1
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Mazzeo P, Ganster C, Wiedenhöft J, Shirneshan K, Rittscher K, Brzuszkiewicz EB, Steinemann D, Schieck M, Müller‐Thomas C, Treiber H, Braulke F, Germing U, Sockel K, Balaian E, Schanz J, Platzbecker U, Götze KS, Haase D. Comprehensive sequential genetic analysis delineating frequency, patterns, and prognostic impact of genomic dynamics in a real-world cohort of patients with lower-risk MDS. Hemasphere 2024; 8:e70014. [PMID: 39315323 PMCID: PMC11417473 DOI: 10.1002/hem3.70014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 07/13/2024] [Accepted: 08/05/2024] [Indexed: 09/25/2024] Open
Abstract
The acquisition of subsequent genetic lesions (clonal evolution, CE) and/or the expansion of existing clones (CEXP) contributes to clonal dynamics (CD) in myelodysplastic syndromes (MDS). Although CD plays an important role in high-risk patients in disease progression and transformation into acute myeloid leukemia (AML), knowledge about CD in lower-risk MDS (LR-MDS) patients is limited due to lack of robust longitudinal data considering the long clinically stable courses of the disease. In this retrospective analysis, we delineate the frequency and the prognostic impact of CD in an unselected real-world cohort of LR-MDS patients. We screened 68 patients with a median follow-up of 40.5 months and a median of 7.5 (range: 2-22) timepoints for CE and CEXP detected by chromosomal banding analysis, fluorescence in situ hybridization, sequencing, and molecular karyotyping. In 30/68 patients, 47 CE events and a CD rate of 1 event per 4 years were documented. Of note, patients with at least 1 CE event had an increased probability for subsequent treatment. Unexpectedly, CE did not correlate with inferior outcomes, which could be reasonably explained by CD detection triggering the subsequent start of a disease-modifying therapy.
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Affiliation(s)
- Paolo Mazzeo
- Department of Hematology and Medical Oncology, INDIGHO laboratoryUniversity Medical Center Göttingen (UMG)GöttingenGermany
| | - Christina Ganster
- Department of Hematology and Medical Oncology, INDIGHO laboratoryUniversity Medical Center Göttingen (UMG)GöttingenGermany
| | - John Wiedenhöft
- Department of Human GeneticsUniversity of Leipzig Medical CenterLeipzigGermany
| | - Katayoon Shirneshan
- Department of Hematology and Medical Oncology, INDIGHO laboratoryUniversity Medical Center Göttingen (UMG)GöttingenGermany
| | - Katharina Rittscher
- Department of Hematology and Medical Oncology, INDIGHO laboratoryUniversity Medical Center Göttingen (UMG)GöttingenGermany
| | - Elzbieta B. Brzuszkiewicz
- Department of Hematology and Medical Oncology, INDIGHO laboratoryUniversity Medical Center Göttingen (UMG)GöttingenGermany
| | - Doris Steinemann
- Department of Human GeneticsHannover Medical SchoolHannoverGermany
| | | | - Catharina Müller‐Thomas
- Department of Medicine IIITechnical University of Munich School of Medicine and HealthMunichGermany
| | - Hannes Treiber
- Department of Hematology and Medical Oncology, INDIGHO laboratoryUniversity Medical Center Göttingen (UMG)GöttingenGermany
| | - Friederike Braulke
- Department of Hematology and Medical Oncology, INDIGHO laboratoryUniversity Medical Center Göttingen (UMG)GöttingenGermany
- Comprehensive Cancer CenterUniversity Medical Center Göttingen (UMG)GöttingenGermany
| | - Ulrich Germing
- Department of Hematology, Oncology and Clinical ImmunologyHeinrich‐Heine‐UniversitätDüsseldorfGermany
| | - Katja Sockel
- Medical Clinic and Policlinic IUniversity Hospital Carl Gustav Carus DresdenDresdenGermany
| | - Ekaterina Balaian
- Medical Clinic and Policlinic IUniversity Hospital Carl Gustav Carus DresdenDresdenGermany
| | - Julie Schanz
- Department of Hematology and Medical Oncology, INDIGHO laboratoryUniversity Medical Center Göttingen (UMG)GöttingenGermany
| | - Uwe Platzbecker
- Medical Clinic and Policlinic 1, Hematology and Cellular TherapyLeipzig University HospitalLeipzigGermany
| | - Katharina S. Götze
- Department of Medicine IIITechnical University of Munich School of Medicine and HealthMunichGermany
| | - Detlef Haase
- Department of Hematology and Medical Oncology, INDIGHO laboratoryUniversity Medical Center Göttingen (UMG)GöttingenGermany
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2
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Shumilov E, Mazzeo P, Ghandili S, Künstner A, Weidemann S, Banz Y, Ströbel P, Pollak M, Kolloch L, Beltraminelli H, Kerkhoff A, Mikesch JH, Schliemann C, Haase D, Wulf G, Legros M, Lenz G, Feldmeyer L, Pabst T, Witte H, Gebauer N, Bacher U. Diagnostic management of blastic plasmacytoid dendritic cell neoplasm (BPDCN) in close interaction with therapeutic considerations. Ann Hematol 2024; 103:1587-1599. [PMID: 38194088 PMCID: PMC11009756 DOI: 10.1007/s00277-023-05587-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/12/2023] [Indexed: 01/10/2024]
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN), a rare malignancy derived from plasmacytoid dendritic cells, can mimic both acute leukemia and aggressive T-cell lymphoma. Therapy of this highly aggressive hematological disease should be initiated as soon as possible, especially in light of novel targeted therapies that have become available. However, differential diagnosis of BPDCN remains challenging. This retrospective study aimed to highlight the challenges to timely diagnoses of BPDCN. We documented the diagnostic and clinical features of 43 BPDCN patients diagnosed at five academic hospitals from 2001-2022. The frequency of BPDCN diagnosis compared to AML was 1:197 cases. The median interval from the first documented clinical manifestation to diagnosis of BPDCN was 3 months. Skin (65%) followed by bone marrow (51%) and blood (45%) involvement represented the most common sites. Immunophenotyping revealed CD4 + , CD45 + , CD56 + , CD123 + , HLA-DR + , and TCL-1 + as the most common surface markers. Overall, 86% (e.g. CD33) and 83% (e.g., CD7) showed co-expression of myeloid and T-cell markers, respectively. In the median, we detected five genomic alterations per case including mutational subtypes typically involved in AML: DNA methylation (70%), signal transduction (46%), splicing factors (38%), chromatin modification (32%), transcription factors (32%), and RAS pathway (30%), respectively. The contribution of patients (30%) proceeding to any form of upfront stem cell transplantation (SCT; autologous or allogeneic) was almost equal resulting in beneficial overall survival rates in those undergoing allogeneic SCT (p = 0.0001). BPDCN is a rare and challenging entity sharing various typical characteristics of other hematological diseases. Comprehensive diagnostics should be initiated timely to ensure appropriate treatment strategies.
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Affiliation(s)
- Evgenii Shumilov
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Paolo Mazzeo
- Clinics of Hematology and Medical Oncology, INDIGHO Laboratory, University Medical Center Goettingen (UMG), Goettingen, Germany
| | - Susanne Ghandili
- Department of Oncology, Hematology and Bone Marrow Transplantation With Section Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Axel Künstner
- Medical Systems Biology Group, Luebeck Institute of Experimental Dermatology, University of Luebeck, Luebeck, Germany
| | - Sören Weidemann
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Yara Banz
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Philipp Ströbel
- Institute of Pathology, University Medical Center Goettingen, Goettingen, Germany
| | - Matthias Pollak
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lina Kolloch
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Helmut Beltraminelli
- Dermatopathology Department, Ente Ospedaliero Cantonale (EOC), Locarno, Switzerland
| | - Andrea Kerkhoff
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Jan-Henrik Mikesch
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Christoph Schliemann
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Detlef Haase
- Clinics of Hematology and Medical Oncology, INDIGHO Laboratory, University Medical Center Goettingen (UMG), Goettingen, Germany
| | - Gerald Wulf
- Department of Hematology and Medical Oncology, University Medical Center Goettingen (UMG), Goettingen, Germany
| | - Myriam Legros
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Georg Lenz
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Laurence Feldmeyer
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Pabst
- Department of Medical Oncology, Bern University Hospital, University of Bern, InselspitalBern, Switzerland
| | - Hanno Witte
- Department for Hematology and Oncology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
- Department for Hematology and Oncology, Bundeswehrkrankenhaus Ulm, Ulm, Germany
| | - Niklas Gebauer
- Department for Hematology and Oncology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Ulrike Bacher
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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3
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Sockel K, Götze K, Ganster C, Bill M, Georgi JA, Balaian E, Aringer M, Trautmann-Grill K, Uhlig M, Bornhäuser M, Haase D, Thiede C. VEXAS syndrome: complete molecular remission after hypomethylating therapy. Ann Hematol 2024; 103:993-997. [PMID: 38214707 PMCID: PMC10866742 DOI: 10.1007/s00277-023-05611-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 12/27/2023] [Indexed: 01/13/2024]
Abstract
The VEXAS syndrome, a genetically defined autoimmune disease, associated with various hematological neoplasms has been attracting growing attention since its initial description in 2020. While various therapeutic strategies have been explored in case studies, the optimal treatment strategy is still under investigation and allogeneic cell transplantation is considered the only curative treatment. Here, we describe 2 patients who achieved complete molecular remission of the underlying UBA1 mutant clone outside the context of allogeneic HCT. Both patients received treatment with the hypomethylating agent azacitidine, and deep molecular remission triggered treatment de-escalation and even cessation with sustained molecular remission in one of them. Prospective studies are necessary to clarify which VEXAS patients will benefit most from hypomethylating therapy and to understand the variability in the response to different treatment strategies.
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Affiliation(s)
- Katja Sockel
- Medical Clinic and Policlinic I, University Hospital Dresden, TU Dresden, Dresden, Germany.
- German Cancer Consortium (DKTK), CHOICE Consortium, Partner Sites, MunichDresden, Germany.
| | - Katharina Götze
- German Cancer Consortium (DKTK), CHOICE Consortium, Partner Sites, MunichDresden, Germany
- Department of Medicine III, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christina Ganster
- Clinics of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Marius Bill
- Medical Clinic and Policlinic I, University Hospital Dresden, TU Dresden, Dresden, Germany
| | - Julia-Annabell Georgi
- Medical Clinic and Policlinic I, University Hospital Dresden, TU Dresden, Dresden, Germany
| | - Ekaterina Balaian
- Medical Clinic and Policlinic I, University Hospital Dresden, TU Dresden, Dresden, Germany
| | - Martin Aringer
- Division of Rheumatology, Department of Medicine III, University Medical Center and Faculty of Medicine Carl Gustav Carus at the TU Dresden, Dresden, Germany
| | | | - Maria Uhlig
- Medical Clinic and Policlinic I, University Hospital Dresden, TU Dresden, Dresden, Germany
| | - Martin Bornhäuser
- Medical Clinic and Policlinic I, University Hospital Dresden, TU Dresden, Dresden, Germany
- German Cancer Consortium (DKTK), CHOICE Consortium, Partner Sites, MunichDresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
| | - Detlef Haase
- Clinics of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Christian Thiede
- Medical Clinic and Policlinic I, University Hospital Dresden, TU Dresden, Dresden, Germany
- AgenDix GmbH, Dresden, Germany
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4
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Loacker L, Petzer V, Bachmann S, Griesmacher A, Wolf D, Stauder R. High concordance of clone detection between peripheral blood and bone marrow by targeted next-generation sequencing-A pilot study in patients with MDS. Br J Haematol 2023; 202:e16-e19. [PMID: 37263977 DOI: 10.1111/bjh.18889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 05/17/2023] [Indexed: 06/03/2023]
Affiliation(s)
- Lorin Loacker
- Central Institute for Medical and Chemical Laboratory Diagnosis, Innsbruck Medical University Hospital, Innsbruck, Austria
| | - Verena Petzer
- Department of Internal Medicine V (Haematology and Oncology), Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck, Innsbruck, Austria
| | - Sebastian Bachmann
- Central Institute for Medical and Chemical Laboratory Diagnosis, Innsbruck Medical University Hospital, Innsbruck, Austria
| | - Andrea Griesmacher
- Central Institute for Medical and Chemical Laboratory Diagnosis, Innsbruck Medical University Hospital, Innsbruck, Austria
| | - Dominik Wolf
- Department of Internal Medicine V (Haematology and Oncology), Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck, Innsbruck, Austria
| | - Reinhard Stauder
- Department of Internal Medicine V (Haematology and Oncology), Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck, Innsbruck, Austria
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5
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Eder LN, Martinovic D, Mazzeo P, Ganster C, Hasenkamp J, Thomson J, Trummer A, Haase D, Wulf G. Fatal Progression of Mutated TP53-Associated Clonal Hematopoiesis following Anti-CD19 CAR-T Cell Therapy. Curr Oncol 2023; 30:1146-1150. [PMID: 36661736 PMCID: PMC9858310 DOI: 10.3390/curroncol30010087] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/06/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
We present the case of a 64-year-old man diagnosed with large B-cell lymphoma who relapsed twice after standard-of-care therapy. Due to persisting cytopenia, Next generation sequencing analysis was performed, revealing a small TP53-mutated clone. As a third-line therapy, the patient was treated with CAR-T cells, which resulted in complete remission. However, this treatment also led to the expansion of the TP53-mutated clone and therapy-related myelodysplasia with a complex aberrant karyotype. This case may serve as a paradigmatic example of clonal hematopoietic progression in a patient undergoing CAR-T cell therapy, especially in the context of a TP53-mutated clone.
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Affiliation(s)
- Lea Naomi Eder
- Department of Hematology and Medical Oncology, University Medicine Goettingen, 37075 Göttingen, Germany
| | - Danilo Martinovic
- Department of Hematology and Medical Oncology, University Medicine Goettingen, 37075 Göttingen, Germany
| | - Paolo Mazzeo
- Department of Hematology and Medical Oncology, University Medicine Goettingen, 37075 Göttingen, Germany
| | - Christina Ganster
- Department of Hematology and Medical Oncology, University Medicine Goettingen, 37075 Göttingen, Germany
| | - Justin Hasenkamp
- Department of Hematology and Medical Oncology, University Medicine Goettingen, 37075 Göttingen, Germany
| | - Julia Thomson
- Department of Hematology and Medical Oncology, University Medicine Goettingen, 37075 Göttingen, Germany
| | - Arne Trummer
- Department of Hematology and Oncology, Städtisches Klinikum Braunschweig, 38114 Braunschweig, Germany
| | - Detlef Haase
- Department of Hematology and Medical Oncology, University Medicine Goettingen, 37075 Göttingen, Germany
| | - Gerald Wulf
- Department of Hematology and Medical Oncology, University Medicine Goettingen, 37075 Göttingen, Germany
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6
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Garcia-Gisbert N, Garcia-Ávila S, Merchán B, Salido M, Fernández-Rodríguez C, Gibert J, Fernández-Ibarrondo L, Camacho L, Lafuente M, Longarón R, Espinet B, Vélez P, Pujol RM, Andrade-Campos M, Arenillas L, Salar A, Calvo X, Besses C, Bellosillo B. Molecular and cytogenetic characterization of myelodysplastic syndromes in cell-free DNA. Blood Adv 2022; 6:3178-3188. [PMID: 35192693 PMCID: PMC9131900 DOI: 10.1182/bloodadvances.2021006565] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/03/2022] [Indexed: 11/20/2022] Open
Abstract
Molecular and cytogenetic studies are essential for diagnosis and prognosis in patients with myelodysplastic syndromes (MDSs). Cell-free DNA (cfDNA) analysis has been reported to be a reliable noninvasive approach for detecting molecular abnormalities in MDS; however, there is limited information about cytogenetic alterations and monitoring in cfDNA. We assessed the molecular and cytogenetic profile of a cohort of 70 patients with MDS by next-generation sequencing (NGS) of cfDNA and compared the results to sequencing of paired bone marrow (BM) DNA. Sequencing of BM DNA and cfDNA showed a comparable mutational profile (92.1% concordance), and variant allele frequencies (VAFs) strongly correlated between both sample types. Of note, SF3B1 mutations were detected with significantly higher VAFs in cfDNA than in BM DNA. NGS and microarrays were highly concordant in detecting chromosomal alterations although with lower sensitivity than karyotype and fluorescence in situ hybridization. Nevertheless, all cytogenetic aberrations detected by NGS in BM DNA were also detected in cfDNA. In addition, we monitored molecular and cytogenetic alterations and observed an excellent correlation between the VAFs of mutations in BM DNA and cfDNA across multiple matched time points. A decrease in the cfDNA VAFs was detected in patients responding to therapy, but not in nonresponding patients. Of note, cfDNA analysis also showed cytogenetic evolution in 2 nonresponsive cases. In summary, although further studies with larger cohorts are needed, our results support the analysis of cfDNA as a promising strategy for performing molecular characterization, detection of chromosomal aberrations and monitoring of patients with MDS.
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Affiliation(s)
- Nieves Garcia-Gisbert
- Group of Applied Clinical Research in Hematology, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Pompeu Fabra University, Barcelona, Spain
| | - Sara Garcia-Ávila
- Group of Applied Clinical Research in Hematology, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Hematology, Hospital del Mar, Barcelona, Spain
| | - Brayan Merchán
- Group of Applied Clinical Research in Hematology, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Marta Salido
- Group of Translational Research on Hematological Neoplasms, IMIM, Barcelona, Spain; and
- Department of Pathology, and
| | - Concepción Fernández-Rodríguez
- Group of Applied Clinical Research in Hematology, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Pathology, and
| | - Joan Gibert
- Group of Applied Clinical Research in Hematology, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Lierni Fernández-Ibarrondo
- Group of Applied Clinical Research in Hematology, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Pompeu Fabra University, Barcelona, Spain
| | - Laura Camacho
- Group of Applied Clinical Research in Hematology, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Pathology, and
| | - Marta Lafuente
- Group of Applied Clinical Research in Hematology, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Pompeu Fabra University, Barcelona, Spain
| | - Raquel Longarón
- Group of Applied Clinical Research in Hematology, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Pathology, and
| | - Blanca Espinet
- Group of Translational Research on Hematological Neoplasms, IMIM, Barcelona, Spain; and
- Department of Pathology, and
| | - Patricia Vélez
- Group of Applied Clinical Research in Hematology, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Hematology, Hospital del Mar, Barcelona, Spain
| | - Ramon M. Pujol
- Department of Dermatology, Hospital del Mar, Barcelona, Spain
| | - Marcio Andrade-Campos
- Group of Applied Clinical Research in Hematology, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Leonor Arenillas
- Group of Translational Research on Hematological Neoplasms, IMIM, Barcelona, Spain; and
- Department of Pathology, and
| | - Antonio Salar
- Group of Applied Clinical Research in Hematology, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Hematology, Hospital del Mar, Barcelona, Spain
| | - Xavier Calvo
- Group of Translational Research on Hematological Neoplasms, IMIM, Barcelona, Spain; and
- Department of Pathology, and
| | - Carles Besses
- Group of Applied Clinical Research in Hematology, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Beatriz Bellosillo
- Group of Applied Clinical Research in Hematology, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Pompeu Fabra University, Barcelona, Spain
- Department of Pathology, and
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7
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Deep sequencing in CD34+ cells from peripheral blood allows sensitive detection of measurable residual disease in AML. Blood Adv 2022; 6:3294-3303. [PMID: 35320339 PMCID: PMC9198930 DOI: 10.1182/bloodadvances.2021006233] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 02/28/2022] [Indexed: 11/20/2022] Open
Abstract
The combination of FACS for enrichment of CD34+ PB cells and deep sequencing enables detection of MRD at levels down to 1:106. NGS in CD34+ PB cells improved early prediction of molecular relapse compared with NGS of unsorted PB or CD34+ donor chimerism.
Monitoring of measurable residual disease (MRD) in patients with acute myeloid leukemia (AML) is predictive of disease recurrence and may identify patients who benefit from treatment intensification. Current MRD techniques rely on multicolor flow cytometry or molecular methods, but are limited in applicability or sensitivity. We evaluated the feasibility of a novel approach for MRD detection in peripheral blood (PB), which combines immunomagnetic preenrichment and fluorescence-activated cell sorting (FACS) for isolation of CD34+ cells with error-reduced targeted next-generation sequencing (NGS). For clinical validation, we retrospectively analyzed 429 PB and 55 bone marrow (BM) samples of 40 patients with AML or high-risk MDS, with/without molecular relapse based on CD34+ donor chimerism (DC), in complete remission after allogeneic stem cell transplantation. Enrichment of CD34+ cells for NGS increased the detection of mutant alleles in PB ∼1000-fold (median variant allele frequency, 1.27% vs 0.0046% in unsorted PB; P < .0001). Although a strong correlation was observed for the parallel analysis of CD34+ PB cells with NGS and DC (r = 0.8601), the combination of FACS and NGS improved sensitivity for MRD detection in dilution experiments ∼10-fold to levels of 10−6. In both assays, MRD detection was superior using PB vs BM for CD34+ enrichment. Importantly, NGS on CD34+ PB cells enabled prediction of molecular relapse with high sensitivity (100%) and specificity (91%), and significantly earlier (median, 48 days; range, 0-281; P = .0011) than by CD34+ DC or NGS of unsorted PB, providing additional time for therapeutic intervention. Moreover, panel sequencing in CD34+ cells allowed for the early assessment of clonal trajectories in hematological complete remission.
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8
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Palomo L, Ibáñez M, Abáigar M, Vázquez I, Álvarez S, Cabezón M, Tazón-Vega B, Rapado I, Fuster-Tormo F, Cervera J, Benito R, Larrayoz MJ, Cigudosa JC, Zamora L, Valcárcel D, Cedena MT, Acha P, Hernández-Sánchez JM, Fernández-Mercado M, Sanz G, Hernández-Rivas JM, Calasanz MJ, Solé F, Such E. Spanish Guidelines for the use of targeted deep sequencing in myelodysplastic syndromes and chronic myelomonocytic leukaemia. Br J Haematol 2019; 188:605-622. [PMID: 31621063 PMCID: PMC7064979 DOI: 10.1111/bjh.16175] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/04/2019] [Accepted: 07/06/2019] [Indexed: 12/20/2022]
Abstract
The landscape of medical sequencing has rapidly changed with the evolution of next generation sequencing (NGS). These technologies have contributed to the molecular characterization of the myelodysplastic syndromes (MDS) and chronic myelomonocytic leukaemia (CMML), through the identification of recurrent gene mutations, which are present in >80% of patients. These mutations contribute to a better classification and risk stratification of the patients. Currently, clinical laboratories include NGS genomic analyses in their routine clinical practice, in an effort to personalize the diagnosis, prognosis and treatment of MDS and CMML. NGS technologies have reduced the cost of large-scale sequencing, but there are additional challenges involving the clinical validation of these technologies, as continuous advances are constantly being made. In this context, it is of major importance to standardize the generation, analysis, clinical interpretation and reporting of NGS data. To that end, the Spanish MDS Group (GESMD) has expanded the present set of guidelines, aiming to establish common quality standards for the adequate implementation of NGS and clinical interpretation of the results, hoping that this effort will ultimately contribute to the benefit of patients with myeloid malignancies.
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Affiliation(s)
- Laura Palomo
- Josep Carreras Leukaemia Research Institute, ICO Badalona-Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Sadalona, Spain
| | - Mariam Ibáñez
- Department of Haematology, Hospital Universitari i Politècnic La Fe, València, Spain.,Centro de Investigacion Biomédica en Red de Cáncer (CIBERONC), Instituto Carlos III, Madrid, Spain.,Departamento de Ciencias Biomédicas, Facultad de Ciencias de la Salud, Universidad CEU Cardenal Herrera, València, Spain
| | - María Abáigar
- Institute of Biomedical Research of Salamanca (IBSAL), Cancer Research Centre (IBMCC-CIC; Univ. of Salamanca-CSIC), Salamanca, Spain
| | - Iria Vázquez
- Haematological Diseases Laboratory, CIMA LAB Diagnostics, University of Navarra, Pamplona, Spain.,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Sara Álvarez
- NIMGenetics, Genómica y Medicina, S.L., Madrid, Spain
| | - Marta Cabezón
- Haematology Service, ICO Badalona-Hospital Germans Trias i Pujol, Josep Carreras Leukaemia Research Institute, Badalona, Spain
| | - Bárbara Tazón-Vega
- Department of Haematology, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Inmaculada Rapado
- Haematology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.,Haematological Malignancies Clinical Research Unit, CNIO, Madrid, Spain.,Centro de investigación Biomédica en Red Cáncer (CIBERONC), Madrid, Spain
| | - Francisco Fuster-Tormo
- Josep Carreras Leukaemia Research Institute, ICO Badalona-Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Sadalona, Spain
| | - José Cervera
- Department of Haematology, Hospital Universitari i Politècnic La Fe, València, Spain.,Centro de Investigacion Biomédica en Red de Cáncer (CIBERONC), Instituto Carlos III, Madrid, Spain.,Genetics Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Rocío Benito
- Institute of Biomedical Research of Salamanca (IBSAL), Cancer Research Centre (IBMCC-CIC; Univ. of Salamanca-CSIC), Salamanca, Spain
| | - María J Larrayoz
- Haematological Diseases Laboratory, CIMA LAB Diagnostics, University of Navarra, Pamplona, Spain.,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | | | - Lurdes Zamora
- Haematology Service, ICO Badalona-Hospital Germans Trias i Pujol, Josep Carreras Leukaemia Research Institute, Badalona, Spain
| | - David Valcárcel
- Department of Haematology, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - María T Cedena
- Haematology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.,Haematological Malignancies Clinical Research Unit, CNIO, Madrid, Spain.,Centro de investigación Biomédica en Red Cáncer (CIBERONC), Madrid, Spain
| | - Pamela Acha
- Josep Carreras Leukaemia Research Institute, ICO Badalona-Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Sadalona, Spain
| | - Jesús M Hernández-Sánchez
- Institute of Biomedical Research of Salamanca (IBSAL), Cancer Research Centre (IBMCC-CIC; Univ. of Salamanca-CSIC), Salamanca, Spain.,University of Salamanca (USAL), Salamanca, Spain
| | - Marta Fernández-Mercado
- Haematological Diseases Laboratory, CIMA LAB Diagnostics, University of Navarra, Pamplona, Spain.,Advanced Genomics Laboratory, Centre for Applied Medical Research (CIMA), University of Navarra, Haemato-Oncology, Pamplona, Spain.,Biomedical Engineering Department, School of Engineering, University of Navarra, San Sebastian, Spain
| | - Guillermo Sanz
- Department of Haematology, Hospital Universitari i Politècnic La Fe, València, Spain.,Centro de Investigacion Biomédica en Red de Cáncer (CIBERONC), Instituto Carlos III, Madrid, Spain
| | - Jesús M Hernández-Rivas
- Institute of Biomedical Research of Salamanca (IBSAL), Cancer Research Centre (IBMCC-CIC; Univ. of Salamanca-CSIC), Salamanca, Spain.,University of Salamanca (USAL), Salamanca, Spain.,Hospital Universitario de Salamanca, Salamanca, Spain
| | - María J Calasanz
- Haematological Diseases Laboratory, CIMA LAB Diagnostics, University of Navarra, Pamplona, Spain.,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Francesc Solé
- Josep Carreras Leukaemia Research Institute, ICO Badalona-Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Sadalona, Spain
| | - Esperanza Such
- Department of Haematology, Hospital Universitari i Politècnic La Fe, València, Spain.,Centro de Investigacion Biomédica en Red de Cáncer (CIBERONC), Instituto Carlos III, Madrid, Spain.,Departamento de Ciencias Biomédicas, Facultad de Ciencias de la Salud, Universidad CEU Cardenal Herrera, València, Spain
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9
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Asadi Fakhr Z, Mehrzad V, Izaditabar A, Salehi M. Evaluation of the utility of peripheral blood vs bone marrow in karyotype and fluorescence in situ hybridization for myelodysplastic syndrome diagnosis. J Clin Lab Anal 2018; 32:e22586. [PMID: 29893006 DOI: 10.1002/jcla.22586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 05/19/2018] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To clear the role of peripheral blood as a substitution for bone marrow in myelodysplastic syndrome and to evaluate the concordance between peripheral blood and bone marrow using karyotype and fluorescence in situ hybridization (FISH) methods. METHODS We examined 35 bone marrow (BM) and peripheral blood (PB) samples from myelodysplastic syndrome (MDS) patient using karyotype and FISH. Karyotype method for BM and PB samples performed using the standard protocol with an exception for peripheral blood in which growth factor for cultivation was not used. FISH testing was performed using a panel of MDS-associated probes to detect 20q12, 20qter, 5q31, 5q33, 5p15 and chromosome 7 and 8 centromeres. RESULTS Our results showed karyotypes of BM and PB are concordant in 74% of cases, while about 53% of these concordances were achieved from cases with normal karyotypes. However, the results of BM FISH were completely concordant with PB FISH. CONCLUSION Although peripheral blood karyotype is not trustworthy for MDS diagnosis, examining peripheral blood, using the FISH method, could be useful for clinical monitoring.
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Affiliation(s)
- Zhaleh Asadi Fakhr
- Department of Genetics and Molecular Biology, Medical School, Isfahan University of Medical Science, Isfahan, Iran
| | - Valiollah Mehrzad
- Department of Hematology and Oncology, Medical School, Omid Hospital, Isfahan University of Medical Science, Isfahan, Iran
| | | | - Mansoor Salehi
- Department of Genetics and Molecular Biology, Medical School, Isfahan University of Medical Science, Isfahan, Iran.,Medical Genetics Center of Genome, Isfahan, Iran
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