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Moen EL, Mariani CJ, Zullow H, Jeff-Eke M, Litwin E, Nikitas JN, Godley LA. New themes in the biological functions of 5-methylcytosine and 5-hydroxymethylcytosine. Immunol Rev 2015; 263:36-49. [PMID: 25510270 DOI: 10.1111/imr.12242] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
5-methylcytosine (5-mC) and 5-hydroxymethylcytosine (5-hmC) play a critical role in development and normal physiology. Alterations in 5-mC and 5-hmC patterns are common events in hematopoietic neoplasms. In this review, we begin by emphasizing the importance of 5-mC, 5-hmC, and their enzymatic modifiers in hematological malignancies. Then, we discuss the functions of 5-mC and 5-hmC at distinct genic contexts, including promoter regions, gene bodies, intron-exon boundaries, alternative promoters, and intragenic microRNAs. Recent advances in technology have allowed for the study of 5-mC and 5-hmC independently and specifically permitting distinction between the bases that show them to have transcriptional effects that vary by their location relative to gene structure. We extend these observations to their functions at enhancers and transcription factor binding sites. We discuss dietary influences on 5-mC and 5-hmC levels and summarize the literature on the effects of folate and vitamin C on 5-mC and 5-hmC, respectively. Finally, we discuss how these new themes in the functions of 5-mC and 5-hmC will likely influence the broader research field of epigenetics.
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Affiliation(s)
- Erika L Moen
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, IL, USA; Committee on Cancer Biology, The University of Chicago, Chicago, IL, USA
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152
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Meldi KM, Figueroa ME. Cytosine modifications in myeloid malignancies. Pharmacol Ther 2015; 152:42-53. [DOI: 10.1016/j.pharmthera.2015.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 04/29/2015] [Indexed: 01/16/2023]
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Let-7a-3 hypomethylation is associated with favorable/intermediate karyotypes but not with survival in acute myeloid leukemia. Tumour Biol 2015; 37:491-501. [PMID: 26227220 DOI: 10.1007/s13277-015-3734-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 06/29/2015] [Indexed: 12/21/2022] Open
Abstract
Aberrant methylation of let-7a-3 promoter has been observed in various malignancies. However, the clinical relevance of let-7a-3 methylation remains poorly known in acute myeloid leukemia (AML). This study was to investigate the let-7a-3 methylation status and to explore its clinical significance in AML. let-7a-3 promoter was significantly hypomethylated in AML patients compared to controls (median 4.51 vs 0.49) (P = 0.0003). Receiver operating characteristic curve (ROC) analysis discriminated all patients or cytogenetically normal patients from controls with an areas under the ROC curve (AUC) of 0.737 or 0.783, respectively (P < 0.001). Patients with favorable/intermediate karyotypes had significantly higher let-7a-3 unmethylation than controls. Patients with DNMT3A mutations had a trend of high level of let-7a-3 unmethylation than did those with wild-type DNMT3A (median 6.76 vs 3.66, P = 0.096). There was no significant difference in overall survival between patients with and without hypomethylated let-7a-3 (median 12 vs 5 months, P = 0.103). No correlation was observed between the level of let-7a-3 expression and let-7a-3 unmethylation in AML samples (R = 0.197, P = 0.150). However, the level of let-7a-3 expression was increased in a dose-dependent manner in THP-1 line treated with 5-aza-dC, while the methylation density of let-7a-3 promoter decreased with 5-aza-dC dose. Our findings suggest that let-7a-3 hypomethylation is associated with favorable and intermediate karyotypes but not a prognostic predictor for AML patients. Let-7a-3 expression may be partially regulated by promoter methylation.
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Abstract
Induction followed by post-remission therapy including intensive chemotherapy with high-dose cytarabine, autologous and allogeneic hematopoietic stem cell transplantation is recognized as the main road towards cure in acute myeloid leukemia. In recent years, also a renaissance of maintenance therapy after completion of intensive consolidation has been observed with the introduction of kinase inhibitors and demethylating agents in clinical trials. Greater insight into the genetic background of the disease fostered the extension of disease classification and pretreatment risk-categorization by gene mutations. In addition, the pre-treatment risk-defining parameters have been supplemented by markers evaluated at distinct time points during treatment and follow up. In this context, minimal residual disease assessment is increasingly used to dynamically fine tune treatment recommendations. Currently, the gold standard to counterbalance a higher risk of relapse by treatment strategies based on hematopoietic stem cell transplantation with grafts from matched related or unrelated donors is still valuable, whereas autologous hematopoietic stem cell transplantation showed promising results especially in patients categorized as low-risk. Nonetheless, more targeted approaches including kinase inhibitors and demethylating agents in combination with or sequentially before or after intensive chemotherapy are currently in clinical evaluation and may lead to more genotype- instead of purely risk-adapted treatment strategies.
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Affiliation(s)
- Richard F Schlenk
- Department of Internal Medicine III, University Hospital Ulm, Germany
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Yang L, Liu Y, Zhu L, Xiao M. DNMT3A R882 mutation is associated with elevated expression of MAFB and M4/M5 immunophenotype of acute myeloid leukemia blasts. Leuk Lymphoma 2015; 56:2914-22. [PMID: 25721756 DOI: 10.3109/10428194.2015.1015123] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Researchers have recognized that aberrant methylation is an important initiating event in the pathogenesis of hematological malignancies. DNMT3A is a DNA methyltransferase that plays a vital role in de novo methylation of DNA. Somatic mutation of DNMT3A, especially at the Arg882 (R882) site of the DNMT3A coding sequence, has been identified in pre-leukemic stem cell clones as one of the driver mutations of acute myeloid leukemia (AML). Statistical analysis has indicated that patients with AML with DNMT3A mutation tend to have the M4/M5 subtype of AML according to the French-American-British classification. In this study we aimed to investigate the association between the typical immunophenotype of leukemic blasts and mutation of DNMT3A R882. In addition, we further determined the relationship between DNMT3A R882 mutation and the expression of monocytic differentiation genes, and its clinical significance.
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Affiliation(s)
- Li Yang
- a Department of Hematology , Tongji Hospital affiliated by Tongji Medical College, Huazhong University of Science and Technology , Wuhan , Hubei Province , China
| | - Ya'Nan Liu
- a Department of Hematology , Tongji Hospital affiliated by Tongji Medical College, Huazhong University of Science and Technology , Wuhan , Hubei Province , China
| | - Li Zhu
- a Department of Hematology , Tongji Hospital affiliated by Tongji Medical College, Huazhong University of Science and Technology , Wuhan , Hubei Province , China
| | - Min Xiao
- a Department of Hematology , Tongji Hospital affiliated by Tongji Medical College, Huazhong University of Science and Technology , Wuhan , Hubei Province , China
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Preparing Patients With Myelodysplastic Syndrome for Transplant When Is Pre-transplant Cytoreductive Therapy Appropriate? Curr Hematol Malig Rep 2015; 10:329-33. [PMID: 26126601 DOI: 10.1007/s11899-015-0276-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
To date, the only treatment option with curative potential for patients suffering from myelodysplastic syndromes (MDS) is allogeneic stem cell transplantation (allo-SCT). However, patient selection for this procedure as well as the choice of the appropriate pre-transplant regime remain challenging. This review discusses both intensive chemotherapy and hypomethylating agents (HMAs) as debulking strategies. Current evidence on the use of AML-like intense chemotherapy suggests that this represents a valuable option especially in fitter and younger MDS patients with aggressive disease, whereas HMAs seem especially indicated in patients presenting with certain mutations and less proliferative disease in order to bridge them to transplant. The actual need for pre-transplant cytoreduction strongly depends on donor availability and disease progression: upfront allo-SCT might be considered for patients with slowly progressing MDS if a donor is readily available. Common to the data discussed in this review is their retrospective nature, making clear recommendations in terms of debulking strategy difficult. Prospective randomized trials are required to explicitly answer this question in the future.
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Brissot E, Mohty M. Which Acute Myeloid Leukemia Patients Should Be Offered Transplantation? Semin Hematol 2015; 52:223-31. [DOI: 10.1053/j.seminhematol.2015.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lin P, Falini B. Acute Myeloid Leukemia With Recurrent Genetic Abnormalities Other Than Translocations. Am J Clin Pathol 2015; 144:19-28. [PMID: 26071459 DOI: 10.1309/ajcp97bjbevzeuin] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES Session 2 of the workshop focused on cases of acute myeloid leukemia (AML) with gene mutations in the setting of a normal karyotype. METHODS Among 22 AML cases submitted, 14 had the NPM1 mutation, most also accompanied by mutations of other genes such as FLT3-ITD, DNMT3A, or, rarely, TP53; three cases had the heterozygous CEBPA mutation; and two cases had MYC amplification. RESULTS We explored prognostic implications of gene mutations such as DNMT3A, issues related to the classification of AML cases with the NPM1 mutation, and myelodysplasia-related changes arising from chronic myelomonocytic leukemia after a short latency interval. Disparate patterns of treatment response to targeted therapy using an FLT3 inhibitor, designated as cytotoxic or differentiation, and their genetic underpinnings were described. Finally, a minimal screening panel for gene mutations and the optimal approach for monitoring minimal residual disease were discussed. CONCLUSIONS In aggregate, this session highlighted the need for a refined molecular classification of AML as well as improved risk stratification based on systematic assessment for genetic alterations and their evolution over time.
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159
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Eriksson A, Lennartsson A, Lehmann S. Epigenetic aberrations in acute myeloid leukemia: Early key events during leukemogenesis. Exp Hematol 2015; 43:609-24. [PMID: 26118500 DOI: 10.1016/j.exphem.2015.05.009] [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: 05/23/2015] [Indexed: 12/17/2022]
Abstract
As a result of the introduction of new sequencing technologies, the molecular landscape of acute myeloid leukemia (AML) is rapidly evolving. From karyotyping, which detects only large genomic aberrations of metaphase chromosomes, we have moved into an era when sequencing of each base pair allows us to define the AML genome at highest resolution. This has revealed a new complex landscape of genetic aberrations where addition of mutations in epigenetic regulators has been one of the most important contributions to the understanding of the pathogenesis of AML. These findings, together with new insights into epigenetic mechanisms, have placed dysregulated epigenetic mechanisms at the forefront of AML development. Not only have several new mutations in genes directly involved in epigenetic regulatory mechanisms been discovered, but also previously well-known gene fusions have been found to exert aberrant effects through epigenetic mechanisms. In addition, mutations in epigenetic regulators such as DNMT3A, TET2, and ASXL1 have recently been found to be the earliest known events during AML evolution and to be present as preleukemic lesions before the onset of AML. In this article, we review epigenetic changes in AML also in relation to what is known about their mechanism of action and their prognostic role.
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Affiliation(s)
- Anna Eriksson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Andreas Lennartsson
- Department of Biosciences and Nutrition, NOVUM, Karolinska Institutet, Stockholm, Sweden
| | - Sören Lehmann
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Centre of Hematology, HERM, Department of Medicine, Karolinska Institute, Huddinge, Stockholm, Sweden.
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Gale RE, Lamb K, Allen C, El-Sharkawi D, Stowe C, Jenkinson S, Tinsley S, Dickson G, Burnett AK, Hills RK, Linch DC. Simpson's Paradox and the Impact of Different DNMT3A Mutations on Outcome in Younger Adults With Acute Myeloid Leukemia. J Clin Oncol 2015; 33:2072-83. [PMID: 25964253 DOI: 10.1200/jco.2014.59.2022] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2024] Open
Abstract
PURPOSE To evaluate the impact of DNMT3A mutations on outcome in younger patients with cytogenetic intermediate-risk acute myeloid leukemia. PATIENTS AND METHODS Diagnostic samples from 914 patients (97% < 60 years old) were screened for mutations in DNMT3A exons 13 to 23. Clinical outcome was evaluated according to presence or absence of a mutation and stratified according to type of mutation (R882, non-R882 missense, or truncation). RESULTS DNMT3A mutations (DNMT3A(MUT)) were identified in 272 patients (30%) and associated with a poorer prognosis than wild-type DNMT3A, but the difference was only seen when the results were stratified according to NPM1 genotype. This example of Simpson's paradox results from the high coincidence of DNMT3A and NPM1 mutations (80% of patients with DNMT3A(MUT) had NPM1 mutations), where the two mutations have opposing prognostic impact. In the stratified analyses, relapse in patients with DNMT3A(MUT) was higher (hazard ratio, 1.35; 95% CI, 1.07 to 1.72; P = .01), and overall survival was lower (hazard ratio, 1.37; 95% CI, 1.12 to 1.87; P = .002). The impact of DNMT3A(MUT) did not differ according to NPM1 genotype (test for heterogeneity: relapse, P = .4; overall survival, P = .9). Further analysis according to the type of DNMT3A mutation indicated that outcome was comparable in patients with R882 and non-R882 missense mutants, whereas in those with truncation mutants, it was comparable to wild-type DNMT3A. CONCLUSION These data confirm that presence of a DNMT3A mutation should be considered as a poor-risk prognostic factor, irrespective of the NPM1 genotype, and suggest that further consideration should be given to the type of DNMT3A mutation.
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Affiliation(s)
- Rosemary E Gale
- Rosemary E. Gale, Katarina Lamb, Christopher Allen, Dima El-Sharkawi, Cassandra Stowe, Sarah Jenkinson, Steven Tinsley, Glenda Dickson, and David C. Linch, University College London Cancer Institute, London; and Alan K. Burnett and Robert K. Hills, Cardiff University School of Medicine, Cardiff, United Kingdom.
| | - Katarina Lamb
- Rosemary E. Gale, Katarina Lamb, Christopher Allen, Dima El-Sharkawi, Cassandra Stowe, Sarah Jenkinson, Steven Tinsley, Glenda Dickson, and David C. Linch, University College London Cancer Institute, London; and Alan K. Burnett and Robert K. Hills, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Christopher Allen
- Rosemary E. Gale, Katarina Lamb, Christopher Allen, Dima El-Sharkawi, Cassandra Stowe, Sarah Jenkinson, Steven Tinsley, Glenda Dickson, and David C. Linch, University College London Cancer Institute, London; and Alan K. Burnett and Robert K. Hills, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Dima El-Sharkawi
- Rosemary E. Gale, Katarina Lamb, Christopher Allen, Dima El-Sharkawi, Cassandra Stowe, Sarah Jenkinson, Steven Tinsley, Glenda Dickson, and David C. Linch, University College London Cancer Institute, London; and Alan K. Burnett and Robert K. Hills, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Cassandra Stowe
- Rosemary E. Gale, Katarina Lamb, Christopher Allen, Dima El-Sharkawi, Cassandra Stowe, Sarah Jenkinson, Steven Tinsley, Glenda Dickson, and David C. Linch, University College London Cancer Institute, London; and Alan K. Burnett and Robert K. Hills, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Sarah Jenkinson
- Rosemary E. Gale, Katarina Lamb, Christopher Allen, Dima El-Sharkawi, Cassandra Stowe, Sarah Jenkinson, Steven Tinsley, Glenda Dickson, and David C. Linch, University College London Cancer Institute, London; and Alan K. Burnett and Robert K. Hills, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Steven Tinsley
- Rosemary E. Gale, Katarina Lamb, Christopher Allen, Dima El-Sharkawi, Cassandra Stowe, Sarah Jenkinson, Steven Tinsley, Glenda Dickson, and David C. Linch, University College London Cancer Institute, London; and Alan K. Burnett and Robert K. Hills, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Glenda Dickson
- Rosemary E. Gale, Katarina Lamb, Christopher Allen, Dima El-Sharkawi, Cassandra Stowe, Sarah Jenkinson, Steven Tinsley, Glenda Dickson, and David C. Linch, University College London Cancer Institute, London; and Alan K. Burnett and Robert K. Hills, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Alan K Burnett
- Rosemary E. Gale, Katarina Lamb, Christopher Allen, Dima El-Sharkawi, Cassandra Stowe, Sarah Jenkinson, Steven Tinsley, Glenda Dickson, and David C. Linch, University College London Cancer Institute, London; and Alan K. Burnett and Robert K. Hills, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Robert K Hills
- Rosemary E. Gale, Katarina Lamb, Christopher Allen, Dima El-Sharkawi, Cassandra Stowe, Sarah Jenkinson, Steven Tinsley, Glenda Dickson, and David C. Linch, University College London Cancer Institute, London; and Alan K. Burnett and Robert K. Hills, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - David C Linch
- Rosemary E. Gale, Katarina Lamb, Christopher Allen, Dima El-Sharkawi, Cassandra Stowe, Sarah Jenkinson, Steven Tinsley, Glenda Dickson, and David C. Linch, University College London Cancer Institute, London; and Alan K. Burnett and Robert K. Hills, Cardiff University School of Medicine, Cardiff, United Kingdom
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Stewart HJS, Shalit E, Halliday L, Morey D, Chevassut TJ. Acute myeloid leukemia cells exhibit selective down-regulation of DNMT3A isoform 2. Leuk Lymphoma 2015; 56:3445-8. [DOI: 10.3109/10428194.2015.1032965] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Insights into cell ontogeny, age, and acute myeloid leukemia. Exp Hematol 2015; 43:745-55. [PMID: 26051919 DOI: 10.1016/j.exphem.2015.05.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 05/12/2015] [Accepted: 05/18/2015] [Indexed: 12/17/2022]
Abstract
Acute myeloid leukemia (AML) is a heterogenous disease of hematopoietic stem cells (HSCs) and progenitor cells (HSPCs). The pathogenesis of AML involves cytogenetic abnormalities, genetic mutations, and epigenetic anomalies. Although it is widely accepted that the cellular biology, gene expression, and epigenetic landscape of normal HSCs change with age, little is known about the interplay between the age at which the cell becomes leukemic and the resultant leukemia. Despite its rarity, childhood AML is a leading cause of childhood cancer mortality. Treatment is in general extrapolated from adult AML on the assumption that adult AML and pediatric AML are similar biological entities. However, distinct biological processes and epigenetic modifications in pediatric and adult AML may mean that response to novel therapies in children may differ from that in adults with AML. A better understanding of the key pathways involved in transformation and how these differ between childhood and adult AML is an important step in identifying effective treatment. This review highlights both the commonalities and differences between pediatric and adult AML disease biology with respect to age.
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163
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Nebbioso A, Benedetti R, Conte M, Iside C, Altucci L. Genetic mutations in epigenetic modifiers as therapeutic targets in acute myeloid leukemia. Expert Opin Ther Targets 2015; 19:1187-202. [PMID: 26028314 DOI: 10.1517/14728222.2015.1051728] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Despite enormous insights into the molecular mechanisms of acute myeloid leukemia (AML) pathophysiology, this disease is still fatal in the majority of patients, highlighting the urgent need for novel biomarkers useful in AML prognosis and therapy. AREAS COVERED The advent of modern sequencing technologies has allowed the identification of genetic mutations in genes encoding for specific enzymes involved in the epigenetic regulation of gene expression. The authors review recent data demonstrating the involvement of mutations in genes encoding for epigenetic players and their complex combination with somatic genetic mutations in the pathogenesis of AML. They also discuss the prognostic and therapeutic implications of these findings. EXPERT OPINION Current clinical and preclinical studies are underscoring the importance of targeting epigenetic modifiers as new biomarkers for a better prognostic risk stratification and therapeutic evaluation of intermediate-risk patients. Combining data from traditional and modern methodologies will allow a definition of the complex networks of epigenetic changes and molecular interactions between candidate epitargets and key regulators of hematopoiesis. It will thus be possible to achieve an overview of potential aberrant mechanisms driving leukemogenesis in different classes of AML patients. Such an improved approach could pave the way towards 'personalized' therapies.
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Affiliation(s)
- Angela Nebbioso
- Department of Biochemistry, Biophysics and General Pathology, Second University of Naples , Via L. De Crecchio 7, 80138 Naples , Italy
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Epigenetic therapy restores normal hematopoiesis in a zebrafish model of NUP98–HOXA9-induced myeloid disease. Leukemia 2015; 29:2086-97. [DOI: 10.1038/leu.2015.126] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 04/07/2015] [Accepted: 04/22/2015] [Indexed: 12/26/2022]
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Takeuchi A, Nishioka C, Ikezoe T, Yang J, Yokoyama A. STAT5A regulates DNMT3A in CD34(+)/CD38(-) AML cells. Leuk Res 2015; 39:897-905. [PMID: 26059451 DOI: 10.1016/j.leukres.2015.05.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 04/17/2015] [Accepted: 05/13/2015] [Indexed: 10/23/2022]
Abstract
Signal transducer and activator of transcription 5 (STAT5) is activated in CD34(+)/CD38(-) acute myelogenous leukemia (AML) cells. Inhibition of STAT5 induced apoptosis and sensitized these cells to the growth inhibition mediated by conventional chemotherapeutic agents. The present study attempted to identify molecules that are regulated by STAT5 in CD34(+)/CD38(-) AML cells by utilizing cDNA microarrays, comparing the gene expression profiles of control and STAT5A shRNA-transduced CD34(+)/CD38(-) AML cells. Interestingly, DNA methyltransferase (DNMT) 3A was downregulated after depletion of STAT5A in CD34(+)/CD38(-) AML cells. Reporter gene assays found that an increase in activity of DNMT3A occurred in response to activation of STAT5A in leukemia cells. On the other hand, dephosphorylation of STAT5A by AZ960 decreased this transcriptional activity. Further studies utilizing a chromatin immunoprecipitation assay identified a STAT5A-binding site on the promoter region of DNMT3A gene. Forced expression of STAT5A in leukemia cells caused hypermethylation on the promoter region of the tumor suppressor gene, PTEN, and downregulated its mRNA levels, as measured by methylation-specific and real-time polymerase chain reaction, respectively. Taken together, these data suggest that STAT5A positively regulates levels of DNMT3A, resulting in inactivation of tumor suppressor genes by epigenetic mechanisms in AML cells.
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Affiliation(s)
- Asako Takeuchi
- Department of Hematology and Respiratory Medicine, Kochi Medical School, Kochi University, Okoh-cho, Nankoku 783-8505, Kochi, Japan.
| | - Chie Nishioka
- Department of Hematology and Respiratory Medicine, Kochi Medical School, Kochi University, Okoh-cho, Nankoku 783-8505, Kochi, Japan
| | - Takayuki Ikezoe
- Department of Hematology and Respiratory Medicine, Kochi Medical School, Kochi University, Okoh-cho, Nankoku 783-8505, Kochi, Japan.
| | - Jing Yang
- Department of Hematology and Respiratory Medicine, Kochi Medical School, Kochi University, Okoh-cho, Nankoku 783-8505, Kochi, Japan
| | - Akihito Yokoyama
- Department of Hematology and Respiratory Medicine, Kochi Medical School, Kochi University, Okoh-cho, Nankoku 783-8505, Kochi, Japan
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Berenstein R, Blau IW, Suckert N, Baldus C, Pezzutto A, Dörken B, Blau O. Quantitative detection of DNMT3A R882H mutation in acute myeloid leukemia. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2015; 34:55. [PMID: 25994761 PMCID: PMC4443651 DOI: 10.1186/s13046-015-0173-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 05/12/2015] [Indexed: 01/08/2023]
Abstract
Background DNMT3A mutations represent one of the most frequent gene alterations detectable in acute myeloid leukemia (AML) with normal karyotype. Although various recurrent somatic mutations of DNMT3A have been described, the most common mutation is located at R882 in the methyltransferase domain of the gene. Because of their prognostic significance and high stability during disease evolution, DNMT3A mutations might represent highly informative biomarkers for prognosis and outcome of disease. Methods We describe an allele-specific PCR with a Blocking reagent for the quantitative detection of DNMT3A R882H mutation providing the possibility to analyze the quantitative amount of mutation during the course of disease. Next, we analyzed 62 follow-up samples from 6 AML patients after therapy and allogeneic stem cell transplantation (alloSCT). Results We developed an ASB-PCR assay for quantitative analysis of R882H DNMT3A mutation. After optimization of blocker concentration, a R882H-positive plasmid was constructed to enhance the accuracy of the sensitivity of quantitative detection. The assay displayed a high efficiency and sensitivity up to 10−3. The reproducibility of assay analyzed using follow-up samples showed the standard deviation less than 3.1 %. This assay displayed a complete concordance with sequencing and endonuclease restriction analysis. We have found persistence of DNMT3A R882H mutations in complete remission (CR) after standard cytoreduction therapy that could be indicating presence of DNMT3A mutation in early pre-leukemic stem cells that resist chemotherapy. The loss of correlation between NPM1 and DNMT3A in CR could be associated with evolution of pre-leukemic and leukemic clones. In patients with CR with complete donor chimerism after alloSCT, we have found no DNMT3A R882H. In relapsed patients, all samples showed an increasing of both NPM1 and DNMT3A mutated alleles. This suggests at least in part the presence of NPM1 and DNMT3A mutations in the same cell clone. Conclusion We developed a rapid and reliable method for quantitative detection of DNMT3A R882H mutations in AML patients. Quantitative detection of DNMT3A R882H mutations at different time points of AML disease enables screening of follow-up samples. This could provide additional information about the role of DNMT3A mutations in development and progression of AML.
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Affiliation(s)
- Rimma Berenstein
- Department of Hematology, Oncology and Tumorimmunology, Charité University School of Medicine, Hindenburgdamm 30, 12200, Berlin, Germany.
| | - Igor Wolfgang Blau
- Department of Hematology, Oncology and Tumorimmunology, Charité University School of Medicine, Hindenburgdamm 30, 12200, Berlin, Germany.
| | - Nikola Suckert
- Department of Hematology, Oncology and Tumorimmunology, Charité University School of Medicine, Hindenburgdamm 30, 12200, Berlin, Germany.
| | - Claudia Baldus
- Department of Hematology, Oncology and Tumorimmunology, Charité University School of Medicine, Hindenburgdamm 30, 12200, Berlin, Germany.
| | - Antonio Pezzutto
- Department of Hematology, Oncology and Tumorimmunology, Charité University School of Medicine, Hindenburgdamm 30, 12200, Berlin, Germany.
| | - Bernd Dörken
- Department of Hematology, Oncology and Tumorimmunology, Charité University School of Medicine, Hindenburgdamm 30, 12200, Berlin, Germany.
| | - Olga Blau
- Department of Hematology, Oncology and Tumorimmunology, Charité University School of Medicine, Hindenburgdamm 30, 12200, Berlin, Germany.
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Xiao SJ, Shen JZ, Huang JL, Fu HY. Prognostic significance of the BAALC gene expression in adult patients with acute myeloid leukemia: A meta-analysis. Mol Clin Oncol 2015; 3:880-888. [PMID: 26171200 DOI: 10.3892/mco.2015.562] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 01/22/2015] [Indexed: 11/06/2022] Open
Abstract
Numerous studies have investigated the prognostic role of brain and acute leukemia, cytoplasmic (BAALC) gene expression in adult patients with acute myeloid leukemia (AML); however, the results are inconclusive. A meta-analysis was conducted to provide a comprehensive evaluation of the prognostic role of BAALC gene expression in AML. Eligible studies were searched through PubMed, Embase, the Cochrane Library, the China National Knowledge Infrastructure and the China Biology Medicine Disc. Correlations between the BAALC gene expression and clinicopathological features and prognosis were analyzed. A total of 15 studies were examined. The pooled results suggest that high BAALC expression had an unfavorable outcome in AML. The combined hazard ratio (HR) for overall survival (OS) was 1.53 and the summary HR for the disease-free survival rate was 1.64. In addition, subgroup analyses considering cytogenetic and survival analysis were also conducted. High BAALC gene expression appeared to be an adverse prognostic indicator in patients with cytogenetically normal AML (HR for OS, 1.43) and in subgroups of survival analysis with multivariate analysis (HR for OS, 2.35). These results indicate that high BAALC gene expression served as an independent poor prognostic indicator in adult patients with AML.
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Affiliation(s)
- Shi-Ji Xiao
- Department of Hematology, Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou, Fujian 350001, P.R. China
| | - Jian-Zhen Shen
- Department of Hematology, Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou, Fujian 350001, P.R. China
| | - Jin-Long Huang
- Department of Hematology, Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou, Fujian 350001, P.R. China
| | - Hai-Ying Fu
- Department of Hematology, Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou, Fujian 350001, P.R. China
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168
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Falini B, Sportoletti P, Brunetti L, Martelli MP. Perspectives for therapeutic targeting of gene mutations in acute myeloid leukaemia with normal cytogenetics. Br J Haematol 2015; 170:305-22. [PMID: 25891481 DOI: 10.1111/bjh.13409] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The acute myeloid leukaemia (AML) genome contains more than 20 driver recurrent mutations. Here, we review the potential for therapeutic targeting of the most common mutations associated with normal cytogenetics AML, focusing on those affecting the FLT3, NPM1 and epigenetic modifier genes (DNMT3A, IDH1/2, TET2). As compared to early compounds, second generation FLT3 inhibitors are more specific and have better pharmacokinetics. They also show higher anti-leukaemic activity, leading to about 50% of composite complete remissions in refractory/relapsed FLT3-internal tandem duplication-mutated AML. However, rapid relapses invariably occur due to various mechanisms of resistance to FLT3 inhibitors. This issue and the best way for using FLT3 inhibitors in combination with other therapeutic modalities are discussed. Potential approaches for therapeutic targeting of NPM1-mutated AML include: (i) reverting the aberrant nuclear export of NPM1 mutant using exportin-1 inhibitors; (ii) disruption of the nucleolus with drugs blocking the oligomerization of wild-type nucleophosmin or inducing nucleolar stress; and (iii) immunotherapeutic targeting of highly expressed CD33 and IL3RA (CD123) antigens. Finally, we discuss the role of demethylating agents (decitabine and azacitidine) and IDH1/2 inhibitors in the treatment of AML patients carrying mutations of genes (DNMT3A, IDH1/2 and TET2) involved in the epigenetic regulation of transcription.
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Affiliation(s)
- Brunangelo Falini
- Institute of Haematology-CREO (Centro di Ricerche Emato-Oncologiche), Ospedale S. Maria Misericordia, University of Perugia, Perugia, Italy
| | - Paolo Sportoletti
- Institute of Haematology-CREO (Centro di Ricerche Emato-Oncologiche), Ospedale S. Maria Misericordia, University of Perugia, Perugia, Italy
| | - Lorenzo Brunetti
- Institute of Haematology-CREO (Centro di Ricerche Emato-Oncologiche), Ospedale S. Maria Misericordia, University of Perugia, Perugia, Italy
| | - Maria Paola Martelli
- Institute of Haematology-CREO (Centro di Ricerche Emato-Oncologiche), Ospedale S. Maria Misericordia, University of Perugia, Perugia, Italy
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169
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Kim TK, Gore SD, Zeidan AM. Epigenetic Therapy in Acute Myeloid Leukemia: Current and Future Directions. Semin Hematol 2015; 52:172-83. [PMID: 26111464 DOI: 10.1053/j.seminhematol.2015.04.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Epigenetic modifications affect gene expression without changes in the actual DNA sequence. Two of the most important mechanisms include DNA methylation and histone tail modifications (especially acetylation and methylation). Epigenetic modulation is a part of normal physiologic development; its dysregulation is an important mechanism of pathogenesis of some cancers, including acute myeloid leukemia (AML). Despite significant progress in understanding the pathogenesis of AML, therapeutic options remain quite limited. Technological advances have facilitated understanding of aberrant DNA methylation and histone methylation/acetylation as key elements in the development of AML and uncovered several recurrent mutations in genes important for epigenetic regulation. However, much remains to be learned about how to exploit this knowledge for epigenetic therapeutic targeting. Currently, no epigenetic therapy is approved for the treatment of AML, although two DNA methyltransferase inhibitors (azacitidine and decitabine) are commonly used in clinical practice. Among the other epigenetic modifiers undergoing research in AML, the histone deacetylase inhibitors are the most studied. Other promising drugs, such as inhibitors of histone methylation (eg, EZH2 and DOT1L inhibitors), inhibitors of histone demethylases (eg, LSD1 inhibitors), inhibitors of bromodomain-containing epigenetic "reader" BET proteins, and inhibitors of mutant isocitrate dehydrogenases, are at early stages of clinical evaluation.
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Affiliation(s)
- Tae Kon Kim
- Section of Hematology, Department of Internal Medicine, Yale University School of Medicine, and Smilow Cancer Hospital at Yale-New Haven Hospital, New Haven, CT
| | - Steven D Gore
- Section of Hematology, Department of Internal Medicine, Yale University School of Medicine, and Smilow Cancer Hospital at Yale-New Haven Hospital, New Haven, CT
| | - Amer M Zeidan
- Section of Hematology, Department of Internal Medicine, Yale University School of Medicine, and Smilow Cancer Hospital at Yale-New Haven Hospital, New Haven, CT.
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170
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Ostronoff F, Othus M, Lazenby M, Estey E, Appelbaum FR, Evans A, Godwin J, Gilkes A, Kopecky KJ, Burnett A, List AF, Fang M, Oehler VG, Petersdorf SH, Pogosova-Agadjanyan EL, Radich JP, Willman CL, Meshinchi S, Stirewalt DL. Prognostic significance of NPM1 mutations in the absence of FLT3-internal tandem duplication in older patients with acute myeloid leukemia: a SWOG and UK National Cancer Research Institute/Medical Research Council report. J Clin Oncol 2015; 33:1157-64. [PMID: 25713434 PMCID: PMC4372852 DOI: 10.1200/jco.2014.58.0571] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Younger patients with acute myeloid leukemia (AML) harboring NPM1 mutations without FLT3-internal tandem duplications (ITDs; NPM1-positive/FLT3-ITD-negative genotype) are classified as better risk; however, it remains uncertain whether this favorable classification can be applied to older patients with AML with this genotype. Therefore, we examined the impact of age on the prognostic significance of NPM1-positive/FLT3-ITD-negative status in older patients with AML. PATIENTS AND METHODS Patients with AML age ≥ 55 years treated with intensive chemotherapy as part of Southwest Oncology Group (SWOG) and UK National Cancer Research Institute/Medical Research Council (NCRI/MRC) trials were evaluated. A comprehensive analysis first examined 156 patients treated in SWOG trials. Validation analyses then examined 1,258 patients treated in MRC/NCRI trials. Univariable and multivariable analyses were used to determine the impact of age on the prognostic significance of NPM1 mutations, FLT3-ITDs, and the NPM1-positive/FLT3-ITD-negative genotype. RESULTS Patients with AML age 55 to 65 years with NPM1-positive/FLT3-ITD-negative genotype treated in SWOG trials had a significantly improved 2-year overall survival (OS) as compared with those without this genotype (70% v 32%; P < .001). Moreover, patients age 55 to 65 years with NPM1-positive/FLT3-ITD-negative genotype had a significantly improved 2-year OS as compared with those age > 65 years with this genotype (70% v 27%; P < .001); any potential survival benefit of this genotype in patients age > 65 years was marginal (27% v 16%; P = .33). In multivariable analysis, NPM1-positive/FLT3-ITD-negative genotype remained independently associated with an improved OS in patients age 55 to 65 years (P = .002) but not in those age > 65 years (P = .82). These results were confirmed in validation analyses examining the NCRI/MRC patients. CONCLUSION NPM1-positive/FLT3-ITD-negative genotype remains a relatively favorable prognostic factor for patients with AML age 55 to 65 years but not in those age > 65 years.
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Affiliation(s)
- Fabiana Ostronoff
- Fabiana Ostronoff, Megan Othus, Elihu Estey, Frederick R. Appelbaum, Kenneth J. Kopecky, Min Fang, Vivian G. Oehler, Era L. Pogosova-Agadjanyan, Jerald P. Radich, Soheil Meshinchi, and Derek L. Stirewalt, Fred Hutchinson Cancer Research Center; Fabiana Ostronoff, Elihu Estey, Frederick R. Appelbaum, Min Fang, Vivian G. Oehler, Jerald P. Radich, and Derek L. Stirewalt, University of Washington; Stephen H. Petersdorf, Seattle Genetics, Seattle, WA; Michelle Lazenby, Anna Evans, Amanda Gilkes, and Alan Burnett, Cardiff University School of Medicine, Cardiff, United Kingdom; John Godwin, Providence Cancer Center Group and Earle A. Chiles Research Institute, Portland, OR; Alan F. List, H. Lee Moffitt Cancer Center, Tampa, FL; and Cheryl L. Willman, University of New Mexico, Albuquerque, NM.
| | - Megan Othus
- Fabiana Ostronoff, Megan Othus, Elihu Estey, Frederick R. Appelbaum, Kenneth J. Kopecky, Min Fang, Vivian G. Oehler, Era L. Pogosova-Agadjanyan, Jerald P. Radich, Soheil Meshinchi, and Derek L. Stirewalt, Fred Hutchinson Cancer Research Center; Fabiana Ostronoff, Elihu Estey, Frederick R. Appelbaum, Min Fang, Vivian G. Oehler, Jerald P. Radich, and Derek L. Stirewalt, University of Washington; Stephen H. Petersdorf, Seattle Genetics, Seattle, WA; Michelle Lazenby, Anna Evans, Amanda Gilkes, and Alan Burnett, Cardiff University School of Medicine, Cardiff, United Kingdom; John Godwin, Providence Cancer Center Group and Earle A. Chiles Research Institute, Portland, OR; Alan F. List, H. Lee Moffitt Cancer Center, Tampa, FL; and Cheryl L. Willman, University of New Mexico, Albuquerque, NM
| | - Michelle Lazenby
- Fabiana Ostronoff, Megan Othus, Elihu Estey, Frederick R. Appelbaum, Kenneth J. Kopecky, Min Fang, Vivian G. Oehler, Era L. Pogosova-Agadjanyan, Jerald P. Radich, Soheil Meshinchi, and Derek L. Stirewalt, Fred Hutchinson Cancer Research Center; Fabiana Ostronoff, Elihu Estey, Frederick R. Appelbaum, Min Fang, Vivian G. Oehler, Jerald P. Radich, and Derek L. Stirewalt, University of Washington; Stephen H. Petersdorf, Seattle Genetics, Seattle, WA; Michelle Lazenby, Anna Evans, Amanda Gilkes, and Alan Burnett, Cardiff University School of Medicine, Cardiff, United Kingdom; John Godwin, Providence Cancer Center Group and Earle A. Chiles Research Institute, Portland, OR; Alan F. List, H. Lee Moffitt Cancer Center, Tampa, FL; and Cheryl L. Willman, University of New Mexico, Albuquerque, NM
| | - Elihu Estey
- Fabiana Ostronoff, Megan Othus, Elihu Estey, Frederick R. Appelbaum, Kenneth J. Kopecky, Min Fang, Vivian G. Oehler, Era L. Pogosova-Agadjanyan, Jerald P. Radich, Soheil Meshinchi, and Derek L. Stirewalt, Fred Hutchinson Cancer Research Center; Fabiana Ostronoff, Elihu Estey, Frederick R. Appelbaum, Min Fang, Vivian G. Oehler, Jerald P. Radich, and Derek L. Stirewalt, University of Washington; Stephen H. Petersdorf, Seattle Genetics, Seattle, WA; Michelle Lazenby, Anna Evans, Amanda Gilkes, and Alan Burnett, Cardiff University School of Medicine, Cardiff, United Kingdom; John Godwin, Providence Cancer Center Group and Earle A. Chiles Research Institute, Portland, OR; Alan F. List, H. Lee Moffitt Cancer Center, Tampa, FL; and Cheryl L. Willman, University of New Mexico, Albuquerque, NM
| | - Frederick R Appelbaum
- Fabiana Ostronoff, Megan Othus, Elihu Estey, Frederick R. Appelbaum, Kenneth J. Kopecky, Min Fang, Vivian G. Oehler, Era L. Pogosova-Agadjanyan, Jerald P. Radich, Soheil Meshinchi, and Derek L. Stirewalt, Fred Hutchinson Cancer Research Center; Fabiana Ostronoff, Elihu Estey, Frederick R. Appelbaum, Min Fang, Vivian G. Oehler, Jerald P. Radich, and Derek L. Stirewalt, University of Washington; Stephen H. Petersdorf, Seattle Genetics, Seattle, WA; Michelle Lazenby, Anna Evans, Amanda Gilkes, and Alan Burnett, Cardiff University School of Medicine, Cardiff, United Kingdom; John Godwin, Providence Cancer Center Group and Earle A. Chiles Research Institute, Portland, OR; Alan F. List, H. Lee Moffitt Cancer Center, Tampa, FL; and Cheryl L. Willman, University of New Mexico, Albuquerque, NM
| | - Anna Evans
- Fabiana Ostronoff, Megan Othus, Elihu Estey, Frederick R. Appelbaum, Kenneth J. Kopecky, Min Fang, Vivian G. Oehler, Era L. Pogosova-Agadjanyan, Jerald P. Radich, Soheil Meshinchi, and Derek L. Stirewalt, Fred Hutchinson Cancer Research Center; Fabiana Ostronoff, Elihu Estey, Frederick R. Appelbaum, Min Fang, Vivian G. Oehler, Jerald P. Radich, and Derek L. Stirewalt, University of Washington; Stephen H. Petersdorf, Seattle Genetics, Seattle, WA; Michelle Lazenby, Anna Evans, Amanda Gilkes, and Alan Burnett, Cardiff University School of Medicine, Cardiff, United Kingdom; John Godwin, Providence Cancer Center Group and Earle A. Chiles Research Institute, Portland, OR; Alan F. List, H. Lee Moffitt Cancer Center, Tampa, FL; and Cheryl L. Willman, University of New Mexico, Albuquerque, NM
| | - John Godwin
- Fabiana Ostronoff, Megan Othus, Elihu Estey, Frederick R. Appelbaum, Kenneth J. Kopecky, Min Fang, Vivian G. Oehler, Era L. Pogosova-Agadjanyan, Jerald P. Radich, Soheil Meshinchi, and Derek L. Stirewalt, Fred Hutchinson Cancer Research Center; Fabiana Ostronoff, Elihu Estey, Frederick R. Appelbaum, Min Fang, Vivian G. Oehler, Jerald P. Radich, and Derek L. Stirewalt, University of Washington; Stephen H. Petersdorf, Seattle Genetics, Seattle, WA; Michelle Lazenby, Anna Evans, Amanda Gilkes, and Alan Burnett, Cardiff University School of Medicine, Cardiff, United Kingdom; John Godwin, Providence Cancer Center Group and Earle A. Chiles Research Institute, Portland, OR; Alan F. List, H. Lee Moffitt Cancer Center, Tampa, FL; and Cheryl L. Willman, University of New Mexico, Albuquerque, NM
| | - Amanda Gilkes
- Fabiana Ostronoff, Megan Othus, Elihu Estey, Frederick R. Appelbaum, Kenneth J. Kopecky, Min Fang, Vivian G. Oehler, Era L. Pogosova-Agadjanyan, Jerald P. Radich, Soheil Meshinchi, and Derek L. Stirewalt, Fred Hutchinson Cancer Research Center; Fabiana Ostronoff, Elihu Estey, Frederick R. Appelbaum, Min Fang, Vivian G. Oehler, Jerald P. Radich, and Derek L. Stirewalt, University of Washington; Stephen H. Petersdorf, Seattle Genetics, Seattle, WA; Michelle Lazenby, Anna Evans, Amanda Gilkes, and Alan Burnett, Cardiff University School of Medicine, Cardiff, United Kingdom; John Godwin, Providence Cancer Center Group and Earle A. Chiles Research Institute, Portland, OR; Alan F. List, H. Lee Moffitt Cancer Center, Tampa, FL; and Cheryl L. Willman, University of New Mexico, Albuquerque, NM
| | - Kenneth J Kopecky
- Fabiana Ostronoff, Megan Othus, Elihu Estey, Frederick R. Appelbaum, Kenneth J. Kopecky, Min Fang, Vivian G. Oehler, Era L. Pogosova-Agadjanyan, Jerald P. Radich, Soheil Meshinchi, and Derek L. Stirewalt, Fred Hutchinson Cancer Research Center; Fabiana Ostronoff, Elihu Estey, Frederick R. Appelbaum, Min Fang, Vivian G. Oehler, Jerald P. Radich, and Derek L. Stirewalt, University of Washington; Stephen H. Petersdorf, Seattle Genetics, Seattle, WA; Michelle Lazenby, Anna Evans, Amanda Gilkes, and Alan Burnett, Cardiff University School of Medicine, Cardiff, United Kingdom; John Godwin, Providence Cancer Center Group and Earle A. Chiles Research Institute, Portland, OR; Alan F. List, H. Lee Moffitt Cancer Center, Tampa, FL; and Cheryl L. Willman, University of New Mexico, Albuquerque, NM
| | - Alan Burnett
- Fabiana Ostronoff, Megan Othus, Elihu Estey, Frederick R. Appelbaum, Kenneth J. Kopecky, Min Fang, Vivian G. Oehler, Era L. Pogosova-Agadjanyan, Jerald P. Radich, Soheil Meshinchi, and Derek L. Stirewalt, Fred Hutchinson Cancer Research Center; Fabiana Ostronoff, Elihu Estey, Frederick R. Appelbaum, Min Fang, Vivian G. Oehler, Jerald P. Radich, and Derek L. Stirewalt, University of Washington; Stephen H. Petersdorf, Seattle Genetics, Seattle, WA; Michelle Lazenby, Anna Evans, Amanda Gilkes, and Alan Burnett, Cardiff University School of Medicine, Cardiff, United Kingdom; John Godwin, Providence Cancer Center Group and Earle A. Chiles Research Institute, Portland, OR; Alan F. List, H. Lee Moffitt Cancer Center, Tampa, FL; and Cheryl L. Willman, University of New Mexico, Albuquerque, NM
| | - Alan F List
- Fabiana Ostronoff, Megan Othus, Elihu Estey, Frederick R. Appelbaum, Kenneth J. Kopecky, Min Fang, Vivian G. Oehler, Era L. Pogosova-Agadjanyan, Jerald P. Radich, Soheil Meshinchi, and Derek L. Stirewalt, Fred Hutchinson Cancer Research Center; Fabiana Ostronoff, Elihu Estey, Frederick R. Appelbaum, Min Fang, Vivian G. Oehler, Jerald P. Radich, and Derek L. Stirewalt, University of Washington; Stephen H. Petersdorf, Seattle Genetics, Seattle, WA; Michelle Lazenby, Anna Evans, Amanda Gilkes, and Alan Burnett, Cardiff University School of Medicine, Cardiff, United Kingdom; John Godwin, Providence Cancer Center Group and Earle A. Chiles Research Institute, Portland, OR; Alan F. List, H. Lee Moffitt Cancer Center, Tampa, FL; and Cheryl L. Willman, University of New Mexico, Albuquerque, NM
| | - Min Fang
- Fabiana Ostronoff, Megan Othus, Elihu Estey, Frederick R. Appelbaum, Kenneth J. Kopecky, Min Fang, Vivian G. Oehler, Era L. Pogosova-Agadjanyan, Jerald P. Radich, Soheil Meshinchi, and Derek L. Stirewalt, Fred Hutchinson Cancer Research Center; Fabiana Ostronoff, Elihu Estey, Frederick R. Appelbaum, Min Fang, Vivian G. Oehler, Jerald P. Radich, and Derek L. Stirewalt, University of Washington; Stephen H. Petersdorf, Seattle Genetics, Seattle, WA; Michelle Lazenby, Anna Evans, Amanda Gilkes, and Alan Burnett, Cardiff University School of Medicine, Cardiff, United Kingdom; John Godwin, Providence Cancer Center Group and Earle A. Chiles Research Institute, Portland, OR; Alan F. List, H. Lee Moffitt Cancer Center, Tampa, FL; and Cheryl L. Willman, University of New Mexico, Albuquerque, NM
| | - Vivian G Oehler
- Fabiana Ostronoff, Megan Othus, Elihu Estey, Frederick R. Appelbaum, Kenneth J. Kopecky, Min Fang, Vivian G. Oehler, Era L. Pogosova-Agadjanyan, Jerald P. Radich, Soheil Meshinchi, and Derek L. Stirewalt, Fred Hutchinson Cancer Research Center; Fabiana Ostronoff, Elihu Estey, Frederick R. Appelbaum, Min Fang, Vivian G. Oehler, Jerald P. Radich, and Derek L. Stirewalt, University of Washington; Stephen H. Petersdorf, Seattle Genetics, Seattle, WA; Michelle Lazenby, Anna Evans, Amanda Gilkes, and Alan Burnett, Cardiff University School of Medicine, Cardiff, United Kingdom; John Godwin, Providence Cancer Center Group and Earle A. Chiles Research Institute, Portland, OR; Alan F. List, H. Lee Moffitt Cancer Center, Tampa, FL; and Cheryl L. Willman, University of New Mexico, Albuquerque, NM
| | - Stephen H Petersdorf
- Fabiana Ostronoff, Megan Othus, Elihu Estey, Frederick R. Appelbaum, Kenneth J. Kopecky, Min Fang, Vivian G. Oehler, Era L. Pogosova-Agadjanyan, Jerald P. Radich, Soheil Meshinchi, and Derek L. Stirewalt, Fred Hutchinson Cancer Research Center; Fabiana Ostronoff, Elihu Estey, Frederick R. Appelbaum, Min Fang, Vivian G. Oehler, Jerald P. Radich, and Derek L. Stirewalt, University of Washington; Stephen H. Petersdorf, Seattle Genetics, Seattle, WA; Michelle Lazenby, Anna Evans, Amanda Gilkes, and Alan Burnett, Cardiff University School of Medicine, Cardiff, United Kingdom; John Godwin, Providence Cancer Center Group and Earle A. Chiles Research Institute, Portland, OR; Alan F. List, H. Lee Moffitt Cancer Center, Tampa, FL; and Cheryl L. Willman, University of New Mexico, Albuquerque, NM
| | - Era L Pogosova-Agadjanyan
- Fabiana Ostronoff, Megan Othus, Elihu Estey, Frederick R. Appelbaum, Kenneth J. Kopecky, Min Fang, Vivian G. Oehler, Era L. Pogosova-Agadjanyan, Jerald P. Radich, Soheil Meshinchi, and Derek L. Stirewalt, Fred Hutchinson Cancer Research Center; Fabiana Ostronoff, Elihu Estey, Frederick R. Appelbaum, Min Fang, Vivian G. Oehler, Jerald P. Radich, and Derek L. Stirewalt, University of Washington; Stephen H. Petersdorf, Seattle Genetics, Seattle, WA; Michelle Lazenby, Anna Evans, Amanda Gilkes, and Alan Burnett, Cardiff University School of Medicine, Cardiff, United Kingdom; John Godwin, Providence Cancer Center Group and Earle A. Chiles Research Institute, Portland, OR; Alan F. List, H. Lee Moffitt Cancer Center, Tampa, FL; and Cheryl L. Willman, University of New Mexico, Albuquerque, NM
| | - Jerald P Radich
- Fabiana Ostronoff, Megan Othus, Elihu Estey, Frederick R. Appelbaum, Kenneth J. Kopecky, Min Fang, Vivian G. Oehler, Era L. Pogosova-Agadjanyan, Jerald P. Radich, Soheil Meshinchi, and Derek L. Stirewalt, Fred Hutchinson Cancer Research Center; Fabiana Ostronoff, Elihu Estey, Frederick R. Appelbaum, Min Fang, Vivian G. Oehler, Jerald P. Radich, and Derek L. Stirewalt, University of Washington; Stephen H. Petersdorf, Seattle Genetics, Seattle, WA; Michelle Lazenby, Anna Evans, Amanda Gilkes, and Alan Burnett, Cardiff University School of Medicine, Cardiff, United Kingdom; John Godwin, Providence Cancer Center Group and Earle A. Chiles Research Institute, Portland, OR; Alan F. List, H. Lee Moffitt Cancer Center, Tampa, FL; and Cheryl L. Willman, University of New Mexico, Albuquerque, NM
| | - Cheryl L Willman
- Fabiana Ostronoff, Megan Othus, Elihu Estey, Frederick R. Appelbaum, Kenneth J. Kopecky, Min Fang, Vivian G. Oehler, Era L. Pogosova-Agadjanyan, Jerald P. Radich, Soheil Meshinchi, and Derek L. Stirewalt, Fred Hutchinson Cancer Research Center; Fabiana Ostronoff, Elihu Estey, Frederick R. Appelbaum, Min Fang, Vivian G. Oehler, Jerald P. Radich, and Derek L. Stirewalt, University of Washington; Stephen H. Petersdorf, Seattle Genetics, Seattle, WA; Michelle Lazenby, Anna Evans, Amanda Gilkes, and Alan Burnett, Cardiff University School of Medicine, Cardiff, United Kingdom; John Godwin, Providence Cancer Center Group and Earle A. Chiles Research Institute, Portland, OR; Alan F. List, H. Lee Moffitt Cancer Center, Tampa, FL; and Cheryl L. Willman, University of New Mexico, Albuquerque, NM
| | - Soheil Meshinchi
- Fabiana Ostronoff, Megan Othus, Elihu Estey, Frederick R. Appelbaum, Kenneth J. Kopecky, Min Fang, Vivian G. Oehler, Era L. Pogosova-Agadjanyan, Jerald P. Radich, Soheil Meshinchi, and Derek L. Stirewalt, Fred Hutchinson Cancer Research Center; Fabiana Ostronoff, Elihu Estey, Frederick R. Appelbaum, Min Fang, Vivian G. Oehler, Jerald P. Radich, and Derek L. Stirewalt, University of Washington; Stephen H. Petersdorf, Seattle Genetics, Seattle, WA; Michelle Lazenby, Anna Evans, Amanda Gilkes, and Alan Burnett, Cardiff University School of Medicine, Cardiff, United Kingdom; John Godwin, Providence Cancer Center Group and Earle A. Chiles Research Institute, Portland, OR; Alan F. List, H. Lee Moffitt Cancer Center, Tampa, FL; and Cheryl L. Willman, University of New Mexico, Albuquerque, NM
| | - Derek L Stirewalt
- Fabiana Ostronoff, Megan Othus, Elihu Estey, Frederick R. Appelbaum, Kenneth J. Kopecky, Min Fang, Vivian G. Oehler, Era L. Pogosova-Agadjanyan, Jerald P. Radich, Soheil Meshinchi, and Derek L. Stirewalt, Fred Hutchinson Cancer Research Center; Fabiana Ostronoff, Elihu Estey, Frederick R. Appelbaum, Min Fang, Vivian G. Oehler, Jerald P. Radich, and Derek L. Stirewalt, University of Washington; Stephen H. Petersdorf, Seattle Genetics, Seattle, WA; Michelle Lazenby, Anna Evans, Amanda Gilkes, and Alan Burnett, Cardiff University School of Medicine, Cardiff, United Kingdom; John Godwin, Providence Cancer Center Group and Earle A. Chiles Research Institute, Portland, OR; Alan F. List, H. Lee Moffitt Cancer Center, Tampa, FL; and Cheryl L. Willman, University of New Mexico, Albuquerque, NM
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Park SH, Lee HJ, Kim IS, Kang JE, Lee EY, Kim HJ, Kim YK, Won JH, Bang SM, Kim H, Song MK, Chung JS, Shin HJ. Incidences and Prognostic Impact of c-KIT, WT1, CEBPA, and CBL Mutations, and Mutations Associated With Epigenetic Modification in Core Binding Factor Acute Myeloid Leukemia: A Multicenter Study in a Korean Population. Ann Lab Med 2015; 35:288-97. [PMID: 25932436 PMCID: PMC4390696 DOI: 10.3343/alm.2015.35.3.288] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 11/24/2014] [Accepted: 02/13/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To identify potential molecular prognostic markers in core binding factor (CBF) AML, we analyzed incidences and prognostic impacts of mutations in c-KIT, WT1, CEBPA, CBL, and a number of epigenetic genes in CBF AML. METHODS Seventy one and 21 AML patients with t(8;21) and inv(16) were enrolled in this study, respectively. NPM1, CEBPA, c-KIT, IDH1/2, DNMT3A, EZH2, WT1, and CBL mutations were analyzed by direct sequencing. Patients were categorized with respect to c-KIT and WT1 mutation status, and both clinical features and prognoses were compared. RESULTS The incidences of FLT3 internal tandem duplication (ITD), NPM1, CEBPA, IDH1/2, DNMT3A, EZH2, and CBL mutations were low (≤5%) in CBF AML patients. However, c-KIT and WT1 mutations occurred frequently (10.9% and 13.8%, respectively). t(8;21) patients with c-KIT mutations showed significantly shorter overall survival (OS) and disease free survival (DFS) periods than those without mutations (P<0.001, for both); however, although the limited number of t(8;21) patients were analyzed, WT1 mutation status did not affect prognosis significantly. Relapse or death during follow-up occurred more frequently in t(8;21) patients carrying c-KIT mutations than in those without the mutation, although the difference was significant only in a specific patient subgroup with no WT1 mutations (P=0.014). CONCLUSIONS The incidences of mutations in epigenetic genes are very low in CBF AML; however, c-KIT and WT1 mutations occur more frequently than others. The poor prognostic impact of c-KIT mutation in t(8;21) AML patients only applies in a specific patient subgroup without WT1 mutations. The prognostic impact of WT1 mutation in CBF AML is not evident and further investigation is required.
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Affiliation(s)
- Sang Hyuk Park
- Department of Laboratory Medicine, Pusan National University School of Medicine, Pusan National University Hospital, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hyun Ji Lee
- Department of Laboratory Medicine, Korean Red cross, Changwon, Korea
| | - In-Suk Kim
- Department of Laboratory Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jeong-Eun Kang
- Department of Laboratory Medicine, Jinhae Yonsei Hospital, Changwon, Korea
| | - Eun Yup Lee
- Department of Laboratory Medicine, Pusan National University School of Medicine, Pusan National University Hospital, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hyeoung-Joon Kim
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Yeo-Kyeoung Kim
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Jong-Ho Won
- Department of Hematology-Oncology, Soonchunhyang University Hospital, Seoul, Korea
| | - Soo Mee Bang
- Department of Hematology-Oncology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hawk Kim
- Department of Hematology-Oncology, Ulsan University Hospital, Ulsan, Korea
| | - Moo-Kon Song
- Division of Hematology-Oncology, Department of Internal Medicine, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Joo Seop Chung
- Division of Hematology-Oncology, Department of Internal Medicine, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Ho-Jin Shin
- Division of Hematology-Oncology, Department of Internal Medicine, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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172
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Yin J, Xie X, Zhang F, Chen Z, Hu C, Su G, Liu H, Zheng Y, He C, Shen H, Qiu Q, He J, Pan Z, Gale RP, Wu D, Yin B. Low frequency of mutations in Chinese with acute myeloid leukemia: Different disease or different aetiology? Leuk Res 2015; 39:646-8. [PMID: 25858894 DOI: 10.1016/j.leukres.2015.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 02/17/2015] [Accepted: 03/05/2015] [Indexed: 11/24/2022]
Abstract
Mutations in FLT3, DNMT3A, NRAS, NF1 and TP53 occur in persons of predominately European descent with acute myeloid leukemia (AML). Some, such as internal tandem duplication of FLT3 (FLT3-ITD) and point mutations in DNMT3A and NRAS, are especially frequent whereas others such as NF1 and TP53 are less so. Frequencies of these mutations in persons with seemingly similar AML from other genetic groups are largely unknown. We studied 269 Chinese (mostly Han) with de novo AML. FLT3-ITD was detected in 51 subjects (23%; 95% CI, 17-28%), R882 mutation of DNMT3A in 17 (6%; 95% CI, 3-9%) and NRAS mutation in 17 (7%; 95% CI, 3-9%). No mutations in NF1 and only 1 mutation in TP53 (1%, 95% CI, <2.5%) were detected. Except for FLT3-ITD, frequencies of these mutations are significantly less than those in persons of predominately European descent with AML. The reason(s) for this disparity is unknown but may offer clues to the aetiology of AML in different populations or may indicate some mutations associated with AML in persons of predominately European descent are not fundamental to the aetiology of the disease.
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Affiliation(s)
- Jiawei Yin
- Cyrus Tang Hematology Center, Jiangsu Institute of Hematology, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu Province 215123, PR China
| | - Xiaoli Xie
- Cyrus Tang Hematology Center, Jiangsu Institute of Hematology, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu Province 215123, PR China
| | - Fan Zhang
- Cyrus Tang Hematology Center, Jiangsu Institute of Hematology, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu Province 215123, PR China
| | - Zheng Chen
- Cyrus Tang Hematology Center, Jiangsu Institute of Hematology, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu Province 215123, PR China
| | - Chenxi Hu
- Cyrus Tang Hematology Center, Jiangsu Institute of Hematology, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu Province 215123, PR China
| | - Guangsong Su
- Cyrus Tang Hematology Center, Jiangsu Institute of Hematology, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu Province 215123, PR China
| | - Hong Liu
- The First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, Suzhou, Jiangsu Province 215006, PR China
| | - Yanwen Zheng
- Cyrus Tang Hematology Center, Jiangsu Institute of Hematology, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu Province 215123, PR China
| | - Chao He
- Cyrus Tang Hematology Center, Jiangsu Institute of Hematology, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu Province 215123, PR China
| | - Hongjie Shen
- The First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, Suzhou, Jiangsu Province 215006, PR China
| | - Qiaocheng Qiu
- The First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, Suzhou, Jiangsu Province 215006, PR China
| | - Jun He
- The First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, Suzhou, Jiangsu Province 215006, PR China
| | - Zhirong Pan
- Suzhou Blood Center, Jiangsu Province 215006, PR China
| | - Robert Peter Gale
- Haematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London SW7 2AZ, UK
| | - Depei Wu
- The First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, Suzhou, Jiangsu Province 215006, PR China
| | - Bin Yin
- Cyrus Tang Hematology Center, Jiangsu Institute of Hematology, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu Province 215123, PR China; Thrombosis and Hemostasis Key Lab of the Ministry of Health, Soochow University, Suzhou, Jiangsu Province 215006, PR China; Collaborative Innovation Center of Hematology, Soochow University, PR China.
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Abstract
DNA methylation patterns are disrupted in various malignancies, suggesting a role in the development of cancer, but genetic aberrations directly linking the DNA methylation machinery to malignancies were rarely observed, so this association remained largely correlative. Recently, however, mutations in the gene encoding DNA methyltransferase 3A (DNMT3A) were reported in patients with acute myeloid leukaemia (AML), and subsequently in patients with various other haematological malignancies, pointing to DNMT3A as a critically important new tumour suppressor. Here, we review the clinical findings related to DNMT3A, tie these data to insights from basic science studies conducted over the past 20 years and present a roadmap for future research that should advance the agenda for new therapeutic strategies.
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Affiliation(s)
- Liubin Yang
- 1] Department of Molecular and Human Genetics, Stem Cells and Regenerative Medicine Center, Baylor College of Medicine, Houston, Texas 77030, USA. [2]
| | - Rachel Rau
- 1] Department of Pediatrics, Stem Cells and Regenerative Medicine Center, Baylor College of Medicine, Houston, Texas 77030, USA. [2]
| | - Margaret A Goodell
- 1] Department of Molecular and Human Genetics, Stem Cells and Regenerative Medicine Center, Baylor College of Medicine, Houston, Texas 77030, USA. [2] Department of Pediatrics, Stem Cells and Regenerative Medicine Center, Baylor College of Medicine, Houston, Texas 77030, USA
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174
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Mancini M, Hasan SK, Ottone T, Lavorgna S, Ciardi C, Angelini DF, Agostini F, Venditti A, Lo-Coco F. Two Novel Methods for Rapid Detection and Quantification of DNMT3A R882 Mutations in Acute Myeloid Leukemia. J Mol Diagn 2015; 17:179-84. [DOI: 10.1016/j.jmoldx.2014.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 09/09/2014] [Accepted: 10/01/2014] [Indexed: 02/02/2023] Open
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175
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Renneville A, Abdelali RB, Chevret S, Nibourel O, Cheok M, Pautas C, Duléry R, Boyer T, Cayuela JM, Hayette S, Raffoux E, Farhat H, Boissel N, Terre C, Dombret H, Castaigne S, Preudhomme C. Clinical impact of gene mutations and lesions detected by SNP-array karyotyping in acute myeloid leukemia patients in the context of gemtuzumab ozogamicin treatment: results of the ALFA-0701 trial. Oncotarget 2015; 5:916-32. [PMID: 24659740 PMCID: PMC4011594 DOI: 10.18632/oncotarget.1536] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
We recently showed that the addition of fractionated doses of gemtuzumab ozogamicin (GO) to standard chemotherapy improves clinical outcome of acute myeloid leukemia (AML) patients. In the present study, we performed mutational analysis of 11 genes (FLT3, NPM1, CEBPA, MLL, WT1, IDH1/2, RUNX1, ASXL1, TET2, DNMT3A), EVI1 overexpression screening, and 6.0 single-nucleotide polymorphism array (SNP-A) analysis in diagnostic samples of the 278 AML patients enrolled in the ALFA-0701 trial. In cytogenetically normal (CN) AML (n=146), 38% of the patients had at least 1 SNP-A lesion and 89% of the patients had at least 1 molecular alteration. In multivariate analysis, the independent predictors of higher cumulative incidence of relapse were unfavorable karyotype (P = 0.013) and randomization in the control arm (P = 0.007) in the whole cohort, and MLL partial tandem duplications (P = 0.014) and DNMT3A mutations (P = 0.010) in CN-AML. The independent predictors of shorter overall survival (OS) were unfavorable karyotype (P <0.001) and SNP-A lesion(s) (P = 0.001) in the whole cohort, and SNP-A lesion(s) (P = 0.006), DNMT3A mutations (P = 0.042) and randomization in the control arm (P = 0.043) in CN-AML. Interestingly, CN-AML patients benefited preferentially more from GO treatment as compared to AML patients with abnormal cytogenetics (hazard ratio for death, 0.52 versus 1.14; test for interaction, P = 0.04). Although the interaction test was not statistically significant, the OS benefit associated with GO treatment appeared also more pronounced in FLT3 internal tandem duplication positive than in negative patients.
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Affiliation(s)
- Aline Renneville
- Laboratory of Hematology, Biology and Pathology Center, CHRU of Lille, Lille
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176
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Abstract
Acute myeloid leukemia (AML) is a clinically heterogeneous disease, yet it is one of the most molecularly well-characterized cancers. Risk stratification of patients currently involves determination of the presence of cytogenetic abnormalities in combination with molecular genetic testing in a few genes. Several new recurrent genetic molecular abnormalities have recently been identified, including TET2, ASXL1, IDH1, IDH2, DNMT3A, and PHF6. Mutational analyses have identified that patients with DNMT3A or NPM1 mutations or MLL translocation have improved overall survival with high-dose chemotherapy. Mutational profiling can refine prognostication, particularly for patients in the intermediate-risk group or with a normal karyotype. CD25 expression status improves prognostic risk classification in AML independent of established biomarkers. Biomarkers such as 2- hydroxyglutarate in IDH1/2-mutant AML patients predict patient responses and minimal residual disease. These recent discoveries are being incorporated into our existing molecular risk stratification as well as the exploration of new therapeutics directed to these molecular targets.
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177
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Parkin B, Ouillette P, Yildiz M, Saiya-Cork K, Shedden K, Malek SN. Integrated genomic profiling, therapy response, and survival in adult acute myelogenous leukemia. Clin Cancer Res 2015; 21:2045-56. [PMID: 25652455 DOI: 10.1158/1078-0432.ccr-14-0921] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 01/25/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE Recurrent gene mutations, chromosomal translocations, and acquired genomic copy number aberrations (aCNA) have been variously associated with acute myelogenous leukemia (AML) patient outcome. However, knowledge of the co-occurrence of such lesions and the relative influence of different types of genomic alterations on clinical outcomes in AML is still evolving. EXPERIMENTAL DESIGN We performed SNP 6.0 array-based genomic profiling of aCNA/copy neutral loss-of-heterozygosity (cnLOH) along with sequence analysis of 13 commonly mutated genes on purified leukemic blast DNA from 156 prospectively enrolled non-FAB-M3 AML patients across the clinical spectrum of de novo, secondary, and therapy-related AML. RESULTS TP53 and RUNX1 mutations are strongly associated with the presence of SNP-A-based aCNA/cnLOH, while FLT3 and NPM1 mutations are strongly associated with the absence of aCNA/cnLOH. The presence of mutations in RUNX1, ASXL1, and TP53, elevated SNP-A-based genomic complexity, and specific recurrent aCNAs predicted failure to achieve a complete response to induction chemotherapy. The presence of ≥1 aCNA/cnLOH and higher thresholds predicted for poor long-term survival irrespective of TP53 status, and the presence of ≥1 aCNA/cnLOH added negative prognostic information to knowledge of mutations in TET2, IDH1, NPM1, DNMT3A, and RUNX1. Results of multivariate analyses support a dominant role for TP53 mutations and a role for elevated genomic complexity as predictors of short survival in AML. CONCLUSIONS Integrated genomic profiling of a clinically relevant adult AML cohort identified genomic aberrations most associated with SNP-A-based genomic complexity, resistance to intensive induction therapies, and shortened overall survival. Identifying SNP-A-based lesions adds prognostic value to the status of several recurrently mutated genes.
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Affiliation(s)
- Brian Parkin
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan
| | - Peter Ouillette
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan
| | - Mehmet Yildiz
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan
| | - Kamlai Saiya-Cork
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan
| | - Kerby Shedden
- Department of Statistics, University of Michigan, Ann Arbor, Michigan
| | - Sami N Malek
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan.
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178
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Sehgal AR, Gimotty PA, Zhao J, Hsu JM, Daber R, Morrissette JD, Luger S, Loren AW, Carroll M. DNMT3A Mutational Status Affects the Results of Dose-Escalated Induction Therapy in Acute Myelogenous Leukemia. Clin Cancer Res 2015; 21:1614-20. [PMID: 25609058 DOI: 10.1158/1078-0432.ccr-14-0327] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 12/11/2014] [Indexed: 11/16/2022]
Abstract
PURPOSE DNA methyltransferase 3A (DNMT3A) is one of the commonly mutated genes in acute myelogenous leukemia (AML). Reports on the prognostic significance of DNMT3A mutations have been inconsistent, and most of the data are available only for patients 60 years of age or younger. We hypothesized that this inconsistency is due to an interaction between the dose of anthracycline used in induction therapy and DNMT3A status. We studied whether patients with DNMT3A-mutated AML treated with standard dose anthracyclines had an inferior survival compared with patients with other mutation profiles or those who received high-dose therapy. EXPERIMENTAL DESIGN A total of 152 patients in this retrospective cohort study (median age, 54 years) with de novo AML underwent induction therapy and next-generation sequencing of 33 commonly mutated genes in hematologic malignancies, including DNMT3A, FLT3-ITD, NPM1, and IDH1/2. Cox regression was used to know whether those with DNMT3A mutations who were treated with standard dose anthracycline had inferior survival. RESULTS DNMT3A mutations, found in 32% of patients, were not associated with an inferior survival. Dose escalation of anthracycline in the induction regimen was associated with improved survival in those with DNMT3A mutations but not those with wild-type DNMT3A. Patients with DNMT3A mutations who received standard dose induction had shorter survival time than other patient groups (10.1 months vs. 19.8 months, P = 0.0129). This relationship remained significant (HR, 1.90; P = 0.006) controlling for multiple variables. CONCLUSIONS Patients with DNMT3A-mutated AML have an inferior survival when treated with standard-dose anthracycline induction therapy. This group should be considered for high-dose induction therapy.
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Affiliation(s)
- Alison R Sehgal
- Division of Hematology and Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Phyllis A Gimotty
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jianhua Zhao
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, Pennsylvania. Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jing-Mei Hsu
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert Daber
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jennifer D Morrissette
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Selina Luger
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alison W Loren
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Martin Carroll
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
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179
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Zare-Abdollahi D, Safari S, Movafagh A, Riazi-Isfahani S, Ghadyani M, Hashemi-Gorji F, Feyzollah HG, Nasrollahi MF, Omrani MD. A mutational and expressional analysis of DNMT3A in acute myeloid leukemia cytogenetic subgroups. ACTA ACUST UNITED AC 2015; 20:397-404. [PMID: 25592687 DOI: 10.1179/1607845415y.0000000001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Despite numerous studies in order to determine the allele frequency and clinical impact of DNA methyltransferase 3 A (DNMT3A) gene mutations in acute myeloid leukemia (AML), reports about the expression analysis of this gene are rare and between the available, differences are evident. METHODS In this study, we decided to investigate DNMT3A possible expression changes with regard to their mutation and cytogenetic status in a series of 96 AML patients. RESULTS Mutations were founded in 17 of the 96 patients (17.7%) and associated with higher age and white blood cell count (P < 0.001). Our mutants have had shorter overall survival (OS) (P < 0.001) and relapse-free survival (RFS) (P = 0.011) than those without. Multivariate analysis showed that DNMT3A mutation is an independent prognostic indicator for OS and RFS (P < 0.001). In relation to expression results, we had over and under expression for our favorable and unfavorable cytogenetic subgroups, respectively (P = 0.005 and P < 0.001, respectively). In intermediate subgroup, total DNMT3A expression did not alter (P = 0.575). Interestingly, we noticed similar expression results for DNMT3A transcript 2, to that of the total. DISCUSSION AND CONCLUSION In relation to DNMT3A expression, from the perspective of diagnostic application and its biological significance, it is difficult to accept its primacy over cytogenetic value in favorable and unfavorable subgroups and if so, we did not address this issue in our study due to sample size limitation. In intermediate subgroup, particularly in normal karyotype-AML, given the lack of convincing results, it seems unlikely that DNMT3A expression analysis could attract attention in diagnostic workup and risk prediction of AML.
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180
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Ilyas AM, Ahmad S, Faheem M, Naseer MI, Kumosani TA, Al-Qahtani MH, Gari M, Ahmed F. Next generation sequencing of acute myeloid leukemia: influencing prognosis. BMC Genomics 2015; 16 Suppl 1:S5. [PMID: 25924101 PMCID: PMC4315161 DOI: 10.1186/1471-2164-16-s1-s5] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Acute myeloid leukemia (AML) is a clonal disorder of the blood forming cells characterized by accumulation of immature blast cells in the bone marrow and peripheral blood. Being a heterogeneous disease, AML has been the subject of numerous studies that focus on unraveling the clinical, cellular and molecular variations with the aim to better understand and treat the disease. Cytogenetic-risk stratification of AML is well established and commonly used by clinicians in therapeutic management of cases with chromosomal abnormalities. Successive inclusion of novel molecular abnormalities has substantially modified the classification and understanding of AML in the past decade. With the advent of next generation sequencing (NGS) technologies the discovery of novel molecular abnormalities has accelerated. NGS has been successfully used in several studies and has provided an unprecedented overview of molecular aberrations as well as the underlying clonal evolution in AML. The extended spectrum of abnormalities discovered by NGS is currently under extensive validation for their prognostic and therapeutic values. In this review we highlight the recent advances in the understanding of AML in the NGS era.
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181
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Incidence and prognostic impact of DNMT3A mutations in Korean normal karyotype acute myeloid leukemia patients. BIOMED RESEARCH INTERNATIONAL 2015; 2015:723682. [PMID: 25650308 PMCID: PMC4306257 DOI: 10.1155/2015/723682] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 12/22/2014] [Accepted: 12/22/2014] [Indexed: 11/28/2022]
Abstract
Background. DNA methyltransferase 3A (DNMT3A) mutation was recently introduced as a prognostic indicator in normal karyotype (NK) AML and we evaluated the incidence and prognostic impact of DNMT3A mutations in Korean NK AML patients. Methods. Total 67 NK AML patients diagnosed during the recent 10 years were enrolled. DNMT3A mutations were analyzed by direct sequencing and categorized into nonsynonymous variations (NSV), deleterious mutations (DM), and R882 mutation based on in silico analysis results. Clinical features and prognosis were compared with respect to DNMT3A mutation status. Results. Three novel (I158M, K219V, and E177V) and two known (R736H and R882H) NSVs were identified and the latter three were predicted as DMs. DNMT3A NSVs, DMs, and R882 mutation were identified in 14.9%–17.9%, 10.3%–10.4%, and 7.5% of patients, respectively. DNMT3A mutations were frequently detected in FLT3 ITD mutated patients (P = 0.054, 0.071, and 0.071 in NSV, DMs, and R882 mutation, resp.) but did not affect clinical features and prognosis significantly. Conclusions. Incidences of DNMT3A NSVs, DMs, and R882 mutation are 14.9%–17.9%, 10.3%–10.4%, and 7.5%, respectively, in Korean NK AML patients. DNMT3A mutations are associated with FLT3 ITD mutations but do not affect clinical outcome significantly in Korean NK AML patients.
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182
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Abstract
DNA methylation and histone modification are epigenetic mechanisms that result in altered gene expression and cellular phenotype. The exact role of methylation in myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML) remains unclear. However, aberrations (e.g. loss-/gain-of-function or up-/down-regulation) in components of epigenetic transcriptional regulation in general, and of the methylation machinery in particular, have been implicated in the pathogenesis of these diseases. In addition, many of these components have been identified as therapeutic targets for patients with MDS/AML, and are also being assessed as potential biomarkers of response or resistance to hypomethylating agents (HMAs). The HMAs 5-azacitidine (AZA) and 2'-deoxy-5-azacitidine (decitabine, DAC) inhibit DNA methylation and have shown significant clinical benefits in patients with myeloid malignancies. Despite being viewed as mechanistically similar drugs, AZA and DAC have differing mechanisms of action. DAC is incorporated 100% into DNA, whereas AZA is incorporated into RNA (80-90%) as well as DNA (10-20%). As such, both drugs inhibit DNA methyltransferases (DNMTs; dependently or independently of DNA replication) resulting in the re-expression of tumor-suppressor genes; however, AZA also has an impact on mRNA and protein metabolism via its inhibition of ribonucleotide reductase, resulting in apoptosis. Herein, we first give an overview of transcriptional regulation, including DNA methylation, post-translational histone-tail modifications, the role of micro-RNA and long-range epigenetic gene silencing. We place special emphasis on epigenetic transcriptional regulation and discuss the implication of various components in the pathogenesis of MDS/AML, their potential as therapeutic targets, and their therapeutic modulation by HMAs and other substances (if known). The main focus of this review is laid on dissecting the rapidly evolving knowledge of AZA and DAC with a special focus on their differing mechanisms of action, and the effect of HMAs on transcriptional regulation.
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Affiliation(s)
- Lisa Pleyer
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, Paracelsus Medical University Hospital Salzburg, Center for Clinical Cancer and Immunology Trials at Salzburg Cancer Research Institute , Salzburg , Austria
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183
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Prognostic significance of DNMT3A mutations in patients with acute myeloid leukemia. Blood Cells Mol Dis 2015; 54:84-9. [DOI: 10.1016/j.bcmd.2014.07.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 07/25/2014] [Indexed: 11/23/2022]
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184
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Thol F, Scherr M, Kirchner A, Shahswar R, Battmer K, Kade S, Chaturvedi A, Koenecke C, Stadler M, Platzbecker U, Thiede C, Schroeder T, Kobbe G, Bug G, Ottmann O, Hofmann WK, Kröger N, Fiedler W, Schlenk R, Döhner K, Döhner H, Krauter J, Eder M, Ganser A, Heuser M. Clinical and functional implications of microRNA mutations in a cohort of 935 patients with myelodysplastic syndromes and acute myeloid leukemia. Haematologica 2014; 100:e122-4. [PMID: 25552704 DOI: 10.3324/haematol.2014.120345] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Felicitas Thol
- Department of Hematology, Hemostasis, Oncology and HSCT, Hannover Medical School, Hannover
| | - Michaela Scherr
- Department of Hematology, Hemostasis, Oncology and HSCT, Hannover Medical School, Hannover
| | - Aylin Kirchner
- Department of Hematology, Hemostasis, Oncology and HSCT, Hannover Medical School, Hannover
| | - Rabia Shahswar
- Department of Hematology, Hemostasis, Oncology and HSCT, Hannover Medical School, Hannover
| | - Karin Battmer
- Department of Hematology, Hemostasis, Oncology and HSCT, Hannover Medical School, Hannover
| | - Sofia Kade
- Department of Hematology, Hemostasis, Oncology and HSCT, Hannover Medical School, Hannover
| | - Anuhar Chaturvedi
- Department of Hematology, Hemostasis, Oncology and HSCT, Hannover Medical School, Hannover
| | - Christian Koenecke
- Department of Hematology, Hemostasis, Oncology and HSCT, Hannover Medical School, Hannover
| | - Michael Stadler
- Department of Hematology, Hemostasis, Oncology and HSCT, Hannover Medical School, Hannover
| | - Uwe Platzbecker
- Medizinische Klinik und Poliklinik I, Universtitätsklinikum Carl Gustav Carus, Dresden
| | - Christian Thiede
- Medizinische Klinik und Poliklinik I, Universtitätsklinikum Carl Gustav Carus, Dresden
| | - Thomas Schroeder
- Klinik für Hämatologie, Onkologie und Klinische Immunologie, Heinreich Heine Universit¨at, Düsseldorf
| | - Guido Kobbe
- Klinik für Hämatologie, Onkologie und Klinische Immunologie, Heinreich Heine Universit¨at, Düsseldorf
| | - Gesine Bug
- Department of Medicine, Hematology/Oncology, University Hospital, Frankfurt
| | - Oliver Ottmann
- Department of Medicine, Hematology/Oncology, University Hospital, Frankfurt
| | | | - Nicolaus Kröger
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg
| | - Walter Fiedler
- Department of Medicine II, Oncological Center, Hubertus Wald University Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg
| | | | | | | | - Jürgen Krauter
- Department of Hematology, Hemostasis, Oncology and HSCT, Hannover Medical School, Hannover Klinikum Braunschweig, Germany
| | - Matthias Eder
- Department of Hematology, Hemostasis, Oncology and HSCT, Hannover Medical School, Hannover
| | - Arnold Ganser
- Department of Hematology, Hemostasis, Oncology and HSCT, Hannover Medical School, Hannover
| | - Michael Heuser
- Department of Hematology, Hemostasis, Oncology and HSCT, Hannover Medical School, Hannover
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185
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Woods BA, Levine RL. The role of mutations in epigenetic regulators in myeloid malignancies. Immunol Rev 2014; 263:22-35. [DOI: 10.1111/imr.12246] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Brittany A. Woods
- Louis V. Gerstner Sloan Kettering Graduate School of Biomedical Sciences; Memorial Sloan Kettering Cancer Center; New York NY USA
- Human Oncology and Pathogenesis Program; Memorial Sloan Kettering Cancer Center; New York NY USA
| | - Ross L. Levine
- Louis V. Gerstner Sloan Kettering Graduate School of Biomedical Sciences; Memorial Sloan Kettering Cancer Center; New York NY USA
- Human Oncology and Pathogenesis Program; Memorial Sloan Kettering Cancer Center; New York NY USA
- Leukemia Service; Department of Medicine; Memorial Sloan Kettering Cancer Center; New York NY USA
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186
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Döhner K, Paschka P. Intermediate-risk acute myeloid leukemia therapy: current and future. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2014; 2014:34-43. [PMID: 25696832 DOI: 10.1182/asheducation-2014.1.34] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In recent years, research in molecular genetics has been instrumental in deciphering the molecular heterogeneity of acute myeloid leukemia (AML), in particular the subset of patients with "intermediate-risk" cytogenetics. However, at present, only the markers NPM1, CEBPA, and FLT3 have entered clinical practice. Treatment of intermediate-risk AML patients eligible for intensive therapy has not changed substantially. The "3 + 7" induction therapy still represents the standard of care. The addition of the immunoconjugate gemtuzumab ozogamicin to therapy has been shown to improve outcome; however, the drug is not approved for this use. A common standard for postremission therapy is the administration of repeated cycles of intermediate- to high-dose cytarabine. Allogeneic stem cell transplantation may offer a survival benefit for many patients with intermediate-risk AML. Patients are best selected based on the genetic profile of the leukemia cells and the risk associated with the transplantation itself. A myriad of novel agents targeting mutant leukemia drivers or deregulated pathways are in clinical development. In the past, many novel compounds have not met expectations; nonetheless, with the rapid developments in comprehensive molecular profiling and new drug design, there is the prospect of personalizing therapy and improving patient outcome.
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Affiliation(s)
- Konstanze Döhner
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | - Peter Paschka
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
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187
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Abstract
Abstract
In recent years, research in molecular genetics has been instrumental in deciphering the molecular heterogeneity of acute myeloid leukemia (AML), in particular the subset of patients with “intermediate-risk” cytogenetics. However, at present, only the markers NPM1, CEBPA, and FLT3 have entered clinical practice. Treatment of intermediate-risk AML patients eligible for intensive therapy has not changed substantially. The “3 + 7” induction therapy still represents the standard of care. The addition of the immunoconjugate gemtuzumab ozogamicin to therapy has been shown to improve outcome; however, the drug is not approved for this use. A common standard for postremission therapy is the administration of repeated cycles of intermediate- to high-dose cytarabine. Allogeneic stem cell transplantation may offer a survival benefit for many patients with intermediate-risk AML. Patients are best selected based on the genetic profile of the leukemia cells and the risk associated with the transplantation itself. A myriad of novel agents targeting mutant leukemia drivers or deregulated pathways are in clinical development. In the past, many novel compounds have not met expectations; nonetheless, with the rapid developments in comprehensive molecular profiling and new drug design, there is the prospect of personalizing therapy and improving patient outcome.
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188
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O'Brien EC, Brewin J, Chevassut T. DNMT3A: the DioNysian MonsTer of acute myeloid leukaemia. Ther Adv Hematol 2014; 5:187-96. [PMID: 25469209 DOI: 10.1177/2040620714554538] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
In the mythology of Ancient Greece, there was often a creative tension between the opposing forces of the gods Apollo and Dionysius, the two sons of Zeus. The Apollonian force was considered to be rational and lifegiving, whilst Dionysian forces were chaotic and elemental. Acute myeloid leukaemia is characterised by the clash of these forces: the chaotic proliferation of immature myeloid cells in the bone marrow overcomes the normal, orderly production of healthy blood cells. DNMT3A mutations occur early in the leukaemogenic process and may even act as "founder" mutations - the first step in a pathway towards malignant transformation. As such, these mutations may represent a Dionysian agent of disorder, inciting the chaotic myeloid proliferation and arrest of differentiation which are hallmarks of AML. This review will focus on the role of DNMT3A mutations in leukaemia pathogenesis, their influence on prognosis, and the potential for therapeutic targeting.
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Affiliation(s)
- Emma Conway O'Brien
- Medical Research Building, Brighton and Sussex Medical School, Sussex University, Falmer, Brighton, UK
| | - John Brewin
- Medical Research Building, Brighton and Sussex Medical School, Sussex University, Falmer, Brighton, UK
| | - Timothy Chevassut
- Medical Research Building, Brighton and Sussex Medical School, Sussex University, Falmer, Brighton BN1 9PS, UK
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189
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Mehdipour P, Santoro F, Minucci S. Epigenetic alterations in acute myeloid leukemias. FEBS J 2014; 282:1786-800. [DOI: 10.1111/febs.13142] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 10/22/2014] [Accepted: 10/31/2014] [Indexed: 12/22/2022]
Affiliation(s)
- Parinaz Mehdipour
- Department of Experimental Oncology at the IFOM-IEO Campus; European Institute of Oncology; Milan Italy
| | - Fabio Santoro
- Department of Experimental Oncology at the IFOM-IEO Campus; European Institute of Oncology; Milan Italy
| | - Saverio Minucci
- Department of Experimental Oncology at the IFOM-IEO Campus; European Institute of Oncology; Milan Italy
- Department of Biosciences; University of Milan; Milan Italy
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190
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Lai CK, Moon Y, Kuchenbauer F, Starzcynowski DT, Argiropoulos B, Yung E, Beer P, Schwarzer A, Sharma A, Park G, Leung M, Lin G, Vollett S, Fung S, Eaves CJ, Karsan A, Weng AP, Humphries RK, Heuser M. Cell fate decisions in malignant hematopoiesis: leukemia phenotype is determined by distinct functional domains of the MN1 oncogene. PLoS One 2014; 9:e112671. [PMID: 25401736 PMCID: PMC4234417 DOI: 10.1371/journal.pone.0112671] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 10/10/2014] [Indexed: 12/02/2022] Open
Abstract
Extensive molecular profiling of leukemias and preleukemic diseases has revealed that distinct clinical entities, like acute myeloid (AML) and T-lymphoblastic leukemia (T-ALL), share similar pathogenetic mutations. It is not well understood how the cell of origin, accompanying mutations, extracellular signals or structural differences in a mutated gene determine the phenotypic identity of leukemias. We dissected the functional aspects of different protein regions of the MN1 oncogene and their effect on the leukemic phenotype, building on the ability of MN1 to induce leukemia without accompanying mutations. We found that the most C-terminal region of MN1 was required to block myeloid differentiation at an early stage, and deletion of an extended C-terminal region resulted in loss of myeloid identity and cell differentiation along the T-cell lineage in vivo. Megakaryocytic/erythroid lineage differentiation was blocked by the N-terminal region. In addition, the N-terminus was required for proliferation and leukemogenesis in vitro and in vivo through upregulation of HoxA9, HoxA10 and Meis2. Our results provide evidence that a single oncogene can modulate cellular identity of leukemic cells based on its active gene regions. It is therefore likely that different mutations in the same oncogene may impact cell fate decisions and phenotypic appearance of malignant diseases.
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Affiliation(s)
- Courteney K. Lai
- Terry Fox Laboratory, BC Cancer Agency Research Centre, Vancouver, BC, Canada
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Yeonsook Moon
- Department of Laboratory Medicine, Medical School of Inha University, Incheon, Korea
| | - Florian Kuchenbauer
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
- Institute of Experimental Cancer Research, Comprehensive Cancer Centre, University Hospital of Ulm, Ulm, Germany
| | - Daniel T. Starzcynowski
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Bob Argiropoulos
- Department of Medical Genetics, University of Calgary, Calgary, AB, Canada
| | - Eric Yung
- Terry Fox Laboratory, BC Cancer Agency Research Centre, Vancouver, BC, Canada
| | - Philip Beer
- Terry Fox Laboratory, BC Cancer Agency Research Centre, Vancouver, BC, Canada
| | - Adrian Schwarzer
- Institute of Experimental Hematology, Hannover Medical School, Hannover, Germany
| | - Amit Sharma
- Institute of Experimental Hematology, Hannover Medical School, Hannover, Germany
| | - Gyeongsin Park
- Department of Hospital Pathology, Catholic University of Korea, Seoul, Korea
| | - Malina Leung
- Terry Fox Laboratory, BC Cancer Agency Research Centre, Vancouver, BC, Canada
| | - Grace Lin
- Terry Fox Laboratory, BC Cancer Agency Research Centre, Vancouver, BC, Canada
| | - Sarah Vollett
- Terry Fox Laboratory, BC Cancer Agency Research Centre, Vancouver, BC, Canada
| | - Stephen Fung
- Terry Fox Laboratory, BC Cancer Agency Research Centre, Vancouver, BC, Canada
| | - Connie J. Eaves
- Terry Fox Laboratory, BC Cancer Agency Research Centre, Vancouver, BC, Canada
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Aly Karsan
- Genome Sciences Centre, BC Cancer Agency, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Andrew P. Weng
- Terry Fox Laboratory, BC Cancer Agency Research Centre, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - R. Keith Humphries
- Terry Fox Laboratory, BC Cancer Agency Research Centre, Vancouver, BC, Canada
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- * E-mail:
| | - Michael Heuser
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
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191
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Li W, Gao C, Cui L, Liu S, Zhao X, Zhang R, Wu M, Zheng H, Deng G, Li Z, Zhang Q. DNMT3A mutations and prognostic significance in childhood acute lymphoblastic leukemia. Leuk Lymphoma 2014; 56:1066-71. [PMID: 25242092 DOI: 10.3109/10428194.2014.947607] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Little is known about DNMT3A mutations in childhood acute lymphoblastic leukemia (ALL). We screened for DNMT3A mutations in exon 23 and its adjacent intron regions in diagnostic samples of 201 children with ALL. The cDNA samples from 82 patients were also sequenced to identify other mutations in the entire coding region. DNMT3A mutations were detected in exon 23 and its adjacent intron regions only in five patients (2.5%). There was only one mutation in exon 23 in two patients, respectively. In the other three patients, five intronic mutations were found. None of the mutations was found in the five corresponding complete remission samples. DNMT3A mutations were correlated with higher minimal residual disease at the end of remission induction (p = 0.078). Treatment outcome was obviously worse in patients with DNMT3A mutations than in other patients (p < 0.05). Thus, DNMT3A mutations can be found in a few children with ALL, and may have an adverse impact on prognosis.
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Affiliation(s)
- Weijing Li
- Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics, Ministry of Education; Key Laboratory of Major Diseases in Children, Ministry of Education; Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University , Beijing , China
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192
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Loghavi S, Zuo Z, Ravandi F, Kantarjian HM, Bueso-Ramos C, Zhang L, Singh RR, Patel KP, Medeiros LJ, Stingo F, Routbort M, Cortes J, Luthra R, Khoury JD. Clinical features of de novo acute myeloid leukemia with concurrent DNMT3A, FLT3 and NPM1 mutations. J Hematol Oncol 2014; 7:74. [PMID: 25281355 PMCID: PMC4197326 DOI: 10.1186/s13045-014-0074-4] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 09/23/2014] [Indexed: 02/06/2023] Open
Abstract
Background De novo acute myeloid leukemia (AML) with concurrent DNMT3A, FLT3 and NPM1 mutations (AMLDNMT3A/FLT3/NPM1) has been suggested to represent a unique AML subset on the basis of integrative genomic analysis, but the clinical features of such patients have not been characterized systematically. Methods We assessed the features of patients (n = 178) harboring mutations in DNMT3A, FLT3 and/or NPM1, including an index group of AMLDNMT3A/FLT3/NPM1 patients. Results Patients with AMLDNMT3A/FLT3/NPM1 (n = 35) were significantly younger (median, 56.0 vs. 62.0 years; p = 0.025), mostly women (65.7% vs. 46.9%; p = 0.045), and presented with a higher percentage of bone marrow blasts (p < 0.001) and normal cytogenetics (p = 0.024) in comparison to patients within other mutation groups in this study. Among patients <60 years old, those with AMLDNMT3A/FLT3/NPM1 had a shorter event-free survival (EFS) (p = 0.047). DNMT3A mutations and not FLT3 or NPM1 mutations were independently associated with overall survival (OS) (p = 0.026). Within mutation subgroups, patients with AMLDNMT3A/NPM1 had a significantly shorter OS compared to those with AMLFLT3-ITD/NPM1 (p = 0.047) suggesting that the adverse impact of DNMT3A mutations is more pronounced than that of FLT3-ITD among patients with NPM1 mutation. Conclusions DNMT3A has a significant dominant effect on the clinical features and outcomes of de novo AML patients with concurrent DNMT3A, FLT3 and NPM1 mutations. Electronic supplementary material The online version of this article (doi:10.1186/s13045-014-0074-4) contains supplementary material, which is available to authorized users.
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194
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Okosun J, Packham G, Fitzgibbon J. Investigational epigenetically targeted drugs in early phase trials for the treatment of haematological malignancies. Expert Opin Investig Drugs 2014; 23:1321-32. [PMID: 24855903 DOI: 10.1517/13543784.2014.923402] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION For decades, cancer research has focussed on the genetic defects that drive tumourigenesis. However, recent high-resolution sequencing studies have uncovered mounting evidence for the complementary role of epigenetic deregulation as a hallmark of haematological malignancies. The reversibility of epigenetic changes makes them suitable candidates for pharmacological manipulation and therapeutic targeting. AREAS COVERED This review summarises the mechanisms of normal epigenetic regulation and how these are perturbed in haematological malignancies as a result of genetic alterations. The article concludes with how these can be reversed and appraises the investigational epigenetically targeted therapies in preclinical and clinical use. EXPERT OPINION The identification of recurring alterations in components of the epigenome of leukaemia and lymphoma has driven the rapid development of highly potent epigenetically targeted therapies. This rapid development has alluded to the possibility of a personalised therapeutic approach in selected patient populations. An enhanced understanding of the biological effects of these epigenetic alterations in initiation and progression of haematological malignancies, together with a clear mechanistic insight into how the drugs reverse the phenotypes, will define their translation into routine clinical use.
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Affiliation(s)
- Jessica Okosun
- Queen Mary University of London, Barts Cancer Institute - a Cancer Research UK Centre of Excellence, Centre for Haemato-Oncology, John Vane Science Centre , Charterhouse Square, London EC1M 6BQ , UK +44 20 7882 8780 ; +44 20 7882 3891 ;
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195
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Abstract
Acute myeloid leukemia (AML) arises within the bone marrow from a malignant hematopoietic progenitor cell. Though AML is still often fatal, cure rates overall continue to improve incrementally yet steadily, primarily for two reasons: first, insights into the pathogenesis of AML over the last several decades have led to the development of a relatively sophisticated classification scheme that allows more nuanced risk stratification to guide treatment choices; second, improvements in stem cell transplantation have allowed many more patients to take advantage of this highly effective therapeutic technique. Improvements in overall survival for patients with AML are expected to continue rising because of the anticipated introduction of targeted therapies into this treatment platform.
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196
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Kadia TM, Ravandi F, O'Brien S, Cortes J, Kantarjian HM. Progress in acute myeloid leukemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2014; 15:139-51. [PMID: 25441110 DOI: 10.1016/j.clml.2014.08.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 08/07/2014] [Accepted: 08/25/2014] [Indexed: 12/11/2022]
Abstract
Significant progress has been made in the treatment of acute myeloid leukemia (AML). Steady gains in clinical research and a renaissance of genomics in leukemia have led to improved outcomes. The recognition of tremendous heterogeneity in AML has allowed individualized treatments of specific disease entities within the context of patient age, cytogenetics, and mutational analysis. The following is a comprehensive review of the current state of AML therapy and a roadmap of our approach to these distinct disease entities.
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Affiliation(s)
- Tapan M Kadia
- Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
| | - Farhad Ravandi
- Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Susan O'Brien
- Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Jorge Cortes
- Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Hagop M Kantarjian
- Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, TX
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197
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Yanada M. Allogeneic hematopoietic cell transplantation for acute myeloid leukemia during first complete remission: a clinical perspective. Int J Hematol 2014; 101:243-54. [PMID: 25212675 DOI: 10.1007/s12185-014-1657-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 08/26/2014] [Accepted: 09/01/2014] [Indexed: 12/28/2022]
Abstract
Allogeneic hematopoietic cell transplantation (HCT) is the most potent therapy for preventing relapse of acute myeloid leukemia (AML). Although its efficacy is compromised by a high risk of treatment-related morbidity and mortality, an accumulating body of evidence has led to the general recommendation favoring allogeneic HCT from a matched sibling donor during first complete remission (CR1) for younger patients with cytogenetically intermediate- or high-risk AML. Over the past few decades, this field has seen a great many advancements. The indications for allogeneic HCT have been refined by taking into account the molecular profiles of leukemic cells and the degree of comorbidities. The introduction of high-resolution human leukocyte antigen-typing technology and advances in immunosuppressive therapy and supportive care measures have improved outcomes in alternative donor transplantation, while the parallel growth of unrelated donor registries and greater use of umbilical cord blood and haploidentical donors have considerably improved the chance of finding an alternative donor. The development of reduced-intensity and non-myeloablative conditioning has made it possible to receive allogeneic HCT for patients who might once have been considered ineligible due to advanced age or comorbidities. Thanks to these advances, the role of allogeneic HCT during CR1 has become progressively more important in the treatment of AML.
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Affiliation(s)
- Masamitsu Yanada
- Department of Hematology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Japan,
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198
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Myeloproliferative Neoplasms: JAK2 Signaling Pathway as a Central Target for Therapy. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2014; 14 Suppl:S23-35. [DOI: 10.1016/j.clml.2014.06.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 06/04/2014] [Indexed: 12/16/2022]
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199
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Matynia AP, Szankasi P, Shen W, Kelley TW. Molecular genetic biomarkers in myeloid malignancies. Arch Pathol Lab Med 2014; 139:594-601. [PMID: 25152312 DOI: 10.5858/arpa.2014-0096-ra] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Recent studies using massively parallel sequencing technologies, so-called next-generation sequencing, have uncovered numerous recurrent, single-gene variants or mutations across the spectrum of myeloid malignancies. OBJECTIVES To review the recent advances in the understanding of the molecular basis of myeloid neoplasms, including their significance for diagnostic and prognostic purposes and the possible implications for the development of novel therapeutic strategies. DATA SOURCES Literature review. CONCLUSIONS The recurrent mutations found in myeloid malignancies fall into distinct functional categories. These include (1) cell signaling factors, (2) transcription factors, (3) regulators of the cell cycle, (4) regulators of DNA methylation, (5) regulators of histone modification, (6) RNA-splicing factors, and (7) components of the cohesin complex. As the clinical significance of these mutations and mutation combinations is established, testing for their presence is likely to become a routine part of the diagnostic workup. This review will attempt to establish a framework for understanding these mutations in the context of myeloproliferative neoplasms, myelodysplastic syndromes, and acute myeloid leukemia.
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Affiliation(s)
- Anna P Matynia
- From the Department of Pathology, University of Utah, Salt Lake City (Drs Matynia and Kelley); and Research and Development, ARUP Laboratories, Salt Lake City, Utah (Drs Szankasi and Shen)
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200
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Abstract
The use of genomic profiling in acute myeloid leukemia (AML) has led to an improved understanding of disease pathogenesis. Genomic profiling has given rise to fundamental observations about the biology of AML and has served to better define clinical outcomes for patients based on somatic mutational status. As additional mutations are identified with a known or postulated role in AML pathogenesis, the challenge ahead will be learning how to integrate these findings into clinical practice in such a way that they have a meaningful impact on patient care and, ultimately, on patient outcomes. Potential goals include using genomic information for refined risk stratification and clinical decision making, and to identify genetic lesions that guide the use of molecularly targeted therapies. The development of next-generation sequencing technologies has made genomic profiling a viable option for use in clinical practice because it can provide robust, high-coverage sequencing data for multiple genes in 1 assay, within a clinically reasonable time frame. The present article discusses recent candidate gene sequencing studies, the development of prognostic models based on these studies, and the current and potential future uses of next-generation sequencing technologies in making treatment decisions for patients with AML.
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Affiliation(s)
- Matias Sanchez
- Leukemia Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Ross L Levine
- Leukemia Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY; Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, NY.
| | - Raajit Rampal
- Leukemia Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY; Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, NY
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