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Pérez-Jacobo F, Tuna-Aguilar E, Demichelis-Gómez R, Crespo-Solís E, Valencia-Rocha U, Aguayo Á, López-Karpovitch X. Prognostic Factors, Response to Treatment, and Survival in Patients With Chronic Myeloid Leukemia in Blast Phase: A Single-Institution Survey. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 15:778-84. [PMID: 26500135 DOI: 10.1016/j.clml.2015.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 09/15/2015] [Accepted: 09/21/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Data from 51 patients (23 women) with chronic myeloid leukemia (CML) in blast phase (BP) were analyzed in order to identify prognostic factors for complete hematologic response (CHR) and survival. PATIENTS AND METHODS Forty-four patients experienced disease progression from chronic or accelerated phase, and 7 cases presented as CML-BP. Thirteen patients (25.5%) had extramedullary involvement at diagnosis, and 71% were myeloid BP. Clonal evolution was identified in 53% of the cases, and the abnormalities most frequently observed were isochromosome (17q), double Philadelphia chromosome, and trisomy 8. Forty-five patients received treatment: 60% chemotherapy (CT) alone and 40% CT plus tyrosine kinase inhibitors (TKI) or TKI alone; 42% of them experienced CHR. RESULTS Median overall survival (OS) in patients whose disease responded to treatment was 7 months (95% confidence interval, 1.7-6.2 months), with a median disease-free survival of 5 months (95% confidence interval, 2.8-5.8 months). One out of 3 patients who underwent hematopoietic stem-cell transplantation remains alive. Multivariate analysis revealed that lymphoid BP and TKI therapy had a statistically significant positive impact as prognostic factors for CHR. In the multivariate analysis, age > 60 years, hemoglobin < 10 g/dL, and complex karyotype were statistically significant negative prognostic factors for OS. There was no statistical significant difference in OS between patients who received only CT (1988-2002) with those treated with CT plus TKI (2003-2013). CONCLUSION This is the first study in Mexico to report prognostic factors associated with CHR and OS in patients with CML-BP.
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Affiliation(s)
- Fernando Pérez-Jacobo
- Chronic Leukemia Clinic, Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, México
| | - Elena Tuna-Aguilar
- Chronic Leukemia Clinic, Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, México
| | - Roberta Demichelis-Gómez
- Chronic Leukemia Clinic, Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, México
| | - Erick Crespo-Solís
- Chronic Leukemia Clinic, Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, México
| | - Ubaldo Valencia-Rocha
- Chronic Leukemia Clinic, Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, México
| | - Álvaro Aguayo
- Chronic Leukemia Clinic, Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, México
| | - Xavier López-Karpovitch
- Chronic Leukemia Clinic, Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, México.
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Fabarius A, Kalmanti L, Dietz CT, Lauseker M, Rinaldetti S, Haferlach C, Göhring G, Schlegelberger B, Jotterand M, Hanfstein B, Seifarth W, Hänel M, Köhne CH, Lindemann HW, Berdel WE, Staib P, Müller MC, Proetel U, Balleisen L, Goebeler ME, Dengler J, Falge C, Kanz L, Burchert A, Kneba M, Stegelmann F, Pfreundschuh M, Waller CF, Spiekermann K, Brümmendorf TH, Edinger M, Hofmann WK, Pfirrmann M, Hasford J, Krause S, Hochhaus A, Saußele S, Hehlmann R. Impact of unbalanced minor route versus major route karyotypes at diagnosis on prognosis of CML. Ann Hematol 2015; 94:2015-24. [PMID: 26385387 DOI: 10.1007/s00277-015-2494-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 08/31/2015] [Indexed: 11/29/2022]
Abstract
Major route additional cytogenetic aberrations (ACA) at diagnosis of chronic myeloid leukaemia (CML) indicate an increased risk of progression and shorter survival. Since major route ACA are almost always unbalanced, it is unclear whether other unbalanced ACA at diagnosis also confer an unfavourable prognosis. On the basis of 1348 Philadelphia chromosome-positive chronic phase patients of the randomized CML study IV, we examined the impact of unbalanced minor route ACA at diagnosis versus major route ACA on prognosis. At diagnosis, 1175 patients (87.2 %) had a translocation t(9;22)(q34;q11) and 74 (5.5 %) a variant translocation t(v;22) only, while a loss of the Y chromosome (-Y) was present in addition in 44 (3.3 %), balanced or unbalanced minor route ACA each in 17 (1.3 %) and major route ACA in 21 (1.6 %) cases. Patients with unbalanced minor route ACA had no significantly different cumulative incidences of complete cytogenetic remission or major molecular remission and no significantly different progression-free survival (PFS) or overall survival (OS) than patients with t(9;22), t(v;22), -Y and balanced minor route karyotypes. In contrast, patients with major route ACA had a shorter OS and PFS than all other groups (all pairwise comparisons to each of the other groups: p ≤ 0.015). Five-year survival probabilities were for t(9;22) 91.4 % (95 % CI 89.5-93.1), t(v; 22) 87 % (77.2-94.3), -Y 89.0 % (76.7-97.0), balanced 100 %, unbalanced minor route 92.3 % (72.4-100) and major route 52.2 % (28.2-75.5). We conclude that only major route, but not balanced or unbalanced minor route ACA at diagnosis, has a negative impact on prognosis of CML.
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Affiliation(s)
- Alice Fabarius
- III. Medizinische Universitätsklinik, Medizinische Fakultät Mannheim der Universität Heidelberg, Pettenkoferstrasse 22, 68169, Mannheim, Germany.
| | - Lida Kalmanti
- III. Medizinische Universitätsklinik, Medizinische Fakultät Mannheim der Universität Heidelberg, Pettenkoferstrasse 22, 68169, Mannheim, Germany
| | - Christian T Dietz
- III. Medizinische Universitätsklinik, Medizinische Fakultät Mannheim der Universität Heidelberg, Pettenkoferstrasse 22, 68169, Mannheim, Germany
| | - Michael Lauseker
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität München, München, Germany
| | - Sébastien Rinaldetti
- III. Medizinische Universitätsklinik, Medizinische Fakultät Mannheim der Universität Heidelberg, Pettenkoferstrasse 22, 68169, Mannheim, Germany
| | | | - Gudrun Göhring
- Institut für Humangenetik, Medizinische Hochschule Hannover, Hannover, Germany
| | | | - Martine Jotterand
- Service de génétique médicale, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Benjamin Hanfstein
- III. Medizinische Universitätsklinik, Medizinische Fakultät Mannheim der Universität Heidelberg, Pettenkoferstrasse 22, 68169, Mannheim, Germany
| | - Wolfgang Seifarth
- III. Medizinische Universitätsklinik, Medizinische Fakultät Mannheim der Universität Heidelberg, Pettenkoferstrasse 22, 68169, Mannheim, Germany
| | - Mathias Hänel
- Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz, Germany
| | - Claus-Henning Köhne
- Klinik für Onkologie und Hämatologie, Klinikum Oldenburg, Oldenburg, Germany
| | - Hans W Lindemann
- Klinik für Hämatologie und Onkologie, St.-Marien-Hospital Hagen, Hagen, Germany
| | - Wolfgang E Berdel
- Medizinische Klinik A, Universitätsklinikum Münster, Münster, Germany
| | - Peter Staib
- Klinik für Hämatologie und Onkologie, St.-Antonius-Hospital Eschweiler, Eschweiler, Germany
| | - Martin C Müller
- III. Medizinische Universitätsklinik, Medizinische Fakultät Mannheim der Universität Heidelberg, Pettenkoferstrasse 22, 68169, Mannheim, Germany
| | - Ulrike Proetel
- III. Medizinische Universitätsklinik, Medizinische Fakultät Mannheim der Universität Heidelberg, Pettenkoferstrasse 22, 68169, Mannheim, Germany
| | - Leopold Balleisen
- Abteilung für Hämatologie-Onkologie, Evangelisches Krankenhaus Hamm, Hamm, Germany
| | | | - Jolanta Dengler
- Abteilung Innere Medizin V, Medizinische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | | | - Lothar Kanz
- Medizinische Klinik, Abteilung II, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Andreas Burchert
- Klinik für Innere Medizin, Schwerpunkt Hämatologie, Onkologie und Immunologie, Universitätsklinikum Marburg, Marburg, Germany
| | - Michael Kneba
- II. Medizinische Klinik und Poliklinik, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Frank Stegelmann
- Klinik für Innere Medizin III, Universitätsklinikum Ulm, Ulm, Germany
| | - Michael Pfreundschuh
- Klinik für Innere Medizin I, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Cornelius F Waller
- Abteilung Innere Medizin I, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Karsten Spiekermann
- Medizinische Klinik und Poliklinik III, Klinikum der Universität München, München, Germany
| | | | - Matthias Edinger
- Klinik und Poliklinik für Innere Medizin III, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Wolf-Karsten Hofmann
- III. Medizinische Universitätsklinik, Medizinische Fakultät Mannheim der Universität Heidelberg, Pettenkoferstrasse 22, 68169, Mannheim, Germany
| | - Markus Pfirrmann
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität München, München, Germany
| | - Joerg Hasford
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität München, München, Germany
| | - Stefan Krause
- Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Andreas Hochhaus
- Abteilung für Hämatologie/Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Susanne Saußele
- III. Medizinische Universitätsklinik, Medizinische Fakultät Mannheim der Universität Heidelberg, Pettenkoferstrasse 22, 68169, Mannheim, Germany
| | - Rüdiger Hehlmann
- III. Medizinische Universitätsklinik, Medizinische Fakultät Mannheim der Universität Heidelberg, Pettenkoferstrasse 22, 68169, Mannheim, Germany
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Wafa A, Asa'ad M, Ikhtiar A, Liehr T, Al-Achkar W. Deletion 9p23 to 9p11.1 as sole additional abnormality in a Philadelphia positive chronic myeloid leukemia in blast crisis: a rare event. Mol Cytogenet 2015; 8:59. [PMID: 26244056 PMCID: PMC4523925 DOI: 10.1186/s13039-015-0165-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 07/18/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Chronic myeloid leukemia (CML) is a myeloproliferative disorder characterized by the presence of a derivative chromosome 22 [der(22)] commonly called Philadelphia chromosome (Ph). The Ph chromosome is a product of the reciprocal translocation t(9;22)(q34.1;q11.2). Additional genetic changes occur in less than 10 % of CML cases at the time of diagnosis and other genetic changes are seen in 60-80 % of the cases in advanced disease. Even though deletions in chromosome 9 are not rare findings in advanced phase-CML, del(9)(p23p11.1) as sole additional abnormality detected by fluorescence in situ hybridization (FISH) technique, to our knowledge has not been described in the literature. RESULTS A complete cytogenetic and molecular cytogenetic analysis, molecular biology method (reverse transcription polymerase chain reaction (RT-PCR)), and immunophenotype confirmed to be a CML case in blast crisis (BC). It revealed del(9)(p23p11.1) as sole abnormality detected by FISH technique besides Ph chromosome, which leads to monoallely of tumor suppressor gene CDKN2A (cyclin-dependent kinase inhibitor 2A) before Imatinib mesylate (IM) treatment. CONCLUSIONS The patient did not demonstrate a good response to IM treatment. The underlying mechanisms and prognostic implications of these cytogenetic abnormalities are discussed.
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Affiliation(s)
- Abdulsamad Wafa
- Department of Molecular Biology and Biotechnology, Human Genetics Division, Atomic Energy Commission, P.O. Box 6091, Damascus, Syria
| | - Manar Asa'ad
- Department of Molecular Biology and Biotechnology, Human Genetics Division, Atomic Energy Commission, P.O. Box 6091, Damascus, Syria
| | - Adnan Ikhtiar
- Department of Molecular Biology and Biotechnology, Mammalians Biology Division, Atomic Energy Commission, Damascus, Syria
| | - Thomas Liehr
- Institute of Human Genetics, Jena University Hospital, Jena, Germany
| | - Walid Al-Achkar
- Department of Molecular Biology and Biotechnology, Human Genetics Division, Atomic Energy Commission, P.O. Box 6091, Damascus, Syria
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104
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Clinical and prognostic significance of 3q26.2 and other chromosome 3 abnormalities in CML in the era of tyrosine kinase inhibitors. Blood 2015; 126:1699-706. [PMID: 26243778 DOI: 10.1182/blood-2015-05-646489] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 08/03/2015] [Indexed: 01/05/2023] Open
Abstract
Chromosome 3q26.2 abnormalities in acute myeloid leukemia, including inv(3)/t(3;3) and t(3;21), have been studied and are associated with a poor prognosis. Their prevalence, response to tyrosine kinase inhibitor (TKI) treatment, and prognostic significance in chronic myelogenous leukemia (CML) are largely unknown. In this study, we explored these aspects using a cohort of 2013 patients with CML diagnosed in the era of TKI therapy. Chromosome 3 abnormalities were observed in 116 (5.8%) of 2013 cases. These cases were divided into 5 distinct groups: A, inv(3)(q21q26.2)/t(3;3)(q21;q26.2), 26%; B, t(3;21)(q26.2;q22), 17%; C, other 3q26.2 rearrangements, 7%; D, rearrangements involving chromosome 3 other than 3q26.2 locus, 32%; and E, gain or loss of partial or whole chromosome 3, 18%. In all, 3q26.2 rearrangements were the most common chromosome 3 abnormalities (50%, groups A-C). 3q26.2 rearrangements emerged at different leukemic phases. For cases with 3q26.2 rearrangements that initially emerged in chronic or accelerated phase, they had a high rate of transformation to blast phase. Patients with 3q26.2 abnormalities showed a marginal response to TKI treatment, and no patients achieved a long-term sustainable response at a cytogenetic or molecular level. Compared with other chromosomal abnormalities in CML, patients with 3q26.2 rearrangements had poorer overall survival. The presence or absence of other concurrent chromosomal abnormalities did not affect survival in these patients, reflecting the predominant role of 3q26.2 rearrangements in determining prognosis. Interestingly, although heterogeneous, chromosome 3 abnormalities involving non-3q26.2 loci (groups D, E) also conferred a worse prognosis compared with changes involving other chromosomes in this cohort.
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105
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Czader M, Orazi A. Acute Myeloid Leukemia and Other Types of Disease Progression in Myeloproliferative Neoplasms. Am J Clin Pathol 2015; 144:188-206. [PMID: 26185305 DOI: 10.1309/ajcpzqk40jozzzcc] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES This session of the Society for Hematopathology/European Association for Haematopathology workshop focused on disease progression in myeloproliferative neoplasms (MPNs). METHODS The session included typical and unusual presentations of chronic myelogenous leukemia (CML), BCR-ABL1 positive; Philadelphia chromosome-negative (Ph-neg) MPNs; and mastocytosis. RESULTS Cases of CML illustrated various manifestations of progression, with emphasis on criteria defining stages of the disease. Issues were discussed related to the patterns of recurrence in patients receiving tyrosine kinase inhibitor therapy, including leukemic transformation occurring in a Ph-neg clone. Ph-neg MPN cases highlighted diagnostic approaches used to establish accelerated and blast phases, including cases with significant myelofibrosis and when an adequate bone marrow aspirate smear is not available. The session also included rare cases of aggressive mastocytosis. CONCLUSIONS There was agreement that a definitive diagnosis can be challenging in the absence of documented review of prior diagnostic material and clinical history.
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106
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Shao L, Miller S, Keller-Ramey J, Zhang Y, Roulston D. Cytogenetic, fluorescence in situ hybridization, and genomic array characterization of chronic myeloid leukemia with cryptic BCR-ABL1 fusions. Cancer Genet 2015; 208:396-403. [DOI: 10.1016/j.cancergen.2015.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 04/03/2015] [Accepted: 04/06/2015] [Indexed: 10/23/2022]
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107
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Aukema SM, Theil L, Rohde M, Bauer B, Bradtke J, Burkhardt B, Bonn BR, Claviez A, Gattenlöhner S, Makarova O, Nagel I, Oschlies I, Pott C, Szczepanowski M, Traulsen A, Kluin PM, Klapper W, Siebert R, Murga Penas EM. Sequential karyotyping in Burkitt lymphoma reveals a linear clonal evolution with increase in karyotype complexity and a high frequency of recurrent secondary aberrations. Br J Haematol 2015; 170:814-25. [DOI: 10.1111/bjh.13501] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 04/10/2015] [Indexed: 12/24/2022]
Affiliation(s)
- Sietse M. Aukema
- Institute of Human Genetics; University Hospital Schleswig-Holstein Campus Kiel/Christian-Albrechts University Kiel; Kiel Germany
- Department of Pathology & Medical Biology; University Medical Centre Groningen; University of Groningen; Groningen the Netherlands
- Department of Haematology; University Medical Centre Groningen; University of Groningen; Groningen the Netherlands
| | - Laura Theil
- Institute of Human Genetics; University Hospital Schleswig-Holstein Campus Kiel/Christian-Albrechts University Kiel; Kiel Germany
| | - Marius Rohde
- Non-Hodgkin Lymphoma Berlin-Frankfurt-Münster Group Study Centre; Department of Paediatric Haematology and Oncology; Justus Liebig University; Gießen Germany
| | - Benedikt Bauer
- Department of Evolutionary Theory; Max Planck Institute for Evolutionary Biology; Plön Germany
| | - Jutta Bradtke
- Institute of Pathology; University Hospital Giessen and Marburg; Justus-Liebig-University Giessen; Giessen Germany
| | - Birgit Burkhardt
- Non-Hodgkin Lymphoma Berlin-Frankfurt-Münster Group Study Center; Department of Pediatric Haematology and Oncology; University Children's Hospital; Münster Germany
| | - Bettina R. Bonn
- Non-Hodgkin Lymphoma Berlin-Frankfurt-Münster Group Study Center; Department of Pediatric Haematology and Oncology; University Children's Hospital; Münster Germany
| | - Alexander Claviez
- Department of Paediatrics; University Hospital Schleswig-Holstein Campus Kiel/Christian-Albrechts University; Kiel Germany
| | - Stefan Gattenlöhner
- Institute of Pathology; University Hospital Giessen and Marburg; Justus-Liebig-University Giessen; Giessen Germany
| | - Olga Makarova
- Non-Hodgkin Lymphoma Berlin-Frankfurt-Münster Group Study Center; Department of Pediatric Haematology and Oncology; University Children's Hospital; Münster Germany
| | - Inga Nagel
- Institute of Human Genetics; University Hospital Schleswig-Holstein Campus Kiel/Christian-Albrechts University Kiel; Kiel Germany
| | - Ilske Oschlies
- Department of Pathology, Haematopathology Section and Lymph Node Registry; University Hospital Schleswig-Holstein Campus Kiel/Christian-Albrechts University Kiel; Kiel Germany
| | - Christiane Pott
- Second Medical Department; University Hospital Schleswig-Holstein Campus Kiel/Christian-Albrechts University Kiel; Kiel Germany
| | - Monika Szczepanowski
- Department of Pathology, Haematopathology Section and Lymph Node Registry; University Hospital Schleswig-Holstein Campus Kiel/Christian-Albrechts University Kiel; Kiel Germany
| | - Arne Traulsen
- Institute of Pathology; University Hospital Giessen and Marburg; Justus-Liebig-University Giessen; Giessen Germany
| | - Philip M. Kluin
- Department of Pathology & Medical Biology; University Medical Centre Groningen; University of Groningen; Groningen the Netherlands
| | - Wolfram Klapper
- Department of Pathology, Haematopathology Section and Lymph Node Registry; University Hospital Schleswig-Holstein Campus Kiel/Christian-Albrechts University Kiel; Kiel Germany
| | - Reiner Siebert
- Institute of Human Genetics; University Hospital Schleswig-Holstein Campus Kiel/Christian-Albrechts University Kiel; Kiel Germany
| | - Eva M. Murga Penas
- Institute of Human Genetics; University Hospital Schleswig-Holstein Campus Kiel/Christian-Albrechts University Kiel; Kiel Germany
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Wang W, Cortes JE, Lin P, Khoury JD, Ai D, Tang Z, Tang G, Jorgensen JL, Medeiros LJ, Hu S. Impact of trisomy 8 on treatment response and survival of patients with chronic myelogenous leukemia in the era of tyrosine kinase inhibitors. Leukemia 2015; 29:2263-6. [PMID: 25931274 DOI: 10.1038/leu.2015.96] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- W Wang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J E Cortes
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - P Lin
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J D Khoury
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - D Ai
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Z Tang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - G Tang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J L Jorgensen
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - L J Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - S Hu
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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109
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Chereda B, Melo JV. Natural course and biology of CML. Ann Hematol 2015; 94 Suppl 2:S107-21. [PMID: 25814077 DOI: 10.1007/s00277-015-2325-z] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 12/07/2014] [Indexed: 12/14/2022]
Abstract
Chronic myeloid leukaemia (CML) is a myeloproliferative disorder arising in the haemopoietic stem cell (HSC) compartment. This disease is characterised by a reciprocal t(9;22) chromosomal translocation, resulting in the formation of the Philadelphia (Ph) chromosome containing the BCR-ABL1 gene. As such, diagnosis and monitoring of disease involves detection of BCR-ABL1. It is the BCR-ABL1 protein, in particular its constitutively active tyrosine kinase activity, that forges the pathogenesis of CML. This aberrant kinase signalling activates downstream targets that reprogram the cell to cause uncontrolled proliferation and results in myeloid hyperplasia and 'indolent' symptoms of chronic phase (CP) CML. Without successful intervention, the disease will progress into blast crisis (BC), resembling an acute leukaemia. This advanced disease stage takes on an aggressive phenotype and is almost always fatal. The cell biology of CML is also centred on BCR-ABL1. The presence of BCR-ABL1 can explain virtually all the cellular features of the leukaemia (enhanced cell growth, inhibition of apoptosis, altered cell adhesion, growth factor independence, impaired genomic surveillance and differentiation). This article provides an overview of the clinical and cell biology of CML, and highlights key findings and unanswered questions essential for understanding this disease.
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MESH Headings
- Animals
- Disease Progression
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/metabolism
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/physiopathology
- Mutation
- Neoplasm Proteins/chemistry
- Neoplasm Proteins/genetics
- Neoplasm Proteins/metabolism
- Prognosis
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Affiliation(s)
- Bradley Chereda
- Departments of Genetics and Molecular Pathology, and Haematology, Centre for Cancer Biology, SA Pathology, Frome Road, Adelaide, 5000, Australia,
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110
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Saußele S, Silver RT. Management of chronic myeloid leukemia in blast crisis. Ann Hematol 2015; 94 Suppl 2:S159-65. [PMID: 25814082 DOI: 10.1007/s00277-015-2324-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 12/07/2014] [Indexed: 12/15/2022]
Abstract
Due to the high efficacy of BCR-ABL tyrosine kinase inhibition (TKI) in chronic phase (CP) chronic myeloid leukemia (CML), the frequency of blast crisis (BC) is greatly reduced compared to the pre-TKI era. However, TKI treatment of BC has only marginally improved the number of favorable responses, including remissions, which for the most part have only been transitory. Occasionally, they provide a therapeutic window to perform an allogeneic stem cell transplantation (allo-SCT). The challenge remains to improve management of BC with the limited options available. We review and summarize articles pertaining to the treatment of BC CML published after 2002. Additionally, we will discuss whether there is a need for a new definition of BC and/or treatment failure.
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Affiliation(s)
- S Saußele
- III. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Pettenkoferstr. 22, 68169, Mannheim, Germany,
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111
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Wang XI, Yin CC, Qazilbash MH, Hu S, Lu G. Clinical significance of acquired cytogenetic clones in patients with treated follicular lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 15:262-9. [PMID: 25573378 DOI: 10.1016/j.clml.2014.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 11/26/2014] [Accepted: 12/06/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Follicular lymphoma (FL) is the second most common B-cell non-Hodgkin lymphoma worldwide. In most patients, the disease is diagnosed at advanced stages and cannot be cured using conventional therapeutic approaches. To assess the role of cytogenetic abnormalities in therapy-related myeloid neoplasms (tMNs), we studied the clinicopathologic and cytogenetic features of treated FL patients who subsequently developed a new acquired cytogenetic clone (ACC). PATIENTS AND METHODS Twenty-five treated FL patients developed new cytogenetic abnormalities from 2009 to 2012. Patients were divided into 3 groups based on the presence and absence of tMNs: group 1, ACC without tMNs after a median follow-up of 15 months; group 2, ACC with possible tMN after silent ACC detection; group 3, tMNs present at the first ACC detection. RESULTS The most frequent cytogenetic aberrations involved chromosome 7. Compared with group 1, group 3 had significantly greater size of ACC, higher frequency of chromosome 7 aberrations, more likely showed dysplasia, and lower platelet count (P = .03). CONCLUSION Our results indicate that the presence of ACC alone is insufficient for diagnosis of tMNs. The proportion of cells with specific aberrations at first ACC, bone marrow dysplasia, and low platelet counts might predict outcome of ACC.
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Affiliation(s)
- Xiaohong I Wang
- Department of Pathology and Laboratory Medicine, UT Health Medical School, Houston, TX
| | - C Cameron Yin
- Department of Hematopathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Muzaffar H Qazilbash
- Department of Stem Cell Transplant, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Shimin Hu
- Department of Hematopathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Gary Lu
- Department of Hematopathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
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112
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Al-Achkar W, Moassass F, Ikhtiar A, Liehr T, Othman MAK, Wafa A. Hyperdiploidy associated with T315I mutation in BCR-ABL kinase domain in an accelerated phase-chronic myeloid leukemia case. Mol Cytogenet 2014; 7:89. [PMID: 25621010 PMCID: PMC4305221 DOI: 10.1186/s13039-014-0089-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 11/11/2014] [Indexed: 12/30/2022] Open
Abstract
Background Chronic myeloid leukemia (CML) is genetically characterized by the occurrence of a reciprocal translocation t(9;22)(q34;q11), resulting in a BCR/ABL gene fusion on the derivative chromosome 22, i.e. the Philadelphia (Ph) chromosome. During CML progression 60–80% of the cases acquire additional genetic changes. Even though hyperdiploidy is not a rare finding in advanced phase-CML, hyperdiploidy together with a T315I kinase domain (KD) mutation in the BCR-ABL gene has not yet been reported. Results A complete cytogenetic and molecular cytogenetic analysis; molecular biology methods such as quantitative reverse transcription polymerase chain reaction (RQ-PCR) and allele-specific oligonucleotide (ASO)-PCR; and immunophenotypically confirmed CML in acceleration phase (AP). Our case revealed the presence of hyperdiploidy including multiple copies of the Ph chromosome, presence of b3a2 fusion transcript,T315I mutation in BCR-ABL KD in pre imatinib mesylate (IM) treatment. The ratio of BCR-ABL/ABL expression in post nilotinib treatment was 0.07% on international scale. Conclusions The patient demonstrated a good response to nilotinib after imatinib failure; while the hyperdiploid clone disappeared the T315I mutation remained during follow-up. The underlying mechanisms and prognostic implications of these cytogenetic abnormalities are discussed.
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Affiliation(s)
- Walid Al-Achkar
- Human Genetics Division, Department of Molecular Biology and Biotechnology, Atomic Energy Commission, P.O. Box 6091 Damascus, Syria
| | - Faten Moassass
- Human Genetics Division, Department of Molecular Biology and Biotechnology, Atomic Energy Commission, P.O. Box 6091 Damascus, Syria
| | - Adnan Ikhtiar
- Mammalians Biology Division, Department of Molecular Biology and Biotechnology, Atomic Energy Commission, Damascus, Syria
| | - Thomas Liehr
- Institute of Human Genetics, Jena University Hospital, Jena, Germany
| | | | - Abdulsamad Wafa
- Human Genetics Division, Department of Molecular Biology and Biotechnology, Atomic Energy Commission, P.O. Box 6091 Damascus, Syria
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113
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Mutational spectrum of myeloid malignancies with inv(3)/t(3;3) reveals a predominant involvement of RAS/RTK signaling pathways. Blood 2014; 125:133-9. [PMID: 25381062 DOI: 10.1182/blood-2014-07-591461] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Myeloid malignancies bearing chromosomal inv(3)/t(3;3) abnormalities are among the most therapy-resistant leukemias. Deregulated expression of EVI1 is the molecular hallmark of this disease; however, the genome-wide spectrum of cooperating mutations in this disease subset has not been systematically elucidated. Here, we show that 98% of inv(3)/t(3;3) myeloid malignancies harbor mutations in genes activating RAS/receptor tyrosine kinase (RTK) signaling pathways. In addition, hemizygous mutations in GATA2, as well as heterozygous alterations in RUNX1, SF3B1, and genes encoding epigenetic modifiers, frequently co-occur with the inv(3)/t(3;3) aberration. Notably, neither mutational patterns nor gene expression profiles differ across inv(3)/t(3;3) acute myeloid leukemia, chronic myeloid leukemia, and myelodysplastic syndrome cases, suggesting recognition of inv(3)/t(3;3) myeloid malignancies as a single disease entity irrespective of blast count. The high incidence of activating RAS/RTK signaling mutations may provide a target for a rational treatment strategy in this high-risk patient group.
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114
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Association des polymorphismes du gène méthylène-tétrahydrofolate réductase avec la leucémie myéloïde chronique. Bull Cancer 2014; 101:803-7. [DOI: 10.1684/bdc.2014.1953] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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115
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de Lima LT, Bueno CT, Vivona D, Hirata RDC, Hirata MH, Hungria VTDM, Chiattone CS, Zanichelli MA, Chauffaille MDLLF, Guerra-Shinohara EM. Relationship between SLCO1B3 and ABCA3 polymorphisms and imatinib response in chronic myeloid leukemia patients. ACTA ACUST UNITED AC 2014; 20:137-42. [PMID: 25056761 DOI: 10.1179/1607845414y.0000000181] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Genetic variations in membrane transporters may contribute to imatinib mesylate (IM) resistance in chronic myeloid leukemia (CML). Objective To investigate the relationship between SLCO1B3, SLCO1A2, and ABCA3 polymorphisms and IM response in CML patients. METHODS Patients in chronic phase CML (N = 118) were studied. All patients were treated with a standard dose of IM (400 mg/day) and classified into one of the two groups according to their responses. Major molecular response (MMR) and complete molecular response (CMR) were evaluated. Criteria for response failure were established according to European LeukemiaNet (2009). Analysis of the SLCO1B3 c.334T > G (rs4149117) and c.699G > A (rs7311358), SLCO1A2 c.516A > C (rs11568563) and c.-62-361G > A (rs3764043), and ABCA3 c.1755C > G (rs323043) and c.4548-191C > A (rs150929) polymorphisms was carried out by real-time polymerase chain reaction. RESULTS SLCO1A2 and ABCA3 polymorphisms have similar frequencies between responders and non-responders. SLCO1B3 699GG and 344TT genotypes were more frequent in the responder group (63.8%) than in the non-responder group (44.7%, P = 0.042). Furthermore, carriers of 699GA/AA and 334TG/GG genotypes presented a higher probability of not responding to the standard dose of IM (odds ratio: 2.17; 95% confidence interval: 1.02-4.64, P = 0.04). Poor CMR for ABCA3 4548-91C > A was observed in patients with the CC/CA genotype when compared to AA carriers in the responder group (P = 0.014). CONCLUSIONS SLCO1B3 699GG and 344TT genotypes are associated with non-response to IM, while ABCA3 4548-91 CC/CA genotypes are related to poor CMR in CML patients treated with standard-dose imatinib.
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MESH Headings
- ATP-Binding Cassette Transporters/genetics
- Adult
- Alleles
- Antineoplastic Agents/therapeutic use
- Female
- Fusion Proteins, bcr-abl/genetics
- Gene Frequency
- Genotype
- Humans
- Imatinib Mesylate/therapeutic use
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/mortality
- Leukemia, Myeloid, Chronic-Phase/drug therapy
- Leukemia, Myeloid, Chronic-Phase/genetics
- Male
- Middle Aged
- Organic Anion Transporters/genetics
- Organic Anion Transporters, Sodium-Independent/genetics
- Polymorphism, Genetic
- Polymorphism, Single Nucleotide
- Protein Kinase Inhibitors/therapeutic use
- Solute Carrier Organic Anion Transporter Family Member 1B3
- Treatment Outcome
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116
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Complex variant of Philadelphia translocation involving chromosomes 9, 12, and 22 in a case with chronic myeloid leukaemia. Case Rep Genet 2014; 2014:691630. [PMID: 25045550 PMCID: PMC4087276 DOI: 10.1155/2014/691630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 05/27/2014] [Indexed: 11/17/2022] Open
Abstract
Chronic myeloid leukemia (CML) is a hematopoietic stem cell disorder included in the broader diagnostic category of myeloproliferative neoplasms, associated with fusion by BCR gene at chromosome 22q11 to ABL1 gene at chromosome 9q34 with the formation of the Philadelphia (Ph) chromosome. In 2-10% of CML cases, the fusion gene arises in connection with a variant translocation, involving chromosomes 9, 22, and one or more different chromosomes; consequently, the Ph chromosome could be masked within a complex chromosome rearrangement. In cases with variant Ph translocation a deletion on der(9) may be more frequently observed than in cases with the classical one. Herein we describe a novel case of CML with complex variant Ph translocation involving chromosomes 9, 12, and 22. We present the hematologic response and cytogenetic response after Imatinib treatment. We also speculated the mechanism which had originated the chromosome rearrangement.
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117
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Jabbour EJ, Hughes TP, Cortés JE, Kantarjian HM, Hochhaus A. Potential mechanisms of disease progression and management of advanced-phase chronic myeloid leukemia. Leuk Lymphoma 2014; 55:1451-62. [PMID: 24050507 PMCID: PMC4186697 DOI: 10.3109/10428194.2013.845883] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Despite vast improvements in the treatment of Philadelphia chromosome-positive chronic myeloid leukemia (CML) in chronic phase (CP), advanced stages of CML, accelerated phase or blast crisis, remain notoriously difficult to treat. Treatments that are highly effective against CML-CP produce disappointing results against advanced disease. Therefore, a primary goal of therapy should be to maintain patients in CP for as long as possible, by (1) striving for deep, early molecular response to treatment; (2) using tyrosine kinase inhibitors that lower risk of disease progression; and (3) more closely observing patients who demonstrate cytogenetic risk factors at diagnosis or during treatment.
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MESH Headings
- Blast Crisis/diagnosis
- Blast Crisis/etiology
- Blast Crisis/therapy
- Disease Management
- Disease Progression
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/etiology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Leukemia, Myeloid, Accelerated Phase/diagnosis
- Leukemia, Myeloid, Accelerated Phase/drug therapy
- Leukemia, Myeloid, Accelerated Phase/etiology
- Neoplasm Staging
- Prognosis
- Treatment Outcome
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Affiliation(s)
- Elias J. Jabbour
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Timothy P. Hughes
- Department of Hematology, The University of Adelaide, Adelaide, Australia
| | - Jorge E. Cortés
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hagop M. Kantarjian
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Andreas Hochhaus
- Abteilung Hämatologie/Onkologie, Universitätsklinikum Jena, Jena, Germany
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118
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Unusual T-lymphoblastic blast phase of chronic myelogenous leukemia. Case Rep Hematol 2014; 2014:304359. [PMID: 25057418 PMCID: PMC4095643 DOI: 10.1155/2014/304359] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 06/06/2014] [Accepted: 06/07/2014] [Indexed: 12/22/2022] Open
Abstract
T-lymphoblastic leukemia/lymphoma (T-ALL) presenting as blast phase of chronic myelogenous leukemia (CML-BP) is rare. In patients without history of CML, it is difficult to differentiate between CML-BP or de novo T-ALL. Here we reported 2 unusual cases of T-ALL presenting as CML-BP. Case 1 was a 24-year-old female with leukocytosis. Besides T-lymphoblasts (32%), her marrow exhibited some morphologic features of CML. Multiple remission or relapsing marrow had never demonstrated morphologic features of CML. Despite of imatinib treatment and stem cell transplant, she died 2.5 years later. Case 2, a 66-year-old male with diffuse lymphadenopathy, showed T-ALL in a lymph node and concurrent CML chronic phase (CML-CP) in his marrow. Same BCR-ABL1 fusion transcript with minor breakpoint was present in both the lymph node and marrow specimens. Although both cases did not have a history of CML, both cases represented T-lymphoblastic CML-BP with unusual features: Case 1 is unusual in that it presented as T-ALL with some CML morphologic feature but never showed CML-CP in her subsequent marrows biopsies; Case 2 is the first reported case of T-lymphoblastic CML-BP harboring BCR-ABL1 transcript with a minor breakpoint.
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119
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Mendiola C, Ortega V, Tonk VS, Coviello JM, Velagaleti G. Complex/variant translocations in chronic myelogenous leukemia (CML): genesis and prognosis with 4 new cases. Exp Mol Pathol 2014; 97:105-10. [PMID: 24927873 DOI: 10.1016/j.yexmp.2014.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 06/09/2014] [Indexed: 11/15/2022]
Abstract
In 5-10% of cases with CML, variant or complex translocations (CT) are seen that may result in atypical fluorescence in situ hybridization signal patterns. Dual color, dual fusion fluorescence in situ hybridization (D-FISH) patterns are instrumental in identifying the genesis of these CT, but their prognostic implications remain controversial. The most common mechanism is a two-step process in which a standard two-way translocation (9;22) is followed by subsequent rearrangements involving other chromosomes. The second common mechanism is the one-step process wherein breakage occurs simultaneously on different chromosomes leading to CT. The typical D-FISH pattern seen with the one-step mechanism is 1F2G2R, while the pattern for the two-step mechanism can be variable (2F1G1R, 1F1G1R, 1F1G2R, 1F2G1R, etc.). We have studied 4 cases of CT using metaphase FISH with triple color, dual fusion ASS1, ABL1 and BCR probes to understand the genesis of these CT. All the patients were treated with imatinib, but only patients 3 and 4 showed remission. Our results indicate that the CT in cases 1, 3 and 4 arose from a one-step mechanism and case 2 from a multi-step mechanism. Response to imatinib varied from full remission to no response. Long term follow-up is necessary to evaluate the prognostic implications of these CT.
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Affiliation(s)
- Christina Mendiola
- Department of Pathology, University of Texas Health Science Center, San Antonio, TX, United States
| | - Veronica Ortega
- Department of Pathology, University of Texas Health Science Center, San Antonio, TX, United States
| | - Vijay S Tonk
- Department of Pediatrics, Texas Tech University, Lubbock, TX, United States
| | - Jean M Coviello
- Department of Pathology, San Antonio Military Medical Center, San Antonio, TX, United States
| | - Gopalrao Velagaleti
- Department of Pathology, University of Texas Health Science Center, San Antonio, TX, United States.
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120
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Ichim CV. Kinase-independent mechanisms of resistance of leukemia stem cells to tyrosine kinase inhibitors. Stem Cells Transl Med 2014; 3:405-15. [PMID: 24598782 DOI: 10.5966/sctm.2012-0159] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Tyrosine kinase inhibitors such as imatinib mesylate have changed the clinical course of chronic myeloid leukemia; however, the observation that these inhibitors do not target the leukemia stem cell implies that patients need to maintain lifelong therapy. The mechanism of this phenomenon is unclear: the question of whether tyrosine kinase inhibitors are inactive inside leukemia stem cells or whether leukemia stem cells do not require breakpoint cluster region (Bcr)-Abl signaling is currently under debate. Herein, I propose an alternative model: perhaps the leukemia stem cell requires Bcr-Abl, but is dependent on its kinase-independent functions. Kinases such as epidermal growth factor receptor and Janus kinase 2 possess kinase-independent roles in regulation of gene expression; it is worth investigating whether Bcr-Abl has similar functions. Mechanistically, Bcr-Abl is able to activate the Ras, phosphatidylinositol 3-kinase/Akt, and/or the Src-kinase Hck/Stat5 pathways in a scaffolding-dependent manner. Whereas the scaffolding activity of Bcr-Abl with Grb2 is dependent on autophosphorylation, kinases such as Hck can use Bcr-Abl as substrate, inducing phosphorylation of Y177 to enable scaffolding ability in the absence of Bcr-Abl catalytic activity. It is worth investigating whether leukemia stem cells exclusively express kinases that are able to use Bcr-Abl as substrate. A kinase-independent role for Bcr-Abl in leukemia stem cells would imply that drugs that target Bcr-Abl's scaffolding ability or its DNA-binding ability should be used in conjunction with current therapeutic regimens to increase their efficacy and eradicate the stem cells of chronic myeloid leukemia.
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MESH Headings
- Animals
- Drug Resistance, Neoplasm
- Gene Expression Regulation, Leukemic/drug effects
- Gene Expression Regulation, Leukemic/genetics
- Humans
- Leukemia
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/enzymology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Neoplasm Proteins/antagonists & inhibitors
- Neoplasm Proteins/genetics
- Neoplasm Proteins/metabolism
- Neoplastic Stem Cells/enzymology
- Neoplastic Stem Cells/pathology
- Phosphatidylinositol 3-Kinases/genetics
- Phosphatidylinositol 3-Kinases/metabolism
- Protein Kinase Inhibitors/pharmacology
- Protein Kinase Inhibitors/therapeutic use
- Protein-Tyrosine Kinases/antagonists & inhibitors
- Protein-Tyrosine Kinases/genetics
- Protein-Tyrosine Kinases/metabolism
- Signal Transduction/drug effects
- Signal Transduction/genetics
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Affiliation(s)
- Christine Victoria Ichim
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada; Discipline of Molecular and Cellular Biology, Sunnybrook Research Institute, Toronto, Ontario, Canada
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121
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Al-Dewik NI, Jewell AP, Yassin MA, El-Ayoubi HR, Morsi HM. Studying the impact of presence of point mutation, insertion mutation and additional chromosomal abnormalities in chronic myeloid leukemia patients treated with imatinib mesylate in the State of Qatar. QSCIENCE CONNECT 2014. [DOI: 10.5339/connect.2014.13] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Nader I Al-Dewik
- 1National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation (HMC), Doha, Qatar
- 2Faculty of Health and Social Care Sciences, Kingston University and St George's University of London, United Kingdom
| | - Andrew P Jewell
- 2Faculty of Health and Social Care Sciences, Kingston University and St George's University of London, United Kingdom
- 3Medical Research Centre, HMC, Doha, Qatar
| | - Mohammed A Yassin
- 1National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Hanadi R El-Ayoubi
- 1National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Hisham M Morsi
- 2Faculty of Health and Social Care Sciences, Kingston University and St George's University of London, United Kingdom
- 3Medical Research Centre, HMC, Doha, Qatar
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122
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Previously Unreported Chromosomal Aberrations of t(3;3)(q29;q23), t(4;11)(q21;q23), and t(11;18)(q10;q10) in a Patient with Accelerated Phase Ph+ CML. Case Rep Genet 2014; 2014:582016. [PMID: 24711936 PMCID: PMC3965933 DOI: 10.1155/2014/582016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 01/15/2014] [Indexed: 01/14/2023] Open
Abstract
Chronic myelogenous leukemia (CML) is a clonal hematological disorder, which is characterized by the presence of the classical or variant Philadelphia translocations. During the progression to blastic phase of the disease secondary chromosomal abnormalities may emerge. Such secondary chromosomal abnormalities are nonrandom, the more frequent ones being trisomy 8 and 19, supernumerary i(17q), and extra Philadelphia chromosomes. Furthermore, a minor percentage of the patients may acquire different secondary chromosomal abnormalities including translocations between other chromosomes. We report here a patient with Ph+ CML presenting secondary chromosomal abnormalities including t(4;11)(q21;q23), t(3;3)(q29;q23) and t(11;18)(q10;q10) during the course of CML progression.
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123
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Krishnan S, Sabai K, Chuah C, Tan SY. Bilineal T lymphoblastic and myeloid blast transformation in chronic myeloid leukemia with TP53 mutation-an uncommon presentation in adults. ACTA ACUST UNITED AC 2014; 21:e147-50. [PMID: 24523612 DOI: 10.3747/co.21.1660] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Bilineal blast transformation of myeloid and T lymphoid type is a rare event in chronic myeloid leukemia. Here, we report a case in which an adult presented with high white cell counts and lymphadenopathy. Bone marrow studies confirmed the presence of 9 and 22 chromosomal translocation, and a diagnosis of chronic myeloid leukemia in chronic phase was made. Examination of a lymph node showed both myeloid and T lymphoblastoid blast crisis. Molecular studies demonstrated the presence of BCR-ABL fusion transcripts in both the myeloid and the T lymphoblastic component, indicating that the myeloid and T lymphoid blast crisis components shared common progenitors. TP53 deletion was demonstrated by fluorescence in situ hybridization.
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Affiliation(s)
- S Krishnan
- Department of Haematology, Singapore General Hospital, Singapore. ; Duke-NUS Graduate Medical School, Singapore
| | - K Sabai
- Singhealth Tissue Repository, Singapore Health Services, Singapore
| | - C Chuah
- Department of Haematology, Singapore General Hospital, Singapore. ; Duke-NUS Graduate Medical School, Singapore
| | - S Y Tan
- Department of Haematology, Singapore General Hospital, Singapore
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124
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Tsunemine H, Arima H, Itoh K, Sakane-Ishikawa E, Akasaka H, Kodaka T, Takahashi T. Monocytic crisis of chronic myeloid leukemia in the era of tyrosine kinase inhibitor. J Clin Exp Hematop 2013; 53:227-33. [PMID: 24369225 DOI: 10.3960/jslrt.53.227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
A 47-year-old man was diagnosed with Philadelphia chromosome-positive chronic myeloid leukemia (CML) in October 2005. He could not receive treatment with imatinib mesylate due to his economic circumstances. He was consequently treated with hydroxyurea with partial hematological remission until June 2008. Although imatinib mesylate was started thereafter, the adherence to this treatment was poor because of his occupational circumstances. In September 2009, imatinib mesylate was switched to nilotinib, with a subsequent phase of acceleration of the disease, presumably due to his poor adherence to the treatment. Dasatinib was started in September 2010, with transient hematological response and final blastic crisis of the disease in January 2011, regardless of improved adherence. Blast cells showed immature monocytic morphology and were positive for α-naphtylbutyrate esterase staining. They also expressed surface CD14 and CD64 antigens. A diagnosis of rare monocytic crisis of CML was made. He was treated with low-dose nilotinib following cytoreduction with MEC (mitoxantrone, etoposide, and cytarabine) chemotherapy. Severe leucopenia without circulating leukemic cells continued for about 2 months with sustained hepatosplenomegaly, and he died of pneumonia in March 2012. Necropsy showed severe bone marrow hypoplasia with focal infiltration of mature leukemic cells and similar infiltration in the liver.
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125
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Khorshied MM, Shaheen IAM, Abu Khalil RE, Sheir RE. Methylene tetrahydrofolate reductase (MTHFR) gene polymorphisms in chronic myeloid leukemia: an Egyptian study. Med Oncol 2013; 31:794. [DOI: 10.1007/s12032-013-0794-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 11/25/2013] [Indexed: 10/25/2022]
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126
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Cortes JE, Kim DW, Pinilla-Ibarz J, le Coutre P, Paquette R, Chuah C, Nicolini FE, Apperley JF, Khoury HJ, Talpaz M, DiPersio J, DeAngelo DJ, Abruzzese E, Rea D, Baccarani M, Müller MC, Gambacorti-Passerini C, Wong S, Lustgarten S, Rivera VM, Clackson T, Turner CD, Haluska FG, Guilhot F, Deininger MW, Hochhaus A, Hughes T, Goldman JM, Shah NP, Kantarjian H. A phase 2 trial of ponatinib in Philadelphia chromosome-positive leukemias. N Engl J Med 2013; 369:1783-96. [PMID: 24180494 PMCID: PMC3886799 DOI: 10.1056/nejmoa1306494] [Citation(s) in RCA: 772] [Impact Index Per Article: 70.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Ponatinib is a potent oral tyrosine kinase inhibitor of unmutated and mutated BCR-ABL, including BCR-ABL with the tyrosine kinase inhibitor-refractory threonine-to-isoleucine mutation at position 315 (T315I). We conducted a phase 2 trial of ponatinib in patients with chronic myeloid leukemia (CML) or Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph-positive ALL). METHODS We enrolled 449 heavily pretreated patients who had CML or Ph-positive ALL with resistance to or unacceptable side effects from dasatinib or nilotinib or who had the BCR-ABL T315I mutation. Ponatinib was administered at an initial dose of 45 mg once daily. The median follow-up was 15 months. RESULTS Among 267 patients with chronic-phase CML, 56% had a major cytogenetic response (51% of patients with resistance to or unacceptable side effects from dasatinib or nilotinib and 70% of patients with the T315I mutation), 46% had a complete cytogenetic response (40% and 66% in the two subgroups, respectively), and 34% had a major molecular response (27% and 56% in the two subgroups, respectively). Responses were observed regardless of the baseline BCR-ABL kinase domain mutation status and were durable; the estimated rate of a sustained major cytogenetic response of at least 12 months was 91%. No single BCR-ABL mutation conferring resistance to ponatinib was detected. Among 83 patients with accelerated-phase CML, 55% had a major hematologic response and 39% had a major cytogenetic response. Among 62 patients with blast-phase CML, 31% had a major hematologic response and 23% had a major cytogenetic response. Among 32 patients with Ph-positive ALL, 41% had a major hematologic response and 47% had a major cytogenetic response. Common adverse events were thrombocytopenia (in 37% of patients), rash (in 34%), dry skin (in 32%), and abdominal pain (in 22%). Serious arterial thrombotic events were observed in 9% of patients; these events were considered to be treatment-related in 3%. A total of 12% of patients discontinued treatment because of an adverse event. CONCLUSIONS Ponatinib had significant antileukemic activity across categories of disease stage and mutation status. (Funded by Ariad Pharmaceuticals and others; PACE ClinicalTrials.gov number, NCT01207440 .).
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Affiliation(s)
- J E Cortes
- The authors' full names, degrees, and affiliations are listed in the Appendix
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Strati P, Kantarjian H, Thomas D, O'Brien S, Konoplev S, Jorgensen JL, Luthra R, Abruzzo L, Jabbour E, Quintas-Cardama A, Borthakur G, Faderl S, Ravandi F, Cortes J. HCVAD plus imatinib or dasatinib in lymphoid blastic phase chronic myeloid leukemia. Cancer 2013; 120:373-80. [PMID: 24151050 DOI: 10.1002/cncr.28433] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 08/27/2013] [Accepted: 09/12/2013] [Indexed: 12/26/2022]
Abstract
BACKGROUND Chronic myeloid leukemia (CML) may progress to blast phase (BP) at the rate of 1% to 1.5% per year. With the use of single-agent tyrosine kinase inhibitors, median overall survival ranges between 7 and 11 months. METHODS The outcome was analyzed for 42 patients with lymphoid BP-CML who were treated with hyperfractionated cyclophosphamide, vincristine, Adriamycin, dexamethasone (HCVAD) plus imatinib or dasatinib. RESULTS Complete hematological response was achieved in 90% of patients, complete cytogenetic remission in 58%, and complete molecular remission in 25%. Flow cytometry minimal residual disease negativity was achieved by 42% of evaluable patients after induction. Eighteen patients received allogeneic stem cell transplant (SCT) while in first complete hematological response. Median remission duration was 14 months and was longer among SCT recipients (P = .01) on multivariate analysis. Median overall survival was 17 months (range, 7-27 months) and was longer among SCT recipients (P < .001) and patients treated with dasatinib (P = .07) on multivariate analysis. Although a high rate of hematologic toxicity (100%) and infectious complications (59%) were observed, the related rate of treatment discontinuation was low (7% and 9%, respectively). CONCLUSIONS HCVAD combined with tyrosine kinase inhibitors is an effective regimen for the management of BP-CML, particularly when followed by allogeneic SCT.
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Affiliation(s)
- Paolo Strati
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Piazza R, Magistroni V, Pirola A, Redaelli S, Spinelli R, Redaelli S, Galbiati M, Valletta S, Giudici G, Cazzaniga G, Gambacorti-Passerini C. CEQer: a graphical tool for copy number and allelic imbalance detection from whole-exome sequencing data. PLoS One 2013; 8:e74825. [PMID: 24124457 PMCID: PMC3790773 DOI: 10.1371/journal.pone.0074825] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 08/06/2013] [Indexed: 11/24/2022] Open
Abstract
Copy number alterations (CNA) are common events occurring in leukaemias and solid tumors. Comparative Genome Hybridization (CGH) is actually the gold standard technique to analyze CNAs; however, CGH analysis requires dedicated instruments and is able to perform only low resolution Loss of Heterozygosity (LOH) analyses. Here we present CEQer (Comparative Exome Quantification analyzer), a new graphical, event-driven tool for CNA/allelic-imbalance (AI) coupled analysis of exome sequencing data. By using case-control matched exome data, CEQer performs a comparative digital exonic quantification to generate CNA data and couples this information with exome-wide LOH and allelic imbalance detection. This data is used to build mixed statistical/heuristic models allowing the identification of CNA/AI events. To test our tool, we initially used in silico generated data, then we performed whole-exome sequencing from 20 leukemic specimens and corresponding matched controls and we analyzed the results using CEQer. Taken globally, these analyses showed that the combined use of comparative digital exon quantification and LOH/AI allows generating very accurate CNA data. Therefore, we propose CEQer as an efficient, robust and user-friendly graphical tool for the identification of CNA/AI in the context of whole-exome sequencing data.
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Affiliation(s)
- Rocco Piazza
- Department of Health Sciences, University of Milano-Bicocca, Monza, Italy
- * E-mail:
| | - Vera Magistroni
- Department of Health Sciences, University of Milano-Bicocca, Monza, Italy
| | - Alessandra Pirola
- Department of Health Sciences, University of Milano-Bicocca, Monza, Italy
| | - Sara Redaelli
- Department of Health Sciences, University of Milano-Bicocca, Monza, Italy
| | - Roberta Spinelli
- Department of Health Sciences, University of Milano-Bicocca, Monza, Italy
| | - Serena Redaelli
- Department of Neurosciences and Biomedical Technologies, University of Milano-Bicocca, Monza, Italy
| | - Marta Galbiati
- Tettamanti Research Center, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Simona Valletta
- Department of Health Sciences, University of Milano-Bicocca, Monza, Italy
| | - Giovanni Giudici
- Tettamanti Research Center, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Giovanni Cazzaniga
- Tettamanti Research Center, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy
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Al-Achkar W, Wafa A, Ikhtiar A, Liehr T. Three-way Philadelphia translocation t(9;10;22)(q34;p11.2;q11.2) as a secondary abnormality in an imatinib mesylate-resistant chronic myeloid leukemia patient. Oncol Lett 2013; 5:1656-1658. [PMID: 23759955 PMCID: PMC3678570 DOI: 10.3892/ol.2013.1228] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 11/29/2012] [Indexed: 11/16/2022] Open
Abstract
Chronic myelogenous leukemia (CML) is characterized by the Philadelphia (Ph) chromosome created by the reciprocal translocation t(9:22)(q34;q11), resulting in the chimeric gene breakpoint cluster region (BCR)-Abelson (ABL). Variant Ph chromosome translocations involving chromosomes other than 9 and 22 occur in 5–10% of CML cases. In the present study, a novel case of a Ph chromosome-positive CML in the chronic phase (CP) is reported, with a three-way Ph translocation involving three chromosomal regions, 9q34, 10p11.2 and 22q11.2, in addition to the loss of the Y chromosome, where the latter was a secondary abnormality. Since the majority of CML cases are currently treated with imatinib, variant rearrangements generally have no specific prognostic significance, although the mechanisms involved in resistance to therapy have yet to be investigated. The underlying mechanisms and prognostic implications of these cytogenetic abnormalities are discussed in the present study.
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Affiliation(s)
- Walid Al-Achkar
- Department of Molecular Biology and Biotechnology, Human Genetics Division, Flow-cytometry Lab, Atomic Energy Commission, Damascus, Syria
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130
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Genomic instability may originate from imatinib-refractory chronic myeloid leukemia stem cells. Blood 2013; 121:4175-83. [PMID: 23543457 DOI: 10.1182/blood-2012-11-466938] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Genomic instability is a hallmark of chronic myeloid leukemia in chronic phase (CML-CP) resulting in BCR-ABL1 mutations encoding resistance to tyrosine kinase inhibitors (TKIs) and/or additional chromosomal aberrations leading to disease relapse and/or malignant progression. TKI-naive and TKI-treated leukemia stem cells (LSCs) and leukemia progenitor cells (LPCs) accumulate high levels of reactive oxygen species (ROS) and oxidative DNA damage. To determine the role of TKI-refractory LSCs in genomic instability, we used a murine model of CML-CP where ROS-induced oxidative DNA damage was elevated in LSCs, including quiescent LSCs, but not in LPCs. ROS-induced oxidative DNA damage in LSCs caused clinically relevant genomic instability in CML-CP-like mice, such as TKI-resistant BCR-ABL1 mutations (E255K, T315I, H396P), deletions in Ikzf1 and Trp53, and additions in Zfp423 and Idh1. Despite inhibition of BCR-ABL1 kinase, imatinib did not downregulate ROS and oxidative DNA damage in TKI-refractory LSCs to the levels detected in normal cells, and CML-CP-like mice treated with imatinib continued to accumulate clinically relevant genetic aberrations. Inhibition of class I p21-activated protein kinases by IPA3 downregulated ROS in TKI-naive and TKI-treated LSCs. Altogether, we postulate that genomic instability may originate in the most primitive TKI-refractory LSCs in TKI-naive and TKI-treated patients.
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131
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A Novel Three-Colour Fluorescence in Situ Hybridization Approach for the Detection of t(7;12)(q36;p13) in Acute Myeloid Leukaemia Reveals New Cryptic Three Way Translocation t(7;12;16). Cancers (Basel) 2013; 5:281-95. [PMID: 24216708 PMCID: PMC3730311 DOI: 10.3390/cancers5010281] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 02/28/2013] [Accepted: 03/04/2013] [Indexed: 01/31/2023] Open
Abstract
The t(7;12)(q36;p13) translocation is a recurrent chromosome abnormality that involves the ETV6 gene on chromosome 12 and has been identified in 20–30% of infant patients with acute myeloid leukaemia (AML). The detection of t(7;12) rearrangements relies on the use of fluorescence in situ hybridization (FISH) because this translocation is hardly visible by chromosome banding methods. Furthermore, a fusion transcript HLXB9-ETV6 is found in approximately 50% of t(7;12) cases, making the reverse transcription PCR approach not an ideal screening method. Considering the report of few cases of variant translocations harbouring a cryptic t(7;12) rearrangement, we believe that the actual incidence of this abnormality is higher than reported to date. The clinical outcome of t(7;12) patients is believed to be poor, therefore an early and accurate diagnosis is important in the clinical management and treatment. In this study, we have designed and tested a novel three-colour FISH approach that enabled us not only to confirm the presence of the t(7;12) in a number of patients studied previously, but also to identify a cryptic t(7;12) as part of a complex rearrangement. This new approach has proven to be an efficient and reliable method to be used in the diagnostic setting.
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132
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Bozkurt S, Uz B, Buyukasik Y, Bektas O, Inanc A, Goker H, Kansu E. Prognostic importance of additional cytogenetic anomalies in chronic myeloid leukemia. Med Oncol 2013; 30:443. [DOI: 10.1007/s12032-012-0443-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 12/14/2012] [Indexed: 12/28/2022]
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133
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Calderón-Cabrera C, Montero I, Morales R, Sánchez J, Carrillo E, Caballero-Velázquez T, Prats C, Bernal R, De Blas J, Pérez-Simón J. Differential cytogenetic profile in advanced chronic myeloid leukemia with sequential lymphoblastic and myeloblastic blast crisis. Leuk Res Rep 2013; 2:79-81. [PMID: 24371788 PMCID: PMC3850375 DOI: 10.1016/j.lrr.2013.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 08/09/2013] [Accepted: 08/16/2013] [Indexed: 11/10/2022] Open
Abstract
Frequency of additional chromosomal abnormalities in chronic myeloid leukemia (CML) is estimated to be 7% in chronic phase and increases to 40–70% in advanced disease. Progression of CML from chronic phase to accelerated phase or blast crisis is often associated with secondary chromosomal aberrations. We report an exceptional case of CML as debut in lymphoblastic blast crisis and a subsequent progression in myeloblastic blast crisis with rare cytogenetic abnormalities.
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134
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Horne SD, Stevens JB, Abdallah BY, Liu G, Bremer SW, Ye CJ, Heng HH. Why imatinib remains an exception of cancer research. J Cell Physiol 2012; 228:665-70. [DOI: 10.1002/jcp.24233] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 09/27/2012] [Indexed: 12/26/2022]
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135
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Al-Achkar W, Aljapawe A, Almedani S, Liehr T, Wafa A. A novel cytogenetic abnormality t(7;8)(p11.2:q11.2) and a four-way Philadelphia translocation in an imatinib mesylate-resistant chronic myeloid leukemia patient. Oncol Lett 2012; 5:617-620. [PMID: 23420612 PMCID: PMC3573104 DOI: 10.3892/ol.2012.1037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 10/16/2012] [Indexed: 11/23/2022] Open
Abstract
Chronic myelogenous leukemia (CML) is characterized by the Philadelphia (Ph) chromosome, created by a reciprocal translocation t(9:22)(q34;q11) which forms the chimeric gene, BCR-ABL. Variant Ph chromosome translocations involving chromosomes other than 9 and 22 have been identified in 5–10% of CML cases. Four-way Ph chromosome translocations are an extremely rare event in myeloid malignancies and the phenotypic consequences of such rearrangements have not been investigated. Deletions in chromosome 9 are known to be associated with a poor prognosis. In the present study, a novel case of Ph chromosome-positive CML in blast crisis is reported. A four-way Ph translocation was identified, involving five chromosomal regions, 9p21, 9q34, 12p13.3, 20q11.2 and 22q11.2, as well as an unbalanced translocation, der(7)t(7;8)(p11.2;q11.2). Since the majority of CML cases are currently treated with imatinib, variant rearrangements in general have no specific prognostic significance, although the mechanisms involved in resistance to therapy have yet to be investigated. In the present case, multiple partial deletions, including ABL and ASS genes on chromosome 9, the region 7p11.2 to 7pter, 8q11.2 to 8pter and two regions on chromosome 12, were identified. An additional Ph chromosome was also detected. Immunophenotyping indicated that the patient had biphenotypic leukemia. The patient did not respond positively to imatinib chemotherapy and died for unknown reasons, one month after diagnosis. The underlying mechanisms and prognostic implications of these cytogenetic abnormalities are discussed.
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Affiliation(s)
- Walid Al-Achkar
- Department of Molecular Biology and Biotechnology, Human Genetics Division, Damascus 6091, Syria
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136
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Al-Achkar W, Wafa A, Liehr T. A new t(9;11;20;22)(q34;p11.2;q11.21;q11) in a Philadelphia-positive chronic myeloid leukemia case. Oncol Lett 2012; 5:605-608. [PMID: 23420768 PMCID: PMC3573154 DOI: 10.3892/ol.2012.1039] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 06/12/2012] [Indexed: 12/02/2022] Open
Abstract
The so-called Philadelphia (Ph) chromosome is found in over 90% of cases of chronic myeloid leukemia (CML). Of these cases, 2–10% demonstrate complex translocations involving a third chromosome in addition to chromosomes 9 and 22. Since the majority of CML cases are currently treated with imatinib, variant rearrangements tend to have no specific prognostic significance, although the mechanisms involved in resistance to therapy have yet to be investigated. This study evaluated a CML case with complex chromosomal aberrations not previously observed. A four-chromosome translocation involving chromosomal regions including 11p11.2 and 20q11.21 in addition to 9q34 and 22q11 was characterized in detail using array-proven multicolor banding (aMCB), a technique which has proven to be of significance in characterizing breakpoint regions in detail. Underlying mechanisms and prognostic factors are discussed.
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Affiliation(s)
- Walid Al-Achkar
- Department of Molecular Biology and Biotechnology, Human Genetics Division, Atomic Energy Commission, Damascus, Syria
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Annamaneni S, Gorre M, Kagita S, Addepalli K, Digumarti RR, Satti V, Battini MR. Association of XRCC1 gene polymorphisms with chronic myeloid leukemia in the population of Andhra Pradesh, India. ACTA ACUST UNITED AC 2012; 18:163-8. [PMID: 23320983 DOI: 10.1179/1607845412y.0000000040] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Chronic myeloid leukemia (CML), a clonal myeloproliferative disorder, is characterized primarily by the presence of chimeric BCR-ABL oncogene, and its progression from chronic to blast phase is associated with the accumulation of additional molecular and chromosomal abnormalities. The molecular mechanisms underlying this genetic instability are poorly understood. The activity of BCR-ABL is known to be associated with the increased production of intracellular reactive oxygen species and spontaneous DNA damage, which when effected by impaired/inaccurate DNA repair systems result in increased susceptibility to CML progression. Using case-control study design, we explored possible association of the repair gene, XRCC1, particularly the codons 399, 280, and 194 polymorphisms screened through PCR-RFLP, with the CML in the sample of 350 cases (206 male and 144 female) and 350 controls from Hyderabad, the capital city of state of the Andhra Pradesh, India. The patient group constituted 301 early chronic phase cases followed by 28 accelerated and 21 blast phase cases. The median age of the patients was 42 years (range, 9-70 years). The genotype distribution revealed significant association of codons 399 (χ(2) = 11.904, degree of freedom (d.f.) = 2; P = 0.002) and 194 (χ(2) = 8.091, d.f. = 2, P = 0.017) with CML, not 280 (P = 0.29). Although these polymorphisms are known to affect the function of XRCC1, the nature and extent of their genetic association with CML does not indicate their direct role in its development. The results seem to suggest that XRCC1 gene might have an important role in CML progression but not in its causation.
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138
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Zámečníkova A, Al Bahar S, Pandita R. Unusual location of BCR-ABL1 fusion sequences in a chronic myeloid leukemia patient. Hematology 2012; 17:321-4. [PMID: 22989955 DOI: 10.1179/1607845412y.0000000012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
We describe a case of a chronic myeloid leukemia patient displaying the chimeric BCR-ABL1 gene on 12p11. Chromosome analysis revealed complex chromosome aberration involving chromosomes 9, 12, and 22. Fluorescence in situ hybridization revealed an unusual signal pattern revealing the BCR-ABL1 fusion signal on chromosome 12, while no reciprocal ABL1-BCR fusion was detected on der(9) chromosome. The relocation of BCR-ABL1 fusion sequences to 12p11 site in our patient represents a rare type of variant translocation, as in almost all patients the chimeric BCR-ABL1 gene is located on der(22) chromosome. Our case illustrates the challenge of recognizing a complex pattern of cytogenetic aberrations that occur with variant t(9;22) and may add further information about clinical significance of unusual variant Ph rearrangements in CML patients receiving tyrosine kinase inhibitor treatment.
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139
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Delgado MD, Albajar M, Gomez-Casares MT, Batlle A, León J. MYC oncogene in myeloid neoplasias. Clin Transl Oncol 2012; 15:87-94. [PMID: 22911553 DOI: 10.1007/s12094-012-0926-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 07/24/2012] [Indexed: 01/13/2023]
Abstract
MYC is a transcription factor that regulates many critical genes for cell proliferation, differentiation, and biomass accumulation. MYC is one of the most prevalent oncogenes found to be altered in human cancer, being deregulated in about 50 % of tumors. Although MYC deregulation has been more frequently associated to lymphoma and lymphoblastic leukemia than to myeloid malignancies, a body of evidence has been gathered showing that MYC plays a relevant role in malignancies derived from the myeloid compartment. The myeloid leukemogenic activity of MYC has been demonstrated in different murine models. Not surprisingly, MYC has been found to be amplified or/and deregulated in the three major types of myeloid neoplasms: acute myeloid leukemia, myelodysplastic syndromes, and myeloproliferative neoplasms, including chronic myeloid leukemia. Here, we review the recent literature describing the involvement of MYC in myeloid tumors.
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Affiliation(s)
- M Dolores Delgado
- Group of Transcriptional Control and Cancer, Departamento de Biología Molecular, Facultad de Medicina, Instituto de Biomedicina y Biotecnología de Cantabria (IBBTEC), Universidad de Cantabria, CSIC, SODERCAN, Avda Cardenal Herrera Oria s/n, 39011, Santander, Spain
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Al-Achkar W, Wafa A, Moassass F, Othman MAK. A novel dic (17;18) (p13.1;q11.2) with loss of TP53 and BCR/ABL rearrangement in an Imatinib resistant chronic myeloid leukemia. Mol Cytogenet 2012; 5:36. [PMID: 22901309 PMCID: PMC3462673 DOI: 10.1186/1755-8166-5-36] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 02/29/2012] [Indexed: 12/22/2022] Open
Abstract
Background The so-called Philadelphia (Ph) chromosome is present in more than 90% of chronic myeloid leukemia (CML) cases. It results in juxtaposition of the 5′ part of the BCR gene on chromosome 22 to the 3′ part of the ABL gene on chromosome 9. Since the majority of CML cases are currently treated with Imatinib, variant rearrangements in general have no specific prognostic significance, although the mechanisms involved in resistance to therapy have yet to be investigated. The T315I mutation within the abl-gene is the most frequent one associated with resistance to tyrosine kinase inhibitors. Results This study evaluated a Ph chromosome positive CML case resistant to imatinib mesylate. A dic(17;18), loss of TP53 gene, co-expression of b2a2 and b3a2 fusions transcript and a T315I mutation were found. Conclusions We reported here a novel case of a Ph chromosome positive CML with a secondary abnormality [dic(17;18)], resulting to Glivec resistance but good response to nilotinib. The dic(17;18) might be a marker for poor prognosis in CML. Our finding indicated for an aggressive progression of the disease. The patient died under the treatment due to unknown reasons.
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Affiliation(s)
- Walid Al-Achkar
- Molecular Biology and Biotechnology Department, Human Genetics Division, Atomic Energy Commission, Damascus, Syria.
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141
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Ohm L, Arvidsson I, Barbany G, Hast R, Stenke L. Early landmark analysis of imatinib treatment in CML chronic phase: less than 10% BCR-ABL by FISH at 3 months associated with improved long-term clinical outcome. Am J Hematol 2012; 87:760-5. [PMID: 22641468 DOI: 10.1002/ajh.23238] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 04/15/2012] [Indexed: 11/10/2022]
Abstract
Imatinib has dramatically improved the clinical outcome in chronic myeloid leukemia, chronic phase (CMLcp), but a risk of resistance and serious disease progression still prevails. We have studied 45 newly diagnosed CMLcp patients initiated on imatinib, assessing treatment responses by interphase extral signal (ES)-fluorescence in situ hybridization (FISH), quantitative real-time (q-RT) polymerase chain reaction (PCR), and chromosome banding analysis. In a landmark analysis, an early favorable response, defined as less than 10% BCR-ABL-positive cells by FISH after 3 months of treatment, was identified as a predictive marker of an improved long-term clinical outcome. Of evaluable patients, 51% achieved this response. A large majority, 95% of such responders reached complete cytogenetic responses (CCyR) within 12 months and 100% event-free survival (EFS) at 48 months, when compared with 67 and 65%, respectively, of patients with higher breakpoint cluster region - Abelson (BCR-ABL) positivity at 3 months (P = 0.04; P = 0.006). No similar, significant correlations were noted between early disease assessments with PCR of BCR-ABL mRNA transcripts or of cytogenetics versus a 12-month CCyR or long-term EFS. Our data, based on a limited patient cohort, indicate that (i) FISH can effectively be used in the early assessment of remaining Ph-positive cells to identify patients at risk for a long-term nonoptimal response to imatinib and that (ii) FISH may be more useful than PCR for this purpose.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Agents/administration & dosage
- Benzamides
- Disease-Free Survival
- Female
- Fusion Proteins, bcr-abl/genetics
- Fusion Proteins, bcr-abl/metabolism
- Humans
- Imatinib Mesylate
- In Situ Hybridization, Fluorescence
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/enzymology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/mortality
- Male
- Middle Aged
- Piperazines/administration & dosage
- Pyrimidines/administration & dosage
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- RNA, Neoplasm/genetics
- RNA, Neoplasm/metabolism
- Retrospective Studies
- Reverse Transcriptase Polymerase Chain Reaction
- Risk Factors
- Survival Rate
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Affiliation(s)
- Lotta Ohm
- Divisions of Hematology and Clinical Genetics, Karolinska University Hospital, Karolinska Insitutet, Stockholm, Sweden.
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142
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Al-Achkar W, Wafa A, Moassass F, Liehr T. A unique cytogenetic abnormality, t(2;7)(p13.1;p21.3), in a Philadelphia-positive chronic myeloid leukemia. Oncol Lett 2012; 4:209-212. [PMID: 22844355 DOI: 10.3892/ol.2012.720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 02/29/2012] [Indexed: 11/05/2022] Open
Abstract
The Philadelphia (Ph) chromosome is present in more than 90% of patients suffering from chronic myeloid leukemia (CML). It is the product of a reciprocal translocation between the long arms of chromosomes 9 and 22, resulting in the transfer of the 3' portion of the proto-oncogene ABL from 9q34 to the 5' portion of the breakpoint cluster region (BCR) on 22q11. Currently, most CML cases are treated with Imatinib and variant rearrangements are thought to have no specific prognostic significance, although the events of therapy resistance have not yet been studied. In this study we report a novel case of CML exhibiting an uncommon t(2;7)(p13.1;p21.3) besides t(9;22)(q34;q11). This unusual translocation has been characterized by fluorescence in situ hybridization (FISH) and array-proven multicolor banding (aMCB), the latter being extremely significant in characterizing breakpoint regions in detail. The underlying mechanisms and prognostic implications of this cytogenetic abnormality are discussed in this study.
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Affiliation(s)
- Walid Al-Achkar
- Department of Molecular Biology and Biotechnology, Human Genetics Division, Atomic Energy Commission, Damascus, Syria
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143
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Skorski T. Genetic mechanisms of chronic myeloid leukemia blastic transformation. Curr Hematol Malig Rep 2012; 7:87-93. [PMID: 22328017 DOI: 10.1007/s11899-012-0114-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The BCR-ABL1 oncogenic tyrosine kinase can transform pluripotent hematopoietic stem cells and initiate chronic myeloid leukemia in chronic phase (CML-CP), a myeloproliferative disorder characterized by excessive accumulation of mature myeloid cells. Patients in CML-CP usually respond to treatment with ABL1 tyrosine kinase inhibitors (TKIs) such as imatinib, though some patients who respond initially may become resistant later. CML-CP leukemia stem cells (LSCs) are intrinsically insensitive to TKIs and thus survive in the long term. These LSCs or their progeny may at some stage acquire additional genetic changes that cause the leukemia to transform further, from CML-CP to a more advanced phase, which has been subclassified as either accelerated phase (CML-AP) or blastic phase (CML-BP). CML-BP is characterized by a major clonal expansion of immature progenitors, which have either myeloid or lymphoid features. CML-BP responds poorly to treatment and is usually fatal. This review discusses the role of genomic instability leading to blastic transformation of CML and proposes some novel therapeutic approaches.
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Affiliation(s)
- Tomasz Skorski
- Department of Microbiology and Immunology, School of Medicine, Temple University, Philadelphia, PA 19140, USA.
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144
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Muvarak N, Nagaria P, Rassool FV. Genomic instability in chronic myeloid leukemia: targets for therapy? Curr Hematol Malig Rep 2012; 7:94-102. [PMID: 22427031 DOI: 10.1007/s11899-012-0119-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Philadelphia positive (Ph+) chronic myeloid leukemia (CML) is characterized by the occurrence of nonrandom genetic and cytogenetic abnormalities during disease progression. Many of these abnormalities are markers for genes which, when altered, can drive the blastic transformation process. Thus, such genetic alterations may be manifestations of an underlying genomic instability resulting from a compromised DNA damage and repair response, leading to advanced stages of CML and resistance to therapy. This article examines the molecular pathways that may lead to genomic instability in CML and the potential of these pathway constituents to be therapeutic targets.
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Affiliation(s)
- N Muvarak
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD 21230, USA
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145
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Righolt C, Mai S. Shattered and stitched chromosomes-chromothripsis and chromoanasynthesis-manifestations of a new chromosome crisis? Genes Chromosomes Cancer 2012; 51:975-81. [PMID: 22811041 DOI: 10.1002/gcc.21981] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 06/13/2012] [Indexed: 12/16/2022] Open
Abstract
Chromothripsis (chromosome shattering) has been described as complex rearrangements affecting single chromosome(s) in one catastrophic event. The chromosomes would be "shattered" and "stitched together" during this event. This phenomenon is proposed to constitute the basis for complex chromosomal rearrangements seen in 2-3% of all cancers and in ∼ 25% of bone cancers. Here we discuss chromothripsis, the use of this term and the evidence presented to support a single catastrophic event that remodels the genome in one step. We discuss why care should be taken in using the term chromothripsis and what evidence is lacking to support its use while describing complex rearrangements.
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Affiliation(s)
- Christiaan Righolt
- Manitoba Institute of Cell Biology, CancerCare Manitoba, Department of Physiology, the University of Manitoba, Winnipeg, Canada
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146
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Additional chromosomal abnormalities in Philadelphia-positive clone: adverse prognostic influence on frontline imatinib therapy: a GIMEMA Working Party on CML analysis. Blood 2012; 120:761-7. [PMID: 22692507 DOI: 10.1182/blood-2011-10-384651] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Additional chromosomal abnormalities (ACAs) in Philadelphia-positive cells have been reported in ∼ 5% of patients with newly diagnosed chronic myeloid leukemia (CML) in chronic phase (CP). Few studies addressing the prognostic significance of baseline ACAs in patients treated with imatinib have been published previously. The European LeukemiaNet recommendations suggest that the presence of ACAs at diagnosis is a "warning" for patients in early CP, but there is not much information about their outcome after therapy with tyrosine kinase inhibitors. To investigate the role of ACAs in early CP CML patients treated with imatinib mesylate, we performed an analysis in a large series of 559 patients enrolled in 3 prospective trials of the Gruppo Italiano Malattie Ematologiche dell'Adulto Working Party on CML: 378 patients were evaluable and ACAs occurred in 21 patients (5.6%). The overall cytogenetic and molecular response rates were significantly lower and the time to response was significantly longer in patients with ACAs. The long-term outcome of patients with ACAs was inferior, but the differences were not significant. The prognostic significance of each specific cytogenetic abnormality was not assessable. Therefore, we confirm that ACAs constitute an adverse prognostic factor in CML patients treated with imatinib as frontline therapy.
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147
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Abstract
Blast crisis (BC) remains the major challenge in the management of chronic myeloid leukemia (CML). It is now generally accepted that BC is the consequence of continued BCR-ABL activity leading to genetic instability, DNA damage, and impaired DNA repair. Most patients with BC carry multiple mutations, and up to 80% show additional chromosomal aberrations in a nonrandom pattern. Treatment with tyrosine kinase inhibitors has improved survival in BC modestly, but most long-term survivors are those who have been transplanted. Patients in BC should be treated with a tyrosine kinase inhibitor according to mutation profile, with or without chemotherapy, with the goal of achieving a second chronic phase and proceeding to allogeneic stem cell transplantation as quickly as possible. Although long-term remissions are rare, allogeneic stem cell transplantation provides the best chance of a cure in BC. Investigational agents are not likely to provide an alternative in the near future. In view of these limited options, prevention of BC by a rigorous and early elimination of BCR-ABL is recommended. Early response indicators should be used to select patients for alternative therapies and early transplantation. Every attempt should be made to reduce or eliminate BCR-ABL consistent with good patient care as far as possible.
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148
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AL-ACHKAR WALID, WAFA ABDULSAMAD, MOASSASS FATEN, LIEHR THOMAS. A chronic myeloid leukemia case with a unique variant Philadelphia translocation: t(9;22;21)(q34;q11;p12). Oncol Lett 2012; 3:1027-1029. [PMID: 22783385 PMCID: PMC3389665 DOI: 10.3892/ol.2012.623] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 07/25/2011] [Indexed: 11/05/2022] Open
Abstract
The so-called Philadelphia (Ph) chromosome is present in more than 90% of chronic myeloid leukemia (CML) patients. Approximately, 5-10% of these patients show complex translocations involving a third chromosome in addition to chromosomes 9 and 22. Since at present the majority of CML cases are treated with imatinib, variant rearrangements do not exhibit specific prognostic significance. However, events of therapy resistance remain to be studied. In this study, we report a unique case of CML exhibiting an uncommon t(21;22)(p12;q11). This translocation has been characterized by fluorescence in situ hybridization (FISH) and array-proven multicolor banding (aMCB). Using specific probes for the BCR and ABL genes, results of FISH showed a three-way variant Philadelphia translocation (9;22;21)(q34;q11;p12) with a BCR/ABL fusion residing on the der(22) and the 3'BCR region translocated on the short arm of the derivative chromosome 21. In addition, the aMCB technique is significant in the detection of the breakpoints of genetic changes. The underlying mechanisms and prognostic significance of these changes are discussed.
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Affiliation(s)
- WALID AL-ACHKAR
- Molecular Biology and Biotechnology Department, Human Genetics Division, Atomic Energy Commission, Damascus, Syria
| | - ABDULSAMAD WAFA
- Molecular Biology and Biotechnology Department, Human Genetics Division, Atomic Energy Commission, Damascus, Syria
| | - FATEN MOASSASS
- Molecular Biology and Biotechnology Department, Human Genetics Division, Atomic Energy Commission, Damascus, Syria
| | - THOMAS LIEHR
- Jena University Hospital, Institute of Human Genetics, Jena, Germany
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149
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Khorashad JS, Deininger MWN. Selection of therapy: rational decisions based on molecular events. Hematol Oncol Clin North Am 2012; 25:1009-23, vi. [PMID: 22054732 DOI: 10.1016/j.hoc.2011.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This article reviews to what extent molecular data can be used to rationalize therapeutic choices in the treatment of chronic myeloid leukemia. Two categories of data are discussed: markers that globally measure risk but do not provide a molecular rationale for therapy selection; and biomarkers with a causal link to a clinical phenotype, such as certain mutations of the BCR-ABL kinase domain. As therapy selection is still mainly based on clinical criteria, molecular biomarkers are discussed in the context of available clinical prognostication tools, focusing on biomarkers that do not reflect disease burden as a surrogate of responsiveness to treatment.
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Affiliation(s)
- Jamshid S Khorashad
- Deininger Lab, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Room 4270, Salt Lake City, UT 84112-5550, USA
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150
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Cytogenetic profile of 1,863 Ph/BCR-ABL-positive chronic myelogenous leukemia patients from the Chinese population. Ann Hematol 2012; 91:1065-72. [PMID: 22349721 DOI: 10.1007/s00277-012-1421-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 01/28/2012] [Indexed: 10/14/2022]
Abstract
Cytogenetic analyses of chronic myelogenous leukemia (CML) have been performed previously in a large number of reports, but systematical research based on large sample sizes from the Chinese population is seldom available. In this study, we analyzed the cytogenetic profiles of 1,863 Philadelphia (Ph)/BCR-ABL-positive CML patients from a research center in China. Of 1,266 newly diagnosed CML patients, the median age was 41 years, which is younger than the median age of diagnosis in western populations. The incidence of additional chromosome abnormalities (ACA) was 3.1% in newly diagnosed chronic phase (CP), 9.1% in CP after therapy, 35.4% in accelerated phase, and 52.9% in blast crisis (BC), reflecting cytogenetic evolution with CML progression. A higher prevalence of ACA was observed in variant Ph translocations than in standard t(9;22) in the disease progression, especially in BC (88.2% vs. 50%, P = 0.002). Moreover, a hyperdiploid karyotype and trisomy 8 were closely correlated with myeloid BC, while a hypodiploid karyotype and monosomy 7 were associated with lymphoid-BC. Among subsets of myeloid-BC, myeloid-BC with minimal differentiation had a higher ACA rate than myeloid-BC with granulocytic differentiation (80% vs. 46.8%, P = 0.009) and myeloid-BC with monocytic differentiation (80% vs. 42.9%, P = 0.006). These data provide novel insights into cytogenetics of CML within the Chinese population.
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