201
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Long ZB, Du YL, Han B. [Research progress on clonal acquired sideroblastic anemia]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2017; 38:83-86. [PMID: 28219236 PMCID: PMC7348407 DOI: 10.3760/cma.j.issn.0253-2727.2017.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Indexed: 11/05/2022]
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202
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Martin-Cabrera P, Jeromin S, Perglerovà K, Haferlach C, Kern W, Haferlach T. Acute myeloid leukemias with ring sideroblasts show a unique molecular signature straddling secondary acute myeloid leukemia and de novo acute myeloid leukemia. Haematologica 2017; 102:e125-e128. [PMID: 28057736 DOI: 10.3324/haematol.2016.156844] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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203
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Hou HA, Liu CY, Kuo YY, Chou WC, Tsai CH, Lin CC, Lin LI, Tseng MH, Chiang YC, Liu MC, Liu CW, Tang JL, Yao M, Li CC, Huang SY, Ko BS, Hsu SC, Chen CY, Lin CT, Wu SJ, Tsay W, Tien HF. Splicing factor mutations predict poor prognosis in patients with de novo acute myeloid leukemia. Oncotarget 2016; 7:9084-101. [PMID: 26812887 PMCID: PMC4891028 DOI: 10.18632/oncotarget.7000] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 01/16/2016] [Indexed: 12/21/2022] Open
Abstract
Mutations in splicing factor (SF) genes are frequently detected in myelodysplastic syndrome, but the prognostic relevance of these genes mutations in acute myeloid leukemia (AML) remains unclear. In this study, we investigated mutations of three SF genes, SF3B1, U2AF1 and SRSF2, by Sanger sequencing in 500 patients with de novo AML and analysed their clinical relevance. SF mutations were identified in 10.8% of total cohort and 13.2% of those with intermediate-risk cytogenetics. SF mutations were closely associated with RUNX1, ASXL1, IDH2 and TET2 mutations. SF-mutated AML patients had a significantly lower complete remission rate and shorter disease-free survival (DFS) and overall survival (OS) than those without the mutation. Multivariate analysis demonstrated that SFmutation was an independent poor prognostic factor for DFS and OS. A scoring system incorporating SF mutation and ten other prognostic factors was proved very useful to risk-stratify AML patients. Sequential study of paired samples showed that SF mutations were stable during AML evolution. In conclusion, SF mutations are associated with distinct clinic-biological features and poor prognosis in de novo AML patients and are rather stable during disease progression. These mutations may be potential targets for novel treatment and biomarkers for disease monitoring in AML.
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Affiliation(s)
- Hsin-An Hou
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chieh-Yu Liu
- Biostatistics Consulting Laboratory, Department of Nursing, National Taipei College of Nursing, Taipei, Taiwan
| | - Yuan-Yeh Kuo
- Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wen-Chien Chou
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Cheng-Hong Tsai
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Tai-Chang Stem Cell Therapy Center, National Taiwan University, Taipei, Taiwan
| | - Chien-Chin Lin
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Liang-In Lin
- Clinical Laboratory Science and Medical Biotechnology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Mei-Hsuan Tseng
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ying-Chieh Chiang
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Chih Liu
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Wen Liu
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Jih-Luh Tang
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming Yao
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Cheng Li
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Tai-Chang Stem Cell Therapy Center, National Taiwan University, Taipei, Taiwan
| | - Shang-Yi Huang
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Bor-Sheng Ko
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Szu-Chun Hsu
- Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Yuan Chen
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Ting Lin
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Tai-Chang Stem Cell Therapy Center, National Taiwan University, Taipei, Taiwan
| | - Shang-Ju Wu
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Woei Tsay
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hwei-Fang Tien
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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204
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Dynamics of clonal evolution in myelodysplastic syndromes. Nat Genet 2016; 49:204-212. [PMID: 27992414 DOI: 10.1038/ng.3742] [Citation(s) in RCA: 310] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 11/16/2016] [Indexed: 12/14/2022]
Abstract
To elucidate differential roles of mutations in myelodysplastic syndromes (MDS), we investigated clonal dynamics using whole-exome and/or targeted sequencing of 699 patients, of whom 122 were analyzed longitudinally. Including the results from previous reports, we assessed a total of 2,250 patients for mutational enrichment patterns. During progression, the number of mutations, their diversity and clone sizes increased, with alterations frequently present in dominant clones with or without their sweeping previous clones. Enriched in secondary acute myeloid leukemia (sAML; in comparison to high-risk MDS), FLT3, PTPN11, WT1, IDH1, NPM1, IDH2 and NRAS mutations (type 1) tended to be newly acquired, and were associated with faster sAML progression and a shorter overall survival time. Significantly enriched in high-risk MDS (in comparison to low-risk MDS), TP53, GATA2, KRAS, RUNX1, STAG2, ASXL1, ZRSR2 and TET2 mutations (type 2) had a weaker impact on sAML progression and overall survival than type-1 mutations. The distinct roles of type-1 and type-2 mutations suggest their potential utility in disease monitoring.
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205
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Tang Q, Rodriguez-Santiago S, Wang J, Pu J, Yuste A, Gupta V, Moldón A, Xu YZ, Query CC. SF3B1/Hsh155 HEAT motif mutations affect interaction with the spliceosomal ATPase Prp5, resulting in altered branch site selectivity in pre-mRNA splicing. Genes Dev 2016; 30:2710-2723. [PMID: 28087715 PMCID: PMC5238730 DOI: 10.1101/gad.291872.116] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 12/12/2016] [Indexed: 11/25/2022]
Abstract
Mutations in the U2 snRNP component SF3B1 are prominent in myelodysplastic syndromes (MDSs) and other cancers and have been shown recently to alter branch site (BS) or 3' splice site selection in splicing. However, the molecular mechanism of altered splicing is not known. We show here that hsh155 mutant alleles in Saccharomyces cerevisiae, counterparts of SF3B1 mutations frequently found in cancers, specifically change splicing of suboptimal BS pre-mRNA substrates. We found that Hsh155p interacts directly with Prp5p, the first ATPase that acts during spliceosome assembly, and localized the interacting regions to HEAT (Huntingtin, EF3, PP2A, and TOR1) motifs in SF3B1 associated with disease mutations. Furthermore, we show that mutations in these motifs from both human disease and yeast genetic screens alter the physical interaction with Prp5p, alter branch region specification, and phenocopy mutations in Prp5p. These and other data demonstrate that mutations in Hsh155p and Prp5p alter splicing because they change the direct physical interaction between Hsh155p and Prp5p. This altered physical interaction results in altered loading (i.e., "fidelity") of the BS-U2 duplex into the SF3B complex during prespliceosome formation. These results provide a mechanistic framework to explain the consequences of intron recognition and splicing of SF3B1 mutations found in disease.
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Affiliation(s)
- Qing Tang
- Key Laboratory of Insect Developmental and Evolutionary Biology, CAS Center for Excellence in Molecular Cell Science, Institute of Plant Physiology and Ecology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200032 China
| | | | - Jing Wang
- Key Laboratory of Insect Developmental and Evolutionary Biology, CAS Center for Excellence in Molecular Cell Science, Institute of Plant Physiology and Ecology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200032 China
| | - Jia Pu
- Key Laboratory of Insect Developmental and Evolutionary Biology, CAS Center for Excellence in Molecular Cell Science, Institute of Plant Physiology and Ecology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200032 China
| | - Andrea Yuste
- Department of Cell Biology, Albert Einstein College of Medicine, Bronx, New York 10461 USA
| | - Varun Gupta
- Department of Cell Biology, Albert Einstein College of Medicine, Bronx, New York 10461 USA
| | - Alberto Moldón
- Department of Cell Biology, Albert Einstein College of Medicine, Bronx, New York 10461 USA
| | - Yong-Zhen Xu
- Key Laboratory of Insect Developmental and Evolutionary Biology, CAS Center for Excellence in Molecular Cell Science, Institute of Plant Physiology and Ecology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200032 China
| | - Charles C Query
- Department of Cell Biology, Albert Einstein College of Medicine, Bronx, New York 10461 USA
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206
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Splicing factor gene mutations in hematologic malignancies. Blood 2016; 129:1260-1269. [PMID: 27940478 DOI: 10.1182/blood-2016-10-692400] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 11/25/2016] [Indexed: 01/27/2023] Open
Abstract
Alternative splicing generates a diversity of messenger RNA (mRNA) transcripts from a single mRNA precursor and contributes to the complexity of our proteome. Splicing is perturbed by a variety of mechanisms in cancer. Recurrent mutations in splicing factors have emerged as a hallmark of several hematologic malignancies. Splicing factor mutations tend to occur in the founding clone of myeloid cancers, and these mutations have recently been identified in blood cells from normal, healthy elderly individuals with clonal hematopoiesis who are at increased risk of subsequently developing a hematopoietic malignancy, suggesting that these mutations contribute to disease initiation. Splicing factor mutations change the pattern of splicing in primary patient and mouse hematopoietic cells and alter hematopoietic differentiation and maturation in animal models. Recent developments in this field are reviewed here, with an emphasis on the clinical consequences of splicing factor mutations, mechanistic insights from animal models, and implications for development of novel therapies targeting the precursor mRNA splicing pathway.
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207
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Dolatshad H, Pellagatti A, Liberante FG, Llorian M, Repapi E, Steeples V, Roy S, Scifo L, Armstrong RN, Shaw J, Yip BH, Killick S, Kušec R, Taylor S, Mills KI, Savage KI, Smith CWJ, Boultwood J. Cryptic splicing events in the iron transporter ABCB7 and other key target genes in SF3B1-mutant myelodysplastic syndromes. Leukemia 2016; 30:2322-2331. [PMID: 27211273 PMCID: PMC5029572 DOI: 10.1038/leu.2016.149] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/04/2016] [Accepted: 05/16/2016] [Indexed: 02/08/2023]
Abstract
The splicing factor SF3B1 is the most frequently mutated gene in myelodysplastic syndromes (MDS), and is strongly associated with the presence of ring sideroblasts (RS). We have performed a systematic analysis of cryptic splicing abnormalities from RNA sequencing data on hematopoietic stem cells (HSCs) of SF3B1-mutant MDS cases with RS. Aberrant splicing events in many downstream target genes were identified and cryptic 3' splice site usage was a frequent event in SF3B1-mutant MDS. The iron transporter ABCB7 is a well-recognized candidate gene showing marked downregulation in MDS with RS. Our analysis unveiled aberrant ABCB7 splicing, due to usage of an alternative 3' splice site in MDS patient samples, giving rise to a premature termination codon in the ABCB7 mRNA. Treatment of cultured SF3B1-mutant MDS erythroblasts and a CRISPR/Cas9-generated SF3B1-mutant cell line with the nonsense-mediated decay (NMD) inhibitor cycloheximide showed that the aberrantly spliced ABCB7 transcript is targeted by NMD. We describe cryptic splicing events in the HSCs of SF3B1-mutant MDS, and our data support a model in which NMD-induced downregulation of the iron exporter ABCB7 mRNA transcript resulting from aberrant splicing caused by mutant SF3B1 underlies the increased mitochondrial iron accumulation found in MDS patients with RS.
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Affiliation(s)
- H Dolatshad
- Bloodwise Molecular Haematology Unit, Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- NIHR Biomedical Research Centre, Oxford, UK
| | - A Pellagatti
- Bloodwise Molecular Haematology Unit, Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- NIHR Biomedical Research Centre, Oxford, UK
| | - F G Liberante
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK
| | - M Llorian
- Department of Biochemistry, Downing Site, University of Cambridge, Cambridge, UK
| | - E Repapi
- The Computational Biology Research Group, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - V Steeples
- Bloodwise Molecular Haematology Unit, Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- NIHR Biomedical Research Centre, Oxford, UK
| | - S Roy
- Bloodwise Molecular Haematology Unit, Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- NIHR Biomedical Research Centre, Oxford, UK
| | - L Scifo
- Bloodwise Molecular Haematology Unit, Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- NIHR Biomedical Research Centre, Oxford, UK
| | - R N Armstrong
- Bloodwise Molecular Haematology Unit, Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- NIHR Biomedical Research Centre, Oxford, UK
| | - J Shaw
- Bloodwise Molecular Haematology Unit, Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- NIHR Biomedical Research Centre, Oxford, UK
| | - B H Yip
- Bloodwise Molecular Haematology Unit, Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- NIHR Biomedical Research Centre, Oxford, UK
| | - S Killick
- Department of Haematology, Royal Bournemouth Hospital, Bournemouth, UK
| | - R Kušec
- Dubrava University hospital and Zagreb School of Medicine, University of Zagreb, Zagreb, Croatia
| | - S Taylor
- The Computational Biology Research Group, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - K I Mills
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK
| | - K I Savage
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK
| | - C W J Smith
- Department of Biochemistry, Downing Site, University of Cambridge, Cambridge, UK
| | - J Boultwood
- Bloodwise Molecular Haematology Unit, Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- NIHR Biomedical Research Centre, Oxford, UK
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208
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Abstract
Abstract
Essential thrombocythemia (ET) is an indolent myeloproliferative neoplasm that may be complicated by vascular events, including both thrombosis and bleeding. This disorder may also transform into more aggressive myeloid neoplasms, in particular into myelofibrosis. The identification of somatic mutations of JAK2, CALR, or MPL, found in about 90% of patients, has considerably improved the diagnostic approach to this disorder. Genomic profiling also holds the potential to improve prognostication and, more generally, clinical decision-making because the different driver mutations are associated with distinct clinical features. Prevention of vascular events has been so far the main objective of therapy, and continues to be extremely important in the management of patients with ET. Low-dose aspirin and cytoreductive drugs can be administered to this purpose, with cytoreductive treatment being primarily given to patients at high risk of vascular complications. Currently used cytoreductive drugs include hydroxyurea, mainly used in older patients, and interferon α, primarily given to younger patients. There is a need for disease-modifying drugs that can eradicate clonal hematopoiesis and/or prevent progression to more aggressive myeloid neoplasms, especially in younger patients. In this article, we use a case-based discussion format to illustrate our approach to diagnosis and treatment of ET.
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209
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Keen R, Pantin J, Savage N, Dainer PM. Treatment of Refractory Anemia with Ring Sideroblasts Associated with Marked Thrombocytosis with Lenalidomide in a Patient Testing Negative for 5q Deletion and JAK2 V617F and MPL W515K/L Mutations. Hematol Rep 2016; 8:6592. [PMID: 27994837 PMCID: PMC5136742 DOI: 10.4081/hr.2016.6592] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 10/11/2016] [Indexed: 11/22/2022] Open
Abstract
Refractory anemia with ring sideroblasts associated with marked thrombocytosis (RARS-T) is a hematologic malignancy that often results in transfusion dependency and a hypercoagulable state. This rare disease currently lacks formal guidelines for treatment; however, various case reports have demonstrated efficacy in the use of lenalidomide. This immunomodulatory drug has shown promise in patients with 5q deletions, with reports of achieving transfusion independence and normalization of platelet counts. Herein we present the case of a 68-year-old African American woman with RARS-T who tested negative for 5q deletion and JAK2 V617F and MPL W515K/L mutations. Her treatment with lenalidomide therapy resulted in a five-year durable complete clinical response.
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Affiliation(s)
- Ryan Keen
- Department of Medicine, Medical College of Georgia, Augusta University , Augusta, GA, USA
| | - Jeremy Pantin
- Department of Hematology/Oncology, Medical College of Georgia, Augusta University , Augusta, GA, USA
| | - Natasha Savage
- Department of Pathology, Medical College of Georgia, Augusta University , Augusta, GA, USA
| | - Paul M Dainer
- Department of Hematology/Oncology, Medical College of Georgia, Augusta University , Augusta, GA, USA
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210
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Bennett JM. Changes in the Updated 2016: WHO Classification of the Myelodysplastic Syndromes and Related Myeloid Neoplasms. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2016; 16:607-609. [DOI: 10.1016/j.clml.2016.08.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 07/09/2016] [Accepted: 08/02/2016] [Indexed: 11/25/2022]
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211
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Martín I, Such E, Navarro B, Vicente A, López-Pavía M, Ibáñez M, Tormo M, Villamón E, Gómez-Seguí I, Luna I, Oltra S, Pedrola L, Sanz MA, Cervera J, Sanz G. Negative impact on clinical outcome of the mutational co-occurrence ofSF3B1andDNMT3Ain refractory anemia with ring sideroblasts (RARS). Leuk Lymphoma 2016; 58:1686-1693. [DOI: 10.1080/10428194.2016.1246725] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Iván Martín
- Department of Hematology, University Hospital La Fe, Valencia, Spain
- Department of Genomics, University Hospital La Fe, Valencia, Spain
| | - Esperanza Such
- Department of Hematology, University Hospital La Fe, Valencia, Spain
| | - Blanca Navarro
- Department of Hematology, University Hospital Clinic, Valencia, Spain
| | - Ana Vicente
- Department of Hematology, Hospital de la Ribera, Alzira, Spain
| | - María López-Pavía
- Department of Hematology, University Hospital La Fe, Valencia, Spain
| | - Mariam Ibáñez
- Department of Hematology, University Hospital La Fe, Valencia, Spain
| | - Mar Tormo
- Department of Hematology, University Hospital Clinic, Valencia, Spain
| | - Eva Villamón
- Department of Hematology, University Hospital La Fe, Valencia, Spain
| | - Inés Gómez-Seguí
- Department of Hematology, University Hospital La Fe, Valencia, Spain
| | - Irene Luna
- Department of Hematology, University Hospital La Fe, Valencia, Spain
| | - Silvestre Oltra
- Department of Genetics, University Hospital La Fe, Valencia, Spain
| | - Laia Pedrola
- Department of Genomics, University Hospital La Fe, Valencia, Spain
| | - Miguel Angel Sanz
- Department of Hematology, University Hospital La Fe, Valencia, Spain
| | - Jose Cervera
- Department of Hematology, University Hospital La Fe, Valencia, Spain
- Department of Genetics, University Hospital La Fe, Valencia, Spain
| | - Guillermo Sanz
- Department of Hematology, University Hospital La Fe, Valencia, Spain
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212
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Ribeiro LB, De Paula EV. New developments in the understanding and diagnosis of myelodysplastic syndromes with ring sideroblasts. Rev Bras Hematol Hemoter 2016; 38:279-280. [PMID: 27863751 PMCID: PMC5119659 DOI: 10.1016/j.bjhh.2016.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 08/25/2016] [Indexed: 11/25/2022] Open
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213
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Obeng EA, Chappell RJ, Seiler M, Chen MC, Campagna DR, Schmidt PJ, Schneider RK, Lord AM, Wang L, Gambe RG, McConkey ME, Ali AM, Raza A, Yu L, Buonamici S, Smith PG, Mullally A, Wu CJ, Fleming MD, Ebert BL. Physiologic Expression of Sf3b1(K700E) Causes Impaired Erythropoiesis, Aberrant Splicing, and Sensitivity to Therapeutic Spliceosome Modulation. Cancer Cell 2016; 30:404-417. [PMID: 27622333 PMCID: PMC5023069 DOI: 10.1016/j.ccell.2016.08.006] [Citation(s) in RCA: 277] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 04/29/2016] [Accepted: 08/16/2016] [Indexed: 12/20/2022]
Abstract
More than 80% of patients with the refractory anemia with ring sideroblasts subtype of myelodysplastic syndrome (MDS) have mutations in Splicing Factor 3B, Subunit 1 (SF3B1). We generated a conditional knockin mouse model of the most common SF3B1 mutation, Sf3b1(K700E). Sf3b1(K700E) mice develop macrocytic anemia due to a terminal erythroid maturation defect, erythroid dysplasia, and long-term hematopoietic stem cell (LT-HSC) expansion. Sf3b1(K700E) myeloid progenitors and SF3B1-mutant MDS patient samples demonstrate aberrant 3' splice-site selection associated with increased nonsense-mediated decay. Tet2 loss cooperates with Sf3b1(K700E) to cause a more severe erythroid and LT-HSC phenotype. Furthermore, the spliceosome modulator, E7017, selectively kills SF3B1(K700E)-expressing cells. Thus, SF3B1(K700E) expression reflects the phenotype of the mutation in MDS and may be a therapeutic target in MDS.
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Affiliation(s)
- Esther A Obeng
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA; Division of Hematology/Oncology, Department of Medicine, Boston Children's Hospital, Boston, MA 02115, USA; Division of Hematology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Ryan J Chappell
- Division of Hematology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | | | - Michelle C Chen
- Division of Hematology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Dean R Campagna
- Department of Pathology, Boston Children's Hospital, Boston, MA 02115, USA
| | - Paul J Schmidt
- Department of Pathology, Boston Children's Hospital, Boston, MA 02115, USA
| | - Rebekka K Schneider
- Division of Hematology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Allegra M Lord
- Division of Hematology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Lili Wang
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA
| | - Rutendo G Gambe
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA
| | - Marie E McConkey
- Division of Hematology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Abdullah M Ali
- Division of Hematology/Oncology, Columbia University Medical Center, New York, NY 10027, USA
| | - Azra Raza
- Division of Hematology/Oncology, Columbia University Medical Center, New York, NY 10027, USA
| | - Lihua Yu
- H3 Biomedicine, Inc., Cambridge, MA 03129, USA
| | | | | | - Ann Mullally
- Division of Hematology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA; Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Catherine J Wu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA; Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Mark D Fleming
- Department of Pathology, Boston Children's Hospital, Boston, MA 02115, USA
| | - Benjamin L Ebert
- Division of Hematology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA; Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA.
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214
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de Necochea-Campion R, Shouse GP, Zhou Q, Mirshahidi S, Chen CS. Aberrant splicing and drug resistance in AML. J Hematol Oncol 2016; 9:85. [PMID: 27613060 PMCID: PMC5018179 DOI: 10.1186/s13045-016-0315-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 09/02/2016] [Indexed: 02/08/2023] Open
Abstract
The advent of next-generation sequencing technologies has unveiled a new window into the heterogeneity of acute myeloid leukemia (AML). In particular, recurrent mutations in spliceosome machinery and genome-wide aberrant splicing events have been recognized as a prominent component of this disease. This review will focus on how these factors influence drug resistance through altered splicing of tumor suppressor and oncogenes and dysregulation of the apoptotic signaling network. A better understanding of these factors in disease progression is necessary to design appropriate therapeutic strategies recognizing specific alternatively spliced or mutated oncogenic targets.
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Affiliation(s)
- Rosalia de Necochea-Campion
- Biospecimen Laboratory, Loma Linda University Cancer Center, Loma Linda University School of Medicine, Loma Linda, CA, 92354, USA
| | - Geoffrey P Shouse
- Division of Hematology/Oncology, Loma Linda University School of Medicine, 11175 Campus Street, Chan Shun Pavilion 11015, Loma Linda, CA, 92354, USA
| | - Qi Zhou
- Biospecimen Laboratory, Loma Linda University Cancer Center, Loma Linda University School of Medicine, Loma Linda, CA, 92354, USA
| | - Saied Mirshahidi
- Biospecimen Laboratory, Loma Linda University Cancer Center, Loma Linda University School of Medicine, Loma Linda, CA, 92354, USA
| | - Chien-Shing Chen
- Biospecimen Laboratory, Loma Linda University Cancer Center, Loma Linda University School of Medicine, Loma Linda, CA, 92354, USA. .,Division of Hematology/Oncology, Loma Linda University School of Medicine, 11175 Campus Street, Chan Shun Pavilion 11015, Loma Linda, CA, 92354, USA.
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215
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Abstract
Tumor-associated alterations in RNA splicing result either from mutations in splicing-regulatory elements or changes in components of the splicing machinery. This review summarizes our current understanding of the role of splicing-factor alterations in human cancers. We describe splicing-factor alterations detected in human tumors and the resulting changes in splicing, highlighting cell-type-specific similarities and differences. We review the mechanisms of splicing-factor regulation in normal and cancer cells. Finally, we summarize recent efforts to develop novel cancer therapies, based on targeting either the oncogenic splicing events or their upstream splicing regulators.
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Affiliation(s)
- Olga Anczuków
- Cold Spring Harbor Laboratory, Cold Spring Harbor, New York 11724, USA
| | - Adrian R Krainer
- Cold Spring Harbor Laboratory, Cold Spring Harbor, New York 11724, USA
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216
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Gidaro A, Deliliers GL, Gallipoli P, Arquati M, Wu MA, Castelli R. Laboratory and clinical risk assessment to treat myelodysplatic syndromes. ACTA ACUST UNITED AC 2016; 54:1411-26. [DOI: 10.1515/cclm-2015-0789] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 11/11/2015] [Indexed: 12/11/2022]
Abstract
Abstract
Myelodisplastic syndromes (MDS) are heterogeneous myeloid disorders characterized by peripheral cytopenias and increased risk of transformation into acute myelogenous leukemia (AML). MDS are generally suspected in the presence of cytopenia on routine analysis and the evaluation of bone marrow cells morphology and cellularity leads to correct diagnosis of MDS. The incidence of MDS is approximately five cases per 100,000 people per year in the general population, but it increases up to 50 cases per 100,000 people per year after 60 years of age. Typically MDS affect the elderly, with a median age at diagnosis of 65–70 years. Here the current therapeutic approaches for MDS are evaluated by searching the PubMed database. Establishing the prognosis in MDS patients is a key element of therapy. In fact an accurate estimate of prognosis drives decisions about the choice and timing of the therapeutic options. Therapy is selected based on prognostic risk assessment, cytogenetic pattern, transfusion needs and biological characteristics of the disease, comorbidities and clinical condition of the patients. In lower-risk patients the goals of therapy are different from those in higher-risk patients. In lower-risk patients, the aim of therapy is to reduce transfusion needs and transformation to higher risk disease or AML, improving the quality of life and survival. In higher-risk patients, the main goal of therapy is to prolong survival and to reduce the risk of AML transformation. Current therapies include growth factor support, lenalidomide, immunomodulatory and hypomethylating agents, intensive chemotherapy, and allogenic stem cell transplantation. The challenge when dealing with MDS patients is to select the optimal treatment by balancing efficacy and toxicity.
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217
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Integrating mutation variant allele frequency into clinical practice in myeloid malignancies. Hematol Oncol Stem Cell Ther 2016; 9:89-95. [DOI: 10.1016/j.hemonc.2016.04.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 02/29/2016] [Accepted: 04/25/2016] [Indexed: 02/07/2023] Open
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218
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Pellagatti A, Boultwood J. Splicing factor gene mutations in the myelodysplastic syndromes: impact on disease phenotype and therapeutic applications. Adv Biol Regul 2016; 63:59-70. [PMID: 27639445 DOI: 10.1016/j.jbior.2016.08.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 08/18/2016] [Accepted: 08/18/2016] [Indexed: 01/05/2023]
Abstract
Splicing factor gene mutations are the most frequent mutations found in patients with the myeloid malignancy myelodysplastic syndrome (MDS), suggesting that spliceosomal dysfunction plays a major role in disease pathogenesis. The aberrantly spliced target genes and deregulated cellular pathways associated with the commonly mutated splicing factor genes in MDS (SF3B1, SRSF2 and U2AF1) are being identified, illuminating the molecular mechanisms underlying MDS. Emerging data from mouse modeling studies indicate that the presence of splicing factor gene mutations can lead to bone marrow hematopoietic stem/myeloid progenitor cell expansion, impaired hematopoiesis and dysplastic differentiation that are hallmarks of MDS. Importantly, recent evidence suggests that spliceosome inhibitors and splicing modulators may have therapeutic value in the treatment of splicing factor mutant myeloid malignancies.
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Affiliation(s)
- Andrea Pellagatti
- Bloodwise Molecular Haematology Unit, Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford; NIHR Biomedical Research Centre, Oxford, UK.
| | - Jacqueline Boultwood
- Bloodwise Molecular Haematology Unit, Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford; NIHR Biomedical Research Centre, Oxford, UK.
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219
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Zeidan AM, Stahl M, Komrokji R. Emerging biological therapies for the treatment of myelodysplastic syndromes. Expert Opin Emerg Drugs 2016; 21:283-300. [DOI: 10.1080/14728214.2016.1220534] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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220
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The genomic landscape of myeloid neoplasms with myelodysplasia and its clinical implications. Curr Opin Oncol 2016; 27:551-9. [PMID: 26352542 DOI: 10.1097/cco.0000000000000229] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW This article will review the most recent advances in the understanding of the genetic basis of myeloid neoplasms with myelodysplasia and will discuss its clinical implications. RECENT FINDINGS Recurrent somatic mutations have been identified in about 90% of patients with myeloid neoplasms with myelodysplasia, involving genes of RNA splicing, DNA methylation, histone modification, transcription regulation, DNA repair, signal transduction, and cohesin complex. Somatic mutations are acquired in a linear manner in a multipotent hematopoietic stem cell, resulting in a growth advantage at the stem cell level and in defective differentiation and maturation of hematopoietic precursors. Recently, evidence has been provided of age-related hematopoietic clones, driven by mutations of genes recurrently mutated in myeloid neoplasms. These hematopoietic clones may represent either premalignant clones with the potential to progress to myeloid neoplasm or small malignant clones at a preclinical stage. SUMMARY The available evidence clearly indicates that greater understanding of the molecular basis of myeloid neoplasms with myelodysplasia has relevant implications in the classification of these disorders, as well as in predicting disease risk and response to specific treatment modalities, and may open avenues of research leading to novel therapeutic options and personalized treatment in the individual patient.
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221
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Malcovati L, Cazzola M. Recent advances in the understanding of myelodysplastic syndromes with ring sideroblasts. Br J Haematol 2016; 174:847-58. [PMID: 27391606 DOI: 10.1111/bjh.14215] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Myeloid neoplasms with ring sideroblasts are currently categorized within the myelodysplastic syndromes (MDS) or myelodysplastic/myeloproliferative neoplasms (MDS/MPN) in the World Health Organization classification. Recent findings have identified that the presence of ring sideroblasts in these disorders has a unique molecular basis, i.e., the somatic mutation of SF3B1, a gene encoding a splicing factor. Mutations of SF3B1 occur in up to 90% of patients with refractory anaemia with unilineage dysplasia (RARS) and 70% of those with refractory cytopenia with multilineage dysplasia and ring sideroblasts or RARS associated with marked thrombocytosis. Experimental evidence has shown that mutant SF3B1 results in the abnormal splicing of several genes, primarily due to misrecognition of 3' splice sites. The resulting aberrant mRNAs undergo nonsense-mediated mRNA decay (NMD), resulting in haploinsufficiency of canonical transcripts and protein expression. In addition, it is also possible that NMD-insensitive aberrant transcripts are translated into proteins with altered function. Patients with MDS carrying the SF3B1 mutation show a homogeneous disease phenotype characterized by isolated erythroid dysplasia and mild dysplasia in granulocytic or megakaryocytic lineages, supporting the notion that the SF3B1 mutation identifies a distinct entity within MDS. The available evidence suggests that these findings may have relevant impact on the diagnosis, classification and management of patients with these neoplasms.
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Affiliation(s)
- Luca Malcovati
- Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Department of Haematology Oncology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Mario Cazzola
- Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Department of Haematology Oncology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
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222
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Donaires FS, Martelli F, Alves-Paiva RDM, Magalhães SMM, Pinheiro RF, Calado RT. Splicing factor SF3B1 mutations and ring sideroblasts in myelodysplastic syndromes: a Brazilian cohort screening study. Rev Bras Hematol Hemoter 2016; 38:320-324. [PMID: 27863760 PMCID: PMC5119671 DOI: 10.1016/j.bjhh.2016.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 06/07/2016] [Accepted: 06/07/2016] [Indexed: 01/06/2023] Open
Abstract
Background Myelodysplastic syndromes (MDS) comprise a group of malignant clonal hematologic disorders characterized by ineffective hematopoiesis and propensity for progression to acute myeloid leukemia. Acquired mutations in the gene encoding RNA splicing factor 3B subunit 1 (SF3B1) are highly associated with the MDS subtypes presenting ring sideroblasts, and represent a specific nosological entity. The effects of these mutations on clinical outcomes are diverse and contrasting. Methods A cohort of 91 Brazilian MDS patients, including patients with ring sideroblasts in the bone marrow, were screened for mutations in the SF3B1 hotspots (exons 12–15) by direct Sanger sequencing. Results SF3B1 heterozygous mutations were identified in six patients (7%), all of them with ring sideroblasts, thus confirming the association between SF3B1 mutations and myelodysplastic syndrome subtypes bearing this morphologic feature (frequency of 6/13, p-value < 0.0001). Conclusion This is the first screening of SF3B1 mutations in a cohort of Brazilian myelodysplastic syndrome patients. Our findings confirm that mutations in this splicing gene correlate with bone marrow ringed sideroblasts.
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223
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Mutations of myelodysplastic syndromes (MDS): An update. MUTATION RESEARCH-REVIEWS IN MUTATION RESEARCH 2016; 769:47-62. [DOI: 10.1016/j.mrrev.2016.04.009] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 04/11/2016] [Indexed: 01/08/2023]
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224
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Santini V, Almeida A, Giagounidis A, Gröpper S, Jonasova A, Vey N, Mufti GJ, Buckstein R, Mittelman M, Platzbecker U, Shpilberg O, Ram R, Del Cañizo C, Gattermann N, Ozawa K, Risueño A, MacBeth KJ, Zhong J, Séguy F, Hoenekopp A, Beach CL, Fenaux P. Randomized Phase III Study of Lenalidomide Versus Placebo in RBC Transfusion-Dependent Patients With Lower-Risk Non-del(5q) Myelodysplastic Syndromes and Ineligible for or Refractory to Erythropoiesis-Stimulating Agents. J Clin Oncol 2016; 34:2988-96. [PMID: 27354480 DOI: 10.1200/jco.2015.66.0118] [Citation(s) in RCA: 163] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This international phase III, randomized, placebo-controlled, double-blind study assessed the efficacy and safety of lenalidomide in RBC transfusion-dependent patients with International Prognostic Scoring System lower-risk non-del(5q) myelodysplastic syndromes ineligible for or refractory to erythropoiesis-stimulating agents. PATIENTS AND METHODS In total, 239 patients were randomly assigned (2:1) to treatment with lenalidomide (n = 160) or placebo (n = 79) once per day (on 28-day cycles). The primary end point was the rate of RBC transfusion independence (TI) ≥ 8 weeks. Secondary end points were RBC-TI ≥ 24 weeks, duration of RBC-TI, erythroid response, health-related quality of life (HRQoL), and safety. RESULTS RBC-TI ≥ 8 weeks was achieved in 26.9% and 2.5% of patients in the lenalidomide and placebo groups, respectively (P < .001). Ninety percent of patients achieving RBC-TI responded within 16 weeks of treatment. Median duration of RBC-TI with lenalidomide was 30.9 weeks (95% CI, 20.7 to 59.1). Transfusion reduction of ≥ 4 units packed RBCs, on the basis of a 112-day assessment, was 21.8% in the lenalidomide group and 0% in the placebo group. Higher response rates were observed in patients with lower baseline endogenous erythropoietin ≤ 500 mU/mL (34.0% v 15.5% for > 500 mU/mL). At week 12, mean changes in HRQoL scores from baseline did not differ significantly between treatment groups, which suggests that lenalidomide did not adversely affect HRQoL. Achievement of RBC-TI ≥ 8 weeks was associated with significant improvements in HRQoL (P < .01). The most common treatment-emergent adverse events were neutropenia and thrombocytopenia. CONCLUSION Lenalidomide yields sustained RBC-TI in 26.9% of RBC transfusion-dependent patients with lower-risk non-del(5q) myelodysplastic syndromes ineligible for or refractory to erythropoiesis-stimulating agents. Response to lenalidomide was associated with improved HRQoL. Treatment-emergent adverse event data were consistent with the known safety profile of lenalidomide.
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Affiliation(s)
- Valeria Santini
- Valeria Santini, University of Florence, Florence, Italy; Antonio Almeida, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal; Aristoteles Giagounidis and Stefanie Gröpper, Marien Hospital Düsseldorf; Norbert Gattermann, Heinrich-Heine-Universität, Düsseldorf; Uwe Platzbecker, Technical University Dresden, Dresden, Germany; Anna Jonasova, Charles University General Hospital, Prague, Czech Republic; Norbert Vey, Centre Régional de Lutte Contre le Cancer, Marseille; Pierre Fenaux, Université Paris, Paris, France; Francis Séguy and Albert Hoenekopp, Celgene International, Boudry, Switzerland; Ghulam J. Mufti, King's College Hospital, London, United Kingdom; Rena Buckstein, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Moshe Mittelman and Ron Ram, Tel Aviv University; Ofer Shpilberg, Assuta Medical Center, Tel Aviv, Israel; Consuelo del Cañizo, Hospital Universitario de Salamanca, Salamanca; Alberto Risueño, Celgene Institute for Translational Research Europe, Seville, Spain; Keiya Ozawa, The University of Tokyo, Tokyo, Japan; Kyle J. MacBeth, Celgene Corporation, San Francisco, CA; and Jianhua Zhong and C.L. Beach, Celgene Corporation, Summit, NJ.
| | - Antonio Almeida
- Valeria Santini, University of Florence, Florence, Italy; Antonio Almeida, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal; Aristoteles Giagounidis and Stefanie Gröpper, Marien Hospital Düsseldorf; Norbert Gattermann, Heinrich-Heine-Universität, Düsseldorf; Uwe Platzbecker, Technical University Dresden, Dresden, Germany; Anna Jonasova, Charles University General Hospital, Prague, Czech Republic; Norbert Vey, Centre Régional de Lutte Contre le Cancer, Marseille; Pierre Fenaux, Université Paris, Paris, France; Francis Séguy and Albert Hoenekopp, Celgene International, Boudry, Switzerland; Ghulam J. Mufti, King's College Hospital, London, United Kingdom; Rena Buckstein, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Moshe Mittelman and Ron Ram, Tel Aviv University; Ofer Shpilberg, Assuta Medical Center, Tel Aviv, Israel; Consuelo del Cañizo, Hospital Universitario de Salamanca, Salamanca; Alberto Risueño, Celgene Institute for Translational Research Europe, Seville, Spain; Keiya Ozawa, The University of Tokyo, Tokyo, Japan; Kyle J. MacBeth, Celgene Corporation, San Francisco, CA; and Jianhua Zhong and C.L. Beach, Celgene Corporation, Summit, NJ
| | - Aristoteles Giagounidis
- Valeria Santini, University of Florence, Florence, Italy; Antonio Almeida, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal; Aristoteles Giagounidis and Stefanie Gröpper, Marien Hospital Düsseldorf; Norbert Gattermann, Heinrich-Heine-Universität, Düsseldorf; Uwe Platzbecker, Technical University Dresden, Dresden, Germany; Anna Jonasova, Charles University General Hospital, Prague, Czech Republic; Norbert Vey, Centre Régional de Lutte Contre le Cancer, Marseille; Pierre Fenaux, Université Paris, Paris, France; Francis Séguy and Albert Hoenekopp, Celgene International, Boudry, Switzerland; Ghulam J. Mufti, King's College Hospital, London, United Kingdom; Rena Buckstein, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Moshe Mittelman and Ron Ram, Tel Aviv University; Ofer Shpilberg, Assuta Medical Center, Tel Aviv, Israel; Consuelo del Cañizo, Hospital Universitario de Salamanca, Salamanca; Alberto Risueño, Celgene Institute for Translational Research Europe, Seville, Spain; Keiya Ozawa, The University of Tokyo, Tokyo, Japan; Kyle J. MacBeth, Celgene Corporation, San Francisco, CA; and Jianhua Zhong and C.L. Beach, Celgene Corporation, Summit, NJ
| | - Stefanie Gröpper
- Valeria Santini, University of Florence, Florence, Italy; Antonio Almeida, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal; Aristoteles Giagounidis and Stefanie Gröpper, Marien Hospital Düsseldorf; Norbert Gattermann, Heinrich-Heine-Universität, Düsseldorf; Uwe Platzbecker, Technical University Dresden, Dresden, Germany; Anna Jonasova, Charles University General Hospital, Prague, Czech Republic; Norbert Vey, Centre Régional de Lutte Contre le Cancer, Marseille; Pierre Fenaux, Université Paris, Paris, France; Francis Séguy and Albert Hoenekopp, Celgene International, Boudry, Switzerland; Ghulam J. Mufti, King's College Hospital, London, United Kingdom; Rena Buckstein, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Moshe Mittelman and Ron Ram, Tel Aviv University; Ofer Shpilberg, Assuta Medical Center, Tel Aviv, Israel; Consuelo del Cañizo, Hospital Universitario de Salamanca, Salamanca; Alberto Risueño, Celgene Institute for Translational Research Europe, Seville, Spain; Keiya Ozawa, The University of Tokyo, Tokyo, Japan; Kyle J. MacBeth, Celgene Corporation, San Francisco, CA; and Jianhua Zhong and C.L. Beach, Celgene Corporation, Summit, NJ
| | - Anna Jonasova
- Valeria Santini, University of Florence, Florence, Italy; Antonio Almeida, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal; Aristoteles Giagounidis and Stefanie Gröpper, Marien Hospital Düsseldorf; Norbert Gattermann, Heinrich-Heine-Universität, Düsseldorf; Uwe Platzbecker, Technical University Dresden, Dresden, Germany; Anna Jonasova, Charles University General Hospital, Prague, Czech Republic; Norbert Vey, Centre Régional de Lutte Contre le Cancer, Marseille; Pierre Fenaux, Université Paris, Paris, France; Francis Séguy and Albert Hoenekopp, Celgene International, Boudry, Switzerland; Ghulam J. Mufti, King's College Hospital, London, United Kingdom; Rena Buckstein, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Moshe Mittelman and Ron Ram, Tel Aviv University; Ofer Shpilberg, Assuta Medical Center, Tel Aviv, Israel; Consuelo del Cañizo, Hospital Universitario de Salamanca, Salamanca; Alberto Risueño, Celgene Institute for Translational Research Europe, Seville, Spain; Keiya Ozawa, The University of Tokyo, Tokyo, Japan; Kyle J. MacBeth, Celgene Corporation, San Francisco, CA; and Jianhua Zhong and C.L. Beach, Celgene Corporation, Summit, NJ
| | - Norbert Vey
- Valeria Santini, University of Florence, Florence, Italy; Antonio Almeida, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal; Aristoteles Giagounidis and Stefanie Gröpper, Marien Hospital Düsseldorf; Norbert Gattermann, Heinrich-Heine-Universität, Düsseldorf; Uwe Platzbecker, Technical University Dresden, Dresden, Germany; Anna Jonasova, Charles University General Hospital, Prague, Czech Republic; Norbert Vey, Centre Régional de Lutte Contre le Cancer, Marseille; Pierre Fenaux, Université Paris, Paris, France; Francis Séguy and Albert Hoenekopp, Celgene International, Boudry, Switzerland; Ghulam J. Mufti, King's College Hospital, London, United Kingdom; Rena Buckstein, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Moshe Mittelman and Ron Ram, Tel Aviv University; Ofer Shpilberg, Assuta Medical Center, Tel Aviv, Israel; Consuelo del Cañizo, Hospital Universitario de Salamanca, Salamanca; Alberto Risueño, Celgene Institute for Translational Research Europe, Seville, Spain; Keiya Ozawa, The University of Tokyo, Tokyo, Japan; Kyle J. MacBeth, Celgene Corporation, San Francisco, CA; and Jianhua Zhong and C.L. Beach, Celgene Corporation, Summit, NJ
| | - Ghulam J Mufti
- Valeria Santini, University of Florence, Florence, Italy; Antonio Almeida, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal; Aristoteles Giagounidis and Stefanie Gröpper, Marien Hospital Düsseldorf; Norbert Gattermann, Heinrich-Heine-Universität, Düsseldorf; Uwe Platzbecker, Technical University Dresden, Dresden, Germany; Anna Jonasova, Charles University General Hospital, Prague, Czech Republic; Norbert Vey, Centre Régional de Lutte Contre le Cancer, Marseille; Pierre Fenaux, Université Paris, Paris, France; Francis Séguy and Albert Hoenekopp, Celgene International, Boudry, Switzerland; Ghulam J. Mufti, King's College Hospital, London, United Kingdom; Rena Buckstein, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Moshe Mittelman and Ron Ram, Tel Aviv University; Ofer Shpilberg, Assuta Medical Center, Tel Aviv, Israel; Consuelo del Cañizo, Hospital Universitario de Salamanca, Salamanca; Alberto Risueño, Celgene Institute for Translational Research Europe, Seville, Spain; Keiya Ozawa, The University of Tokyo, Tokyo, Japan; Kyle J. MacBeth, Celgene Corporation, San Francisco, CA; and Jianhua Zhong and C.L. Beach, Celgene Corporation, Summit, NJ
| | - Rena Buckstein
- Valeria Santini, University of Florence, Florence, Italy; Antonio Almeida, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal; Aristoteles Giagounidis and Stefanie Gröpper, Marien Hospital Düsseldorf; Norbert Gattermann, Heinrich-Heine-Universität, Düsseldorf; Uwe Platzbecker, Technical University Dresden, Dresden, Germany; Anna Jonasova, Charles University General Hospital, Prague, Czech Republic; Norbert Vey, Centre Régional de Lutte Contre le Cancer, Marseille; Pierre Fenaux, Université Paris, Paris, France; Francis Séguy and Albert Hoenekopp, Celgene International, Boudry, Switzerland; Ghulam J. Mufti, King's College Hospital, London, United Kingdom; Rena Buckstein, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Moshe Mittelman and Ron Ram, Tel Aviv University; Ofer Shpilberg, Assuta Medical Center, Tel Aviv, Israel; Consuelo del Cañizo, Hospital Universitario de Salamanca, Salamanca; Alberto Risueño, Celgene Institute for Translational Research Europe, Seville, Spain; Keiya Ozawa, The University of Tokyo, Tokyo, Japan; Kyle J. MacBeth, Celgene Corporation, San Francisco, CA; and Jianhua Zhong and C.L. Beach, Celgene Corporation, Summit, NJ
| | - Moshe Mittelman
- Valeria Santini, University of Florence, Florence, Italy; Antonio Almeida, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal; Aristoteles Giagounidis and Stefanie Gröpper, Marien Hospital Düsseldorf; Norbert Gattermann, Heinrich-Heine-Universität, Düsseldorf; Uwe Platzbecker, Technical University Dresden, Dresden, Germany; Anna Jonasova, Charles University General Hospital, Prague, Czech Republic; Norbert Vey, Centre Régional de Lutte Contre le Cancer, Marseille; Pierre Fenaux, Université Paris, Paris, France; Francis Séguy and Albert Hoenekopp, Celgene International, Boudry, Switzerland; Ghulam J. Mufti, King's College Hospital, London, United Kingdom; Rena Buckstein, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Moshe Mittelman and Ron Ram, Tel Aviv University; Ofer Shpilberg, Assuta Medical Center, Tel Aviv, Israel; Consuelo del Cañizo, Hospital Universitario de Salamanca, Salamanca; Alberto Risueño, Celgene Institute for Translational Research Europe, Seville, Spain; Keiya Ozawa, The University of Tokyo, Tokyo, Japan; Kyle J. MacBeth, Celgene Corporation, San Francisco, CA; and Jianhua Zhong and C.L. Beach, Celgene Corporation, Summit, NJ
| | - Uwe Platzbecker
- Valeria Santini, University of Florence, Florence, Italy; Antonio Almeida, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal; Aristoteles Giagounidis and Stefanie Gröpper, Marien Hospital Düsseldorf; Norbert Gattermann, Heinrich-Heine-Universität, Düsseldorf; Uwe Platzbecker, Technical University Dresden, Dresden, Germany; Anna Jonasova, Charles University General Hospital, Prague, Czech Republic; Norbert Vey, Centre Régional de Lutte Contre le Cancer, Marseille; Pierre Fenaux, Université Paris, Paris, France; Francis Séguy and Albert Hoenekopp, Celgene International, Boudry, Switzerland; Ghulam J. Mufti, King's College Hospital, London, United Kingdom; Rena Buckstein, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Moshe Mittelman and Ron Ram, Tel Aviv University; Ofer Shpilberg, Assuta Medical Center, Tel Aviv, Israel; Consuelo del Cañizo, Hospital Universitario de Salamanca, Salamanca; Alberto Risueño, Celgene Institute for Translational Research Europe, Seville, Spain; Keiya Ozawa, The University of Tokyo, Tokyo, Japan; Kyle J. MacBeth, Celgene Corporation, San Francisco, CA; and Jianhua Zhong and C.L. Beach, Celgene Corporation, Summit, NJ
| | - Ofer Shpilberg
- Valeria Santini, University of Florence, Florence, Italy; Antonio Almeida, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal; Aristoteles Giagounidis and Stefanie Gröpper, Marien Hospital Düsseldorf; Norbert Gattermann, Heinrich-Heine-Universität, Düsseldorf; Uwe Platzbecker, Technical University Dresden, Dresden, Germany; Anna Jonasova, Charles University General Hospital, Prague, Czech Republic; Norbert Vey, Centre Régional de Lutte Contre le Cancer, Marseille; Pierre Fenaux, Université Paris, Paris, France; Francis Séguy and Albert Hoenekopp, Celgene International, Boudry, Switzerland; Ghulam J. Mufti, King's College Hospital, London, United Kingdom; Rena Buckstein, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Moshe Mittelman and Ron Ram, Tel Aviv University; Ofer Shpilberg, Assuta Medical Center, Tel Aviv, Israel; Consuelo del Cañizo, Hospital Universitario de Salamanca, Salamanca; Alberto Risueño, Celgene Institute for Translational Research Europe, Seville, Spain; Keiya Ozawa, The University of Tokyo, Tokyo, Japan; Kyle J. MacBeth, Celgene Corporation, San Francisco, CA; and Jianhua Zhong and C.L. Beach, Celgene Corporation, Summit, NJ
| | - Ron Ram
- Valeria Santini, University of Florence, Florence, Italy; Antonio Almeida, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal; Aristoteles Giagounidis and Stefanie Gröpper, Marien Hospital Düsseldorf; Norbert Gattermann, Heinrich-Heine-Universität, Düsseldorf; Uwe Platzbecker, Technical University Dresden, Dresden, Germany; Anna Jonasova, Charles University General Hospital, Prague, Czech Republic; Norbert Vey, Centre Régional de Lutte Contre le Cancer, Marseille; Pierre Fenaux, Université Paris, Paris, France; Francis Séguy and Albert Hoenekopp, Celgene International, Boudry, Switzerland; Ghulam J. Mufti, King's College Hospital, London, United Kingdom; Rena Buckstein, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Moshe Mittelman and Ron Ram, Tel Aviv University; Ofer Shpilberg, Assuta Medical Center, Tel Aviv, Israel; Consuelo del Cañizo, Hospital Universitario de Salamanca, Salamanca; Alberto Risueño, Celgene Institute for Translational Research Europe, Seville, Spain; Keiya Ozawa, The University of Tokyo, Tokyo, Japan; Kyle J. MacBeth, Celgene Corporation, San Francisco, CA; and Jianhua Zhong and C.L. Beach, Celgene Corporation, Summit, NJ
| | - Consuelo Del Cañizo
- Valeria Santini, University of Florence, Florence, Italy; Antonio Almeida, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal; Aristoteles Giagounidis and Stefanie Gröpper, Marien Hospital Düsseldorf; Norbert Gattermann, Heinrich-Heine-Universität, Düsseldorf; Uwe Platzbecker, Technical University Dresden, Dresden, Germany; Anna Jonasova, Charles University General Hospital, Prague, Czech Republic; Norbert Vey, Centre Régional de Lutte Contre le Cancer, Marseille; Pierre Fenaux, Université Paris, Paris, France; Francis Séguy and Albert Hoenekopp, Celgene International, Boudry, Switzerland; Ghulam J. Mufti, King's College Hospital, London, United Kingdom; Rena Buckstein, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Moshe Mittelman and Ron Ram, Tel Aviv University; Ofer Shpilberg, Assuta Medical Center, Tel Aviv, Israel; Consuelo del Cañizo, Hospital Universitario de Salamanca, Salamanca; Alberto Risueño, Celgene Institute for Translational Research Europe, Seville, Spain; Keiya Ozawa, The University of Tokyo, Tokyo, Japan; Kyle J. MacBeth, Celgene Corporation, San Francisco, CA; and Jianhua Zhong and C.L. Beach, Celgene Corporation, Summit, NJ
| | - Norbert Gattermann
- Valeria Santini, University of Florence, Florence, Italy; Antonio Almeida, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal; Aristoteles Giagounidis and Stefanie Gröpper, Marien Hospital Düsseldorf; Norbert Gattermann, Heinrich-Heine-Universität, Düsseldorf; Uwe Platzbecker, Technical University Dresden, Dresden, Germany; Anna Jonasova, Charles University General Hospital, Prague, Czech Republic; Norbert Vey, Centre Régional de Lutte Contre le Cancer, Marseille; Pierre Fenaux, Université Paris, Paris, France; Francis Séguy and Albert Hoenekopp, Celgene International, Boudry, Switzerland; Ghulam J. Mufti, King's College Hospital, London, United Kingdom; Rena Buckstein, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Moshe Mittelman and Ron Ram, Tel Aviv University; Ofer Shpilberg, Assuta Medical Center, Tel Aviv, Israel; Consuelo del Cañizo, Hospital Universitario de Salamanca, Salamanca; Alberto Risueño, Celgene Institute for Translational Research Europe, Seville, Spain; Keiya Ozawa, The University of Tokyo, Tokyo, Japan; Kyle J. MacBeth, Celgene Corporation, San Francisco, CA; and Jianhua Zhong and C.L. Beach, Celgene Corporation, Summit, NJ
| | - Keiya Ozawa
- Valeria Santini, University of Florence, Florence, Italy; Antonio Almeida, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal; Aristoteles Giagounidis and Stefanie Gröpper, Marien Hospital Düsseldorf; Norbert Gattermann, Heinrich-Heine-Universität, Düsseldorf; Uwe Platzbecker, Technical University Dresden, Dresden, Germany; Anna Jonasova, Charles University General Hospital, Prague, Czech Republic; Norbert Vey, Centre Régional de Lutte Contre le Cancer, Marseille; Pierre Fenaux, Université Paris, Paris, France; Francis Séguy and Albert Hoenekopp, Celgene International, Boudry, Switzerland; Ghulam J. Mufti, King's College Hospital, London, United Kingdom; Rena Buckstein, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Moshe Mittelman and Ron Ram, Tel Aviv University; Ofer Shpilberg, Assuta Medical Center, Tel Aviv, Israel; Consuelo del Cañizo, Hospital Universitario de Salamanca, Salamanca; Alberto Risueño, Celgene Institute for Translational Research Europe, Seville, Spain; Keiya Ozawa, The University of Tokyo, Tokyo, Japan; Kyle J. MacBeth, Celgene Corporation, San Francisco, CA; and Jianhua Zhong and C.L. Beach, Celgene Corporation, Summit, NJ
| | - Alberto Risueño
- Valeria Santini, University of Florence, Florence, Italy; Antonio Almeida, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal; Aristoteles Giagounidis and Stefanie Gröpper, Marien Hospital Düsseldorf; Norbert Gattermann, Heinrich-Heine-Universität, Düsseldorf; Uwe Platzbecker, Technical University Dresden, Dresden, Germany; Anna Jonasova, Charles University General Hospital, Prague, Czech Republic; Norbert Vey, Centre Régional de Lutte Contre le Cancer, Marseille; Pierre Fenaux, Université Paris, Paris, France; Francis Séguy and Albert Hoenekopp, Celgene International, Boudry, Switzerland; Ghulam J. Mufti, King's College Hospital, London, United Kingdom; Rena Buckstein, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Moshe Mittelman and Ron Ram, Tel Aviv University; Ofer Shpilberg, Assuta Medical Center, Tel Aviv, Israel; Consuelo del Cañizo, Hospital Universitario de Salamanca, Salamanca; Alberto Risueño, Celgene Institute for Translational Research Europe, Seville, Spain; Keiya Ozawa, The University of Tokyo, Tokyo, Japan; Kyle J. MacBeth, Celgene Corporation, San Francisco, CA; and Jianhua Zhong and C.L. Beach, Celgene Corporation, Summit, NJ
| | - Kyle J MacBeth
- Valeria Santini, University of Florence, Florence, Italy; Antonio Almeida, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal; Aristoteles Giagounidis and Stefanie Gröpper, Marien Hospital Düsseldorf; Norbert Gattermann, Heinrich-Heine-Universität, Düsseldorf; Uwe Platzbecker, Technical University Dresden, Dresden, Germany; Anna Jonasova, Charles University General Hospital, Prague, Czech Republic; Norbert Vey, Centre Régional de Lutte Contre le Cancer, Marseille; Pierre Fenaux, Université Paris, Paris, France; Francis Séguy and Albert Hoenekopp, Celgene International, Boudry, Switzerland; Ghulam J. Mufti, King's College Hospital, London, United Kingdom; Rena Buckstein, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Moshe Mittelman and Ron Ram, Tel Aviv University; Ofer Shpilberg, Assuta Medical Center, Tel Aviv, Israel; Consuelo del Cañizo, Hospital Universitario de Salamanca, Salamanca; Alberto Risueño, Celgene Institute for Translational Research Europe, Seville, Spain; Keiya Ozawa, The University of Tokyo, Tokyo, Japan; Kyle J. MacBeth, Celgene Corporation, San Francisco, CA; and Jianhua Zhong and C.L. Beach, Celgene Corporation, Summit, NJ
| | - Jianhua Zhong
- Valeria Santini, University of Florence, Florence, Italy; Antonio Almeida, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal; Aristoteles Giagounidis and Stefanie Gröpper, Marien Hospital Düsseldorf; Norbert Gattermann, Heinrich-Heine-Universität, Düsseldorf; Uwe Platzbecker, Technical University Dresden, Dresden, Germany; Anna Jonasova, Charles University General Hospital, Prague, Czech Republic; Norbert Vey, Centre Régional de Lutte Contre le Cancer, Marseille; Pierre Fenaux, Université Paris, Paris, France; Francis Séguy and Albert Hoenekopp, Celgene International, Boudry, Switzerland; Ghulam J. Mufti, King's College Hospital, London, United Kingdom; Rena Buckstein, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Moshe Mittelman and Ron Ram, Tel Aviv University; Ofer Shpilberg, Assuta Medical Center, Tel Aviv, Israel; Consuelo del Cañizo, Hospital Universitario de Salamanca, Salamanca; Alberto Risueño, Celgene Institute for Translational Research Europe, Seville, Spain; Keiya Ozawa, The University of Tokyo, Tokyo, Japan; Kyle J. MacBeth, Celgene Corporation, San Francisco, CA; and Jianhua Zhong and C.L. Beach, Celgene Corporation, Summit, NJ
| | - Francis Séguy
- Valeria Santini, University of Florence, Florence, Italy; Antonio Almeida, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal; Aristoteles Giagounidis and Stefanie Gröpper, Marien Hospital Düsseldorf; Norbert Gattermann, Heinrich-Heine-Universität, Düsseldorf; Uwe Platzbecker, Technical University Dresden, Dresden, Germany; Anna Jonasova, Charles University General Hospital, Prague, Czech Republic; Norbert Vey, Centre Régional de Lutte Contre le Cancer, Marseille; Pierre Fenaux, Université Paris, Paris, France; Francis Séguy and Albert Hoenekopp, Celgene International, Boudry, Switzerland; Ghulam J. Mufti, King's College Hospital, London, United Kingdom; Rena Buckstein, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Moshe Mittelman and Ron Ram, Tel Aviv University; Ofer Shpilberg, Assuta Medical Center, Tel Aviv, Israel; Consuelo del Cañizo, Hospital Universitario de Salamanca, Salamanca; Alberto Risueño, Celgene Institute for Translational Research Europe, Seville, Spain; Keiya Ozawa, The University of Tokyo, Tokyo, Japan; Kyle J. MacBeth, Celgene Corporation, San Francisco, CA; and Jianhua Zhong and C.L. Beach, Celgene Corporation, Summit, NJ
| | - Albert Hoenekopp
- Valeria Santini, University of Florence, Florence, Italy; Antonio Almeida, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal; Aristoteles Giagounidis and Stefanie Gröpper, Marien Hospital Düsseldorf; Norbert Gattermann, Heinrich-Heine-Universität, Düsseldorf; Uwe Platzbecker, Technical University Dresden, Dresden, Germany; Anna Jonasova, Charles University General Hospital, Prague, Czech Republic; Norbert Vey, Centre Régional de Lutte Contre le Cancer, Marseille; Pierre Fenaux, Université Paris, Paris, France; Francis Séguy and Albert Hoenekopp, Celgene International, Boudry, Switzerland; Ghulam J. Mufti, King's College Hospital, London, United Kingdom; Rena Buckstein, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Moshe Mittelman and Ron Ram, Tel Aviv University; Ofer Shpilberg, Assuta Medical Center, Tel Aviv, Israel; Consuelo del Cañizo, Hospital Universitario de Salamanca, Salamanca; Alberto Risueño, Celgene Institute for Translational Research Europe, Seville, Spain; Keiya Ozawa, The University of Tokyo, Tokyo, Japan; Kyle J. MacBeth, Celgene Corporation, San Francisco, CA; and Jianhua Zhong and C.L. Beach, Celgene Corporation, Summit, NJ
| | - C L Beach
- Valeria Santini, University of Florence, Florence, Italy; Antonio Almeida, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal; Aristoteles Giagounidis and Stefanie Gröpper, Marien Hospital Düsseldorf; Norbert Gattermann, Heinrich-Heine-Universität, Düsseldorf; Uwe Platzbecker, Technical University Dresden, Dresden, Germany; Anna Jonasova, Charles University General Hospital, Prague, Czech Republic; Norbert Vey, Centre Régional de Lutte Contre le Cancer, Marseille; Pierre Fenaux, Université Paris, Paris, France; Francis Séguy and Albert Hoenekopp, Celgene International, Boudry, Switzerland; Ghulam J. Mufti, King's College Hospital, London, United Kingdom; Rena Buckstein, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Moshe Mittelman and Ron Ram, Tel Aviv University; Ofer Shpilberg, Assuta Medical Center, Tel Aviv, Israel; Consuelo del Cañizo, Hospital Universitario de Salamanca, Salamanca; Alberto Risueño, Celgene Institute for Translational Research Europe, Seville, Spain; Keiya Ozawa, The University of Tokyo, Tokyo, Japan; Kyle J. MacBeth, Celgene Corporation, San Francisco, CA; and Jianhua Zhong and C.L. Beach, Celgene Corporation, Summit, NJ
| | - Pierre Fenaux
- Valeria Santini, University of Florence, Florence, Italy; Antonio Almeida, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal; Aristoteles Giagounidis and Stefanie Gröpper, Marien Hospital Düsseldorf; Norbert Gattermann, Heinrich-Heine-Universität, Düsseldorf; Uwe Platzbecker, Technical University Dresden, Dresden, Germany; Anna Jonasova, Charles University General Hospital, Prague, Czech Republic; Norbert Vey, Centre Régional de Lutte Contre le Cancer, Marseille; Pierre Fenaux, Université Paris, Paris, France; Francis Séguy and Albert Hoenekopp, Celgene International, Boudry, Switzerland; Ghulam J. Mufti, King's College Hospital, London, United Kingdom; Rena Buckstein, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Moshe Mittelman and Ron Ram, Tel Aviv University; Ofer Shpilberg, Assuta Medical Center, Tel Aviv, Israel; Consuelo del Cañizo, Hospital Universitario de Salamanca, Salamanca; Alberto Risueño, Celgene Institute for Translational Research Europe, Seville, Spain; Keiya Ozawa, The University of Tokyo, Tokyo, Japan; Kyle J. MacBeth, Celgene Corporation, San Francisco, CA; and Jianhua Zhong and C.L. Beach, Celgene Corporation, Summit, NJ
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Wu DH, Yao DM, Yang L, Ma JC, Wen XM, Yang J, Guo H, Li XX, Qian W, Lin J, Qian J. Hypomethylation of let-7a-3 is associated with poor prognosis in myelodysplastic syndrome. Leuk Lymphoma 2016; 58:96-103. [PMID: 27244225 DOI: 10.1080/10428194.2016.1187273] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Abnormal methylation of let-7a-3 has been found in various cancers and may consequently affect their survival. In this study, real-time quantitative methylation specific PCR (RQ-MSP) was used to determine the unmethylation level of let-7a-3 in 95 patients with myelodysplastic syndrome (MDS). The hypomethylation of let-7a-3 promoter was detected in 22 of 95 (23.2%) patients with MDS compared to 4.2% (1/24) of controls (p= 0.0419). Moreover, the frequency of let-7a-3 hypomethylation was higher in older patients (≥70 years) than in younger patients (<70 years). No significant difference was observed in distribution of WHO, IPSS, and cytogenetic classification. However, hypomethylated patients had significantly shorter overall survival than those without hypomethylation (p= 0.007). Moreover both Kaplan-Meier and Multivariate Cox analyses confirmed that let-7a-3 hypomethylation was an independent prognostic risk factor in cohorts of MDS patients with lower-risk disease. Our study suggested that let-7a-3 hypomethylation may predict poor outcome in MDS.
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Affiliation(s)
- De-Hong Wu
- a Department of Hematology , Affiliated People's Hospital of Jiangsu University , Zhenjiang , China.,c Department of Hematology , the Third People's Hospital of Kunshan City , Kunshan , China
| | - Dong-Ming Yao
- b Laboratory Center , Affiliated People's Hospital of Jiangsu University , Zhenjiang , China
| | - Lei Yang
- a Department of Hematology , Affiliated People's Hospital of Jiangsu University , Zhenjiang , China
| | - Ji-Chun Ma
- b Laboratory Center , Affiliated People's Hospital of Jiangsu University , Zhenjiang , China
| | - Xiang-Mei Wen
- b Laboratory Center , Affiliated People's Hospital of Jiangsu University , Zhenjiang , China
| | - Jing Yang
- a Department of Hematology , Affiliated People's Hospital of Jiangsu University , Zhenjiang , China
| | - Hong Guo
- b Laboratory Center , Affiliated People's Hospital of Jiangsu University , Zhenjiang , China
| | - Xi-Xi Li
- a Department of Hematology , Affiliated People's Hospital of Jiangsu University , Zhenjiang , China
| | - Wei Qian
- b Laboratory Center , Affiliated People's Hospital of Jiangsu University , Zhenjiang , China
| | - Jiang Lin
- b Laboratory Center , Affiliated People's Hospital of Jiangsu University , Zhenjiang , China
| | - Jun Qian
- a Department of Hematology , Affiliated People's Hospital of Jiangsu University , Zhenjiang , China
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226
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Zahid MF, Patnaik MM, Gangat N, Hashmi SK, Rizzieri DA. Insight into the molecular pathophysiology of myelodysplastic syndromes: targets for novel therapy. Eur J Haematol 2016; 97:313-20. [DOI: 10.1111/ejh.12771] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2016] [Indexed: 01/07/2023]
Affiliation(s)
| | - Mrinal M. Patnaik
- Division of Hematology; Mayo Clinic; Rochester MN USA
- Mayo Clinic Transplant Center; Blood and Marrow Transplant Program; Mayo Clinic; Rochester MN USA
| | | | - Shahrukh K. Hashmi
- Division of Hematology; Mayo Clinic; Rochester MN USA
- Mayo Clinic Transplant Center; Blood and Marrow Transplant Program; Mayo Clinic; Rochester MN USA
| | - David A. Rizzieri
- Division of Hematologic Malignancies & Cellular Therapy; Duke University Medical Center; Durham NC USA
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227
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Sutton LA, Young E, Baliakas P, Hadzidimitriou A, Moysiadis T, Plevova K, Rossi D, Kminkova J, Stalika E, Pedersen LB, Malcikova J, Agathangelidis A, Davis Z, Mansouri L, Scarfò L, Boudjoghra M, Navarro A, Muggen AF, Yan XJ, Nguyen-Khac F, Larrayoz M, Panagiotidis P, Chiorazzi N, Niemann CU, Belessi C, Campo E, Strefford JC, Langerak AW, Oscier D, Gaidano G, Pospisilova S, Davi F, Ghia P, Stamatopoulos K, Rosenquist R. Different spectra of recurrent gene mutations in subsets of chronic lymphocytic leukemia harboring stereotyped B-cell receptors. Haematologica 2016; 101:959-67. [PMID: 27198719 DOI: 10.3324/haematol.2016.141812] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 05/12/2016] [Indexed: 12/12/2022] Open
Abstract
We report on markedly different frequencies of genetic lesions within subsets of chronic lymphocytic leukemia patients carrying mutated or unmutated stereotyped B-cell receptor immunoglobulins in the largest cohort (n=565) studied for this purpose. By combining data on recurrent gene mutations (BIRC3, MYD88, NOTCH1, SF3B1 and TP53) and cytogenetic aberrations, we reveal a subset-biased acquisition of gene mutations. More specifically, the frequency of NOTCH1 mutations was found to be enriched in subsets expressing unmutated immunoglobulin genes, i.e. #1, #6, #8 and #59 (22-34%), often in association with trisomy 12, and was significantly different (P<0.001) to the frequency observed in subset #2 (4%, aggressive disease, variable somatic hypermutation status) and subset #4 (1%, indolent disease, mutated immunoglobulin genes). Interestingly, subsets harboring a high frequency of NOTCH1 mutations were found to carry few (if any) SF3B1 mutations. This starkly contrasts with subsets #2 and #3 where, despite their immunogenetic differences, SF3B1 mutations occurred in 45% and 46% of cases, respectively. In addition, mutations within TP53, whilst enriched in subset #1 (16%), were rare in subsets #2 and #8 (both 2%), despite all being clinically aggressive. All subsets were negative for MYD88 mutations, whereas BIRC3 mutations were infrequent. Collectively, this striking bias and skewed distribution of mutations and cytogenetic aberrations within specific chronic lymphocytic leukemia subsets implies that the mechanisms underlying clinical aggressiveness are not uniform, but rather support the existence of distinct genetic pathways of clonal evolution governed by a particular stereotyped B-cell receptor selecting a certain molecular lesion(s).
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Affiliation(s)
- Lesley-Ann Sutton
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Emma Young
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Panagiotis Baliakas
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | | | | | - Karla Plevova
- Central European Institute of Technology, Masaryk University and University Hospital Brno, Czech Republic
| | - Davide Rossi
- Division of Haematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Jana Kminkova
- Central European Institute of Technology, Masaryk University and University Hospital Brno, Czech Republic
| | | | | | - Jitka Malcikova
- Central European Institute of Technology, Masaryk University and University Hospital Brno, Czech Republic
| | - Andreas Agathangelidis
- Università Vita-Salute San Raffaele, Milan, Italy Division of Experimental Oncology and Department of Onco-Hematology, IRCCS, San Raffaele Scientific Institute, Milan, Italy
| | - Zadie Davis
- Department of Haematology, Royal Bournemouth Hospital, Bournemouth, UK
| | - Larry Mansouri
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Lydia Scarfò
- Università Vita-Salute San Raffaele, Milan, Italy Division of Experimental Oncology and Department of Onco-Hematology, IRCCS, San Raffaele Scientific Institute, Milan, Italy
| | - Myriam Boudjoghra
- Hematology Department and University Pierre et Marie Curie, Hopital Pitie-Salpetriere, Paris, France
| | - Alba Navarro
- Hematopathology Unit and Department of Hematology, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi iSunyer (IDIBAPS), Barcelona, Spain
| | - Alice F Muggen
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Xiao-Jie Yan
- The Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, New York, NY, USA
| | - Florence Nguyen-Khac
- Hematology Department and University Pierre et Marie Curie, Hopital Pitie-Salpetriere, Paris, France
| | - Marta Larrayoz
- Cancer Sciences, Faculty of Medicine, University of Southampton, UK
| | | | - Nicholas Chiorazzi
- The Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, New York, NY, USA
| | | | | | - Elias Campo
- Hematopathology Unit and Department of Hematology, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi iSunyer (IDIBAPS), Barcelona, Spain
| | | | - Anton W Langerak
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - David Oscier
- Department of Haematology, Royal Bournemouth Hospital, Bournemouth, UK
| | - Gianluca Gaidano
- Division of Haematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Sarka Pospisilova
- Central European Institute of Technology, Masaryk University and University Hospital Brno, Czech Republic
| | - Frederic Davi
- Hematology Department and University Pierre et Marie Curie, Hopital Pitie-Salpetriere, Paris, France
| | - Paolo Ghia
- Università Vita-Salute San Raffaele, Milan, Italy Division of Experimental Oncology and Department of Onco-Hematology, IRCCS, San Raffaele Scientific Institute, Milan, Italy
| | - Kostas Stamatopoulos
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden Institute of Applied Biosciences, CERTH, Thessaloniki, Greece Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - Richard Rosenquist
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
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Geyer JT, Orazi A. Myeloproliferative neoplasms (BCR-ABL1 negative) and myelodysplastic/myeloproliferative neoplasms: current diagnostic principles and upcoming updates. Int J Lab Hematol 2016; 38 Suppl 1:12-9. [PMID: 27161873 DOI: 10.1111/ijlh.12509] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 05/04/2016] [Indexed: 01/24/2023]
Abstract
Since the publication of the latest World Health Organization (WHO) classification in 2008, there has been a significant effort for clarification of unresolved questions, especially with the help of the rapidly developing field of molecular genetic studies, next-generation sequencing in particular. Numerous entities within the WHO categories of myeloproliferative neoplasms (MPNs) and myelodysplastic (MDS)/MPNs have been extensively studied, with large published series attempting to characterize and better define their morphologic and molecular genetic features. This emerging genetic landscape maintains a robust correlation with the various disease entities recognized by the WHO classification scheme based on a careful integration of detailed clinical information, bone marrow and peripheral blood morphology, immunohistology, and genomics. This brief review summarizes the current guidelines as they apply to diagnosing both the classical BCR-ABL1 negative MPN (polycythemia vera, essential thrombocythemia, and primary myelofibrosis) and the more common subtypes of MDS/MPN overlap syndromes. The more important recent molecular updates as well as the upcoming changes to the current WHO classification, expected to be published in late 2016, will also be briefly reviewed.
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Affiliation(s)
- J T Geyer
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
| | - A Orazi
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
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The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood 2016; 127:2391-405. [PMID: 27069254 DOI: 10.1182/blood-2016-03-643544] [Citation(s) in RCA: 6168] [Impact Index Per Article: 771.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 04/06/2016] [Indexed: 02/06/2023] Open
Abstract
The World Health Organization (WHO) classification of tumors of the hematopoietic and lymphoid tissues was last updated in 2008. Since then, there have been numerous advances in the identification of unique biomarkers associated with some myeloid neoplasms and acute leukemias, largely derived from gene expression analysis and next-generation sequencing that can significantly improve the diagnostic criteria as well as the prognostic relevance of entities currently included in the WHO classification and that also suggest new entities that should be added. Therefore, there is a clear need for a revision to the current classification. The revisions to the categories of myeloid neoplasms and acute leukemia will be published in a monograph in 2016 and reflect a consensus of opinion of hematopathologists, hematologists, oncologists, and geneticists. The 2016 edition represents a revision of the prior classification rather than an entirely new classification and attempts to incorporate new clinical, prognostic, morphologic, immunophenotypic, and genetic data that have emerged since the last edition. The major changes in the classification and their rationale are presented here.
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230
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Reinig E, Yang F, Traer E, Arora R, Brown S, Rattray R, Braziel R, Fan G, Press R, Dunlap J. Targeted Next-Generation Sequencing in Myelodysplastic Syndrome and Chronic Myelomonocytic Leukemia Aids Diagnosis in Challenging Cases and Identifies Frequent Spliceosome Mutations in Transformed Acute Myeloid Leukemia. Am J Clin Pathol 2016; 145:497-506. [PMID: 27124934 DOI: 10.1093/ajcp/aqw016] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Optimal integration of next-generation sequencing (NGS) into clinical practice in hematologic malignancies remains unclear. We evaluate the utility of NGS in myeloid malignancies. METHODS A 42-gene panel was used to sequence 109 cases of myelodysplastic syndrome (MDS, n = 38), chronic myelomonocytic leukemia (CMML, n = 14), myeloproliferative neoplasm (MPN, n = 24), and MDS and/or MPN transformed to acute myeloid leukemia (AML, n = 33). RESULTS At least one pathogenic mutation was identified in 74% of cases of MDS, 100% of CMMLs, and 96% of MPNs. In contrast, only 47% of cases of MDS (18/38) and 7% (1/14) of CMMLs exhibited abnormal cytogenetics. In diagnostically difficult cases of MDS or CMML with normal cytogenetics, NGS identified a pathogenic mutation and was critical in establishing the correct diagnosis. Spliceosomal genes and epigenetic modifiers were frequently mutated. Spliceosome mutations were also frequently detected in AML arising from MDS, CMML, or MPN (39%) compared with the reported rate in de novo AML (7%-14%). CONCLUSIONS In difficult cases of MDS or MPN, NGS facilitates diagnosis by detection of gene mutations to confirm clonality, and AMLs evolving from MDS or MPN carry frequent mutations in spliceosomal genes.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Child
- Child, Preschool
- DNA Mutational Analysis/methods
- Female
- High-Throughput Nucleotide Sequencing/methods
- Humans
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myelomonocytic, Chronic/diagnosis
- Leukemia, Myelomonocytic, Chronic/genetics
- Male
- Middle Aged
- Mutation
- Myelodysplastic Syndromes/diagnosis
- Myelodysplastic Syndromes/genetics
- Spliceosomes
- Young Adult
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Affiliation(s)
| | | | - Elie Traer
- Knight Cancer Institute, Division of Hematology & Medical Oncology, Oregon Health & Science University, Portland
| | - Ranjana Arora
- From the Department of Pathology, Knight Cancer Institute
| | - Shari Brown
- From the Department of Pathology, Knight Cancer Institute
| | | | - Rita Braziel
- From the Department of Pathology, Knight Cancer Institute
| | - Guang Fan
- From the Department of Pathology, Knight Cancer Institute
| | - Richard Press
- From the Department of Pathology, Knight Cancer Institute
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231
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Zhu Y, Li X, Chang C, Xu F, He Q, Guo J, Tao Y, Liu Y, Liu L, Shi W. SF3B1-mutated myelodysplastic syndrome with ring sideroblasts harbors more severe iron overload and corresponding over-erythropoiesis. Leuk Res 2016; 44:8-16. [PMID: 26970172 DOI: 10.1016/j.leukres.2016.02.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 01/15/2016] [Accepted: 02/25/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To clarify the possible biological differences and implication of the SF3B1 gene for patients with MDS-RS (myelodysplastic syndromes with ring sideroblasts). METHODS Sanger sequencing was performed on mutation hotspots of the SF3B1 gene in MDS-RS patients. The differences between the SF3B1 mutated and wild-type subsets, including the ultrastructure of erythroid precursors, iron profile parameters, erythropoiesis-related measurements, as well as clinical features, were analyzed. RESULTS SF3B1 mutations were detected in 33 out of fifty-two MDS-RS patients (63%). The vast majority of patients with mutations (94%) were categorized in the lower risk group according to the IPSS (International Prognostic Scoring System), in contrast to only fifty-eight percent of the wild-type cases. In addition to the notably higher percentages of erythroblasts and ring sideroblasts in patients with mutations, abundant electron-dense granules in the mitochondria of the erythroid precursors were clearly observed. Moreover, patients with mutations presented both improper iron uptake and distribution (lower serum hepcidin-25 concentration, P=0.028) and enhanced erythropoietic activity (higher soluble transferrin receptor level, P=0.132; higher growth differentiation factor 15 concentration, P<0.001). Finally, MDS-RS patients carrying SF3B1 mutations had a better overall survival (median 38 vs. 18 months, P=0.001) compared to those without mutations. By multivariable analysis, the prognostic significance of the SF3B1 mutation was primarily accounted for by IPSS risk categorization. CONCLUSION MDS-RS patients carrying SF3B1 mutations harbored a more severe iron overload and corresponding over-erythropoiesis. The better overall survival of SF3B1-mutated MDS-RS patients may be mainly due to the clustering of patients with lower risk disease in this group.
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Affiliation(s)
- Yang Zhu
- Department of Haematology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xiao Li
- Department of Haematology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
| | - Chunkang Chang
- Department of Haematology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Feng Xu
- Department of Haematology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Qi He
- Department of Haematology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Juan Guo
- Department of Haematology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Ying Tao
- Department of Haematology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yizhi Liu
- Department of Haematology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Li Liu
- Department of Haematology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Wenhui Shi
- Department of Haematology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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232
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Abstract
Although high-dose chemotherapy may cure a small subset of patients with myelodysplastic syndrome (MDS), allogeneic hematopoietic cell transplantation (HCT) is the only currently available modality that is curative in a large proportion of patients. Approximately 30% to 40% of patients with high-risk MDS and 60% to 80% of patients with low-risk MDS survive long-term in remission. Disease classification and risk assessment schemes, such as the World Health Organization (WHO) Prognostic Scoring System (WPSS), the Revised International Prognostic Scoring System (IPSS-R), and patient characteristics as assessed by the HCT Comorbidity Index (HCT-CI) or other scores, provide guidance for patient management. First, by defining the prognosis of patients without HCT, these tools help physicians decide who should and who should not be transplanted. Second, they predict at least in part how successful a transplant is likely to be. Pretransplant cytogenetics and marrow myeloblast count are the strongest risk factors for post-transplant relapse. The HCT-CI allows physicians to estimate the probability of nonrelapse mortality after HCT; recent data suggest that there is also a relationship to the development of graft-versus-host disease (GVHD). In general, the emphasis has shifted from high-dose therapy, aimed at maximum tumor-cell kill, to reduced-intensity conditioning (RIC), relying on the donor cell-mediated graft-versus-tumor (GVT) effects to eradicate the disease. GVT effects are most prominent in patients who also develop GVHD, especially chronic GVHD. Thus, ongoing work is directed at reducing GVHD while maintaining potent GVT effects and at exploiting the growing knowledge of somatic mutations for the development of targeted therapies.
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Affiliation(s)
- H Joachim Deeg
- From the Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA
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233
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Tan SY, Smeets MF, Chalk AM, Nandurkar H, Walkley CR, Purton LE, Wall M. Insights into myelodysplastic syndromes from current preclinical models. World J Hematol 2016; 5:1-22. [DOI: 10.5315/wjh.v5.i1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 11/17/2015] [Accepted: 12/14/2015] [Indexed: 02/05/2023] Open
Abstract
In recent years, there has been significant progress made in our understanding of the molecular genetics of myelodysplastic syndromes (MDS). Using massively parallel sequencing techniques, recurring mutations are identified in up to 80% of MDS cases, including many with a normal karyotype. The differential role of some of these mutations in the initiation and progression of MDS is starting to be elucidated. Engineering candidate genes in mice to model MDS has contributed to recent insights into this complex disease. In this review, we examine currently available mouse models, with detailed discussion of selected models. Finally, we highlight some advances made in our understanding of MDS biology, and conclude with discussions of questions that remain unanswered.
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234
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Genomic landscape of megakaryopoiesis and platelet function defects. Blood 2016; 127:1249-59. [PMID: 26787733 DOI: 10.1182/blood-2015-07-607952] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 01/05/2016] [Indexed: 12/17/2022] Open
Abstract
Megakaryopoiesis is a complex, stepwise process that takes place largely in the bone marrow. At the apex of the hierarchy, hematopoietic stem cells undergo a number of lineage commitment decisions that ultimately lead to the production of polyploid megakaryocytes. On average, megakaryocytes release 10(11) platelets per day into the blood that repair vascular injuries and prevent excessive bleeding. This differentiation process is tightly controlled by exogenous and endogenous factors, which have been the topics of intense research in the hematopoietic field. Indeed, a skewing of megakaryocyte commitment and differentiation may entail the onset of myeloproliferative neoplasms and other preleukemic disorders together with acute megakaryoblastic leukemia, whereas quantitative or qualitative defects in platelet production can lead to inherited platelet disorders. The recent advent of next-generation sequencing has prompted mapping of the genomic landscape of these conditions to provide an accurate view of the underlying lesions. The aims of this review are to introduce the physiological pathways of megakaryopoiesis and to present landmark studies on acquired and inherited disorders that target them. These studies have not only introduced a new era in the fields of molecular medicine and targeted therapies but may also provide us with a better understanding of the mechanisms underlying normal megakaryopoiesis and thrombopoiesis that can inform efforts to create alternative sources of megakaryocytes and platelets.
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235
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Küsters-Vandevelde HVN, Creytens D, Grunsven ACHVEV, Jeunink M, Winnepenninckx V, Groenen PJTA, Küsters B, Wesseling P, Blokx WAM, Prinsen CFM. SF3B1 and EIF1AX mutations occur in primary leptomeningeal melanocytic neoplasms; yet another similarity to uveal melanomas. Acta Neuropathol Commun 2016; 4:5. [PMID: 26769193 PMCID: PMC4714515 DOI: 10.1186/s40478-016-0272-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 01/04/2016] [Indexed: 01/25/2023] Open
Abstract
Introduction Like uveal melanomas, primary leptomeningeal melanocytic neoplasms (LMNs) frequently carry GNAQ and GNA11 mutations. However, it is currently unknown whether these LMNs harbor mutations in BAP1, SF3B1 and/or EIF1AX like uveal melanomas as well. In this study, we used Sanger sequencing for the detection of mutations in SF3B1 (hotspots in exon 14 and 15) and EIF1AX (exon 1 and 2 and flanking intronic regions) in a series of 24 primary LMNs. Additionally, BAP1 immunohistochemistry was used as a surrogate marker for the detection of inactivating mutations in the BAP1 gene. Results Mutations in either SF3B1 or EIF1AX were identified in 8 out of 24 primary LMNs (33 %). The presence of these mutations was mutually exclusive and occurred in primary LMNs of different malignancy grades (melanocytomas, intermediate-grade melanocytic tumors, melanomas). Complete absence of nuclear BAP1 staining as is typically seen in BAP1-mutated tumors was not observed. Conclusions Our finding that an SF3B1 or EIF1AX mutation is present in a substantial subset of primary LMNs underscores that these tumors genetically resemble uveal melanoma and are different from cutaneous melanoma at the genetic level. This information may not only aid in the differential diagnosis of primary versus metastatic melanocytic tumor in/around the central nervous system, but also in the identification of more promising therapeutic approaches targeting the molecular pathways involved in the oncogenesis of LMNs. As none of the primary LMNs in our series showed complete loss of nuclear BAP1 protein, it is unlikely that BAP1 mutations are frequent in these tumors but the role of this gene warrants further investigation.
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236
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Lee EJ, Podoltsev N, Gore SD, Zeidan AM. The evolving field of prognostication and risk stratification in MDS: Recent developments and future directions. Blood Rev 2016; 30:1-10. [DOI: 10.1016/j.blre.2015.06.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 06/08/2015] [Accepted: 06/15/2015] [Indexed: 01/01/2023]
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237
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Abstract
Myelodysplastic syndrome (MDS) encompasses a heterogeneous group of diseases originating in hematopoietic stem cells and is characterized by inefficient hematopoiesis and dysplastic changes in the bone marrow. In peripheral blood patients show anemia (mostly macrocytic), frequently accompanied by neutropenia and thrombocytopenia. Thus, clinically the patients suffer from fatigue (anemia), increased bleeding (thrombocytopenia) and infectious complications (neutropenia). Approximately one quarter of MDS patients develop acute myeloid leukemia (AML) in the course of the disease, which is characterized by a 20 % or more increase of blasts in the bone marrow. The estimated overall survival as well as the risk for AML transformation can be calculated with the international prognostic scoring system (IPSS) as well as the revised IPSS score (IPSS-R). Novel sequencing methods (e.g. next generation sequencing) allow the detection of recurrent gene mutations in MDS patients. Genes of the splicing machinery as well as genes involved in epigenetic regulation (e.g. ASXL1 and TET2) are most frequently mutated in MDS. Therapy is selected based on the patient risk profile (IPSS). Allogeneic stem cell transplantation is a curative approach for high risk patients (i.e. IPSS int-2 and higher) with a good performance status and a biological age below 70 years. Otherwise, high risk patients are treated with demethylating agents (e.g. decitabine and azacitidine). Low risk patients (IPSS low and int-1) mainly receive supportive therapy including iron chelation. An exceptional position is presented by MDS with an isolated 5q deletion as it can be treated with lenalidomide with good success. Enrolling patients in clinical trials is strongly recommended to improve the prospects of this disease.
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Affiliation(s)
- F Thol
- Klinik für Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland,
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238
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Diagnosis and treatment of sideroblastic anemias: from defective heme synthesis to abnormal RNA splicing. Hematology 2015; 2015:19-25. [DOI: 10.1182/asheducation-2015.1.19] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
AbstractThe sideroblastic anemias are a heterogeneous group of inherited and acquired disorders characterized by the presence of ring sideroblasts in the bone marrow. X-linked sideroblastic anemia (XLSA) is caused by germline mutations in ALAS2. Hemizygous males have a hypochromic microcytic anemia, which is generally mild to moderate and is caused by defective heme synthesis and ineffective erythropoiesis. XLSA is a typical iron-loading anemia; although most patients are responsive to pyridoxine, treatment of iron overload is also important in the management of these patients. Autosomal recessive sideroblastic anemia attributable to mutations in SLC25A38, a member of the mitochondrial carrier family, is a severe disease: patients present in infancy with microcytic anemia, which soon becomes transfusion dependent. Conservative therapy includes regular red cell transfusion and iron chelation, whereas allogenic stem cell transplantation represents the only curative treatment. Refractory anemia with ring sideroblasts (RARS) is a myelodysplastic syndrome characterized mainly by anemia attributable to ineffective erythropoiesis. The clinical course of RARS is generally indolent, but there is a tendency to worsening of anemia over time, so that most patients become transfusion dependent in the long run. More than 90% of these patients carry somatic mutations in SF3B1, a gene encoding a core component of the RNA splicing machinery. These mutations cause misrecognition of 3′ splice sites in downstream genes, resulting in truncated gene products and/or decreased expression attributable to nonsense-mediated RNA decay; this explains the multifactorial pathogenesis of RARS. Variants of RARS include refractory cytopenia with multilineage dysplasia and ring sideroblasts, and RARS associated with marked thrombocytosis; these variants involve additional genetic lesions. Inhibitors of molecules of the transforming growth factor-β superfamily have been shown recently to target ineffective erythropoiesis and ameliorate anemia both in animal models of myelodysplastic syndrome and in RARS patients.
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239
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The shadowlands of MDS: idiopathic cytopenias of undetermined significance (ICUS) and clonal hematopoiesis of indeterminate potential (CHIP). Hematology 2015; 2015:299-307. [DOI: 10.1182/asheducation-2015.1.299] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
AbstractThe WHO classification provides the best diagnostic approach to myelodysplastic syndromes (MDS). However, biologic and analytic limitations have emerged in the criteria currently adopted to establish the diagnosis and to classify MDS. The provisional category of idiopathic cytopenia of undetermined significance (ICUS) has been proposed to describe patients in whom MDS is possible but not proven. To formulate a diagnosis of ICUS, a thorough diagnostic work-up is required and repeated tests should be performed to reach a conclusive diagnosis. Recent studies provided consistent evidence of age-related hematopoietic clones (clonal hematopoiesis of indeterminate potential; CHIP), driven by mutations of genes that are recurrently mutated in myeloid neoplasms and associated with increase in the risk of hematologic cancer. A subset of mutated genes, mainly involved in epigenetic regulation, are likely initiating lesions driving the expansion of a premalignant clone. However, in a fraction of subjects the detected clone may be a small malignant clone expanding under the drive of the detected and additional undetected mutations. In addition, several experimental evidences suggest the potential relevance of an abnormal bone marrow environment in the selection and evolution of hematopoietic clones in MDS. The spreading of massively parallel sequencing techniques is offering translational opportunities in the clinical approach to myeloid neoplasms. Although several issues remain to be clarified, targeted gene sequencing may be of potential value in the dissection between clonal myelodysplasia, nonclonal cytopenia, and clonal hematopoiesis arising upon aging or in the context of acquired marrow failure.
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240
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Effect of lenalidomide treatment on clonal architecture of myelodysplastic syndromes without 5q deletion. Blood 2015; 127:749-60. [PMID: 26626993 DOI: 10.1182/blood-2015-04-640128] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 11/17/2015] [Indexed: 12/22/2022] Open
Abstract
Non-del(5q) transfusion-dependent low/intermediate-1 myelodysplastic syndrome (MDS) patients achieve an erythroid response with lenalidomide in 25% of cases. Addition of an erythropoiesis-stimulating agent could improve response rate. The impact of recurrent somatic mutations identified in the diseased clone in response to lenalidomide and the drug's effects on clonal evolution remain unknown. We investigated recurrent mutations by next-generation sequencing in 94 non-del(5q) MDS patients randomized in the GFM-Len-Epo-08 clinical trial to lenalidomide or lenalidomide plus epoetin β. Clonal evolution was analyzed after 4 cycles of treatment in 42 cases and reanalyzed at later time points in 18 cases. The fate of clonal architecture of single CD34(+)CD38(-) hematopoietic stem cells was also determined in 5 cases. Mutation frequency was >10%: SF3B1 (74.5%), TET2 (45.7%), DNMT3A (20.2%), and ASXL1 (19.1%). Analysis of variant allele frequencies indicated a decrease of major mutations in 15 of 20 responders compared with 10 of 22 nonresponders after 4 cycles. The decrease in the variant allele frequency of major mutations was more significant in responders than in nonresponders (P < .001). Genotyping of single CD34(+)CD38(-) cell-derived colonies showed that the decrease in the size of dominant subclones could be associated with the rise of founding clones or of hematopoietic stem cells devoid of recurrent mutations. These effects remained transient, and disease escape was associated with the re-emergence of the dominant subclones. In conclusion, we show that, although the drug initially modulates the distribution of subclones, loss of treatment efficacy coincides with the re-expansion of the dominant subclone. This trial was registered at www.clinicaltrials.gov as #NCT01718379.
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241
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SF3B1 and IGHV gene mutation status predict poor prognosis in Japanese CLL patients. Int J Hematol 2015; 103:219-26. [DOI: 10.1007/s12185-015-1912-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 11/12/2015] [Accepted: 11/12/2015] [Indexed: 11/24/2022]
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242
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Impact of TP53 mutation variant allele frequency on phenotype and outcomes in myelodysplastic syndromes. Leukemia 2015; 30:666-73. [PMID: 26514544 DOI: 10.1038/leu.2015.304] [Citation(s) in RCA: 158] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 10/09/2015] [Accepted: 10/13/2015] [Indexed: 12/31/2022]
Abstract
Although next-generation sequencing has allowed for the detection of somatic mutations in myelodysplastic syndromes (MDS), the clinical relevance of variant allele frequency (VAF) for the majority of mutations is unknown. We profiled TP53 and 20 additional genes in our training set of 219 patients with MDS or secondary acute myeloid leukemia with findings confirmed in a validation cohort. When parsed by VAF, TP53 VAF predicted for complex cytogenetics in both the training (P=0.001) and validation set (P<0.0001). MDS patients with a TP53 VAF > 40% had a median overall survival (OS) of 124 days versus an OS that was not reached in patients with VAF <20% (hazard ratio (HR), 3.52; P=0.01) with validation in an independent cohort (HR, 4.94, P=0.01). TP53 VAF further stratified distinct prognostic groups independent of clinical prognostic scoring systems (P=0.0005). In multivariate analysis, only a TP53 VAF >40% was an independent covariate (HR, 1.61; P<0.0001). In addition, SRSF2 VAF predicted for monocytosis (P=0.003), RUNX1 VAF with thrombocytopenia (P=0.01) and SF3B1 with ringed sideroblasts (P=0.001). Together, our study indicates that VAF should be incorporated in patient management and risk stratification in MDS.
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243
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Wu L, Song L, Xu L, Chang C, Xu F, Wu D, He Q, Su J, Zhou L, Xiao C, Zhang Z, Zhao Y, Chen S, Li X. Genetic landscape of recurrent ASXL1, U2AF1, SF3B1, SRSF2, and EZH2 mutations in 304 Chinese patients with myelodysplastic syndromes. Tumour Biol 2015; 37:4633-40. [PMID: 26508027 DOI: 10.1007/s13277-015-4305-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 10/20/2015] [Indexed: 12/21/2022] Open
Abstract
We determined the biological and prognostic significance of five recurrent genetic aberrations in Chinese patients with myelodysplastic syndromes (MDS). A total of 304 Chinese MDS patients were screened for known mutations in five genes (ASXL1, U2AF1, SF3B1, SRSF2, and EZH2) using next-generation sequencing. Of these, 97 patients (31.9 %) harbored at least one mutation in the five genes, and patients harboring these mutations had distinct clinical features. Incidence ratios for mutations in ASXL1, U2AF1, SF3B1, SRSF2, and EZH2 were 11.8, 8.6, 8.2, 4.3, and 3.6 %, respectively. Patients with U2AF1, SRSF2, and EZH2 mutations more commonly had high-risk than low-risk subtypes, while SF3B1 mutations were frequently confirmed in MDS subtypes with increased ring sideroblasts. Cases with ASXL1 mutations had a higher percentage of complex karyotypes, while U2AF1 mutations were more common in patients with trisomy 8 or 20q deletions. Notably, among 124 patients with a normal karyotype, 48 (38.7 %) had at least one mutation. Patients with U2AF1 or SRSF2 mutations had significantly shorter overall survival (OS) times compared with patients without these mutations (U2AF1 mutations: median OS, 18 vs 54 months, p = 0.032; SRSF2 mutations: median OS 11 vs 54 months, p = 0.005, respectively). Multivariate analysis showed that the presence of SRSF2 mutations was an independent unfavorable prognostic factor for OS (hazard ratio 2.039; 95 % confidence interval 1.040-4.000; p = 0.038). These data suggest that mutations in epigenetic modification and splicesome genes are common in Chinese patients with MDS, while mutations in U2AF1 and SRSF2 appear to predict an unfavorable prognosis.
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Affiliation(s)
- Lingyun Wu
- Department of Hematology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Luxi Song
- Department of Hematology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Lan Xu
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Chunkang Chang
- Department of Hematology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Feng Xu
- Department of Hematology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Dong Wu
- Department of Hematology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Qi He
- Department of Hematology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Jiying Su
- Department of Hematology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Liyu Zhou
- Department of Hematology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Chao Xiao
- Department of Hematology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Zheng Zhang
- Department of Hematology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Youshan Zhao
- Department of Hematology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Saijuan Chen
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Xiao Li
- Department of Hematology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.
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244
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Sutton LA, Rosenquist R. The complex interplay between cell-intrinsic and cell-extrinsic factors driving the evolution of chronic lymphocytic leukemia. Semin Cancer Biol 2015; 34:22-35. [DOI: 10.1016/j.semcancer.2015.04.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 04/24/2015] [Accepted: 04/27/2015] [Indexed: 01/08/2023]
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245
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Clonal dynamics in a single AML case tracked for 9 years reveals the complexity of leukemia progression. Leukemia 2015; 30:295-302. [PMID: 26424407 DOI: 10.1038/leu.2015.264] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 09/16/2015] [Accepted: 09/22/2015] [Indexed: 12/30/2022]
Abstract
Most types of cancers are made up of heterogeneous mixtures of genetically distinct subclones. In particular, acute myeloid leukemia (AML) has been shown to undergo substantial clonal evolution over the course of the disease. AML tends to harbor fewer mutations than solid tumors, making it challenging to infer clonal structure. Here, we present a 9-year, whole-exome sequencing study of a single case at 12 time points, from the initial diagnosis until a fourth relapse, including 6 remission samples in between. To the best of our knowledge, it covers the longest time span of any data set of its kind. We used these time series data to track the hierarchy and order of variant acquisition, and subsequently analyzed the evolution of somatic variants to infer clonal structure. From this, we postulate the development and extinction of subclones, as well as their anticorrelated expansion via varying drug responses. In particular, we show that new subclones started appearing after the first complete remission. The presence and absence of different subclones during remission and relapses implies differing drug responses among subclones. Our study shows that time series analysis contrasting remission and relapse periods provides a much more comprehensive view of clonal structure and evolution.
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246
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MDS-associated somatic mutations and clonal hematopoiesis are common in idiopathic cytopenias of undetermined significance. Blood 2015; 126:2355-61. [PMID: 26429975 DOI: 10.1182/blood-2015-08-667063] [Citation(s) in RCA: 227] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 09/22/2015] [Indexed: 12/24/2022] Open
Abstract
Establishing a diagnosis in patients suspected of having a myelodysplastic syndrome (MDS) can be challenging and could be informed by the identification of somatic mutations. We performed a prospective study to examine the frequency and types of mutations encountered in 144 patients with unexplained cytopenias. Based on bone marrow findings, 17% were diagnosed with MDS, 15% with idiopathic cytopenias of undetermined significance (ICUS) and some evidence of dysplasia, and 69% with ICUS and no dysplasia. Bone marrow DNA was sequenced for mutations in 22 frequently mutated myeloid malignancy genes. Somatic mutations were identified in 71% of MDS patients, 62% of patients with ICUS and some dysplasia, and 20% of ICUS patients and no dysplasia. In total, 35% of ICUS patients carried a somatic mutation or chromosomal abnormality indicative of clonal hematopoiesis. We validated these results in a cohort of 91 lower-risk MDS and 249 ICUS cases identified over a 6-month interval. Mutations were found in 79% of those with MDS, in 45% of those with ICUS with dysplasia, and in 17% of those with ICUS without dysplasia. The spectrum of mutated genes was similar with the exception of SF3B1 which was rarely mutated in patients without dysplasia. Variant allele fractions were comparable between clonal ICUS (CCUS) and MDS as were mean age and blood counts. We demonstrate that CCUS is a more frequent diagnosis than MDS in cytopenic patients. Clinical and mutational features are similar in these groups and may have diagnostic utility once outcomes in CCUS patients are better understood.
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Garcia-Manero G. Myelodysplastic syndromes: 2015 Update on diagnosis, risk-stratification and management. Am J Hematol 2015; 90:831-41. [PMID: 26294090 DOI: 10.1002/ajh.24102] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 06/24/2015] [Indexed: 02/03/2023]
Abstract
DISEASE OVERVIEW The myelodysplastic syndromes (MDS) are a very heterogeneous group of myeloid disorders characterized by peripheral blood cytopenias and increased risk of transformation to acute myelogenous leukemia (AML). MDS occurs more frequently in older males and in individuals with prior exposure to cytotoxic therapy. DIAGNOSIS Diagnosis of MDS is based on morphological evidence of dysplasia upon visual examination of a bone marrow aspirate and biopsy. Information obtained from additional studies such as karyotype, flow cytometry, or molecular genetics is complementary but not diagnostic. Risk-stratification: Prognosis of patients with MDS can be calculated using a number of scoring systems. In general, all these scoring systems include analysis of peripheral cytopenias, percentage of blasts in the bone marrow, and cytogenetic characteristics. The most commonly used system still is probably the International Prognostic Scoring System (IPSS). IPSS is being replaced by the new revised score IPSS-R. RISK-ADAPTED THERAPY Therapy is selected based on risk, transfusion needs, percent of bone marrow blasts, and more recently cytogenetic and mutational profiles. Goals of therapy are different in lower risk patients than in higher risk. In lower risk, the goal is to decrease transfusion needs and transformation to higher risk disease or AML, as well as to improve survival. In higher risk, the goal is to prolong survival. Current available therapies include growth factor support, lenalidomide, hypomethylating agents, intensive chemotherapy, and allogeneic stem cell transplantation. The use of lenalidomide has significant clinical activity in patients with lower risk disease, anemia, and a chromosome 5 alteration. 5-Azacitidine and decitabine have activity in higher risk MDS. 5-Azacitidine has been shown to improve survival in higher risk MDS. A number of new molecular lesions have been described in MDS that may serve as new therapeutic targets or aid in the selection of currently available agents. Additional supportive care measures may include the use of prophylactic antibiotics and iron chelation. Management of progressive or refractory disease: At the present time there are no approved interventions for patients with progressive or refractory disease particularly after hypomethylating based therapy. Options include participation in a clinical trial or cytarabine based therapy and stem cell transplantation.
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Negri G, Crescenzi B, Colombo EA, Fontana L, Barba G, Arcioni F, Gervasini C, Mecucci C, Larizza L. Expanding the role of the splicingUSB1gene from Poikiloderma with Neutropenia to acquired myeloid neoplasms. Br J Haematol 2015; 171:557-65. [DOI: 10.1111/bjh.13651] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 07/22/2015] [Indexed: 12/18/2022]
Affiliation(s)
- Gloria Negri
- Medical Genetics; Department of Health Sciences; University of Milan; Milan Italy
| | | | - Elisa Adele Colombo
- Medical Genetics; Department of Health Sciences; University of Milan; Milan Italy
| | - Laura Fontana
- Medical Genetics; Department of Health Sciences; University of Milan; Milan Italy
| | - Gianluca Barba
- Haematology Unit; Polo Unico S.M. Misericordia; Perugia Italy
| | - Francesco Arcioni
- Pediatric Oncology Haematology Unit; University of Perugia; Polo Unico S.M. Misericordia; Perugia Italy
| | - Cristina Gervasini
- Medical Genetics; Department of Health Sciences; University of Milan; Milan Italy
| | | | - Lidia Larizza
- Medical Cytogenetics and Molecular Genetics Laboratory; Centro di Ricerche e Tecnologie Biomediche IRCCS; Istituto Auxologico Italiano; Milan Italy
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249
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Hahn CN, Venugopal P, Scott HS, Hiwase DK. Splice factor mutations and alternative splicing as drivers of hematopoietic malignancy. Immunol Rev 2015; 263:257-78. [PMID: 25510282 DOI: 10.1111/imr.12241] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Differential splicing contributes to the vast complexity of mRNA transcripts and protein isoforms that are necessary for cellular homeostasis and response to developmental cues and external signals. The hematopoietic system provides an exquisite example of this. Recently, discovery of mutations in components of the spliceosome in various hematopoietic malignancies (HMs) has led to an explosion in knowledge of the role of splicing and splice factors in HMs and other cancers. A better understanding of the mechanisms by which alternative splicing and aberrant splicing contributes to the leukemogenic process will enable more efficacious targeted approaches to tackle these often difficult to treat diseases. The clinical implications are only just starting to be realized with novel drug targets and therapeutic strategies open to exploitation for patient benefit.
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Affiliation(s)
- Christopher N Hahn
- Centre for Cancer Biology, SA Pathology, Adelaide, SA, Australia; Department of Molecular Pathology, SA Pathology, Adelaide, SA, Australia; School of Medicine, University of Adelaide, Adelaide, SA, Australia; Molecular and Biomedical Science, University of Adelaide, Adelaide, SA, Australia
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250
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Conte S, Katayama S, Vesterlund L, Karimi M, Dimitriou M, Jansson M, Mortera-Blanco T, Unneberg P, Papaemmanuil E, Sander B, Skoog T, Campbell P, Walfridsson J, Kere J, Hellström-Lindberg E. Aberrant splicing of genes involved in haemoglobin synthesis and impaired terminal erythroid maturation in SF3B1 mutated refractory anaemia with ring sideroblasts. Br J Haematol 2015; 171:478-90. [PMID: 26255870 PMCID: PMC4832260 DOI: 10.1111/bjh.13610] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 06/25/2015] [Indexed: 02/06/2023]
Abstract
Refractory anaemia with ring sideroblasts (RARS) is distinguished by hyperplastic inefficient erythropoiesis, aberrant mitochondrial ferritin accumulation and anaemia. Heterozygous mutations in the spliceosome gene SF3B1 are found in a majority of RARS cases. To explore the link between SF3B1 mutations and anaemia, we studied mutated RARS CD34+ marrow cells with regard to transcriptome sequencing, splice patterns and mutational allele burden during erythroid differentiation. Transcriptome profiling during early erythroid differentiation revealed a marked up‐regulation of genes involved in haemoglobin synthesis and in the oxidative phosphorylation process, and down‐regulation of mitochondrial ABC transporters compared to normal bone marrow. Moreover, mis‐splicing of genes involved in transcription regulation, particularly haemoglobin synthesis, was confirmed, indicating a compromised haemoglobinization during RARS erythropoiesis. In order to define the phase during which erythroid maturation of SF3B1 mutated cells is most affected, we assessed allele burden during erythroid differentiation in vitro and in vivo and found that SF3B1 mutated erythroblasts showed stable expansion until late erythroblast stage but that terminal maturation to reticulocytes was significantly reduced. In conclusion, SF3B1 mutated RARS progenitors display impaired splicing with potential downstream consequences for genes of key importance for haemoglobin synthesis and terminal erythroid differentiation.
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Affiliation(s)
- Simona Conte
- Karolinska Institutet, Department of Medicine (Huddinge), Centre for Hematology and Regenerative Medicine, Stockholm, Sweden
| | - Shintaro Katayama
- Karolinska Institutet, Department of Biosciences and Nutrition and Center for Innovative Medicine, Stockholm, Sweden
| | - Liselotte Vesterlund
- Karolinska Institutet, Department of Biosciences and Nutrition and Center for Innovative Medicine, Stockholm, Sweden
| | - Mohsen Karimi
- Karolinska Institutet, Department of Medicine (Huddinge), Centre for Hematology and Regenerative Medicine, Stockholm, Sweden
| | - Marios Dimitriou
- Karolinska Institutet, Department of Medicine (Huddinge), Centre for Hematology and Regenerative Medicine, Stockholm, Sweden
| | - Monika Jansson
- Karolinska Institutet, Department of Medicine (Huddinge), Centre for Hematology and Regenerative Medicine, Stockholm, Sweden
| | - Teresa Mortera-Blanco
- Karolinska Institutet, Department of Medicine (Huddinge), Centre for Hematology and Regenerative Medicine, Stockholm, Sweden
| | - Per Unneberg
- Department of Biochemistry and Biophysics, Science for Life Laboratory, Stockholm, Sweden
| | - Elli Papaemmanuil
- Cancer Genetics & Genomics, The Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK
| | - Birgitta Sander
- Karolinska Institutet, Department of Laboratory Medicine, Division of Pathology, Stockholm, Sweden
| | - Tiina Skoog
- Karolinska Institutet, Department of Biosciences and Nutrition and Center for Innovative Medicine, Stockholm, Sweden
| | - Peter Campbell
- Cancer Genetics & Genomics, The Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK
| | - Julian Walfridsson
- Karolinska Institutet, Department of Medicine (Huddinge), Centre for Hematology and Regenerative Medicine, Stockholm, Sweden
| | - Juha Kere
- Karolinska Institutet, Department of Biosciences and Nutrition and Center for Innovative Medicine, Stockholm, Sweden
| | - Eva Hellström-Lindberg
- Karolinska Institutet, Department of Medicine (Huddinge), Centre for Hematology and Regenerative Medicine, Stockholm, Sweden
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