1451
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Rosko A, Lazarus HM. Refining hematopoietic cell transplant: a concise review. CYTOMETRY PART B-CLINICAL CYTOMETRY 2012; 82:266-7. [PMID: 22956436 DOI: 10.1002/cyto.b.21035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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1452
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Cornelissen JJ, Gratwohl A, Schlenk RF, Sierra J, Bornhäuser M, Juliusson G, Råcil Z, Rowe JM, Russell N, Mohty M, Löwenberg B, Socié G, Niederwieser D, Ossenkoppele GJ. The European LeukemiaNet AML Working Party consensus statement on allogeneic HSCT for patients with AML in remission: an integrated-risk adapted approach. Nat Rev Clin Oncol 2012; 9:579-90. [PMID: 22949046 DOI: 10.1038/nrclinonc.2012.150] [Citation(s) in RCA: 289] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Allogeneic haematopoietic stem-cell transplantation (HSCT) is frequently applied as part of the treatment in patients with acute myeloid leukaemia (AML) in their first or subsequent remission. Allogeneic HSCT reduces relapse, but nonrelapse mortality and morbidity might counterbalance this beneficial effect. Here, we review recent studies reporting new disease-specific prognostic markers, in addition to allogeneic-HSCT-related risk factors, which can be assessed at specific time points during treatment. We propose risk assessment as a dynamic process during treatment, incorporating both disease-related and transplant-related factors for the decision to proceed either to allogeneic HSCT or to apply a nontransplant strategy. We suggest that allogeneic HSCT might be favoured if the projected disease-free survival is expected to improve by at least 10% based on an individual's risk assessment. The approach requires initial disease risk assessment, identifying a sibling or unrelated donor soon after diagnosis and the incorporation of time-dependent risk factors, all within the context of an integrated therapeutic management approach.
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Affiliation(s)
- Jan J Cornelissen
- Department of Hematology, Erasmus University Medical Center, Groene Hilledijk 301, 3075 EA, Rotterdam, The Netherlands.
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1453
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White DL, Brown AL, D'Andrea RJ, Rice AM. Unraveling the “Known Unknowns”: Lessons and Reflections from the New Directions in Leukemia Research 2012 Conference. Cancer Res 2012; 72:4300-3. [DOI: 10.1158/0008-5472.can-12-1832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Patients diagnosed with leukemia approach their treatment with the hope of cure despite the effect on their quality of life. Some patients will be cured, others will die from treatment, and some will die of their disease. A common theme at the New Directions in Leukemia Research (NDLR 2012) meeting was that cure will come if the drivers of the disease are better understood. Key messages included the power of combination platforms to understand the genetic and epigenetic modifications in leukemia to enable development of rational therapies, which can be tested via new clinical trial designs ensuring rapid clinical implementation. Cancer Res; 72(17); 4300–3. ©2012 AACR.
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Affiliation(s)
- Deborah L. White
- Authors' Affiliations: 1Division of Haematology, Centre for Cancer Biology; 2School of Medicine and 3School of Molecular and Biomedical sciences, University of Adelaide; 4Department of Haematology and Oncology, The Queen Elizabeth Hospital, Adelaide, South Australia; 5Mater Medical Research Institute, South Brisbane; and 6Faculty of Health Sciences, The University of Queensland, St Lucia, Queensland, Australia
- Authors' Affiliations: 1Division of Haematology, Centre for Cancer Biology; 2School of Medicine and 3School of Molecular and Biomedical sciences, University of Adelaide; 4Department of Haematology and Oncology, The Queen Elizabeth Hospital, Adelaide, South Australia; 5Mater Medical Research Institute, South Brisbane; and 6Faculty of Health Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Anna L. Brown
- Authors' Affiliations: 1Division of Haematology, Centre for Cancer Biology; 2School of Medicine and 3School of Molecular and Biomedical sciences, University of Adelaide; 4Department of Haematology and Oncology, The Queen Elizabeth Hospital, Adelaide, South Australia; 5Mater Medical Research Institute, South Brisbane; and 6Faculty of Health Sciences, The University of Queensland, St Lucia, Queensland, Australia
- Authors' Affiliations: 1Division of Haematology, Centre for Cancer Biology; 2School of Medicine and 3School of Molecular and Biomedical sciences, University of Adelaide; 4Department of Haematology and Oncology, The Queen Elizabeth Hospital, Adelaide, South Australia; 5Mater Medical Research Institute, South Brisbane; and 6Faculty of Health Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Richard J. D'Andrea
- Authors' Affiliations: 1Division of Haematology, Centre for Cancer Biology; 2School of Medicine and 3School of Molecular and Biomedical sciences, University of Adelaide; 4Department of Haematology and Oncology, The Queen Elizabeth Hospital, Adelaide, South Australia; 5Mater Medical Research Institute, South Brisbane; and 6Faculty of Health Sciences, The University of Queensland, St Lucia, Queensland, Australia
- Authors' Affiliations: 1Division of Haematology, Centre for Cancer Biology; 2School of Medicine and 3School of Molecular and Biomedical sciences, University of Adelaide; 4Department of Haematology and Oncology, The Queen Elizabeth Hospital, Adelaide, South Australia; 5Mater Medical Research Institute, South Brisbane; and 6Faculty of Health Sciences, The University of Queensland, St Lucia, Queensland, Australia
- Authors' Affiliations: 1Division of Haematology, Centre for Cancer Biology; 2School of Medicine and 3School of Molecular and Biomedical sciences, University of Adelaide; 4Department of Haematology and Oncology, The Queen Elizabeth Hospital, Adelaide, South Australia; 5Mater Medical Research Institute, South Brisbane; and 6Faculty of Health Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Alison M. Rice
- Authors' Affiliations: 1Division of Haematology, Centre for Cancer Biology; 2School of Medicine and 3School of Molecular and Biomedical sciences, University of Adelaide; 4Department of Haematology and Oncology, The Queen Elizabeth Hospital, Adelaide, South Australia; 5Mater Medical Research Institute, South Brisbane; and 6Faculty of Health Sciences, The University of Queensland, St Lucia, Queensland, Australia
- Authors' Affiliations: 1Division of Haematology, Centre for Cancer Biology; 2School of Medicine and 3School of Molecular and Biomedical sciences, University of Adelaide; 4Department of Haematology and Oncology, The Queen Elizabeth Hospital, Adelaide, South Australia; 5Mater Medical Research Institute, South Brisbane; and 6Faculty of Health Sciences, The University of Queensland, St Lucia, Queensland, Australia
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1454
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Shih AH, Abdel-Wahab O, Patel JP, Levine RL. The role of mutations in epigenetic regulators in myeloid malignancies. Nat Rev Cancer 2012; 12:599-612. [PMID: 22898539 DOI: 10.1038/nrc3343] [Citation(s) in RCA: 539] [Impact Index Per Article: 44.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Recent genomic studies have identified novel recurrent somatic mutations in patients with myeloid malignancies, including myeloproliferative neoplasms (MPNs), myelodysplastic syndrome (MDS) and acute myeloid leukaemia (AML). In some cases these mutations occur in genes with known roles in regulating chromatin and/or methylation states in haematopoietic progenitors, and in other cases genetic and functional studies have elucidated a role for specific mutations in altering epigenetic patterning in myeloid malignancies. In this Review we discuss recent genetic and functional data implicating mutations in epigenetic modifiers, including tet methylcytosine dioxygenase 2 (TET2), isocitrate dehydrogenase 1 (IDH1), IDH2, additional sex combs-like 1 (ASXL1), enhancer of zeste homologue 2 (EZH2) and DNA methyltransferase 3A (DNMT3A), in the pathogenesis of MPN, MDS and AML, and discuss how this knowledge is leading to novel clinical, biological and therapeutic insights.
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Affiliation(s)
- Alan H Shih
- Human Oncology and Pathogenesis Program, Department of Medicine, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, New York, USA
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1455
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Aljitawi OS, Lin TL. Research Highlights: Highlights from the latest articles in molecular profiling and prognosis in acute myeloid leukemia. Per Med 2012; 9:679-682. [PMID: 29776265 DOI: 10.2217/pme.12.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Omar S Aljitawi
- University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
| | - Tara L Lin
- University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
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1456
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Management of AML: who do we really cure? Leuk Res 2012; 36:1475-80. [PMID: 22938830 DOI: 10.1016/j.leukres.2012.08.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 07/30/2012] [Accepted: 08/06/2012] [Indexed: 11/21/2022]
Abstract
Most clinicians caring for patients with AML do not use the word "cure" casually, since for many patients diagnosed with AML, a state of cure or even of long term survival remains elusive. Analysis of prognostic factors may aid in defining the chance for cure in various AML subtypes, and improvements are required at all stages of AML treatment if cure is to be realized in a higher proportion of patients. In order to improve outcome, requirements will include targeting the mutation responsible for the leukemia emergence, suppressing the stem or progenitor cell which acquires the mutation, and the capability to deliver therapy to patients who themselves have adverse co-morbidities.
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1457
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1458
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Abdel-Wahab O, Tefferi A, Levine RL. Role of TET2 and ASXL1 mutations in the pathogenesis of myeloproliferative neoplasms. Hematol Oncol Clin North Am 2012; 26:1053-64. [PMID: 23009937 DOI: 10.1016/j.hoc.2012.07.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Since the discovery of activating mutations in JAK2 in patients with myeloproliferative neoplasms (MPNs) in 2005, gene discovery efforts have identified additional disease alleles, which can predate or occur subsequent to acquisition of JAK2/MPL mutations. In 2009, somatic copy number loss and mutations in the genes TET2 and ASXL1 were identified in MPN patients. Genetic analysis of MPN patient cohorts with adequate sample size and clear clinical annotation are needed to understand the importance of these mutations on MPN phenotype, risk of transformation to leukemia, response to therapy, and influence on overall survival.
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Affiliation(s)
- Omar Abdel-Wahab
- Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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1459
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Abstract
The karyotype is so far the most important prognostic parameter in acute myeloid leukemia (AML). Molecular mutations have been analyzed to subdivide AML with normal karyotype into prognostic subsets. The aim of this study was to develop a prognostic model for the entire AML cohort solely based on molecular markers. One thousand patients with cytogenetic data were investigated for the following molecular alterations: PML-RARA, RUNX1-RUNX1T1, CBFB-MYH11, FLT3-ITD, and MLL-PTD, as well as mutations in NPM1, CEPBA, RUNX1, ASXL1, and TP53. Clinical data were available in 841 patients. Based on Cox regression and Kaplan-Meier analyses, 5 distinct prognostic subgroups were identified: (1) very favorable: PML-RARA rearrangement (n = 29) or CEPBA double mutations (n = 42; overall survival [OS] at 3 years: 82.9%); (2) favorable: RUNX1-RUNX1T1 (n = 35), CBFB-MYH11 (n = 31), or NPM1 mutation without FLT3-ITD (n = 186; OS at 3 years: 62.6%); (3) intermediate: none of the mutations leading to assignment into groups 1, 2, 4, or 5 (n = 235; OS at 3 years: 44.2%); (4) unfavorable: MLL-PTD and/or RUNX1 mutation and/or ASXL1 mutation (n = 203; OS at 3 years: 21.9%); and (5) very unfavorable: TP53 mutation (n = 80; OS at 3 years: 0%; P < .001). This comprehensive molecular characterization provides a more powerful model for prognostication than cytogenetics.
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1460
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Khan I, Altman JK, Licht JD. New strategies in acute myeloid leukemia: redefining prognostic markers to guide therapy. Clin Cancer Res 2012; 18:5163-71. [PMID: 22893630 DOI: 10.1158/1078-0432.ccr-12-0313] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Although standard therapy for AML has been relatively constant over the past 2 decades, this may be changing with enhanced technologies allowing for the classification of acute myeloid leukemia (AML) into molecularly distinct subsets. Some specific subsets of AML have an excellent prognosis in response to standard therapy, whereas the poor prognosis of AML associated with specific sets of mutations or chromosomal anomalies requires the development of new therapies. Elucidation of the molecular pathogenesis of AML has led to the development of therapies that affect signaling, apoptosis, protein and intermediate metabolism, the surface of the leukemia cell, leukemia cell/stromal interaction, and epigenetic regulation of gene expression.
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Affiliation(s)
- Irum Khan
- Division of Hematology/Oncology, Northwestern University-Feinberg School of Medicine, Chicago, IL, USA
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1461
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Pauwels D, Sweron B, Cools J. The N676D and G697R mutations in the kinase domain of FLT3 confer resistance to the inhibitor AC220. Haematologica 2012; 97:1773-4. [PMID: 22875611 DOI: 10.3324/haematol.2012.069781] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
MESH Headings
- Amino Acid Substitution
- Benzothiazoles/pharmacology
- Cell Line, Tumor
- Drug Resistance, Neoplasm/genetics
- Female
- Humans
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/enzymology
- Leukemia, Myeloid, Acute/genetics
- Male
- Mutation, Missense
- Phenylurea Compounds/pharmacology
- Protein Kinase Inhibitors/pharmacology
- Protein Structure, Tertiary
- fms-Like Tyrosine Kinase 3/antagonists & inhibitors
- fms-Like Tyrosine Kinase 3/genetics
- fms-Like Tyrosine Kinase 3/metabolism
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1462
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Eriksson A, Hermanson M, Wickström M, Lindhagen E, Ekholm C, Jenmalm Jensen A, Löthgren A, Lehmann F, Larsson R, Parrow V, Höglund M. The novel tyrosine kinase inhibitor AKN-028 has significant antileukemic activity in cell lines and primary cultures of acute myeloid leukemia. Blood Cancer J 2012; 2:e81. [PMID: 22864397 PMCID: PMC3432483 DOI: 10.1038/bcj.2012.28] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Aberrantly expressed tyrosine kinases have emerged as promising targets for drug development in acute myeloid leukemia (AML). We report that AKN-028, a novel tyrosine kinase inhibitor (TKI), is a potent FMS-like receptor tyrosine kinase 3 (FLT3) inhibitor (IC50=6 nℳ), causing dose-dependent inhibition of FLT3 autophosphorylation. Inhibition of KIT autophosphorylation was shown in a human megakaryoblastic leukemia cell line overexpressing KIT. In a panel of 17 cell lines, AKN-028 showed cytotoxic activity in all five AML cell lines included. AKN-028 triggered apoptosis in MV4-11 by activation of caspase 3. In primary AML samples (n=15), AKN-028 induced a clear dose-dependent cytotoxic response (mean IC50 1 μℳ). However, no correlation between antileukemic activity and FLT3 mutation status, or to the quantitative expression of FLT3, was observed. Combination studies showed synergistic activity when cytarabine or daunorubicin was added simultaneously or 24 h before AKN-028. In mice, AKN-028 demonstrated high oral bioavailability and antileukemic effect in primary AML and MV4-11 cells, with no major toxicity observed in the experiment. In conclusion, AKN-028 is a novel TKI with significant preclinical antileukemic activity in AML. Possible sequence-dependent synergy with standard AML drugs and good oral bioavailability has made it a candidate drug for clinical trials (ongoing).
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Affiliation(s)
- A Eriksson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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1463
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Human disease modeling with induced pluripotent stem cells. Curr Opin Genet Dev 2012; 22:509-16. [PMID: 22868174 DOI: 10.1016/j.gde.2012.07.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 06/21/2012] [Accepted: 07/04/2012] [Indexed: 02/07/2023]
Abstract
In the past few years, cellular programming, whereby virtually all human cell types, including those deep within the brain or internal organs, can potentially be produced and propagated indefinitely in culture, has opened the door to a new type of disease modeling. Importantly, many diseases or disease predispositions have genetic components that vary from person to person. Now cells from individuals can be readily reprogrammed to form pluripotent cells, and then directed to differentiate into the lineage and the cell type in which the disease manifests. Those cells will contain the genetic contribution of the donor, providing an excellent model to delve into human disease at the level of individuals and their genomic variants. To date, over fifty such disease models have been reported, and while the field is young and hurdles remain, these tools promise to inform scientists about the cause and cellular-molecular mechanisms involved in pathology, unravel the role of environmental versus hereditary factors driving disease, and provide an unprecedented tool for screening therapeutic agents that might slow or halt disease progression.
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1464
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CD25 expression status improves prognostic risk classification in AML independent of established biomarkers: ECOG phase 3 trial, E1900. Blood 2012; 120:2297-306. [PMID: 22855599 DOI: 10.1182/blood-2012-02-414425] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
We determined the prognostic relevance of CD25 (IL-2 receptor-α) expression in 657 patients (≤ 60 years) with de novo acute myeloid leukemia (AML) treated in the Eastern Cooperative Oncology Group trial, E1900. We identified CD25(POS) myeloblasts in 87 patients (13%), of whom 92% had intermediate-risk cytogenetics. CD25 expression correlated with expression of stem cell antigen CD123. In multivariate analysis, controlled for prognostic baseline characteristics and daunorubicin dose, CD25(POS) patients had inferior complete remission rates (P = .0005) and overall survival (P < .0001) compared with CD25(NEG) cases. In a subset of 396 patients, we integrated CD25 expression with somatic mutation status to determine whether CD25 impacted outcome independent of prognostic mutations. CD25 was positively correlated with internal tandem duplications in FLT3 (FLT3-ITD), DNMT3A, and NPM1 mutations. The adverse prognostic impact of FLT3-ITD(POS) AML was restricted to CD25(POS) patients. CD25 expression improved AML prognostication independent of integrated, cytogenetic and mutational data, such that it reallocated 11% of patients with intermediate-risk disease to the unfavorable-risk group. Gene expression analysis revealed that CD25(POS) status correlated with the expression of previously reported leukemia stem cell signatures. We conclude that CD25(POS) status provides prognostic relevance in AML independent of known biomarkers and is correlated with stem cell gene-expression signatures associated with adverse outcome in AML.
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1465
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Hamilton BK, Copelan EA. Concise Review: The Role of Hematopoietic Stem Cell Transplantation in the Treatment of Acute Myeloid Leukemia. Stem Cells 2012; 30:1581-1586. [DOI: 10.1002/stem.1140] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Betty K. Hamilton
- Department of Hematologic Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Edward A. Copelan
- Department of Hematologic Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
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1466
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Murati A, Brecqueville M, Devillier R, Mozziconacci MJ, Gelsi-Boyer V, Birnbaum D. Myeloid malignancies: mutations, models and management. BMC Cancer 2012; 12:304. [PMID: 22823977 PMCID: PMC3418560 DOI: 10.1186/1471-2407-12-304] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 06/30/2012] [Indexed: 12/05/2022] Open
Abstract
Myeloid malignant diseases comprise chronic (including myelodysplastic syndromes, myeloproliferative neoplasms and chronic myelomonocytic leukemia) and acute (acute myeloid leukemia) stages. They are clonal diseases arising in hematopoietic stem or progenitor cells. Mutations responsible for these diseases occur in several genes whose encoded proteins belong principally to five classes: signaling pathways proteins (e.g. CBL, FLT3, JAK2, RAS), transcription factors (e.g. CEBPA, ETV6, RUNX1), epigenetic regulators (e.g. ASXL1, DNMT3A, EZH2, IDH1, IDH2, SUZ12, TET2, UTX), tumor suppressors (e.g. TP53), and components of the spliceosome (e.g. SF3B1, SRSF2). Large-scale sequencing efforts will soon lead to the establishment of a comprehensive repertoire of these mutations, allowing for a better definition and classification of myeloid malignancies, the identification of new prognostic markers and therapeutic targets, and the development of novel therapies. Given the importance of epigenetic deregulation in myeloid diseases, the use of drugs targeting epigenetic regulators appears as a most promising therapeutic approach.
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Affiliation(s)
- Anne Murati
- Centre de Recherche en Cancérologie de Marseille, Laboratoire d'Oncologie Moléculaire; UMR1068 Inserm, Institut Paoli-Calmettes, 27 Bd, Leï Roure, BP 30059, Marseille, 13273, France
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1467
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Cools J. Detection of clonal blood cells with specific chromosomal abnormalities in the general population. Haematologica 2012; 97:961-2. [PMID: 22798544 DOI: 10.3324/haematol.2012.072298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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1468
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Watkins DB, Hughes TP, White DL, D'Andrea RJ. NPM1 mutations occur rarely or not at all in chronic myeloid leukaemia patients in chronic phase or blast crisis. Leukemia 2012; 27:489-90. [PMID: 22791379 DOI: 10.1038/leu.2012.193] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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1469
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Kühnl A, Grimwade D. Molecular markers in acute myeloid leukaemia. Int J Hematol 2012; 96:153-63. [PMID: 22791509 DOI: 10.1007/s12185-012-1123-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 05/29/2012] [Accepted: 06/07/2012] [Indexed: 12/14/2022]
Abstract
An increasing number of cytogenetic and molecular genetic aberrations have been identified in acute myeloid leukaemia (AML), highlighting the biological heterogeneity of the disease. Moreover, the characterisation of specific molecular abnormalities provides the basis for targeted therapies, such as all trans retinoic acid (ATRA) and arsenic trioxide treatment in acute promyelocytic leukaemia or tyrosine kinase inhibitors in AML with FLT3 mutations. Several cytogenetic and molecular genetic changes have been shown to be prognostically relevant and have been acknowledged in the latest WHO classification of AML as separate entities. A detailed marker assessment at diagnosis is crucial for risk-stratification of AML patients, allowing the identification of those at high risk of relapse, who may benefit from early allogeneic stem cell transplantation. Finally, molecular markers are important for the detection of minimal residual disease after initial therapy and during long-term follow-up, which enables a more tailored treatment approach for individual AML patients.
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Affiliation(s)
- Andrea Kühnl
- Department of Medical and Molecular Genetics, King's College London School of Medicine, London, UK
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1470
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Stein EM, Tallman MS. Remission induction in acute myeloid leukemia. Int J Hematol 2012; 96:164-70. [PMID: 22791508 DOI: 10.1007/s12185-012-1121-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 05/24/2012] [Indexed: 11/29/2022]
Abstract
Inducing a complete remission (CR) in patients with acute myeloid leukemia is a prerequisite to long-term disease control with subsequent post-remission consolidation chemotherapy or allogeneic hematopoietic stem cell transplantation. The use of 7 days of infusional cytarabine and 3 days of daunorubicin or idarubicin (7 + 3) has become the standard of care to induce CR, based on clinical trials conducted in the 1980s. Efforts to improve on the CR rate seen with the 7 + 3 regimen that translates into better overall patient survival have been disappointing. Here we review recent phase III studies of novel induction strategies that show promise in increasing the rate of CR and improving disease outcome.
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Affiliation(s)
- Eytan M Stein
- Memorial Sloan Kettering Cancer Center, Leukemia Service, New York, NY 10065, USA
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1471
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Thomas R, Phuong J, McHale CM, Zhang L. Using bioinformatic approaches to identify pathways targeted by human leukemogens. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2012; 9:2479-503. [PMID: 22851955 PMCID: PMC3407916 DOI: 10.3390/ijerph9072479] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 06/25/2012] [Accepted: 06/26/2012] [Indexed: 12/28/2022]
Abstract
We have applied bioinformatic approaches to identify pathways common to chemical leukemogens and to determine whether leukemogens could be distinguished from non-leukemogenic carcinogens. From all known and probable carcinogens classified by IARC and NTP, we identified 35 carcinogens that were associated with leukemia risk in human studies and 16 non-leukemogenic carcinogens. Using data on gene/protein targets available in the Comparative Toxicogenomics Database (CTD) for 29 of the leukemogens and 11 of the non-leukemogenic carcinogens, we analyzed for enrichment of all 250 human biochemical pathways in the Kyoto Encyclopedia of Genes and Genomes (KEGG) database. The top pathways targeted by the leukemogens included metabolism of xenobiotics by cytochrome P450, glutathione metabolism, neurotrophin signaling pathway, apoptosis, MAPK signaling, Toll-like receptor signaling and various cancer pathways. The 29 leukemogens formed 18 distinct clusters comprising 1 to 3 chemicals that did not correlate with known mechanism of action or with structural similarity as determined by 2D Tanimoto coefficients in the PubChem database. Unsupervised clustering and one-class support vector machines, based on the pathway data, were unable to distinguish the 29 leukemogens from 11 non-leukemogenic known and probable IARC carcinogens. However, using two-class random forests to estimate leukemogen and non-leukemogen patterns, we estimated a 76% chance of distinguishing a random leukemogen/non-leukemogen pair from each other.
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Affiliation(s)
- Reuben Thomas
- Genes and Environment Laboratory, School of Public Health, University of California, Berkeley, CA 94720, USA.
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1472
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Genome-wide methylation profiling in decitabine-treated patients with acute myeloid leukemia. Blood 2012; 120:2466-74. [PMID: 22786882 DOI: 10.1182/blood-2012-05-429175] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The outcome of older (≥ 60 years) acute myeloid leukemia (AML) patients is poor, and novel treatments are needed. In a phase 2 trial for older AML patients, low-dose (20 mg/m(2) per day for 10 days) decitabine, a DNA hypomethylating azanucleoside, produced 47% complete response rate with an excellent toxicity profile. To assess the genome-wide activity of decitabine, we profiled pretreatment and post treatment (day 25/course 1) methylomes of marrow samples from patients (n = 16) participating in the trial using deep-sequencing analysis of methylated DNA captured by methyl-binding protein (MBD2). Decitabine significantly reduced global methylation compared with pretreatment baseline (P = .001). Percent marrow blasts did not correlate with global methylation levels, suggesting that hypomethylation was related to the activity of decitabine rather than to a mere decrease in leukemia burden. Hypomethylation occurred predominantly in CpG islands and CpG island-associated regions (P ranged from .03 to .04) A significant concentration (P < .001) of the hypomehtylated CpG islands was found in chromosome subtelomeric regions, suggesting a differential activity of decitabine in distinct chromosome regions. Hypermethylation occurred much less frequently than hypomethylation and was associated with low CpG content regions. Decitabine-related methylation changes were concordant with those previously reported in distinct genes. In summary, our study supports the feasibility of methylome analyses as a pharmacodynamic endpoint for hypomethylating therapies.
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Hutchinson L. Turning the clock back on clonal evolution. Nat Rev Clin Oncol 2012; 9:245. [DOI: 10.1038/nrclinonc.2012.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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