51
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The role of mutant IDH1 and IDH2 inhibitors in the treatment of acute myeloid leukemia. Ann Hematol 2017; 96:1983-1991. [PMID: 29090344 DOI: 10.1007/s00277-017-3161-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 10/22/2017] [Indexed: 12/19/2022]
Abstract
For decades, researchers have looked into the pathophysiology of acute myeloid leukemia (AML). With the advances in molecular techniques, the two-hit hypothesis was replaced by a multi-hit model, which also emphasizes the importance of aberrant epigenetic regulation in the pathogenesis of AML. IDH1 and IDH2 are two isoforms of isocitrate dehydrogenase that perform crucial roles in cellular metabolism. Somatic mutations in either of these two genes impart a neomorphic enzymatic activity upon the encoded enzymes resulting in the ability to convert α-ketoglutarate (αKG) into the oncometabolite R2-hydroxyglutarate (R2-HG), which can competitively inhibit multiple αKG-dependent dioxygenases. Inhibition of various classes of αKG-dependent dioxygenases results in dramatic epigenetic changes in hematopoietic cells, which has been found to directly impair differentiation. In addition to a global dysregulation of gene expression, other mechanisms have been described through which R2-HG promotes leukemic transformation including the induction of B cell lymphoma 2 dependency and stimulation of the EglN family of prolyl 4-hydroxylases (EglN). Due to the fact that mutations in IDH1 and IDH2 are acquired early during AML clonal evolution as well as because these mutations tend to remain stable during AML progression, the pharmaceutical industry has prompted the development of specific mutant IDH enzyme inhibitors. More recently, the FDA approved the first mutant IDH2 inhibitor, enasidenib (AG-221), for patients with relapsed or refractory IDH2-mutated AML (RR-AML). This has brought a lot of excitement to researchers, clinicians, and patients, especially because the treatment of AML remains challenging and is still associated with a high mortality.
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52
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Yang MY, Hsiao HH, Liu YC, Hsu CM, Lin SF, Lin PM. Phe354Leu Polymorphism of LKB1 Is a Potential Prognostic Factor for Cytogenetically Normal Acute Myeloid Leukemia. ACTA ACUST UNITED AC 2017; 31:841-847. [PMID: 28882949 DOI: 10.21873/invivo.11137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 07/28/2017] [Accepted: 08/02/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Liver kinase B1 (LKB1) is a major activator of the AMP-dependent kinase/mammalian target of rapamycin pathway. The prevalence and the specificity of LKB1 gene mutation in acute myeloid leukemia (AML) have not been well established. This study aimed to examine mutation of LKB1 in AML and its clinical and pathological implications. PATIENTS AND METHODS Eighty-five patients newly diagnosed with cytogenetically normal AML were analyzed using polymerase chain reaction followed by direct sequencing. RESULTS A silent mutation (837C>T) of LKB1 was detected in one patient and a pathogenic polymorphism Phe354Leu which diminishes LKB1 ability to maintain cell polarity was detected in six (7%) patients. The Phe354Leu polymorphism occurred concurrently with mutations of nucleophosmin 1 (NPM1), fms-related tyrosine kinase 3 (FLT3) and CCAAT/enhancer binding protein alpha (CEBPA), but not with metabolism-related genes, isocitrate dehydrogenase [nicotinamide adenine dinucleotide phosphate (+)]1 (IDH1) and IDH2. Patients with Phe354Leu polymorphism diagnosed at younger ages had a worse overall survival. CONCLUSION LKB1 may be involved in the leukemogenesis and progression of cytogenetically normal AML.
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Affiliation(s)
- Ming-Yu Yang
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, R.O.C.,Departments of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, R.O.C
| | - Hui-Hua Hsiao
- Division of Hematology-Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, R.O.C.,Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C
| | - Yi-Chang Liu
- Division of Hematology-Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, R.O.C.,Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C
| | - Cheng-Ming Hsu
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, R.O.C. .,Department of Otolaryngology, Chiayi Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Chiayi, Taiwan, R.O.C
| | - Sheng-Fung Lin
- Division of Hematology-Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, R.O.C. .,Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C
| | - Pai-Mei Lin
- Department of Nursing, I-Shou University, Kaohsiung, Taiwan, R.O.C.
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53
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Wang N, Wang F, Shan N, Sui X, Xu H. IDH1 Mutation Is an Independent Inferior Prognostic Indicator for Patients with Myelodysplastic Syndromes. Acta Haematol 2017; 138:143-151. [PMID: 28873367 DOI: 10.1159/000479546] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 07/17/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Genomic sequencing technologies have identified isocitrate dehydrogenase (IDH) mutations in haematological malignancies. The prognostic implications of somatic IDH mutation (mIDH) in myelodysplastic syndromes (MDS) remain controversial. METHODS Mutations in IDH1 and IDH2 were detected using genomic sequencing technologies in 97 patients with MDS. RESULTS Seven (7.2%) mutations were identified: 3 in IDH1 (all R132C) and 4 in IDH2 (3 R140Q and 1 R140L). The frequency of mutation was 16.6% (2/12) in refractory anaemia with excess blasts (RAEB)-1 and 14.7% (5/34) in RAEB-2. IDH1/2 mutations were closely associated with higher bone marrow blast counts (median 10.0 vs. 2.3%; p = 0.019) and lower absolute neutrophil counts (median 0.44 × 109/L vs. 1.21 × 109/L; p = 0.027). All IDH mutations were mutually exclusive and heterozygous. IDH mutations were not significantly correlated with any specific karyotype. Patients with IDH1 mutations exhibited shorter overall and progression-free survival (OS and PFS; p = 0.039 and p = 0.042, respectively), whereas IDH2 mutations did not affect OS or PFS (p = 0.560 and p = 0.218, respectively). Multivariate analysis indicated that IDH1 mutation (p = 0.018; hazard ratio [HR] 4.735; 95% confidence interval [CI] 1.299-17.264), karyotype risk (p = 0.036; HR 1.619; 95% CI 1.033-2.539) and the revised International Prognostic Scoring System risk category (p < 0.0001; HR 2.122; 95% CI 1.401-3.213) were independent inferior prognostic factors. CONCLUSIONS IDH1 mutation is associated with a poor prognosis.
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Affiliation(s)
- Na Wang
- Department of Haematology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, People's Republic of China
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54
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Cargo C, Bowen D. Individual risk assessment in MDS in the era of genomic medicine. Semin Hematol 2017; 54:133-140. [PMID: 28958286 DOI: 10.1053/j.seminhematol.2017.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 07/10/2017] [Indexed: 02/06/2023]
Abstract
Assessment of risk for patients with myelodysplastic syndromes has evolved from pure morphological bone marrow assessment to a series of validated prognostic scoring systems whose 'risk' assessment is of death (overall survival) or disease progression (AML transformation). The revised International Prognostic Scoring System (2012) improved the precision for prognosis but did not consider patient-specific factors such as comorbidity and performance status, which have a clear impact on outcome, particularly in lower-risk MDS. The improved understanding of MDS biology predominantly through genomic mutational analysis, flow cytometry and gene expression profiling poses a question regarding incorporation of these parameters into the existing scoring systems. Although some gene mutations have clear prognostic significance (e.g. SF3B1, TP53), there is no definitive and reproducible evidence that this additional knowledge will change management. Although incorporation of some of these novel data into risk assessment may be imminent, the IPSS-R remains the gold standard tool for everyday practice.
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Affiliation(s)
- Catherine Cargo
- Haematological Malignancies Diagnostic Service and Department of Haematology, Leeds Teaching Hospitals, St. James's Institute of Oncology, Beckett Street, Leeds UK
| | - David Bowen
- Department of Haematology, Leeds Teaching Hospitals, St. James's Institute of Oncology, Beckett Street, Leeds UK
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55
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Ali MAM, Ahmed EK, Assem MMA, Helwa R. The Synonymous Isocitrate Dehydrogenase 1 315C>T SNP Confers an Adverse Prognosis in Egyptian Adult Patients with NPM1-/CEBPA-Negative Acute Myeloid Leukemia. Indian J Hematol Blood Transfus 2017; 34:240-252. [PMID: 29622865 DOI: 10.1007/s12288-017-0852-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 07/17/2017] [Indexed: 11/26/2022] Open
Abstract
Although the clinical features of isocitrate dehydrogenase (IDH) genetic aberrations have been well-characterized in acute myeloid leukemia (AML), definitive information on their prognostic significance is lacking. We aimed to explore the prognostic significance of IDH gene alterations in an Egyptian cohort of adult patients with de novo AML. Diagnostic peripheral blood samples from 51 AML patients were analyzed for the presence of mutations/SNPs in exon 4 of IDH1 and IDH2 genes using polymerase chain reaction amplification followed by direct sequencing. IDH mutational status had no impact on event-free survival (EFS) and overall survival (OS), whereas the presence of IDH1 315C>T SNP was significantly associated with inferior EFS (P = 0.037) and OS (P = 0.034) as compared with wild-type IDH1. IDH1 315C>T SNP but not IDH mutations is associated with unfavorable outcomes, suggesting that AML patients with IDH1 315C>T SNP can represent a new subgroup of patients which allows refined risk stratification.
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Affiliation(s)
- Mohamed A M Ali
- 1Department of Biochemistry, Faculty of Science, Ain Shams University, Abbassia, Cairo, 11566 Egypt
| | - Emad K Ahmed
- 1Department of Biochemistry, Faculty of Science, Ain Shams University, Abbassia, Cairo, 11566 Egypt
| | - Magda M A Assem
- 2Clinical Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Reham Helwa
- 3Zoology Department, Faculty of Science, Ain Shams University, Cairo, Egypt
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56
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Ali SM, Yao M, Yao J, Wang J, Cheng Y, Schrock AB, Chirn GW, Chen H, Mu S, Gay L, Elvin JA, Suh J, Miller VA, Stephens PJ, Ross JS, Wang K. Comprehensive genomic profiling of different subtypes of nasopharyngeal carcinoma reveals similarities and differences to guide targeted therapy. Cancer 2017; 123:3628-3637. [PMID: 28581676 DOI: 10.1002/cncr.30781] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/31/2017] [Accepted: 04/19/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND To date, no targeted therapy has been approved for nasopharyngeal carcinoma (NPC), and this underscores the need for an in-depth understanding of clinically relevant genomic alterations (CRGAs). METHODS Comprehensive genomic profiling was performed for 190 NPC patients, including 20 patients with nasopharyngeal adenocarcinoma (NPAC), 62 patients with nasopharyngeal squamous cell carcinoma (NPSCC), and 108 patients with nasopharyngeal undifferentiated carcinoma (NPUC). The associations of genes and pathways with subtypes, Epstein-Barr virus (EBV) infections, and the tumor mutation burden (TMB) were statistically evaluated. RESULTS Although the overall rates of genomic alterations were similar, the 3 NPC subtypes exhibited different mutational landscapes. Notably, mutations in a proven-treatable target gene, isocitrate dehydrogenase 2 (IDH2), were significantly associated with NPUC but not with NPAC or NPSCC. The top 5 ranked CRGAs included CDKN2A (29%), IDH2 (16%), SMARCB1 (7%), PIK3CA (6%), and NF1 (5%) in NPUC; CDKN2A (27%), PIK3CA (23%), FBXW7 (11%), PTEN (11%), and EGFR (8%) in NPSCC; and CDKN2A (20%), KRAS (15%), CCND1 (10%), MAP3K1 (10%), and NOTCH1 (10%) in NPAC. The incidence of EBV infections significantly correlated with the subtypes and with TP53, CDKN2A, and CDKN2B. The TMB status correlated with the subtypes and with LRP1B, FBXW7, and PIK3CA mutations as well as DNA repair, phosphoinositide 3-kinase/mammalian target of rapamycin, and mitogen-activated protein kinase pathways. CONCLUSIONS These results indicate that different NPC subtypes harbor different CRGAs. Both EBV infections and the TMB are associated with the NPC subtypes as well as the alterations of individual genes and pathways. The high frequency of IDH2 mutations in NPUC may facilitate potential targeted therapy and will ultimately point to new therapeutic strategies. Cancer 2017;123:3628-37. © 2017 American Cancer Society.
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Affiliation(s)
- Siraj M Ali
- Foundation Medicine, Inc, Cambridge, Massachusetts
| | | | | | | | | | | | | | | | | | - Laurie Gay
- Foundation Medicine, Inc, Cambridge, Massachusetts
| | | | - James Suh
- Foundation Medicine, Inc, Cambridge, Massachusetts
| | | | | | - Jeffrey S Ross
- Foundation Medicine, Inc, Cambridge, Massachusetts.,Albany Medical College, Albany, New York
| | - Kai Wang
- OrigiMed, Shanghai, China.,Zhejiang University International Hospital, Hangzhou, China
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57
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Stein E, Yen K. Targeted Differentiation Therapy with Mutant IDH Inhibitors: Early Experiences and Parallels with Other Differentiation Agents. ANNUAL REVIEW OF CANCER BIOLOGY-SERIES 2017. [DOI: 10.1146/annurev-cancerbio-050216-122051] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Somatic mutations in the isocitrate dehydrogenase (IDH) 1 and 2 genes have been described in multiple hematologic and solid tumors, and confer a gain of function, permitting the production of the oncometabolite (R)-2-hydroxyglutarate (2-HG). 2-HG accumulation induces DNA and histone hypermethylation and altered gene expression, ultimately resulting in a block in cellular differentiation. Proof-of-concept preclinical work demonstrated that targeted inhibition of the mutant IDH (mIDH) enzyme is a feasible therapeutic strategy, based on the hypothesis that inhibition of the mIDH enzyme blocks 2-HG production, resulting in an appropriate methylation state and the onset of cellular differentiation. Clinical development programs for targeted inhibitors are underway, and preliminary data in patients with mIDH acute myeloid leukemia suggest that these inhibitors act as differentiation agents. Here we review the use of differentiation agents for the treatment of hematologic and solid tumors and discuss the preclinical and early clinical evidence that mIDH inhibitors mediate antitumor effects through the induction of differentiation.
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Affiliation(s)
- Eytan Stein
- Memorial Sloan Kettering Cancer Center, New York, NY 10065
| | - Katharine Yen
- Agios Pharmaceuticals, Inc., Cambridge, Massachusetts 02139
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58
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Pan-mutant-IDH1 inhibitor BAY1436032 is highly effective against human IDH1 mutant acute myeloid leukemia in vivo. Leukemia 2017; 31:2020-2028. [PMID: 28232670 PMCID: PMC5629366 DOI: 10.1038/leu.2017.46] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 01/07/2017] [Accepted: 01/13/2017] [Indexed: 01/15/2023]
Abstract
Neomorphic mutations in isocitrate dehydrogenase 1 (IDH1) are frequently found in several human cancer types including acute myeloid leukemia (AML) and lead to the production of high levels of the oncometabolite (R)-2-hydroxyglutarate (R-2HG). Here we report the characterization of BAY1436032, a novel pan-mutant IDH1 inhibitor, both in vitro and in vivo. BAY1436032 specifically inhibits R-2HG production and colony growth, and induces myeloid differentiation of AML cells carrying IDH1R132H, IDH1R132C, IDH1R132G, IDH1R132L and IDH1R132S mutations. In addition, the compound impacts on DNA methylation and attenuates histone hypermethylation. Oral administration of BAY1436032 led to leukemic blast clearance, myeloid differentiation, depletion of leukemic stem cells and prolonged survival in two independent patient-derived xenograft IDH1 mutant AML mouse models. Together, BAY1436032 is highly effective against all major types of IDH1 mutant AML.
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59
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Chang CK, Zhao YS, Xu F, Guo J, Zhang Z, He Q, Wu D, Wu LY, Su JY, Song LX, Xiao C, Li X. TP53mutations predict decitabine-induced complete responses in patients with myelodysplastic syndromes. Br J Haematol 2016; 176:600-608. [PMID: 27984642 DOI: 10.1111/bjh.14455] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 09/05/2016] [Indexed: 02/01/2023]
Affiliation(s)
- Chun-Kang Chang
- Department of Haematology; Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai China
| | - You-Shan Zhao
- Department of Haematology; Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai China
| | - Feng Xu
- Department of Haematology; Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai China
| | - Juan Guo
- Department of Haematology; Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai China
| | - Zheng Zhang
- Department of Haematology; Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai China
| | - Qi He
- Department of Haematology; Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai China
| | - Dong Wu
- Department of Haematology; Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai China
| | - Ling-Yun Wu
- Department of Haematology; Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai China
| | - Ji-Ying Su
- Department of Haematology; Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai China
| | - Lu-Xi Song
- Department of Haematology; Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai China
| | - Chao Xiao
- Department of Haematology; Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai China
| | - Xiao Li
- Department of Haematology; Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai China
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60
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Sensitivity of hematopoietic stem cells to mitochondrial dysfunction by SdhD gene deletion. Cell Death Dis 2016; 7:e2516. [PMID: 27929539 PMCID: PMC5261010 DOI: 10.1038/cddis.2016.411] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 08/25/2016] [Accepted: 11/07/2016] [Indexed: 02/07/2023]
Abstract
It is established that hematopoietic stem cells (HSC) in the hypoxic bone marrow have adapted their metabolism to oxygen-limiting conditions. This adaptation includes suppression of mitochondrial activity, induction of anerobic glycolysis, and activation of hypoxia-inducible transcription factor 1α (Hif1α)-dependent gene expression. During progression of hematopoiesis, a metabolic switch towards mitochondrial oxidative phosphorylation is observed, making this organelle essential for determining cell fate choice in bone marrow. However, given that HSC metabolism is essentially oxygen-independent, it is still unclear whether functional mitochondria are absolutely required for their survival. To assess the actual dependency of these undifferentiated cells on mitochondrial function, we have performed an analysis of the hematopoiesis in a mouse mutant, named SDHD-ESR, with inducible deletion of the mitochondrial protein-encoding SdhD gene. This gene encodes one of the subunits of the mitochondrial complex II (MCII). In this study, we demonstrate that, in contrast to what has been previously established, survival of HSC, and also myeloid and B-lymphoid progenitors, depends on proper mitochondrial activity. In addition, gene expression analysis of these hematopoietic lineages in SDHD-ESR mutants calls into question the proposed activation of Hif1α in response to MCII dysfunction.
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61
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Medeiros BC, Fathi AT, DiNardo CD, Pollyea DA, Chan SM, Swords R. Isocitrate dehydrogenase mutations in myeloid malignancies. Leukemia 2016; 31:272-281. [PMID: 27721426 PMCID: PMC5292675 DOI: 10.1038/leu.2016.275] [Citation(s) in RCA: 250] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/17/2016] [Accepted: 08/25/2016] [Indexed: 12/14/2022]
Abstract
Alterations to genes involved in cellular metabolism and epigenetic regulation are implicated in the pathogenesis of myeloid malignancies. Recurring mutations in isocitrate dehydrogenase (IDH) genes are detected in approximately 20% of adult patients with acute myeloid leukemia (AML) and 5% of adults with myelodysplastic syndromes (MDS). IDH proteins are homodimeric enzymes involved in diverse cellular processes, including adaptation to hypoxia, histone demethylation and DNA modification. The IDH2 protein is localized in the mitochondria and is a critical component of the tricarboxylic acid (also called the ‘citric acid' or Krebs) cycle. Both IDH2 and IDH1 (localized in the cytoplasm) proteins catalyze the oxidative decarboxylation of isocitrate to α-ketoglutarate (α-KG). Mutant IDH enzymes have neomorphic activity and catalyze reduction of α-KG to the (R) enantiomer of 2-hydroxyglutarate, which is associated with DNA and histone hypermethylation, altered gene expression and blocked differentiation of hematopoietic progenitor cells. The prognostic significance of mutant IDH (mIDH) is controversial but appears to be influenced by co-mutational status and the specific location of the mutation (IDH1-R132, IDH2-R140, IDH2-R172). Treatments specifically or indirectly targeted to mIDH are currently under clinical investigation; these therapies have been generally well tolerated and, when used as single agents, have shown promise for inducing responses in some mIDH patients when used as first-line treatment or in relapsed or refractory AML or MDS. Use of mIDH inhibitors in combination with drugs with non-overlapping mechanisms of action is especially promising, as such regimens may address the clonal heterogeneity and the multifactorial pathogenic processes involved in mIDH myeloid malignancies. Advances in mutational analysis have made testing more rapid and convenient, and less expensive; such testing should become part of routine diagnostic workup and repeated at relapse to identify patients who may benefit from treatments that target mIDH.
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Affiliation(s)
- B C Medeiros
- Division of Hematology, Department of Medicine, Stanford University School of Medicine, Stanford Cancer Center, Stanford, CA, USA
| | - A T Fathi
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - C D DiNardo
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - D A Pollyea
- Division of Hematology, University of Colorado School of Medicine, Aurora, CO, USA
| | - S M Chan
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - R Swords
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
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62
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Hilgendorf S, Folkerts H, Schuringa JJ, Vellenga E. Loss of ASXL1 triggers an apoptotic response in human hematopoietic stem and progenitor cells. Exp Hematol 2016; 44:1188-1196.e6. [PMID: 27616637 DOI: 10.1016/j.exphem.2016.08.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/26/2016] [Accepted: 08/29/2016] [Indexed: 12/31/2022]
Abstract
ASXL1 is frequently mutated in myelodysplastic syndrome and other hematological malignancies. It has been reported that a loss of ASXL1 leads to a reduction of H3K27me3 via the polycomb repressive complex 2 (PRC2). To determine the role of ASXL1 loss in normal hematopoietic stem and progenitor cells, cord blood CD34+ cells were transduced with independent small hairpin interfering RNA lentiviral vectors against ASXL1 and cultured under myeloid and erythroid permissive conditions. Knockdown of ASXL1 led to a significant reduction in stem-cell frequency and a reduced cell expansion along the myeloid lineage. Cell expansion along the erythroid lineage was also reduced significantly and was accompanied by an increase in apoptosis of erythroid progenitor cells throughout differentiation and by an accumulation of cells in the G0/G1 phase. Bone marrow stromal cells supported the growth of immature erythroid cells, but did not alter the adverse phenotype of ASXL1 knockdown. Chromatin immunoprecipitation revealed no loss of H3K27me3 in myeloid progenitor cells, but demonstrated a loss of H3K27me3 on the HOXA and the p21 locus in erythroid progenitors. We conclude that ASXL1 is essential for erythroid development and differentiation and that the aberrant differentiation is, at least in part, facilitated via PRC2.
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Affiliation(s)
- Susan Hilgendorf
- Department of Experimental Hematology, Cancer Research Center Groningen, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hendrik Folkerts
- Department of Experimental Hematology, Cancer Research Center Groningen, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jan Jacob Schuringa
- Department of Experimental Hematology, Cancer Research Center Groningen, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Edo Vellenga
- Department of Experimental Hematology, Cancer Research Center Groningen, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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63
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Mondesir J, Willekens C, Touat M, de Botton S. IDH1 and IDH2 mutations as novel therapeutic targets: current perspectives. J Blood Med 2016; 7:171-80. [PMID: 27621679 PMCID: PMC5015873 DOI: 10.2147/jbm.s70716] [Citation(s) in RCA: 149] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Isocitrate dehydrogenase 1 and 2 (IDH1 and IDH2) are key metabolic enzymes that convert isocitrate to α-ketoglutarate. IDH1/2 mutations define distinct subsets of cancers, including low-grade gliomas and secondary glioblastomas, chondrosarcomas, intrahepatic cholangiocarcinomas, and hematologic malignancies. Somatic point mutations in IDH1/2 confer a gain-of-function in cancer cells, resulting in the accumulation and secretion in vast excess of an oncometabolite, the D-2-hydroxyglutarate (D-2HG). Overproduction of D-2HG interferes with cellular metabolism and epigenetic regulation, contributing to oncogenesis. Indeed, high levels of D-2HG inhibit α-ketoglutarate-dependent dioxygenases, including histone and DNA demethylases, leading to histone and DNA hypermethylation and finally a block in cell differentiation. Furthermore, D-2HG is a biomarker suitable for the detection of IDH1/2 mutations at diagnosis and predictive of the clinical response. Finally, mutant-IDH1/2 enzymes inhibitors have entered clinical trials for patients with IDH1/2 mutations and represent a novel drug class for targeted therapy.
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Affiliation(s)
- Johanna Mondesir
- Service d'Immunopathologie Clinique, Hôpital Saint Louis; CNRS UMR8104, INSERM U1016, Institut Cochin, Université Paris Descartes, Paris
| | - Christophe Willekens
- Gustave Roussy, Université Paris-Saclay, Service d'Hématologie Clinique; INSERM U1170, Gustave Roussy, Université Paris-Saclay, Villejuif; Faculté de médecine Paris-Sud, Kremlin-Bicêtre
| | - Mehdi Touat
- AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Paris; Gustave Roussy, Université Paris-Saclay, Département d'Innovation Thérapeutique et d'Essais Précoces, Villejuif, France
| | - Stéphane de Botton
- Gustave Roussy, Université Paris-Saclay, Service d'Hématologie Clinique; INSERM U1170, Gustave Roussy, Université Paris-Saclay, Villejuif; Faculté de médecine Paris-Sud, Kremlin-Bicêtre
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Zeidan AM, Stahl M, Komrokji R. Emerging biological therapies for the treatment of myelodysplastic syndromes. Expert Opin Emerg Drugs 2016; 21:283-300. [DOI: 10.1080/14728214.2016.1220534] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Zahid MF, Patnaik MM, Gangat N, Hashmi SK, Rizzieri DA. Insight into the molecular pathophysiology of myelodysplastic syndromes: targets for novel therapy. Eur J Haematol 2016; 97:313-20. [DOI: 10.1111/ejh.12771] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2016] [Indexed: 01/07/2023]
Affiliation(s)
| | - Mrinal M. Patnaik
- Division of Hematology; Mayo Clinic; Rochester MN USA
- Mayo Clinic Transplant Center; Blood and Marrow Transplant Program; Mayo Clinic; Rochester MN USA
| | | | - Shahrukh K. Hashmi
- Division of Hematology; Mayo Clinic; Rochester MN USA
- Mayo Clinic Transplant Center; Blood and Marrow Transplant Program; Mayo Clinic; Rochester MN USA
| | - David A. Rizzieri
- Division of Hematologic Malignancies & Cellular Therapy; Duke University Medical Center; Durham NC USA
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Harnan S, Ren S, Gomersall T, Everson-Hock ES, Sutton A, Dhanasiri S, Kulasekararaj A. Association between Transfusion Status and Overall Survival in Patients with Myelodysplastic Syndromes: A Systematic Literature Review and Meta-Analysis. Acta Haematol 2016; 136:23-42. [PMID: 27160308 DOI: 10.1159/000445163] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 03/02/2016] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Multiple studies show that transfusion independence (TI) in myelodysplastic syndrome (MDS) has a positive impact on overall survival (OS). To assess this, a systematic review and meta-analysis of the association between TI and OS in patients with MDS was conducted (PROSPERO ID: CRD42014007264). METHODS Comprehensive searches of 5 key bibliographic databases were conducted and supplemented with additional search techniques. Included were studies that had recruited adults aged >18 years with MDS and had examined the impact of transfusion status on OS. RESULTS Fifty-five studies (89 citations) were included. The vast majority reported a statistically significant hazard ratio (HR) for OS in favor of TI patients or in patients who acquired TI after treatment. A random-effects meta-analysis was conducted. Patients classed as TI at baseline showed a 59% decrease in the risk of death compared with transfusion-dependent (TD) patients [HR 0.41; 95% credible interval (CrI) 0.29-0.56], and this effect did not appear to interact significantly with illness severity (interaction coefficient HR 1.38; 95% CrI 0.62-3.41). A meta-analysis of studies where patients acquired TI was not possible, but those studies consistently reported a survival benefit for those who acquired TI. CONCLUSION The findings revealed a 59% pooled reduction in mortality among TI patients when compared with TD patients.
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Affiliation(s)
- Sue Harnan
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
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67
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Dang L, Yen K, Attar E. IDH mutations in cancer and progress toward development of targeted therapeutics. Ann Oncol 2016; 27:599-608. [DOI: 10.1093/annonc/mdw013] [Citation(s) in RCA: 301] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 12/24/2015] [Indexed: 12/29/2022] Open
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Secondary Adult Acute Myeloid Leukemia: a Review of Our Evolving Understanding of a Complex Disease Process. Curr Treat Options Oncol 2016; 16:37. [PMID: 26143266 DOI: 10.1007/s11864-015-0355-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OPINION STATEMENT Secondary AML (s-AML) encompasses AML evolving from myelodysplasia (AML-MDS) and treatment-related AML (t-AML) after exposure to chemotherapy, radiation, or environmental toxins. S-AML has traditionally been considered a devastating disease, affecting a vulnerable population of heavily pretreated, older adults. A limited understanding of disease pathogenesis/heterogeneity and lack of effective treatments have hampered overall improvements in patient outcomes. With the recent understanding that the secondary nature of sAML does not by itself incur a poor prognosis and incorporation of cytogenetics and molecular genetics into patient care and the advancement of treatment, including improved supportive care, novel chemotherapeutics agents, and nonmyeloablative conditioning regimens as part of allogeneic hematopoietic cell transplantation (HCT), modest gains in survival and quality of life are beginning to be seen among patients with s-AML.
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Inoue S, Lemonnier F, Mak TW. Roles of IDH1/2 and TET2 mutations in myeloid disorders. Int J Hematol 2016; 103:627-33. [PMID: 26980223 DOI: 10.1007/s12185-016-1973-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 02/22/2016] [Accepted: 03/02/2016] [Indexed: 12/19/2022]
Abstract
Mutations of the epigenetic enzymes isocitrate dehydrogenase (IDH) 1 and 2, and the methylcytosine dioxygenase 'ten-eleven translocation 2' (TET2), are common in human myeloid malignancies and drivers of these disorders but the underlying mechanisms remain obscure. This review examines mutant IDH1/2 and TET2 enzymes in the context of responses to DNA damage and their potential involvement in age-related genomic instability. The clinical relevance of these findings and their potential application in novel therapeutic strategies is also discussed.
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Affiliation(s)
- Satoshi Inoue
- The Campbell Family Institute for Breast Cancer Research, Princess Margaret Cancer Centre, Ontario Cancer Institute, University Health Network, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - François Lemonnier
- The Campbell Family Institute for Breast Cancer Research, Princess Margaret Cancer Centre, Ontario Cancer Institute, University Health Network, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Tak W Mak
- The Campbell Family Institute for Breast Cancer Research, Princess Margaret Cancer Centre, Ontario Cancer Institute, University Health Network, 610 University Avenue, Toronto, ON, M5G 2M9, Canada.
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Ahn JS, Kim HJ, Kim YK, Lee SS, Jung SH, Yang DH, Lee JJ, Kim NY, Choi SH, Jung CW, Jang JH, Kim HJ, Moon JH, Sohn SK, Won JH, Kim SH, Kim DDH. DNMT3A R882 Mutation with FLT3-ITD Positivity Is an Extremely Poor Prognostic Factor in Patients with Normal-Karyotype Acute Myeloid Leukemia after Allogeneic Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2016; 22:61-70. [DOI: 10.1016/j.bbmt.2015.07.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/28/2015] [Indexed: 12/17/2022]
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Abstract
Abstract
A 68-year-old male with history of hypertension and arthritis presented with bruising and increasing fatigue over several months. He was found to be thrombocytopenic (platelets 30), WCB 2.0 K/mm3, Hg 11.6 g/dL, ANC 870, and 1% circulating blasts. Bone marrow biopsy revealed 40%-50% cellular with multilineage dysplasia and 10% blasts. Cytogenetic genetic studies showed trisomy 2, and translocation (3;21). FISH studies for 5q, 7p, 8, 17p, and 20q abnormalities were negative. Molecular diagnostics were sent to a commercial laboratory to aid in prognostication. These studies showed mutations in TET2 (exons 1- 9 tested) and PHF6 (exons 1-9 tested). No abnormalities in other epigenetic regulators (DNMT3A, ASXL1), RNA splicing (SF3B1, SRSF2, URAF1, ZRSR2), transcription factors (RUNX1 or ETV6), or signaling (CBL, NRAS, KIT, JAK2, MPL) were detected. He was referred for consultation regarding initial treatment. In this elderly patient with preserved organ function and good performance status who is being considered for reduced intensity conditioned allogeneic hematopoietic cell transplant, what should the initial treatment be and can we use the molecular diagnostic results to guide therapy?
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72
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Yonal-Hindilerden I, Daglar-Aday A, Hindilerden F, Akadam-Teker B, Yilmaz C, Nalcaci M, Yavuz AS, Sargin D. The Clinical Significance of IDH Mutations in Essential Thrombocythemia and Primary Myelofibrosis. J Clin Med Res 2015; 8:29-39. [PMID: 26668680 PMCID: PMC4676343 DOI: 10.14740/jocmr2405w] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2015] [Indexed: 01/01/2023] Open
Abstract
Background Limited data exist regarding impact of IDH mutations in Philadelphia-negative myeloproliferative neoplasms (Ph-negative MPNs). Prognostic significance of IDH mutations was asessed in 184 Ph-negative MPN patients - 107 essential thrombocythemia (ET) and 77 primary myelofibrosis (PMF). Methods High-resolution melting (HRM) analysis was used to detect IDH1 and IDH2 mutations. Results PMF and ET patients showed no significant difference for prevalence of IDH mutations. Mutant IDH (IDH1 or IDH2) was documented in five of PMF (6.5%) and two of ET patients (1.9%). IDH mutations in ET patients included one IDH1 R132C and one IDH2 R140Q. Of the five IDH-mutated PMF patients, four (80%) displayed IDH1 (three IDH1 R132C and one IDH1 R132S) and one (20%) carried IDH2 (IDH2 R140Q) mutation. Sixty percent (three in five) of IDH-mutated PMF patients carried JAK2V617F with following allele burdens: 31-50%, 5-12.5% and 31-50%, respectively. Three of 77 PMF patients (3.9%) simultaneously harbored IDH and JAK2V617F mutations. IDH mutations in PMF showed a trend towards higher rate in females (100% and 52.8%, respectively). Bleeding complications were significantly higher in IDH-mutated PMF patients compared to IDH wild-type counterparts. Trend towards a lower prevalance of acetylsalicylic acid (ASA) use was present in IDH mutant PMF patients compared to wild-type counterparts (20% and 63.9%, respectively). Death rate was higher in IDH-mutated PMF patients compared to IDH wild-type PMF patients (60% and 15.3%). In univariate analysis, a significantly shorter leukemia-free survival (LFS) was observed in IDH-mutated PMF patients. Conclusions We conclude that IDH mutations indicate a risk for leukemic transformation in PMF.
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Affiliation(s)
- Ipek Yonal-Hindilerden
- Division of Hematology, Department of Internal Medicine, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Aynur Daglar-Aday
- Division of Hematology, Department of Internal Medicine, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Fehmi Hindilerden
- Hematology Clinic, Istanbul Bakirkoy Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Basak Akadam-Teker
- Division of Hematology, Department of Internal Medicine, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Ceylan Yilmaz
- Division of Hematology, Department of Internal Medicine, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Meliha Nalcaci
- Division of Hematology, Department of Internal Medicine, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Akif Selim Yavuz
- Division of Hematology, Department of Internal Medicine, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Deniz Sargin
- Division of Hematology, Department of Internal Medicine, Medipol University, Istanbul, Turkey
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73
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Balss J, Thiede C, Bochtler T, Okun JG, Saadati M, Benner A, Pusch S, Ehninger G, Schaich M, Ho AD, von Deimling A, Krämer A, Heilig CE. Pretreatment d-2-hydroxyglutarate serum levels negatively impact on outcome in IDH1-mutated acute myeloid leukemia. Leukemia 2015; 30:782-8. [DOI: 10.1038/leu.2015.317] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 10/23/2015] [Accepted: 11/02/2015] [Indexed: 11/09/2022]
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74
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Ahn JS, Kim JY, Kim HJ, Kim YK, Lee SS, Jung SH, Yang DH, Lee JJ, Kim NY, Choi SH, Minden MD, Jung CW, Jang JH, Kim HJ, Moon JH, Sohn SK, Won JH, Kim SH, Kim DDH. Normal karyotype acute myeloid leukemia patients with CEBPA double mutation have a favorable prognosis but no survival benefit from allogeneic stem cell transplant. Ann Hematol 2015; 95:301-10. [DOI: 10.1007/s00277-015-2540-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 10/24/2015] [Indexed: 12/19/2022]
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75
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Han JA, An J, Ko M. Functions of TET Proteins in Hematopoietic Transformation. Mol Cells 2015; 38:925-35. [PMID: 26552488 PMCID: PMC4673406 DOI: 10.14348/molcells.2015.0294] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 11/04/2015] [Indexed: 12/12/2022] Open
Abstract
DNA methylation is a well-characterized epigenetic modification that plays central roles in mammalian development, genomic imprinting, X-chromosome inactivation and silencing of retrotransposon elements. Aberrant DNA methylation pattern is a characteristic feature of cancers and associated with abnormal expression of oncogenes, tumor suppressor genes or repair genes. Ten-eleven-translocation (TET) proteins are recently characterized dioxygenases that catalyze progressive oxidation of 5-methylcytosine to produce 5-hydroxymethylcytosine and further oxidized derivatives. These oxidized methylcytosines not only potentiate DNA demethylation but also behave as independent epigenetic modifications per se. The expression or activity of TET proteins and DNA hydroxymethylation are highly dysregulated in a wide range of cancers including hematologic and non-hematologic malignancies, and accumulating evidence points TET proteins as a novel tumor suppressor in cancers. Here we review DNA demethylation-dependent and -independent functions of TET proteins. We also describe diverse TET loss-of-function mutations that are recurrently found in myeloid and lymphoid malignancies and their potential roles in hematopoietic transformation. We discuss consequences of the deficiency of individual Tet genes and potential compensation between different Tet members in mice. Possible mechanisms underlying facilitated oncogenic transformation of TET-deficient hematopoietic cells are also described. Lastly, we address non-mutational mechanisms that lead to suppression or inactivation of TET proteins in cancers. Strategies to restore normal 5mC oxidation status in cancers by targeting TET proteins may provide new avenues to expedite the development of promising anti-cancer agents.
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Affiliation(s)
- Jae-A Han
- School of Life Sciences, Ulsan National Institute of Science and Technology
| | - Jungeun An
- Center for Genomic Integrity, Institute for Basic Science (IBS), Ulsan 689-798,
Korea
| | - Myunggon Ko
- School of Life Sciences, Ulsan National Institute of Science and Technology
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76
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Ko M, An J, Pastor WA, Koralov SB, Rajewsky K, Rao A. TET proteins and 5-methylcytosine oxidation in hematological cancers. Immunol Rev 2015; 263:6-21. [PMID: 25510268 DOI: 10.1111/imr.12239] [Citation(s) in RCA: 148] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
DNA methylation has pivotal regulatory roles in mammalian development, retrotransposon silencing, genomic imprinting, and X-chromosome inactivation. Cancer cells display highly dysregulated DNA methylation profiles characterized by global hypomethylation in conjunction with hypermethylation of promoter CpG islands that presumably lead to genome instability and aberrant expression of tumor suppressor genes or oncogenes. The recent discovery of ten-eleven-translocation (TET) family dioxygenases that oxidize 5mC to 5-hydroxymethylcytosine (5hmC), 5-formylcytosine (5fC), and 5-carboxylcytosine (5caC) in DNA has led to profound progress in understanding the mechanism underlying DNA demethylation. Among the three TET genes, TET2 recurrently undergoes inactivating mutations in a wide range of myeloid and lymphoid malignancies. TET2 functions as a bona fide tumor suppressor particularly in the pathogenesis of myeloid malignancies resembling chronic myelomonocytic leukemia (CMML) and myelodysplastic syndromes (MDS) in human. Here we review diverse functions of TET proteins and the novel epigenetic marks that they generate in DNA methylation/demethylation dynamics and normal and malignant hematopoietic differentiation. The impact of TET2 inactivation in hematopoiesis and various mechanisms modulating the expression or activity of TET proteins are also discussed. Furthermore, we also present evidence that TET2 and TET3 collaborate to suppress aberrant hematopoiesis and hematopoietic transformation. A detailed understanding of the normal and pathological functions of TET proteins may provide new avenues to develop novel epigenetic therapies for treating hematological malignancies.
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Affiliation(s)
- Myunggon Ko
- Division of Signaling and Gene Expression, La Jolla Institute for Allergy and Immunology, La Jolla, CA, USA
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77
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DiNardo CD, Jabbour E, Ravandi F, Takahashi K, Daver N, Routbort M, Patel KP, Brandt M, Pierce S, Kantarjian H, Garcia-Manero G. IDH1 and IDH2 mutations in myelodysplastic syndromes and role in disease progression. Leukemia 2015; 30:980-4. [PMID: 26228814 PMCID: PMC4733599 DOI: 10.1038/leu.2015.211] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- C D DiNardo
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - E Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - F Ravandi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - K Takahashi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - N Daver
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M Routbort
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - K P Patel
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M Brandt
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - S Pierce
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - H Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - G Garcia-Manero
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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78
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Gondek LP, DeZern AE. I walk the line: how to tell MDS from other bone marrow failure conditions. Curr Hematol Malig Rep 2015; 9:389-99. [PMID: 25079655 DOI: 10.1007/s11899-014-0224-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Myelodysplastic syndromes (MDS) are clonal hematopoietic stem cell disorders characterized by peripheral cytopenias and ineffective hematopoiesis. MDS is an example of an age-related malignancy and its increasing prevalence and incidence can be attributed to a greater life expectancy in developed countries. Although frequently encountered in hematology/oncology clinics, MDS may constitute a diagnostic challenge especially with equivocal bone marrow morphology. Certain syndromes of bone marrow failure (BMF) may mimic MDS and formulating a correct diagnosis is vital for adequate prognostication as well as therapeutic approaches. Metaphase karyotyping (MK) is a very important diagnostic tool and marker of prognosis and can be an indicator of response to certain therapies. Unfortunately, chromosomal abnormalities may only be found in approximately 50 % of patients with MDS. In this review, we discuss the diagnostic approaches to patients with pancytopenia with a particular focus on the growing number of somatic mutations through new molecular testing.
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Affiliation(s)
- Lukasz P Gondek
- Department of Oncology, Division of Hematological Malignancies, Johns Hopkins University, 1650 Orleans St, CRB1-290, Baltimore, MD, 21231, USA,
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79
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Heuser M, Araujo Cruz MM, Goparaju R, Chaturvedi A. Enigmas of IDH mutations in hematology/oncology. Exp Hematol 2015; 43:685-97. [PMID: 26032956 DOI: 10.1016/j.exphem.2015.05.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 05/14/2015] [Accepted: 05/18/2015] [Indexed: 12/28/2022]
Abstract
The discovery of oncogenic mutations in isocitrate dehydrogenase (IDH) enzymes has highlighted the delicate interplay of metabolism, cellular signaling, and transcriptional regulation that was off-focus for some time in the genomic era. Although IDH inhibitors are being evaluated for clinical efficacy, an in-depth understanding of disease pathogenesis linked to IDH mutations is required to develop rational combination treatments and to be evaluated in the clinic. To gain such an understanding, several questions need to be addressed: Why do IDH mutations occur selectively in subsets of a disease entity although they are found to be present in a very heterogeneous set of unrelated tumors? Why are 2-hydroxyglutarate-producing tumors specifically selected for the R-enantiomer and not for the S-enantiomer? Are the changes in 2-hydroxyglutarate-induced DNA methylation primary or secondary alterations in tumorigenesis? What are the roles of hypoxia-inducible factor (HIF) and its prolyl 4-hydroxylases in IDH-mutant tumors? Here, we address these questions and discuss the consequences for basic and clinical research related to IDH-mutant tumors.
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Affiliation(s)
- Michael Heuser
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany.
| | - Michelle Maria Araujo Cruz
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Ramya Goparaju
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Anuhar Chaturvedi
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
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80
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Comparison of next-generation sequencing mutation profiling with BRAF and IDH1 mutation-specific immunohistochemistry. Am J Surg Pathol 2015; 39:454-61. [PMID: 25634750 DOI: 10.1097/pas.0000000000000325] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Mutation-specific antibodies for BRAF V600E and IDH1 R132H offer convenient immunohistochemical (IHC) assays to detect these mutations in tumors. Previous studies using these antibodies have shown high sensitivity and specificity, but use in routine diagnosis with qualitative assessment has not been well studied. In this retrospective study, we reviewed BRAF and IDH1 mutation-specific IHC results compared with separately obtained clinical next-generation sequencing results. For 67 tumors with combined IDH1 IHC and mutation data, IHC was unequivocally reported as positive or negative in all cases. Sensitivity of IHC for IDH1 R132H was 98% and specificity was 100% compared with mutation status. Four IHC-negative samples showed non-R132H IDH1 mutations including R132C, R132G, and P127T. For 128 tumors with combined BRAF IHC and mutation data, IHC was positive in 33, negative in 82, and equivocal in 13 tumors. The sensitivity of IHC was 97% and specificity was 99% when including only unequivocally positive or negative results. If equivocal IHC cases were included in the analysis as negative, sensitivity fell to 81%. If equivocal cases were classified as positive, specificity dropped to 91%. Eight IHC-negative samples showed non-V600E BRAF mutations including V600K, N581I, V600M, and K601E. We conclude that IHC for BRAF V600E and IDH1 R132H is relatively sensitive and specific, but there is a discordance rate that is not trivial. In addition, a significant proportion of patients harbor BRAF non-V600E or IDH1 non-R132H mutations not detectable by IHC, potentially limiting utility of IHC screening for BRAF and IDH1 mutations.
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81
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Genetics factors associated with myelodysplastic syndromes. Blood Cells Mol Dis 2015; 55:76-81. [PMID: 25976472 DOI: 10.1016/j.bcmd.2015.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 04/16/2015] [Indexed: 12/16/2022]
Abstract
The myelodysplastic syndromes (MDS) are a clinically and cytogenetically heterogeneous group of clonal diseases. Clonal chromosomal abnormalities are observed in 30-50% of patients with MDS. The deletions are among the most common alterations, and often involve the long arms of chromosomes 5, 7, 8, 13, and 20 and the short arms of chromosomes 12 and 17. The advent of new technologies for the detection of genetic abnormalities led to the description of a new set of recurrent mutations, leading to new insights into the pathophysiology of MDS. The recent recognition that genes involved in the regulation of histone function (EZH2, ASXL1, and UTX) and DNA methylation (DNMT3A, IDH1/IDH2, and TET2) are frequently mutated in MDS, has led to the proposal that there is an important link between genetic and epigenetic alterations in this disease. In fact, regulatory factors have also been considered as miR-143/miR-145, miR-146a, miR-125a and MiR-21. Somatic mutations may influence the clinical phenotype but are not included in current prognostic scoring systems. In recent years research has brought new insights into these diseases, but few of the findings are sufficiently robust to be incorporated into the clinical routine at this time. Thus, the aim of this study was to review the role of genetic factors involved in the diagnosis and development of the different phenotypes of MDS.
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82
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Pellagatti A, Boultwood J. The molecular pathogenesis of the myelodysplastic syndromes. Eur J Haematol 2015; 95:3-15. [DOI: 10.1111/ejh.12515] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2014] [Indexed: 02/07/2023]
Affiliation(s)
- Andrea Pellagatti
- Leukaemia & Lymphoma Research Molecular Haematology Unit; Nuffield Division of Clinical Laboratory Sciences; Radcliffe Department of Medicine; University of Oxford; Oxford UK
| | - Jacqueline Boultwood
- Leukaemia & Lymphoma Research Molecular Haematology Unit; Nuffield Division of Clinical Laboratory Sciences; Radcliffe Department of Medicine; University of Oxford; Oxford UK
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Abstract
The prognosis for patients with acute myeloid leukemia (AML) is determined to a large degree by the biology of the leukemic cell. In recent years, the identification and characterization of genetic aberrations has vastly improved our understanding of the pathogenesis of AML. In contrast, however, there has been a lack of clinically meaningful therapeutic advances. The same chemotherapeutic strategies have been applied to AML for several decades now, and while these regimens are effective in inducing remission, most patients relapse within months after initial treatment. Hence, there is an urgent need for novel therapies. We review herein a number of lines of laboratory and clinical trial data supporting the clinical value of targeted treatment approaches that will likely result in improved outcomes for patients with AML.
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Affiliation(s)
- Heiko Konig
- Johns Hopkins University, Baltimore, MD, USA
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84
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DeZern AE. Nine years without a new FDA-approved therapy for MDS: how can we break through the impasse? HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2015; 2015:308-316. [PMID: 26637738 DOI: 10.1182/asheducation-2015.1.308] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The myelodysplastic syndromes (MDSs) are a heterogeneous collection of clonal hematopoietic malignancies that compromise a large subgroup of the myeloid neoplasms and collectively are the most common acquired adult bone marrow failure syndromes. Currently, only 3 agents are approved for the treatment of MDS by the US Food and Drug Administration (FDA): azacitidine, decitabine, and lenalidomide. The latter drug, approved in 2006, is the most recent agent approved by the FDA for MDS and there has been mediocre success with novel agents for the past 9 years. The heterogeneity of MDS as a disease group is likely to be a strong contributor to this slow progress but recent developments in molecular characterization of MDS are improving diagnostic accuracy, providing insights into pathogenesis and refining our prognostic ability in the field. With the advent of these developments, appropriately chosen therapeutics or even targeted agents may be able to improve patient outcomes in the future.
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Affiliation(s)
- Amy E DeZern
- Division of Hematologic Malignancies, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
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85
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Zhang L, Padron E, Lancet J. The molecular basis and clinical significance of genetic mutations identified in myelodysplastic syndromes. Leuk Res 2015; 39:6-17. [DOI: 10.1016/j.leukres.2014.10.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 10/25/2014] [Indexed: 01/07/2023]
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86
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Chotirat S, Thongnoppakhun W, Wanachiwanawin W, Auewarakul CU. Acquired somatic mutations of isocitrate dehydrogenases 1 and 2 (IDH1 and IDH2) in preleukemic disorders. Blood Cells Mol Dis 2014; 54:286-91. [PMID: 25486927 DOI: 10.1016/j.bcmd.2014.11.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 11/15/2014] [Indexed: 11/28/2022]
Abstract
Mutations of isocitrate dehydrogenase isoform 1 and 2 (IDH1 and IDH2) genes have been identified in glioblastoma and acute myeloid leukemia (AML). However, little is known about the molecular alterations of IDH genes in preleukemic disorders with a propensity to transform to AML. We performed polymerase chain reaction-denaturing high performance liquid chromatography (PCR-DHPLC) followed by direct sequencing to detect IDH mutations in 237 patients with myeloproliferative neoplasms (MPNs; n=108), myelodysplastic syndrome (MDS; n=22), paroxysmal nocturnal hemoglobinuria (PNH; n=41), and aplastic anemia (AA; n=66). No IDH1 R132 and IDH2 R172 mutations were identified in the entire cohort, whereas IDH1 G105G allele was detected in 4/108 MPN (3.70%), 2/22 MDS (9.09%), and 2/41 PNH (4.88%) patients. Three IDH2 R140Q mutations were found in 2/108 MPN (1.85%) and 1/22 MDS (4.54%) patients, while one IDH2 G145G allele was found in 0.92% (1/108) of MPN patients. Overall, our data suggest that IDH mutations are rare in the preleukemic disorders and may not be the major initial step in AML leukemogenesis.
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Affiliation(s)
- Sadudee Chotirat
- Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Wanna Thongnoppakhun
- Office of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Wanchai Wanachiwanawin
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Chirayu U Auewarakul
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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87
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Bravo GM, Lee E, Merchan B, Kantarjian HM, García-Manero G. Integrating genetics and epigenetics in myelodysplastic syndromes: advances in pathogenesis and disease evolution. Br J Haematol 2014; 166:646-59. [PMID: 24903747 PMCID: PMC5553700 DOI: 10.1111/bjh.12957] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 04/19/2014] [Indexed: 01/09/2023]
Abstract
The myelodysplastic syndromes (MDS) are a group of clonal diseases characterized by inefficient haematopoiesis, increased apoptosis and risk of evolution to acute myeloid leukaemia. Alterations in epigenetic processes, including DNA methylation, histone modifications, miRNA and splicing machinery, are well known pathogenical events in MDS. Although many advances have been made in determining the mutational frequency, distribution and association affecting these epigenomic regulators, functional integration to better understand pathogenesis of the disease is a challenging and expanding area. Recent studies are shedding light on the molecular basis of myelodysplasia and how mutations and epimutations can induce and promote this neoplastic process through aberrant transcription factor function (RUNX1, ETV6, TP53), kinase signalling (FLT3, NRAS, KIT, CBL) and epigenetic deregulation (TET2, IDH1/2, DNMT3A, EZH2, ASXL1, SF3B1, U2AF1, SRSF2, ZRSR2). In this review we will try to focus on the description of these mutations, their impact on prognosis, the functional connections between the different epigenetic pathways, and the existing and future therapies targeting these processes.
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88
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Matynia AP, Szankasi P, Shen W, Kelley TW. Molecular genetic biomarkers in myeloid malignancies. Arch Pathol Lab Med 2014; 139:594-601. [PMID: 25152312 DOI: 10.5858/arpa.2014-0096-ra] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Recent studies using massively parallel sequencing technologies, so-called next-generation sequencing, have uncovered numerous recurrent, single-gene variants or mutations across the spectrum of myeloid malignancies. OBJECTIVES To review the recent advances in the understanding of the molecular basis of myeloid neoplasms, including their significance for diagnostic and prognostic purposes and the possible implications for the development of novel therapeutic strategies. DATA SOURCES Literature review. CONCLUSIONS The recurrent mutations found in myeloid malignancies fall into distinct functional categories. These include (1) cell signaling factors, (2) transcription factors, (3) regulators of the cell cycle, (4) regulators of DNA methylation, (5) regulators of histone modification, (6) RNA-splicing factors, and (7) components of the cohesin complex. As the clinical significance of these mutations and mutation combinations is established, testing for their presence is likely to become a routine part of the diagnostic workup. This review will attempt to establish a framework for understanding these mutations in the context of myeloproliferative neoplasms, myelodysplastic syndromes, and acute myeloid leukemia.
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Affiliation(s)
- Anna P Matynia
- From the Department of Pathology, University of Utah, Salt Lake City (Drs Matynia and Kelley); and Research and Development, ARUP Laboratories, Salt Lake City, Utah (Drs Szankasi and Shen)
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89
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Waterfall JJ, Killian JK, Meltzer PS. The role of mutation of metabolism-related genes in genomic hypermethylation. Biochem Biophys Res Commun 2014; 455:16-23. [PMID: 25111818 DOI: 10.1016/j.bbrc.2014.08.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 07/28/2014] [Accepted: 08/01/2014] [Indexed: 12/17/2022]
Abstract
Genetic mutations, metabolic dysfunction, and epigenetic misregulation are commonly considered to play distinct roles in tumor development and maintenance. However, intimate relationships between these mechanisms are now emerging. In particular, mutations in genes for the core metabolic enzymes IDH, SDH, and FH are significant drivers of diverse tumor types. In each case, the resultant accumulation of particular metabolites inhibits TET enzymes responsible for oxidizing 5-methylcytosine, leading to pervasive DNA hypermethylation.
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Affiliation(s)
- Joshua J Waterfall
- Genetics Branch, Center for Cancer Research, NCI, NIH, Bethesda, MD 20892, USA
| | - J Keith Killian
- Genetics Branch, Center for Cancer Research, NCI, NIH, Bethesda, MD 20892, USA
| | - Paul S Meltzer
- Genetics Branch, Center for Cancer Research, NCI, NIH, Bethesda, MD 20892, USA.
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90
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Jin J, Hu C, Yu M, Chen F, Ye L, Yin X, Zhuang Z, Tong H. Prognostic value of isocitrate dehydrogenase mutations in myelodysplastic syndromes: a retrospective cohort study and meta-analysis. PLoS One 2014; 9:e100206. [PMID: 24936872 PMCID: PMC4061070 DOI: 10.1371/journal.pone.0100206] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 05/21/2014] [Indexed: 02/04/2023] Open
Abstract
Background Recent genomic sequencing efforts have identified a number of recurrent mutations in myelodysplastic syndromes (MDS) that may contribute to disease progression and overall survival, including mutations in isocitrate dehydrogenases 1 and 2 (IDH1 and IDH2). Methods Pretreatment bone marrow (BM) samples were acquired from mononuclear cells in 146 adult patients with de novo MDS from January 2006 to June 2013. Polymerase chain reaction (PCR) and direct sequencing were performed on exon 4 of IDH1/2 genes and mutation status was correlated with overall survival (OS) and leukemia-free survival (LFS). We then performed a meta-analysis combining previously published and current studies to explore the effect of IDH mutations on OS and LFS in MDS. Results In our study, somatic mutations of either IDH gene were discovered in 11 MDS patients (7.53%) and were significantly correlated with poorer OS (P = 0.007). IDH mutations were specifically associated with a poorer OS in the intermediate-1 risk group by the International Prognostic Scoring System (IPSS) (P = 0.039). In addition, we discovered decitabine achieved a better therapeutic effect compared to other treatments in IDH mutation-positive patients (P = 0.023). We identified six previous studies of IDH mutations in MDS. A meta-analysis of these studies included 111 MDS patients IDH mutations and 1671 MDS patients with wild-type IDH1/2. The hazard ratios (HRs) of OS and LFS for patients with IDH mutations were 1.62 (95% CI, 1.27–2.09) and 2.21 (95% CI, 1.48–3.30), respectively. Conclusion The results from our study and the meta-analysis provide firm evidence that IDH mutations are significantly associated with poorer clinical outcomes in MDS. Identification of IDH mutations may be pivotal for better risk stratification in MDS patients and improving IPSS score. Additionally, hypomethylating agents may be an effective treatment option for MDS patients with IDH mutations.
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Affiliation(s)
- Jie Jin
- Department of Hematology, the First Affiliated Hospital of Zhejiang University, Hangzhou, People’s Republic of China
- Institute of Hematology, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Chao Hu
- Department of Hematology, the First Affiliated Hospital of Zhejiang University, Hangzhou, People’s Republic of China
- Institute of Hematology, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Mengxia Yu
- Department of Hematology, the First Affiliated Hospital of Zhejiang University, Hangzhou, People’s Republic of China
- Institute of Hematology, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Feifei Chen
- Department of Hematology, the First Affiliated Hospital of Zhejiang University, Hangzhou, People’s Republic of China
- Institute of Hematology, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Li Ye
- Department of Hematology, the First Affiliated Hospital of Zhejiang University, Hangzhou, People’s Republic of China
- Institute of Hematology, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Xiufeng Yin
- Department of Hematology, the First Affiliated Hospital of Zhejiang University, Hangzhou, People’s Republic of China
- Institute of Hematology, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Zhengping Zhuang
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Hongyan Tong
- Department of Hematology, the First Affiliated Hospital of Zhejiang University, Hangzhou, People’s Republic of China
- Institute of Hematology, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- * E-mail:
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91
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DeZern AE, Sekeres MA. The challenging world of cytopenias: distinguishing myelodysplastic syndromes from other disorders of marrow failure. Oncologist 2014; 19:735-45. [PMID: 24899643 DOI: 10.1634/theoncologist.2014-0056] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Over the past decade, our understanding of bone marrow failure has advanced considerably. Marrow failure encompasses multiple overlapping diseases, and there is increasing availability of diagnostic tools to distinguish among the subtypes. Identification of genetic alterations that underlie marrow failure has also greatly expanded, especially for myelodysplastic syndromes. Molecular markers are increasingly used to guide the management of myelodysplasia and may distinguish this diagnosis from other marrow failure disorders. This review summarizes the current state of distinguishing among causes of marrow failure and discusses the potential uses of multiple diagnostic and prognostic indicators in the management of myelodysplastic syndromes and other bone marrow failure disorders.
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Affiliation(s)
- Amy E DeZern
- The Sidney Kimmel Comprehensive Cancer Center and Division of Hematology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Leukemia Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mikkael A Sekeres
- The Sidney Kimmel Comprehensive Cancer Center and Division of Hematology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Leukemia Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
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92
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Molenaar RJ, Radivoyevitch T, Maciejewski JP, van Noorden CJF, Bleeker FE. The driver and passenger effects of isocitrate dehydrogenase 1 and 2 mutations in oncogenesis and survival prolongation. Biochim Biophys Acta Rev Cancer 2014; 1846:326-41. [PMID: 24880135 DOI: 10.1016/j.bbcan.2014.05.004] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 04/30/2014] [Accepted: 05/22/2014] [Indexed: 01/06/2023]
Abstract
Mutations in isocitrate dehydrogenase 1 and 2 (IDH1 and IDH2) are key events in the development of glioma, acute myeloid leukemia (AML), chondrosarcoma, intrahepatic cholangiocarcinoma (ICC), and angioimmunoblastic T-cell lymphoma. They also cause D-2-hydroxyglutaric aciduria and Ollier and Maffucci syndromes. IDH1/2 mutations are associated with prolonged survival in glioma and in ICC, but not in AML. The reason for this is unknown. In their wild-type forms, IDH1 and IDH2 convert isocitrate and NADP(+) to α-ketoglutarate (αKG) and NADPH. Missense mutations in the active sites of these enzymes induce a neo-enzymatic reaction wherein NADPH reduces αKG to D-2-hydroxyglutarate (D-2HG). The resulting D-2HG accumulation leads to hypoxia-inducible factor 1α degradation, and changes in epigenetics and extracellular matrix homeostasis. Such mutations also imply less NADPH production capacity. Each of these effects could play a role in cancer formation. Here, we provide an overview of the literature and discuss which downstream molecular effects are likely to be the drivers of the oncogenic and survival-prolonging properties of IDH1/2 mutations. We discuss interactions between mutant IDH1/2 inhibitors and conventional therapies. Understanding of the biochemical consequences of IDH1/2 mutations in oncogenesis and survival prolongation will yield valuable information for rational therapy design: it will tell us which oncogenic processes should be blocked and which "survivalogenic" effects should be retained.
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Affiliation(s)
- Remco J Molenaar
- Department of Cell Biology & Histology, Academic Medical Center, University of Amsterdam, The Netherlands.
| | - Tomas Radivoyevitch
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA
| | - Jaroslaw P Maciejewski
- Department of Translational Hematology and Oncology Research, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - Cornelis J F van Noorden
- Department of Cell Biology & Histology, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Fonnet E Bleeker
- Department of Clinical Genetics, Academic Medical Center, University of Amsterdam, The Netherlands
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93
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Abstract
CONTEXT Hematopathology is a dynamic field that has always been on the frontier of clinical research within the scope of pathology. Several recent developments in hematopathology will likely affect its practice clinically. OBJECTIVE To review 5 important recent advances in hematopathology: (1) detection and prognostic implication of MYC in diffuse large B-cell lymphomas, (2) determining origin and prognosis through immunoglobulin gene usage in mature B-cell neoplasms, (3)detecting minimal residual disease in multiple myeloma, (4) using genome-wide analysis in myelodysplastic syndromes, and (5) employing whole-genome sequencing in acute myeloid leukemias. DATA SOURCES Literature review and the authors' experiences in an academic center. CONCLUSIONS These advances will bring hematopathology into a new molecular era and help us to better understand the molecular, pathologic mechanisms of lymphomas, leukemias, myelomas, and myelodysplastic syndromes. They will help us to identify diagnostic and prognostic markers and eventually provide new therapeutic targets and treatments for these diseases.
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Affiliation(s)
- Min Shi
- From the Department of Pathology, UMass Memorial Medical Center, Worcester, Massachusetts
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94
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Fathi AT, Sadrzadeh H, Comander AH, Higgins MJ, Bardia A, Perry A, Burke M, Silver R, Matulis CR, Straley KS, Yen KE, Agresta S, Kim H, Schenkein DP, Borger DR. Isocitrate dehydrogenase 1 (IDH1) mutation in breast adenocarcinoma is associated with elevated levels of serum and urine 2-hydroxyglutarate. Oncologist 2014; 19:602-7. [PMID: 24760710 DOI: 10.1634/theoncologist.2013-0417] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Mutations in the IDH1 and IDH2 (isocitrate dehydrogenase) genes have been discovered across a range of solid-organ and hematologic malignancies, including acute myeloid leukemia, glioma, chondrosarcoma, and cholangiocarcinoma. An intriguing aspect of IDH-mutant tumors is the aberrant production and accumulation of the oncometabolite 2-hydroxyglutarate (2-HG), which may play a pivotal oncogenic role in these malignancies. We describe the first reported case of an IDH1 p.R132L mutation in a patient with hormone receptor-positive (HR+) breast adenocarcinoma. This patient was initially treated for locally advanced disease, but then suffered a relapse and metastasis, at which point an IDH1-R132 mutation was discovered in an affected lymph node. The mutation was subsequently found in the primary tumor tissue and all metastatic sites, but not in an uninvolved lymph node. In addition, the patient's serum and urine displayed marked elevations in the concentration of 2-HG, significantly higher than that measured in six other patients with metastatic HR+ breast carcinoma whose tumors were found to harbor wild-type IDH1. In summary, IDH1 mutations may impact a rare subgroup of patients with breast adenocarcinoma. This may suggest future avenues for disease monitoring through noninvasive measurement of 2-HG, as well as for the development and study of targeted therapies against the aberrant IDH1 enzyme.
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Affiliation(s)
- Amir T Fathi
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA; Agios Pharmaceuticals, Cambridge, Massachusetts, USA
| | - Hossein Sadrzadeh
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA; Agios Pharmaceuticals, Cambridge, Massachusetts, USA
| | - Amy H Comander
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA; Agios Pharmaceuticals, Cambridge, Massachusetts, USA
| | - Michaela J Higgins
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA; Agios Pharmaceuticals, Cambridge, Massachusetts, USA
| | - Aditya Bardia
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA; Agios Pharmaceuticals, Cambridge, Massachusetts, USA
| | - Ashley Perry
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA; Agios Pharmaceuticals, Cambridge, Massachusetts, USA
| | - Meghan Burke
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA; Agios Pharmaceuticals, Cambridge, Massachusetts, USA
| | - Regina Silver
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA; Agios Pharmaceuticals, Cambridge, Massachusetts, USA
| | - Christina R Matulis
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA; Agios Pharmaceuticals, Cambridge, Massachusetts, USA
| | - Kimberly S Straley
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA; Agios Pharmaceuticals, Cambridge, Massachusetts, USA
| | - Katharine E Yen
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA; Agios Pharmaceuticals, Cambridge, Massachusetts, USA
| | - Sam Agresta
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA; Agios Pharmaceuticals, Cambridge, Massachusetts, USA
| | - Hyeryun Kim
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA; Agios Pharmaceuticals, Cambridge, Massachusetts, USA
| | - David P Schenkein
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA; Agios Pharmaceuticals, Cambridge, Massachusetts, USA
| | - Darrell R Borger
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA; Agios Pharmaceuticals, Cambridge, Massachusetts, USA
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95
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Im AP, Sehgal AR, Carroll MP, Smith BD, Tefferi A, Johnson DE, Boyiadzis M. DNMT3A and IDH mutations in acute myeloid leukemia and other myeloid malignancies: associations with prognosis and potential treatment strategies. Leukemia 2014; 28:1774-83. [PMID: 24699305 DOI: 10.1038/leu.2014.124] [Citation(s) in RCA: 190] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 03/05/2014] [Accepted: 03/25/2014] [Indexed: 02/08/2023]
Abstract
The development of effective treatment strategies for most forms of acute myeloid leukemia (AML) has languished for the past several decades. There are a number of reasons for this, but key among them is the considerable heterogeneity of this disease and the paucity of molecular markers that can be used to predict clinical outcomes and responsiveness to different therapies. The recent large-scale sequencing of AML genomes is now providing opportunities for patient stratification and personalized approaches to treatment that are based on individual mutational profiles. It is particularly notable that studies by The Cancer Genome Atlas and others have determined that 44% of patients with AML exhibit mutations in genes that regulate methylation of genomic DNA. In particular, frequent mutation has been observed in the genes encoding DNA methyltransferase 3A (DNMT3A), isocitrate dehydrogenase 1 (IDH1) and isocitrate dehydrogenase 2 (IDH2), as well as Tet oncogene family member 2. This review will summarize the incidence of these mutations, their impact on biochemical functions including epigenetic modification of genomic DNA and their potential usefulness as prognostic indicators. Importantly, the presence of DNMT3A, IDH1 or IDH2 mutations may confer sensitivity to novel therapeutic approaches, including the use of demethylating agents. Therefore, the clinical experience with decitabine and azacitidine in the treatment of patients harboring these mutations will be reviewed. Overall, we propose that understanding the role of these mutations in AML biology will lead to more rational therapeutic approaches targeting molecularly defined subtypes of the disease.
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Affiliation(s)
- A P Im
- Division of Hematology/Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - A R Sehgal
- Division of Hematology/Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - M P Carroll
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - B D Smith
- The Sidney Kimmel Comprehensive Cancer Center, Department of Oncology at the Johns Hopkins University, Baltimore, MD, USA
| | - A Tefferi
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - D E Johnson
- Division of Hematology/Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - M Boyiadzis
- Division of Hematology/Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
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96
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Cagnetta A, Adamia S, Acharya C, Patrone F, Miglino M, Nencioni A, Gobbi M, Cea M. Role of genotype-based approach in the clinical management of adult acute myeloid leukemia with normal cytogenetics. Leuk Res 2014; 38:649-59. [PMID: 24726781 DOI: 10.1016/j.leukres.2014.03.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 03/03/2014] [Accepted: 03/09/2014] [Indexed: 02/02/2023]
Abstract
Acute myeloid leukemia (AML) is the most common form of acute leukemia affecting adults. Although it is a complex disease driven by numerous genetic and epigenetic abnormalities, nearly 50% of patients exhibit a normal karyotype (CN-AML) with an intermediate cytogenetic risk. However, a widespread genomic analysis has recently shown the recurrence of genomic aberrations in this category (mutations of FLT3, CEBPA, NPM1, RUNX1, TET2, IDH1/2, DNMT3A, ASXL1, MLL and WT1) thus revealing its marked genomic heterogeneity. In this perspective, a global gene expression analysis of AML patients provides an independent prognostic marker to categorize each patient into clinic-pathologic subgroups based on its molecular genetic defects. Consistently such classification, taking into account the uniqueness of each AML patient, furnishes an individualized treatment approach leading a step closer to personalized medicine. Overall the genome-wide analysis of AML patients, by providing novel insights into biology of this tumor, furnishes accurate prognostic markers as well as useful tools for selecting the most appropriate treatment option. Moreover it provides novel therapeutic targets useful to enhance efficacy of the current anti-AML therapeutics. Here we describe the prognostic relevance of such new genetic data and discuss how this approach can be used to improve survival and treatment of AML patients.
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Affiliation(s)
- Antonia Cagnetta
- Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA; Department of Hematology and Oncology, I.R.C.C.S. A.O.U. San Martino-IST, Genoa, Italy.
| | - Sophia Adamia
- Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Chirag Acharya
- Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Franco Patrone
- Department of Hematology and Oncology, I.R.C.C.S. A.O.U. San Martino-IST, Genoa, Italy
| | - Maurizio Miglino
- Department of Hematology and Oncology, I.R.C.C.S. A.O.U. San Martino-IST, Genoa, Italy
| | - Alessio Nencioni
- Department of Hematology and Oncology, I.R.C.C.S. A.O.U. San Martino-IST, Genoa, Italy
| | - Marco Gobbi
- Department of Hematology and Oncology, I.R.C.C.S. A.O.U. San Martino-IST, Genoa, Italy
| | - Michele Cea
- Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA; Department of Hematology and Oncology, I.R.C.C.S. A.O.U. San Martino-IST, Genoa, Italy.
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97
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Lin CC, Hou HA, Chou WC, Kuo YY, Liu CY, Chen CY, Lai YJ, Tseng MH, Huang CF, Chiang YC, Lee FY, Liu MC, Liu CW, Tang JL, Yao M, Huang SY, Ko BS, Wu SJ, Tsay W, Chen YC, Tien HF. IDH mutations are closely associated with mutations of DNMT3A, ASXL1 and SRSF2 in patients with myelodysplastic syndromes and are stable during disease evolution. Am J Hematol 2014; 89:137-44. [PMID: 24115220 DOI: 10.1002/ajh.23596] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 09/19/2013] [Indexed: 11/06/2022]
Abstract
Current information about clinical significance of IDH mutations in myelodysplastic syndromes (MDS), their association with other genetic alterations and the stability during disease progression is limited. In this study, IDH mutations were identified in 4.6% of 477 patients with MDS based on the FAB classification and in 2.2 % of 368 patients based on the 2008 WHO classification. IDH mutations were closely associated with older age, higher platelet counts, and mutations of DNMT3A (36.4% vs. 8.7%, P < 0.001), ASXL1 (47.6% vs. 22.0%, P = 0.007), and SRSF2 (45.5% vs. 11.8%, P < 0.001). IDH2 mutation was a poor prognostic factor for overall survival in patients with lower-risk MDS, based on international prognosis scoring system (IPSS), FAB classification, WHO classification, or revised IPSS (all P ≦ 0.001), but not in higher-risk groups. Sequential studies in 151 patients demonstrated that all IDH-mutated patients retained the same mutation during disease evolution while none of the IDH-wild patients acquired a novel mutation during follow-ups. In conclusion, IDH mutation is a useful biomarker for risk stratification of patients with lower-risk MDS. IDH mutations are stable during the clinical course. The mutation, in association with other genetic alterations, may play a role in the development, but not progression of MDS.
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Affiliation(s)
- Chien-Chin Lin
- Division of Hematology, Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
| | - Hsin-An Hou
- Division of Hematology, Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine; National Taiwan University; Taipei Taiwan
| | - Wen-Chien Chou
- Division of Hematology, Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
- Division of Hematology, Department of Laboratory Medicine; National Taiwan University Hospital; Taipei Taiwan
| | - Yuan-Yeh Kuo
- Graduate Institute of Oncology, College of Medicine; National Taiwan University; Taipei Taiwan
| | - Chieh-Yu Liu
- Biostatistics Consulting Laboratory; School of Nursing and Center of General Education, National Taipei University of Nursing and Health Sciences; Taipei Taiwan
| | - Chien-Yuan Chen
- Division of Hematology, Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
| | - Yan-Jun Lai
- Division of Hematology, Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
| | - Mei-Hsuan Tseng
- Division of Hematology, Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
| | - Chi-Fei Huang
- Division of Hematology, Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
| | - Ying-Chieh Chiang
- Division of Hematology, Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
| | - Fen-Yu Lee
- Division of Hematology, Department of Pathology; National Taiwan University Hospital; Taipei Taiwan
| | - Ming-Chih Liu
- Division of Hematology, Department of Pathology; National Taiwan University Hospital; Taipei Taiwan
| | - Chia-Wen Liu
- Division of Hematology, Department of Pathology; National Taiwan University Hospital; Taipei Taiwan
| | - Jih-Luh Tang
- Division of Hematology, Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
| | - Ming Yao
- Division of Hematology, Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
| | - Shang-Yi Huang
- Division of Hematology, Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
| | - Bor-Sheng Ko
- Division of Hematology, Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
| | - Shang-Ju Wu
- Division of Hematology, Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
| | - Woei Tsay
- Division of Hematology, Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
| | - Yao-Chang Chen
- Division of Hematology, Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
- Division of Hematology, Department of Laboratory Medicine; National Taiwan University Hospital; Taipei Taiwan
| | - Hwei-Fang Tien
- Division of Hematology, Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
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98
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Elias HK, Schinke C, Bhattacharyya S, Will B, Verma A, Steidl U. Stem cell origin of myelodysplastic syndromes. Oncogene 2013; 33:5139-50. [PMID: 24336326 DOI: 10.1038/onc.2013.520] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 10/17/2013] [Accepted: 10/17/2013] [Indexed: 01/18/2023]
Abstract
Myelodysplastic syndromes (MDS) are common hematologic disorders that are characterized by decreased blood counts due to ineffective hematopoiesis. MDS is considered a 'preleukemic' disorder linked to a significantly elevated risk of developing an overt acute leukemia. Cytopenias can be observed in all three myeloid lineages suggesting the involvement of multipotent, immature hematopoietic cells in the pathophysiology of this disease. Recent studies using murine models of MDS as well as primary patient-derived bone marrow samples have provided direct evidence that the most immature, self-renewing hematopoietic stem cells (HSC), as well as lineage-committed progenitor cells, are critically altered in patients with MDS. Besides significant changes in the number and distribution of stem as well as immature progenitor cells, genetic and epigenetic aberrations have been identified, which confer functional changes to these aberrant stem cells, impairing their ability to proliferate and differentiate. Most importantly, aberrant stem cells can persist and further expand after treatment, even upon transient achievement of clinical complete remission, pointing to a critical role of these cells in disease relapse. Ongoing preclinical and clinical studies are particularly focusing on the precise molecular and functional characterization of aberrant MDS stem cells in response to therapy, with the goal to develop stem cell-targeted strategies for therapy and disease monitoring that will allow for achievement of longer-lasting remissions in MDS.
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Affiliation(s)
- H K Elias
- 1] Albert Einstein College of Medicine, Albert Einstein Cancer Center, New York, NY, USA [2] Departments of Cell Biology and Developmental and Molecular Biology, New York, NY, USA [3] Division of Hematologic Malignancies, Department of Medicine (Oncology), New York, NY, USA [4] Ruth L. and David S. Gottesman Institute for Stem Cell and Regenerative Medicine Research, Chanin Institute for Cancer Research, New York, NY, USA
| | - C Schinke
- 1] Albert Einstein College of Medicine, Albert Einstein Cancer Center, New York, NY, USA [2] Departments of Cell Biology and Developmental and Molecular Biology, New York, NY, USA [3] Division of Hematologic Malignancies, Department of Medicine (Oncology), New York, NY, USA [4] Ruth L. and David S. Gottesman Institute for Stem Cell and Regenerative Medicine Research, Chanin Institute for Cancer Research, New York, NY, USA
| | - S Bhattacharyya
- 1] Albert Einstein College of Medicine, Albert Einstein Cancer Center, New York, NY, USA [2] Departments of Cell Biology and Developmental and Molecular Biology, New York, NY, USA [3] Division of Hematologic Malignancies, Department of Medicine (Oncology), New York, NY, USA [4] Ruth L. and David S. Gottesman Institute for Stem Cell and Regenerative Medicine Research, Chanin Institute for Cancer Research, New York, NY, USA
| | - B Will
- 1] Albert Einstein College of Medicine, Albert Einstein Cancer Center, New York, NY, USA [2] Departments of Cell Biology and Developmental and Molecular Biology, New York, NY, USA [3] Division of Hematologic Malignancies, Department of Medicine (Oncology), New York, NY, USA [4] Ruth L. and David S. Gottesman Institute for Stem Cell and Regenerative Medicine Research, Chanin Institute for Cancer Research, New York, NY, USA
| | - A Verma
- 1] Albert Einstein College of Medicine, Albert Einstein Cancer Center, New York, NY, USA [2] Departments of Cell Biology and Developmental and Molecular Biology, New York, NY, USA [3] Division of Hematologic Malignancies, Department of Medicine (Oncology), New York, NY, USA [4] Ruth L. and David S. Gottesman Institute for Stem Cell and Regenerative Medicine Research, Chanin Institute for Cancer Research, New York, NY, USA
| | - U Steidl
- 1] Albert Einstein College of Medicine, Albert Einstein Cancer Center, New York, NY, USA [2] Departments of Cell Biology and Developmental and Molecular Biology, New York, NY, USA [3] Division of Hematologic Malignancies, Department of Medicine (Oncology), New York, NY, USA [4] Ruth L. and David S. Gottesman Institute for Stem Cell and Regenerative Medicine Research, Chanin Institute for Cancer Research, New York, NY, USA
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99
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Reichard KK, Hanson CA. Hematological diseases: prototypical conditions requiring the diagnostic and prognostic use of molecular data. Semin Diagn Pathol 2013; 30:382-92. [PMID: 24342292 DOI: 10.1053/j.semdp.2013.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The field of diagnostic hematopathology is dynamic and evolving given the ongoing accumulation of molecular information and demand for integration of this information into routine clinical practice. In light of this molecular revolution, the appropriate and effective utilization of molecular studies by clinicians/pathologists is of paramount importance to the current diagnosis, prognosis, and monitoring of nearly all hematologic diseases. In the routine workup of certain hematologic neoplasms, it is more pertinent and practical to understand the purpose of these analyses and how to generally apply them to particular diseases rather than trying to remember a likely outdated list of genes. We will see advances in the treatment of hematologic malignancies as drug development catches up to our molecular understanding of diseases.
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Affiliation(s)
- Kaaren K Reichard
- Department of Laboratory Medicine and Pathology, The Mayo Clinic, 200 1st St SW, Rochester, Minnesota 55901; Division of Hematopathology, The Mayo Clinic, Rochester, Minnesota.
| | - Curtis A Hanson
- Department of Laboratory Medicine and Pathology, The Mayo Clinic, 200 1st St SW, Rochester, Minnesota 55901; Division of Hematopathology, The Mayo Clinic, Rochester, Minnesota; Division of Laboratory Genetics, The Mayo Clinic, Rochester, Minnesota
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100
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Abstract
Patients with low-risk myelodysplastic syndromes (MDS) that rapidly progress to acute myeloid leukemia (AML) remain a challenge in disease management. Using whole-exome sequencing of an MDS patient, we identified a somatic mutation in the BCOR gene also mutated in AML. Sequencing of BCOR and related BCORL1 genes in a cohort of 354 MDS patients identified 4.2% and 0.8% of mutations respectively. BCOR mutations were associated with RUNX1 (P = .002) and DNMT3A mutations (P = .015). BCOR is also mutated in chronic myelomonocytic leukemia patients (7.4%) and BCORL1 in AML patients with myelodysplasia-related changes (9.1%). Using deep sequencing, we show that BCOR mutations arise after mutations affecting genes involved in splicing machinery or epigenetic regulation. In univariate analysis, BCOR mutations were associated with poor prognosis in MDS (overall survival [OS]: P = .013; cumulative incidence of AML transformation: P = .005). Multivariate analysis including age, International Prognostic Scoring System, transfusion dependency, and mutational status confirmed a significant inferior OS to patients with a BCOR mutation (hazard ratio, 3.3; 95% confidence interval, 1.4-8.1; P = .008). These data suggest that BCOR mutations define the clinical course rather than disease initiation. Despite infrequent mutations, BCOR analyses should be considered in risk stratification.
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