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Kaniyattu SM, Meenakshi A, Kumar MB, Kumar KR, Rao S, Shetty PD, Shetty V, Shetty JK, Shetty PK. Cytogenetic and cytokine profile in elderly patients with cytopenia. Exp Hematol 2020; 89:80-86. [PMID: 32739457 DOI: 10.1016/j.exphem.2020.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/06/2020] [Accepted: 07/26/2020] [Indexed: 10/23/2022]
Abstract
In the elderly with cytopenia, the diagnosis of myelodysplastic syndrome (MDS) may be missed. Cytokine levels contribute to the pathology of MDS. Hence, the objectives were to evaluate cytogenetic profile as a prognostic indicator in risk stratification and cytokine levels as a screening tool in patients with cytopenia for diagnosis. Over 2 years (2016-2018), 150 elderly patients were screened. MDS diagnosis was confirmed by morphology. Interleukin-2 (IL-2) and IL-6 levels were assessed in 50 patients, and karyotyping was performed in 20 confirmed cases of MDS. Age-matched healthy controls were used for comparison of cytokine levels. Among 150 patients, 88.6% had anemia, including nutritional anemia (51.2%). MDS diagnosis was confirmed in 35 patients. In 15 patients, unexplained cytopenia (UC) was present. Karyotyping in 20 MDS patients was normal in 15 (75%) patients and revealed a complex karyotype in four (20%) patients and double chromosomal abnormality in one (5%) patient. The Revised International Prognostic Scoring System (IPSS-R) scored 91% in the low-risk group and 9% (n = 3) in the high-risk group; the latter three developed acute myeloid leukemia (AML) and two of them had a 7q deletion. Among the 15 cases of UC, one patient died from refractory anemia. No significant difference in levels of IL-2 and IL-6 were found between MDS and UC patients when compared with healthy controls, as well as between different risk groups and karyotypes. A significant difference in IL-2 levels was found in MDS patients with disease progression and with stable disease. On the basis of the findings, it is suggested that IL-2 levels will help in predicting disease progression.
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Affiliation(s)
| | - Arumugam Meenakshi
- K. S. Hegde Medical Academy, Nitte (Deemed to Be University), Deralakatte, Mangaluru, India
| | - Mohana B Kumar
- K. S. Hegde Medical Academy, Nitte (Deemed to Be University), Deralakatte, Mangaluru, India
| | | | - Shama Rao
- K. S. Hegde Medical Academy, Nitte (Deemed to Be University), Deralakatte, Mangaluru, India
| | - Prashanth D Shetty
- K. S. Hegde Medical Academy, Nitte (Deemed to Be University), Deralakatte, Mangaluru, India
| | - Vijith Shetty
- K. S. Hegde Medical Academy, Nitte (Deemed to Be University), Deralakatte, Mangaluru, India
| | - Jayaprakash K Shetty
- K. S. Hegde Medical Academy, Nitte (Deemed to Be University), Deralakatte, Mangaluru, India
| | - Padma K Shetty
- K. S. Hegde Medical Academy, Nitte (Deemed to Be University), Deralakatte, Mangaluru, India.
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Aggarwal N, Swerdlow SH, TenEyck SP, Boyiadzis M, Felgar RE. Natural killer cell (NK) subsets and NK-like T-cell populations in acute myeloid leukemias and myelodysplastic syndromes. CYTOMETRY PART B-CLINICAL CYTOMETRY 2016; 90:349-57. [DOI: 10.1002/cyto.b.21349] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 09/28/2015] [Accepted: 12/01/2015] [Indexed: 11/06/2022]
Affiliation(s)
- N. Aggarwal
- Department of Pathology; University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania
| | - S. H. Swerdlow
- Department of Pathology; University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania
| | - S. P. TenEyck
- Department of Pathology; University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania
| | - M. Boyiadzis
- Department of Medicine; University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania
| | - R. E. Felgar
- Department of Pathology; University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania
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Baier C, Fino A, Sanchez C, Farnault L, Rihet P, Kahn-Perlès B, Costello RT. Natural killer cells modulation in hematological malignancies. Front Immunol 2013; 4:459. [PMID: 24391641 PMCID: PMC3867693 DOI: 10.3389/fimmu.2013.00459] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 12/02/2013] [Indexed: 12/26/2022] Open
Abstract
Hematological malignancies (HM) treatment improved over the last years resulting in increased achievement of complete or partial remission, but unfortunately high relapse rates are still observed, due to remaining minimal residual disease. Therefore, sustainment of long-term remission is crucial, using either drug maintenance treatment or by boosting or prolonging an immune response. Immune system has a key role in tumor surveillance. Nonetheless, tumor-cells evade the specific T-lymphocyte mediated immune surveillance using many mechanisms but especially by the down-regulation of the expression of HLA class I antigens. In theory, these tumor-cells lacking normal expression of HLA class I molecules should be destroyed by natural killer (NK) cells, according to the missing-self hypothesis. NK cells, at the frontier of innate and adaptive immune system, have a central role in tumor-cells surveillance as demonstrated in the setting of allogenic stem cell transplantation. Nevertheless, tumors develop various mechanisms to escape from NK innate immune pressure. Abnormal NK cytolytic functions have been described in many HM. We present here various mechanisms involved in the escape of HM from NK-cell surveillance, i.e., NK-cells quantitative and qualitative abnormalities.
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Affiliation(s)
- Céline Baier
- UMR1090 TAGC, INSERM , Marseille , France ; UMR1090 TAGC, Aix-Marseille Université , Marseille , France
| | - Aurore Fino
- UMR1090 TAGC, INSERM , Marseille , France ; UMR1090 TAGC, Aix-Marseille Université , Marseille , France
| | | | - Laure Farnault
- UMR1090 TAGC, INSERM , Marseille , France ; Service d'hématologie, APHM, Hôpital de la Conception , Marseille , France
| | - Pascal Rihet
- UMR1090 TAGC, INSERM , Marseille , France ; UMR1090 TAGC, Aix-Marseille Université , Marseille , France
| | - Brigitte Kahn-Perlès
- UMR1090 TAGC, INSERM , Marseille , France ; UMR1090 TAGC, Aix-Marseille Université , Marseille , France
| | - Régis T Costello
- UMR1090 TAGC, INSERM , Marseille , France ; UMR1090 TAGC, Aix-Marseille Université , Marseille , France ; Service d'hématologie, APHM, Hôpital de la Conception , Marseille , France
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Hematological malignancies escape from NK cell innate immune surveillance: mechanisms and therapeutic implications. Clin Dev Immunol 2012; 2012:421702. [PMID: 22899948 PMCID: PMC3415262 DOI: 10.1155/2012/421702] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 06/01/2012] [Accepted: 06/03/2012] [Indexed: 12/02/2022]
Abstract
Hematological malignancies treatment improved over the last years resulting in increased achievement of complete or partial remission, but unfortunately high relapse rates are still observed. Therefore, sustainment of long-term remission is crucial. Immune system has a key role in tumor surveillance. Natural killer (NK) cells, at the frontier of innate and adaptive immune system, have a central role in tumor cells surveillance as demonstrated in the setting of allogenic stem cell transplantation. Nevertheless, tumor cells develop various mechanisms to escape from NK cells innate immune pressure. Abnormal NK cytolytic functions have been described in nearly all hematological malignancies. We present here various mechanisms involved in the escape of hematological malignancies from NK cells surveillance: NK cells quantitative deficiency and NK cell qualitative deficiency by increased inhibition signaling or decreased activating stimuli. A challenge of immunotherapy is to restore an efficient antitumor response. A combination of classical therapy plus immune modulation strategies will soon become a standard of care for hematological malignancies.
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Sanchez CJ, Le Treut T, Boehrer A, Knoblauch B, Imbert J, Olive D, Costello RT. Natural killer cells and malignant haemopathies: a model for the interaction of cancer with innate immunity. Cancer Immunol Immunother 2011; 60:1-13. [PMID: 20697893 PMCID: PMC11029698 DOI: 10.1007/s00262-010-0898-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Accepted: 07/24/2010] [Indexed: 01/01/2023]
Abstract
Despite recent progress in the therapeutic approach of malignant haemopathies, their prognoses remain frequently poor. Immunotherapy offers an alternative of great interest in this context but defect or abnormal expression of human leukocyte antigens (HLA), frequently observed in cancer cells, limits its efficiency. Natural killer (NK) cells, which are able to kill target cells in a HLA-independent way, represent a novel tool in the treatment of haematological malignancies. Abnormal NK cytolytic function is observed in all the haematological malignancies studied, such as acute leukaemia, myelodysplastic syndromes or chronic myeloid/lymphoid leukaemia. Several mechanisms are involved in the alterations of NK cytotoxicity: decreased expression of activating receptors, increased expression of inhibitory receptors or defective expression of NK ligands on target cells. Further studies are needed to identify how each type of haematological malignancy escapes from the innate immune response. Attempts to increase the expression of activating receptors, to counteract inhibitory receptors expression, or to increase NK cell cytotoxic capacities could overcome tumour escape from innate immunity. These therapies are based on monoclonal antibodies or culture of NK cells in presence of cytokines or dendritic cells. Moreover, many novel drugs used in haematological malignancies [tyrosine kinase inhibitors, IMIDs(®), proteasome inhibitors, demethylating agents, histone deacetylase inhibitors (HDACis), histamine dihydrochloride] display interesting immunomodulatory properties that affect NK cells. These data suggest that combined modalities associating cytotoxic drugs with innate immunity modulators may represent a major breakthrough in tumour eradication.
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Affiliation(s)
- C. J. Sanchez
- Laboratoire de Biochimie et de Biologie Moléculaire, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Marseille, France
- Université de la Méditerranée, Marseille, France
- U928 Inserm, TAGC, Marseille, France
- Laboratoire d’Hématologie, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - T. Le Treut
- U928 Inserm, TAGC, Marseille, France
- Laboratoire d’Hématologie, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - A. Boehrer
- Laboratoire d’Hématologie, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - B. Knoblauch
- Laboratoire d’Hématologie, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - J. Imbert
- U928 Inserm, TAGC, Marseille, France
| | - D. Olive
- Université de la Méditerranée, Marseille, France
- Centre de Recherche en Cancérologie de Marseille, UMR891 Inserm, Marseille, France
| | - R. T. Costello
- Université de la Méditerranée, Marseille, France
- U928 Inserm, TAGC, Marseille, France
- Laboratoire d’Hématologie, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Marseille, France
- Service d’Hématologie, Hôpital La Conception, Assistance Publique des Hôpitaux de Marseille, 147 boulevard Baille, 13005 Marseille, France
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Oki Y, Kato H, Matsuo K, Kuwatsuka Y, Taji H, Yamamoto K, Kagami Y, Morishima Y. Prognostic value of serum soluble interleukin-2 receptor level in patients with diffuse large B cell lymphoma, treated with CHOP- or RCHOP-based therapy. Leuk Lymphoma 2008; 49:1345-51. [PMID: 18452099 DOI: 10.1080/10428190802108888] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The emergence of rituximab has changed the clinical outcome of patients with B-cell lymphoma, which necessitates reassessment of previously determined prognostic factors. Thus, we evaluated the prognostic significance of serum soluble interleukin-2 receptor (sIL2R) levels in patients with diffuse large B cell lymphoma (DLBCL), treated with CHOP (n = 108) or RCHOP (n = 94). Serum sIL2R level ranged from 316 to 23 800 U/mL (median 1064 U/mL) and levels were generally higher in higher IPI risk group. Multivariate analyses revealed that sIL2R > or =1000 U/mL was associated with shorter progression free survival [hazard ratio (HR) = 2.52, p = 0.011] and overall survival (HR = 2.34, p = 0.037) independent of IPI risk group or rituximab use. Further subgroup analyses revealed that the impact of sIL2R was most apparent in patients with IPI low risk, both in CHOP alone and RCHOP group. Our study confirmed the prognostic value of sIL2R in patients with DLBCL with low International Prognostic Index (IPI) risk, also in the era of rituximab.
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Affiliation(s)
- Yasuhiro Oki
- Department of Hematology and Cell Therapy, Aichi Cancer Center, Nagoya, Aichi, Japan.
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Shioi Y, Tamura H, Yokose N, Satoh C, Dan K, Ogata K. Increased apoptosis of circulating T cells in myelodysplastic syndromes. Leuk Res 2007; 31:1641-8. [PMID: 17485109 DOI: 10.1016/j.leukres.2007.03.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2006] [Revised: 03/13/2007] [Accepted: 03/21/2007] [Indexed: 11/16/2022]
Abstract
The mechanism of T cell lymphopenia in myelodysplastic syndromes (MDS) is unknown. We investigated apoptosis in freshly isolated and cultured lymphocytes; the latter were used to detect cells not yet apoptotic but destined for apoptosis. Apoptosis increased in both fresh and cultured T cells in MDS compared with those from healthy controls. Furthermore, in lymphopenic MDS patients the lymphocyte count correlated negatively with the degree of T cell apoptosis. MDS T cells showed increased Fas expression. However, in MDS but not in controls, the degree of T cell apoptosis was independent of the Fas expression level, and exogenous anti-Fas antibodies did not modulate T cell apoptosis. Mechanisms other than the Fas-Fas ligand pathway may induce T cell apoptosis in MDS.
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Affiliation(s)
- Yumiko Shioi
- Division of Hematology, Department of Medicine, Nippon Medical School, Tokyo, Japan
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Ogata K. Myelodysplastic Syndromes: Recent Progress in Diagnosis and Understanding of Their Pathophysiology. J NIPPON MED SCH 2006; 73:300-7. [PMID: 17220579 DOI: 10.1272/jnms.73.300] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Myelodysplastic syndromes (MDS) are common malignant disorders with a poor prognosis. MDS are a group of highly heterogeneous disorders but show certain universal findings including a high incidence in the elderly population, cytopenia, dysplastic myeloid cells, and frequent transformation to acute myeloid leukemia. Until recently, the vast majority of MDS patients were treated with supportive therapy alone, such as transfusions. Allogeneic stem cell transplantation (SCT) has the potential for cure, although due to the age and comorbidity of MDS patients, the role of allogeneic SCT in MDS has been limited. Recently, research in MDS has shown substantial advances that have deepened our understanding of MDS pathophysiology and changed our approach to MDS patients. This review touches on some recent developments in the diagnosis and pathophysiology of MDS.
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Affiliation(s)
- Kiyoyuki Ogata
- Division of Hematology, Department of Medicine, Nippon Medical School, Tokyo, Japan.
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Ng T, Yeghen T, Pagliuca A, Gillett DS, Mufti GJ. Non-caseating granulomata associated with hypocellular myelodysplastic syndrome. Leuk Lymphoma 2000; 39:397-403. [PMID: 11342321 DOI: 10.3109/10428190009065840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Non-caseating granuloma (NCG) remains a histopathological hallmark for sarcoidosis. Although the exact mechanism for NCG formation is unknown, the pathogenesis may involve a disordered antigen presentation in the monocyte/macrophage system, functional abnormalities in activated T-lymphocytes and uncontrolled cytokine production. Similar immunological dysfunction has been described in myelodysplastic syndrome (MDS). However, the association of NCG and MDS is rarely documented. We report a case of hypocellular MDS associated with generalized NCG. Despite treatment for both sarcoidosis and tuberculosis, the patient failed to respond. A clonal myeloid disorder which was initially suppressed by T-cell immunosurveillance evolved after treatment with anti-thymocyte globulin. Although the coexistence of sarcoidosis remains a possibility, the lack of supportive clinical evidence of sarcoidosis, the abnormal appearances of the bone marrow, together with the failure to improve on high-dose steroid favour the clonal myeloid disorder as the sole pathology.
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Affiliation(s)
- T Ng
- Department of Haematological Medicine, King's College Hospital, Denmark Hill, London SE5 9RS.
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Yokose N, Ogata K. Plasma soluble interleukin-2 receptors in patients with myelodysplastic syndromes. Leuk Lymphoma 1997; 28:171-6. [PMID: 9498716 DOI: 10.3109/10428199709058343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We examined the plasma soluble interleukin-2 receptor (sIL-2R) level in 80 subjects with myelodysplastic syndromes (MDS) and analyzed its correlation with hematologic/immunologic parameters and the subsequent clinical course. Compared with low-risk MDS (refractory anemia (RA) and RA with ringed sideroblasts) and normal individuals, the plasma sIL-2R level was significantly elevated in high-risk MDS (three other MDS subtypes and acute leukemia following MDS) patients. There was a significant negative correlation between the plasma sIL-2R level and the absolute counts of T and natural killer cells. Furthermore, the plasma sIL-2R level showed a significant positive correlation with the total cell mass and blast mass in particular, in the marrow, but not with the absolute count of IL-2Ralpha-chain-positive lymphocytes in the circulation. Fourteen of our 40 low-risk MDS subjects developed at least one of the following events during the follow-up period: erythrocyte transfusion dependence, infections requiring hospitalization, disease progression or MDS-related death. The plasma sIL-2R level was significantly higher in these patients than in event-free low-risk cases. By logistic regression analysis of various parameters in the 40 low-risk subjects, the plasma sIL-2R level was identified as a valuable independent parameter for predicting the development of events. Based on these findings, we hypothesize that the sIL-2R plays a role in the development of morbidity and mortality in MDS by inducing immunologic dysfunction.
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Affiliation(s)
- N Yokose
- Third Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
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Demeter J, Schmid M, Vargha P, Porzsolt F. Correlation of elevated plasma soluble IL-2 receptor levels with defective NK and CD8+ T-cells in myelodysplastic syndromes: is it part of a spectrum? Leuk Res 1995; 19:583-4. [PMID: 7658706 DOI: 10.1016/0145-2126(95)00021-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Affiliation(s)
- I T Whicher
- Research School of Medicine, University of Leeds, UK
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