Maria Testi, University La Sapienza, Rome; Elena Barisone, Regina Margherita Children's Hospital, Turin; Ottavio Ziino, Azienda di Rilievo Nazionale ad Alta Specializzazione Ospedali Civico Di Cristina, Palermo; Rosanna Parasole, Santobono-Pausilipon Children's Hospital; Fiorina Casale, University of Naples, Naples; Giuseppe Basso, University of Padova, Padova, Italy; Andishe Attarbaschi, Georg Mann, and Renate Panzer-Grümayer, St Anna Children's Hospital and Medical University of Vienna, Vienna, Austria; and Felix Niggli and Beat Schäfer, University Hospital Zürich, Zürich, Switzerland
| | - Andrea Biondi
- Martin Schrappe, Kirsten Bleckmann, Anja Möricke, and Gunnar Cario, University Hospital Schleswig-Holstein, Campus Kiel, Kiel; Martin Zimmermann and Gudrun Göhring, Hannover Medical School, Hannover; Claus R. Bartram, Institute of Human Genetics, Ruprecht-Karls University, Heidelberg; Charlotte Niemeyer, University of Freiburg, Freiburg; Rita Beier, University Hospital, Essen; Wolf-Dieter Ludwig, HELIOS Medical Center Berlin-Buch, Berlin; Paul-Gerhardt Schlegel, University of Würzburg, Würzburg, Germany; Andrea Biondi, Carmelo Rizzari, Maria Grazia Valsecchi, and Valentino Conter, University of Milano-Bicocca; Andrea Biondi, Carmelo Rizzari, and Valentino Conter, Ospedale San Gerardo, Monza; Franco Locatelli, University of Pavia and Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Pediatrico Bambino Gesù; Anna Maria Testi, University La Sapienza, Rome; Elena Barisone, Regina Margherita Children's Hospital, Turin; Ottavio Ziino, Azienda di Rilievo Nazionale ad Alta Specializzazione Ospedali Civico Di Cristina, Palermo; Rosanna Parasole, Santobono-Pausilipon Children's Hospital; Fiorina Casale, University of Naples, Naples; Giuseppe Basso, University of Padova, Padova, Italy; Andishe Attarbaschi, Georg Mann, and Renate Panzer-Grümayer, St Anna Children's Hospital and Medical University of Vienna, Vienna, Austria; and Felix Niggli and Beat Schäfer, University Hospital Zürich, Zürich, Switzerland
| | - Anja Möricke
- Martin Schrappe, Kirsten Bleckmann, Anja Möricke, and Gunnar Cario, University Hospital Schleswig-Holstein, Campus Kiel, Kiel; Martin Zimmermann and Gudrun Göhring, Hannover Medical School, Hannover; Claus R. Bartram, Institute of Human Genetics, Ruprecht-Karls University, Heidelberg; Charlotte Niemeyer, University of Freiburg, Freiburg; Rita Beier, University Hospital, Essen; Wolf-Dieter Ludwig, HELIOS Medical Center Berlin-Buch, Berlin; Paul-Gerhardt Schlegel, University of Würzburg, Würzburg, Germany; Andrea Biondi, Carmelo Rizzari, Maria Grazia Valsecchi, and Valentino Conter, University of Milano-Bicocca; Andrea Biondi, Carmelo Rizzari, and Valentino Conter, Ospedale San Gerardo, Monza; Franco Locatelli, University of Pavia and Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Pediatrico Bambino Gesù; Anna Maria Testi, University La Sapienza, Rome; Elena Barisone, Regina Margherita Children's Hospital, Turin; Ottavio Ziino, Azienda di Rilievo Nazionale ad Alta Specializzazione Ospedali Civico Di Cristina, Palermo; Rosanna Parasole, Santobono-Pausilipon Children's Hospital; Fiorina Casale, University of Naples, Naples; Giuseppe Basso, University of Padova, Padova, Italy; Andishe Attarbaschi, Georg Mann, and Renate Panzer-Grümayer, St Anna Children's Hospital and Medical University of Vienna, Vienna, Austria; and Felix Niggli and Beat Schäfer, University Hospital Zürich, Zürich, Switzerland
| | - Franco Locatelli
- Martin Schrappe, Kirsten Bleckmann, Anja Möricke, and Gunnar Cario, University Hospital Schleswig-Holstein, Campus Kiel, Kiel; Martin Zimmermann and Gudrun Göhring, Hannover Medical School, Hannover; Claus R. Bartram, Institute of Human Genetics, Ruprecht-Karls University, Heidelberg; Charlotte Niemeyer, University of Freiburg, Freiburg; Rita Beier, University Hospital, Essen; Wolf-Dieter Ludwig, HELIOS Medical Center Berlin-Buch, Berlin; Paul-Gerhardt Schlegel, University of Würzburg, Würzburg, Germany; Andrea Biondi, Carmelo Rizzari, Maria Grazia Valsecchi, and Valentino Conter, University of Milano-Bicocca; Andrea Biondi, Carmelo Rizzari, and Valentino Conter, Ospedale San Gerardo, Monza; Franco Locatelli, University of Pavia and Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Pediatrico Bambino Gesù; Anna Maria Testi, University La Sapienza, Rome; Elena Barisone, Regina Margherita Children's Hospital, Turin; Ottavio Ziino, Azienda di Rilievo Nazionale ad Alta Specializzazione Ospedali Civico Di Cristina, Palermo; Rosanna Parasole, Santobono-Pausilipon Children's Hospital; Fiorina Casale, University of Naples, Naples; Giuseppe Basso, University of Padova, Padova, Italy; Andishe Attarbaschi, Georg Mann, and Renate Panzer-Grümayer, St Anna Children's Hospital and Medical University of Vienna, Vienna, Austria; and Felix Niggli and Beat Schäfer, University Hospital Zürich, Zürich, Switzerland
| | - Gunnar Cario
- Martin Schrappe, Kirsten Bleckmann, Anja Möricke, and Gunnar Cario, University Hospital Schleswig-Holstein, Campus Kiel, Kiel; Martin Zimmermann and Gudrun Göhring, Hannover Medical School, Hannover; Claus R. Bartram, Institute of Human Genetics, Ruprecht-Karls University, Heidelberg; Charlotte Niemeyer, University of Freiburg, Freiburg; Rita Beier, University Hospital, Essen; Wolf-Dieter Ludwig, HELIOS Medical Center Berlin-Buch, Berlin; Paul-Gerhardt Schlegel, University of Würzburg, Würzburg, Germany; Andrea Biondi, Carmelo Rizzari, Maria Grazia Valsecchi, and Valentino Conter, University of Milano-Bicocca; Andrea Biondi, Carmelo Rizzari, and Valentino Conter, Ospedale San Gerardo, Monza; Franco Locatelli, University of Pavia and Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Pediatrico Bambino Gesù; Anna Maria Testi, University La Sapienza, Rome; Elena Barisone, Regina Margherita Children's Hospital, Turin; Ottavio Ziino, Azienda di Rilievo Nazionale ad Alta Specializzazione Ospedali Civico Di Cristina, Palermo; Rosanna Parasole, Santobono-Pausilipon Children's Hospital; Fiorina Casale, University of Naples, Naples; Giuseppe Basso, University of Padova, Padova, Italy; Andishe Attarbaschi, Georg Mann, and Renate Panzer-Grümayer, St Anna Children's Hospital and Medical University of Vienna, Vienna, Austria; and Felix Niggli and Beat Schäfer, University Hospital Zürich, Zürich, Switzerland
| | - Carmelo Rizzari
- Martin Schrappe, Kirsten Bleckmann, Anja Möricke, and Gunnar Cario, University Hospital Schleswig-Holstein, Campus Kiel, Kiel; Martin Zimmermann and Gudrun Göhring, Hannover Medical School, Hannover; Claus R. Bartram, Institute of Human Genetics, Ruprecht-Karls University, Heidelberg; Charlotte Niemeyer, University of Freiburg, Freiburg; Rita Beier, University Hospital, Essen; Wolf-Dieter Ludwig, HELIOS Medical Center Berlin-Buch, Berlin; Paul-Gerhardt Schlegel, University of Würzburg, Würzburg, Germany; Andrea Biondi, Carmelo Rizzari, Maria Grazia Valsecchi, and Valentino Conter, University of Milano-Bicocca; Andrea Biondi, Carmelo Rizzari, and Valentino Conter, Ospedale San Gerardo, Monza; Franco Locatelli, University of Pavia and Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Pediatrico Bambino Gesù; Anna Maria Testi, University La Sapienza, Rome; Elena Barisone, Regina Margherita Children's Hospital, Turin; Ottavio Ziino, Azienda di Rilievo Nazionale ad Alta Specializzazione Ospedali Civico Di Cristina, Palermo; Rosanna Parasole, Santobono-Pausilipon Children's Hospital; Fiorina Casale, University of Naples, Naples; Giuseppe Basso, University of Padova, Padova, Italy; Andishe Attarbaschi, Georg Mann, and Renate Panzer-Grümayer, St Anna Children's Hospital and Medical University of Vienna, Vienna, Austria; and Felix Niggli and Beat Schäfer, University Hospital Zürich, Zürich, Switzerland
| | - Andishe Attarbaschi
- Martin Schrappe, Kirsten Bleckmann, Anja Möricke, and Gunnar Cario, University Hospital Schleswig-Holstein, Campus Kiel, Kiel; Martin Zimmermann and Gudrun Göhring, Hannover Medical School, Hannover; Claus R. Bartram, Institute of Human Genetics, Ruprecht-Karls University, Heidelberg; Charlotte Niemeyer, University of Freiburg, Freiburg; Rita Beier, University Hospital, Essen; Wolf-Dieter Ludwig, HELIOS Medical Center Berlin-Buch, Berlin; Paul-Gerhardt Schlegel, University of Würzburg, Würzburg, Germany; Andrea Biondi, Carmelo Rizzari, Maria Grazia Valsecchi, and Valentino Conter, University of Milano-Bicocca; Andrea Biondi, Carmelo Rizzari, and Valentino Conter, Ospedale San Gerardo, Monza; Franco Locatelli, University of Pavia and Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Pediatrico Bambino Gesù; Anna Maria Testi, University La Sapienza, Rome; Elena Barisone, Regina Margherita Children's Hospital, Turin; Ottavio Ziino, Azienda di Rilievo Nazionale ad Alta Specializzazione Ospedali Civico Di Cristina, Palermo; Rosanna Parasole, Santobono-Pausilipon Children's Hospital; Fiorina Casale, University of Naples, Naples; Giuseppe Basso, University of Padova, Padova, Italy; Andishe Attarbaschi, Georg Mann, and Renate Panzer-Grümayer, St Anna Children's Hospital and Medical University of Vienna, Vienna, Austria; and Felix Niggli and Beat Schäfer, University Hospital Zürich, Zürich, Switzerland
| | - Maria Grazia Valsecchi
- Martin Schrappe, Kirsten Bleckmann, Anja Möricke, and Gunnar Cario, University Hospital Schleswig-Holstein, Campus Kiel, Kiel; Martin Zimmermann and Gudrun Göhring, Hannover Medical School, Hannover; Claus R. Bartram, Institute of Human Genetics, Ruprecht-Karls University, Heidelberg; Charlotte Niemeyer, University of Freiburg, Freiburg; Rita Beier, University Hospital, Essen; Wolf-Dieter Ludwig, HELIOS Medical Center Berlin-Buch, Berlin; Paul-Gerhardt Schlegel, University of Würzburg, Würzburg, Germany; Andrea Biondi, Carmelo Rizzari, Maria Grazia Valsecchi, and Valentino Conter, University of Milano-Bicocca; Andrea Biondi, Carmelo Rizzari, and Valentino Conter, Ospedale San Gerardo, Monza; Franco Locatelli, University of Pavia and Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Pediatrico Bambino Gesù; Anna Maria Testi, University La Sapienza, Rome; Elena Barisone, Regina Margherita Children's Hospital, Turin; Ottavio Ziino, Azienda di Rilievo Nazionale ad Alta Specializzazione Ospedali Civico Di Cristina, Palermo; Rosanna Parasole, Santobono-Pausilipon Children's Hospital; Fiorina Casale, University of Naples, Naples; Giuseppe Basso, University of Padova, Padova, Italy; Andishe Attarbaschi, Georg Mann, and Renate Panzer-Grümayer, St Anna Children's Hospital and Medical University of Vienna, Vienna, Austria; and Felix Niggli and Beat Schäfer, University Hospital Zürich, Zürich, Switzerland
| | - Claus R Bartram
- Martin Schrappe, Kirsten Bleckmann, Anja Möricke, and Gunnar Cario, University Hospital Schleswig-Holstein, Campus Kiel, Kiel; Martin Zimmermann and Gudrun Göhring, Hannover Medical School, Hannover; Claus R. Bartram, Institute of Human Genetics, Ruprecht-Karls University, Heidelberg; Charlotte Niemeyer, University of Freiburg, Freiburg; Rita Beier, University Hospital, Essen; Wolf-Dieter Ludwig, HELIOS Medical Center Berlin-Buch, Berlin; Paul-Gerhardt Schlegel, University of Würzburg, Würzburg, Germany; Andrea Biondi, Carmelo Rizzari, Maria Grazia Valsecchi, and Valentino Conter, University of Milano-Bicocca; Andrea Biondi, Carmelo Rizzari, and Valentino Conter, Ospedale San Gerardo, Monza; Franco Locatelli, University of Pavia and Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Pediatrico Bambino Gesù; Anna Maria Testi, University La Sapienza, Rome; Elena Barisone, Regina Margherita Children's Hospital, Turin; Ottavio Ziino, Azienda di Rilievo Nazionale ad Alta Specializzazione Ospedali Civico Di Cristina, Palermo; Rosanna Parasole, Santobono-Pausilipon Children's Hospital; Fiorina Casale, University of Naples, Naples; Giuseppe Basso, University of Padova, Padova, Italy; Andishe Attarbaschi, Georg Mann, and Renate Panzer-Grümayer, St Anna Children's Hospital and Medical University of Vienna, Vienna, Austria; and Felix Niggli and Beat Schäfer, University Hospital Zürich, Zürich, Switzerland
| | - Elena Barisone
- Martin Schrappe, Kirsten Bleckmann, Anja Möricke, and Gunnar Cario, University Hospital Schleswig-Holstein, Campus Kiel, Kiel; Martin Zimmermann and Gudrun Göhring, Hannover Medical School, Hannover; Claus R. Bartram, Institute of Human Genetics, Ruprecht-Karls University, Heidelberg; Charlotte Niemeyer, University of Freiburg, Freiburg; Rita Beier, University Hospital, Essen; Wolf-Dieter Ludwig, HELIOS Medical Center Berlin-Buch, Berlin; Paul-Gerhardt Schlegel, University of Würzburg, Würzburg, Germany; Andrea Biondi, Carmelo Rizzari, Maria Grazia Valsecchi, and Valentino Conter, University of Milano-Bicocca; Andrea Biondi, Carmelo Rizzari, and Valentino Conter, Ospedale San Gerardo, Monza; Franco Locatelli, University of Pavia and Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Pediatrico Bambino Gesù; Anna Maria Testi, University La Sapienza, Rome; Elena Barisone, Regina Margherita Children's Hospital, Turin; Ottavio Ziino, Azienda di Rilievo Nazionale ad Alta Specializzazione Ospedali Civico Di Cristina, Palermo; Rosanna Parasole, Santobono-Pausilipon Children's Hospital; Fiorina Casale, University of Naples, Naples; Giuseppe Basso, University of Padova, Padova, Italy; Andishe Attarbaschi, Georg Mann, and Renate Panzer-Grümayer, St Anna Children's Hospital and Medical University of Vienna, Vienna, Austria; and Felix Niggli and Beat Schäfer, University Hospital Zürich, Zürich, Switzerland
| | - Felix Niggli
- Martin Schrappe, Kirsten Bleckmann, Anja Möricke, and Gunnar Cario, University Hospital Schleswig-Holstein, Campus Kiel, Kiel; Martin Zimmermann and Gudrun Göhring, Hannover Medical School, Hannover; Claus R. Bartram, Institute of Human Genetics, Ruprecht-Karls University, Heidelberg; Charlotte Niemeyer, University of Freiburg, Freiburg; Rita Beier, University Hospital, Essen; Wolf-Dieter Ludwig, HELIOS Medical Center Berlin-Buch, Berlin; Paul-Gerhardt Schlegel, University of Würzburg, Würzburg, Germany; Andrea Biondi, Carmelo Rizzari, Maria Grazia Valsecchi, and Valentino Conter, University of Milano-Bicocca; Andrea Biondi, Carmelo Rizzari, and Valentino Conter, Ospedale San Gerardo, Monza; Franco Locatelli, University of Pavia and Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Pediatrico Bambino Gesù; Anna Maria Testi, University La Sapienza, Rome; Elena Barisone, Regina Margherita Children's Hospital, Turin; Ottavio Ziino, Azienda di Rilievo Nazionale ad Alta Specializzazione Ospedali Civico Di Cristina, Palermo; Rosanna Parasole, Santobono-Pausilipon Children's Hospital; Fiorina Casale, University of Naples, Naples; Giuseppe Basso, University of Padova, Padova, Italy; Andishe Attarbaschi, Georg Mann, and Renate Panzer-Grümayer, St Anna Children's Hospital and Medical University of Vienna, Vienna, Austria; and Felix Niggli and Beat Schäfer, University Hospital Zürich, Zürich, Switzerland
| | - Charlotte Niemeyer
- Martin Schrappe, Kirsten Bleckmann, Anja Möricke, and Gunnar Cario, University Hospital Schleswig-Holstein, Campus Kiel, Kiel; Martin Zimmermann and Gudrun Göhring, Hannover Medical School, Hannover; Claus R. Bartram, Institute of Human Genetics, Ruprecht-Karls University, Heidelberg; Charlotte Niemeyer, University of Freiburg, Freiburg; Rita Beier, University Hospital, Essen; Wolf-Dieter Ludwig, HELIOS Medical Center Berlin-Buch, Berlin; Paul-Gerhardt Schlegel, University of Würzburg, Würzburg, Germany; Andrea Biondi, Carmelo Rizzari, Maria Grazia Valsecchi, and Valentino Conter, University of Milano-Bicocca; Andrea Biondi, Carmelo Rizzari, and Valentino Conter, Ospedale San Gerardo, Monza; Franco Locatelli, University of Pavia and Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Pediatrico Bambino Gesù; Anna Maria Testi, University La Sapienza, Rome; Elena Barisone, Regina Margherita Children's Hospital, Turin; Ottavio Ziino, Azienda di Rilievo Nazionale ad Alta Specializzazione Ospedali Civico Di Cristina, Palermo; Rosanna Parasole, Santobono-Pausilipon Children's Hospital; Fiorina Casale, University of Naples, Naples; Giuseppe Basso, University of Padova, Padova, Italy; Andishe Attarbaschi, Georg Mann, and Renate Panzer-Grümayer, St Anna Children's Hospital and Medical University of Vienna, Vienna, Austria; and Felix Niggli and Beat Schäfer, University Hospital Zürich, Zürich, Switzerland
| | - Anna Maria Testi
- Martin Schrappe, Kirsten Bleckmann, Anja Möricke, and Gunnar Cario, University Hospital Schleswig-Holstein, Campus Kiel, Kiel; Martin Zimmermann and Gudrun Göhring, Hannover Medical School, Hannover; Claus R. Bartram, Institute of Human Genetics, Ruprecht-Karls University, Heidelberg; Charlotte Niemeyer, University of Freiburg, Freiburg; Rita Beier, University Hospital, Essen; Wolf-Dieter Ludwig, HELIOS Medical Center Berlin-Buch, Berlin; Paul-Gerhardt Schlegel, University of Würzburg, Würzburg, Germany; Andrea Biondi, Carmelo Rizzari, Maria Grazia Valsecchi, and Valentino Conter, University of Milano-Bicocca; Andrea Biondi, Carmelo Rizzari, and Valentino Conter, Ospedale San Gerardo, Monza; Franco Locatelli, University of Pavia and Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Pediatrico Bambino Gesù; Anna Maria Testi, University La Sapienza, Rome; Elena Barisone, Regina Margherita Children's Hospital, Turin; Ottavio Ziino, Azienda di Rilievo Nazionale ad Alta Specializzazione Ospedali Civico Di Cristina, Palermo; Rosanna Parasole, Santobono-Pausilipon Children's Hospital; Fiorina Casale, University of Naples, Naples; Giuseppe Basso, University of Padova, Padova, Italy; Andishe Attarbaschi, Georg Mann, and Renate Panzer-Grümayer, St Anna Children's Hospital and Medical University of Vienna, Vienna, Austria; and Felix Niggli and Beat Schäfer, University Hospital Zürich, Zürich, Switzerland
| | - Georg Mann
- Martin Schrappe, Kirsten Bleckmann, Anja Möricke, and Gunnar Cario, University Hospital Schleswig-Holstein, Campus Kiel, Kiel; Martin Zimmermann and Gudrun Göhring, Hannover Medical School, Hannover; Claus R. Bartram, Institute of Human Genetics, Ruprecht-Karls University, Heidelberg; Charlotte Niemeyer, University of Freiburg, Freiburg; Rita Beier, University Hospital, Essen; Wolf-Dieter Ludwig, HELIOS Medical Center Berlin-Buch, Berlin; Paul-Gerhardt Schlegel, University of Würzburg, Würzburg, Germany; Andrea Biondi, Carmelo Rizzari, Maria Grazia Valsecchi, and Valentino Conter, University of Milano-Bicocca; Andrea Biondi, Carmelo Rizzari, and Valentino Conter, Ospedale San Gerardo, Monza; Franco Locatelli, University of Pavia and Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Pediatrico Bambino Gesù; Anna Maria Testi, University La Sapienza, Rome; Elena Barisone, Regina Margherita Children's Hospital, Turin; Ottavio Ziino, Azienda di Rilievo Nazionale ad Alta Specializzazione Ospedali Civico Di Cristina, Palermo; Rosanna Parasole, Santobono-Pausilipon Children's Hospital; Fiorina Casale, University of Naples, Naples; Giuseppe Basso, University of Padova, Padova, Italy; Andishe Attarbaschi, Georg Mann, and Renate Panzer-Grümayer, St Anna Children's Hospital and Medical University of Vienna, Vienna, Austria; and Felix Niggli and Beat Schäfer, University Hospital Zürich, Zürich, Switzerland
| | - Ottavio Ziino
- Martin Schrappe, Kirsten Bleckmann, Anja Möricke, and Gunnar Cario, University Hospital Schleswig-Holstein, Campus Kiel, Kiel; Martin Zimmermann and Gudrun Göhring, Hannover Medical School, Hannover; Claus R. Bartram, Institute of Human Genetics, Ruprecht-Karls University, Heidelberg; Charlotte Niemeyer, University of Freiburg, Freiburg; Rita Beier, University Hospital, Essen; Wolf-Dieter Ludwig, HELIOS Medical Center Berlin-Buch, Berlin; Paul-Gerhardt Schlegel, University of Würzburg, Würzburg, Germany; Andrea Biondi, Carmelo Rizzari, Maria Grazia Valsecchi, and Valentino Conter, University of Milano-Bicocca; Andrea Biondi, Carmelo Rizzari, and Valentino Conter, Ospedale San Gerardo, Monza; Franco Locatelli, University of Pavia and Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Pediatrico Bambino Gesù; Anna Maria Testi, University La Sapienza, Rome; Elena Barisone, Regina Margherita Children's Hospital, Turin; Ottavio Ziino, Azienda di Rilievo Nazionale ad Alta Specializzazione Ospedali Civico Di Cristina, Palermo; Rosanna Parasole, Santobono-Pausilipon Children's Hospital; Fiorina Casale, University of Naples, Naples; Giuseppe Basso, University of Padova, Padova, Italy; Andishe Attarbaschi, Georg Mann, and Renate Panzer-Grümayer, St Anna Children's Hospital and Medical University of Vienna, Vienna, Austria; and Felix Niggli and Beat Schäfer, University Hospital Zürich, Zürich, Switzerland
| | - Beat Schäfer
- Martin Schrappe, Kirsten Bleckmann, Anja Möricke, and Gunnar Cario, University Hospital Schleswig-Holstein, Campus Kiel, Kiel; Martin Zimmermann and Gudrun Göhring, Hannover Medical School, Hannover; Claus R. Bartram, Institute of Human Genetics, Ruprecht-Karls University, Heidelberg; Charlotte Niemeyer, University of Freiburg, Freiburg; Rita Beier, University Hospital, Essen; Wolf-Dieter Ludwig, HELIOS Medical Center Berlin-Buch, Berlin; Paul-Gerhardt Schlegel, University of Würzburg, Würzburg, Germany; Andrea Biondi, Carmelo Rizzari, Maria Grazia Valsecchi, and Valentino Conter, University of Milano-Bicocca; Andrea Biondi, Carmelo Rizzari, and Valentino Conter, Ospedale San Gerardo, Monza; Franco Locatelli, University of Pavia and Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Pediatrico Bambino Gesù; Anna Maria Testi, University La Sapienza, Rome; Elena Barisone, Regina Margherita Children's Hospital, Turin; Ottavio Ziino, Azienda di Rilievo Nazionale ad Alta Specializzazione Ospedali Civico Di Cristina, Palermo; Rosanna Parasole, Santobono-Pausilipon Children's Hospital; Fiorina Casale, University of Naples, Naples; Giuseppe Basso, University of Padova, Padova, Italy; Andishe Attarbaschi, Georg Mann, and Renate Panzer-Grümayer, St Anna Children's Hospital and Medical University of Vienna, Vienna, Austria; and Felix Niggli and Beat Schäfer, University Hospital Zürich, Zürich, Switzerland
| | - Renate Panzer-Grümayer
- Martin Schrappe, Kirsten Bleckmann, Anja Möricke, and Gunnar Cario, University Hospital Schleswig-Holstein, Campus Kiel, Kiel; Martin Zimmermann and Gudrun Göhring, Hannover Medical School, Hannover; Claus R. Bartram, Institute of Human Genetics, Ruprecht-Karls University, Heidelberg; Charlotte Niemeyer, University of Freiburg, Freiburg; Rita Beier, University Hospital, Essen; Wolf-Dieter Ludwig, HELIOS Medical Center Berlin-Buch, Berlin; Paul-Gerhardt Schlegel, University of Würzburg, Würzburg, Germany; Andrea Biondi, Carmelo Rizzari, Maria Grazia Valsecchi, and Valentino Conter, University of Milano-Bicocca; Andrea Biondi, Carmelo Rizzari, and Valentino Conter, Ospedale San Gerardo, Monza; Franco Locatelli, University of Pavia and Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Pediatrico Bambino Gesù; Anna Maria Testi, University La Sapienza, Rome; Elena Barisone, Regina Margherita Children's Hospital, Turin; Ottavio Ziino, Azienda di Rilievo Nazionale ad Alta Specializzazione Ospedali Civico Di Cristina, Palermo; Rosanna Parasole, Santobono-Pausilipon Children's Hospital; Fiorina Casale, University of Naples, Naples; Giuseppe Basso, University of Padova, Padova, Italy; Andishe Attarbaschi, Georg Mann, and Renate Panzer-Grümayer, St Anna Children's Hospital and Medical University of Vienna, Vienna, Austria; and Felix Niggli and Beat Schäfer, University Hospital Zürich, Zürich, Switzerland
| | - Rita Beier
- Martin Schrappe, Kirsten Bleckmann, Anja Möricke, and Gunnar Cario, University Hospital Schleswig-Holstein, Campus Kiel, Kiel; Martin Zimmermann and Gudrun Göhring, Hannover Medical School, Hannover; Claus R. Bartram, Institute of Human Genetics, Ruprecht-Karls University, Heidelberg; Charlotte Niemeyer, University of Freiburg, Freiburg; Rita Beier, University Hospital, Essen; Wolf-Dieter Ludwig, HELIOS Medical Center Berlin-Buch, Berlin; Paul-Gerhardt Schlegel, University of Würzburg, Würzburg, Germany; Andrea Biondi, Carmelo Rizzari, Maria Grazia Valsecchi, and Valentino Conter, University of Milano-Bicocca; Andrea Biondi, Carmelo Rizzari, and Valentino Conter, Ospedale San Gerardo, Monza; Franco Locatelli, University of Pavia and Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Pediatrico Bambino Gesù; Anna Maria Testi, University La Sapienza, Rome; Elena Barisone, Regina Margherita Children's Hospital, Turin; Ottavio Ziino, Azienda di Rilievo Nazionale ad Alta Specializzazione Ospedali Civico Di Cristina, Palermo; Rosanna Parasole, Santobono-Pausilipon Children's Hospital; Fiorina Casale, University of Naples, Naples; Giuseppe Basso, University of Padova, Padova, Italy; Andishe Attarbaschi, Georg Mann, and Renate Panzer-Grümayer, St Anna Children's Hospital and Medical University of Vienna, Vienna, Austria; and Felix Niggli and Beat Schäfer, University Hospital Zürich, Zürich, Switzerland
| | - Rosanna Parasole
- Martin Schrappe, Kirsten Bleckmann, Anja Möricke, and Gunnar Cario, University Hospital Schleswig-Holstein, Campus Kiel, Kiel; Martin Zimmermann and Gudrun Göhring, Hannover Medical School, Hannover; Claus R. Bartram, Institute of Human Genetics, Ruprecht-Karls University, Heidelberg; Charlotte Niemeyer, University of Freiburg, Freiburg; Rita Beier, University Hospital, Essen; Wolf-Dieter Ludwig, HELIOS Medical Center Berlin-Buch, Berlin; Paul-Gerhardt Schlegel, University of Würzburg, Würzburg, Germany; Andrea Biondi, Carmelo Rizzari, Maria Grazia Valsecchi, and Valentino Conter, University of Milano-Bicocca; Andrea Biondi, Carmelo Rizzari, and Valentino Conter, Ospedale San Gerardo, Monza; Franco Locatelli, University of Pavia and Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Pediatrico Bambino Gesù; Anna Maria Testi, University La Sapienza, Rome; Elena Barisone, Regina Margherita Children's Hospital, Turin; Ottavio Ziino, Azienda di Rilievo Nazionale ad Alta Specializzazione Ospedali Civico Di Cristina, Palermo; Rosanna Parasole, Santobono-Pausilipon Children's Hospital; Fiorina Casale, University of Naples, Naples; Giuseppe Basso, University of Padova, Padova, Italy; Andishe Attarbaschi, Georg Mann, and Renate Panzer-Grümayer, St Anna Children's Hospital and Medical University of Vienna, Vienna, Austria; and Felix Niggli and Beat Schäfer, University Hospital Zürich, Zürich, Switzerland
| | - Gudrun Göhring
- Martin Schrappe, Kirsten Bleckmann, Anja Möricke, and Gunnar Cario, University Hospital Schleswig-Holstein, Campus Kiel, Kiel; Martin Zimmermann and Gudrun Göhring, Hannover Medical School, Hannover; Claus R. Bartram, Institute of Human Genetics, Ruprecht-Karls University, Heidelberg; Charlotte Niemeyer, University of Freiburg, Freiburg; Rita Beier, University Hospital, Essen; Wolf-Dieter Ludwig, HELIOS Medical Center Berlin-Buch, Berlin; Paul-Gerhardt Schlegel, University of Würzburg, Würzburg, Germany; Andrea Biondi, Carmelo Rizzari, Maria Grazia Valsecchi, and Valentino Conter, University of Milano-Bicocca; Andrea Biondi, Carmelo Rizzari, and Valentino Conter, Ospedale San Gerardo, Monza; Franco Locatelli, University of Pavia and Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Pediatrico Bambino Gesù; Anna Maria Testi, University La Sapienza, Rome; Elena Barisone, Regina Margherita Children's Hospital, Turin; Ottavio Ziino, Azienda di Rilievo Nazionale ad Alta Specializzazione Ospedali Civico Di Cristina, Palermo; Rosanna Parasole, Santobono-Pausilipon Children's Hospital; Fiorina Casale, University of Naples, Naples; Giuseppe Basso, University of Padova, Padova, Italy; Andishe Attarbaschi, Georg Mann, and Renate Panzer-Grümayer, St Anna Children's Hospital and Medical University of Vienna, Vienna, Austria; and Felix Niggli and Beat Schäfer, University Hospital Zürich, Zürich, Switzerland
| | - Wolf-Dieter Ludwig
- Martin Schrappe, Kirsten Bleckmann, Anja Möricke, and Gunnar Cario, University Hospital Schleswig-Holstein, Campus Kiel, Kiel; Martin Zimmermann and Gudrun Göhring, Hannover Medical School, Hannover; Claus R. Bartram, Institute of Human Genetics, Ruprecht-Karls University, Heidelberg; Charlotte Niemeyer, University of Freiburg, Freiburg; Rita Beier, University Hospital, Essen; Wolf-Dieter Ludwig, HELIOS Medical Center Berlin-Buch, Berlin; Paul-Gerhardt Schlegel, University of Würzburg, Würzburg, Germany; Andrea Biondi, Carmelo Rizzari, Maria Grazia Valsecchi, and Valentino Conter, University of Milano-Bicocca; Andrea Biondi, Carmelo Rizzari, and Valentino Conter, Ospedale San Gerardo, Monza; Franco Locatelli, University of Pavia and Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Pediatrico Bambino Gesù; Anna Maria Testi, University La Sapienza, Rome; Elena Barisone, Regina Margherita Children's Hospital, Turin; Ottavio Ziino, Azienda di Rilievo Nazionale ad Alta Specializzazione Ospedali Civico Di Cristina, Palermo; Rosanna Parasole, Santobono-Pausilipon Children's Hospital; Fiorina Casale, University of Naples, Naples; Giuseppe Basso, University of Padova, Padova, Italy; Andishe Attarbaschi, Georg Mann, and Renate Panzer-Grümayer, St Anna Children's Hospital and Medical University of Vienna, Vienna, Austria; and Felix Niggli and Beat Schäfer, University Hospital Zürich, Zürich, Switzerland
| | - Fiorina Casale
- Martin Schrappe, Kirsten Bleckmann, Anja Möricke, and Gunnar Cario, University Hospital Schleswig-Holstein, Campus Kiel, Kiel; Martin Zimmermann and Gudrun Göhring, Hannover Medical School, Hannover; Claus R. Bartram, Institute of Human Genetics, Ruprecht-Karls University, Heidelberg; Charlotte Niemeyer, University of Freiburg, Freiburg; Rita Beier, University Hospital, Essen; Wolf-Dieter Ludwig, HELIOS Medical Center Berlin-Buch, Berlin; Paul-Gerhardt Schlegel, University of Würzburg, Würzburg, Germany; Andrea Biondi, Carmelo Rizzari, Maria Grazia Valsecchi, and Valentino Conter, University of Milano-Bicocca; Andrea Biondi, Carmelo Rizzari, and Valentino Conter, Ospedale San Gerardo, Monza; Franco Locatelli, University of Pavia and Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Pediatrico Bambino Gesù; Anna Maria Testi, University La Sapienza, Rome; Elena Barisone, Regina Margherita Children's Hospital, Turin; Ottavio Ziino, Azienda di Rilievo Nazionale ad Alta Specializzazione Ospedali Civico Di Cristina, Palermo; Rosanna Parasole, Santobono-Pausilipon Children's Hospital; Fiorina Casale, University of Naples, Naples; Giuseppe Basso, University of Padova, Padova, Italy; Andishe Attarbaschi, Georg Mann, and Renate Panzer-Grümayer, St Anna Children's Hospital and Medical University of Vienna, Vienna, Austria; and Felix Niggli and Beat Schäfer, University Hospital Zürich, Zürich, Switzerland
| | - Paul-Gerhardt Schlegel
- Martin Schrappe, Kirsten Bleckmann, Anja Möricke, and Gunnar Cario, University Hospital Schleswig-Holstein, Campus Kiel, Kiel; Martin Zimmermann and Gudrun Göhring, Hannover Medical School, Hannover; Claus R. Bartram, Institute of Human Genetics, Ruprecht-Karls University, Heidelberg; Charlotte Niemeyer, University of Freiburg, Freiburg; Rita Beier, University Hospital, Essen; Wolf-Dieter Ludwig, HELIOS Medical Center Berlin-Buch, Berlin; Paul-Gerhardt Schlegel, University of Würzburg, Würzburg, Germany; Andrea Biondi, Carmelo Rizzari, Maria Grazia Valsecchi, and Valentino Conter, University of Milano-Bicocca; Andrea Biondi, Carmelo Rizzari, and Valentino Conter, Ospedale San Gerardo, Monza; Franco Locatelli, University of Pavia and Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Pediatrico Bambino Gesù; Anna Maria Testi, University La Sapienza, Rome; Elena Barisone, Regina Margherita Children's Hospital, Turin; Ottavio Ziino, Azienda di Rilievo Nazionale ad Alta Specializzazione Ospedali Civico Di Cristina, Palermo; Rosanna Parasole, Santobono-Pausilipon Children's Hospital; Fiorina Casale, University of Naples, Naples; Giuseppe Basso, University of Padova, Padova, Italy; Andishe Attarbaschi, Georg Mann, and Renate Panzer-Grümayer, St Anna Children's Hospital and Medical University of Vienna, Vienna, Austria; and Felix Niggli and Beat Schäfer, University Hospital Zürich, Zürich, Switzerland
| | - Giuseppe Basso
- Martin Schrappe, Kirsten Bleckmann, Anja Möricke, and Gunnar Cario, University Hospital Schleswig-Holstein, Campus Kiel, Kiel; Martin Zimmermann and Gudrun Göhring, Hannover Medical School, Hannover; Claus R. Bartram, Institute of Human Genetics, Ruprecht-Karls University, Heidelberg; Charlotte Niemeyer, University of Freiburg, Freiburg; Rita Beier, University Hospital, Essen; Wolf-Dieter Ludwig, HELIOS Medical Center Berlin-Buch, Berlin; Paul-Gerhardt Schlegel, University of Würzburg, Würzburg, Germany; Andrea Biondi, Carmelo Rizzari, Maria Grazia Valsecchi, and Valentino Conter, University of Milano-Bicocca; Andrea Biondi, Carmelo Rizzari, and Valentino Conter, Ospedale San Gerardo, Monza; Franco Locatelli, University of Pavia and Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Pediatrico Bambino Gesù; Anna Maria Testi, University La Sapienza, Rome; Elena Barisone, Regina Margherita Children's Hospital, Turin; Ottavio Ziino, Azienda di Rilievo Nazionale ad Alta Specializzazione Ospedali Civico Di Cristina, Palermo; Rosanna Parasole, Santobono-Pausilipon Children's Hospital; Fiorina Casale, University of Naples, Naples; Giuseppe Basso, University of Padova, Padova, Italy; Andishe Attarbaschi, Georg Mann, and Renate Panzer-Grümayer, St Anna Children's Hospital and Medical University of Vienna, Vienna, Austria; and Felix Niggli and Beat Schäfer, University Hospital Zürich, Zürich, Switzerland
| | - Valentino Conter
- Martin Schrappe, Kirsten Bleckmann, Anja Möricke, and Gunnar Cario, University Hospital Schleswig-Holstein, Campus Kiel, Kiel; Martin Zimmermann and Gudrun Göhring, Hannover Medical School, Hannover; Claus R. Bartram, Institute of Human Genetics, Ruprecht-Karls University, Heidelberg; Charlotte Niemeyer, University of Freiburg, Freiburg; Rita Beier, University Hospital, Essen; Wolf-Dieter Ludwig, HELIOS Medical Center Berlin-Buch, Berlin; Paul-Gerhardt Schlegel, University of Würzburg, Würzburg, Germany; Andrea Biondi, Carmelo Rizzari, Maria Grazia Valsecchi, and Valentino Conter, University of Milano-Bicocca; Andrea Biondi, Carmelo Rizzari, and Valentino Conter, Ospedale San Gerardo, Monza; Franco Locatelli, University of Pavia and Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Pediatrico Bambino Gesù; Anna Maria Testi, University La Sapienza, Rome; Elena Barisone, Regina Margherita Children's Hospital, Turin; Ottavio Ziino, Azienda di Rilievo Nazionale ad Alta Specializzazione Ospedali Civico Di Cristina, Palermo; Rosanna Parasole, Santobono-Pausilipon Children's Hospital; Fiorina Casale, University of Naples, Naples; Giuseppe Basso, University of Padova, Padova, Italy; Andishe Attarbaschi, Georg Mann, and Renate Panzer-Grümayer, St Anna Children's Hospital and Medical University of Vienna, Vienna, Austria; and Felix Niggli and Beat Schäfer, University Hospital Zürich, Zürich, Switzerland
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Moriyama T, Yang YL, Nishii R, Ariffin H, Liu C, Lin TN, Yang W, Lin DT, Yu CH, Kham S, Pui CH, Evans WE, Jeha S, Relling MV, Yeoh AEJ, Yang JJ. Novel variants in NUDT15 and thiopurine intolerance in children with acute lymphoblastic leukemia from diverse ancestry. Blood 2017; 130:1209-1212. [PMID: 28659275 PMCID: PMC5606007 DOI: 10.1182/blood-2017-05-782383] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 06/20/2017] [Indexed: 12/19/2022] Open
Abstract
Prolonged exposure to thiopurines (eg, mercaptopurine [MP]) is essential for curative therapy in acute lymphoblastic leukemia (ALL), but is also associated with frequent dose-limiting hematopoietic toxicities, which is partly explained by inherited genetic polymorphisms in drug metabolizing enzymes (eg, TPMT). Recently, our group and others identified germ line genetic variants in NUDT15 as another major cause of thiopurine-related myelosuppression, particularly in Asian and Hispanic people. In this article, we describe 3 novel NUDT15 coding variants (p.R34T, p.K35E, and p.G17_V18del) in 5 children with ALL enrolled in frontline protocols in Singapore, Taiwan, and at St. Jude Children's Research Hospital. Patients carrying these variants experienced significant toxicity and reduced tolerance to MP across treatment protocols. Functionally, all 3 variants led to partial to complete loss of NUDT15 nucleotide diphosphatase activity and negatively influenced protein stability. In particular, the p.G17_V18del variant protein showed extremely low thermostability and was completely void of catalytic activity, thus likely to confer a high risk of thiopurine intolerance. This in-frame deletion was only seen in African and European patients, and is the first NUDT15 risk variant identified in non-Asian, non-Hispanic populations. In conclusion, we discovered 3 novel loss-of-function variants in NUDT15 associated with MP toxicity, enabling more comprehensive pharmacogenetics-based thiopurine dose adjustments across diverse populations.
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Affiliation(s)
- Takaya Moriyama
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN
| | - Yung-Li Yang
- Department of Laboratory Medicine and Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Rina Nishii
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Hany Ariffin
- Paediatric Haematology-Oncology Unit, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Chengcheng Liu
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN
| | - Ting-Nien Lin
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN
| | - Wenjian Yang
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN
| | - Dong-Tsamn Lin
- Department of Laboratory Medicine and Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Hsiang Yu
- Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shirley Kham
- National University Cancer Institute, National University Health System, Singapore
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN; and
| | - William E Evans
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN
| | - Sima Jeha
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN; and
| | - Mary V Relling
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN
| | - Allen Eng-Juh Yeoh
- Centre for Translational Research in Acute Leukaemia, Department of Paediatrics, Yong Loo Lin School of Medicine, and
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Jun J Yang
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN
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68
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How do we measure MRD in ALL and how should measurements affect decisions. Re: Treatment and prognosis? Best Pract Res Clin Haematol 2017; 30:237-248. [DOI: 10.1016/j.beha.2017.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 07/03/2017] [Indexed: 12/18/2022]
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Tay CG, Lee VWM, Ong LC, Goh KJ, Ariffin H, Fong CY. Vincristine-induced peripheral neuropathy in survivors of childhood acute lymphoblastic leukaemia. Pediatr Blood Cancer 2017; 64. [PMID: 28139029 DOI: 10.1002/pbc.26471] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 12/09/2016] [Accepted: 12/25/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Vincristine, an essential component of childhood acute lymphoblastic leukaemia (ALL) therapeutic protocols, is associated with dose-dependent neurotoxicity, but its long-term morbidity in treated children has not been clearly elucidated. The aim of this study is to determine the prevalence of vincristine-induced peripheral neuropathy (VIPN) among Malaysian childhood ALL survivors and its impact on motor function and quality of life. PROCEDURE Survivors of childhood ALL aged 4-18 years who had completed chemotherapy for 2 years or more were evaluated for VIPN using both the clinical Total Neuropathy Score (cTNS) and nerve conduction studies. Motor function and quality of life of the survivors were assessed via the Bruininks-Oseretsky Test of Motor Proficiency Brief Form, Second Edition (BOT-2 Brief Form) and the Paediatric Quality of Life version 4.0 Generic Core Scales (PedsQL4.0) questionnaire, respectively. RESULTS One hundred and one survivors with a duration of follow-up ranging from 2.0 to 10.3 years were recruited. Twenty-seven (26.7%) had abnormal cTNS scores and 69 (68.3%) had electrophysiological evidence of neuropathy. Of these, 16 (15.8%) had combined clinical and electrophysiological neuropathy (VIPN). Those previously treated on the intermediate- or high-risk treatment stratification arms had a higher risk of developing VIPN (67.3 vs. 32.7%; odds ratio [OR]: 9.06, 95% confidence interval [CI]: 1.14-71.86; P = 0.014). Survivors with VIPN had significantly lower quality of life scores in the physical (P = 0.024) and social domains (P = 0.039) compared with peers without VIPN, but no association with poorer motor function was observed. CONCLUSIONS Sixteen percent of ALL survivors had VIPN. VIPN should be increasingly recognised as a late effect of chemotherapy, as it significantly affects physical and social function quality of life.
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Affiliation(s)
- Chee Geap Tay
- Division of Paediatric Neurology, Department of Paediatrics, University of Malaya, Kuala Lampur, Malaysia
| | - Vanessa Wan Mun Lee
- Division of Paediatric Neurology, Department of Paediatrics, University of Malaya, Kuala Lampur, Malaysia
| | - Lai Choo Ong
- Division of Paediatric Neurology, Department of Paediatrics, University of Malaya, Kuala Lampur, Malaysia
| | - Khean Jin Goh
- Division of Neurology, Department of Medicine, University of Malaya, Kuala Lampur, Malaysia
| | - Hany Ariffin
- Division of Paediatric Haematology Oncology, Department of Paediatrics, University of Malaya, Kuala Lampur, Malaysia
| | - Choong Yi Fong
- Division of Paediatric Neurology, Department of Paediatrics, University of Malaya, Kuala Lampur, Malaysia
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70
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Meyer C, Burmeister T, Gröger D, Tsaur G, Fechina L, Renneville A, Sutton R, Venn NC, Emerenciano M, Pombo-de-Oliveira MS, Barbieri Blunck C, Almeida Lopes B, Zuna J, Trka J, Ballerini P, Lapillonne H, De Braekeleer M, Cazzaniga G, Corral Abascal L, van der Velden VHJ, Delabesse E, Park TS, Oh SH, Silva MLM, Lund-Aho T, Juvonen V, Moore AS, Heidenreich O, Vormoor J, Zerkalenkova E, Olshanskaya Y, Bueno C, Menendez P, Teigler-Schlegel A, Zur Stadt U, Lentes J, Göhring G, Kustanovich A, Aleinikova O, Schäfer BW, Kubetzko S, Madsen HO, Gruhn B, Duarte X, Gameiro P, Lippert E, Bidet A, Cayuela JM, Clappier E, Alonso CN, Zwaan CM, van den Heuvel-Eibrink MM, Izraeli S, Trakhtenbrot L, Archer P, Hancock J, Möricke A, Alten J, Schrappe M, Stanulla M, Strehl S, Attarbaschi A, Dworzak M, Haas OA, Panzer-Grümayer R, Sedék L, Szczepański T, Caye A, Suarez L, Cavé H, Marschalek R. The MLL recombinome of acute leukemias in 2017. Leukemia 2017; 32:273-284. [PMID: 28701730 PMCID: PMC5808070 DOI: 10.1038/leu.2017.213] [Citation(s) in RCA: 477] [Impact Index Per Article: 68.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/25/2017] [Accepted: 06/21/2017] [Indexed: 12/16/2022]
Abstract
Chromosomal rearrangements of the human MLL/KMT2A gene are associated with infant, pediatric, adult and therapy-induced acute leukemias. Here we present the data obtained from 2345 acute leukemia patients. Genomic breakpoints within the MLL gene and the involved translocation partner genes (TPGs) were determined and 11 novel TPGs were identified. Thus, a total of 135 different MLL rearrangements have been identified so far, of which 94 TPGs are now characterized at the molecular level. In all, 35 out of these 94 TPGs occur recurrently, but only 9 specific gene fusions account for more than 90% of all illegitimate recombinations of the MLL gene. We observed an age-dependent breakpoint shift with breakpoints localizing within MLL intron 11 associated with acute lymphoblastic leukemia and younger patients, while breakpoints in MLL intron 9 predominate in AML or older patients. The molecular characterization of MLL breakpoints suggests different etiologies in the different age groups and allows the correlation of functional domains of the MLL gene with clinical outcome. This study provides a comprehensive analysis of the MLL recombinome in acute leukemia and demonstrates that the establishment of patient-specific chromosomal fusion sites allows the design of specific PCR primers for minimal residual disease analyses for all patients.
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Affiliation(s)
- C Meyer
- Institute of Pharmaceutical Biology/Diagnostic Center of Acute Leukemia (DCAL), Goethe-University, Frankfurt/Main, Germany
| | - T Burmeister
- Charité-Department of Hematology, Oncology and Tumorimmunology, Berlin, Germany
| | - D Gröger
- Charité-Department of Hematology, Oncology and Tumorimmunology, Berlin, Germany
| | - G Tsaur
- Regional Children Hospital 1, Research Institute of Medical Cell Technologies, Pediatric Oncology and Hematology Center, Ural Federal University, Ekaterinburg, Russia
| | - L Fechina
- Regional Children Hospital 1, Research Institute of Medical Cell Technologies, Pediatric Oncology and Hematology Center, Ural Federal University, Ekaterinburg, Russia
| | - A Renneville
- Laboratory of Hematology, Biology and Pathology Center, CHRU of Lille; INSERM, UMR-S 1172, Cancer Research Institute of Lille, Lille, France
| | - R Sutton
- Children's Cancer Institute Australia, Uinversity of NSW Sydney, Sydney, New South Wales, Australia
| | - N C Venn
- Children's Cancer Institute Australia, Uinversity of NSW Sydney, Sydney, New South Wales, Australia
| | - M Emerenciano
- Pediatric Hematology-Oncology Program-Research Center, Instituto Nacional de Cancer Rio de Janeiro, Rio de Janeiro, Brazil
| | - M S Pombo-de-Oliveira
- Pediatric Hematology-Oncology Program-Research Center, Instituto Nacional de Cancer Rio de Janeiro, Rio de Janeiro, Brazil
| | - C Barbieri Blunck
- Pediatric Hematology-Oncology Program-Research Center, Instituto Nacional de Cancer Rio de Janeiro, Rio de Janeiro, Brazil
| | - B Almeida Lopes
- Pediatric Hematology-Oncology Program-Research Center, Instituto Nacional de Cancer Rio de Janeiro, Rio de Janeiro, Brazil
| | - J Zuna
- CLIP, Department of Paediatric Haematology/Oncology, Charles University Prague, 2nd Faculty of Medicine, Prague, Czech Republic
| | - J Trka
- CLIP, Department of Paediatric Haematology/Oncology, Charles University Prague, 2nd Faculty of Medicine, Prague, Czech Republic
| | - P Ballerini
- Biological Hematology, AP-HP A. Trousseau, Pierre et Marie Curie University, Paris, France
| | - H Lapillonne
- Biological Hematology, AP-HP A. Trousseau, Pierre et Marie Curie University, Paris, France
| | - M De Braekeleer
- Université de Bretagne Occidentale, Faculté de Médecine et des Sciences de la Santé, Laboratoire d'Histologie, Embryologie et Cytogénétique & INSERM-U1078, Brest, France
| | - G Cazzaniga
- Centro Ricerca Tettamanti, Clinica Pediatrica Univ. Milano Bicocca, Monza, Italy
| | - L Corral Abascal
- Centro Ricerca Tettamanti, Clinica Pediatrica Univ. Milano Bicocca, Monza, Italy
| | | | - E Delabesse
- CHU Purpan, Laboratoire d'Hématologie, Toulouse, France
| | - T S Park
- Department of Laboratory Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
| | - S H Oh
- Department of Laboratory Medicine, Inje University College of Medicine, Busan, Korea
| | - M L M Silva
- Cytogenetics Department, Bone Marrow Transplantation Unit, National Cancer Institute (INCA), Rio de Janeiro, Brazil
| | - T Lund-Aho
- Laboratory of Clinical Genetics, Fimlab Laboratories, Tampere, Finland
| | - V Juvonen
- Department of Clinical Chemistry and TYKSLAB, University of Turku and Turku University Central Hospital, Turku, Finland
| | - A S Moore
- The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - O Heidenreich
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - J Vormoor
- The Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - E Zerkalenkova
- Dmitry Rogachev National Scientific and Practical Center of Pediatric Hematology, Oncology and Immunology, Moscow
| | - Y Olshanskaya
- Dmitry Rogachev National Scientific and Practical Center of Pediatric Hematology, Oncology and Immunology, Moscow
| | - C Bueno
- Josep Carreras Leukemia Research Institute, Department of Biomedicine, School of Medicine, University of Barcelona, Barcelona, Spain.,CIBER de Cancer (CIBERONC), ISCIII, Madrid, Spain.,Institucio Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - P Menendez
- Josep Carreras Leukemia Research Institute, Department of Biomedicine, School of Medicine, University of Barcelona, Barcelona, Spain.,CIBER de Cancer (CIBERONC), ISCIII, Madrid, Spain.,Institucio Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - A Teigler-Schlegel
- Department of Experimental Pathology and Cytology, Institute of Pathology, Giessen, Germany
| | - U Zur Stadt
- Center for Diagnostic, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - J Lentes
- Department of Human Genetics, Hannover Medical School, Hanover, Germany
| | - G Göhring
- Department of Human Genetics, Hannover Medical School, Hanover, Germany
| | - A Kustanovich
- Belarusian Research Center for Pediatric Oncology, Hematology and Immunology, Minsk, Republic of Belarus
| | - O Aleinikova
- Belarusian Research Center for Pediatric Oncology, Hematology and Immunology, Minsk, Republic of Belarus
| | - B W Schäfer
- Department of Oncology, University Children's Hospital Zurich, Zurich, Switzerland
| | - S Kubetzko
- Department of Oncology, University Children's Hospital Zurich, Zurich, Switzerland
| | - H O Madsen
- Department of Clinical Immunology, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - B Gruhn
- Department of Pediatrics, Jena University Hospital, Jena, Germany
| | - X Duarte
- Department of Pediatrics, Portuguese Institute of Oncology of Lisbon, Lisbon, Portugal
| | - P Gameiro
- Hemato-Oncology Laboratory, UIPM, Portuguese Institute of Oncology of Lisbon, Lisbon, Portugal
| | - E Lippert
- Hématologie Biologique, CHU de Brest and INSERM U1078, Université de Bretagne Occidentale, Brest, France
| | - A Bidet
- Hématologie Biologique, CHU de Brest and INSERM U1078, Université de Bretagne Occidentale, Brest, France
| | - J M Cayuela
- Laboratoire d'hématologie, AP-HP Saint-Louis, Paris Diderot University, Paris, France
| | - E Clappier
- Laboratoire d'hématologie, AP-HP Saint-Louis, Paris Diderot University, Paris, France
| | - C N Alonso
- Hospital Nacional de Pediatría Prof Dr J. P. Garrahan, Servcio de Hemato-Oncología, Buenos Aires, Argentina
| | - C M Zwaan
- Department of Pediatric Oncology/Hematology, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - M M van den Heuvel-Eibrink
- Department of Pediatric Oncology/Hematology, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - S Izraeli
- The Chaim Sheba Medical Center, Department of Pediatric Hemato-Oncology and the Cancer Research Center, Tel Aviv, Israel.,Sackler Medical School Tel Aviv University, Tel Aviv, Israel
| | - L Trakhtenbrot
- The Chaim Sheba Medical Center, Department of Pediatric Hemato-Oncology and the Cancer Research Center, Tel Aviv, Israel.,Sackler Medical School Tel Aviv University, Tel Aviv, Israel
| | - P Archer
- Bristol Genetics Laboratory, Pathology Sciences, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - J Hancock
- Bristol Genetics Laboratory, Pathology Sciences, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - A Möricke
- Department of Pediatrics, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - J Alten
- Department of Pediatrics, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - M Schrappe
- Department of Pediatrics, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - M Stanulla
- Department of Pediatrics, MHH, Hanover, Germany
| | - S Strehl
- Children's Cancer Research Institute and St Anna Children's Hospital, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - A Attarbaschi
- Children's Cancer Research Institute and St Anna Children's Hospital, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - M Dworzak
- Children's Cancer Research Institute and St Anna Children's Hospital, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - O A Haas
- Children's Cancer Research Institute and St Anna Children's Hospital, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - R Panzer-Grümayer
- Children's Cancer Research Institute and St Anna Children's Hospital, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - L Sedék
- Department of Microbiology and Immunology, Medical University of Silesia, Zabrze, Poland
| | - T Szczepański
- Department of Pediatric Hematology and Oncology, Medical University of Silesia, Zabrze, Poland
| | - A Caye
- Department of Genetics, AP-HP Robert Debré, Paris Diderot University, Paris, France
| | - L Suarez
- Department of Genetics, AP-HP Robert Debré, Paris Diderot University, Paris, France
| | - H Cavé
- Department of Genetics, AP-HP Robert Debré, Paris Diderot University, Paris, France
| | - R Marschalek
- Institute of Pharmaceutical Biology/Diagnostic Center of Acute Leukemia (DCAL), Goethe-University, Frankfurt/Main, Germany
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71
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Ariffin H, Azanan MS, Abd Ghafar SS, Oh L, Lau KH, Thirunavakarasu T, Sedan A, Ibrahim K, Chan A, Chin TF, Liew FF, Jeyamogan S, Rosli ES, Baharudin R, Yap TY, Skinner R, Lum SH, Hainaut P. Young adult survivors of childhood acute lymphoblastic leukemia show evidence of chronic inflammation and cellular aging. Cancer 2017; 123:4207-4214. [PMID: 28654149 DOI: 10.1002/cncr.30857] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/28/2017] [Accepted: 05/29/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Large epidemiologic studies have reported the premature onset of age-related conditions, such as ischemic heart disease and diabetes mellitus, in childhood cancer survivors, decades earlier than in their peers. The authors investigated whether young adult survivors of childhood acute lymphoblastic leukemia (ALL) have a biologic phenotype of cellular ageing and chronic inflammation. METHODS Plasma inflammatory cytokines were measured using a cytometric bead array in 87 asymptomatic young adult survivors of childhood ALL (median age, 25 years; age range, 18-35 years) who attended annual follow-up clinic and compared with healthy, age-matched and sex-matched controls. Leukocyte telomere length (LTL) was measured using Southern blot analysis. RESULTS Survivors had significant elevation of plasma interleukin-2 (IL-2), IL-10, IL-17a, and high-sensitivity C-reactive protein levels (all P < .05). A raised high-sensitivity C-reactive protein level (>0.8 mg/dL) was related to increased odds of having metabolic syndrome (odds ratio, 7.256; 95% confidence interval, 1.501-35.074). Survivors also had significantly shorter LTL compared with controls (median, 9866 vs 10,392 base pairs; P = .021). Compared with published data, LTL in survivors was similar to that in healthy individuals aged 20 years older. Survivors who received cranial irradiation had shorter LTL compared with those who had not (P = .013). CONCLUSIONS Asymptomatic young adult survivors of childhood ALL demonstrate a biologic profile of chronic inflammation and telomere attrition, consistent with an early onset of cellular processes that drive accelerated aging. These processes may explain the premature development of age-related chronic conditions in childhood cancer survivors. Understanding their molecular basis may facilitate targeted interventions to disrupt the accelerated aging process and its long-term impact on overall health. Cancer 2017;123:4207-4214. © 2017 American Cancer Society.
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Affiliation(s)
- Hany Ariffin
- Department of Pediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohamad Shafiq Azanan
- Department of Pediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Lixian Oh
- Department of Pediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kee Hie Lau
- Department of Pediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Atiqah Sedan
- Department of Pediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kamariah Ibrahim
- Department of Pediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Adelyne Chan
- Department of Pediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Tong Foh Chin
- Department of Pediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Fong Fong Liew
- Department of Pediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shareni Jeyamogan
- Department of Pediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Erda Syerena Rosli
- Department of Pediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Rashidah Baharudin
- Department of Pediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Tsiao Yi Yap
- Department of Pediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Roderick Skinner
- Department of Pediatric and Adolescent Hematology/Oncology, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals, University of Newcastle, Newcastle, United Kingdom
| | - Su Han Lum
- Department of Pediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Pierre Hainaut
- Institute of Advanced Biosciences, University of Grenoble-Alpes, Grenoble, France
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72
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Lee JW, Cho B. Prognostic factors and treatment of pediatric acute lymphoblastic leukemia. KOREAN JOURNAL OF PEDIATRICS 2017; 60:129-137. [PMID: 28592975 PMCID: PMC5461276 DOI: 10.3345/kjp.2017.60.5.129] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 03/30/2017] [Accepted: 04/11/2017] [Indexed: 12/13/2022]
Abstract
The event-free survival (EFS) for pediatric acute lymphoblastic leukemia (ALL) has shown remarkable improvement in the past several decades. In Korea also, a recent study showed 10-year EFS of 78.5%. Much of the improved outcome for pediatric ALL stems from the accurate identification of prognostic factors, the designation of risk group based on these factors, and treatment of appropriate duration and intensity according to risk group, done within the setting of cooperative clinical trials. The schema of first-line therapy for ALL remains mostly unchanged, although many groups have now reported on the elimination of cranial irradiation in all patients with low rates of central nervous system relapse. Specific high risk subgroups, such as Philadelphia chromosome-positive (Ph+) ALL and infant ALL continue to have significantly lower survival than other ALL patients. The introduction of tyrosine kinase inhibitors into therapy has led to enhanced outcome for Ph+ ALL patients. Infant ALL patients, particularly those with MLL rearrangements, continue to have poor outcome, despite treatment intensification including allogeneic hematopoietic cell transplantation. Relapsed ALL is a leading cause of mortality in pediatric cancer. Recent advances in immunotherapy targeting the CD19 of the ALL blast have shown remarkable efficacy in some of these relapsed and refractory patients. With improved survival, much of the current focus is on decreasing the long-term toxicities of treatment.
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Affiliation(s)
- Jae Wook Lee
- Division of Hematology and Oncology, Department of Pediatrics, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Bin Cho
- Division of Hematology and Oncology, Department of Pediatrics, The Catholic University of Korea, College of Medicine, Seoul, Korea
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73
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Hourigan CS, Gale RP, Gormley NJ, Ossenkoppele GJ, Walter RB. Measurable residual disease testing in acute myeloid leukaemia. Leukemia 2017; 31:1482-1490. [PMID: 28386105 DOI: 10.1038/leu.2017.113] [Citation(s) in RCA: 171] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 03/15/2017] [Accepted: 03/21/2017] [Indexed: 12/24/2022]
Abstract
There is considerable interest in developing techniques to detect and/or quantify remaining leukaemia cells termed measurable or, less precisely, minimal residual disease (MRD) in persons with acute myeloid leukaemia (AML) in complete remission defined by cytomorphological criteria. An important reason for AML MRD-testing is the possibility of estimating the likelihood (and timing) of leukaemia relapse. A perfect MRD-test would precisely quantify leukaemia cells biologically able and likely to cause leukaemia relapse within a defined interval. AML is genetically diverse and there is currently no uniform approach to detecting such cells. Several technologies focused on immune phenotype or cytogenetic and/or molecular abnormalities have been developed, each with advantages and disadvantages. Many studies report a positive MRD-test at diverse time points during AML therapy identifies persons with a higher risk of leukaemia relapse compared with those with a negative MRD-test even after adjusting for other prognostic and predictive variables. No MRD-test in AML has perfect sensitivity and specificity for relapse prediction at the cohort- or subject levels and there are substantial rates of false-positive and -negative tests. Despite these limitations, correlations between MRD-test results and relapse risk have generated interest in MRD-test result-directed therapy interventions. However, convincing proof that a specific intervention will reduce relapse risk in persons with a positive MRD-test is lacking and needs testing in randomized trials. Routine clinical use of MRD-testing requires further refinements and standardization/harmonization of assay platforms and results reporting. Such data are needed to determine whether results of MRD-testing can be used as a surrogate end point in AML therapy trials. This could make drug-testing more efficient and accelerate regulatory approvals. Although MRD-testing in AML has advanced substantially, much remains to be done.
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Affiliation(s)
- C S Hourigan
- Myeloid Malignancies Section, Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - R P Gale
- Haematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, UK
| | - N J Gormley
- Division of Hematology Products, Office of Hematology and Oncology Products, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - G J Ossenkoppele
- Division of Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - R B Walter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
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74
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Campana D, Pui CH. Minimal residual disease-guided therapy in childhood acute lymphoblastic leukemia. Blood 2017; 129:1913-1918. [PMID: 28167658 PMCID: PMC5383866 DOI: 10.1182/blood-2016-12-725804] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 02/01/2017] [Indexed: 12/19/2022] Open
Affiliation(s)
- Dario Campana
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ching-Hon Pui
- Departments of Oncology and Pathology, St. Jude Children's Research Hospital, Memphis, TN; and
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
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75
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Chatterjee T, Somasundaram V. Flow cytometric detection of minimal residual disease in B-lineage acute lymphoblastic leukemia by using "MRD lite" panel. Med J Armed Forces India 2017; 73:54-57. [PMID: 28123246 DOI: 10.1016/j.mjafi.2016.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 10/13/2016] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Normal B lymphoid precursors that express CD19, CD10, and/or CD34 are highly sensitive to corticosteroids and after two weeks of remission-induction therapy, they form less than 0.01% of the bone marrow population. More than 0.01% of such cells indicate minimal residual disease (MRD). MRD "lite" panel uses only three antibodies, namely CD19, CD10, and CD34 for MRD detection in cases of B-lineage acute lymphoblastic leukemia (B-ALL) expressing CD19, CD10, and/or CD34 by flow cytometry. METHODS Fifteen cases of B-ALL were studied for MRD at Day 19 of remission-induction therapy by employing a simplified MRD detection protocol using a 3-color fluorochrome conjugated antibody panel (CD19, CD10, and CD34) on bone marrow aspirate samples. RESULTS All cases at diagnosis expressed CD19, CD10, and CD34. Of fifteen patients, five (33.33%) were MRD negative with less than 0.01% of mononuclear cells and remaining ten cases (66.66%) were MRD positive, with the level of 0.01% to less than 0.1% cells. CONCLUSION The MRD assay used in this study is a simplified method for detecting MRD at Day 19 of remission-induction therapy for B-lineage ALL. This MRD assay is an effective and useful methodology in cases of B-ALL expressing CD19, CD10, and/or CD34 by flow cytometry.
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76
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Qian M, Zhang H, Kham SKY, Liu S, Jiang C, Zhao X, Lu Y, Goodings C, Lin TN, Zhang R, Moriyama T, Yin Z, Li Z, Quah TC, Ariffin H, Tan AM, Shen S, Bhojwani D, Hu S, Chen S, Zheng H, Pui CH, Yeoh AEJ, Yang JJ. Whole-transcriptome sequencing identifies a distinct subtype of acute lymphoblastic leukemia with predominant genomic abnormalities of EP300 and CREBBP. Genome Res 2016; 27:185-195. [PMID: 27903646 PMCID: PMC5287225 DOI: 10.1101/gr.209163.116] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 11/29/2016] [Indexed: 12/30/2022]
Abstract
Chromosomal translocations are a genomic hallmark of many hematologic malignancies. Often as initiating events, these structural abnormalities result in fusion proteins involving transcription factors important for hematopoietic differentiation and/or signaling molecules regulating cell proliferation and cell cycle. In contrast, epigenetic regulator genes are more frequently targeted by somatic sequence mutations, possibly as secondary events to further potentiate leukemogenesis. Through comprehensive whole-transcriptome sequencing of 231 children with acute lymphoblastic leukemia (ALL), we identified 58 putative functional and predominant fusion genes in 54.1% of patients (n = 125), 31 of which have not been reported previously. In particular, we described a distinct ALL subtype with a characteristic gene expression signature predominantly driven by chromosomal rearrangements of the ZNF384 gene with histone acetyltransferases EP300 and CREBBP. ZNF384-rearranged ALL showed significant up-regulation of CLCF1 and BTLA expression, and ZNF384 fusion proteins consistently showed higher activity to promote transcription of these target genes relative to wild-type ZNF384 in vitro. Ectopic expression of EP300-ZNF384 and CREBBP-ZNF384 fusion altered differentiation of mouse hematopoietic stem and progenitor cells and also potentiated oncogenic transformation in vitro. EP300- and CREBBP-ZNF384 fusions resulted in loss of histone lysine acetyltransferase activity in a dominant-negative fashion, with concomitant global reduction of histone acetylation and increased sensitivity of leukemia cells to histone deacetylase inhibitors. In conclusion, our results indicate that gene fusion is a common class of genomic abnormalities in childhood ALL and that recurrent translocations involving EP300 and CREBBP may cause epigenetic deregulation with potential for therapeutic targeting.
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Affiliation(s)
- Maoxiang Qian
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA
| | - Hui Zhang
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA.,Department of Pediatrics, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China, 510120
| | - Shirley Kow-Yin Kham
- Centre for Translational Research in Acute Leukaemia, Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117599
| | - Shuguang Liu
- Beijing Key Laboratory of Pediatric Hematology Oncology, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, Beijing, China, 100045
| | - Chuang Jiang
- School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China, 200240
| | - Xujie Zhao
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA
| | - Yi Lu
- Centre for Translational Research in Acute Leukaemia, Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117599
| | - Charnise Goodings
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA
| | - Ting-Nien Lin
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA
| | - Ranran Zhang
- Department of Pediatrics, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China, 510120
| | - Takaya Moriyama
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA
| | - Zhaohong Yin
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA
| | - Zhenhua Li
- Centre for Translational Research in Acute Leukaemia, Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117599
| | - Thuan Chong Quah
- Centre for Translational Research in Acute Leukaemia, Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117599.,VIVA-University Children's Cancer Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, 119228
| | - Hany Ariffin
- Paediatric Haematology-Oncology Unit, University of Malaya Medical Centre, Kuala Lumpur, Malaysia, 59100
| | - Ah Moy Tan
- KKH-CCF Children's Cancer Centre, Paediatric Haematology & Oncology, KK Women's and Children's Hospital, Singapore, 229899
| | - Shuhong Shen
- Department of Hematology and Oncology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China, 200127
| | - Deepa Bhojwani
- Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, California 90027, USA
| | - Shaoyan Hu
- Department of Hematology & Oncology, Children's Hospital of Soochow University, Suzhou, China, 215025
| | - Suning Chen
- Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou, China, 215006
| | - Huyong Zheng
- Beijing Key Laboratory of Pediatric Hematology Oncology, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, Beijing, China, 100045
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA.,Hematological Malignancies Program, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA
| | - Allen Eng-Juh Yeoh
- Centre for Translational Research in Acute Leukaemia, Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117599.,VIVA-University Children's Cancer Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, 119228
| | - Jun J Yang
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA.,Hematological Malignancies Program, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA
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77
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Sekiya Y, Xu Y, Muramatsu H, Okuno Y, Narita A, Suzuki K, Wang X, Kawashima N, Sakaguchi H, Yoshida N, Hama A, Takahashi Y, Kato K, Kojima S. Clinical utility of next-generation sequencing-based minimal residual disease in paediatric B-cell acute lymphoblastic leukaemia. Br J Haematol 2016; 176:248-257. [DOI: 10.1111/bjh.14420] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 08/22/2016] [Indexed: 01/19/2023]
Affiliation(s)
- Yuko Sekiya
- Department of Pediatrics; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - Yinyan Xu
- Department of Pediatrics; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - Hideki Muramatsu
- Department of Pediatrics; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - Yusuke Okuno
- Department of Pediatrics; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - Atsushi Narita
- Department of Pediatrics; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - Kyogo Suzuki
- Department of Pediatrics; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - Xinan Wang
- Department of Pediatrics; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - Nozomu Kawashima
- Department of Pediatrics; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - Hirotoshi Sakaguchi
- Department of Hematology and Oncology; Children's Medical Center; Japanese Red Cross Nagoya First Hospital; Nagoya Japan
| | - Nao Yoshida
- Department of Hematology and Oncology; Children's Medical Center; Japanese Red Cross Nagoya First Hospital; Nagoya Japan
| | - Asahito Hama
- Department of Pediatrics; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - Yoshiyuki Takahashi
- Department of Pediatrics; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - Koji Kato
- Department of Hematology and Oncology; Children's Medical Center; Japanese Red Cross Nagoya First Hospital; Nagoya Japan
| | - Seiji Kojima
- Department of Pediatrics; Nagoya University Graduate School of Medicine; Nagoya Japan
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78
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Long-term outcome of 6-month maintenance chemotherapy for acute lymphoblastic leukemia in children. Leukemia 2016; 31:580-584. [PMID: 27698447 DOI: 10.1038/leu.2016.274] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 07/29/2016] [Accepted: 09/06/2016] [Indexed: 12/27/2022]
Abstract
In the treatment of childhood acute lymphoblastic leukemia (ALL), excess shortening of maintenance therapy resulted in high relapse rate, as shown by our previous trial, TCCSG L92-13, in which maintenance therapy was terminated at 1 year from initiation of treatment. In this study, we aimed to confirm the long-term outcome of L92-13, and to identify who can or cannot be cured by shorter duration of maintenance therapy. To obtain sentinel cytogenetics information that had been missed before, we performed genetic analysis with genomic microarray and target intron-capture sequencing from diagnostic bone marrow smear. Disease-free survival (DFS) at 10 years from the end of therapy was 66.0±2.8%. Females (n=138) had better DFS (74.6±3.7%) than males (n=142, 57.5±4.2%, P=0.002). Patients with TCF3-PBX1 (n=11) and ETV6-RUNX1 (n=16) had excellent DFS (90.9±8.7% and 93.8±6.1%, respectively), whereas high hyperdiploidy (n=23) was the most unfavorable subgroup, with 56.6±10.3% of DFS. Short duration of therapy can cure more than half of pediatric ALL, especially females, TCF3-PBX1 and ETV6-RUNX1. Our retrospective observations suggest a gender/karyotype inhomogeneity on the impact of brief therapy.
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Clinical impact of minimal residual disease in children with different subtypes of acute lymphoblastic leukemia treated with Response-Adapted therapy. Leukemia 2016; 31:333-339. [PMID: 27560110 PMCID: PMC5288281 DOI: 10.1038/leu.2016.234] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 07/26/2016] [Accepted: 08/04/2016] [Indexed: 01/01/2023]
Abstract
To determine the clinical significance of minimal residual disease (MRD) in patients with prognostically relevant subtypes of childhood acute lymphoblastic leukemia (ALL), we analyzed data from 488 patients treated in St Jude Total Therapy Study XV with treatment intensity based mainly on MRD levels measured during remission induction. MRD levels on day 19 predicted treatment outcome for patients with hyperdiploid >50 ALL, National Cancer Institute (NCI) standard-risk B-ALL or T-cell ALL, while MRD levels on day 46 were prognostic for patients with NCI standard-risk or high-risk B-ALL. Patients with t(12;21)/(ETV6-RUNX1) or hyperdiploidy >50 ALL had the best prognosis; those with a negative MRD on day 19 had a particularly low risk of relapse: 1.9% and 3.8%, respectively. Patients with NCI high-risk B-ALL or T-cell ALL had an inferior outcome; even with undetectable MRD on day 46, cumulative risk of relapse was 12.7% and 15.5%, respectively. Among patients with NCI standard-risk B-ALL, the outcome was intermediate overall but was poor if MRD was ⩾1% on day 19 or MRD was detectable at any level on day 46. Our results indicate that the clinical impact of MRD on treatment outcome in childhood ALL varies considerably according to leukemia subtype and time of measurement.
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Rajagopal R, Abd-Ghafar S, Ganesan D, Bustam Mainudin AZ, Wong KT, Ramli N, Jawin V, Lum SH, Yap TY, Bouffet E, Qaddoumi I, Krishnan S, Ariffin H, Abdullah WA. Challenges of Treating Childhood Medulloblastoma in a Country With Limited Resources: 20 Years of Experience at a Single Tertiary Center in Malaysia. J Glob Oncol 2016; 3:143-156. [PMID: 28717752 PMCID: PMC5493270 DOI: 10.1200/jgo.2015.002659] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Pediatric medulloblastoma (MB) treatment has evolved over the past few decades; however, treating children in countries with limited resources remains challenging. Until now, the literature regarding childhood MB in Malaysia has been nonexistent. Our objectives were to review the demographics and outcome of pediatric MB treated at the University Malaya Medical Center between January 1994 and December 2013 and describe the challenges encountered. METHODS Fifty-one patients with childhood MB were seen at University Malaya Medical Center. Data from 43 patients were analyzed; eight patients were excluded because their families refused treatment after surgery. RESULTS Headache and vomiting were the most common presenting symptoms, and the mean interval between symptom onset and diagnosis was 4 weeks. Fourteen patients presented with metastatic disease. Five-year progression-free survival (± SE) for patients ≥ 3 years old was 41.7% ± 14.2% (95% CI, 21.3% to 81.4%) in the high-risk group and 68.6% ± 18.6% (95% CI, 40.3% to 100%) in the average-risk group, and 5-year overall survival (± SE) in these two groups was 41.7% ± 14.2% (95% CI, 21.3% to 81.4%) and 58.3% ± 18.6% (95% CI, 31.3% to 100%), respectively. Children younger than 3 years old had 5-year progression-free and overall survival rates (± SE) of 47.6% ± 12.1% (95% CI, 28.9% to 78.4%) and 45.6% ± 11.7% (95% CI, 27.6% to 75.5%), respectively. Time to relapse ranged from 4 to 132 months. Most patients who experienced relapse died within 1 year. Febrile neutropenia, hearing loss, and endocrinopathy were the most common treatment-related complications. CONCLUSION The survival rate of childhood MB in Malaysia is inferior to that usually reported in the literature. We postulate that the following factors contribute to this difference: lack of a multidisciplinary neuro-oncology team, limited health care facilities, inconsistent risk assessment, insufficient data in the National Cancer Registry and pathology reports, inadequate long-term follow-up, and cultural beliefs leading to treatment abandonment.
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Affiliation(s)
- Revathi Rajagopal
- , , , , , , , , , , and , University of Malaya; and , University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia; , Hospital for Sick Children, Toronto, Ontario, Canada; and , St Jude Children's Research Hospital, Memphis, TN
| | - Sayyidatul Abd-Ghafar
- , , , , , , , , , , and , University of Malaya; and , University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia; , Hospital for Sick Children, Toronto, Ontario, Canada; and , St Jude Children's Research Hospital, Memphis, TN
| | - Dharmendra Ganesan
- , , , , , , , , , , and , University of Malaya; and , University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia; , Hospital for Sick Children, Toronto, Ontario, Canada; and , St Jude Children's Research Hospital, Memphis, TN
| | - Anita Zarina Bustam Mainudin
- , , , , , , , , , , and , University of Malaya; and , University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia; , Hospital for Sick Children, Toronto, Ontario, Canada; and , St Jude Children's Research Hospital, Memphis, TN
| | - Kum Thong Wong
- , , , , , , , , , , and , University of Malaya; and , University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia; , Hospital for Sick Children, Toronto, Ontario, Canada; and , St Jude Children's Research Hospital, Memphis, TN
| | - Norlisah Ramli
- , , , , , , , , , , and , University of Malaya; and , University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia; , Hospital for Sick Children, Toronto, Ontario, Canada; and , St Jude Children's Research Hospital, Memphis, TN
| | - Vida Jawin
- , , , , , , , , , , and , University of Malaya; and , University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia; , Hospital for Sick Children, Toronto, Ontario, Canada; and , St Jude Children's Research Hospital, Memphis, TN
| | - Su Han Lum
- , , , , , , , , , , and , University of Malaya; and , University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia; , Hospital for Sick Children, Toronto, Ontario, Canada; and , St Jude Children's Research Hospital, Memphis, TN
| | - Tsiao Yi Yap
- , , , , , , , , , , and , University of Malaya; and , University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia; , Hospital for Sick Children, Toronto, Ontario, Canada; and , St Jude Children's Research Hospital, Memphis, TN
| | - Eric Bouffet
- , , , , , , , , , , and , University of Malaya; and , University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia; , Hospital for Sick Children, Toronto, Ontario, Canada; and , St Jude Children's Research Hospital, Memphis, TN
| | - Ibrahim Qaddoumi
- , , , , , , , , , , and , University of Malaya; and , University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia; , Hospital for Sick Children, Toronto, Ontario, Canada; and , St Jude Children's Research Hospital, Memphis, TN
| | - Shekhar Krishnan
- , , , , , , , , , , and , University of Malaya; and , University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia; , Hospital for Sick Children, Toronto, Ontario, Canada; and , St Jude Children's Research Hospital, Memphis, TN
| | - Hany Ariffin
- , , , , , , , , , , and , University of Malaya; and , University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia; , Hospital for Sick Children, Toronto, Ontario, Canada; and , St Jude Children's Research Hospital, Memphis, TN
| | - Wan Ariffin Abdullah
- , , , , , , , , , , and , University of Malaya; and , University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia; , Hospital for Sick Children, Toronto, Ontario, Canada; and , St Jude Children's Research Hospital, Memphis, TN
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Pettit K, Stock W, Walter RB. Incorporating measurable ('minimal') residual disease-directed treatment strategies to optimize outcomes in adults with acute myeloid leukemia. Leuk Lymphoma 2016; 57:1527-33. [PMID: 27269126 DOI: 10.3109/10428194.2016.1160085] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Curative-intent therapy leads to complete remissions in many adults with acute myeloid leukemia (AML), but relapse remains common. Numerous studies have unequivocally demonstrated that the persistence of measurable ('minimal') residual disease (MRD) at the submicroscopic level during morphologic remission identifies patients at high risk of disease recurrence and short survival. This association has provided the impetus to customize anti-leukemia therapy based on MRD data, a strategy that is now routinely pursued in acute promyelocytic leukemia (APL). While it is currently uncertain whether this approach will improve outcomes in AML other than APL, randomized studies have validated MRD-based risk-stratified treatment algorithms in acute lymphoblastic leukemia. Here, we review the available studies examining MRD-directed therapy in AML, appraise their strengths and limitations, and discuss avenues for future investigation.
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Affiliation(s)
- Kristen Pettit
- a Section of Hematology/Oncology and University of Chicago Comprehensive Cancer Center , University of Chicago , Chicago , IL , USA
| | - Wendy Stock
- a Section of Hematology/Oncology and University of Chicago Comprehensive Cancer Center , University of Chicago , Chicago , IL , USA
| | - Roland B Walter
- b Clinical Research Division , Fred Hutchinson Cancer Research Center , Seattle , WA , USA ;,c Department of Medicine, Division of Hematology , University of Washington , Seattle , WA , USA ;,d Department of Epidemiology , University of Washington , Seattle , WA , USA
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Pieters R, de Groot-Kruseman H, Van der Velden V, Fiocco M, van den Berg H, de Bont E, Egeler RM, Hoogerbrugge P, Kaspers G, Van der Schoot E, De Haas V, Van Dongen J. Successful Therapy Reduction and Intensification for Childhood Acute Lymphoblastic Leukemia Based on Minimal Residual Disease Monitoring: Study ALL10 From the Dutch Childhood Oncology Group. J Clin Oncol 2016; 34:2591-601. [PMID: 27269950 DOI: 10.1200/jco.2015.64.6364] [Citation(s) in RCA: 235] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Outcome of childhood acute lymphoblastic leukemia (ALL) improved greatly by intensifying chemotherapy for all patients. Minimal residual disease (MRD) levels during the first months predict outcome and may select patients for therapy reduction or intensification. METHODS Patients 1 to 18 years old with ALL were stratified on the basis of MRD levels after the first and second course of chemotherapy. Thereafter, therapy was substantially reduced in patients with undetectable MRD (standard risk) and intensified in patients with intermediate (medium risk) and high (high risk) levels of MRD. Seven hundred seventy-eight consecutive patients were enrolled. The method of analysis was intention-to-treat. Outcome was compared with historical controls. RESULTS In MRD-based standard-risk patients, the 5-year event-free survival (EFS) rate was 93% (SE 2%), the 5-year survival rate was 99% (SE 1%), and the 5-year cumulative incidence of relapse rate was 6% (SE 2%). The safety upper limit of number of observation years was reached and therapy reduction was declared safe.MRD-based medium-risk patients had a significantly higher 5-year EFS rate (88%, SE 2%) with therapy intensification (including 30 weeks of asparaginase exposure and dexamethasone/vincristine pulses) compared with historical controls (76%, SE 6%). Intensive chemotherapy and stem cell transplantation in MRD-based high-risk patients resulted in a significantly better 5-year EFS rate (78%, SE 8% v 16%, SE 8% in controls). Overall outcome improved significantly (5-year EFS rate 87%, 5-year survival rate 92%, and 5-year cumulative incidence of relapse rate 8%) compared with preceding Dutch Childhood Oncology Group protocols. CONCLUSION Chemotherapy was substantially reduced safely in one-quarter of children with ALL who were selected on the basis of undetectable MRD levels, without jeopardizing the survival rate. Outcomes of patients with intermediate and high levels of MRD improved with therapy intensification.
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Affiliation(s)
- Rob Pieters
- Rob Pieters, Peter Hoogerbrugge, and Gertjan Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Rob Pieters, Hester de Groot-Kruseman, Marta Fiocco, and Valerie De Haas, Dutch Childhood Oncology Group, The Hague; Vincent Van der Velden and Jacques Van Dongen, University Medical Center Rotterdam, Rotterdam; Marta Fiocco, Leiden University, Leiden; Henk van den Berg, Academic Medical Center; Gertjan Kaspers, Free University Hospital Amsterdam; Ellen Van der Schoot, Sanquin Research, Amsterdam; Evelien de Bont, University of Groningen, Groningen, the Netherlands; and R. Maarten Egeler, The Hospital for Sick Children, Toronto, Canada.
| | - Hester de Groot-Kruseman
- Rob Pieters, Peter Hoogerbrugge, and Gertjan Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Rob Pieters, Hester de Groot-Kruseman, Marta Fiocco, and Valerie De Haas, Dutch Childhood Oncology Group, The Hague; Vincent Van der Velden and Jacques Van Dongen, University Medical Center Rotterdam, Rotterdam; Marta Fiocco, Leiden University, Leiden; Henk van den Berg, Academic Medical Center; Gertjan Kaspers, Free University Hospital Amsterdam; Ellen Van der Schoot, Sanquin Research, Amsterdam; Evelien de Bont, University of Groningen, Groningen, the Netherlands; and R. Maarten Egeler, The Hospital for Sick Children, Toronto, Canada
| | - Vincent Van der Velden
- Rob Pieters, Peter Hoogerbrugge, and Gertjan Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Rob Pieters, Hester de Groot-Kruseman, Marta Fiocco, and Valerie De Haas, Dutch Childhood Oncology Group, The Hague; Vincent Van der Velden and Jacques Van Dongen, University Medical Center Rotterdam, Rotterdam; Marta Fiocco, Leiden University, Leiden; Henk van den Berg, Academic Medical Center; Gertjan Kaspers, Free University Hospital Amsterdam; Ellen Van der Schoot, Sanquin Research, Amsterdam; Evelien de Bont, University of Groningen, Groningen, the Netherlands; and R. Maarten Egeler, The Hospital for Sick Children, Toronto, Canada
| | - Marta Fiocco
- Rob Pieters, Peter Hoogerbrugge, and Gertjan Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Rob Pieters, Hester de Groot-Kruseman, Marta Fiocco, and Valerie De Haas, Dutch Childhood Oncology Group, The Hague; Vincent Van der Velden and Jacques Van Dongen, University Medical Center Rotterdam, Rotterdam; Marta Fiocco, Leiden University, Leiden; Henk van den Berg, Academic Medical Center; Gertjan Kaspers, Free University Hospital Amsterdam; Ellen Van der Schoot, Sanquin Research, Amsterdam; Evelien de Bont, University of Groningen, Groningen, the Netherlands; and R. Maarten Egeler, The Hospital for Sick Children, Toronto, Canada
| | - Henk van den Berg
- Rob Pieters, Peter Hoogerbrugge, and Gertjan Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Rob Pieters, Hester de Groot-Kruseman, Marta Fiocco, and Valerie De Haas, Dutch Childhood Oncology Group, The Hague; Vincent Van der Velden and Jacques Van Dongen, University Medical Center Rotterdam, Rotterdam; Marta Fiocco, Leiden University, Leiden; Henk van den Berg, Academic Medical Center; Gertjan Kaspers, Free University Hospital Amsterdam; Ellen Van der Schoot, Sanquin Research, Amsterdam; Evelien de Bont, University of Groningen, Groningen, the Netherlands; and R. Maarten Egeler, The Hospital for Sick Children, Toronto, Canada
| | - Evelien de Bont
- Rob Pieters, Peter Hoogerbrugge, and Gertjan Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Rob Pieters, Hester de Groot-Kruseman, Marta Fiocco, and Valerie De Haas, Dutch Childhood Oncology Group, The Hague; Vincent Van der Velden and Jacques Van Dongen, University Medical Center Rotterdam, Rotterdam; Marta Fiocco, Leiden University, Leiden; Henk van den Berg, Academic Medical Center; Gertjan Kaspers, Free University Hospital Amsterdam; Ellen Van der Schoot, Sanquin Research, Amsterdam; Evelien de Bont, University of Groningen, Groningen, the Netherlands; and R. Maarten Egeler, The Hospital for Sick Children, Toronto, Canada
| | - R Maarten Egeler
- Rob Pieters, Peter Hoogerbrugge, and Gertjan Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Rob Pieters, Hester de Groot-Kruseman, Marta Fiocco, and Valerie De Haas, Dutch Childhood Oncology Group, The Hague; Vincent Van der Velden and Jacques Van Dongen, University Medical Center Rotterdam, Rotterdam; Marta Fiocco, Leiden University, Leiden; Henk van den Berg, Academic Medical Center; Gertjan Kaspers, Free University Hospital Amsterdam; Ellen Van der Schoot, Sanquin Research, Amsterdam; Evelien de Bont, University of Groningen, Groningen, the Netherlands; and R. Maarten Egeler, The Hospital for Sick Children, Toronto, Canada
| | - Peter Hoogerbrugge
- Rob Pieters, Peter Hoogerbrugge, and Gertjan Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Rob Pieters, Hester de Groot-Kruseman, Marta Fiocco, and Valerie De Haas, Dutch Childhood Oncology Group, The Hague; Vincent Van der Velden and Jacques Van Dongen, University Medical Center Rotterdam, Rotterdam; Marta Fiocco, Leiden University, Leiden; Henk van den Berg, Academic Medical Center; Gertjan Kaspers, Free University Hospital Amsterdam; Ellen Van der Schoot, Sanquin Research, Amsterdam; Evelien de Bont, University of Groningen, Groningen, the Netherlands; and R. Maarten Egeler, The Hospital for Sick Children, Toronto, Canada
| | - Gertjan Kaspers
- Rob Pieters, Peter Hoogerbrugge, and Gertjan Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Rob Pieters, Hester de Groot-Kruseman, Marta Fiocco, and Valerie De Haas, Dutch Childhood Oncology Group, The Hague; Vincent Van der Velden and Jacques Van Dongen, University Medical Center Rotterdam, Rotterdam; Marta Fiocco, Leiden University, Leiden; Henk van den Berg, Academic Medical Center; Gertjan Kaspers, Free University Hospital Amsterdam; Ellen Van der Schoot, Sanquin Research, Amsterdam; Evelien de Bont, University of Groningen, Groningen, the Netherlands; and R. Maarten Egeler, The Hospital for Sick Children, Toronto, Canada
| | - Ellen Van der Schoot
- Rob Pieters, Peter Hoogerbrugge, and Gertjan Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Rob Pieters, Hester de Groot-Kruseman, Marta Fiocco, and Valerie De Haas, Dutch Childhood Oncology Group, The Hague; Vincent Van der Velden and Jacques Van Dongen, University Medical Center Rotterdam, Rotterdam; Marta Fiocco, Leiden University, Leiden; Henk van den Berg, Academic Medical Center; Gertjan Kaspers, Free University Hospital Amsterdam; Ellen Van der Schoot, Sanquin Research, Amsterdam; Evelien de Bont, University of Groningen, Groningen, the Netherlands; and R. Maarten Egeler, The Hospital for Sick Children, Toronto, Canada
| | - Valerie De Haas
- Rob Pieters, Peter Hoogerbrugge, and Gertjan Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Rob Pieters, Hester de Groot-Kruseman, Marta Fiocco, and Valerie De Haas, Dutch Childhood Oncology Group, The Hague; Vincent Van der Velden and Jacques Van Dongen, University Medical Center Rotterdam, Rotterdam; Marta Fiocco, Leiden University, Leiden; Henk van den Berg, Academic Medical Center; Gertjan Kaspers, Free University Hospital Amsterdam; Ellen Van der Schoot, Sanquin Research, Amsterdam; Evelien de Bont, University of Groningen, Groningen, the Netherlands; and R. Maarten Egeler, The Hospital for Sick Children, Toronto, Canada
| | - Jacques Van Dongen
- Rob Pieters, Peter Hoogerbrugge, and Gertjan Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Rob Pieters, Hester de Groot-Kruseman, Marta Fiocco, and Valerie De Haas, Dutch Childhood Oncology Group, The Hague; Vincent Van der Velden and Jacques Van Dongen, University Medical Center Rotterdam, Rotterdam; Marta Fiocco, Leiden University, Leiden; Henk van den Berg, Academic Medical Center; Gertjan Kaspers, Free University Hospital Amsterdam; Ellen Van der Schoot, Sanquin Research, Amsterdam; Evelien de Bont, University of Groningen, Groningen, the Netherlands; and R. Maarten Egeler, The Hospital for Sick Children, Toronto, Canada
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Bartram J, Mountjoy E, Brooks T, Hancock J, Williamson H, Wright G, Moppett J, Goulden N, Hubank M. Accurate Sample Assignment in a Multiplexed, Ultrasensitive, High-Throughput Sequencing Assay for Minimal Residual Disease. J Mol Diagn 2016; 18:494-506. [PMID: 27183494 DOI: 10.1016/j.jmoldx.2016.02.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 01/14/2016] [Accepted: 02/01/2016] [Indexed: 10/21/2022] Open
Abstract
High-throughput sequencing (HTS) (next-generation sequencing) of the rearranged Ig and T-cell receptor genes promises to be less expensive and more sensitive than current methods of monitoring minimal residual disease (MRD) in patients with acute lymphoblastic leukemia. However, the adoption of new approaches by clinical laboratories requires careful evaluation of all potential sources of error and the development of strategies to ensure the highest accuracy. Timely and efficient clinical use of HTS platforms will depend on combining multiple samples (multiplexing) in each sequencing run. Here we examine the Ig heavy-chain gene HTS on the Illumina MiSeq platform for MRD. We identify errors associated with multiplexing that could potentially impact the accuracy of MRD analysis. We optimize a strategy that combines high-purity, sequence-optimized oligonucleotides, dual indexing, and an error-aware demultiplexing approach to minimize errors and maximize sensitivity. We present a probability-based, demultiplexing pipeline Error-Aware Demultiplexer that is suitable for all MiSeq strategies and accurately assigns samples to the correct identifier without excessive loss of data. Finally, using controls quantified by digital PCR, we show that HTS-MRD can accurately detect as few as 1 in 10(6) copies of specific leukemic MRD.
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Affiliation(s)
- Jack Bartram
- Genetics and Genomic Medicine Program, Institute of Child Health, University College London, London, United Kingdom; Department of Haematology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Edward Mountjoy
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Tony Brooks
- UCL Genomics Centre, Institute of Child Health, University College London, London, United Kingdom
| | - Jeremy Hancock
- Bristol Genetics Laboratory, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Helen Williamson
- Bristol Genetics Laboratory, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Gary Wright
- Department of Haematology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - John Moppett
- Department of Paediatric Haematology/Oncology, Royal Hospital for Children, Bristol, United Kingdom
| | - Nick Goulden
- Department of Haematology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Mike Hubank
- Genetics and Genomic Medicine Program, Institute of Child Health, University College London, London, United Kingdom; UCL Genomics Centre, Institute of Child Health, University College London, London, United Kingdom.
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84
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Bartram J, Wade R, Vora A, Hancock J, Mitchell C, Kinsey S, Steward C, Moppett J, Goulden N. Excellent outcome of minimal residual disease-defined low-risk patients is sustained with more than 10 years follow-up: results of UK paediatric acute lymphoblastic leukaemia trials 1997-2003. Arch Dis Child 2016; 101:449-54. [PMID: 26865705 DOI: 10.1136/archdischild-2015-309617] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 01/20/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND Minimal residual disease (MRD) is defined as the presence of sub-microscopic levels of leukaemia. Measurement of MRD from bone marrow at the end of induction chemotherapy (day 28) for childhood acute lymphoblastic leukaemia (ALL) can highlight a large group of patients (>40%) with an excellent (>90%) short-term event-free survival (EFS). However, follow-up in recent published trials is relatively short, raising concerns about using this result to infer the safety of further therapy reduction in the future. METHODS We examined MRD data on 225 patients treated on one of three UKALL trials between 1997 and 2003 to assess the long-term (>10 years follow-up) outcome of those patients who had low-risk MRD (<0.01%) at day 28. RESULTS Our pilot data define a cohort of 53% of children with MRD <0.01% at day 28 who have an EFS of 91% and long-term overall survival of 97%. Of 120 patients with day-28 MRD <0.01% and extended follow-up, there was one death due to treatment-related toxicity, one infectious death while in complete remission, and four relapse deaths. CONCLUSIONS The excellent outcome for childhood ALL in patients with MRD <0.01% after induction chemotherapy is sustained for more than 10 years from diagnosis. This supports the potential exploration of further reduction of therapy in this group, in an attempt to reduce treatment-related mortality and late effects.
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Affiliation(s)
- Jack Bartram
- Department of Haematology, Great Ormond Street Hospital for Children, London, UK
| | - Rachel Wade
- Clinical Trial Service Unit, University of Oxford, Oxford, UK
| | - Ajay Vora
- Department of Haematology, Sheffield Children's Hospital, Sheffield, UK
| | - Jeremy Hancock
- Bristol Genetics Laboratory, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Chris Mitchell
- Paediatric Haematology and Oncology, John Radcliffe Hospital, Oxford, UK
| | - Sally Kinsey
- Department of Paediatric Haematology, St James' University Hospital, Leeds, UK
| | - Colin Steward
- Department of Paediatric Haematology/Oncology, Royal Hospital for Children, Bristol, UK
| | - John Moppett
- Department of Paediatric Haematology/Oncology, Royal Hospital for Children, Bristol, UK
| | - Nick Goulden
- Department of Haematology, Great Ormond Street Hospital for Children, London, UK
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85
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Chatterjee T, Mallhi RS, Venkatesan S. Minimal residual disease detection using flow cytometry: Applications in acute leukemia. Med J Armed Forces India 2016; 72:152-6. [PMID: 27257325 DOI: 10.1016/j.mjafi.2016.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 02/12/2016] [Indexed: 11/17/2022] Open
Abstract
Minimal residual disease (MRD) describes disease that can be diagnosed by methodologies other than conventional morphology, and includes molecular methods (like polymerase chain reaction (PCR)) or flow cytometry (FCM). Detection and monitoring of MRD is becoming the standard of care, considering its importance in predicting the treatment outcome. MRD aids in identifying high-risk patients and hence therapy can be intensified in them while deintensification of therapy can prevent long-term sequelae of chemotherapy in low-risk category. FCM is considered as a less labor-intensive and faster MRD technique as compared to PCR although it has its own share of disadvantages. Current immune-based methodologies for detection of MRD depend on establishing leukemia-associated aberrant immunophenotype (LAIP), at diagnosis or relapse and use this information at specified time points for detection of MRD, or apply a standardized panel of antibody combinations for all MRD cases, in a different-from-normal approach. This review highlights MRD detection by FCM and its application in acute leukemia.
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Affiliation(s)
- T Chatterjee
- Commandant, 166 Military Hospital, C/o 56 APO, India
| | - R S Mallhi
- Professor, Department of Immunohaematology & Blood Transfusion, Armed Forces Medical College, Pune 411040, India
| | - S Venkatesan
- Assistant Professor, Department of Pathology, Armed Forces Medical College, Pune 411040, India
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86
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Moriyama T, Nishii R, Perez-Andreu V, Yang W, Klussmann FA, Zhao X, Lin TN, Hoshitsuki K, Nersting J, Kihira K, Hofmann U, Komada Y, Kato M, McCorkle R, Li L, Koh K, Najera CR, Kham SKY, Isobe T, Chen Z, Chiew EKH, Bhojwani D, Jeffries C, Lu Y, Schwab M, Inaba H, Pui CH, Relling MV, Manabe A, Hori H, Schmiegelow K, Yeoh AEJ, Evans WE, Yang JJ. NUDT15 polymorphisms alter thiopurine metabolism and hematopoietic toxicity. Nat Genet 2016; 48:367-73. [PMID: 26878724 DOI: 10.1038/ng.3508] [Citation(s) in RCA: 340] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 01/15/2016] [Indexed: 12/14/2022]
Abstract
Widely used as anticancer and immunosuppressive agents, thiopurines have narrow therapeutic indices owing to frequent toxicities, partly explained by TPMT genetic polymorphisms. Recent studies identified germline NUDT15 variation as another critical determinant of thiopurine intolerance, but the underlying molecular mechanisms and the clinical implications of this pharmacogenetic association remain unknown. In 270 children enrolled in clinical trials for acute lymphoblastic leukemia in Guatemala, Singapore and Japan, we identified four NUDT15 coding variants (p.Arg139Cys, p.Arg139His, p.Val18Ile and p.Val18_Val19insGlyVal) that resulted in 74.4-100% loss of nucleotide diphosphatase activity. Loss-of-function NUDT15 diplotypes were consistently associated with thiopurine intolerance across the three cohorts (P = 0.021, 2.1 × 10(-5) and 0.0054, respectively; meta-analysis P = 4.45 × 10(-8), allelic effect size = -11.5). Mechanistically, NUDT15 inactivated thiopurine metabolites and decreased thiopurine cytotoxicity in vitro, and patients with defective NUDT15 alleles showed excessive levels of thiopurine active metabolites and toxicity. Taken together, these results indicate that a comprehensive pharmacogenetic model integrating NUDT15 variants may inform personalized thiopurine therapy.
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Affiliation(s)
- Takaya Moriyama
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.,Department of Pediatrics, Mie University Graduate School of Medicine, Mie, Japan
| | - Rina Nishii
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.,Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Virginia Perez-Andreu
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Wenjian Yang
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Federico Antillon Klussmann
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala.,Francisco Marroquin Medical School, Guatemala City, Guatemala
| | - Xujie Zhao
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Ting-Nien Lin
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Keito Hoshitsuki
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.,School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jacob Nersting
- Department of Paediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Kentaro Kihira
- Department of Pediatrics, Mie University Graduate School of Medicine, Mie, Japan
| | - Ute Hofmann
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany.,Department of Clinical Pharmacology, University Hospital Tübingen, Tübingen, Germany
| | - Yoshihiro Komada
- Department of Pediatrics, Mie University Graduate School of Medicine, Mie, Japan
| | - Motohiro Kato
- Department of Pediatric Hematology and Oncology Research, National Center for Child Health and Development, Tokyo, Japan
| | - Robert McCorkle
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Lie Li
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Katsuyoshi Koh
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan
| | | | - Shirley Kow-Yin Kham
- National University Cancer Institute, National University Health System, Singapore
| | - Tomoya Isobe
- Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Zhiwei Chen
- National University Cancer Institute, National University Health System, Singapore
| | | | - Deepa Bhojwani
- Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Cynthia Jeffries
- Department of Chemical Biology and Therapeutics, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Yan Lu
- Department of Chemical Biology and Therapeutics, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Matthias Schwab
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany.,Department of Clinical Pharmacology, University Hospital Tübingen, Tübingen, Germany.,German Cancer Consortium, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Pharmacy and Biochemistry, University of Tübingen, Tübingen, Germany
| | - Hiroto Inaba
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Mary V Relling
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Atsushi Manabe
- Department of Pediatrics, St. Luke's International Hospital, Tokyo, Japan
| | - Hiroki Hori
- Department of Pediatrics, Mie University Graduate School of Medicine, Mie, Japan
| | - Kjeld Schmiegelow
- Department of Paediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Allen E J Yeoh
- National University Cancer Institute, National University Health System, Singapore.,Viva University Children's Cancer Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - William E Evans
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jun J Yang
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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87
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Okamoto Y, Koga Y, Inagaki J, Ozono S, Ueda K, Shimoura M, Itonaga N, Shinkoda Y, Moritake H, Nomura Y, Nakayama H, Hotta N, Hidaka Y, Shimonodan H, Suga N, Tanabe T, Nakashima K, Fukano R, Kawano Y. Effective VCR/DEX pulse maintenance therapy in the KYCCSG ALL-02 protocol for pediatric acute lymphoblastic leukemia. Int J Hematol 2015; 103:202-9. [DOI: 10.1007/s12185-015-1910-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 11/11/2015] [Accepted: 11/12/2015] [Indexed: 11/29/2022]
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88
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Ravandi F, Jorgensen JL, O'Brien SM, Jabbour E, Thomas DA, Borthakur G, Garris R, Huang X, Garcia-Manero G, Burger JA, Ferrajoli A, Wierda W, Kadia T, Jain N, Wang SA, Konoplev S, Kebriaei P, Champlin RE, McCue D, Estrov Z, Cortes JE, Kantarjian HM. Minimal residual disease assessed by multi-parameter flow cytometry is highly prognostic in adult patients with acute lymphoblastic leukaemia. Br J Haematol 2015; 172:392-400. [PMID: 26492205 DOI: 10.1111/bjh.13834] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 09/22/2015] [Indexed: 12/15/2022]
Abstract
The prognostic value of minimal residual disease (MRD) assessed by multi-parameter flow cytometry (MFC) was investigated among 340 adult patients with B-cell acute lymphoblastic leukaemia (B-ALL) treated between 2004 and 2014 using regimens including the hyperCVAD (hyperfractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone, methotrexate, cytarabine) backbone. Among them, 323 (95%) achieved complete remission (CR) and were included in this study. Median age was 52 years (range, 15-84). Median white blood cell count (WBC) was 9·35 × 10(9) /l (range, 0·4-658·1 ×1 0(9) /l). MRD by MFC was initially assessed with a sensitivity of 0·01%, using a 15-marker, 4-colour panel and subsequently a 6-colour panel on bone marrow specimens obtained at CR achievement and at approximately 3 month intervals thereafter. MRD negative status at CR was associated with improved disease-free survival (DFS) and overall survival (OS) (P = 0·004 and P = 0·03, respectively). Similarly, achieving MRD negative status at approximately 3 and 6 months was associated with improved DFS (P = 0·004 and P < 0·0001, respectively) and OS (P = 0·004 and P < 0·0001, respectively). Multivariate analysis including age, WBC at presentation, cytogenetics (standard versus high risk) and MRD status at CR, 3 and 6 months, indicated that MRD negative status at CR was an independent predictor of DFS (P < 0·05). Achievement of an MRD negative state assessed by MFC is an important predictor of DFS and OS in adult patients with ALL.
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Affiliation(s)
- Farhad Ravandi
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey L Jorgensen
- Departments of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Susan M O'Brien
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elias Jabbour
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Deborah A Thomas
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gautam Borthakur
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rebecca Garris
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xuelin Huang
- Departments of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Guillermo Garcia-Manero
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jan A Burger
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alessandra Ferrajoli
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - William Wierda
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tapan Kadia
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nitin Jain
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sa A Wang
- Departments of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sergei Konoplev
- Departments of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Partow Kebriaei
- Departments of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Richard E Champlin
- Departments of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Deborah McCue
- Departments of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Zeev Estrov
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jorge E Cortes
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hagop M Kantarjian
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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89
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Chen SH. Asparaginase Therapy in Pediatric Acute Lymphoblastic Leukemia: A Focus on the Mode of Drug Resistance. Pediatr Neonatol 2015; 56:287-93. [PMID: 25603726 DOI: 10.1016/j.pedneo.2014.10.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 08/28/2014] [Accepted: 10/06/2014] [Indexed: 10/24/2022] Open
Abstract
Asparaginase is one of the most important chemotherapeutic agents against pediatric acute lymphoblastic leukemia (ALL), the most common form of childhood cancer. The therapeutic efficacy (e.g., chemoresistance) and adverse effects of asparaginase (e.g., hypersensivity and pancreatitis) have been investigated over the past four decades. It was suggested early on that leukemic cells are resistant to asparaginase because of their increased asparagine synthetase activity. Afterward, other mechanisms associated with asparaginase resistance were reported. Not only leukemic cells but also patients themselves may play a role in causing asparaginase resistance, which has been associated with unfavorable outcome in children with ALL. This article will briefly review asparaginase therapy in children with ALL and comprehensively analyze recent reports on the potential mechanisms of asparaginase resistance.
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Affiliation(s)
- Shih-Hsiang Chen
- Division of Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, 5 Fu-Shin Street, Kwei-Shan 333, Taoyuan, Taiwan.
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90
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Rodriguez-Galindo C, Friedrich P, Alcasabas P, Antillon F, Banavali S, Castillo L, Israels T, Jeha S, Harif M, Sullivan MJ, Quah TC, Patte C, Pui CH, Barr R, Gross T. Toward the Cure of All Children With Cancer Through Collaborative Efforts: Pediatric Oncology As a Global Challenge. J Clin Oncol 2015; 33:3065-73. [PMID: 26304881 DOI: 10.1200/jco.2014.60.6376] [Citation(s) in RCA: 268] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Advances in the treatment of childhood cancers have resulted in part from the development of national and international collaborative initiatives that have defined biologic determinants and generated risk-adapted therapies that maximize cure while minimizing acute and long-term effects. Currently, more than 80% of children with cancer who are treated with modern multidisciplinary treatments in developed countries are cured; however, of the approximately 160,000 children and adolescents who are diagnosed with cancer every year worldwide, 80% live in low- and middle-income countries (LMICs), where access to quality care is limited and chances of cure are low. In addition, the disease burden is not fully known because of the lack of population-based cancer registries in low-resource countries. Regional and ethnic variations in the incidence of the different childhood cancers suggest unique interactions between genetic and environmental factors that could provide opportunities for etiologic research. Regional collaborative initiatives have been developed in Central and South America and the Caribbean, Africa, the Middle East, Asia, and Oceania. These initiatives integrate regional capacity building, education of health care providers, implementation of intensity-graduated treatments, and establishment of research programs that are adjusted to local capacity and local needs. Together, the existing consortia and regional networks operating in LMICs have the potential to reach out to almost 60% of all children with cancer worldwide. In summary, childhood cancer burden has been shifted toward LMICs and, for that reason, global initiatives directed at pediatric cancer care and control are needed. Regional networks aiming to build capacity while incorporating research on epidemiology, health services, and outcomes should be supported.
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Affiliation(s)
- Carlos Rodriguez-Galindo
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD.
| | - Paola Friedrich
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD
| | - Patricia Alcasabas
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD
| | - Federico Antillon
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD
| | - Shripad Banavali
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD
| | - Luis Castillo
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD
| | - Trijn Israels
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD
| | - Sima Jeha
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD
| | - Mhammed Harif
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD
| | - Michael J Sullivan
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD
| | - Thuan Chong Quah
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD
| | - Catherine Patte
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD
| | - Ching-Hon Pui
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD
| | - Ronald Barr
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD
| | - Thomas Gross
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD
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Pui CH, Yang JJ, Hunger SP, Pieters R, Schrappe M, Biondi A, Vora A, Baruchel A, Silverman LB, Schmiegelow K, Escherich G, Horibe K, Benoit YCM, Izraeli S, Yeoh AEJ, Liang DC, Downing JR, Evans WE, Relling MV, Mullighan CG. Childhood Acute Lymphoblastic Leukemia: Progress Through Collaboration. J Clin Oncol 2015; 33:2938-48. [PMID: 26304874 DOI: 10.1200/jco.2014.59.1636] [Citation(s) in RCA: 635] [Impact Index Per Article: 70.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To review the impact of collaborative studies on advances in the biology and treatment of acute lymphoblastic leukemia (ALL) in children and adolescents. METHODS A review of English literature on childhood ALL focusing on collaborative studies was performed. The resulting article was reviewed and revised by the committee chairs of the major ALL study groups. RESULTS With long-term survival rates for ALL approaching 90% and the advent of high-resolution genome-wide analyses, several international study groups or consortia were established to conduct collaborative research to further improve outcome. As a result, treatment strategies have been improved for several subtypes of ALL, such as infant, MLL-rearranged, Philadelphia chromosome-positive, and Philadelphia chromosome-like ALL. Many recurrent genetic abnormalities that respond to tyrosine kinase inhibitors and multiple genetic determinants of drug resistance and toxicities have been identified to help develop targeted therapy. Several genetic polymorphisms have been recognized that show susceptibility to developing ALL and that help explain the racial/ethnic differences in the incidence of ALL. CONCLUSION The information gained from collaborative studies has helped decipher the heterogeneity of ALL to help improve personalized treatment, which will further advance the current high cure rate and the quality of life for children and adolescents with ALL.
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Affiliation(s)
- Ching-Hon Pui
- Ching-Hon Pui, Jun J. Yang, James R. Downing, Williams E. Evans, Mary V. Relling, and Charles G. Mullighan, St Jude Children's Research Hospital and the University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, University of Colorado School of Medicine and the University of Colorado Cancer Center and Children's Hospital Colorado, Aurora, CO; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Martin Schrappe, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Gabriele Escherich, Clinic of Pediatric Hematology and Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany; Andrea Biondi, Clinica Pediatrica and Centro Ricerca Tettamanti, Università di Milano-Bicocca, Monza, Italy; Ajay Vora, Children's Cancer Group, School of Cancer, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom; André Baruchel, Hôpital Robert Debré and University of Paris Diderot, Paris, France; Lewis B. Silverman, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Kjeld Schmiegelow, Institute of Clinical Medicine, University of Copenhagen and Juliane Marie Centre, the University Hospital Rigshospitalet, Copenhagen, Denmark; Keizo Horibe, Nagoya Medical Center, Clinical Research Center, Nagoya, Japan; Yves C.M. Benoit, Universiteit Gent, Gent, Belgium; Shai Izraeli, Chaim Sheba Medical Center and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel; Allen Eng Juh Yeoh, Yong Loo Lin School of Medicine and Cancer Science Institute, National University of Singapore, and Viva-University Children's Cancer Centre, National University Hospital, Singapore; and Der-Cherng Liang, Mackay Memorial Hospital, Taipei, Taiwan.
| | - Jun J Yang
- Ching-Hon Pui, Jun J. Yang, James R. Downing, Williams E. Evans, Mary V. Relling, and Charles G. Mullighan, St Jude Children's Research Hospital and the University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, University of Colorado School of Medicine and the University of Colorado Cancer Center and Children's Hospital Colorado, Aurora, CO; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Martin Schrappe, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Gabriele Escherich, Clinic of Pediatric Hematology and Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany; Andrea Biondi, Clinica Pediatrica and Centro Ricerca Tettamanti, Università di Milano-Bicocca, Monza, Italy; Ajay Vora, Children's Cancer Group, School of Cancer, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom; André Baruchel, Hôpital Robert Debré and University of Paris Diderot, Paris, France; Lewis B. Silverman, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Kjeld Schmiegelow, Institute of Clinical Medicine, University of Copenhagen and Juliane Marie Centre, the University Hospital Rigshospitalet, Copenhagen, Denmark; Keizo Horibe, Nagoya Medical Center, Clinical Research Center, Nagoya, Japan; Yves C.M. Benoit, Universiteit Gent, Gent, Belgium; Shai Izraeli, Chaim Sheba Medical Center and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel; Allen Eng Juh Yeoh, Yong Loo Lin School of Medicine and Cancer Science Institute, National University of Singapore, and Viva-University Children's Cancer Centre, National University Hospital, Singapore; and Der-Cherng Liang, Mackay Memorial Hospital, Taipei, Taiwan
| | - Stephen P Hunger
- Ching-Hon Pui, Jun J. Yang, James R. Downing, Williams E. Evans, Mary V. Relling, and Charles G. Mullighan, St Jude Children's Research Hospital and the University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, University of Colorado School of Medicine and the University of Colorado Cancer Center and Children's Hospital Colorado, Aurora, CO; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Martin Schrappe, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Gabriele Escherich, Clinic of Pediatric Hematology and Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany; Andrea Biondi, Clinica Pediatrica and Centro Ricerca Tettamanti, Università di Milano-Bicocca, Monza, Italy; Ajay Vora, Children's Cancer Group, School of Cancer, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom; André Baruchel, Hôpital Robert Debré and University of Paris Diderot, Paris, France; Lewis B. Silverman, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Kjeld Schmiegelow, Institute of Clinical Medicine, University of Copenhagen and Juliane Marie Centre, the University Hospital Rigshospitalet, Copenhagen, Denmark; Keizo Horibe, Nagoya Medical Center, Clinical Research Center, Nagoya, Japan; Yves C.M. Benoit, Universiteit Gent, Gent, Belgium; Shai Izraeli, Chaim Sheba Medical Center and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel; Allen Eng Juh Yeoh, Yong Loo Lin School of Medicine and Cancer Science Institute, National University of Singapore, and Viva-University Children's Cancer Centre, National University Hospital, Singapore; and Der-Cherng Liang, Mackay Memorial Hospital, Taipei, Taiwan
| | - Rob Pieters
- Ching-Hon Pui, Jun J. Yang, James R. Downing, Williams E. Evans, Mary V. Relling, and Charles G. Mullighan, St Jude Children's Research Hospital and the University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, University of Colorado School of Medicine and the University of Colorado Cancer Center and Children's Hospital Colorado, Aurora, CO; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Martin Schrappe, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Gabriele Escherich, Clinic of Pediatric Hematology and Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany; Andrea Biondi, Clinica Pediatrica and Centro Ricerca Tettamanti, Università di Milano-Bicocca, Monza, Italy; Ajay Vora, Children's Cancer Group, School of Cancer, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom; André Baruchel, Hôpital Robert Debré and University of Paris Diderot, Paris, France; Lewis B. Silverman, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Kjeld Schmiegelow, Institute of Clinical Medicine, University of Copenhagen and Juliane Marie Centre, the University Hospital Rigshospitalet, Copenhagen, Denmark; Keizo Horibe, Nagoya Medical Center, Clinical Research Center, Nagoya, Japan; Yves C.M. Benoit, Universiteit Gent, Gent, Belgium; Shai Izraeli, Chaim Sheba Medical Center and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel; Allen Eng Juh Yeoh, Yong Loo Lin School of Medicine and Cancer Science Institute, National University of Singapore, and Viva-University Children's Cancer Centre, National University Hospital, Singapore; and Der-Cherng Liang, Mackay Memorial Hospital, Taipei, Taiwan
| | - Martin Schrappe
- Ching-Hon Pui, Jun J. Yang, James R. Downing, Williams E. Evans, Mary V. Relling, and Charles G. Mullighan, St Jude Children's Research Hospital and the University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, University of Colorado School of Medicine and the University of Colorado Cancer Center and Children's Hospital Colorado, Aurora, CO; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Martin Schrappe, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Gabriele Escherich, Clinic of Pediatric Hematology and Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany; Andrea Biondi, Clinica Pediatrica and Centro Ricerca Tettamanti, Università di Milano-Bicocca, Monza, Italy; Ajay Vora, Children's Cancer Group, School of Cancer, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom; André Baruchel, Hôpital Robert Debré and University of Paris Diderot, Paris, France; Lewis B. Silverman, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Kjeld Schmiegelow, Institute of Clinical Medicine, University of Copenhagen and Juliane Marie Centre, the University Hospital Rigshospitalet, Copenhagen, Denmark; Keizo Horibe, Nagoya Medical Center, Clinical Research Center, Nagoya, Japan; Yves C.M. Benoit, Universiteit Gent, Gent, Belgium; Shai Izraeli, Chaim Sheba Medical Center and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel; Allen Eng Juh Yeoh, Yong Loo Lin School of Medicine and Cancer Science Institute, National University of Singapore, and Viva-University Children's Cancer Centre, National University Hospital, Singapore; and Der-Cherng Liang, Mackay Memorial Hospital, Taipei, Taiwan
| | - Andrea Biondi
- Ching-Hon Pui, Jun J. Yang, James R. Downing, Williams E. Evans, Mary V. Relling, and Charles G. Mullighan, St Jude Children's Research Hospital and the University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, University of Colorado School of Medicine and the University of Colorado Cancer Center and Children's Hospital Colorado, Aurora, CO; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Martin Schrappe, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Gabriele Escherich, Clinic of Pediatric Hematology and Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany; Andrea Biondi, Clinica Pediatrica and Centro Ricerca Tettamanti, Università di Milano-Bicocca, Monza, Italy; Ajay Vora, Children's Cancer Group, School of Cancer, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom; André Baruchel, Hôpital Robert Debré and University of Paris Diderot, Paris, France; Lewis B. Silverman, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Kjeld Schmiegelow, Institute of Clinical Medicine, University of Copenhagen and Juliane Marie Centre, the University Hospital Rigshospitalet, Copenhagen, Denmark; Keizo Horibe, Nagoya Medical Center, Clinical Research Center, Nagoya, Japan; Yves C.M. Benoit, Universiteit Gent, Gent, Belgium; Shai Izraeli, Chaim Sheba Medical Center and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel; Allen Eng Juh Yeoh, Yong Loo Lin School of Medicine and Cancer Science Institute, National University of Singapore, and Viva-University Children's Cancer Centre, National University Hospital, Singapore; and Der-Cherng Liang, Mackay Memorial Hospital, Taipei, Taiwan
| | - Ajay Vora
- Ching-Hon Pui, Jun J. Yang, James R. Downing, Williams E. Evans, Mary V. Relling, and Charles G. Mullighan, St Jude Children's Research Hospital and the University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, University of Colorado School of Medicine and the University of Colorado Cancer Center and Children's Hospital Colorado, Aurora, CO; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Martin Schrappe, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Gabriele Escherich, Clinic of Pediatric Hematology and Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany; Andrea Biondi, Clinica Pediatrica and Centro Ricerca Tettamanti, Università di Milano-Bicocca, Monza, Italy; Ajay Vora, Children's Cancer Group, School of Cancer, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom; André Baruchel, Hôpital Robert Debré and University of Paris Diderot, Paris, France; Lewis B. Silverman, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Kjeld Schmiegelow, Institute of Clinical Medicine, University of Copenhagen and Juliane Marie Centre, the University Hospital Rigshospitalet, Copenhagen, Denmark; Keizo Horibe, Nagoya Medical Center, Clinical Research Center, Nagoya, Japan; Yves C.M. Benoit, Universiteit Gent, Gent, Belgium; Shai Izraeli, Chaim Sheba Medical Center and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel; Allen Eng Juh Yeoh, Yong Loo Lin School of Medicine and Cancer Science Institute, National University of Singapore, and Viva-University Children's Cancer Centre, National University Hospital, Singapore; and Der-Cherng Liang, Mackay Memorial Hospital, Taipei, Taiwan
| | - André Baruchel
- Ching-Hon Pui, Jun J. Yang, James R. Downing, Williams E. Evans, Mary V. Relling, and Charles G. Mullighan, St Jude Children's Research Hospital and the University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, University of Colorado School of Medicine and the University of Colorado Cancer Center and Children's Hospital Colorado, Aurora, CO; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Martin Schrappe, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Gabriele Escherich, Clinic of Pediatric Hematology and Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany; Andrea Biondi, Clinica Pediatrica and Centro Ricerca Tettamanti, Università di Milano-Bicocca, Monza, Italy; Ajay Vora, Children's Cancer Group, School of Cancer, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom; André Baruchel, Hôpital Robert Debré and University of Paris Diderot, Paris, France; Lewis B. Silverman, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Kjeld Schmiegelow, Institute of Clinical Medicine, University of Copenhagen and Juliane Marie Centre, the University Hospital Rigshospitalet, Copenhagen, Denmark; Keizo Horibe, Nagoya Medical Center, Clinical Research Center, Nagoya, Japan; Yves C.M. Benoit, Universiteit Gent, Gent, Belgium; Shai Izraeli, Chaim Sheba Medical Center and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel; Allen Eng Juh Yeoh, Yong Loo Lin School of Medicine and Cancer Science Institute, National University of Singapore, and Viva-University Children's Cancer Centre, National University Hospital, Singapore; and Der-Cherng Liang, Mackay Memorial Hospital, Taipei, Taiwan
| | - Lewis B Silverman
- Ching-Hon Pui, Jun J. Yang, James R. Downing, Williams E. Evans, Mary V. Relling, and Charles G. Mullighan, St Jude Children's Research Hospital and the University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, University of Colorado School of Medicine and the University of Colorado Cancer Center and Children's Hospital Colorado, Aurora, CO; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Martin Schrappe, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Gabriele Escherich, Clinic of Pediatric Hematology and Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany; Andrea Biondi, Clinica Pediatrica and Centro Ricerca Tettamanti, Università di Milano-Bicocca, Monza, Italy; Ajay Vora, Children's Cancer Group, School of Cancer, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom; André Baruchel, Hôpital Robert Debré and University of Paris Diderot, Paris, France; Lewis B. Silverman, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Kjeld Schmiegelow, Institute of Clinical Medicine, University of Copenhagen and Juliane Marie Centre, the University Hospital Rigshospitalet, Copenhagen, Denmark; Keizo Horibe, Nagoya Medical Center, Clinical Research Center, Nagoya, Japan; Yves C.M. Benoit, Universiteit Gent, Gent, Belgium; Shai Izraeli, Chaim Sheba Medical Center and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel; Allen Eng Juh Yeoh, Yong Loo Lin School of Medicine and Cancer Science Institute, National University of Singapore, and Viva-University Children's Cancer Centre, National University Hospital, Singapore; and Der-Cherng Liang, Mackay Memorial Hospital, Taipei, Taiwan
| | - Kjeld Schmiegelow
- Ching-Hon Pui, Jun J. Yang, James R. Downing, Williams E. Evans, Mary V. Relling, and Charles G. Mullighan, St Jude Children's Research Hospital and the University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, University of Colorado School of Medicine and the University of Colorado Cancer Center and Children's Hospital Colorado, Aurora, CO; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Martin Schrappe, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Gabriele Escherich, Clinic of Pediatric Hematology and Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany; Andrea Biondi, Clinica Pediatrica and Centro Ricerca Tettamanti, Università di Milano-Bicocca, Monza, Italy; Ajay Vora, Children's Cancer Group, School of Cancer, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom; André Baruchel, Hôpital Robert Debré and University of Paris Diderot, Paris, France; Lewis B. Silverman, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Kjeld Schmiegelow, Institute of Clinical Medicine, University of Copenhagen and Juliane Marie Centre, the University Hospital Rigshospitalet, Copenhagen, Denmark; Keizo Horibe, Nagoya Medical Center, Clinical Research Center, Nagoya, Japan; Yves C.M. Benoit, Universiteit Gent, Gent, Belgium; Shai Izraeli, Chaim Sheba Medical Center and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel; Allen Eng Juh Yeoh, Yong Loo Lin School of Medicine and Cancer Science Institute, National University of Singapore, and Viva-University Children's Cancer Centre, National University Hospital, Singapore; and Der-Cherng Liang, Mackay Memorial Hospital, Taipei, Taiwan
| | - Gabriele Escherich
- Ching-Hon Pui, Jun J. Yang, James R. Downing, Williams E. Evans, Mary V. Relling, and Charles G. Mullighan, St Jude Children's Research Hospital and the University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, University of Colorado School of Medicine and the University of Colorado Cancer Center and Children's Hospital Colorado, Aurora, CO; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Martin Schrappe, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Gabriele Escherich, Clinic of Pediatric Hematology and Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany; Andrea Biondi, Clinica Pediatrica and Centro Ricerca Tettamanti, Università di Milano-Bicocca, Monza, Italy; Ajay Vora, Children's Cancer Group, School of Cancer, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom; André Baruchel, Hôpital Robert Debré and University of Paris Diderot, Paris, France; Lewis B. Silverman, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Kjeld Schmiegelow, Institute of Clinical Medicine, University of Copenhagen and Juliane Marie Centre, the University Hospital Rigshospitalet, Copenhagen, Denmark; Keizo Horibe, Nagoya Medical Center, Clinical Research Center, Nagoya, Japan; Yves C.M. Benoit, Universiteit Gent, Gent, Belgium; Shai Izraeli, Chaim Sheba Medical Center and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel; Allen Eng Juh Yeoh, Yong Loo Lin School of Medicine and Cancer Science Institute, National University of Singapore, and Viva-University Children's Cancer Centre, National University Hospital, Singapore; and Der-Cherng Liang, Mackay Memorial Hospital, Taipei, Taiwan
| | - Keizo Horibe
- Ching-Hon Pui, Jun J. Yang, James R. Downing, Williams E. Evans, Mary V. Relling, and Charles G. Mullighan, St Jude Children's Research Hospital and the University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, University of Colorado School of Medicine and the University of Colorado Cancer Center and Children's Hospital Colorado, Aurora, CO; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Martin Schrappe, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Gabriele Escherich, Clinic of Pediatric Hematology and Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany; Andrea Biondi, Clinica Pediatrica and Centro Ricerca Tettamanti, Università di Milano-Bicocca, Monza, Italy; Ajay Vora, Children's Cancer Group, School of Cancer, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom; André Baruchel, Hôpital Robert Debré and University of Paris Diderot, Paris, France; Lewis B. Silverman, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Kjeld Schmiegelow, Institute of Clinical Medicine, University of Copenhagen and Juliane Marie Centre, the University Hospital Rigshospitalet, Copenhagen, Denmark; Keizo Horibe, Nagoya Medical Center, Clinical Research Center, Nagoya, Japan; Yves C.M. Benoit, Universiteit Gent, Gent, Belgium; Shai Izraeli, Chaim Sheba Medical Center and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel; Allen Eng Juh Yeoh, Yong Loo Lin School of Medicine and Cancer Science Institute, National University of Singapore, and Viva-University Children's Cancer Centre, National University Hospital, Singapore; and Der-Cherng Liang, Mackay Memorial Hospital, Taipei, Taiwan
| | - Yves C M Benoit
- Ching-Hon Pui, Jun J. Yang, James R. Downing, Williams E. Evans, Mary V. Relling, and Charles G. Mullighan, St Jude Children's Research Hospital and the University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, University of Colorado School of Medicine and the University of Colorado Cancer Center and Children's Hospital Colorado, Aurora, CO; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Martin Schrappe, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Gabriele Escherich, Clinic of Pediatric Hematology and Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany; Andrea Biondi, Clinica Pediatrica and Centro Ricerca Tettamanti, Università di Milano-Bicocca, Monza, Italy; Ajay Vora, Children's Cancer Group, School of Cancer, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom; André Baruchel, Hôpital Robert Debré and University of Paris Diderot, Paris, France; Lewis B. Silverman, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Kjeld Schmiegelow, Institute of Clinical Medicine, University of Copenhagen and Juliane Marie Centre, the University Hospital Rigshospitalet, Copenhagen, Denmark; Keizo Horibe, Nagoya Medical Center, Clinical Research Center, Nagoya, Japan; Yves C.M. Benoit, Universiteit Gent, Gent, Belgium; Shai Izraeli, Chaim Sheba Medical Center and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel; Allen Eng Juh Yeoh, Yong Loo Lin School of Medicine and Cancer Science Institute, National University of Singapore, and Viva-University Children's Cancer Centre, National University Hospital, Singapore; and Der-Cherng Liang, Mackay Memorial Hospital, Taipei, Taiwan
| | - Shai Izraeli
- Ching-Hon Pui, Jun J. Yang, James R. Downing, Williams E. Evans, Mary V. Relling, and Charles G. Mullighan, St Jude Children's Research Hospital and the University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, University of Colorado School of Medicine and the University of Colorado Cancer Center and Children's Hospital Colorado, Aurora, CO; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Martin Schrappe, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Gabriele Escherich, Clinic of Pediatric Hematology and Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany; Andrea Biondi, Clinica Pediatrica and Centro Ricerca Tettamanti, Università di Milano-Bicocca, Monza, Italy; Ajay Vora, Children's Cancer Group, School of Cancer, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom; André Baruchel, Hôpital Robert Debré and University of Paris Diderot, Paris, France; Lewis B. Silverman, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Kjeld Schmiegelow, Institute of Clinical Medicine, University of Copenhagen and Juliane Marie Centre, the University Hospital Rigshospitalet, Copenhagen, Denmark; Keizo Horibe, Nagoya Medical Center, Clinical Research Center, Nagoya, Japan; Yves C.M. Benoit, Universiteit Gent, Gent, Belgium; Shai Izraeli, Chaim Sheba Medical Center and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel; Allen Eng Juh Yeoh, Yong Loo Lin School of Medicine and Cancer Science Institute, National University of Singapore, and Viva-University Children's Cancer Centre, National University Hospital, Singapore; and Der-Cherng Liang, Mackay Memorial Hospital, Taipei, Taiwan
| | - Allen Eng Juh Yeoh
- Ching-Hon Pui, Jun J. Yang, James R. Downing, Williams E. Evans, Mary V. Relling, and Charles G. Mullighan, St Jude Children's Research Hospital and the University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, University of Colorado School of Medicine and the University of Colorado Cancer Center and Children's Hospital Colorado, Aurora, CO; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Martin Schrappe, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Gabriele Escherich, Clinic of Pediatric Hematology and Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany; Andrea Biondi, Clinica Pediatrica and Centro Ricerca Tettamanti, Università di Milano-Bicocca, Monza, Italy; Ajay Vora, Children's Cancer Group, School of Cancer, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom; André Baruchel, Hôpital Robert Debré and University of Paris Diderot, Paris, France; Lewis B. Silverman, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Kjeld Schmiegelow, Institute of Clinical Medicine, University of Copenhagen and Juliane Marie Centre, the University Hospital Rigshospitalet, Copenhagen, Denmark; Keizo Horibe, Nagoya Medical Center, Clinical Research Center, Nagoya, Japan; Yves C.M. Benoit, Universiteit Gent, Gent, Belgium; Shai Izraeli, Chaim Sheba Medical Center and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel; Allen Eng Juh Yeoh, Yong Loo Lin School of Medicine and Cancer Science Institute, National University of Singapore, and Viva-University Children's Cancer Centre, National University Hospital, Singapore; and Der-Cherng Liang, Mackay Memorial Hospital, Taipei, Taiwan
| | - Der-Cherng Liang
- Ching-Hon Pui, Jun J. Yang, James R. Downing, Williams E. Evans, Mary V. Relling, and Charles G. Mullighan, St Jude Children's Research Hospital and the University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, University of Colorado School of Medicine and the University of Colorado Cancer Center and Children's Hospital Colorado, Aurora, CO; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Martin Schrappe, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Gabriele Escherich, Clinic of Pediatric Hematology and Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany; Andrea Biondi, Clinica Pediatrica and Centro Ricerca Tettamanti, Università di Milano-Bicocca, Monza, Italy; Ajay Vora, Children's Cancer Group, School of Cancer, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom; André Baruchel, Hôpital Robert Debré and University of Paris Diderot, Paris, France; Lewis B. Silverman, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Kjeld Schmiegelow, Institute of Clinical Medicine, University of Copenhagen and Juliane Marie Centre, the University Hospital Rigshospitalet, Copenhagen, Denmark; Keizo Horibe, Nagoya Medical Center, Clinical Research Center, Nagoya, Japan; Yves C.M. Benoit, Universiteit Gent, Gent, Belgium; Shai Izraeli, Chaim Sheba Medical Center and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel; Allen Eng Juh Yeoh, Yong Loo Lin School of Medicine and Cancer Science Institute, National University of Singapore, and Viva-University Children's Cancer Centre, National University Hospital, Singapore; and Der-Cherng Liang, Mackay Memorial Hospital, Taipei, Taiwan
| | - James R Downing
- Ching-Hon Pui, Jun J. Yang, James R. Downing, Williams E. Evans, Mary V. Relling, and Charles G. Mullighan, St Jude Children's Research Hospital and the University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, University of Colorado School of Medicine and the University of Colorado Cancer Center and Children's Hospital Colorado, Aurora, CO; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Martin Schrappe, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Gabriele Escherich, Clinic of Pediatric Hematology and Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany; Andrea Biondi, Clinica Pediatrica and Centro Ricerca Tettamanti, Università di Milano-Bicocca, Monza, Italy; Ajay Vora, Children's Cancer Group, School of Cancer, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom; André Baruchel, Hôpital Robert Debré and University of Paris Diderot, Paris, France; Lewis B. Silverman, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Kjeld Schmiegelow, Institute of Clinical Medicine, University of Copenhagen and Juliane Marie Centre, the University Hospital Rigshospitalet, Copenhagen, Denmark; Keizo Horibe, Nagoya Medical Center, Clinical Research Center, Nagoya, Japan; Yves C.M. Benoit, Universiteit Gent, Gent, Belgium; Shai Izraeli, Chaim Sheba Medical Center and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel; Allen Eng Juh Yeoh, Yong Loo Lin School of Medicine and Cancer Science Institute, National University of Singapore, and Viva-University Children's Cancer Centre, National University Hospital, Singapore; and Der-Cherng Liang, Mackay Memorial Hospital, Taipei, Taiwan
| | - William E Evans
- Ching-Hon Pui, Jun J. Yang, James R. Downing, Williams E. Evans, Mary V. Relling, and Charles G. Mullighan, St Jude Children's Research Hospital and the University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, University of Colorado School of Medicine and the University of Colorado Cancer Center and Children's Hospital Colorado, Aurora, CO; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Martin Schrappe, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Gabriele Escherich, Clinic of Pediatric Hematology and Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany; Andrea Biondi, Clinica Pediatrica and Centro Ricerca Tettamanti, Università di Milano-Bicocca, Monza, Italy; Ajay Vora, Children's Cancer Group, School of Cancer, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom; André Baruchel, Hôpital Robert Debré and University of Paris Diderot, Paris, France; Lewis B. Silverman, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Kjeld Schmiegelow, Institute of Clinical Medicine, University of Copenhagen and Juliane Marie Centre, the University Hospital Rigshospitalet, Copenhagen, Denmark; Keizo Horibe, Nagoya Medical Center, Clinical Research Center, Nagoya, Japan; Yves C.M. Benoit, Universiteit Gent, Gent, Belgium; Shai Izraeli, Chaim Sheba Medical Center and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel; Allen Eng Juh Yeoh, Yong Loo Lin School of Medicine and Cancer Science Institute, National University of Singapore, and Viva-University Children's Cancer Centre, National University Hospital, Singapore; and Der-Cherng Liang, Mackay Memorial Hospital, Taipei, Taiwan
| | - Mary V Relling
- Ching-Hon Pui, Jun J. Yang, James R. Downing, Williams E. Evans, Mary V. Relling, and Charles G. Mullighan, St Jude Children's Research Hospital and the University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, University of Colorado School of Medicine and the University of Colorado Cancer Center and Children's Hospital Colorado, Aurora, CO; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Martin Schrappe, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Gabriele Escherich, Clinic of Pediatric Hematology and Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany; Andrea Biondi, Clinica Pediatrica and Centro Ricerca Tettamanti, Università di Milano-Bicocca, Monza, Italy; Ajay Vora, Children's Cancer Group, School of Cancer, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom; André Baruchel, Hôpital Robert Debré and University of Paris Diderot, Paris, France; Lewis B. Silverman, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Kjeld Schmiegelow, Institute of Clinical Medicine, University of Copenhagen and Juliane Marie Centre, the University Hospital Rigshospitalet, Copenhagen, Denmark; Keizo Horibe, Nagoya Medical Center, Clinical Research Center, Nagoya, Japan; Yves C.M. Benoit, Universiteit Gent, Gent, Belgium; Shai Izraeli, Chaim Sheba Medical Center and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel; Allen Eng Juh Yeoh, Yong Loo Lin School of Medicine and Cancer Science Institute, National University of Singapore, and Viva-University Children's Cancer Centre, National University Hospital, Singapore; and Der-Cherng Liang, Mackay Memorial Hospital, Taipei, Taiwan
| | - Charles G Mullighan
- Ching-Hon Pui, Jun J. Yang, James R. Downing, Williams E. Evans, Mary V. Relling, and Charles G. Mullighan, St Jude Children's Research Hospital and the University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, University of Colorado School of Medicine and the University of Colorado Cancer Center and Children's Hospital Colorado, Aurora, CO; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Martin Schrappe, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Gabriele Escherich, Clinic of Pediatric Hematology and Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany; Andrea Biondi, Clinica Pediatrica and Centro Ricerca Tettamanti, Università di Milano-Bicocca, Monza, Italy; Ajay Vora, Children's Cancer Group, School of Cancer, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom; André Baruchel, Hôpital Robert Debré and University of Paris Diderot, Paris, France; Lewis B. Silverman, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Kjeld Schmiegelow, Institute of Clinical Medicine, University of Copenhagen and Juliane Marie Centre, the University Hospital Rigshospitalet, Copenhagen, Denmark; Keizo Horibe, Nagoya Medical Center, Clinical Research Center, Nagoya, Japan; Yves C.M. Benoit, Universiteit Gent, Gent, Belgium; Shai Izraeli, Chaim Sheba Medical Center and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel; Allen Eng Juh Yeoh, Yong Loo Lin School of Medicine and Cancer Science Institute, National University of Singapore, and Viva-University Children's Cancer Centre, National University Hospital, Singapore; and Der-Cherng Liang, Mackay Memorial Hospital, Taipei, Taiwan
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Prognostic significance of minimal residual disease in high risk B-ALL: a report from Children's Oncology Group study AALL0232. Blood 2015; 126:964-71. [PMID: 26124497 DOI: 10.1182/blood-2015-03-633685] [Citation(s) in RCA: 249] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 06/12/2015] [Indexed: 12/28/2022] Open
Abstract
Minimal residual disease (MRD) is highly prognostic in pediatric B-precursor acute lymphoblastic leukemia (B-ALL). In Children's Oncology Group high-risk B-ALL study AALL0232, we investigated MRD in subjects randomized in a 2 × 2 factorial design to receive either high-dose methotrexate (HD-MTX) or Capizzi methotrexate (C-MTX) during interim maintenance (IM) or prednisone or dexamethasone during induction. Subjects with end-induction MRD ≥0.1% or those with morphologic slow early response were nonrandomly assigned to receive a second IM and delayed intensification phase. MRD was measured by 6-color flow cytometry in 1 of 2 reference labs, with excellent agreement between the two. Subjects with end-induction MRD <0.01% had a 5-year event-free survival (EFS) of 87% ± 1% vs 74% ± 4% for those with MRD 0.01% to 0.1%; increasing MRD amounts was associated with progressively worse outcome. Subjects converting from MRD positive to negative by end consolidation had a relatively favorable 79% ± 5% 5-year disease-free survival vs 39% ± 7% for those with MRD ≥0.01%. Although HD-MTX was superior to C-MTX, MRD retained prognostic significance in both groups (86% ± 2% vs 58% ± 4% for MRD-negative vs positive C-MTX subjects; 88% ± 2% vs 68% ± 4% for HD-MTX subjects). Intensified therapy given to subjects with MRD >0.1% did not improve either 5-year EFS or overall survival (OS). However, these subjects showed an early relapse rate similar to that seen in MRD-negative ones, with EFS/OS curves for patients with 0.1% to 1% MRD crossing those with 0.01% to 0.1% MRD at 3 and 4 years, thus suggesting that the intensified therapy altered the disease course of MRD-positive subjects. Additional interventions targeted at the MRD-positive group may further improve outcome. This trial was registered at www.clinicaltrials.gov as #NCT00075725.
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Minimal residual disease diagnostics in acute lymphoblastic leukemia: need for sensitive, fast, and standardized technologies. Blood 2015; 125:3996-4009. [PMID: 25999452 DOI: 10.1182/blood-2015-03-580027] [Citation(s) in RCA: 334] [Impact Index Per Article: 37.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 05/10/2015] [Indexed: 12/26/2022] Open
Abstract
Monitoring of minimal residual disease (MRD) has become routine clinical practice in frontline treatment of virtually all childhood acute lymphoblastic leukemia (ALL) and in many adult ALL patients. MRD diagnostics has proven to be the strongest prognostic factor, allowing for risk group assignment into different treatment arms, ranging from significant treatment reduction to mild or strong intensification. Also in relapsed ALL patients and patients undergoing stem cell transplantation, MRD diagnostics is guiding treatment decisions. This is also why the efficacy of innovative drugs, such as antibodies and small molecules, are currently being evaluated with MRD diagnostics within clinical trials. In fact, MRD measurements might well be used as a surrogate end point, thereby significantly shortening the follow-up. The MRD techniques need to be sensitive (≤10(-4)), broadly applicable, accurate, reliable, fast, and affordable. Thus far, flow cytometry and polymerase chain reaction (PCR) analysis of rearranged immunoglobulin and T-cell receptor genes (allele-specific oligonucleotide [ASO]-PCR) are claimed to meet these criteria, but classical flow cytometry does not reach a solid 10(-4), whereas classical ASO-PCR is time-consuming and labor intensive. Therefore, 2 high-throughput technologies are being explored, ie, high-throughput sequencing and next-generation (multidimensional) flow cytometry, both evaluating millions of sequences or cells, respectively. Each of them has specific advantages and disadvantages.
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94
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Pui CH, Pei D, Coustan-Smith E, Jeha S, Cheng C, Bowman WP, Sandlund JT, Ribeiro RC, Rubnitz JE, Inaba H, Bhojwani D, Gruber TA, Leung WH, Downing JR, Evans WE, Relling MV, Campana D. Clinical utility of sequential minimal residual disease measurements in the context of risk-based therapy in childhood acute lymphoblastic leukaemia: a prospective study. Lancet Oncol 2015; 16:465-74. [PMID: 25800893 DOI: 10.1016/s1470-2045(15)70082-3] [Citation(s) in RCA: 145] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The level of minimal residual disease during remission induction is the most important prognostic indicator in patients with acute lymphoblastic leukaemia (ALL). We aimed to establish the clinical significance of minimal residual disease in a prospective trial that used sequential minimal residual disease measurements to guide treatment decisions. METHODS Between June 7, 2000, and Oct 24, 2007, 498 assessable patients with newly diagnosed ALL were enrolled in a clinical trial at St Jude Children's Research Hospital. We provisionally classified the risk of relapse as low, standard, or high according to patients' baseline clinical and laboratory features. Final risk assignment to establish treatment intensity was based mainly on minimal residual disease levels measured on days 19 and 46 of remission induction, and on week 7 of maintenance treatment. Additional measurements of minimal residual disease were made on weeks 17, 48, and 120 (end of treatment). The primary aim was to establish the association between event-free survival and patients' minimal residual disease levels during remission induction and sequentially post-remission. This trial was registered at ClinicalTrials.gov, number NCT00137111. FINDINGS Irrespective of the provisional risk classification, 10-year event-free survival was significantly worse for patients with 1% or greater minimal residual disease levels on day 19 compared with patients with lower minimal residual disease levels (69·2%, 95% CI 49·6-82·4, n=36 vs 95·5%, 91·7-97·5, n=244; p<0·001 for the provisional low-risk group and 65·1%, 50·7-76·2, n=56 vs 82·9%, 75·6-88·2, n=142; p=0·01 for the provisional standard-risk group). 12 patients with provisional low-risk ALL and 1% or higher minimal residual disease levels on day 19 but negative minimal residual disease (<0·01%) on day 46 were treated for standard-risk ALL and had a 10-year event-free survival of 88·9% (43·3-98·4). For the 280 provisional low-risk patients, a minimal residual disease level of less than 1% on day 19 predicted a better outcome, irrespective of the minimal residual disease level on day 46. Of provisional standard-risk patients with minimal residual disease of less than 1% on day 19, the 15 with persistent minimal residual disease on day 46 seemed to have an inferior 10-year event-free survival compared with the 126 with negative minimal residual disease (72·7%, 42·5-88·8 vs 84·0%, 76·3-89·4; p=0·06) after receiving the same post-remission treatment for standard-risk ALL. Of patients attaining negative minimal residual disease status after remission induction, minimal residual disease re-emerged in four of 382 studied on week 7, one of 448 at week 17, and one of 437 at week 48; all but one of these six patients died despite additional treatment. By contrast, relapse occurred in only two of the 11 patients who had decreasing minimal residual disease levels between the end of induction and week 7 of maintenance therapy and were treated with chemotherapy alone. INTERPRETATION Minimal residual disease levels during remission induction treatment have important prognostic and therapeutic implications even in the context of minimal residual disease-guided treatment. Sequential minimal residual disease monitoring after remission induction is warranted for patients with detectable minimal residual disease. FUNDING National Institutes of Health and American Lebanese Syrian Associated Charities.
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Affiliation(s)
- Ching-Hon Pui
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Pathology, St Jude Children's Research Hospital, Memphis, TN, USA; University of Tennessee Health Science Center, Memphis, TN, USA.
| | - Deqing Pei
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Elaine Coustan-Smith
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sima Jeha
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA; University of Tennessee Health Science Center, Memphis, TN, USA
| | - Cheng Cheng
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN, USA
| | - W Paul Bowman
- Department of Pediatrics, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - John T Sandlund
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA; University of Tennessee Health Science Center, Memphis, TN, USA
| | - Raul C Ribeiro
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA; University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jeffrey E Rubnitz
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA; University of Tennessee Health Science Center, Memphis, TN, USA
| | - Hiroto Inaba
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA; University of Tennessee Health Science Center, Memphis, TN, USA
| | - Deepa Bhojwani
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA; University of Tennessee Health Science Center, Memphis, TN, USA
| | - Tanja A Gruber
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Pathology, St Jude Children's Research Hospital, Memphis, TN, USA; University of Tennessee Health Science Center, Memphis, TN, USA
| | - Wing H Leung
- Department of Bone Marrow Transplantation and Cellular Therapy, St Jude Children's Research Hospital, Memphis, TN, USA; University of Tennessee Health Science Center, Memphis, TN, USA
| | - James R Downing
- Department of Pathology, St Jude Children's Research Hospital, Memphis, TN, USA; University of Tennessee Health Science Center, Memphis, TN, USA
| | - William E Evans
- Department of Pharmaceutical Sciences, St Jude Children's Research Hospital, Memphis, TN, USA; University of Tennessee Health Science Center, Memphis, TN, USA
| | - Mary V Relling
- Department of Pharmaceutical Sciences, St Jude Children's Research Hospital, Memphis, TN, USA; University of Tennessee Health Science Center, Memphis, TN, USA
| | - Dario Campana
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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95
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Salari F, Shahjahani M, Shahrabi S, Saki N. Minimal residual disease in acute lymphoblastic leukemia: optimal methods and clinical relevance, pitfalls and recent approaches. Med Oncol 2014; 31:266. [PMID: 25287907 DOI: 10.1007/s12032-014-0266-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 09/20/2014] [Indexed: 11/29/2022]
Abstract
After advances in experimental and clinical testing, minimal residual disease (MRD) assay results are considered a determining factor in treatment of acute lymphoblastic leukemia patients. According to MRD assay results, bone marrow (BM) leukemic burden and the rate of its decline after treatment can be directly evaluated. Detailed knowledge of the leukemic burden in BM can minimize toxicity and treatment complications in patients by tailoring the therapeutic dose based on patients' conditions. In addition, reduction of MRD before allo-HSCT is an important prerequisite for reception of transplant by the patient. In direct examination of MRD by morphological methods (even by a professional hematologist), leukemic cells can be under- or over-estimated due to similarity with hematopoietic precursor cells. As a result, considering the importance of MRD, it is necessary to use other methods including flow cytometry, polymerase chain reaction (PCR) amplification and RQ-PCR to detect MRD. Each of these methods has its own advantages and disadvantages in terms of accuracy and sensitivity. In this review article, different MRD assay methods and their sensitivity, correlation of MRD assay results with clinical symptoms of the patient as well as pitfalls in results of these methods are evaluated. In the final section, recent advances in MRD have been addressed.
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Affiliation(s)
- Fatemeh Salari
- Health Research Institute, Research Center of Thalassemia and Hemoglobinopathy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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96
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Multi-agent chemotherapy overcomes glucocorticoid resistance conferred by a BIM deletion polymorphism in pediatric acute lymphoblastic leukemia. PLoS One 2014; 9:e103435. [PMID: 25090024 PMCID: PMC4121131 DOI: 10.1371/journal.pone.0103435] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 06/29/2014] [Indexed: 12/03/2022] Open
Abstract
A broad range of anti-cancer agents, including glucocorticoids (GCs) and tyrosine kinase inhibitors (TKIs), kill cells by upregulating the pro-apoptotic BCL2 family member, BIM. A common germline deletion in the BIM gene was recently shown to favor the production of non-apoptotic BIM isoforms, and to predict inferior responses in TKI-treated chronic myeloid leukemia (CML) and EGFR-driven lung cancer patients. Given that both in vitro and in vivo GC resistance are predictive of adverse outcomes in acute lymphoblastic leukemia (ALL), we hypothesized that this polymorphism would mediate GC resistance, and serve as a biomarker of poor response in ALL. Accordingly, we used zinc finger nucleases to generate ALL cell lines with the BIM deletion, and confirmed the ability of the deletion to mediate GC resistance in vitro. In contrast to CML and lung cancer, the BIM deletion did not predict for poorer clinical outcome in a retrospective analysis of 411 pediatric ALL patients who were uniformly treated with GCs and chemotherapy. Underlying the lack of prognostic significance, we found that the chemotherapy agents used in our cohort (vincristine, L-asparaginase, and methotrexate) were each able to induce ALL cell death in a BIM-independent fashion, and resensitize BIM deletion-containing cells to GCs. Together, our work demonstrates how effective therapy can overcome intrinsic resistance in ALL patients, and suggests the potential of using combinations of drugs that work via divergent mechanisms of cell killing to surmount BIM deletion-mediated drug resistance in other cancers.
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97
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Park KD. How do we prepare ourselves for a new paradigm of medicine to advance the treatment of pediatric acute lymphoblastic leukemia? Blood Res 2014; 49:3-4. [PMID: 24724058 PMCID: PMC3974954 DOI: 10.5045/br.2014.49.1.3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Kyung Duk Park
- Pediatric ALL Working Party, Korean Society of Hematology, Department of Pediatrics, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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98
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Kotecha RS, Gottardo NG, Kees UR, Cole CH. The evolution of clinical trials for infant acute lymphoblastic leukemia. Blood Cancer J 2014; 4:e200. [PMID: 24727996 PMCID: PMC4003413 DOI: 10.1038/bcj.2014.17] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 02/20/2014] [Indexed: 02/07/2023] Open
Abstract
Acute lymphoblastic leukemia (ALL) in infants has a significantly inferior outcome in comparison with older children. Despite initial improvements in survival of infants with ALL since establishment of the first pediatric cooperative group ALL trials, the poor outcome has plateaued in recent years. Historically, infants were treated on risk-adapted childhood ALL protocols. These studies were pivotal in identifying the need for infant-specific protocols, delineating prognostic categories and the requirement for a more unified approach between study groups to overcome limitations in accrual because of low incidence. This subsequently led to the development of collaborative infant-specific studies. Landmark outcomes have included the elimination of cranial radiotherapy following the discovery of intrathecal and high-dose systemic therapy as a superior and effective treatment strategy for central nervous system disease prophylaxis, with improved neurodevelopmental outcome. Universal prospective identification of independent adverse prognostic factors, including presence of a mixed lineage leukemia rearrangement and young age, has established the basis for risk stratification within current trials. The infant-specific trials have defined limits to which conventional chemotherapeutic agents can be intensified to optimize the balance between treatment efficacy and toxicity. Despite variations in therapeutic intensity, there has been no recent improvement in survival due to the equilibrium between relapse and toxicity. Ultimately, to improve the outcome for infants with ALL, key areas still to be addressed include identification and adaptation of novel prognostic markers and innovative therapies, establishing the role of hematopoietic stem cell transplantation in first complete remission, treatment strategies for relapsed/refractory disease and monitoring and timely intervention of late effects in survivors. This would be best achieved through a single unified international trial.
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Affiliation(s)
- R S Kotecha
- 1] Department of Haematology and Oncology, Princess Margaret Hospital for Children, Perth, Western Australia, Australia [2] Telethon Institute for Child Health Research, University of Western Australia, Perth, Western Australia, Australia [3] School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
| | - N G Gottardo
- 1] Department of Haematology and Oncology, Princess Margaret Hospital for Children, Perth, Western Australia, Australia [2] Telethon Institute for Child Health Research, University of Western Australia, Perth, Western Australia, Australia [3] School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
| | - U R Kees
- Telethon Institute for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
| | - C H Cole
- 1] Department of Haematology and Oncology, Princess Margaret Hospital for Children, Perth, Western Australia, Australia [2] Telethon Institute for Child Health Research, University of Western Australia, Perth, Western Australia, Australia [3] School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
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Abstract
The 50th anniversary of Seminars in Hematology coincides with the 50th anniversary of St. Jude Children's Research Hospital, and both milestones are inexorably linked to studies contributing to the cure of childhood acute lymphoblastic leukemia (ALL). We thought it fitting, therefore, to mark these events by traveling back in time to point out some of the achievements, institutions, study groups, and individuals that have made cure of childhood ALL a reality. In many instances, progress was driven by new ideas, while in others it was driven by new experimental tools that allowed more precise assessment of the biology of leukemic blasts and their utility in selecting therapy. We also discuss a number of contemporary advances that point the way to exciting future directions. Whatever pathways are taken, a clear challenge will be to use emerging genome-based or immunologic-based treatment options in ways that will enhance, rather than duplicate or compromise, recent gains in outcome with classic cytotoxic chemotherapy. The theme of this journey serves as a reminder of the chief ingredient of any research directed to a catastrophic disease such as ALL. It is the audacity of a small group of investigators who confronted a childhood cancer with the goal of cure, not palliation, as their mindset.
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Affiliation(s)
- Ching-Hon Pui
- Departments of Oncology and Pharmaceutical Sciences, St. Jude Children's Research Hospital.
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100
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Host genetic variants of ABCB1 and IL15 influence treatment outcome in paediatric acute lymphoblastic leukaemia. Br J Cancer 2014; 110:1673-80. [PMID: 24434428 PMCID: PMC3960629 DOI: 10.1038/bjc.2014.7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 12/11/2013] [Accepted: 12/17/2013] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Host germline variations and their potential prognostic importance is an emerging area of interest in paediatric ALL. METHODS We investigated the associations between 20 germline variations and various clinical end points in 463 children with ALL. RESULTS After adjusting for known prognostic factors, variants in two genes were found to be independently associated with poorer EFS: ABCB1 T/T at either 2677 (rs2032582) or 3435 (rs1045642) position (P=0.003) and IL15 67276493G/G (rs17015014; P=0.022). These variants showed a strong additive effect affecting outcome (P<0.001), whereby patients with both risk genotypes had the worst EFS (P=0.001), even after adjusting for MRD levels at the end of remission induction. The adverse effect of ABCB1 T/T genotypes was most pronounced in patients with favourable cytogenetics (P=0.011) while the IL15 67276493G/G genotype mainly affected patients without common chromosomal abnormalities (P=0.022). In both cytogenetic subgroups, increasing number of such risk genotypes still predicted worsening outcome (P<0.001 and=0.009, respectively). CONCLUSION These results point to the prognostic importance of host genetic variants, although the specific mechanisms remain unclarified. Inclusion of ABCB1 and IL15 variants may help improve risk assignment strategies in paediatric ALL.
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