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Reuvekamp T, Bachas C, Cloos J. Immunophenotypic features of early haematopoietic and leukaemia stem cells. Int J Lab Hematol 2024. [PMID: 39045906 DOI: 10.1111/ijlh.14348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 07/10/2024] [Indexed: 07/25/2024]
Abstract
Many tumours are organised in a hierarchical structure with at its apex a cell that can maintain, establish, and repopulate the tumour-the cancer stem cell. The haematopoietic stem cell (HSC) is the founder cell for all functional blood cells. Like HSCs, the leukaemia stem cells (LSC) are hypothesised to be the leukaemia-initiating cells, which have features of stemness such as self-renewal, quiescence, and resistance to cytotoxic drugs. Immunophenotypically, CD34+CD38- defines HSCs by adding lineage negativity and CD90+CD45RA-. At which stage of maturation the further differentiation is blocked, determines the type of leukaemia, and determines the immunophenotype of the LSC specific to the leukaemia type. No apparent LSC phenotype has been described in lymphoid leukaemia, and it is debated if a specific acute lymphocytic leukaemia-initiating cell is present, as all cells are capable of engraftment in a secondary mouse model. In chronic lymphocytic leukaemia, a B-cell clone is responsible for uncontrolled proliferation, not a specific LSC. In chronic and acute myeloid leukaemia, LSC is described as CD34+CD38- with the expression of a marker that is aberrantly expressed (LSC marker), such as CD45RA, CD123 or in the case of chronic myeloid leukaemia CD26. In acute myeloid leukaemia, the LSC load had prognostic relevance and might be a biomarker that can be used for monitoring and as an addition to measurable residual disease. However, challenges such as the CD34-negative immunophenotype need to be explored.
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Affiliation(s)
- Tom Reuvekamp
- Department of Hematology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
- Department of Hematology, Amsterdam UMC Location Universiteit van Amsterdam, Amsterdam, The Netherlands
| | - Costa Bachas
- Department of Hematology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - Jacqueline Cloos
- Department of Hematology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
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Chaudhary N, Rahman K, Gupta P, Gupta R, Sarkar MK, Singh MK, Chandra D, Kumar S, Kashyap R. Peripheral blood quantitation of CD26 positive leukemic stem cells as a predictor of tyrosine kinase inhibitor response in chronic myeloid leukemia. Int J Lab Hematol 2024. [PMID: 38711332 DOI: 10.1111/ijlh.14301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/18/2024] [Indexed: 05/08/2024]
Abstract
INTRODUCTION Leukemic stem cells (LSCs) are the transcriptionally low/silent cells which are resistant to the tyrosine kinase inhibitor. These have been found to play a pivotal role in disease relapse in chronic myeloid leukemia (CML) cases. The present study evaluated the correlation of absolute CML-LSC count in the peripheral blood (PB) at diagnosis and achievement of major molecular response (MMR) at 12 months in patients of CML-CP. METHODS This was a prospective, observational, non-interventional single center study including newly diagnosed adult (>18 yrs) CML-CP patients. Absolute CD26 + CML-LSC quantification was done by multiparametric flow cytometry. Patients were treated with Imatinib treatment and subsequently monitored at 3-month intervals for BCR::ABL transcript levels. MMR was defined as a BCR::ABL1 transcript level of less than 0.1% on international scale. RESULTS A total of 89 patients were enrolled in the study out of which 40.5% achieved MMR at 12 months. There was a significant difference in the median absolute CML-LSC count of the patients who achieved MMR at 12 months as compared to those who did not (58.5 vs 368.1 cells/μL; p value <0.001). Using a ROC analysis, a count of <165.69 CML LSC/μL was identified to have a sensitivity of 83.8% and specificity of 72.4%, in predicting the MMR at 12 months. CONCLUSION Absolute CML-LSC count at diagnosis in the PB predicts the MMR achievement at 12 months. An absolute count of less than 165 cells/μL is highly predictive of achieving MMR at 12 months.
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Affiliation(s)
| | | | | | - Ruchi Gupta
- Department of Hematology, SGPGIMS, Lucknow, India
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Kana S, John S, Basu D, Kar R, Nachiappa Ganesh R, Dubashi B. Flow Cytometric Assessment of CD26-Positive Leukemic Stem Cells: A Rapid and Valuable Tool in the Diagnosis and Follow-Up of Chronic Myeloid Leukemia. Cureus 2024; 16:e56944. [PMID: 38665755 PMCID: PMC11044527 DOI: 10.7759/cureus.56944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
Context Chronic myeloid leukemia (CML) is a clonal myeloproliferative neoplasm. Recent studies have suggested that CD26-positive leukemic stem cells (LSCs) circulating in peripheral blood are specific for CML. Objective This study was undertaken to determine the proportion of CD26-positive LSCs at diagnosis and its change during tyrosine kinase inhibitor therapy. Design This prospective study was conducted on 43 cases of CML at diagnosis. For flow cytometry, peripheral blood cells were stained with CD45, CD34, CD38, CD3, and CD26. A sequential gating strategy with CD45/SSC (side scatter), CD34/SSC, and CD34/CD38 was applied to identify CD45+/34+/38- populations, from which CD26-positive stem cells were identified and compared with controls. Data analysis was done with Kaluza software. Results All patients diagnosed with CML were detected with CD26-positive LSCs. The median percentage of CD26-positive CML LSCs was 0.02 with a range of 0.001 to 1.77. None of the control samples showed CD26 positivity. The percentage and absolute count of CD26-positive CML LSCs were reduced after six months of tyrosine kinase therapy in patients with complete hematological remission. Conclusion Flow cytometric analysis of circulating CD26-positive CML LSCs is a non-invasive, rapid, and useful tool in the diagnosis and follow-up of CML.
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Affiliation(s)
- Sreerag Kana
- Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Sarah John
- Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Debdatta Basu
- Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Rakhee Kar
- Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Rajesh Nachiappa Ganesh
- Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Biswajit Dubashi
- Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
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Abruzzese E, Bocchia M, Trawinska MM, Raspadori D, Bondanini F, Sicuranza A, Pacelli P, Re F, Cavalleri A, Farina M, Malagola M, Russo D, De Fabritiis P, Bernardi S. Minimal Residual Disease Detection at RNA and Leukemic Stem Cell (LSC) Levels: Comparison of RT-qPCR, d-PCR and CD26+ Stem Cell Measurements in Chronic Myeloid Leukemia (CML) Patients in Deep Molecular Response (DMR). Cancers (Basel) 2023; 15:4112. [PMID: 37627140 PMCID: PMC10452239 DOI: 10.3390/cancers15164112] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/08/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
A Deep Molecular Response (DMR), defined as a BCR::ABL1 transcript at levels ≤ 0.01% by RT-qPCR, is the prerequisite for the successful interruption of treatment among patients with Chronic Myeloid Leukemia (CML). However, approximately 50% of patients in Treatment-Free Remission (TFR) studies had to resume therapy after their BCR::ABL1 transcript levels rose above the 0.1% threshold. To improve transcript detection sensitivity and accuracy, transcript levels can be analyzed using digital PCR (dPCR). dPCR increases BCR::ABL1 transcript detection sensitivity 10-100 fold; however, its ability to better select successful TFR patients remains unclear. Beyond the role of the immune system, relapses may be due to the presence of residual leukemic stem cells (LSCs) that are transcriptionally silent. Flow cytometry can be used to identify and quantify circulating bone marrow Ph+ LSCs CD34+/CD38- co-expressing CD26 (dipeptidylpeptidase-IV). To date, the significance of circulating Ph+ LSCs in TFR is unclear. The aim of this work is to compare and examine the values obtained using the three different methods of detecting minimal residual disease (MRD) in CML at RNA (RT-qPCR and dPCR) and LSC (flowcytometry) levels among patients in TFR or exhibiting a DMR. The twenty-seven patients enrolled received treatment with either imatinib (12), dasatinib (6), nilotinib (7), bosutinib (1), or interferon (1). Twelve patients were in TFR, while the rest exhibited a DMR. The TFR patients had stopped therapy for less than 1 year (3), <3 years (2), 6 years (6), and 17 years (1). Blood samples were collected and tested using the three methods at the same time. Both d-PCR and LSCs showed higher sensitivity than RT-qPCR, exhibiting positive results in samples that were undetectable using RT-qPCR (17/27). None of the patients tested negative with d-PCR; however, 23/27 were under the threshold of 0.468 copies/μL, corresponding to a stable DMR. The results were divided into quartiles, and the lowest quartiles defined the lowest MRD. These data were strongly correlated in 15/27 patients, corresponding to almost half of the TFR patients. Indeed, the TFR patients, some lasting up to 17 years, corresponded to the lowest detectable DMR categories. To the best of our knowledge, this is the first attempt to analyze and compare DMRs in a CML population using standard (RT-qPCR) and highly sensitive (dPCR and LSCs) methods.
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Affiliation(s)
- Elisabetta Abruzzese
- Hematology Unit, S. Eugenio Hospital, ASL Roma 2, Tor Vergata University, 00144 Rome, Italy; (M.M.T.); (P.D.F.)
| | - Monica Bocchia
- Chair of Hematology, University of Siena, Azienda Ospedaliera Universitaria, 53100 Siena, Italy; (M.B.); (D.R.); (A.S.); (P.P.)
| | - Malgorzata Monika Trawinska
- Hematology Unit, S. Eugenio Hospital, ASL Roma 2, Tor Vergata University, 00144 Rome, Italy; (M.M.T.); (P.D.F.)
| | - Donatella Raspadori
- Chair of Hematology, University of Siena, Azienda Ospedaliera Universitaria, 53100 Siena, Italy; (M.B.); (D.R.); (A.S.); (P.P.)
| | - Francesco Bondanini
- Laboratory Medicine Unit, S. Eugenio Hospital, ASL Roma 2, 00144 Rome, Italy;
| | - Anna Sicuranza
- Chair of Hematology, University of Siena, Azienda Ospedaliera Universitaria, 53100 Siena, Italy; (M.B.); (D.R.); (A.S.); (P.P.)
| | - Paola Pacelli
- Chair of Hematology, University of Siena, Azienda Ospedaliera Universitaria, 53100 Siena, Italy; (M.B.); (D.R.); (A.S.); (P.P.)
| | - Federica Re
- Bone Marrow Transplant Unit, ASST-Spedali Civili di Brescia, Chair of Hematology, Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy; (F.R.); (A.C.); (M.F.); (M.M.); (D.R.)
| | - Alessia Cavalleri
- Bone Marrow Transplant Unit, ASST-Spedali Civili di Brescia, Chair of Hematology, Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy; (F.R.); (A.C.); (M.F.); (M.M.); (D.R.)
| | - Mirko Farina
- Bone Marrow Transplant Unit, ASST-Spedali Civili di Brescia, Chair of Hematology, Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy; (F.R.); (A.C.); (M.F.); (M.M.); (D.R.)
| | - Michele Malagola
- Bone Marrow Transplant Unit, ASST-Spedali Civili di Brescia, Chair of Hematology, Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy; (F.R.); (A.C.); (M.F.); (M.M.); (D.R.)
| | - Domenico Russo
- Bone Marrow Transplant Unit, ASST-Spedali Civili di Brescia, Chair of Hematology, Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy; (F.R.); (A.C.); (M.F.); (M.M.); (D.R.)
| | - Paolo De Fabritiis
- Hematology Unit, S. Eugenio Hospital, ASL Roma 2, Tor Vergata University, 00144 Rome, Italy; (M.M.T.); (P.D.F.)
| | - Simona Bernardi
- Bone Marrow Transplant Unit, ASST-Spedali Civili di Brescia, Chair of Hematology, Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy; (F.R.); (A.C.); (M.F.); (M.M.); (D.R.)
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Pacelli P, Santoni A, Sicuranza A, Abruzzese E, Giai V, Crugnola M, Annunziata M, Galimberti S, Iurlo A, Luciano L, Sorà F, Fava C, Bestoso E, Marzano C, Cartocci A, Defina M, Sammartano V, Cencini E, Raspadori D, Bocchia M. Prospective monitoring of chronic myeloid leukemia patients from the time of TKI discontinuation: the fate of peripheral blood CD26 + leukemia stem cells. Front Pharmacol 2023; 14:1194712. [PMID: 37305536 PMCID: PMC10250640 DOI: 10.3389/fphar.2023.1194712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/15/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction: In chronic myeloid leukemia (CML), about half of the patients achieving a deep and stable molecular response with tyrosine kinase inhibitors (TKIs) may discontinue TKI treatment without disease recurrence. As such, treatment-free remission (TFR) has become an ambitious goal of treatment. Given the evidence that deepness and duration of molecular response are necessary but not sufficient requisites for a successful TFR, additional biological criteria are needed to identify CML patients suitable for efficacious discontinuation. Leukemia stem cells (LSCs) are supposed to be the reservoir of the disease. Previously, we demonstrated that residual circulating CD34+/CD38-/CD26+ LSCs were still detectable in a consistent number of CML patients during TFR. Methods: CML LSCs could be easily identified by flow-cytometry as they express the CD34+/CD38-/CD26+ phenotype. In this study, we explored the role of these cells and their correlation with molecular response in a cohort of 109 consecutive chronic phase CML patients prospectively monitored from the time of TKI discontinuation. Results: After a median observation time of 33 months from TKI discontinuation, 38/109 (35%) patients failed TFR after a median time of 4 months, while 71/109 (65%) patients are still in TFR. At TKI discontinuation, peripheral blood CD26+LSCs were undetectable in 48/109 (44%) patients and detectable in 61/109 (56%). No statistically significant correlation between detectable/undetectable CD26+LSCs and the rate of TFR loss was found (p = 0.616). The incidence of TFR loss based on the type of TKI treatment was statistically significant for imatinib treatment compared to that of nilotinib (p = 0.039). Exploring the behavior of CD26+LSCs during TFR, we observed fluctuating values that were very variable between patients, and they were not predictive of TFR loss. Discussion: Up to date, our results confirm that CD26+LSCs are detectable at the time of TKI discontinuation and during TFR. Moreover, at least for the observation median time of the study, the persistence of "fluctuating" values of residual CD26+LSCs does not hamper the possibility to maintain a stable TFR. On the contrary, even patients discontinuing TKI with undetectable CD26+LSCs could undergo TFR loss. Our results suggest that factors other than residual LSCs "burden" playing an active role in controlling disease recurrence. Additional studies evaluating CD26+LSCs' ability to modulate the immune system and their interaction in CML patients with very long stable TFR are ongoing.
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Affiliation(s)
- Paola Pacelli
- Hematology Unit, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Adele Santoni
- Hematology Unit, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Anna Sicuranza
- Hematology Unit, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | | | - Valentina Giai
- Division of Hematology, Città Della Salute e Della Scienza, Turin, Italy
| | - Monica Crugnola
- Ematologia e Centro BMT, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | | | - Sara Galimberti
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luigiana Luciano
- Hematology, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Federica Sorà
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carmen Fava
- Azienda Ospedaliera Ordine Mauriziano di Torino, Turin, Italy
| | - Elena Bestoso
- Hematology Unit, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Cristina Marzano
- Hematology Unit, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | | | - Marzia Defina
- Hematology Unit, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Vincenzo Sammartano
- Hematology Unit, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Emanuele Cencini
- Hematology Unit, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Donatella Raspadori
- Hematology Unit, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Monica Bocchia
- Hematology Unit, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
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Elhadary M, Elsabagh AA, Ferih K, Elsayed B, Elshoeibi AM, Kaddoura R, Akiki S, Ahmed K, Yassin M. Applications of Machine Learning in Chronic Myeloid Leukemia. Diagnostics (Basel) 2023; 13:diagnostics13071330. [PMID: 37046547 PMCID: PMC10093579 DOI: 10.3390/diagnostics13071330] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/11/2023] [Accepted: 03/15/2023] [Indexed: 04/14/2023] Open
Abstract
Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm characterized by dysregulated growth and the proliferation of myeloid cells in the bone marrow caused by the BCR-ABL1 fusion gene. Clinically, CML demonstrates an increased production of mature and maturing granulocytes, mainly neutrophils. When a patient is suspected to have CML, peripheral blood smears and bone marrow biopsies may be manually examined by a hematologist. However, confirmatory testing for the BCR-ABL1 gene is still needed to confirm the diagnosis. Despite tyrosine kinase inhibitors (TKIs) being the mainstay of treatment for patients with CML, different agents should be used in different patients given their stage of disease and comorbidities. Moreover, some patients do not respond well to certain agents and some need more aggressive courses of therapy. Given the innovations and development that machine learning (ML) and artificial intelligence (AI) have undergone over the years, multiple models and algorithms have been put forward to help in the assessment and treatment of CML. In this review, we summarize the recent studies utilizing ML algorithms in patients with CML. The search was conducted on the PubMed/Medline and Embase databases and yielded 66 full-text articles and abstracts, out of which 11 studies were included after screening against the inclusion criteria. The studies included show potential for the clinical implementation of ML models in the diagnosis, risk assessment, and treatment processes of patients with CML.
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Affiliation(s)
- Mohamed Elhadary
- College of Medicine, QU Health, Qatar University, Doha 2713, Qatar
| | | | - Khaled Ferih
- College of Medicine, QU Health, Qatar University, Doha 2713, Qatar
| | - Basel Elsayed
- College of Medicine, QU Health, Qatar University, Doha 2713, Qatar
| | | | - Rasha Kaddoura
- Pharmacy Department, Heart Hospital, Hamad Medical Corporation (HMC), Doha 3050, Qatar
| | - Susanna Akiki
- Diagnostic Genomic Division, Hamad Medical Corporation (HMC), Doha 3050, Qatar
| | - Khalid Ahmed
- Department of Hematology, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation (HMC), Doha 3050, Qatar
| | - Mohamed Yassin
- Hematology Section, Medical Oncology, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation (HMC), Doha 3050, Qatar
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Patterson SD, Copland M. The Bone Marrow Immune Microenvironment in CML: Treatment Responses, Treatment-Free Remission, and Therapeutic Vulnerabilities. Curr Hematol Malig Rep 2023; 18:19-32. [PMID: 36780103 PMCID: PMC9995533 DOI: 10.1007/s11899-023-00688-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 02/14/2023]
Abstract
PURPOSE OF REVIEW Tyrosine kinase inhibitors (TKIs) are very successful for the treatment of chronic myeloid leukaemia (CML) but are not curative in most patients due to persistence of TKI-resistant leukaemia stem cells (LSCs). The bone marrow immune microenvironment (BME) provides protection to the LSC through multidimensional interactions, driving therapy resistance, and highlighting the need to circumvent these protective niches therapeutically. This review updates the evidence for interactions between CML cells and the immune microenvironment with a view to identifying targetable therapeutic vulnerabilities and describes what is known about the role of immune regulation in treatment-free remission (TFR). RECENT FINDINGS Intracellular signalling downstream of the chemotactic CXCL12-CXCR4 axis, responsible for disrupted homing in CML, has been elucidated in LSCs, highlighting novel therapeutic opportunities. In addition, LSCs expressing CXCL12-cleaving surface protein CD26 were highly correlated with CML burden, building on existing evidence. Newer findings implicate the adhesion molecule CD44 in TKI resistance, while JAK/STAT-mediated resistance to TKIs may occur downstream of extrinsic signalling in the BME. Exosomal BME-LSC cross-communication has also been explored. Finally, further detail on the phenotypes of natural killer (NK) cells putatively involved in maintaining successful TFR has been published, and NK-based immunotherapies are discussed. Recent studies highlight and build on our understanding of the BME in CML persistence and TKI resistance, pinpointing therapeutically vulnerable interactions. Repurposing existing drugs and/or the development of novel inhibitors targeting these relationships may help to overcome these issues in TKI-resistant CML and be used as adjuvant therapy for sustained TFR.
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Affiliation(s)
- Shaun David Patterson
- School of Cancer Sciences, College of Medical, Veterinary and Life Sciences, Paul O'Gorman Leukaemia Research Centre, University of Glasgow, 21 Shelley Road, Glasgow, G12 0ZD, UK.
| | - Mhairi Copland
- School of Cancer Sciences, College of Medical, Veterinary and Life Sciences, Paul O'Gorman Leukaemia Research Centre, University of Glasgow, 21 Shelley Road, Glasgow, G12 0ZD, UK.
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Rinaldi I, Winston K. Chronic Myeloid Leukemia, from Pathophysiology to Treatment-Free Remission: A Narrative Literature Review. J Blood Med 2023; 14:261-277. [PMID: 37051025 PMCID: PMC10084831 DOI: 10.2147/jbm.s382090] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 02/06/2023] [Indexed: 04/14/2023] Open
Abstract
Chronic myeloid leukemia (CML) is one of the most common leukemias occurring in the adult population. The course of CML is divided into three phases: the chronic phase, the acceleration phase, and the blast phase. Pathophysiology of CML revolves around Philadelphia chromosome that constitutively activate tyrosine kinase through BCR-ABL1 oncoprotein. In the era of tyrosine kinase inhibitors (TKIs), CML patients now have a similar life expectancy to people without CML, and it is now very rare for CML patients to progress to the blast phase. Only a small proportion of CML patients have resistance to TKI, caused by BCR-ABL1 point mutations. CML patients with TKI resistance should be treated with second or third generation TKI, depending on the BCR-ABL1 mutation. Recently, many studies have shown that it is possible for CML patients who achieve a long-term deep molecular response to stop TKIs treatment and maintain remission. This review aimed to provide an overview of CML, including its pathophysiology, clinical manifestations, the role of stem cells, CML treatments, and treatment-free remission.
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Affiliation(s)
- Ikhwan Rinaldi
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Correspondence: Ikhwan Rinaldi, Division of Hematology and Medical Oncology, Department of Internal Medicine, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia, Email
| | - Kevin Winston
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Hospital Medicine, Bhakti Medicare Hospital, Sukabumi, Indonesia
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Inzoli E, Aroldi A, Piazza R, Gambacorti‐Passerini C. Tyrosine Kinase Inhibitor discontinuation in Chronic Myeloid Leukemia: eligibility criteria and predictors of success. Am J Hematol 2022; 97:1075-1085. [PMID: 35384030 PMCID: PMC9546318 DOI: 10.1002/ajh.26556] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 12/11/2022]
Abstract
TKI discontinuation proved to be safe and feasible in patients with CML with deep and durable molecular responses, introducing an additional treatment goal for these patients beyond overall survival. However, treatment interruption is a safe procedure only with appropriate patient selection and monitoring. Clinical and biological factors associated with better outcomes do not yet offer a precise stratification of patients according to their risk of relapse. This article aims at reviewing the leading studies present in the field in order to define eligibility criteria for discontinuation and predictors of success.
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Affiliation(s)
- Elena Inzoli
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMilanoItaly
- Hematology Division and Bone Marrow UnitSan Gerardo Hospital, ASST MonzaMonzaItaly
| | - Andrea Aroldi
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMilanoItaly
- Hematology Division and Bone Marrow UnitSan Gerardo Hospital, ASST MonzaMonzaItaly
| | - Rocco Piazza
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMilanoItaly
- Hematology Division and Bone Marrow UnitSan Gerardo Hospital, ASST MonzaMonzaItaly
| | - Carlo Gambacorti‐Passerini
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMilanoItaly
- Hematology Division and Bone Marrow UnitSan Gerardo Hospital, ASST MonzaMonzaItaly
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Nasrollahpour H, Khalilzadeh B, Naseri A, Yousefi H, Erk N, Rahbarghazi R. Electrochemical biosensors for stem cell analysis; applications in diagnostics, differentiation and follow-up. Trends Analyt Chem 2022. [DOI: 10.1016/j.trac.2022.116696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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11
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Ebian HF, Abdelnabi ALSM, Abdelazem AS, Khamis T, Fawzy HM, Hussein S. Peripheral Blood CD26 Positive Leukemic Stem Cells as a Possible Diagnostic and Prognostic Marker in Chronic Myeloid Leukemia. Leuk Res Rep 2022; 17:100321. [PMID: 35602932 PMCID: PMC9118510 DOI: 10.1016/j.lrr.2022.100321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/27/2022] [Accepted: 05/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background CD26 is expressed in all chronic myeloid leukemia (CML) patients. This study investigated the role of CD26+ LSCs in diagnosis and follow up of CML patients. Method Flow cytometry was performed to evaluate CD26+ LSC in peripheral blood (PB) in CML patients. BCR-ABL1 transcript level measurement was performed using standard qRT-PCR technique. Results CD26+ LSCs were significantly correlated with BCR-ABL1 transcript level at diagnosis and after three months of treatment. CD26+ LSCs also were significantly associated with the risk score after 12 months of treatment. Conclusion CD26+ LSCs can be a useful marker in diagnosis and follow up of patients with CML.
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Affiliation(s)
- Huda F Ebian
- Clinical Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | | | - Tarek Khamis
- Pharmacology Department, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt
| | - Hebatallah M. Fawzy
- Public Health and Community Medicine Department, Faculty of Medicine, Zagazig University Zagazig, Egypt
| | - Samia Hussein
- Medical Biochemistry& Molecular Biology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
- Corresponding author.
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12
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Rahman K, Singh MK, Chandra D, Gupta R, Sarkar MK, Gupta P, Gupta A, Yadav S, Kashyap R, Nityanand S. CD26 expression on circulating CD34+/CD38- progenitor population is a specific and reliable tool for the rapid flow cytometric diagnosis of chronic myeloid leukemia-A single-center validation study. Int J Lab Hematol 2022; 44:524-530. [PMID: 35315228 DOI: 10.1111/ijlh.13826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/14/2022] [Accepted: 02/27/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recently, CD26 have been identified as one of the promising and specific marker for the identification of leukemic stem cells (LSCs) in chronic myeloid leukemia (CML). METHODS This was a prospective, observational validation study. Peripheral blood (PB) samples from suspected cases of CML and other hematolymphoid neoplasm were evaluated for the expression of CD26 on stem cells (SC) (CD45 dim/CD34+/CD38-) fraction by flow cytometry (FCM) using a single tube four-color antibodies cocktail: CD45-V500 /CD26-PE/CD34-PerCPcy5.5/CD38-APC-H7. The diagnosis of CML was confirmed using cytogenetics and/or molecular studies. Additionally, 12 paired PB and bone marrow (BM) samples of CML cases were compared for the proportion of CD26+ LSCs. RESULTS Expression of CD26 on the SC fraction was invariably noted in all cases (116/116) of CML, irrespective of the disease phase and transcript type. None of other neoplasm (0/26), including the Ph + ALLs expressed CD26. Proportion of SCs expressing CD26 was variable with a median (range) proportion being 61.3% (7.6%-98.6%). Evaluation of paired PB and BM samples showed similar proportion of CD26 + LSCs (R2 : 0.969). CONCLUSION We confirmed that FCM evaluation of CD26 expression in the PB LSCs is a rapid and specific tool for CML diagnosis. Its utility as a marker for residual disease evaluation can also be explored in the future.
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Affiliation(s)
- Khaliqur Rahman
- Department of Hematology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Manish Kumar Singh
- Department of Hematology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Dinesh Chandra
- Department of Hematology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Ruchi Gupta
- Department of Hematology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Manoj K Sarkar
- Department of Hematology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Priyanka Gupta
- Department of Hematology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Anshul Gupta
- Department of Hematology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Sanjeev Yadav
- Department of Hematology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rajesh Kashyap
- Department of Hematology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Soniya Nityanand
- Department of Hematology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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CD26/DPP-4 in Chronic Myeloid Leukemia. Cancers (Basel) 2022; 14:cancers14040891. [PMID: 35205639 PMCID: PMC8870104 DOI: 10.3390/cancers14040891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/09/2022] [Accepted: 02/09/2022] [Indexed: 02/04/2023] Open
Abstract
CD26 expression is altered in many solid tumors and hematological malignancies. Recently, it has been demonstrated that it is a specific marker expressed on LSCs of CML, both in BM and PB samples, and absent on CD34+/CD38− stem cells in normal subjects or on LSCs of other myeloid neoplasms. CD26+ LSCs have been detected by flow-cytometry assays in all PB samples of Chronic-Phase CML patients evaluated at diagnosis. Additionally, it has been demonstrated that most CML patients undergoing Tyrosine Kinase Inhibitors (TKIs) treatment still harbored circulating measurable residual CD26+ LSCs, even when displaying a consistent deep molecular response without any significant association among the amounts of BCR-ABL transcript and CD26+ LSCs. Preliminary data of our Italian prospective multicenter study showed that CML patients with a poorer response presented with a higher number of CD26+ LSCs at diagnosis. These data confirmed that CD26 is a specific marker of CML and suggest that it could be considered for the monitoring of therapeutic responses.
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Sharma P, Sachdeva MUS, Naseem S, Sreedharanunni S, Das R, Malhotra P, Varma N. Identification of peripheral blood CD26+ leukemic stem cells has a potential role in the rapid diagnosis of chronic myeloid leukemia. Int J Lab Hematol 2022; 44:518-523. [PMID: 35142061 DOI: 10.1111/ijlh.13807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/14/2022] [Accepted: 01/27/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chronic myeloid leukemia (CML) is a hematopoietic stem cell (SC) neoplasm diagnosed by the demonstration of t(9;22)(BCR-ABL1) fusion gene. We performed a flow cytometric assay to identify CD26+ CML leukemic stem cells (LSCs) for its value as a standalone diagnostic investigation for CML and its utility for detection of residual disease in CML patients on therapy. METHODS Patients with clinical suspicion of CML/CML on follow-up were included, and peripheral (PB) and/or bone marrow (BM) samples were utilized for flow cytometric analysis. PB and/or BM of patients with diseases other than CML were used as controls. A pre-titrated antibody cocktail containing CD45, CD34, CD38, and CD26 MoABs was used. RESULTS A total of 104 samples (63 PB and 41 BM) from 64 patients [suspected CML (n = 30), CML on follow-up (n = 15), and non-CML (n = 19)] were tested. CD26+ LSCs were identified in all patients with a confirmed diagnosis of CML (median = 0.07 (range 0.002%-26.79%)). None of the patients in the control group (non-CML) and follow-up patients with negative reverse transcriptase-polymerase chain reaction (RT-PCR) results showed the presence of CD26+ LSCs. Also, there was a strong correlation between CD26+ CML LSCs in the PB and BM (r = .917). CONCLUSION Flow cytometric identification of CD26+ LSCs in the peripheral blood can be a cheap, rapid, robust, and potential diagnostic tool for the diagnosis of CML compared to available testing methods. It is irrespective of BCR-ABL1 transcript type, and its role in residual disease monitoring needs thorough investigation.
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Affiliation(s)
- Praveen Sharma
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Man Updesh Singh Sachdeva
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shano Naseem
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sreejesh Sreedharanunni
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Reena Das
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Department of Internal Medicine (Clinical Hematology Division), Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neelam Varma
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Multiparametric Flow Cytometry for MRD Monitoring in Hematologic Malignancies: Clinical Applications and New Challenges. Cancers (Basel) 2021; 13:cancers13184582. [PMID: 34572809 PMCID: PMC8470441 DOI: 10.3390/cancers13184582] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/05/2021] [Accepted: 09/08/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary In hematologic cancers, Minimal Residual Disease (MRD) monitoring, using either molecular (PCR) or immunophenotypic (MFC) diagnostics, allows the identification of rare cancer cells, readily detectable either in the bone marrow or in the peripheral blood at very low levels, far below the limit of classic microscopy. In this paper, we outlined the state-of-the-art of MFC-based MRD detection in different hematologic settings, highlighting main recommendations and new challenges for using such method in patients with acute leukemias or chronic hematologic neoplasms. The combination of new molecular technologies with advanced flow cytometry is progressively allowing clinicians to design a personalized therapeutic path, proportionate to the biological aggressiveness of the disease, in particular by using novel immunotherapies, in view of a modern decision-making process, based on precision medicine. Abstract Along with the evolution of immunophenotypic and molecular diagnostics, the assessment of Minimal Residual Disease (MRD) has progressively become a keystone in the clinical management of hematologic malignancies, enabling valuable post-therapy risk stratifications and guiding risk-adapted therapeutic approaches. However, specific prognostic values of MRD in different hematological settings, as well as its appropriate clinical uses (basically, when to measure it and how to deal with different MRD levels), still need further investigations, aiming to improve standardization and harmonization of MRD monitoring protocols and MRD-driven therapeutic strategies. Currently, MRD measurement in hematological neoplasms with bone marrow involvement is based on advanced highly sensitive methods, able to detect either specific genetic abnormalities (by PCR-based techniques and next-generation sequencing) or tumor-associated immunophenotypic profiles (by multiparametric flow cytometry, MFC). In this review, we focus on the growing clinical role for MFC-MRD diagnostics in hematological malignancies—from acute myeloid and lymphoblastic leukemias (AML, B-ALL and T-ALL) to chronic lymphocytic leukemia (CLL) and multiple myeloma (MM)—providing a comparative overview on technical aspects, clinical implications, advantages and pitfalls of MFC-MRD monitoring in different clinical settings.
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Soverini S, De Santis S, Monaldi C, Bruno S, Mancini M. Targeting Leukemic Stem Cells in Chronic Myeloid Leukemia: Is It Worth the Effort? Int J Mol Sci 2021; 22:ijms22137093. [PMID: 34209376 PMCID: PMC8269304 DOI: 10.3390/ijms22137093] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/24/2021] [Accepted: 06/24/2021] [Indexed: 02/07/2023] Open
Abstract
Chronic myeloid leukemia (CML) is a classical example of stem cell cancer since it arises in a multipotent hematopoietic stem cell upon the acquisition of the t(9;22) chromosomal translocation, that converts it into a leukemic stem cell (LSC). The resulting BCR-ABL1 fusion gene encodes a deregulated tyrosine kinase that is recognized as the disease driver. Therapy with tyrosine kinase inhibitors (TKIs) eliminates progenitor and more differentiated cells but fails to eradicate quiescent LSCs. Thus, although many patients obtain excellent responses and a proportion of them can even attempt treatment discontinuation (treatment free remission [TFR]) after some years of therapy, LSCs persist, and represent a potentially dangerous reservoir feeding relapse and hampering TFR. Over the past two decades, intensive efforts have been devoted to the characterization of CML LSCs and to the dissection of the cell-intrinsic and -extrinsic mechanisms sustaining their persistence, in an attempt to find druggable targets enabling LSC eradication. Here we provide an overview and an update on these mechanisms, focusing in particular on the most recent acquisitions. Moreover, we provide a critical appraisal of the clinical relevance and feasibility of LSC targeting in CML.
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MESH Headings
- Drug Delivery Systems
- Fusion Proteins, bcr-abl/antagonists & inhibitors
- Fusion Proteins, bcr-abl/genetics
- Fusion Proteins, bcr-abl/metabolism
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/enzymology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Neoplastic Stem Cells/enzymology
- Protein Kinase Inhibitors/therapeutic use
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Affiliation(s)
- Simona Soverini
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna, 40138 Bologna, Italy; (S.D.S.); (C.M.); (S.B.)
- Correspondence: ; Tel.: +39-051-214-3832
| | - Sara De Santis
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna, 40138 Bologna, Italy; (S.D.S.); (C.M.); (S.B.)
| | - Cecilia Monaldi
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna, 40138 Bologna, Italy; (S.D.S.); (C.M.); (S.B.)
| | - Samantha Bruno
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna, 40138 Bologna, Italy; (S.D.S.); (C.M.); (S.B.)
| | - Manuela Mancini
- Istituto di Ematologia “Seràgnoli”, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
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Ilhan O, Narli Ozdemir Z, Dalva K, Arslan A, Okay Ozgeyik M, Ipek S, Saydam G, Haznedaroglu IC. Leukemic stem cells shall be searched in the bone marrow before "tyrosine kinase inhibitor-discontinuation" in chronic myeloid leukemia. Int J Lab Hematol 2021; 43:1110-1116. [PMID: 33834631 DOI: 10.1111/ijlh.13528] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/03/2021] [Accepted: 03/09/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Leukemic stem cells (LSCs) of chronic myeloid leukemia (CML), persisting in the bone marrow (BM) niche, could be responsible for the relapses within the patients of whom the treatment-free remission (TFR) had been attempted. We assessed the presence of the CML LSCs in the peripheral blood (PB) and concurrently in the BM in the patients with chronic-phase CML (CP CML). PATIENTS AND METHODS Thirty-eight patients with CP CML were included into the study. CD45+ /CD34+ /CD38- cells with positive CD26 expression were considered as CML LSCs (CD26+ LSC) by using multiparameter flow cytometry (FCM). RESULTS Mean BCR-ABL, PB LSC, and BM LSC were 58.528 IS (37.405-83.414 IS), 237.5 LSC/μL (16-737.5 LSC/μL), and 805 LSC/106 WBCs (134.6-2470 LSC/106 WBCs), respectively, in newly diagnosed CML patients. In the patients with BCR-ABL positive hematopoiesis, mean BCR-ABL, PB LSCs, and BM LSCs were 30.09 IS (0.024-147.690 IS), 13.5 LSC/μL (0-248.7 LSC/μL) and 143.5 LSC/106 WBCs (9-455.2 LSC/106 WBCs), respectively. No CML LSCs were detected in PB of patients who achieved deep molecular response (DMR). BM LSCs of the patients who were in DMR were 281.1 LSC/106 WBCs (3.1-613.7 LSC/106 WBCs). The amount of PB LSCs was highest in patients with newly diagnosed CML (P < .001). CONCLUSION LSCs persisted in the BM of the patients with DMR, whereas there was no LSCs in the peripheral blood. The investigation of the CML LSCs in bone marrow before deciding TKI discontinuation could be justified to achieve and maintain stable TFR.
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Affiliation(s)
- Osman Ilhan
- Department of Hematology, Ankara University School of Medicine, Ankara, Turkey
| | - Zehra Narli Ozdemir
- Department of Hematology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Klara Dalva
- Department of Hematology, Ankara University School of Medicine, Ankara, Turkey
| | - Aysenur Arslan
- Department of Hematology, Ege University School of Medicine, İzmir, Turkey
| | - Mufide Okay Ozgeyik
- Department of Hematology, Ministry of Health Eskisehir City Hospital, Eskisehir, Turkey
| | - Senay Ipek
- Department of Hematology, Ankara University School of Medicine, Ankara, Turkey
| | - Guray Saydam
- Department of Hematology, Ege University School of Medicine, İzmir, Turkey
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Moffitt LR, Bilandzic M, Wilson AL, Chen Y, Gorrell MD, Oehler MK, Plebanski M, Stephens AN. Hypoxia Regulates DPP4 Expression, Proteolytic Inactivation, and Shedding from Ovarian Cancer Cells. Int J Mol Sci 2020; 21:ijms21218110. [PMID: 33143089 PMCID: PMC7672561 DOI: 10.3390/ijms21218110] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/28/2020] [Indexed: 01/03/2023] Open
Abstract
The treatment of ovarian cancer has not significantly changed in decades and it remains one of the most lethal malignancies in women. The serine protease dipeptidyl peptidase 4 (DPP4) plays key roles in metabolism and immunity, and its expression has been associated with either pro- or anti-tumour effects in multiple tumour types. In this study, we provide the first evidence that DPP4 expression and enzyme activity are uncoupled under hypoxic conditions in ovarian cancer cells. Whilst we identified strong up-regulation of DPP4 mRNA expression under hypoxic growth, the specific activity of secreted DPP4 was paradoxically decreased. Further investigation revealed matrix metalloproteinases (MMP)-dependent inactivation and proteolytic shedding of DPP4 from the cell surface, mediated by at least MMP10 and MMP13. This is the first report of uncoupled DPP4 expression and activity in ovarian cancer cells, and suggests a previously unrecognized, cell- and tissue-type-dependent mechanism for the regulation of DPP4 in solid tumours. Further studies are necessary to identify the functional consequences of DPP4 processing and its potential prognostic or therapeutic value.
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Affiliation(s)
- Laura R. Moffitt
- Department of Molecular and Translational Sciences, Monash University, Clayton, VIC 3168, Australia; (L.R.M.); (M.B.); (A.L.W.); (Y.C.)
- Centre for Cancer Research, Hudson Institute of Medical Research, Clayton, VIC 3168, Australia
| | - Maree Bilandzic
- Department of Molecular and Translational Sciences, Monash University, Clayton, VIC 3168, Australia; (L.R.M.); (M.B.); (A.L.W.); (Y.C.)
- Centre for Cancer Research, Hudson Institute of Medical Research, Clayton, VIC 3168, Australia
| | - Amy L. Wilson
- Department of Molecular and Translational Sciences, Monash University, Clayton, VIC 3168, Australia; (L.R.M.); (M.B.); (A.L.W.); (Y.C.)
- Centre for Cancer Research, Hudson Institute of Medical Research, Clayton, VIC 3168, Australia
| | - Yiqian Chen
- Department of Molecular and Translational Sciences, Monash University, Clayton, VIC 3168, Australia; (L.R.M.); (M.B.); (A.L.W.); (Y.C.)
- Centre for Cancer Research, Hudson Institute of Medical Research, Clayton, VIC 3168, Australia
| | - Mark D. Gorrell
- Centenary Institute, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia;
| | - Martin K. Oehler
- Department of Gynaecological Oncology, Royal Adelaide Hospital, Adelaide, SA 5000, Australia;
- Robinson Institute, University of Adelaide, Adelaide, SA 5000, Australia
| | - Magdalena Plebanski
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC 3082, Australia;
| | - Andrew N. Stephens
- Department of Molecular and Translational Sciences, Monash University, Clayton, VIC 3168, Australia; (L.R.M.); (M.B.); (A.L.W.); (Y.C.)
- Centre for Cancer Research, Hudson Institute of Medical Research, Clayton, VIC 3168, Australia
- Correspondence: ; Tel.: +61-3-8572-2686
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Walcher L, Kistenmacher AK, Suo H, Kitte R, Dluczek S, Strauß A, Blaudszun AR, Yevsa T, Fricke S, Kossatz-Boehlert U. Cancer Stem Cells-Origins and Biomarkers: Perspectives for Targeted Personalized Therapies. Front Immunol 2020; 11:1280. [PMID: 32849491 PMCID: PMC7426526 DOI: 10.3389/fimmu.2020.01280] [Citation(s) in RCA: 454] [Impact Index Per Article: 113.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 05/20/2020] [Indexed: 02/06/2023] Open
Abstract
The use of biomarkers in diagnosis, therapy and prognosis has gained increasing interest over the last decades. In particular, the analysis of biomarkers in cancer patients within the pre- and post-therapeutic period is required to identify several types of cells, which carry a risk for a disease progression and subsequent post-therapeutic relapse. Cancer stem cells (CSCs) are a subpopulation of tumor cells that can drive tumor initiation and can cause relapses. At the time point of tumor initiation, CSCs originate from either differentiated cells or adult tissue resident stem cells. Due to their importance, several biomarkers that characterize CSCs have been identified and correlated to diagnosis, therapy and prognosis. However, CSCs have been shown to display a high plasticity, which changes their phenotypic and functional appearance. Such changes are induced by chemo- and radiotherapeutics as well as senescent tumor cells, which cause alterations in the tumor microenvironment. Induction of senescence causes tumor shrinkage by modulating an anti-tumorigenic environment in which tumor cells undergo growth arrest and immune cells are attracted. Besides these positive effects after therapy, senescence can also have negative effects displayed post-therapeutically. These unfavorable effects can directly promote cancer stemness by increasing CSC plasticity phenotypes, by activating stemness pathways in non-CSCs, as well as by promoting senescence escape and subsequent activation of stemness pathways. At the end, all these effects can lead to tumor relapse and metastasis. This review provides an overview of the most frequently used CSC markers and their implementation as biomarkers by focussing on deadliest solid (lung, stomach, liver, breast and colorectal cancers) and hematological (acute myeloid leukemia, chronic myeloid leukemia) cancers. Furthermore, it gives examples on how the CSC markers might be influenced by therapeutics, such as chemo- and radiotherapy, and the tumor microenvironment. It points out, that it is crucial to identify and monitor residual CSCs, senescent tumor cells, and the pro-tumorigenic senescence-associated secretory phenotype in a therapy follow-up using specific biomarkers. As a future perspective, a targeted immune-mediated strategy using chimeric antigen receptor based approaches for the removal of remaining chemotherapy-resistant cells as well as CSCs in a personalized therapeutic approach are discussed.
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Affiliation(s)
- Lia Walcher
- Department of Immunology, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | - Ann-Kathrin Kistenmacher
- Department of Immunology, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | - Huizhen Suo
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Reni Kitte
- Department of Immunology, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | - Sarah Dluczek
- Department of Immunology, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | - Alexander Strauß
- Department of Immunology, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | - André-René Blaudszun
- Department of Immunology, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | - Tetyana Yevsa
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Stephan Fricke
- Department of Immunology, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | - Uta Kossatz-Boehlert
- Department of Immunology, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
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Issue Highlights - July 2019. CYTOMETRY PART B-CLINICAL CYTOMETRY 2020; 96:253-255. [PMID: 31321907 DOI: 10.1002/cyto.b.21836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Kinstrie R, Horne GA, Morrison H, Irvine D, Munje C, Castañeda EG, Moka HA, Dunn K, Cassels JE, Parry N, Clarke CJ, Scott MT, Clark RE, Holyoake TL, Wheadon H, Copland M. CD93 is expressed on chronic myeloid leukemia stem cells and identifies a quiescent population which persists after tyrosine kinase inhibitor therapy. Leukemia 2020; 34:1613-1625. [PMID: 31896780 PMCID: PMC7272220 DOI: 10.1038/s41375-019-0684-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 11/17/2019] [Accepted: 12/05/2019] [Indexed: 01/10/2023]
Abstract
The introduction of BCR-ABL tyrosine kinase inhibitors has revolutionized the treatment of chronic myeloid leukemia (CML). A major clinical aim remains the identification and elimination of low-level disease persistence, termed "minimal residual disease". The phenomenon of disease persistence suggests that despite targeted therapeutic approaches, BCR-ABL-independent mechanisms exist which sustain the survival of leukemic stem cells (LSCs). Although other markers of a primitive CML LSC population have been identified in the preclinical setting, only CD26 appears to offer clinical utility. Here we demonstrate consistent and selective expression of CD93 on a lin-CD34+CD38-CD90+ CML LSC population and show in vitro and in vivo data to suggest increased stem cell characteristics, as well as robust engraftment in patient-derived xenograft models in comparison with a CD93- CML stem/progenitor cell population, which fails to engraft. Through bulk and single-cell analyses of selected stem cell and cell survival-specific genes, we confirmed the quiescent character and demonstrate their persistence in a population of CML patient samples who demonstrate molecular relapse on TKI withdrawal. Taken together, our results identify that CD93 is consistently and selectively expressed on a lin-CD34+CD38-CD90+ CML LSC population with stem cell characteristics and may be an important indicator in determining poor TKI responders.
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Affiliation(s)
- Ross Kinstrie
- Paul O'Gorman Leukaemia Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Gillian A Horne
- Paul O'Gorman Leukaemia Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Heather Morrison
- Paul O'Gorman Leukaemia Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - David Irvine
- Paul O'Gorman Leukaemia Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Chinmay Munje
- Paul O'Gorman Leukaemia Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Eduardo Gómez Castañeda
- Paul O'Gorman Leukaemia Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Hothri A Moka
- Paul O'Gorman Leukaemia Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Karen Dunn
- Paul O'Gorman Leukaemia Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Jennifer E Cassels
- Paul O'Gorman Leukaemia Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Narissa Parry
- Paul O'Gorman Leukaemia Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Cassie J Clarke
- Paul O'Gorman Leukaemia Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Mary T Scott
- Paul O'Gorman Leukaemia Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Richard E Clark
- Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Tessa L Holyoake
- Paul O'Gorman Leukaemia Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Helen Wheadon
- Paul O'Gorman Leukaemia Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Mhairi Copland
- Paul O'Gorman Leukaemia Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK.
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Carrà G, Cartellà A, Maffeo B, Morotti A. Strategies For Targeting Chronic Myeloid Leukaemia Stem Cells. BLOOD AND LYMPHATIC CANCER-TARGETS AND THERAPY 2019; 9:45-52. [PMID: 31807112 PMCID: PMC6842740 DOI: 10.2147/blctt.s228815] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 10/19/2019] [Indexed: 02/06/2023]
Abstract
Chronic Myeloid Leukaemia is a myeloproliferative disorder driven by the t(9;22) chromosomal translocation coding for the chimeric protein BCR-ABL. CML treatment represents the paradigm of molecular therapy of cancer. Since the development of the tyrosine kinase inhibitor of the BCR-ABL kinase, the clinical approach to CML has dramatically changed, with a stunning improvement in the quality of life and response rates of patients. However, it remains clear that tyrosine kinase inhibitors (TKIs) are unable to target the most immature cellular component of CML, the CML stem cell. This review summarizes new insights into the mechanisms of resistance to TKIs.
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Affiliation(s)
- Giovanna Carrà
- Department Of Clinical And Biological Sciences, University Of Turin, Orbassano 10043, Italy
| | - Antonio Cartellà
- Department Of Clinical And Biological Sciences, University Of Turin, Orbassano 10043, Italy
| | - Beatrice Maffeo
- Department Of Clinical And Biological Sciences, University Of Turin, Orbassano 10043, Italy
| | - Alessandro Morotti
- Department Of Clinical And Biological Sciences, University Of Turin, Orbassano 10043, Italy
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23
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Bonifacio M, Stagno F, Scaffidi L, Krampera M, Di Raimondo F. Management of Chronic Myeloid Leukemia in Advanced Phase. Front Oncol 2019; 9:1132. [PMID: 31709190 PMCID: PMC6823861 DOI: 10.3389/fonc.2019.01132] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 10/10/2019] [Indexed: 12/14/2022] Open
Abstract
Management of chronic myeloid leukemia (CML) in advanced phases remains a challenge also in the era of tyrosine kinase inhibitors (TKIs) treatment. Cytogenetic clonal evolution and development of resistant mutations represent crucial events that limit the benefit of subsequent therapies in these patients. CML is diagnosed in accelerated (AP) or blast phase (BP) in <5% of patients, and the availability of effective treatments for chronic phase (CP) has dramatically reduced progressions on therapy. Due to smaller number of patients, few randomized studies are available in this setting and evidences are limited. Nevertheless, three main scenarios may be drawn: (a) patients diagnosed in AP are at higher risk of failure as compared to CP patients, but if they achieve optimal responses with frontline TKI treatment their outcome may be similarly favorable; (b) patients diagnosed in BP may be treated with TKI alone or with TKI together with conventional chemotherapy regimens, and subsequent transplant decisions should rely on kinetics of response and individual transplant risk; (c) patients in CP progressing under TKI treatment represent the most challenging population and they should be treated with alternative TKI according to the mutational profile, optional chemotherapy in BP patients, and transplant should be considered in suitable cases after return to second CP. Due to lack of validated and reliable markers to predict blast crisis and the still unsatisfactory results of treatments in this setting, prevention of progression by careful selection of frontline treatment in CP and early treatment intensification in non-optimal responders remains the main goal. Personalized evaluation of response kinetics could help in identifying patients at risk for progression.
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Affiliation(s)
| | - Fabio Stagno
- Division of Hematology With BMT, AOU Policlinico “Vittorio Emanuele”, University of Catania, Catania, Italy
| | - Luigi Scaffidi
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Mauro Krampera
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Francesco Di Raimondo
- Division of Hematology With BMT, AOU Policlinico “Vittorio Emanuele”, University of Catania, Catania, Italy
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24
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Raspadori D, Pacelli P, Sicuranza A, Abruzzese E, Iurlo A, Cattaneo D, Gozzini A, Galimberti S, Baratè C, Pregno P, Nicolosi M, Sorà F, Annunziata M, Luciano L, Caocci G, Moretti S, Sgherza N, Fozza C, Russo S, Usala E, Liberati MA, Ciofini S, Trawinska MM, Gozzetti A, Bocchia M. Flow Cytometry Assessment of CD26 + Leukemic Stem Cells in Peripheral Blood: A Simple and Rapid New Diagnostic Tool for Chronic Myeloid Leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019; 96:294-299. [PMID: 30714299 PMCID: PMC6767040 DOI: 10.1002/cyto.b.21764] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 12/18/2018] [Accepted: 01/03/2019] [Indexed: 11/17/2022]
Abstract
Background Recent investigations in chronic myeloid leukemia (CML) have focused on the identification and characterization of leukemic stem cells (LSCs). These cells reside within the CD34+/CD38─/Lin─ fraction and score positive for CD26 (dipeptidylpeptidase IV) a marker, expressed in both bone marrow (BM) and peripheral blood (PB) samples, that discriminates CML cells from normal hematopoietic stem cells (HSCs) or from LSCs of other myeloid neoplasms. CD26 evaluation could be a useful tool to improve the identification of CML LCSs by using flow‐cytometry assay. Methods CD26+ LSCs have been isolated from EDTA PB and BM samples of patients with leucocytosis suspected for CML. Analysis of LSCs CML has been performed by using custom‐made lyophilized pre‐titrated antibody mixture test and control tube and a CD45+/CD34+/CD38−/CD26+ panel as a strict flow cytometric gating strategy. Results The expression of CD26 on CD34+/CD38− population was detectable in 211/211 PB and 84/84 BM samples of subsequently confirmed BCR‐ABL+ CP‐CML patients. None of the 32 samples suspicious for CML but scoring negative for circulating CD26+ LSCs were diagnosed as CML after conventional cytogenetic and molecular testing. To validate our results, we checked for PB CD26+ LSCs in patients affected by other hematological disorders and they all scored negative for CD26 expression. Conclusions We propose flow cytometry evaluation of CD26 expression on PB CD34+/CD38− population as a new rapid, reproducible, and powerful diagnostic tool for the diagnosis of CML. © 2019 The Authors. Cytometry Part B: Clinical Cytometry published by Wiley Periodicals, Inc. on behalf of International Clinical Cytometry Society.
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Affiliation(s)
- Donatella Raspadori
- Hematology Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy.,Hematology Unit, University of Siena and Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Paola Pacelli
- Hematology Unit, University of Siena and Azienda Ospedaliera Universitaria Senese, Siena, Italy.,Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Anna Sicuranza
- Hematology Unit, University of Siena and Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | | | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Daniele Cattaneo
- Hematology Division, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Antonella Gozzini
- Hematology Unit, Careggi University Hospital (AOUC) Firenze, Florence, Italy
| | - Sara Galimberti
- Department of Hematology, Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Claudia Baratè
- Department of Hematology, Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Patrizia Pregno
- Hematology Division, Azienda Ospedaliera Città della Salute e della Scienza, Torino, Turin, Italy
| | - Maura Nicolosi
- Hematology Division, Azienda Ospedaliera Città della Salute e della Scienza, Torino, Turin, Italy
| | - Federica Sorà
- Università Cattolica del Sacro Cuore Sede di Roma, Rome, Italy
| | | | | | - Giovanni Caocci
- Hematology Unit, Department of Medical Sciences, University of Cagliari, Cagliari, Italy
| | - Sabrina Moretti
- Azienda USL Toscana Centro, Ospedale San Giovanni di Dio, Florence, Italy
| | - Nicola Sgherza
- Division of Hematology, Casa Sollievo Sofferenza, San Giovanni Rotondo, Italy
| | - Claudio Fozza
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | | | - Emilio Usala
- Hematology Unit, Ospedale Oncologico A. Businco, Cagliari, Italy
| | - Marina A Liberati
- Azienda Ospedaliera S. Maria, Division of Onco-Hematology, Terni, Italy
| | - Sara Ciofini
- Hematology Unit, University of Siena and Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | | | - Alessandro Gozzetti
- Hematology Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy.,Hematology Unit, University of Siena and Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Monica Bocchia
- Hematology Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy.,Hematology Unit, University of Siena and Azienda Ospedaliera Universitaria Senese, Siena, Italy
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