201
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Ivey A, Hills RK, Simpson MA, Jovanovic JV, Gilkes A, Grech A, Patel Y, Bhudia N, Farah H, Mason J, Wall K, Akiki S, Griffiths M, Solomon E, McCaughan F, Linch DC, Gale RE, Vyas P, Freeman SD, Russell N, Burnett AK, Grimwade D. Assessment of Minimal Residual Disease in Standard-Risk AML. N Engl J Med 2016; 374:422-33. [PMID: 26789727 DOI: 10.1056/nejmoa1507471] [Citation(s) in RCA: 573] [Impact Index Per Article: 71.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Despite the molecular heterogeneity of standard-risk acute myeloid leukemia (AML), treatment decisions are based on a limited number of molecular genetic markers and morphology-based assessment of remission. Sensitive detection of a leukemia-specific marker (e.g., a mutation in the gene encoding nucleophosmin [NPM1]) could improve prognostication by identifying submicroscopic disease during remission. METHODS We used a reverse-transcriptase quantitative polymerase-chain-reaction assay to detect minimal residual disease in 2569 samples obtained from 346 patients with NPM1-mutated AML who had undergone intensive treatment in the National Cancer Research Institute AML17 trial. We used a custom 51-gene panel to perform targeted sequencing of 223 samples obtained at the time of diagnosis and 49 samples obtained at the time of relapse. Mutations associated with preleukemic clones were tracked by means of digital polymerase chain reaction. RESULTS Molecular profiling highlighted the complexity of NPM1-mutated AML, with segregation of patients into more than 150 subgroups, thus precluding reliable outcome prediction. The determination of minimal-residual-disease status was more informative. Persistence of NPM1-mutated transcripts in blood was present in 15% of the patients after the second chemotherapy cycle and was associated with a greater risk of relapse after 3 years of follow-up than was an absence of such transcripts (82% vs. 30%; hazard ratio, 4.80; 95% confidence interval [CI], 2.95 to 7.80; P<0.001) and a lower rate of survival (24% vs. 75%; hazard ratio for death, 4.38; 95% CI, 2.57 to 7.47; P<0.001). The presence of minimal residual disease was the only independent prognostic factor for death in multivariate analysis (hazard ratio, 4.84; 95% CI, 2.57 to 9.15; P<0.001). These results were validated in an independent cohort. On sequential monitoring of minimal residual disease, relapse was reliably predicted by a rising level of NPM1-mutated transcripts. Although mutations associated with preleukemic clones remained detectable during ongoing remission after chemotherapy, NPM1 mutations were detected in 69 of 70 patients at the time of relapse and provided a better marker of disease status. CONCLUSIONS The presence of minimal residual disease, as determined by quantitation of NPM1-mutated transcripts, provided powerful prognostic information independent of other risk factors. (Funded by Bloodwise and the National Institute for Health Research; Current Controlled Trials number, ISRCTN55675535.).
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Affiliation(s)
- Adam Ivey
- From the Molecular Oncology Unit and Cancer Genetics Laboratory, Department of Medical and Molecular Genetics, Guy's Hospital (A.I.), the Department of Medical and Molecular Genetics (M.A.S., J.V.J., E.S., D.G.) and Department of Asthma, Allergy and Respiratory Science (H.F., F.M.), Faculty of Life Sciences and Medicine, King's College London, the Department of Haematology, University College London (Y.P., D.C.L., R.E.G.), and the Innovation Department, Cancer Research UK (N.B.), London, the Experimental Cancer Medicine Centre (A. Gilkes) and Department of Haematology (R.K.H., A.K.B.), Cardiff University School of Medicine, and the Haematology Clinical Trials Unit, Cardiff University (A. Grech), Cardiff, West Midlands Regional Genetics Laboratory, Birmingham (J.M., K.W., S.A., M.G.), MRC Molecular Haematology Unit, Weatherall Institute of Molecular Medicine and Department of Haematology, University of Oxford and Oxford University Hospitals NHS Trust, and the National Institute for Health Research Oxford Biomedical Research Centre (P.V.), Oxford, the Department of Clinical Immunology, University of Birmingham, Birmingham (S.D.F.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.R.) - all in the United Kingdom
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202
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Ommen HB. Monitoring minimal residual disease in acute myeloid leukaemia: a review of the current evolving strategies. Ther Adv Hematol 2016; 7:3-16. [PMID: 26834951 DOI: 10.1177/2040620715614529] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Several disease-monitoring techniques are available for the physician treating acute myeloid leukaemia (AML). Besides immunohistochemistry assisted light microscopy, the past 20 years have seen the development and preclinical perfection of a number of techniques, most notably quantitative polymerase chain reaction (PCR) and multicolor flow cytometry. Late additions to the group of applicable assays include next generation sequencing and digital PCR. In this review the principles of use of these modalities at three different time points during the AML disease course are discussed, namely at the time of treatment evaluation, pretransplantation and postconsolidation. The drawbacks and pitfalls of each different technique are delineated. The evidence or lack of evidence for minimal residual disease guided treatment decisions is discussed. Lastly, future strategies in the MRD field are suggested and commented upon.
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Affiliation(s)
- Hans Beier Ommen
- Department of Hematology, Aarhus University Hospital, Tage-Hansens gade 2, Aarhus C, 8000, Denmark
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203
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Khan M, DiNardo CD. Great expectations in acute myeloid leukemia. Future Oncol 2016; 12:289-92. [PMID: 26768493 DOI: 10.2217/fon.15.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Maliha Khan
- Department of Leukemia, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA
| | - Courtney D DiNardo
- Department of Leukemia, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA
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204
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DeAngelo DJ, Stein EM, Ravandi F. Evolving Therapies in Acute Myeloid Leukemia: Progress at Last? Am Soc Clin Oncol Educ Book 2016; 35:e302-e312. [PMID: 27249736 DOI: 10.1200/edbk_161258] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Acute myeloid leukemia (AML) is an acquired disease characterized by chromosomal translocations and somatic mutations that lead to leukemogenesis. Systemic combination chemotherapy with an anthracycline and cytarabine remains the standard induction regimen for "fit" adults. Patients who achieve complete remission generally receive postinduction therapy with cytarabine-based chemotherapy or an allogeneic bone marrow transplant. Those unfit for induction chemotherapy are treated with hypomethylating agents (HMAs), low-dose cytarabine, or they are offered supportive care alone with transfusions and prophylactic antimicrobials. The revolution in understanding the genetics of AML, facilitated by next-generation sequencing, has led to many new drugs against driver mutations. Better methods of identification of leukemic blasts have provided us with better means to detect the disease left behind after cytotoxic chemotherapy regimens. This measurable residual disease has been correlated with poorer relapse-free survival, demonstrating the need for novel strategies to eradicate it to improve the outcome of patients with acute leukemias. In this article, we discuss adapting and improving AML therapy by age and comorbidities, emerging targeted therapies in AML, and minimal residual disease (MRD) assessment in AML.
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Affiliation(s)
- Daniel J DeAngelo
- From the Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA; Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY; The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eytan M Stein
- From the Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA; Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY; The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Farhad Ravandi
- From the Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA; Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY; The University of Texas MD Anderson Cancer Center, Houston, TX
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205
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Kantarjian H. Acute myeloid leukemia--major progress over four decades and glimpses into the future. Am J Hematol 2016; 91:131-45. [PMID: 26598393 DOI: 10.1002/ajh.24246] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 11/18/2015] [Indexed: 12/17/2022]
Abstract
In this Review, the progress in research and therapy of acute myeloid leukemia is detailed.
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Affiliation(s)
- Hagop Kantarjian
- Department of Leukemia; MD Anderson Cancer Center; Houston Texas
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206
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Lambert J, Lambert J, Nibourel O, Pautas C, Hayette S, Cayuela JM, Terré C, Rousselot P, Dombret H, Chevret S, Preudhomme C, Castaigne S, Renneville A. MRD assessed by WT1 and NPM1 transcript levels identifies distinct outcomes in AML patients and is influenced by gemtuzumab ozogamicin. Oncotarget 2015; 5:6280-8. [PMID: 25026287 PMCID: PMC4171629 DOI: 10.18632/oncotarget.2196] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We analysed the prognostic significance of minimal residual disease (MRD) level in adult patients with acute myeloid leukemia (AML) treated in the randomized gemtuzumab ozogamicin (GO) ALFA-0701 trial. Levels of WT1 and NPM1 gene transcripts were assessed using cDNA-based real-time quantitative PCR in 183 patients with WT1 overexpression and in 77 patients with NMP1 mutation (NPM1mut) at diagnosis. Positive WT1 MRD (defined as > 0.5% in the peripheral blood) after induction and at the end of treatment were both significantly associated with a higher risk of relapse and a shorter overall survival (OS). Positive NPM1mut MRD (defined as > 0.1% in the bone marrow) after induction and at the end of treatment also predicted a higher risk of relapse, but did not influence OS. Interestingly, the achievement of a negative NPM1mut MRD was significantly more frequent in patients treated in the GO arm compared to those treated in control arm (39 % versus 7% (p=0.006) after induction and 91% versus 61% (p=0.028) at the end of treatment). However, GO did not influence WT1 MRD levels. Our study supports the prognostic significance of MRD assessed by WT1 and NPM1mut transcript levels and show that NPM1 MRD is decreased by GO treatment.
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Affiliation(s)
- Juliette Lambert
- Department of Hematology, Hôpital de Versailles, Le Chesnay, Université de Versailles-Saint Quentin; France
| | | | - Olivier Nibourel
- Laboratory of Hematology, CHRU de Lille; Université de Lille Nord de France, Inserm, U837, Team 3, Cancer Research Institute of Lille, Lille; France
| | - Cécile Pautas
- Department of Hematology, Hôpital Henri Mondor, AP-HP, Créteil; France
| | - Sandrine Hayette
- Laboratory of Hematology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, UMR5239, Université Claude Bernard, Lyon; France
| | - Jean-Michel Cayuela
- Laboratory of Hematology, Hôpital Saint-Louis, AP-HP, EA3518, University Paris Diderot, Paris; France
| | - Christine Terré
- Laboratory of Cytogenetics, Hôpital de Versailles, Le Chesnay; France
| | - Philippe Rousselot
- Department of Hematology, Hôpital de Versailles, Le Chesnay, Université de Versailles-Saint Quentin; France
| | - Hervé Dombret
- Department of Hematology, Hôpital Saint Louis, AP-HP, Université Paris Diderot, EA 3518, Paris; France
| | - Sylvie Chevret
- Department of Informatics and Biostatistics, Hôpital Saint Louis, Université Paris Diderot, INSERM S 717, Paris; France
| | - Claude Preudhomme
- Laboratory of Hematology, CHRU de Lille; Université de Lille Nord de France, Inserm, U837, Team 3, Cancer Research Institute of Lille, Lille; France
| | - Sylvie Castaigne
- Department of Hematology, Hôpital de Versailles, Le Chesnay, Université de Versailles-Saint Quentin; France
| | - Aline Renneville
- Laboratory of Hematology, CHRU de Lille; Université de Lille Nord de France, Inserm, U837, Team 3, Cancer Research Institute of Lille, Lille; France
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207
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Xue E, Tresoldi C, Sala E, Crippa A, Mazzi B, Greco R, Messina C, Carrabba MG, Lupo Stanghellini MT, Marktel S, Corti C, Peccatori J, Bernardi M, Ciceri F, Vago L. Longitudinal qPCR monitoring of nucleophosmin 1 mutations after allogeneic hematopoietic stem cell transplantation to predict AML relapse. Bone Marrow Transplant 2015; 51:466-9. [PMID: 26642331 DOI: 10.1038/bmt.2015.296] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- E Xue
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milano, Italy.,Unit of Immunogenetics, Leukemia Genomics and Immunobiology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - C Tresoldi
- Molecular Hematology Laboratory, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - E Sala
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - A Crippa
- Molecular Hematology Laboratory, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - B Mazzi
- Unit of Immunogenetics, Leukemia Genomics and Immunobiology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - R Greco
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - C Messina
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - M G Carrabba
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - M T Lupo Stanghellini
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - S Marktel
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - C Corti
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - J Peccatori
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - M Bernardi
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - F Ciceri
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - L Vago
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milano, Italy.,Unit of Immunogenetics, Leukemia Genomics and Immunobiology, IRCCS San Raffaele Scientific Institute, Milano, Italy
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208
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Hofmann S, Mead A, Malinovskis A, Hardwick NR, Guinn BA. Analogue peptides for the immunotherapy of human acute myeloid leukemia. Cancer Immunol Immunother 2015; 64:1357-67. [PMID: 26438084 PMCID: PMC11029593 DOI: 10.1007/s00262-015-1762-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 09/27/2015] [Indexed: 12/14/2022]
Abstract
The use of peptide vaccines, enhanced by adjuvants, has shown some efficacy in clinical trials. However, responses are often short-lived and rarely induce notable memory responses. The reason is that self-antigens have already been presented to the immune system as the tumor develops, leading to tolerance or some degree of host tumor cell destruction. To try to break tolerance against self-antigens, one of the methods employed has been to modify peptides at the anchor residues to enhance their ability to bind major histocompatibility complex molecules, extending their exposure to the T-cell receptor. These modified or analogue peptides have been investigated as stimulators of the immune system in patients with different cancers with variable but sometimes notable success. In this review we describe the background and recent developments in the use of analogue peptides for the immunotherapy of acute myeloid leukemia describing knowledge useful for the application of analogue peptide treatments for other malignancies.
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Affiliation(s)
- Susanne Hofmann
- Third Clinic for Internal Medicine, University of Ulm, Ulm, Germany
| | - Andrew Mead
- Department of Life Sciences, University of Bedfordshire, Park Square, Luton, LU1 3JU, UK
| | - Aleksandrs Malinovskis
- Department of Life Sciences, University of Bedfordshire, Park Square, Luton, LU1 3JU, UK
| | - Nicola R Hardwick
- Division of Translational Vaccine Research, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA, USA
- Department of Haematological Medicine, Guy's, King's & St. Thomas' School of Medicine, The Rayne Institute, King's College London, 123 Coldharbour Lane, London, UK
| | - Barbara-Ann Guinn
- Department of Life Sciences, University of Bedfordshire, Park Square, Luton, LU1 3JU, UK.
- Department of Haematological Medicine, Guy's, King's & St. Thomas' School of Medicine, The Rayne Institute, King's College London, 123 Coldharbour Lane, London, UK.
- Cancer Sciences Unit, Southampton University Hospitals Trust, University of Southampton, Southampton, UK.
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209
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Falini B, Martelli MP. Impact of genomics in the clinical management of patients with cytogenetically normal acute myeloid leukemia. Best Pract Res Clin Haematol 2015; 28:90-7. [PMID: 26590764 DOI: 10.1016/j.beha.2015.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Acute myeloid leukemia (AML) is a clinically and molecularly heterogeneous disease. Cytogenetics and FISH have contributed to the stratification of AML patients into favorable, intermediate, and unfavorable risk categories. However, until recently, the prognostic stratification and treatment decision for the intermediate risk category, mostly comprising AML patients with normal cytogenetics (CN-AML), has been difficult due to the scarce knowledge of the molecular alterations underlying this large AML subgroup (which accounts for about 50% of all adult AML). During the past decade, the discovery of numerous mutations associated with CN-AML has resulted in significant advances in the AML field. Here, we review the biological characteristics of the most common mutations underlying CN-AML and outline their clinical impact in the following settings: (i) definition of new molecular leukemia entities in the WHO classification; (ii) risk stratification of CN-AML patients according to mutational profile; and (iii) monitoring of minimal residual disease by specific quantitative molecular assays.
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Affiliation(s)
- Brunangelo Falini
- Institute of Hematology-Centro di Ricerche Emato-Oncologiche (CREO), University of Perugia, Italy.
| | - Maria Paola Martelli
- Institute of Hematology-Centro di Ricerche Emato-Oncologiche (CREO), University of Perugia, Italy
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210
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Wakita S, Yamaguchi H, Ueki T, Usuki K, Kurosawa S, Kobayashi Y, Kawata E, Tajika K, Gomi S, Koizumi M, Fujiwara Y, Yui S, Fukunaga K, Ryotokuji T, Hirakawa T, Arai K, Kitano T, Kosaka F, Tamai H, Nakayama K, Fukuda T, Inokuchi K. Complex molecular genetic abnormalities involving three or more genetic mutations are important prognostic factors for acute myeloid leukemia. Leukemia 2015; 30:545-54. [DOI: 10.1038/leu.2015.288] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 10/04/2015] [Accepted: 10/07/2015] [Indexed: 01/07/2023]
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211
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Profiling of somatic mutations in acute myeloid leukemia with FLT3-ITD at diagnosis and relapse. Blood 2015; 126:2491-501. [PMID: 26438511 DOI: 10.1182/blood-2015-05-646240] [Citation(s) in RCA: 163] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 09/22/2015] [Indexed: 01/15/2023] Open
Abstract
Acute myeloid leukemia (AML) with an FLT3 internal tandem duplication (FLT3-ITD) mutation is an aggressive hematologic malignancy with a grave prognosis. To identify the mutational spectrum associated with relapse, whole-exome sequencing was performed on 13 matched diagnosis, relapse, and remission trios followed by targeted sequencing of 299 genes in 67 FLT3-ITD patients. The FLT3-ITD genome has an average of 13 mutations per sample, similar to other AML subtypes, which is a low mutation rate compared with that in solid tumors. Recurrent mutations occur in genes related to DNA methylation, chromatin, histone methylation, myeloid transcription factors, signaling, adhesion, cohesin complex, and the spliceosome. Their pattern of mutual exclusivity and cooperation among mutated genes suggests that these genes have a strong biological relationship. In addition, we identified mutations in previously unappreciated genes such as MLL3, NSD1, FAT1, FAT4, and IDH3B. Mutations in 9 genes were observed in the relapse-specific phase. DNMT3A mutations are the most stable mutations, and this DNMT3A-transformed clone can be present even in morphologic complete remissions. Of note, all AML matched trio samples shared at least 1 genomic alteration at diagnosis and relapse, suggesting common ancestral clones. Two types of clonal evolution occur at relapse: either the founder clone recurs or a subclone of the founder clone escapes from induction chemotherapy and expands at relapse by acquiring new mutations. Relapse-specific mutations displayed an increase in transversions. Functional assays demonstrated that both MLL3 and FAT1 exert tumor-suppressor activity in the FLT3-ITD subtype. An inhibitor of XPO1 synergized with standard AML induction chemotherapy to inhibit FLT3-ITD growth. This study clearly shows that FLT3-ITD AML requires additional driver genetic alterations in addition to FLT3-ITD alone.
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212
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Abstract
PURPOSE OF REVIEW Acute myeloid leukemia (AML) is a heterogeneous disease. Detection of minimal residual disease (MRD) has the potential to improve risk stratification, and its routine monitoring may allow timely therapeutic actions such as allogeneic hematopoietic stem cell transplantation. The current review will discuss challenges and available evidence for clinical application of MRD detection in AML management. RECENT FINDINGS The heterogeneous nature of AML, variations in genetic aberrations and immunophenotypes among patients and between malignant subclones coexisting within a single patient, is a challenge for the development of a reliable MRD test in AML. MRD value was demonstrated in subtypes of AML in which reliable leukemia-specific genetic marker is present (e.g., core-binding leukemia, AML positive for NPM1 mutation). Multicolor flow cytometry and quantitative PCR monitoring for Wilms tumor 1 gene transcript have also been shown to correlate with disease progression. MRD results should always be interpreted within patient-specific clinical context considering other risk factors and timing of MRD eradication. SUMMARY Introduction of MRD testing into routine clinical practice is a challenge in AML. An improvement in laboratory techniques along with identification of additional leukemia-specific markers is required.
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213
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Peripheral blood minimal residual disease may replace bone marrow minimal residual disease as an immunophenotypic biomarker for impending relapse in acute myeloid leukemia. Leukemia 2015; 30:708-15. [DOI: 10.1038/leu.2015.255] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 08/30/2015] [Accepted: 09/04/2015] [Indexed: 11/09/2022]
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214
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Abstract
Induction followed by post-remission therapy including intensive chemotherapy with high-dose cytarabine, autologous and allogeneic hematopoietic stem cell transplantation is recognized as the main road towards cure in acute myeloid leukemia. In recent years, also a renaissance of maintenance therapy after completion of intensive consolidation has been observed with the introduction of kinase inhibitors and demethylating agents in clinical trials. Greater insight into the genetic background of the disease fostered the extension of disease classification and pretreatment risk-categorization by gene mutations. In addition, the pre-treatment risk-defining parameters have been supplemented by markers evaluated at distinct time points during treatment and follow up. In this context, minimal residual disease assessment is increasingly used to dynamically fine tune treatment recommendations. Currently, the gold standard to counterbalance a higher risk of relapse by treatment strategies based on hematopoietic stem cell transplantation with grafts from matched related or unrelated donors is still valuable, whereas autologous hematopoietic stem cell transplantation showed promising results especially in patients categorized as low-risk. Nonetheless, more targeted approaches including kinase inhibitors and demethylating agents in combination with or sequentially before or after intensive chemotherapy are currently in clinical evaluation and may lead to more genotype- instead of purely risk-adapted treatment strategies.
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Affiliation(s)
- Richard F Schlenk
- Department of Internal Medicine III, University Hospital Ulm, Germany
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215
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Brissot E, Mohty M. Which Acute Myeloid Leukemia Patients Should Be Offered Transplantation? Semin Hematol 2015; 52:223-31. [DOI: 10.1053/j.seminhematol.2015.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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216
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Lin P, Falini B. Acute Myeloid Leukemia With Recurrent Genetic Abnormalities Other Than Translocations. Am J Clin Pathol 2015; 144:19-28. [PMID: 26071459 DOI: 10.1309/ajcp97bjbevzeuin] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES Session 2 of the workshop focused on cases of acute myeloid leukemia (AML) with gene mutations in the setting of a normal karyotype. METHODS Among 22 AML cases submitted, 14 had the NPM1 mutation, most also accompanied by mutations of other genes such as FLT3-ITD, DNMT3A, or, rarely, TP53; three cases had the heterozygous CEBPA mutation; and two cases had MYC amplification. RESULTS We explored prognostic implications of gene mutations such as DNMT3A, issues related to the classification of AML cases with the NPM1 mutation, and myelodysplasia-related changes arising from chronic myelomonocytic leukemia after a short latency interval. Disparate patterns of treatment response to targeted therapy using an FLT3 inhibitor, designated as cytotoxic or differentiation, and their genetic underpinnings were described. Finally, a minimal screening panel for gene mutations and the optimal approach for monitoring minimal residual disease were discussed. CONCLUSIONS In aggregate, this session highlighted the need for a refined molecular classification of AML as well as improved risk stratification based on systematic assessment for genetic alterations and their evolution over time.
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217
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Liu H, Stock W. Is it time to use minimal residual disease to stratify post-remission treatment for acute myeloid leukemia? Leuk Lymphoma 2015; 56:3005-7. [PMID: 25944470 DOI: 10.3109/10428194.2015.1048444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Hongtao Liu
- a Department of Medicine , Section of Hematology/Oncology, The University of Chicago Medical Center , Chicago , IL , USA
| | - Wendy Stock
- a Department of Medicine , Section of Hematology/Oncology, The University of Chicago Medical Center , Chicago , IL , USA
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218
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Lamba G, Zaidi SK, Luebbers K, Verschraegen C, Stein GS, Rosmarin A. Epigenetic landscape of acute myelogenous leukemia--moving toward personalized medicine. J Cell Biochem 2015; 115:1669-72. [PMID: 24905899 DOI: 10.1002/jcb.24853] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 05/28/2014] [Indexed: 12/13/2022]
Abstract
Acute myeloid leukemia (AML) is an aggressive hematologic cancer that is characterized by accumulation of immature myeloid cells in the blood and bone marrow. The malignant cells in AML have reduced capacity to mature fully, and often exhibit chromosomal abnormalities, defects in cell signaling, and abnormal cell cycle control. Genetic and epigenetic changes are implicated in the onset and progression of AML. While progress has been made in using genetic and epigenetic changes as prognostic features of AML, these findings have not yet been effectively translated into novel treatment strategies. Disappointingly, rates of recurrence in AML remain high and overall survival is poor. Research strategies should focus on developing a comprehensive landscape of genetic and epigenetic changes in individual patients with AML to expand the clinicians' therapeutic armamentarium and to individualize and optimize treatment.
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Affiliation(s)
- Gurpreet Lamba
- Division of Hematology/Oncology, University of Vermont, Burlington, Vermont; Vermont Cancer Center, Burlington, Vermont
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Goswami M, McGowan KS, Lu K, Jain N, Candia J, Hensel NF, Tang J, Calvo KR, Battiwalla M, Barrett AJ, Hourigan CS. A multigene array for measurable residual disease detection in AML patients undergoing SCT. Bone Marrow Transplant 2015; 50:642-51. [PMID: 25665046 PMCID: PMC4424111 DOI: 10.1038/bmt.2014.326] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 12/15/2014] [Accepted: 12/19/2014] [Indexed: 02/04/2023]
Abstract
AML is a diagnosis encompassing a diverse group of myeloid malignancies. Heterogeneous genetic etiology, together with the potential for oligoclonality within the individual patient, have made the identification of a single high-sensitivity marker of disease burden challenging. We developed a multiple gene measurable residual disease (MG-MRD) RQ-PCR array for the high-sensitivity detection of AML, retrospectively tested on 74 patients who underwent allo-SCT at the NHLBI in the period 1994-2012. MG-MRD testing on peripheral blood samples prior to transplantation demonstrated excellent concordance with traditional BM-based evaluation and improved risk stratification for post-transplant relapse and OS outcomes. Pre-SCT assessment by MG-MRD predicted all clinical relapses occurring in the first 100 days after allo-SCT compared with 57% sensitivity using WT1 RQ-PCR alone. Nine patients who were negative for WT1 prior to transplantation were correctly reclassified into a high-risk MG-MRD-positive group, associated with 100% post-transplant mortality. This study provides proof of principle that a multiple gene approach may be superior to the use of WT1 expression alone for AML residual disease detection.
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Affiliation(s)
- M Goswami
- Myeloid Malignancies Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - K S McGowan
- Myeloid Malignancies Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - K Lu
- Stem Cell Allogenic Transplantation Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - N Jain
- Stem Cell Allogenic Transplantation Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - J Candia
- Department of Physics, University of Maryland, College Park, MD, USA
- School of Medicine, University of Maryland, Baltimore, MD, USA
| | - N F Hensel
- Stem Cell Allogenic Transplantation Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - J Tang
- Myeloid Malignancies Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - K R Calvo
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - M Battiwalla
- Stem Cell Allogenic Transplantation Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - A J Barrett
- Stem Cell Allogenic Transplantation Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - C S Hourigan
- Myeloid Malignancies Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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Falini B, Sportoletti P, Brunetti L, Martelli MP. Perspectives for therapeutic targeting of gene mutations in acute myeloid leukaemia with normal cytogenetics. Br J Haematol 2015; 170:305-22. [PMID: 25891481 DOI: 10.1111/bjh.13409] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The acute myeloid leukaemia (AML) genome contains more than 20 driver recurrent mutations. Here, we review the potential for therapeutic targeting of the most common mutations associated with normal cytogenetics AML, focusing on those affecting the FLT3, NPM1 and epigenetic modifier genes (DNMT3A, IDH1/2, TET2). As compared to early compounds, second generation FLT3 inhibitors are more specific and have better pharmacokinetics. They also show higher anti-leukaemic activity, leading to about 50% of composite complete remissions in refractory/relapsed FLT3-internal tandem duplication-mutated AML. However, rapid relapses invariably occur due to various mechanisms of resistance to FLT3 inhibitors. This issue and the best way for using FLT3 inhibitors in combination with other therapeutic modalities are discussed. Potential approaches for therapeutic targeting of NPM1-mutated AML include: (i) reverting the aberrant nuclear export of NPM1 mutant using exportin-1 inhibitors; (ii) disruption of the nucleolus with drugs blocking the oligomerization of wild-type nucleophosmin or inducing nucleolar stress; and (iii) immunotherapeutic targeting of highly expressed CD33 and IL3RA (CD123) antigens. Finally, we discuss the role of demethylating agents (decitabine and azacitidine) and IDH1/2 inhibitors in the treatment of AML patients carrying mutations of genes (DNMT3A, IDH1/2 and TET2) involved in the epigenetic regulation of transcription.
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Affiliation(s)
- Brunangelo Falini
- Institute of Haematology-CREO (Centro di Ricerche Emato-Oncologiche), Ospedale S. Maria Misericordia, University of Perugia, Perugia, Italy
| | - Paolo Sportoletti
- Institute of Haematology-CREO (Centro di Ricerche Emato-Oncologiche), Ospedale S. Maria Misericordia, University of Perugia, Perugia, Italy
| | - Lorenzo Brunetti
- Institute of Haematology-CREO (Centro di Ricerche Emato-Oncologiche), Ospedale S. Maria Misericordia, University of Perugia, Perugia, Italy
| | - Maria Paola Martelli
- Institute of Haematology-CREO (Centro di Ricerche Emato-Oncologiche), Ospedale S. Maria Misericordia, University of Perugia, Perugia, Italy
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Chen X, Xie H, Wood BL, Walter RB, Pagel JM, Becker PS, Sandhu VK, Abkowitz JL, Appelbaum FR, Estey EH. Relation of Clinical Response and Minimal Residual Disease and Their Prognostic Impact on Outcome in Acute Myeloid Leukemia. J Clin Oncol 2015; 33:1258-64. [DOI: 10.1200/jco.2014.58.3518] [Citation(s) in RCA: 183] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Purpose Both presence of minimal residual disease (MRD) and achievement of complete remission (CR) with incomplete platelet recovery (CRp) rather than CR after induction therapy predict relapse in acute myeloid leukemia (AML). These results suggest a correlation between response (peripheral count recovery) and MRD at the time of morphologic remission. Here we examine this hypothesis and whether MRD and response provide independent prognostic information after accounting for other relevant covariates. Patients and Methods We retrospectively analyzed data from 245 adults with AML who achieved CR, CRp, or CR with incomplete blood count recovery (CRi) after induction therapy. Bone marrow samples were collected on or closest to the first date of blood count recovery, and MRD was determined by 10-color multiparameter flow cytometry. Results The 71.0% of patients who achieved CR had MRD less frequently and had lower levels of MRD than the 19.6% of patients achieving CRp and 9.4% achieving CRi. Although pretreatment covariates such as cytogenetics, monosomal karyotype, relapsed or refractory rather than newly diagnosed AML, and FLT3 internal tandem duplication were associated with relapse, their prognostic effect was much lower once MRD and response were taken into account, the univariable statistical effect of which was not materially affected by inclusion of pretreatment covariates. Conclusion Our data indicate that post-therapy parameters including MRD status and response are important independent prognostic factors for outcome in patients with AML achieving remission. MRD status and type of response (CR v CRp or CRi) should play important, and perhaps dominant, roles in planning postinduction therapy.
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Affiliation(s)
- Xueyan Chen
- Xueyan Chen, Brent L. Wood, Roland B. Walter, Pamela S. Becker, Janis L. Abkowitz, and Elihu H. Estey, University of Washington; and Hu Xie, Roland B. Walter, John M. Pagel, Pamela S. Becker, Vicky K. Sandhu, Frederick R. Appelbaum, and Elihu H. Estey, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Hu Xie
- Xueyan Chen, Brent L. Wood, Roland B. Walter, Pamela S. Becker, Janis L. Abkowitz, and Elihu H. Estey, University of Washington; and Hu Xie, Roland B. Walter, John M. Pagel, Pamela S. Becker, Vicky K. Sandhu, Frederick R. Appelbaum, and Elihu H. Estey, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Brent L. Wood
- Xueyan Chen, Brent L. Wood, Roland B. Walter, Pamela S. Becker, Janis L. Abkowitz, and Elihu H. Estey, University of Washington; and Hu Xie, Roland B. Walter, John M. Pagel, Pamela S. Becker, Vicky K. Sandhu, Frederick R. Appelbaum, and Elihu H. Estey, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Roland B. Walter
- Xueyan Chen, Brent L. Wood, Roland B. Walter, Pamela S. Becker, Janis L. Abkowitz, and Elihu H. Estey, University of Washington; and Hu Xie, Roland B. Walter, John M. Pagel, Pamela S. Becker, Vicky K. Sandhu, Frederick R. Appelbaum, and Elihu H. Estey, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - John M. Pagel
- Xueyan Chen, Brent L. Wood, Roland B. Walter, Pamela S. Becker, Janis L. Abkowitz, and Elihu H. Estey, University of Washington; and Hu Xie, Roland B. Walter, John M. Pagel, Pamela S. Becker, Vicky K. Sandhu, Frederick R. Appelbaum, and Elihu H. Estey, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Pamela S. Becker
- Xueyan Chen, Brent L. Wood, Roland B. Walter, Pamela S. Becker, Janis L. Abkowitz, and Elihu H. Estey, University of Washington; and Hu Xie, Roland B. Walter, John M. Pagel, Pamela S. Becker, Vicky K. Sandhu, Frederick R. Appelbaum, and Elihu H. Estey, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Vicky K. Sandhu
- Xueyan Chen, Brent L. Wood, Roland B. Walter, Pamela S. Becker, Janis L. Abkowitz, and Elihu H. Estey, University of Washington; and Hu Xie, Roland B. Walter, John M. Pagel, Pamela S. Becker, Vicky K. Sandhu, Frederick R. Appelbaum, and Elihu H. Estey, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Janis L. Abkowitz
- Xueyan Chen, Brent L. Wood, Roland B. Walter, Pamela S. Becker, Janis L. Abkowitz, and Elihu H. Estey, University of Washington; and Hu Xie, Roland B. Walter, John M. Pagel, Pamela S. Becker, Vicky K. Sandhu, Frederick R. Appelbaum, and Elihu H. Estey, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Frederick R. Appelbaum
- Xueyan Chen, Brent L. Wood, Roland B. Walter, Pamela S. Becker, Janis L. Abkowitz, and Elihu H. Estey, University of Washington; and Hu Xie, Roland B. Walter, John M. Pagel, Pamela S. Becker, Vicky K. Sandhu, Frederick R. Appelbaum, and Elihu H. Estey, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Elihu H. Estey
- Xueyan Chen, Brent L. Wood, Roland B. Walter, Pamela S. Becker, Janis L. Abkowitz, and Elihu H. Estey, University of Washington; and Hu Xie, Roland B. Walter, John M. Pagel, Pamela S. Becker, Vicky K. Sandhu, Frederick R. Appelbaum, and Elihu H. Estey, Fred Hutchinson Cancer Research Center, Seattle, WA
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Hokland P, Ommen HB, Mulé MP, Hourigan CS. Advancing the Minimal Residual Disease Concept in Acute Myeloid Leukemia. Semin Hematol 2015; 52:184-92. [PMID: 26111465 DOI: 10.1053/j.seminhematol.2015.04.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The criteria to evaluate response to treatment in acute myeloid leukemia (AML) have changed little in the past 60 years. It is now possible to use higher sensitivity tools to measure residual disease burden in AML. Such minimal or measurable residual disease (MRD) measurements provide a deeper understanding of current patient status and allow stratification for risk of subsequent clinical relapse. Despite these obvious advantages, and after over a decade of laboratory investigation and preclinical validation, MRD measurements are not currently routinely used for clinical decision-making or drug development in non-acute promyelocytic leukemia (non-APL) AML. We review here some potential constraints that may have delayed adoption, including a natural hesitancy of end users, economic impact concerns, misperceptions regarding the meaning of and need for assay sensitivity, the lack of one single MRD solution for all AML patients, and finally the need to involve patients in decision-making based on such correlates. It is our opinion that none of these issues represent insurmountable barriers and our hope is that by providing potential solutions we can help map a path forward to a future where our patients will be offered personalized treatment plans based on the amount of AML they have left remaining to treat.
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Affiliation(s)
- Peter Hokland
- Department of Hematology, Aarhus University Hospital, Denmark
| | - Hans B Ommen
- Department of Hematology, Aarhus University Hospital, Denmark
| | - Matthew P Mulé
- Myeloid Malignancies Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Christopher S Hourigan
- Myeloid Malignancies Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD.
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Quan J, Gao YJ, Yang ZL, Chen H, Xian JR, Zhang SS, Zou Q, Zhang L. Quantitative detection of circulating nucleophosmin mutations DNA in the plasma of patients with acute myeloid leukemia. Int J Med Sci 2015; 12:17-22. [PMID: 25552914 PMCID: PMC4278871 DOI: 10.7150/ijms.10144] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 10/21/2014] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE The aim of this study was to quantify the copies of circulating nucleophosmin (NPM) mutations DNA in the plasma of patients with acute myeloid leukemia (AML) and to explore the association of circulating NPM mutation levels with clinical characteristics. DESIGN AND METHODS The presence of NPM mutations in 100 Chinese patients newly diagnosed with AML were identified by RT-PCR and sequencing analysis. Copies of circulating NPM mutation A (NPM mut.A) DNA in the plasma of mutation-positive cases were quantified by real-time quantitative PCR (qRT-PCR). Furthermore, the association of circulating NPM mutation levels and clinical characteristics was analyzed. RESULTS NPM mutations were identified in 37 of the 100 patients and all cases were NPM mut.A. The circulating NPM mut.A levels ranged from 0.35×10(8) copies/ml to 6.0×10(8) copies/ml in the 37 mutation-positive cases. The medium and quartile M (P25, P75) of the circulating NPM mut.A levels in patients classified as M2, M4 and M5 morphological subtypes were 1.35×10(8) (0.76×10(8), 1.91×10(8)) copies/ml, 1.81×10(8) (1.47×10(8), 2.2×10(8)) copies/ml and 2.50×10(8) (2.42×10(8), 3.05×10(8)) copies/ml, respectively. Circulating NPM mut.A levels were significantly higher in patients with the M5 subtype of AML compared to patients with the M2 and M4 subtypes (p=0.000, p=0.046). In addition, circulating NPM mut.A copies were significantly associated with a higher white blood cell count, platelet count and bone marrow blast percentage (p<0.05). CONCLUSION Our results suggest that circulating NPM mutations DNA assay serves as a complementary to the routine investigative protocol of NPM-mutated leukemia.
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Affiliation(s)
- Jing Quan
- 1. Key Laboratory of Laboratory Medical Diagnostics Designated by the Ministry of Education, College of Laboratory Medicine, Chongqing Medical University, Yixueyuan Road, Chongqing 400016, P.R.China
| | - Yu-jie Gao
- 2. Department of Laboratory Medicine, Yantai Yuhuangding Hospital, Yantai 264000, P.R.China
| | - Zai-lin Yang
- 3. Center for Hematology, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R.China
| | - Hui Chen
- 4. Department of Laboratory Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R.China
| | - Jing-rong Xian
- 1. Key Laboratory of Laboratory Medical Diagnostics Designated by the Ministry of Education, College of Laboratory Medicine, Chongqing Medical University, Yixueyuan Road, Chongqing 400016, P.R.China
| | - Shuai-shuai Zhang
- 1. Key Laboratory of Laboratory Medical Diagnostics Designated by the Ministry of Education, College of Laboratory Medicine, Chongqing Medical University, Yixueyuan Road, Chongqing 400016, P.R.China
| | - Qin Zou
- 1. Key Laboratory of Laboratory Medical Diagnostics Designated by the Ministry of Education, College of Laboratory Medicine, Chongqing Medical University, Yixueyuan Road, Chongqing 400016, P.R.China
| | - Ling Zhang
- 1. Key Laboratory of Laboratory Medical Diagnostics Designated by the Ministry of Education, College of Laboratory Medicine, Chongqing Medical University, Yixueyuan Road, Chongqing 400016, P.R.China
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Röllig C, Bornhäuser M, Kramer M, Thiede C, Ho AD, Krämer A, Schäfer-Eckart K, Wandt H, Hänel M, Einsele H, Aulitzky WE, Schmitz N, Berdel WE, Stelljes M, Müller-Tidow C, Krug U, Platzbecker U, Wermke M, Baldus CD, Krause SW, Stölzel F, von Bonin M, Schaich M, Serve H, Schetelig J, Ehninger G. Allogeneic stem-cell transplantation in patients with NPM1-mutated acute myeloid leukemia: results from a prospective donor versus no-donor analysis of patients after upfront HLA typing within the SAL-AML 2003 trial. J Clin Oncol 2014; 33:403-10. [PMID: 25547501 DOI: 10.1200/jco.2013.54.4973] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The presence of a mutated nucleophosmin-1 gene (NPM1(mut)) in acute myeloid leukemia (AML) is associated with a favorable prognosis. To assess the predictive value with regard to allogeneic stem-cell transplantation (SCT), we compared the clinical course of patients with NPM1(mut) AML eligible for allogeneic SCT in a donor versus no-donor analysis. PATIENTS AND METHODS Of 1,179 patients with AML (age 18 to 60 years) treated in the Study Alliance Leukemia AML 2003 trial, we identified all NPM1(mut) patients with an intermediate-risk karyotype. According to the trial protocol, patients were intended to receive an allogeneic SCT if an HLA-identical sibling donor was available. Patients with no available donor received consolidation or autologous SCT. We compared relapse-free survival (RFS) and overall survival (OS) depending on the availability of a suitable donor. RESULTS Of 304 eligible patients, 77 patients had a sibling donor and 227 had no available matched family donor. The 3-year RFS rates in the donor and no-donor groups were 71% and 47%, respectively (P = .005); OS rates were 70% and 60%, respectively (P = .114). In patients with normal karyotype and no FLT3 internal tandem duplication (n = 148), the 3-year RFS rates in the donor and no-donor groups were 83% and 53%, respectively (P = .004); and the 3-year OS rates were 81% and 75%, respectively (P = .300). CONCLUSION Allogeneic SCT led to a significantly prolonged RFS in patients with NPM1(mut) AML. The absence of a statistically significant difference in OS is most likely a result of the fact that NPM1(mut) patients who experienced relapse responded well to salvage treatment. Allogeneic SCT in first remission has potent antileukemic efficacy and is a valuable treatment option in patients with NPM1(mut) AML with a sibling donor.
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Affiliation(s)
- Christoph Röllig
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany.
| | - Martin Bornhäuser
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Michael Kramer
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Christian Thiede
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Anthony D Ho
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Alwin Krämer
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Kerstin Schäfer-Eckart
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Hannes Wandt
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Mathias Hänel
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Hermann Einsele
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Walter E Aulitzky
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Norbert Schmitz
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Wolfgang E Berdel
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Matthias Stelljes
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Carsten Müller-Tidow
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Utz Krug
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Uwe Platzbecker
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Martin Wermke
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Claudia D Baldus
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Stefan W Krause
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Friedrich Stölzel
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Malte von Bonin
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Markus Schaich
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Hubert Serve
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Johannes Schetelig
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Gerhard Ehninger
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
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Abstract
Abstract
The past 40 years have witnessed major advances in defining the cytogenetic aberrations, mutational landscape, epigenetic profiles, and expression changes underlying hematological malignancies. Although it has become apparent that acute myeloid leukemia (AML) is highly heterogeneous at the molecular level, the standard framework for risk stratification guiding transplant practice in this disease remains largely based on pretreatment assessment of cytogenetics and a limited panel of molecular genetic markers, coupled with morphological assessment of bone marrow (BM) blast percentage after induction. However, application of more objective methodology such as multiparameter flow cytometry (MFC) has highlighted the limitations of morphology for reliable determination of remission status. Moreover, there is a growing body of evidence that detection of subclinical levels of leukemia (ie, minimal residual disease, MRD) using MFC or molecular-based approaches provides powerful independent prognostic information. Consequently, there is increasing interest in the use of MRD detection to provide early end points in clinical trials and to inform patient management. However, implementation of MRD assessment into clinical practice remains a major challenge, hampered by differences in the assays and preferred analytical methods employed between routine laboratories. Although this should be addressed through adoption of standardized assays with external quality control, it is clear that the molecular heterogeneity of AML coupled with increasing understanding of its clonal architecture dictates that a “one size fits all” approach to MRD detection in this disease is not feasible. However, with the range of platforms now available, there is considerable scope to realistically track treatment response in every patient.
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227
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Grimwade D, Freeman SD. Defining minimal residual disease in acute myeloid leukemia: which platforms are ready for "prime time"? HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2014; 2014:222-233. [PMID: 25696859 DOI: 10.1182/asheducation-2014.1.222] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The past 40 years have witnessed major advances in defining the cytogenetic aberrations, mutational landscape, epigenetic profiles, and expression changes underlying hematological malignancies. Although it has become apparent that acute myeloid leukemia (AML) is highly heterogeneous at the molecular level, the standard framework for risk stratification guiding transplant practice in this disease remains largely based on pretreatment assessment of cytogenetics and a limited panel of molecular genetic markers, coupled with morphological assessment of bone marrow (BM) blast percentage after induction. However, application of more objective methodology such as multiparameter flow cytometry (MFC) has highlighted the limitations of morphology for reliable determination of remission status. Moreover, there is a growing body of evidence that detection of subclinical levels of leukemia (ie, minimal residual disease, MRD) using MFC or molecular-based approaches provides powerful independent prognostic information. Consequently, there is increasing interest in the use of MRD detection to provide early end points in clinical trials and to inform patient management. However, implementation of MRD assessment into clinical practice remains a major challenge, hampered by differences in the assays and preferred analytical methods employed between routine laboratories. Although this should be addressed through adoption of standardized assays with external quality control, it is clear that the molecular heterogeneity of AML coupled with increasing understanding of its clonal architecture dictates that a "one size fits all" approach to MRD detection in this disease is not feasible. However, with the range of platforms now available, there is considerable scope to realistically track treatment response in every patient.
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Affiliation(s)
- David Grimwade
- Department of Medical & Molecular Genetics, King's College London School of Medicine, London, United Kingdom; and
| | - Sylvie D Freeman
- Department of Clinical Immunology, University of Birmingham Medical School, Edgbaston, Birmingham, United Kingdom
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228
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Döhner K, Paschka P. Intermediate-risk acute myeloid leukemia therapy: current and future. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2014; 2014:34-43. [PMID: 25696832 DOI: 10.1182/asheducation-2014.1.34] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In recent years, research in molecular genetics has been instrumental in deciphering the molecular heterogeneity of acute myeloid leukemia (AML), in particular the subset of patients with "intermediate-risk" cytogenetics. However, at present, only the markers NPM1, CEBPA, and FLT3 have entered clinical practice. Treatment of intermediate-risk AML patients eligible for intensive therapy has not changed substantially. The "3 + 7" induction therapy still represents the standard of care. The addition of the immunoconjugate gemtuzumab ozogamicin to therapy has been shown to improve outcome; however, the drug is not approved for this use. A common standard for postremission therapy is the administration of repeated cycles of intermediate- to high-dose cytarabine. Allogeneic stem cell transplantation may offer a survival benefit for many patients with intermediate-risk AML. Patients are best selected based on the genetic profile of the leukemia cells and the risk associated with the transplantation itself. A myriad of novel agents targeting mutant leukemia drivers or deregulated pathways are in clinical development. In the past, many novel compounds have not met expectations; nonetheless, with the rapid developments in comprehensive molecular profiling and new drug design, there is the prospect of personalizing therapy and improving patient outcome.
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Affiliation(s)
- Konstanze Döhner
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | - Peter Paschka
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
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229
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Abstract
Abstract
In recent years, research in molecular genetics has been instrumental in deciphering the molecular heterogeneity of acute myeloid leukemia (AML), in particular the subset of patients with “intermediate-risk” cytogenetics. However, at present, only the markers NPM1, CEBPA, and FLT3 have entered clinical practice. Treatment of intermediate-risk AML patients eligible for intensive therapy has not changed substantially. The “3 + 7” induction therapy still represents the standard of care. The addition of the immunoconjugate gemtuzumab ozogamicin to therapy has been shown to improve outcome; however, the drug is not approved for this use. A common standard for postremission therapy is the administration of repeated cycles of intermediate- to high-dose cytarabine. Allogeneic stem cell transplantation may offer a survival benefit for many patients with intermediate-risk AML. Patients are best selected based on the genetic profile of the leukemia cells and the risk associated with the transplantation itself. A myriad of novel agents targeting mutant leukemia drivers or deregulated pathways are in clinical development. In the past, many novel compounds have not met expectations; nonetheless, with the rapid developments in comprehensive molecular profiling and new drug design, there is the prospect of personalizing therapy and improving patient outcome.
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230
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Swaminathan S, Garg S, Madkaikar M, Gupta M, Jijina F, Ghosh K. FLT3 and NPM-1 mutations in a cohort of acute promyelocytic leukemia patients from India. INDIAN JOURNAL OF HUMAN GENETICS 2014; 20:160-5. [PMID: 25400345 PMCID: PMC4228568 DOI: 10.4103/0971-6866.142884] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Acute promyelocytic leukemia (APL) with t (15;17) is a distinct category of acute myeloid leukemia (AML) and is reported to show better response to anthracyclin based chemotherapy. A favorable overall prognosis over other subtypes of AML has been reported for APL patients but still about 15% patients relapse. METHODS This study evaluated the presence of Famus like tyrosine kinase-3 (FLT3) and nucleophosmin-1 (NPM1) gene mutations in a cohort of 40 APL patients. Bone marrow/peripheral blood samples from patients at the time of diagnosis and follow-up were processed for immunophenotyping, cytogenetic markers and isolation of DNA and RNA. Samples were screened for the presence of mutations in FLT3 and NPM1 genes using polymerase chain reaction followed by sequencing. RESULTS Frequency of FLT3/internal tandem duplication and FLT3/tyrosine kinase domain was found to be 25% and 7% respectively. We observed a high frequency of NPM1 mutation (45%) in the present population of APL patients.
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Affiliation(s)
- Suchitra Swaminathan
- Department of Pediatric Immunology and Leukocyte Biology, National Institute of Immunohaematology, Indian Council of Medical Research, K.E.M. Hospital, Parel, Mumbai, Maharashtra, India ; Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Swati Garg
- Department of Pediatric Immunology and Leukocyte Biology, National Institute of Immunohaematology, Indian Council of Medical Research, K.E.M. Hospital, Parel, Mumbai, Maharashtra, India
| | - Manisha Madkaikar
- Department of Pediatric Immunology and Leukocyte Biology, National Institute of Immunohaematology, Indian Council of Medical Research, K.E.M. Hospital, Parel, Mumbai, Maharashtra, India
| | - Maya Gupta
- Department of Pediatric Immunology and Leukocyte Biology, National Institute of Immunohaematology, Indian Council of Medical Research, K.E.M. Hospital, Parel, Mumbai, Maharashtra, India
| | - Farah Jijina
- Department of Hematology, K.E.M. Hospital, Parel, Mumbai, Maharashtra, India
| | - Kanjaksha Ghosh
- Department of Pediatric Immunology and Leukocyte Biology, National Institute of Immunohaematology, Indian Council of Medical Research, K.E.M. Hospital, Parel, Mumbai, Maharashtra, India
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Detection of minimal residual disease in NPM1-mutated acute myeloid leukemia by next-generation sequencing. Mod Pathol 2014; 27:1438-46. [PMID: 24743218 PMCID: PMC4201902 DOI: 10.1038/modpathol.2014.57] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 02/15/2014] [Accepted: 02/18/2014] [Indexed: 01/08/2023]
Abstract
Detection of minimal residual disease predicts adverse outcome in patients with acute myeloid leukemia. Currently, minimal residual disease may be detected by RQ-PCR or flow cytometry, both of which have practical and diagnostic limitations. Here, we describe a next-generation sequencing assay for minimal residual disease detection in NPM1-mutated acute myeloid leukemia, which encompasses ∼60% of patients with normal karyotype acute myeloid leukemia. Exon 12 of NPM1 was PCR amplified using sequencing adaptor-linked primers and deep sequenced to enable detection of low-prevalence, acute myeloid leukemia-specific activating mutations. We benchmarked our results against flow cytometry, the standard of care for acute myeloid leukemia minimal residual disease diagnosis at our institution. The performance of both approaches was evaluated using defined dilutions of an NPM1 mutation-positive cell line and longitudinal clinical samples from acute myeloid leukemia patients. Using defined control material, we found this assay sensitive to approximately 0.001% mutant cells, outperforming flow cytometry by an order of magnitude. Next-generation sequencing was precise and semiquantitative over four orders of magnitude. In 22 longitudinal samples from six acute myeloid leukemia patients, next-generation sequencing detected minimal residual disease in all samples deemed negative by flow cytometry. Further, in one-third of patients, sequencing detected alternate NPM1 mutations in addition to the patient's index mutation, consistent with tumor heterogeneity. Next-generation sequencing provides information without prior knowledge of NPM1 mutation subtype or validation of allele-specific probes as required for RQ-PCR assays, and without generation and interpretation of complex multidimensional flow cytometry data. This approach may complement current technologies to enhance patient-specific clinical decision-making.
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232
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Gojo I, Karp JE. New strategies in acute myelogenous leukemia: leukemogenesis and personalized medicine. Clin Cancer Res 2014; 20:6233-41. [PMID: 25324141 DOI: 10.1158/1078-0432.ccr-14-0900] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Recent advances in molecular technology have unraveled the complexity of leukemogenesis and provided the opportunity to design more personalized and pathophysiology-targeted therapeutic strategies. Despite the use of intensive chemotherapy, relapse remains the most common cause for therapeutic failure in acute myelogenous leukemia (AML). The interactions between leukemia stem cells (LSC) and marrow microenvironment appear to be critical in promoting therapeutic resistance through progressive acquisition of genetic and epigenetic changes within leukemia cells and immune evasion, resulting in leukemia cell survival. With advances in genomic-sequencing efforts, epigenetic and phenotypic characterization, personalized therapeutic strategies aimed at critical leukemia survival mechanisms may be feasible in the near future. Here, we review select novel approaches to therapy of AML such as targeting LSC, altering leukemia/marrow microenvironment interactions, inhibiting DNA repair or cell-cycle checkpoints, and augmenting immune-based antileukemia activity.
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Affiliation(s)
- Ivana Gojo
- Division of Hematologic Malignancies, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland.
| | - Judith E Karp
- Division of Hematologic Malignancies, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
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Subklewe M, Geiger C, Lichtenegger FS, Javorovic M, Kvalheim G, Schendel DJ, Bigalke I. New generation dendritic cell vaccine for immunotherapy of acute myeloid leukemia. Cancer Immunol Immunother 2014; 63:1093-103. [PMID: 25186611 PMCID: PMC11028838 DOI: 10.1007/s00262-014-1600-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 08/11/2014] [Indexed: 01/22/2023]
Abstract
Dendritic cell (DC)-based immunotherapy is a promising strategy for the elimination of minimal residual disease in patients with acute myeloid leukemia (AML). Particularly, patients with a high risk of relapse who are not eligible for hematopoietic stem cell transplantation could benefit from such a therapeutic approach. Here, we review our extensive studies on the development of a protocol for the generation of DCs with improved immunogenicity and optimized for the use in cell-based immunotherapy. This new generation DC vaccine combines the production of DCs in only 3 days with Toll-like receptor-signaling-induced cell maturation. These mature DCs are then loaded with RNA encoding the leukemia-associated antigens Wilm's tumor protein 1 and preferentially expressed antigen in melanoma in order to stimulate an AML-specific T-cell-based immune response. In vitro as well as in vivo studies demonstrated the enhanced capacity of these improved DCs for the induction of tumor-specific immune responses. Finally, a proof-of-concept Phase I/II clinical trial is discussed for post-remission AML patients with high risk for disease relapse.
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Affiliation(s)
- Marion Subklewe
- Department of Internal Medicine III, Klinikum der Universität München, Munich, Germany
| | - Christiane Geiger
- Institute of Molecular Immunology, Helmholtz Zentrum München, Munich, Germany
- Trianta Immunotherapies GmbH, A subsidiary of Medigene AG, Lochhamer Str. 11, 82152 Planegg-Martinsried, Germany
| | - Felix S. Lichtenegger
- Department of Internal Medicine III, Klinikum der Universität München, Munich, Germany
| | - Miran Javorovic
- Institute of Molecular Immunology, Helmholtz Zentrum München, Munich, Germany
| | - Gunnar Kvalheim
- Department of Cellular Therapy, Oslo University Hospital, Oslo, Norway
| | - Dolores J. Schendel
- Institute of Molecular Immunology, Helmholtz Zentrum München, Munich, Germany
- Trianta Immunotherapies GmbH, A subsidiary of Medigene AG, Lochhamer Str. 11, 82152 Planegg-Martinsried, Germany
| | - Iris Bigalke
- Institute of Molecular Immunology, Helmholtz Zentrum München, Munich, Germany
- Department of Cellular Therapy, Oslo University Hospital, Oslo, Norway
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235
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Ofran Y. Genetic stratification in myeloid diseases: from risk assessment to clinical decision support tool. Rambam Maimonides Med J 2014; 5:e0025. [PMID: 25386341 PMCID: PMC4222414 DOI: 10.5041/rmmj.10159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Genetic aberrations have become a dominant factor in the stratification of myeloid malignancies. Cytogenetic and a few mutation studies are the backbone of risk assessment models of myeloid malignancies which are a major consideration in clinical decisions, especially patient assignment for allogeneic stem cell transplantation. Progress in our understanding of the genetic basis of the pathogenesis of myeloid malignancies and the growing capabilities of mass sequencing may add new roles for the clinical usage of genetic data. A few recently identified mutations recognized to be associated with specific diseases or clinical scenarios may soon become part of the diagnostic criteria of such conditions. Mutational studies may also advance our capabilities for a more efficient patient selection process, assigning the most effective therapy at the best timing for each patient. The clinical utility of genetic data is anticipated to advance further with the adoption of deep sequencing and next-generation sequencing techniques. We herein suggest some future potential applications of sequential genetic data to identify pending deteriorations at time points which are the best for aggressive interventions such as allogeneic stem cell transplantation. Genetics is moving from being mostly a prognostic factor to becoming a multitasking decision support tool for hematologists. Physicians must pay attention to advances in molecular hematology as it will soon be accessible and influential for most of our patients.
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Affiliation(s)
- Yishai Ofran
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel and ; Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
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236
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Ossenkoppele GJ, Schuurhuis GJ. MRD in AML: It is time to change the definition of remission. Best Pract Res Clin Haematol 2014; 27:265-71. [DOI: 10.1016/j.beha.2014.10.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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237
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Grunwald MR, Tseng LH, Lin MT, Pratz KW, Eshleman JR, Levis MJ, Gocke CD. Improved FLT3 internal tandem duplication PCR assay predicts outcome after allogeneic transplant for acute myeloid leukemia. Biol Blood Marrow Transplant 2014; 20:1989-95. [PMID: 25240816 DOI: 10.1016/j.bbmt.2014.08.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 08/18/2014] [Indexed: 11/29/2022]
Abstract
Patients with acute myeloid leukemia (AML) who harbor internal tandem duplication (ITD) mutations of the FMS-like tyrosine kinase 3 (FLT3) gene carry a poor prognosis. Although allogeneic transplantation may improve outcomes, relapse occurs frequently. The FLT3/ITD mutation has been deemed an unsuitable minimal residual disease (MRD) marker because it is unstable and because the standard assay for the mutation is relatively insensitive. The FLT3 mutation is undetectable by PCR at pre- or post-transplant time points in many FLT3/ITD AML patients who subsequently relapse after transplant. We report the application of a new technique, tandem duplication PCR (TD-PCR), for detecting MRD in FLT3/ITD AML patients. Between October 2004 and January 2012, 54 FLT3/ITD AML patients in remission underwent transplantation at our institution. Of 37 patients with available day 60 marrow samples, 28 (76%) were assessable for MRD detection. In seven of 28 patients (25%), the FLT3/ITD mutation was detectable by TD-PCR but not by standard PCR on day 60. Six of 7 patients (86%) with MRD by TD-PCR have relapsed to date compared with only 2 of 21 patients (10%) who were negative for MRD (P = .0003). The ability to detect MRD by this sensitive technique may provide an opportunity for early clinical intervention.
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Affiliation(s)
- Michael R Grunwald
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina
| | - Li-Hui Tseng
- Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ming-Tseh Lin
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Keith W Pratz
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - James R Eshleman
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mark J Levis
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Christopher D Gocke
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland.
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238
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Meyer SC, Levine RL. Translational implications of somatic genomics in acute myeloid leukaemia. Lancet Oncol 2014; 15:e382-94. [DOI: 10.1016/s1470-2045(14)70008-7] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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239
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Hirsch P, Labopin M, Viguié F, Perot C, Isnard F, Mamez AC, Bilhou-Nabera C, Marzac C, Delhommeau F, Lapusan S, Marie JP, Mohty M, Legrand O. Interest of cytogenetic and FISH evaluation for prognosis evaluation in 198 patients with acute myeloid leukemia in first complete remission in a single institution. Leuk Res 2014; 38:907-12. [PMID: 24957411 DOI: 10.1016/j.leukres.2014.05.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 05/16/2014] [Accepted: 05/27/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Pierre Hirsch
- Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint-Antoine, APHP, Paris, France; UPMC, Univ Paris 06, GRC n°7, Groupe de Recherche Clinique sur les Myéloproliférations Aiguës et Chroniques MYPAC, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMR_S 938, CDR Saint-Antoine, F-75012 Paris, France; INSERM, UMR_S 938, CDR Saint-Antoine, F-75012 Paris, France.
| | - Myriam Labopin
- Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint-Antoine, APHP, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMR_S 938, CDR Saint-Antoine, F-75012 Paris, France; INSERM, UMR_S 938, CDR Saint-Antoine, F-75012 Paris, France
| | - Frank Viguié
- Laboratoire d'Immunologie et Hématologie Biologique, Hôpital Saint-Antoine, APHP, Paris, France
| | - Christine Perot
- Laboratoire d'Immunologie et Hématologie Biologique, Hôpital Saint-Antoine, APHP, Paris, France
| | - Françoise Isnard
- Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint-Antoine, APHP, Paris, France; UPMC, Univ Paris 06, GRC n°7, Groupe de Recherche Clinique sur les Myéloproliférations Aiguës et Chroniques MYPAC, Paris, France
| | - Anne-Claire Mamez
- Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint-Antoine, APHP, Paris, France; UPMC, Univ Paris 06, GRC n°7, Groupe de Recherche Clinique sur les Myéloproliférations Aiguës et Chroniques MYPAC, Paris, France
| | - Chrystèle Bilhou-Nabera
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 938, CDR Saint-Antoine, F-75012 Paris, France; INSERM, UMR_S 938, CDR Saint-Antoine, F-75012 Paris, France; Laboratoire d'Immunologie et Hématologie Biologique, Hôpital Saint-Antoine, APHP, Paris, France
| | - Christophe Marzac
- UPMC, Univ Paris 06, GRC n°7, Groupe de Recherche Clinique sur les Myéloproliférations Aiguës et Chroniques MYPAC, Paris, France; Laboratoire d'Immunologie et Hématologie Biologique, Hôpital Saint-Antoine, APHP, Paris, France
| | - François Delhommeau
- UPMC, Univ Paris 06, GRC n°7, Groupe de Recherche Clinique sur les Myéloproliférations Aiguës et Chroniques MYPAC, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMR_S 938, CDR Saint-Antoine, F-75012 Paris, France; INSERM, UMR_S 938, CDR Saint-Antoine, F-75012 Paris, France; Laboratoire d'Immunologie et Hématologie Biologique, Hôpital Saint-Antoine, APHP, Paris, France
| | - Simona Lapusan
- Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint-Antoine, APHP, Paris, France; UPMC, Univ Paris 06, GRC n°7, Groupe de Recherche Clinique sur les Myéloproliférations Aiguës et Chroniques MYPAC, Paris, France
| | - Jean Pierre Marie
- Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint-Antoine, APHP, Paris, France; UPMC, Univ Paris 06, GRC n°7, Groupe de Recherche Clinique sur les Myéloproliférations Aiguës et Chroniques MYPAC, Paris, France
| | - Mohamad Mohty
- Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint-Antoine, APHP, Paris, France; UPMC, Univ Paris 06, GRC n°7, Groupe de Recherche Clinique sur les Myéloproliférations Aiguës et Chroniques MYPAC, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMR_S 938, CDR Saint-Antoine, F-75012 Paris, France; INSERM, UMR_S 938, CDR Saint-Antoine, F-75012 Paris, France
| | - Ollivier Legrand
- Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint-Antoine, APHP, Paris, France; UPMC, Univ Paris 06, GRC n°7, Groupe de Recherche Clinique sur les Myéloproliférations Aiguës et Chroniques MYPAC, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMR_S 938, CDR Saint-Antoine, F-75012 Paris, France; INSERM, UMR_S 938, CDR Saint-Antoine, F-75012 Paris, France
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240
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Defining minimal residual disease in acute myeloid leukemia: which platforms are ready for "prime time"? Blood 2014; 124:3345-55. [PMID: 25049280 DOI: 10.1182/blood-2014-05-577593] [Citation(s) in RCA: 192] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The past 40 years have witnessed major advances in defining the cytogenetic aberrations, mutational landscape, epigenetic profiles, and expression changes underlying hematological malignancies. Although it has become apparent that acute myeloid leukemia (AML) is highly heterogeneous at the molecular level, the standard framework for risk stratification guiding transplant practice in this disease remains largely based on pretreatment assessment of cytogenetics and a limited panel of molecular genetic markers, coupled with morphological assessment of bone marrow (BM) blast percentage after induction. However, application of more objective methodology such as multiparameter flow cytometry (MFC) has highlighted the limitations of morphology for reliable determination of remission status. Moreover, there is a growing body of evidence that detection of subclinical levels of leukemia (ie, minimal residual disease, MRD) using MFC or molecular-based approaches provides powerful independent prognostic information. Consequently, there is increasing interest in the use of MRD detection to provide early end points in clinical trials and to inform patient management. However, implementation of MRD assessment into clinical practice remains a major challenge, hampered by differences in the assays and preferred analytical methods employed between routine laboratories. Although this should be addressed through adoption of standardized assays with external quality control, it is clear that the molecular heterogeneity of AML coupled with increasing understanding of its clonal architecture dictates that a "one size fits all" approach to MRD detection in this disease is not feasible. However, with the range of platforms now available, there is considerable scope to realistically track treatment response in every patient.
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241
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Bacher U, Dicker F, Haferlach C, Alpermann T, Rose D, Kern W, Haferlach T, Schnittger S. Quantification of rareNPM1mutation subtypes by digital PCR. Br J Haematol 2014; 167:710-4. [DOI: 10.1111/bjh.13038] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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242
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Webersinke G, Kranewitter W, Deutschbauer S, Zach O, Hasenschwandtner S, Wiesinger K, Erdel M, Marschon R, Böhm A, Tschurtschenthaler G. Switch of the mutation type of the NPM1 gene in acute myeloid leukemia (AML): relapse or secondary AML? Blood Cancer J 2014; 4:e221. [PMID: 24972150 PMCID: PMC4080213 DOI: 10.1038/bcj.2014.42] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- G Webersinke
- Laboratory for Molecular Biology and Tumor Cytogenetics, Department of Internal Medicine, Hospital Barmherzige Schwestern Linz, Linz, Austria
| | - W Kranewitter
- Laboratory for Molecular Biology and Tumor Cytogenetics, Department of Internal Medicine, Hospital Barmherzige Schwestern Linz, Linz, Austria
| | - S Deutschbauer
- Laboratory for Molecular Biology and Tumor Cytogenetics, Department of Internal Medicine, Hospital Barmherzige Schwestern Linz, Linz, Austria
| | - O Zach
- Department of Hematology, Stemcell-Transplantation, Hemostaseology and Oncology, Elisabethinen Hospital, Linz, Austria
| | - S Hasenschwandtner
- Department of Internal Medicine, Linz, Hospital Barmherzige Schwestern Linz, Austria
| | | | - M Erdel
- Laboratory for Molecular Biology and Tumor Cytogenetics, Department of Internal Medicine, Hospital Barmherzige Schwestern Linz, Linz, Austria
| | - R Marschon
- Laboratory for Molecular Biology and Tumor Cytogenetics, Department of Internal Medicine, Hospital Barmherzige Schwestern Linz, Linz, Austria
| | - A Böhm
- Department of Hematology, Stemcell-Transplantation, Hemostaseology and Oncology, Elisabethinen Hospital, Linz, Austria
| | - G Tschurtschenthaler
- Department of Internal Medicine, Linz, Hospital Barmherzige Schwestern Linz, Austria
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243
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Early assessment of minimal residual disease in AML by flow cytometry during aplasia identifies patients at increased risk of relapse. Leukemia 2014; 29:377-86. [PMID: 24912430 DOI: 10.1038/leu.2014.186] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 05/11/2014] [Accepted: 05/27/2014] [Indexed: 01/28/2023]
Abstract
In acute myeloid leukemia (AML), assessment of minimal residual disease (MRD) by flow cytometry (flow MRD) after induction and consolidation therapy has been shown to provide independent prognostic information. However, data on the value of earlier flow MRD assessment are lacking. Therefore, the value of flow MRD detection was determined during aplasia in 178 patients achieving complete remission after treatment according to AMLCG (AML Cooperative Group) induction protocols. Flow MRD positivity during aplasia predicted poor outcome (5-year relapse-free survival (RFS) 16% vs 43%, P<0.001) independently from age and cytogenetic risk group (hazard ratio for MRD positivity 1.71; P=0.009). Importantly, the prognosis of patients without detectable MRD was neither impacted by morphological blast count during aplasia nor by MRD status postinduction. Early flow MRD was also evaluated in the context of existing risk factors. Flow MRD was prognostic within the intermediate cytogenetic risk group (5-year RFS 15% vs 37%, P=0.016) as well as for patients with normal karyotype and NPM1 mutations (5-year RFS 13% vs 49%, P=0.02) or FLT3-ITD (3-year RFS rates 9% vs 44%, P=0.016). Early flow MRD assessment can improve current risk stratification approaches by prediction of RFS in AML and might facilitate adaptation of postremission therapy for patients at high risk of relapse.
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244
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Hubmann M, Köhnke T, Hoster E, Schneider S, Dufour A, Zellmeier E, Fiegl M, Braess J, Bohlander SK, Subklewe M, Sauerland MC, Berdel WE, Büchner T, Wörmann B, Hiddemann W, Spiekermann K. Molecular response assessment by quantitative real-time polymerase chain reaction after induction therapy in NPM1-mutated patients identifies those at high risk of relapse. Haematologica 2014; 99:1317-25. [PMID: 24816240 DOI: 10.3324/haematol.2014.104133] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Monitoring minimal residual disease is an important way to identify patients with acute myeloid leukemia at high risk of relapse. In this study we investigated the prognostic potential of minimal residual disease monitoring by quantitative real-time polymerase chain reaction analysis of NPM1 mutations in patients treated in the AMLCG 1999, 2004 and 2008 trials. Minimal residual disease was monitored - in aplasia, after induction therapy, after consolidation therapy, and during follow-up - in 588 samples from 158 patients positive for NPM1 mutations A, B and D (with a sensitivity of 10(-6)). One hundred and twenty-seven patients (80.4%) achieved complete remission after induction therapy and, of these, 56 patients (44.1%) relapsed. At each checkpoint, minimal residual disease cut-offs were calculated. After induction therapy a cut-off NPM1 mutation ratio of 0.01 was associated with a high hazard ratio of 4.26 and the highest sensitivity of 76% for the prediction of relapse. This was reflected in a cumulative incidence of relapse after 2 years of 77.8% for patients with ratios above the cut-off versus 26.4% for those with ratios below the cut-off. In the favorable subgroup according to European LeukemiaNet, the cut-off after induction therapy also separated the cohort into two prognostic groups with a cumulative incidence of relapse of 76% versus 6% after 2 years. Our data demonstrate that in addition to pre-therapeutic factors, the course of minimal residual disease in an individual is an important prognostic factor and could be included in clinical trials for the guidance of post-remission therapy. The trials from which data were obtained were registered at www.clinicaltrials.gov (#NCT01382147, #NCT00266136) and at the European Leukemia Trial Registry (#LN_AMLINT2004_230).
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Affiliation(s)
- Max Hubmann
- Department of Medicine III, University Hospital Grosshadern, Munich, Germany
| | - Thomas Köhnke
- Department of Medicine III, University Hospital Grosshadern, Munich, Germany
| | - Eva Hoster
- Institute of Medical Informatics, Biometry and Epidemiology (IBE), Faculty of Medicine, Ludwig Maximilian University of Munich, Germany
| | - Stephanie Schneider
- Department of Medicine III, University Hospital Grosshadern, Munich, Germany
| | - Annika Dufour
- Department of Medicine III, University Hospital Grosshadern, Munich, Germany
| | - Evelyn Zellmeier
- Department of Medicine III, University Hospital Grosshadern, Munich, Germany
| | - Michael Fiegl
- Department of Medicine III, University Hospital Grosshadern, Munich, Germany
| | - Jan Braess
- Department of Hematology and Oncology, Barmherzige Brüder Hospital, Regensburg, Germany
| | - Stefan K Bohlander
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Marion Subklewe
- Department of Medicine III, University Hospital Grosshadern, Munich, Germany Clinical Cooperation Group Immunotherapy, Helmholtz Zentrum Munich, German Research Center for Environmental Health, Munich, Germany
| | | | - Wolfgang E Berdel
- Department of Medicine A, Hematology and Oncology, University of Muenster, Germany
| | - Thomas Büchner
- Department of Medicine A, Hematology and Oncology, University of Muenster, Germany
| | | | - Wolfgang Hiddemann
- Department of Medicine III, University Hospital Grosshadern, Munich, Germany
| | - Karsten Spiekermann
- Department of Medicine III, University Hospital Grosshadern, Munich, Germany Clinical Cooperation Group Leukemia, Helmholtz Zentrum Munich, German Research Center for Environmental Health, Munich, Germany
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245
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Klco JM, Spencer DH, Miller CA, Griffith M, Lamprecht TL, O'Laughlin M, Fronick C, Magrini V, Demeter RT, Fulton RS, Eades WC, Link DC, Graubert TA, Walter MJ, Mardis ER, Dipersio JF, Wilson RK, Ley TJ. Functional heterogeneity of genetically defined subclones in acute myeloid leukemia. Cancer Cell 2014; 25:379-92. [PMID: 24613412 PMCID: PMC3983786 DOI: 10.1016/j.ccr.2014.01.031] [Citation(s) in RCA: 298] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 12/23/2013] [Accepted: 01/31/2014] [Indexed: 12/20/2022]
Abstract
The relationships between clonal architecture and functional heterogeneity in acute myeloid leukemia (AML) samples are not yet clear. We used targeted sequencing to track AML subclones identified by whole-genome sequencing using a variety of experimental approaches. We found that virtually all AML subclones trafficked from the marrow to the peripheral blood, but some were enriched in specific cell populations. Subclones showed variable engraftment potential in immunodeficient mice. Xenografts were predominantly comprised of a single genetically defined subclone, but there was no predictable relationship between the engrafting subclone and the evolutionary hierarchy of the leukemia. These data demonstrate the importance of integrating genetic and functional data in studies of primary cancer samples, both in xenograft models and in patients.
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Affiliation(s)
- Jeffery M Klco
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - David H Spencer
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | | | - Malachi Griffith
- The Genome Institute, Washington University, St. Louis, MO 63110, USA
| | - Tamara L Lamprecht
- Division of Oncology, Section of Stem Cell Biology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | | | - Catrina Fronick
- The Genome Institute, Washington University, St. Louis, MO 63110, USA
| | - Vincent Magrini
- The Genome Institute, Washington University, St. Louis, MO 63110, USA
| | - Ryan T Demeter
- The Genome Institute, Washington University, St. Louis, MO 63110, USA
| | - Robert S Fulton
- The Genome Institute, Washington University, St. Louis, MO 63110, USA
| | - William C Eades
- Division of Oncology, Section of Stem Cell Biology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Daniel C Link
- Division of Oncology, Section of Stem Cell Biology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Timothy A Graubert
- Division of Oncology, Section of Stem Cell Biology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Matthew J Walter
- Division of Oncology, Section of Stem Cell Biology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Elaine R Mardis
- The Genome Institute, Washington University, St. Louis, MO 63110, USA
| | - John F Dipersio
- Division of Oncology, Section of Stem Cell Biology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Richard K Wilson
- The Genome Institute, Washington University, St. Louis, MO 63110, USA
| | - Timothy J Ley
- The Genome Institute, Washington University, St. Louis, MO 63110, USA; Division of Oncology, Section of Stem Cell Biology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA.
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246
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Ommen HB, Hokland P, Haferlach T, Abildgaard L, Alpermann T, Haferlach C, Kern W, Schnittger S. Relapse kinetics in acute myeloid leukaemias with MLL translocations or partial tandem duplications within the MLL gene. Br J Haematol 2014; 165:618-28. [PMID: 24611505 DOI: 10.1111/bjh.12792] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 01/10/2014] [Indexed: 01/03/2023]
Abstract
Correct action upon re-emergence of minimal residual disease in acute myeloid leukaemia (AML) patients has not yet been established. The applicability of demethylating agents and use of allogeneic stem cell transplantation will be dependent on pre-relapse AML growth rates. We here delineate molecular growth kinetics of AML harbouring MLL partial tandem duplication (MLL-PTD; 37 cases) compared to those harbouring MLL translocations (43 cases). The kinetics of MLL-PTD relapses was both significantly slower than those of MLL translocation positive ones (median doubling time: MLL-PTD: 24 d, MLL-translocations: 12 d, P = 0·015, Wilcoxon rank sum test), and displayed greater variation depending on additional mutations. Thus, MLL-PTD+ cases with additional RUNX1 mutations or FLT3-internal tandem duplication relapsed significantly faster than cases without one of those two mutations (Wilcoxon rank sum test, P = 0·042). As rapid relapses occurred in all MLL subgroups, frequent sampling are necessary to obtain acceptable relapse detection rates and times from molecular relapse to haematological relapse (blood sampling every second month: MLL-PTD: 75%/50 d; MLL translocations: 85%/25 d). In conclusion, in this cohort relapse kinetics is heavily dependent on AML subtype as well as additional genetic aberrations, with possibly great consequences for the rational choice of pre-emptive therapies.
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Affiliation(s)
- Hans B Ommen
- Department of Haematology, Aarhus University Hospital, Aarhus, Denmark
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Rossi G, Minervini MM, Melillo L, di Nardo F, de Waure C, Scalzulli PR, Perla G, Valente D, Sinisi N, Cascavilla N. Predictive role of minimal residual disease and log clearance in acute myeloid leukemia: a comparison between multiparameter flow cytometry and Wilm's tumor 1 levels. Ann Hematol 2014; 93:1149-57. [PMID: 24554303 DOI: 10.1007/s00277-014-2029-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 02/03/2014] [Indexed: 11/29/2022]
Abstract
In acute myeloid leukemia (AML), the detection of minimal residual disease (MRD) as well as the degree of log clearance similarly identifies patients with poor prognosis. No comparison was provided between the two approaches in order to identify the best one to monitor follow-up patients. In this study, MRD and clearance were assessed by both multiparameter flow cytometry (MFC) and WT1 expression at different time points on 45 AML patients achieving complete remission. Our results by WT1 expression showed that log clearance lower than 1.96 after induction predicted the recurrence better than MRD higher than 77.0 copies WT1/10(4) ABL. Conversely, on MFC, MRD higher than 0.2 % after consolidation was more predictive than log clearance below 2.64. At univariate and multivariate analysis, positive MRD values and log clearance below the optimal cutoffs were associated with a shorter disease-free survival (DFS). At the univariate analysis, positive MRD values were also associated with overall survival (OS). Therefore, post-induction log clearance by WT1 and post-consolidation MRD by MFC represented the most informative approaches to identify the relapse. At the optimal timing of assessment, positive MRD and log-clearance values lower than calculated thresholds similarly predicted an adverse prognosis in AML.
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Affiliation(s)
- Giovanni Rossi
- Department of Hematology and Stem Cell Transplant Unit, IRCCS "Casa Sollievo della Sofferenza" Hospital, v.le Cappuccini 1, 71013, San Giovanni Rotondo, Italy,
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Kohlmann A, Bacher U, Schnittger S, Haferlach T. Perspective on how to approach molecular diagnostics in acute myeloid leukemia and myelodysplastic syndromes in the era of next-generation sequencing. Leuk Lymphoma 2014; 55:1725-34. [PMID: 24144312 DOI: 10.3109/10428194.2013.856427] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Molecular mutation information became essential for biological subclassification, risk stratification and therapeutic decisions in patients with acute myeloid leukemia (AML). In myelodysplastic syndromes (MDS), a broad spectrum of molecular biomarkers such as the spliceosome mutations has been identified in recent years. The currently established combination of various polymerase chain reaction (PCR) methods with capillary Sanger sequencing for mutation analysis in AML is time-consuming and labor-intensive. The constantly increasing spectrum of molecular mutations is a tremendous challenge for hematological laboratories. The introduction of high-throughput sequencing technology, which allows the massive parallel analysis of hundreds of thousands of alleles in the shortest time, provides new options for molecular mutation analyses and for follow-up diagnostics in myeloid neoplasms. In contrast to whole-genome or exome analyses, amplicon deep-sequencing focuses on distinct genomic loci and their mutation patterns and enables a comprehensive biomarker analysis in a multitude of patients per analysis. This review summarizes thus far established common molecular diagnostic strategies and intends to outline the perspective of distinct novel amplicon deep-sequencing panels for patients with AML and MDS. It is foreseeable that clearly defined algorithms for molecular investigations will revolutionize diagnosis in patients with AML and MDS in the near future.
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249
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Liersch R, Müller-Tidow C, Berdel WE, Krug U. Prognostic factors for acute myeloid leukaemia in adults - biological significance and clinical use. Br J Haematol 2014; 165:17-38. [DOI: 10.1111/bjh.12750] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Ruediger Liersch
- Department of Haematology and Oncology; Internal Medicine III; Clemenshospital Muenster; Muenster Germany
| | - Carsten Müller-Tidow
- Department of Medicine A - Haematology and Oncology; University Hospital of Muenster; Muenster Germany
| | - Wolfgang E. Berdel
- Department of Medicine A - Haematology and Oncology; University Hospital of Muenster; Muenster Germany
| | - Utz Krug
- Department of Medicine A - Haematology and Oncology; University Hospital of Muenster; Muenster Germany
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Abstract
SUMMARY Predictive/prognostic factors in acute leukemia continue to be sought, in order to refine treatment strategies. Minimal residual disease (MRD) testing has been shown to be a statistically significant factor by multivariate analysis in both acute lymphoblastic leukemia (ALL) and acute myeloid leukemia. Its utility in guiding therapy has been more extensively studied in pediatric ALL, with some protocols having instituted MRD testing into therapeutic algorithms. The clinical impact of MRD testing in ALL and acute myeloid leukemia will be presented, including both molecular and flow cytometric methodologies, with a more focused discussion of the strategy, methodology and interpretation of MRD testing by multiparametric flow cytometry.
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Affiliation(s)
- Lorinda Soma
- University of Washington, Department of Laboratory Medicine, Division of Hematopathology, Room NW120, Box 357110, 1959 NE Pacific Street, Seattle, WA 98195, USA
| | - Brent Wood
- University of Washington, Department of Laboratory Medicine, Division of Hematopathology, Room NW120, Box 357110, 1959 NE Pacific Street, Seattle, WA 98195, USA
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