1
|
Hernández‐Boluda J, Pereira A, Kröger N, Cornelissen JJ, Finke J, Beelen D, Witte M, Wilson K, Platzbecker U, Sengeloev H, Blaise D, Einsele H, Sockel K, Krüger W, Lenhoff S, Salaroli A, Martin H, García‐Gutiérrez V, Pavone V, Alvarez‐Larrán A, Raya J, Zinger N, Gras L, Hayden P, Czerw T, P. McLornan D, Yakoub‐Agha I. Allogeneic hematopoietic cell transplantation in older myelofibrosis patients: A study of the chronic malignancies working party of EBMT and the Spanish Myelofibrosis Registry. Am J Hematol 2021; 96:1186-1194. [PMID: 34152630 DOI: 10.1002/ajh.26279] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/11/2021] [Accepted: 06/17/2021] [Indexed: 01/13/2023]
Abstract
Allogeneic hematopoietic cell transplantation (allo-HCT) is increasingly used in older myelofibrosis (MF) patients, but its risk/benefit ratio compared to non-transplant approaches has not been evaluated in this population. We analyzed the outcomes of allo-HCT in 556 MF patients aged ≥65 years from the EBMT registry, and determined the excess mortality over the matched general population of MF patients ≥65 years managed with allo-HCT (n = 556) or conventional drug treatment (n = 176). The non-transplant cohort included patients with intermediate-2 or high risk DIPSS from the Spanish Myelofibrosis Registry. After a median follow-up of 3.4 years, the estimated 5-year survival rate, non-relapse mortality (NRM), and relapse incidence after transplantation was 40%, 37%, and 25%, respectively. Busulfan-based conditioning was associated with decreased mortality (HR: 0.7, 95% CI: 0.5-0.9) whereas the recipient CMV+/donor CMV- combination (HR: 1.7, 95% CI: 1.2-2.4) and the JAK2 mutated genotype (HR: 1.9, 95% CI: 1.1-3.5) predicted higher mortality. Busulfan-based conditioning correlated with improved survival due to less NRM, despite its higher relapse rate when compared with melphalan-based regimens. Excess mortality was higher in transplanted patients than in the non-HCT cohort in the first year of follow-up (ratio: 1.93, 95% CI: 1.13-2.80), whereas the opposite occurred between the fourth and eighth follow-up years (ratio: 0.31, 95% CI: 0.18-0.53). Comparing the excess mortality of the two treatments, male patients seemed to benefit more than females from allo-HCT, mainly due to their worse prognosis with non-transplant approaches. These findings could potentially enhance counseling and treatment decision-making in elderly transplant-eligible MF patients.
Collapse
Affiliation(s)
| | - Arturo Pereira
- Department of Hemotherapy and Hemostasis Hospital Clínic Barcelona Spain
| | - Nicolaus Kröger
- Hematology Department University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Jan J. Cornelissen
- Erasmus MC Cancer Center University Medical Center Rotterdam the Netherlands
| | - Jürgen Finke
- Medical Center University of Freiburg, Faculty of Medicine Freiburg Germany
| | | | - Moniek Witte
- Hematology Department University Medical Center Utrecht the Netherlands
| | - Keith Wilson
- Hematology Department University Hospital of Wales Cardiff UK
| | - Uwe Platzbecker
- Hematology Department University Hospital Leipzig Leipzig Germany
| | | | - Didier Blaise
- Hematology Department Institut Paoli Calmettes Marseille France
| | - Hermann Einsele
- Hematology Department Universitaetsklinikum Würzburg Wuerzburg Germany
| | - Katja Sockel
- Hematology Department University Hospital Dresden, TU Dresden Dresden Germany
| | - William Krüger
- Hematology Department Universitaetsklinikum Greifswald Greifswald Germany
| | - Stig Lenhoff
- Hematology Department Skanes University Hospital Lund Sweden
| | | | - Hans Martin
- Hematology Department Universitaetsklinikum Frankfurt Frankfurt Germany
| | | | | | | | - José‐María Raya
- Hematology Department Hospital Universitario de Canarias Tenerife Spain
| | | | - Luuk Gras
- EBMT Statistical Unit Leiden The Netherlands
| | - Patrick Hayden
- Hematology Department Trinity College Dublin, St. James's Hospital Dublin Ireland
| | - Tomasz Czerw
- Hematology Department Maria Skłodowska‐Curie National Research Institute of Oncology, Gliwice Branch Gliwice Poland
| | - Donal P. McLornan
- Hematology Department Guys' and St. Thomas' NHS Foundation Trust and University College London Hospitals London UK
| | - Ibrahim Yakoub‐Agha
- Hematology Department CHU de Lille, Université de Lille, INSERM U1286 Lille France
| |
Collapse
|
2
|
Fang Y, Guo J, Wu D, Wu LY, Song LX, Zhang Z, Zhao YS, Chang CK. Integration Analysis of JAK2 or RUNX1 Mutation With Bone Marrow Blast Can Improve Risk Stratification in the Patients With Lower Risk Myelodysplastic Syndrome. Front Oncol 2021; 10:610525. [PMID: 33520721 PMCID: PMC7839382 DOI: 10.3389/fonc.2020.610525] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 11/10/2020] [Indexed: 11/13/2022] Open
Abstract
Despite the improvements in prognostication of the revised International Prognostic Scoring System (IPSS-R) in myelodysplastic syndrome (MDS), there remain a portion of patients with lower risk (low/intermediate risk, LR) but poor prognostics. This study aimed to evaluate the relative contribution of mutational status when added to the IPSS-R, for estimating overall survival (OS) and progression-free survival (PFS) in patients with LR-MDS. We retrospectively analyzed clinical and laboratory variables of 328 patients diagnosed with MDS according to the FAB criteria. Twenty-nine-gene NGS assay was applied to bone marrow samples obtained at diagnosis. 233 (71.04%) patients were classified as LR-MDS. Univariate analysis showed association between inferior outcome (OS and PFS) and presence of JAK2 (p = 0.0177, p = 0.0002), RUNX1 (p = 0.0250, p = 0.0387), and U2AF1 (p = 0.0227, p = 0.7995) mutations. Multivariable survival analysis revealed JAK2 (p < 0.0001) and RUNX1 (p = 0.0215) mutations were independently prognostic for PFS in LR-MDS. Interestingly, bone marrow blast >1.5% could further predict disease progression of patients with LR-MDS (HR 8.06, 95%CI 2.95–22.04, p < 0.0001). Incorporation of JAK2, RUNX1 mutation and bone marrow blast in the IPSS-R can improve risk stratification in patients with LR-MDS. In summary, our result provided new risk factors for LR-MDS prognostics to identify candidates for early therapeutic intervention.
Collapse
Affiliation(s)
- Ying Fang
- Department of Hematology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Juan Guo
- Department of Hematology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Dong Wu
- Department of Hematology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Ling-Yun Wu
- Department of Hematology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Lu-Xi Song
- Department of Hematology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Zheng Zhang
- Department of Hematology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - You-Shan Zhao
- Department of Hematology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Chun-Kang Chang
- Department of Hematology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| |
Collapse
|
3
|
He W, Zhao C, Hu H. Prognostic effect of RUNX1 mutations in myelodysplastic syndromes: a meta-analysis. ACTA ACUST UNITED AC 2020; 25:494-501. [PMID: 33317419 DOI: 10.1080/16078454.2020.1858598] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES RUNX1 mutations have been widely found in patients with myelodysplastic syndrome (MDS). Majority of reports revealed that RUNX1 mutations are associated with a poor prognosis. However, discrepancies still remain. The results of univariate analysis were not confirmed in multivariate analysis in some cases. Therefore, we performed a meta-analysis to assess the prognostic effect of RUNX1 mutations in MDS. METHODS We extracted data from qualified studies that were searched from PubMed, Embase and the Cochrane Library. Hazard ratios (HRs) and their 95% confidence intervals (CIs) for the overall survival (OS) and leukemia free survival (LFS) were pooled from the multivariate Cox proportional hazard models. RESULTS Sixteen studies containing 5422 patients were included in this meta-analysis. There were 617 patients with mutated RUNX1 and 4805 patients with wide type RUNX1. The total HR for OS was 1.43 (95% CI = 1.21-1.70, P < 0.0001) and the counterpart of LFS was 1.88 (95% CI = 1.42-2.51, P < 0.0001). DISCUSSION AND CONCLUSION These results suggest that the RUNX1 mutations are associated with unfavorable outcomes and shorter survival in patients with MDS. Furthermore, poor prognosis of patients might be alleviated by stem cell transplantation. Patients bearing these mutations should be prioritized for aggressive therapy.
Collapse
Affiliation(s)
- Wei He
- Department of Hematology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, People's Republic of China
| | - Caifang Zhao
- Department of Hematology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, People's Republic of China
| | - Huixian Hu
- Department of Hematology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, People's Republic of China
| |
Collapse
|
4
|
Buckstein RJ. Integrating patient-centered factors in the risk assessment of MDS. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2019; 2019:373-380. [PMID: 31808887 PMCID: PMC6913474 DOI: 10.1182/hematology.2019000041] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Myelodysplastic syndromes are clonal myeloid neoplasms that primarily present in older adults. Although leukemia develops in approximately 25% to 30% of individuals, the significantly shortened survival in this population is attributed more commonly to nonleukemic causes. The current prognostic scoring systems for leukemia and overall survival based on disease characteristics are becoming increasingly sophisticated and accurate with the incorporation of molecular data. The addition of patient-related factors such as comorbidity, disability, frailty, and fatigue to these new models may improve their predictive power for overall survival, treatment toxicity, and health care costs. To improve the generalizability of clinical trial results to the real world, geriatric assessment testing should become a standard of care in MDS clinical trials.
Collapse
Affiliation(s)
- Rena J Buckstein
- Odette Cancer Center, Sunnybrook Health Sciences Center, Toronto, ON, Canada
| |
Collapse
|
5
|
Ye X, Chen D, Zheng Y, Wu C, Zhu X, Huang J. The incidence, risk factors, and survival of acute myeloid leukemia secondary to myelodysplastic syndrome: A population-based study. Hematol Oncol 2019; 37:438-446. [PMID: 31378958 PMCID: PMC6900108 DOI: 10.1002/hon.2660] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/11/2019] [Accepted: 07/26/2019] [Indexed: 12/19/2022]
Abstract
To determine the incidence, risk factors, and relative survival of acute myeloid leukemia (AML) secondary to myelodysplastic syndrome (MDS) in the Surveillance, Epidemiology, and End Results (SEER) database. Retrospective analysis of all patients with new MDS onset in the SEER‐18 database from 2001 to 2013. We identified 36 558 patients with primary MDS. The rate of secondary AML (sAML) was 3.7% among patients 40 years or younger and 2.5% among those older than 40 (P = .039). The median transformation interval was significantly shorter for the younger group (4.04 vs 13.1 mo; P < .001). For both age groups, median overall and cancer‐specific survival were significantly longer for patients who did not develop sAML. Although the younger patients survived longer than the older patients, sAML development had a more negative effect on the survival of younger patients. Female sex, age, and World Health Organization (WHO) type MDS with single lineage dysplasia (MDS‐SLD) were associated with a decreased risk of sAML for older but not younger patients. Among older patients with MDS, a married status, Black race, female sex, shorter time to sAML, and WHO type MDS‐SLD or MDS with ringed sideroblasts were favorable prognostic factors for survival. In the SEER database, the rate of sAML among patients with MDS is lower than that in previous reports, but these patients still have worse survival. Risk assessment should include clinical and demographic factors.
Collapse
Affiliation(s)
- Xingnong Ye
- Department of Hematology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.,Department of Hematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Dan Chen
- Department of Hematology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Yan Zheng
- Department of Hematology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Cai Wu
- Department of Hematology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Xiaoqiong Zhu
- Department of Hematology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Jian Huang
- Department of Hematology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.,Department of Hematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| |
Collapse
|
6
|
Girmenia C, Candoni A, Delia M, Latagliata R, Molteni A, Oliva EN, Palumbo GA, Poloni A, Salutari P, Santini V, Voso MT, Musto P. Infection control in patients with myelodysplastic syndromes who are candidates for active treatment: Expert panel consensus-based recommendations. Blood Rev 2018; 34:16-25. [PMID: 30448050 DOI: 10.1016/j.blre.2018.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/05/2018] [Accepted: 10/26/2018] [Indexed: 12/15/2022]
Abstract
The improvement in supportive care and the introduction of new therapeutic agents, including lenalidomide and hypomethylating agents, in myelodysplastic syndromes have improved patients' outcomes; however, at the same time, the frequency and epidemiology of infections have changed. Therefore, the great strides in the indications and use of new treatment strategies for myelodysplastic syndromes need a parallel progress in the best approach to prophylaxis and supportive therapy for infections. Based on the recognition that the above issues represent an unmet clinical need in myelodysplastic syndromes, an Italian expert panel performed a review of the literature and composed a framework of the best recommendations for optimal infection control in patient candidates to receive active treatment for myelodysplastic syndromes. In this consensus document we report the outcomes of that review and of the consensus meetings held during 2017. The issues tackled in the project dealt with: information to be collected from candidates for active treatment for myelodysplastic syndromes; how to monitor the risk of infection; antimicrobial prophylaxis; the role of iron chelation and antiviral/antibacterial vaccinations. For each of these issues, practice recommendations are provided.
Collapse
Affiliation(s)
- Corrado Girmenia
- Dipartimento di Ematologia, Oncologia e Dermatologia, Policlinico Umberto I, Sapienza University of Rome, Italy.
| | - Anna Candoni
- Clinica Ematologica, Centro Trapianti e Terapie Cellulari, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Mario Delia
- Hematology and BMT Unit, Policlinic of Bari, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Roberto Latagliata
- Dipartimento di Ematologia, Oncologia e Dermatologia, Policlinico Umberto I, Sapienza University of Rome, Italy
| | | | - Esther N Oliva
- Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | - Giuseppe A Palumbo
- Dipartimento di Scienze Mediche Chirurgiche e Tecnologie Avanzate "G.F.Ingrassia", Università degli Studi di Catania, Catania, Italy
| | - Antonella Poloni
- Clinica di Ematologia, AOU Ospedali Riuniti, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona, Italy
| | - Prassede Salutari
- Dipartimento di Ematologia, Medicina Trasfusionale e Biotecnologie, Ospedale Spirito Santo, Pescara, Italy
| | - Valeria Santini
- MDS UNIT, Hematology, AOU-Careggi University Hospital, Department of Experimental and Clinical Medicine, Università degli Studi di Firenze, Florence, Italy
| | - Maria Teresa Voso
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Pellegrino Musto
- Scientific Direction, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture, PZ, Italy
| |
Collapse
|
7
|
Falantes JF, Márquez-Malaver FJ, Calderón-Cabrera C, Pedrote B, Martino ML, González J, Espigado I, Pérez-Simón JA. Evaluation of Parameters Related to the Probability of Leukemic Progression in Patients With Lower-Risk Myelodysplastic Syndrome. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:469-474.e1. [PMID: 29807802 DOI: 10.1016/j.clml.2018.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 04/19/2018] [Accepted: 05/02/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND The prognosis of patients with lower-risk myelodysplastic syndrome (LR-MDS) is very heterogeneous. In addition to survival estimates, identification of factors related to the probability of leukemic progression might help prognosis assessment. PATIENTS AND METHODS The present study is a retrospective analysis of 409 patients with primary LR-MDS. The probability of leukemic progression was estimated in the competing risk framework by the cumulative incidence method considering death without acute myeloid leukemia (AML) as a competing event. RESULTS Sixty-six patients (16.1%) progressed to AML. The following covariates influenced the probability of leukemic progression in a multivariate competing risk regression model: intermediate karyotype versus diploid or chromosome 5 deletion, 5% to 9% bone marrow blast percentage, platelet count <50 × 10e9/L and age younger than 75 years. CONCLUSION According to these, a predictive model is proposed, which categorizes patients with different probability of leukemic progression (P < .001). Validation of these results might help prognostic refinement of patients with LR-MDS.
Collapse
Affiliation(s)
- Jose F Falantes
- Department of Hematology, University Hospital Virgen del Rocío, Seville, Spain.
| | | | | | - Begoña Pedrote
- Department of Hematology, University Hospital Virgen del Rocío, Seville, Spain
| | - María L Martino
- Department of Hematology, University Hospital Virgen del Rocío, Seville, Spain
| | - Jose González
- Department of Hematology, University Hospital Virgen del Rocío, Seville, Spain
| | - Ildefonso Espigado
- Department of Hematology, University Hospital Virgen del Rocío, Seville, Spain
| | - Jose A Pérez-Simón
- Department of Hematology, University Hospital Virgen del Rocío, Seville, Spain
| |
Collapse
|
8
|
Gangat N, Mudireddy M, Lasho TL, Finke CM, Nicolosi M, Szuber N, Patnaik MM, Pardanani A, Hanson CA, Ketterling RP, Tefferi A. Mutations and prognosis in myelodysplastic syndromes: karyotype-adjusted analysis of targeted sequencing in 300 consecutive cases and development of a genetic risk model. Am J Hematol 2018; 93:691-697. [PMID: 29417633 DOI: 10.1002/ajh.25064] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 01/31/2018] [Accepted: 02/02/2018] [Indexed: 01/02/2023]
Abstract
To develop a genetic risk model for primary myelodysplastic syndromes (MDS), we queried the prognostic significance of next-generation sequencing (NGS)-derived mutations, in the context of the Mayo cytogenetic risk stratification, which includes high-risk (monosomal karyotype; MK), intermediate-risk (non-MK, classified as intermediate/poor/very poor, per the revised international prognostic scoring system; IPSS-R), and low-risk (classified as good/very good, per IPSS-R). Univariate analysis in 300 consecutive patients with primary MDS identified TP53, RUNX1, U2AF1, ASXL1, EZH2, and SRSF2 mutations as "unfavorable" and SF3B1 as "favorable" risk factors for survival; for the purposes of the current study, the absence of SF3B1 mutation was accordingly dubbed as an "adverse" mutation. Analysis adjusted for age and MK, based on our previous observation of significant clustering between MK and TP53 mutations, confirmed independent prognostic contribution from RUNX1, ASXL1, and SF3B1 mutations. Multivariable analysis that included age, the Mayo cytogenetics risk model and the number of adverse mutations resulted in HRs (95% CI) of 5.3 (2.5-10.3) for presence of three adverse mutations, 2.4 (1.6-3.7) for presence of two adverse mutations, 1.5 (1.02-2.2) for presence of one adverse mutation, 5.6 (3.4-9.1) for high-risk karyotype, 1.5 (1.1-2.2) for intermediate-risk karyotype and 2.4 (1.8-3.3) for age >70 years; HR-weighted risk point assignment generated a three-tiered genetic risk model: high (N = 65; 5-year survival 2%), intermediate (N = 100; 5-year survival 18%), and low (N = 135; 5-year survival 56%). The current study provides a practically simple risk model in MDS that is based on age, karyotype, and mutations only.
Collapse
Affiliation(s)
- Naseema Gangat
- Divisions of Hematology; Mayo Clinic; Rochester Minnesota
| | | | - Terra L. Lasho
- Divisions of Hematology; Mayo Clinic; Rochester Minnesota
| | | | - Maura Nicolosi
- Divisions of Hematology; Mayo Clinic; Rochester Minnesota
| | - Natasha Szuber
- Divisions of Hematology; Mayo Clinic; Rochester Minnesota
| | | | | | | | - Rhett P. Ketterling
- Divisions of Laboratory Genetics and Genomics, Departments of Internal and Laboratory Medicine; Mayo Clinic; Rochester Minnesota
| | - Ayalew Tefferi
- Divisions of Hematology; Mayo Clinic; Rochester Minnesota
| |
Collapse
|
9
|
Clinical and biological significance of isolated Y chromosome loss in myelodysplastic syndromes and chronic myelomonocytic leukemia. A report from the Spanish MDS Group. Leuk Res 2017; 63:85-89. [PMID: 29121539 DOI: 10.1016/j.leukres.2017.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 10/24/2017] [Accepted: 10/26/2017] [Indexed: 11/21/2022]
Abstract
Isolate loss of chromosome Y (-Y) in myelodysplastic syndromes (MDS) is associated to a better outcome but it is also well described as an age-related phenomenon. In this study we aimed to analyze the prognostic impact of -Y in the context of the IPSS-R cytogenetic classification, evaluate the clinical significance of the percentage of metaphases with isolated -Y, and test whether finding -Y may predispose to over-diagnose MDS in patients with borderline morphological features. We evaluated 3581 male patients from the Spanish MDS Registry with a diagnosis of MDS or chronic myelomonocytic leukemia (CMML). -Y was identified in 177 patients (4.9%). Compared with the 2246 male patients with normal karyotype, -Y group showed a reduced risk of leukemic transformation that did not translate into a survival advantage. The overall survival and the risk of leukemic transformation were not influenced by the percentage of metaphases with -Y. The -Y group was not enriched in patients with minor morphologic traits of dysplasia, suggesting that the better outcome in the -Y group cannot be explained by enrichment in cases misdiagnosed as MDS. In conclusion, our results support the current recommendation of classifying patients with -Y within the very good risk category of the IPSS-R for MDS and rule out a selection bias as a possible explanation of this better outcome. An analysis of the molecular basis of MDS with isolated -Y would be of interest as it may provide a biological basis of protection against progression to acute leukemia.
Collapse
|
10
|
Ramos F, Robledo C, Pereira A, Pedro C, Benito R, de Paz R, del Rey M, Insunza A, Tormo M, Díez-Campelo M, Xicoy B, Salido E, Sánchez-del-Real J, Arenillas L, Florensa L, Luño E, del Cañizo C, Sanz GF, María Hernández-Rivas J. Multidimensional assessment of patient condition and mutational analysis in peripheral blood, as tools to improve outcome prediction in myelodysplastic syndromes: A prospective study of the Spanish MDS group. Am J Hematol 2017; 92:E534-E541. [PMID: 28612357 DOI: 10.1002/ajh.24813] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 06/04/2017] [Accepted: 06/05/2017] [Indexed: 12/13/2022]
Abstract
The International Prognostic Scoring System and its revised form (IPSS-R) are the most widely used indices for prognostic assessment of patients with myelodysplastic syndromes (MDS), but can only partially account for the observed variation in patient outcomes. This study aimed to evaluate the relative contribution of patient condition and mutational status in peripheral blood when added to the IPSS-R, for estimating overall survival and the risk of leukemic transformation in patients with MDS. A prospective cohort (2006-2015) of 200 consecutive patients with MDS were included in the study series and categorized according to the IPSS-R. Patients were further stratified according to patient condition (assessed using the multidimensional Lee index for older adults) and genetic mutations (peripheral blood samples screened using next-generation sequencing). The change in likelihood-ratio was tested in Cox models after adding individual covariates. The addition of the Lee index to the IPSS-R significantly improved prediction of overall survival [hazard ratio (HR) 3.02, 95% confidence interval (CI) 1.96-4.66, P < 0.001), and mutational analysis significantly improved prediction of leukemic evolution (HR 2.64, 1.56-4.46, P < 0.001). Non-leukemic death was strongly linked to patient condition (HR 2.71, 1.72-4.25, P < 0.001), but not to IPSS-R score (P = 0.35) or mutational status (P = 0.75). Adjustment for exposure to disease-modifying therapy, evaluated as a time-dependent covariate, had no effect on the proposed model's predictive ability. In conclusion, patient condition, assessed by the multidimensional Lee index and patient mutational status can improve the prediction of clinical outcomes of patients with MDS already stratified by IPSS-R.
Collapse
Affiliation(s)
- Fernando Ramos
- Department of Hematology; Hospital Universitario de León; León Spain
- Institute of Biomedicine (IBIOMED, León); León Spain
| | - Cristina Robledo
- Unidad de Diagnóstico Molecular y Celular del Cáncer, IBSAL, IBMCC-Centro de Investigación del Cáncer (USAL-CSIC); Salamanca Spain
| | - Arturo Pereira
- Department of Blood Transfusion; Hospital Clínic i Provincial; Barcelona Spain
| | - Carmen Pedro
- Department of Hematology; Hospital del Mar; Barcelona Spain
| | - Rocío Benito
- Unidad de Diagnóstico Molecular y Celular del Cáncer, IBSAL, IBMCC-Centro de Investigación del Cáncer (USAL-CSIC); Salamanca Spain
| | - Raquel de Paz
- Department of Hematology; Hospital Universitario La Paz; Madrid Spain
| | - Mónica del Rey
- Unidad de Diagnóstico Molecular y Celular del Cáncer, IBSAL, IBMCC-Centro de Investigación del Cáncer (USAL-CSIC); Salamanca Spain
| | - Andrés Insunza
- Department of Hematology; Hospital Universitario Marqués de Valdecilla; Santander Spain
| | - Mar Tormo
- Department of Hematology and Oncology; Hospital Clínico de Valencia; Valencia Spain
| | - María Díez-Campelo
- Department of Hematology; Hospital Universitario de Salamanca; Salamanca Spain
| | - Blanca Xicoy
- Department of Hematology, Institut Català d'Oncologia-Hospital Universitari Germans Trias i Pujol, Badalona, Josep Carreras Leukemia Research Institute; Badalona Spain
| | - Eduardo Salido
- Department of Hematology; Hospital Universitario La Arrixaca; Murcia Spain
| | | | | | | | - Elisa Luño
- Department of Hematology; Hospital Universitario Central de Asturias; Oviedo Spain
| | - Consuelo del Cañizo
- Department of Hematology; Hospital Universitario de Salamanca; Salamanca Spain
| | - Guillermo F. Sanz
- Department of Hematology Hospital Universitari i Politècnic La Fe; Valencia Spain
| | - Jesús María Hernández-Rivas
- Unidad de Diagnóstico Molecular y Celular del Cáncer, IBSAL, IBMCC-Centro de Investigación del Cáncer (USAL-CSIC); Salamanca Spain
- Department of Hematology; Hospital Universitario de Salamanca; Salamanca Spain
| | | |
Collapse
|
11
|
Liang C, Li J, Cheng J, Chen S, Ye Z, Zhang F, Wang Z, Wang F, Peng C, Ouyang J. Characteristics of bone marrow cell dysplasia and its effectiveness in diagnosing myelodysplastic syndrome. ACTA ACUST UNITED AC 2017; 23:65-76. [PMID: 28675126 DOI: 10.1080/10245332.2017.1347247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Although dysplasia plays an important role in the diagnosis of myelodysplasia syndrome (MDS), its morphologic variety and irregularity result in difficulties in its clinical application. METHODS Bone marrow smears from cases with MDS and non-clonal disease were collected and performed microscopy analysis. We respectively recorded the percentage of specific dysplastic cells (PSDC) and incidence of specific dysplasia (ISD) of each dysplastic type in three hematopoietic cell lineages for the comprehensive analysis of diagnostic efficacy to MDS. RESULTS Compared with non-clonal anemia, the PSDCs and ISDs of the four specific dysplastic types as petal nucleus and internuclear bridging in erythroid lineage, pseudo-Pelger-Huet in granulocytic lineage and lymphoid small megakaryocyte in megakaryocytic lineage were significantly higher in MDS; and their area under the curves were all greater than 0.600. If the dysplastic rate in each lineage was higher than 10%, their corresponding false positive rates (FPRs) were below 0.033, 1 × 10-4 and 1 × 10-4, respectively. If the dysplastic rates in three cell lineages reached 0.065, 0.045 and 0.040, respectively, their corresponding FPRs were all below 0.050. CONCLUSION Four specific dysplastic types possess higher diagnostic efficacy for the diagnosis of MDS. Though the dysplastic rate over 10% in any hematopoietic cell lineage presents a lower FPR, it is possibly considered to lower the diagnostic threshold of MDS if a specific dysplastic type with higher diagnostic efficacy presents.
Collapse
Affiliation(s)
- Chujia Liang
- a Department of Medical Laboratory , First Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Junxun Li
- a Department of Medical Laboratory , First Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Jing Cheng
- a Department of Medical Laboratory , First Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Shaoqian Chen
- a Department of Medical Laboratory , First Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Zhuangjian Ye
- a Department of Medical Laboratory , First Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Fan Zhang
- a Department of Medical Laboratory , First Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Zhe Wang
- a Department of Medical Laboratory , First Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Fang Wang
- a Department of Medical Laboratory , First Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Cheng Peng
- a Department of Medical Laboratory , First Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Juan Ouyang
- a Department of Medical Laboratory , First Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| |
Collapse
|
12
|
Calvo X, Arenillas L, Luño E, Senent L, Arnan M, Ramos F, Pedro C, Tormo M, Montoro J, Díez-Campelo M, Blanco ML, Arrizabalaga B, Xicoy B, Bonanad S, Jerez A, Nomdedeu M, Ferrer A, Sanz GF, Florensa L. Enumerating bone marrow blasts from nonerythroid cellularity improves outcome prediction in myelodysplastic syndromes and permits a better definition of the intermediate risk category of the Revised International Prognostic Scoring System (IPSS-R). Am J Hematol 2017; 92:614-621. [PMID: 28370234 DOI: 10.1002/ajh.24732] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 03/16/2017] [Accepted: 03/20/2017] [Indexed: 01/21/2023]
Abstract
The Revised International Prognostic Scoring System (IPSS-R) has been recognized as the score with the best outcome prediction capability in MDS, but this brought new concerns about the accurate prognostication of patients classified into the intermediate risk category. The correct enumeration of blasts is essential in prognostication of MDS. Recent data evidenced that considering blasts from nonerythroid cellularity (NECs) improves outcome prediction in the context of IPSS and WHO classification. We assessed the percentage of blasts from total nucleated cells (TNCs) and NECs in 3924 MDS patients from the GESMD, 498 of whom were MDS with erythroid predominance (MDS-E). We assessed if calculating IPSS-R by enumerating blasts from NECs improves prognostication of MDS. Twenty-four percent of patients classified into the intermediate category were reclassified into higher-risk categories and showed shorter overall survival (OS) and time to AML evolution than those who remained into the intermediate one. Likewise, a better distribution of patients was observed, since lower-risk patients showed longer survivals than previously whereas higher-risk ones maintained the outcome expected in this poor prognostic group (median OS < 20 months). Furthermore, our approach was particularly useful for detecting patients at risk of dying with AML. Regarding MDS-E, 51% patients classified into the intermediate category were reclassified into higher-risk ones and showed shorter OS and time to AML. In this subgroup of MDS, IPSS-R was capable of splitting our series in five groups with significant differences in OS only when blasts were assessed from NECs. In conclusion, our easy-applicable approach improves prognostic assessment of MDS patients.
Collapse
Affiliation(s)
- Xavier Calvo
- Laboratorio Citología Hematológica. Servicio Patología, GRETNHE, IMIM Hospital del Mar Research Institute, Barcelona, Spain
| | - Leonor Arenillas
- Laboratorio Citología Hematológica. Servicio Patología, GRETNHE, IMIM Hospital del Mar Research Institute, Barcelona, Spain
| | - Elisa Luño
- Servicio Hematología, Hospital Universitario Central Asturias, Oviedo, Spain
| | - Leonor Senent
- Servicio Hematología, Hospital Universitario La Fe, Valencia, Spain
| | | | - Fernando Ramos
- Servicio Hematología, Hospital Universitario de León, León, Spain
| | - Carme Pedro
- Servicio Hematología, IMIM Hospital del Mar Research Institute, Barcelona, Spain
| | - Mar Tormo
- Servicio Hematología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Julia Montoro
- Servicio Hematología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - María Díez-Campelo
- Servicio Hematología, Hospital Universitario de Salamanca, Salamanca, Spain
| | - María Laura Blanco
- Servicio Hematología, Hospital de la Santa Creu i Sant Pau, Univeristat Autònoma de Barcelona, Barcelona, Spain
| | | | - Blanca Xicoy
- Servicio Hematología, ICO-Badalona, Badalona, Spain
| | - Santiago Bonanad
- Servicio Hematología, Hospital Universitario La Fe, Valencia, Spain
| | - Andrés Jerez
- Servicio Hematología y Oncología Médica, Hospital Morales Meseguer, IMIB-Arrixaca, Murcia, Spain
| | | | - Ana Ferrer
- Laboratorio Citología Hematológica. Servicio Patología, GRETNHE, IMIM Hospital del Mar Research Institute, Barcelona, Spain
| | - Guillermo F Sanz
- Servicio Hematología, Hospital Universitario La Fe, Valencia, Spain
| | - Lourdes Florensa
- Laboratorio Citología Hematológica. Servicio Patología, GRETNHE, IMIM Hospital del Mar Research Institute, Barcelona, Spain
| |
Collapse
|
13
|
Madanat Y, Sekeres MA. Optimizing the use of hypomethylating agents in myelodysplastic syndromes: Selecting the candidate, predicting the response, and enhancing the activity. Semin Hematol 2017; 54:147-153. [PMID: 28958288 DOI: 10.1053/j.seminhematol.2017.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 06/13/2017] [Indexed: 11/11/2022]
Abstract
Myelodysplastic syndromes (MDS) are a heterogeneous group of clonal hematopoietic stem cell disorders that have a substantial impact on patients' quality of life, in addition to causing significant morbidity and mortality. The hypomethylating agents (HMAs) azacitidine and decitabine are approved for use in the United States and in Europe for the treatment of MDS or acute myeloid leukemia (AML) and, in the case of azacitidine, prolong survival in higher-risk patients. Neither is curative, though, and given the lack of clear treatment guidelines after HMA treatment failure, it is imperative to optimize patient selection and identify the right timing of HMA treatment initiation and response evaluation to maximize patient benefit. Initiatives to improve outcomes have focused on HMA-based drug combinations to enhance HMA activity or treat MDS using complementary drug mechanisms of action. In this review, we will summarize the available data to aid decision-making while treating MDS patients with HMAs.
Collapse
Affiliation(s)
- Yazan Madanat
- Leukemia Program, Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH
| | - Mikkael A Sekeres
- Leukemia Program, Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH.
| |
Collapse
|