1
|
Kokate P, Dalvi R, Koppaka N, Mandava S. Prognostic classification of MDS is improved by the inclusion of FISH panel testing with conventional cytogenetics. Cancer Genet 2017; 216-217:120-127. [PMID: 29025586 DOI: 10.1016/j.cancergen.2017.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 01/06/2017] [Accepted: 05/24/2017] [Indexed: 10/19/2022]
Abstract
Cytogenetics is a critical independent prognostic factor in myelodysplastic syndromes (MDS). Conventional cytogenetics (CC) and Fluorescence in situ hybridization (FISH) Panel Testing are extensively used for the prognostic stratification of MDS, although the FISH test is not yet a bona fide component of the International Prognostic Scoring System (IPSS). The present study compares the utility of CC and FISH to detect chromosomal anomalies and in prognostic categorization. GTG-Banding and FISH Panel Testing specifically for -5/-5q, -7/-7q, +8 and -20q was performed on whole blood or bone marrow samples from 136 patients with MDS. Chromosomal anomalies were found in 40 cases by CC, including three novel translocations. FISH identified at least one anomaly in 54/136 (39.7%) cases. More than one anomaly was found in 18/54 (33.3%) cases, therefore, overall FISH identified 75 anomalies of which 32 (42.6%) were undetected by CC. FISH provided additional information in cases with CC failure and in cases with a normal karyotype. Further, in ten cases with an abnormal karyotype, FISH could identify additional anomalies, increasing the number of abnormalities per patient. Although CC is the gold standard in the cytogenetic profiling of MDS, FISH has proven to be an asset in identifying additional abnormalities. The number of anomalies per patient can predict the prognosis in MDS and hence, FISH contributed towards prognostic re-categorization. The FISH Panel testing should be used as an adjunct to CC, irrespective of the adequacy of the number of metaphases in CC, as it improves the prognostic classification of MDS.
Collapse
Affiliation(s)
- Prajakta Kokate
- Cytogenetics division, SRL Diagnostic Ltd., Prime Square Building, Gaiwadi Industrial Estate, S.V.Road, Goregaon, Mumbai 400 062, India
| | - Rupa Dalvi
- Cytogenetics division, SRL Diagnostic Ltd., Prime Square Building, Gaiwadi Industrial Estate, S.V.Road, Goregaon, Mumbai 400 062, India
| | - Neeraja Koppaka
- Cytogenetics division, SRL Diagnostic Ltd., Prime Square Building, Gaiwadi Industrial Estate, S.V.Road, Goregaon, Mumbai 400 062, India
| | - Swarna Mandava
- Cytogenetics division, SRL Diagnostic Ltd., Prime Square Building, Gaiwadi Industrial Estate, S.V.Road, Goregaon, Mumbai 400 062, India.
| |
Collapse
|
2
|
Courville EL, Singh C, Yohe S, Linden MA, Naemi K, Berger M, Ustun C, McKenna RW, Dolan M. Patients With a History of Chemotherapy and Isolated del(20q) With Minimal Myelodysplasia Have an Indolent Course. Am J Clin Pathol 2016; 145:459-66. [PMID: 27124938 DOI: 10.1093/ajcp/aqw024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Isolated deletion (20q) is relatively common in myeloid neoplasms and has been rarely reported in cases of therapy-related myelodysplastic syndrome (MDS). Our aim was to characterize cases of isolated del(20q) in bone marrow biopsy specimens from patients with a history of chemotherapy with morphologic findings insufficient for a diagnosis of MDS. METHODS In this retrospective study from one institution, we identified 22 patients with isolated del(20q) and no or minimal dysplasia and evaluated clinical and pathologic characteristics. RESULTS Eleven of the patients had a history of chemotherapy for mostly lymphoproliferative disorders. There were no statistically significant differences in peripheral blood or bone marrow features between patients with a history of chemotherapy and those without. Three patients with a history of chemotherapy had died at last follow-up; cause of death was recurrent nonmyeloid neoplasm. None of the patients with a history of chemotherapy subsequently developed a high-grade myeloid neoplasm, whereas one of the patients who had not received prior chemotherapy developed refractory anemia with excess blasts 2. CONCLUSIONS The presence of del(20q) as an isolated bone marrow cytogenetic abnormality in the absence of morphologic findings sufficient for a diagnosis of acute myeloid leukemia, myeloproliferative neoplasm, or MDS portends an indolent clinical course, regardless of previous exposure to chemotherapy.
Collapse
Affiliation(s)
| | | | - Sophia Yohe
- From the Departments of Laboratory Medicine and Pathology
| | | | - Kaveh Naemi
- From the Departments of Laboratory Medicine and Pathology
| | - Michael Berger
- From the Departments of Laboratory Medicine and Pathology
| | | | | | - Michelle Dolan
- From the Departments of Laboratory Medicine and Pathology
| |
Collapse
|
3
|
Yin CC, Tang G, Lu G, Feng X, Keating MJ, Medeiros LJ, Abruzzo LV. Del(20q) in patients with chronic lymphocytic leukemia: a therapy-related abnormality involving lymphoid or myeloid cells. Mod Pathol 2015; 28:1130-7. [PMID: 25953391 PMCID: PMC4522203 DOI: 10.1038/modpathol.2015.58] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/13/2015] [Accepted: 03/14/2015] [Indexed: 12/16/2022]
Abstract
Deletion 20q (Del(20q)), a common cytogenetic abnormality in myeloid neoplasms, is rare in chronic lymphocytic leukemia. We report 64 patients with chronic lymphocytic leukemia and del(20q), as the sole abnormality in 40, a stemline abnormality in 21, and a secondary abnormality in 3 cases. Fluorescence in situ hybridization (FISH) analysis revealed an additional high-risk abnormality, del(11q) or del(17p), in 25/64 (39%) cases. In most cases, the leukemic cells showed atypical cytologic features, unmutated IGHV (immunoglobulin heavy-chain variable region) genes, and ZAP70 positivity. The del(20q) was detected only after chemotherapy in all 27 cases with initial karyotypes available. With a median follow-up of 90 months, 30 patients (47%) died, most as a direct consequence of chronic lymphocytic leukemia. Eight patients developed a therapy-related myeloid neoplasm, seven with a complex karyotype. Combined morphologic and FISH analysis for del(20q) performed in 12 cases without morphologic evidence of a myeloid neoplasm localized the del(20q) to the chronic lymphocytic leukemia cells in 5 (42%) cases, and to myeloid/erythroid cells in 7 (58)% cases. The del(20q) was detected in myeloid cells in all 4 cases of myelodysplastic syndrome. In aggregate, these data indicate that chronic lymphocytic leukemia with del(20q) acquired after therapy is heterogeneous. In cases with morphologic evidence of dysplasia, the del(20q) likely resides in the myeloid lineage. However, in cases without morphologic evidence of dysplasia, the del(20q) may represent clonal evolution and disease progression. Combining morphologic analysis with FISH for del(20q) or performing FISH on immunomagnetically selected sub-populations to localize the cell population with this abnormality may help guide patient management.
Collapse
Affiliation(s)
- C. Cameron Yin
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Guilin Tang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Gary Lu
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Xiaoli Feng
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Michael J. Keating
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - L. Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Lynne V. Abruzzo
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| |
Collapse
|
4
|
Di Giacomo D, Lema Fernandez AG, Pierini T, Crescenzi B, Brandimarte L, Matteucci C, Testoni N, Mecucci C. The GNAS1 gene in myelodysplastic syndromes (MDS). Leuk Res 2014; 38:804-7. [PMID: 24795070 DOI: 10.1016/j.leukres.2014.03.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 03/19/2014] [Accepted: 03/21/2014] [Indexed: 10/25/2022]
Abstract
GNAS1 gene is located at the long arm of chromosome 20 (q13.32). GNAS1 gene deletion has never been investigated in MDS. A GNAS1 activating mutation (R201) was recently found in MDS. We applied FISH and DHPLC plus sequencing to investigate GNAS1 gene in MDS cases with and without del(20q) at karyotype.
Collapse
Affiliation(s)
- Danika Di Giacomo
- Hematology and Bone Marrow Transplantation Unit, University of Perugia, Perugia, Italy
| | | | - Tiziana Pierini
- Hematology and Bone Marrow Transplantation Unit, University of Perugia, Perugia, Italy
| | - Barbara Crescenzi
- Hematology and Bone Marrow Transplantation Unit, University of Perugia, Perugia, Italy
| | - Lucia Brandimarte
- Hematology and Bone Marrow Transplantation Unit, University of Perugia, Perugia, Italy
| | - Caterina Matteucci
- Hematology and Bone Marrow Transplantation Unit, University of Perugia, Perugia, Italy
| | - Nicoletta Testoni
- Institute of Hematology and Medical Oncology "Seràgnoli", University of Bologna, Bologna, Italy
| | - Cristina Mecucci
- Hematology and Bone Marrow Transplantation Unit, University of Perugia, Perugia, Italy.
| |
Collapse
|
5
|
Pan J, Wu C, Xue Y, Qiu H, Chen S, Zhang J, Bai S, Wu Y, Wang Y, Shen J, Gong Y. The characteristics and prognostic analysis in 213 myeloid malignancy patients with del(20q): a report of a single-center case series. Cancer Genet 2014; 207:51-6. [DOI: 10.1016/j.cancergen.2014.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 02/05/2014] [Accepted: 02/06/2014] [Indexed: 11/15/2022]
|
6
|
Kitahara T, Umezu T, Ando K, Kodama A, Ohyashiki JH, Ohyashiki K. Non-random chromosomal deletion clustering at 20q in Waldenström macroglobulinemia. Hematology 2013; 16:139-42. [DOI: 10.1179/102453311x12953015767338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Toshihiko Kitahara
- First Department of Internal Medicine (Hematology Division)Tokyo Medical University, Japan
| | - Tomohiro Umezu
- First Department of Internal Medicine (Hematology Division)Tokyo Medical University, Japan
| | - Keiko Ando
- First Department of Internal Medicine (Hematology Division)Tokyo Medical University, Japan
| | - Atsushi Kodama
- Chromosome Unit, Central Laboratory, Tokyo Medical University Hospital, Japan
| | - Junko H Ohyashiki
- Institute of Medical Science (Intractable Disease Research Center)Tokyo Medical University, Japan
| | - Kazuma Ohyashiki
- First Department of Internal Medicine (Hematology Division)Tokyo Medical University, Japan
| |
Collapse
|
7
|
Padhi S, Varghese RG, Phansalkar MD, Sarangi R. Isolated deletion of the long arm of chromosome 20 [del(20q12)] in myelodysplastic syndrome: a case report and literature review. Singapore Med J 2013; 54:e185-9. [PMID: 24068064 DOI: 10.11622/smedj.2013119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Isolated deletion of the long arm of chromosome 20 [del(20q12)] is a rare abnormality in patients with de novo myelodysplastic syndrome. It is characterised by refractory thrombocytopenia, minimal haematological dysplasia and a lower risk for progression to acute myeloid leukaemia. Its distinction from chronic autoimmune thrombocytopenia, although clinically and morphologically difficult, is critical. We report a case of refractory cytopenia and unilineage dysplasia in an elderly woman with isolated del(20q12), identified via fluorescence in situ hybridisation analysis of her bone marrow. In order to avoid a misdiagnosis, we suggest that cytogenetic analysis be performed on all patients suspected to have myelodysplastic syndrome with predominant thrombocytopenic presentation.
Collapse
Affiliation(s)
- Somanath Padhi
- Pondicherry Institute of Medical Sciences, Ganapathychettykulam, Puducherry 605014, India.
| | | | | | | |
Collapse
|
8
|
White JS, Zordan A, Batzios C, Campbell LJ. Deletion(20q) as the sole abnormality in plasma cell myeloma is not associated with plasma cells as identified by cIg FISH. Cancer Genet 2012. [PMID: 23200818 DOI: 10.1016/j.cancergen.2012.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Deletion of 20q is a common finding in myeloid disorders but it is also observed in plasma cell myeloma (PCM). As a del(20q) in a patient receiving treatment for myeloma may indicate therapy-related myelodysplastic syndrome (t-MDS), it is important to differentiate chromosome abnormalities associated with myeloma from those reflecting t-MDS. We performed fluorescence in situ hybridization (FISH) using a 20q12 probe (D20S108) in conjunction with cytoplasmic immunoglobulin (cIg) staining in 20 PCM cases with a del(20q) in order to confirm the cell type involved. Of the nine cases studied with a clone showing a del(20q) as the sole abnormality, 8 of 9 demonstrated loss of the D20S108 signals in non-plasma cells only and 5 of 9 had either a confirmed myeloid malignancy in addition to PCM or showed evidence of dysplastic changes in the marrow; however, of the 11 patients with a del(20q) within a complex PCM karyotype, 4 of 11 showed loss of the D20S108 signals in plasma cells only and 7 of 11 showed no significant loss in either plasma cells or non-plasma cells. Therefore, our results indicate that a del(20q) as the sole abnormality in PCM is present in non-plasma cells and, therefore, suggests the presence of an associated myeloid malignancy.
Collapse
Affiliation(s)
- Joanne S White
- Victorian Cancer Cytogenetics Service, St. Vincent's Hospital Melbourne, Fitzroy, Australia.
| | | | | | | |
Collapse
|
9
|
Hahm C, Mun YC, Seong CM, Chung WS, Huh J. Additional genomic aberrations identified by single nucleotide polymorphism array-based karyotyping in an acute myeloid leukemia case with isolated del(20q) abnormality. Ann Lab Med 2012; 32:445-9. [PMID: 23130347 PMCID: PMC3486942 DOI: 10.3343/alm.2012.32.6.445] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 08/13/2012] [Accepted: 09/20/2012] [Indexed: 11/19/2022] Open
Abstract
Prognosis is known to be better in cases with isolated chromosomal abnormalities than in those with complex karyotypes. Accordingly, del(20q) as an isolated abnormality must be distinguished from cases in which it is associated with other chromosomal rearrangements for a better stratification of prognosis. We report a case of an isolated del(20q) abnormality with additional genomic aberrations identified using whole-genome single nucleotide polymorphism array (SNP-A)-based karyotyping. A 39-yr-old man was diagnosed with AML without maturation. Metaphase cytogenetic analysis (MC) revealed del(20)(q11.2) as the isolated abnormality in 100% of metaphase cells analyzed, and FISH analysis using D20S108 confirmed the 20q deletion in 99% of interphase cells. Using FISH, other rearrangements such as BCR/ABL1, RUNX1/RUNX1T1, PML/RARA, CBFB/MYH11, and MLL were found to be negative. SNP-A identified an additional copy neutral loss of heterozygosity (CN-LOH) in the 11q13.1-q25 region. Furthermore, SNP-A allowed for a more precise definition of the breakpoints of the 20q deletion (20q11.22-q13.31). Unexpectedly, the terminal regions showed gain on chromosome 20q. The patient did not achieve complete remission; 8 months later, he died from complications of leukemic cell infiltrations into the central nervous system. This study suggests that a presumably isolated chromosomal abnormality by MC may have additional genomic aberrations, including CN-LOH, which could be associated with a poor prognosis. SNP-A-based karyotyping may be helpful for distinguishing true isolated cases from cases in combination with additional genomic aberrations not detected by MC.
Collapse
Affiliation(s)
- Chorong Hahm
- Department of Laboratory Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | | | | | | | | |
Collapse
|
10
|
Mullier F, Daliphard S, Garand R, Dekeyser M, Cornet Y, Luquet I, Talmant P, Richebourg S, Jamar M, Dogné JM, Chatelain C, Michaux L, Chatelain B. Morphology, cytogenetics, and survival in myelodysplasia with del(20q) or ider(20q): a multicenter study. Ann Hematol 2011; 91:203-13. [PMID: 21744002 DOI: 10.1007/s00277-011-1286-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 06/16/2011] [Indexed: 10/18/2022]
Abstract
Isochromosome of the long arm of chromosome 20 with interstitial loss of material [ider(20q)] is a rare cytogenetic abnormality reported in myelodysplastic syndrome (MDS), with neither specific morphological pattern nor clear prognostic significance. The aim of this retrospective multicentric study is to compare the peripheral blood and bone marrow morphology of MDS patients with ider(20q) (n = 13) and del(20q) (n = 21) and controls (n = 47) in order to investigate whether the ider(20q) harbors specific morphological features. The secondary objective is to compare the outcome of patients from both groups. This study performed on the largest cohort of MDS patients with ider(20q) is the first that identifies specific morphological features (hypogranulated and vacuolized neutrophils and neutrophil erythrophagocytosis) allowing the identification of this cytogenetic abnormality with high sensitivity (70%) and specificity (85.7%). Suspected ider(20q) by morphology should therefore support targeted FISH tests in case of non informative karyotype. This combined approach will allow a better estimation of the prevalence of this underdiagnozed entity. The overall survival and progression-free survival did not statistically differ in both groups. However, hypogranulated and vacuolized neutrophils were significantly associated with survival.
Collapse
Affiliation(s)
- François Mullier
- Laboratory of Hematology, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for LIfe Sciences (NARILIS), UCL Mont-Godinne, Avenue Gaston Therasse 1, 5530, Yvoir, Belgium.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Huh J, Tiu RV, Gondek LP, O'Keefe CL, Jasek M, Makishima H, Jankowska AM, Jiang Y, Verma A, Theil KS, McDevitt MA, Maciejewski JP. Characterization of chromosome arm 20q abnormalities in myeloid malignancies using genome-wide single nucleotide polymorphism array analysis. Genes Chromosomes Cancer 2010; 49:390-9. [PMID: 20095039 DOI: 10.1002/gcc.20748] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Deletion of the long arm of chromosome 20 is a common abnormality associated with myeloid malignancies. We characterized abnormalities of chromosome 20 as defined by metaphase cytogenetics (MC) in patients with myeloid neoplasms to define commonly deleted regions (CDR) and commonly retained regions (CRR) using genome-wide, high resolution single nucleotide polymorphism array (SNP-A) analysis. We reviewed the MC results of a cohort of 1,162 patients with myeloid malignancies, including myelodysplastic syndromes (MDS), MDS/myeloproliferative neoplasia (MDS/MPN), and acute myeloid leukemia (AML). We further analyzed a subcohort of 532 patients by SNP-A using the Affymetrix Genome-Wide Human SNP Array 6.0 and GeneChip Human Mapping 250K Nsp arrays. By MC, 5% (54/1,162) harbored a deletion of 20q; in 30% (16/54), del(20q) was the sole cytogenetic abnormality. By SNP-A analysis, we identified del(20q) in 23 patients, 3 not detected by MC. In four cases, monosomy 20 with a marker chromosome by MC was proven to be an interstitial deletion of 20q by SNP-A. We defined 2 CDR and 2 CRR on chromosome arm 20q: CDR1 spanned 2.5 Mb between bands 20q11.23 and 20q12, while CDR2 encompassed 1.8 Mb within 20q13.12. CRR1 spanned 1.9 Mb within 20q11.21 and CRR2 encompassed 2.5 Mb within 20q13.33. In contrast to other chromosomes frequently affected by deletions, no somatic copy neutral loss of heterozygosity (CN-LOH) was detected. Our data suggest that SNP-A is useful for the detection of cryptic aberrations of chromosome 20q and allows for a more precise characterization of complex karyotypes. Furthermore, SNP-A allowed definition of a CDR on 20q.
Collapse
Affiliation(s)
- Jungwon Huh
- Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Cytogenetic evolution correlates with poor prognosis in myelodysplastic syndrome. ACTA ACUST UNITED AC 2010; 196:159-66. [PMID: 20082852 DOI: 10.1016/j.cancergencyto.2009.09.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Revised: 09/04/2009] [Accepted: 09/13/2009] [Indexed: 11/21/2022]
Abstract
Clonal chromosomal abnormalities are observed in 30-50% of primary myelodysplastic syndrome (MDS) patients. Although the prognostic relevance of cytogenetics is generally appreciated, the prognostic value of cytogenetic evolution has rarely been evaluated. In this study, we retrospectively analyzed cytogenetic features at diagnosis and during follow-up in 85 patients with primary MDS. Cytogenetic evolution occurred in 18 of the 85 patients (21%), with chromosomes 8, 5, and 1 most often involved. Patients with higher levels of marrow blasts (P = 0.034), more advanced stages of World Health Organization (WHO) subtypes (44% vs. 16%, P = 0.035), and higher risk International Prognostic Scoring System (IPSS) subgroups (47% vs. 16%, P = 0.021) had higher incidences of developing cytogenetic evolution. Furthermore, the median survival of patients in the group with cytogenetic evolution was 25.8 months, compared with 45.4 months for patients in the group without cytogenetic evolution (P = 0.01). The same result was also found for time to progression: patients with cytogenetic evolution progressed more rapidly than those without cytogenetic evolution (P = 0.007). Knowledge of cytogenetic evolution offers useful information for clinicians to make more accurate prognostic assessments for patients with MDS.
Collapse
|
13
|
Bacher U, Haferlach C, Kröger N, Schnittger S, Kern W, Wiedemann B, Zander AR, Haferlach T. Diagnostic tools in the indications for allogeneic stem cell transplantation in myelodysplastic syndromes. Biol Blood Marrow Transplant 2009; 16:1-11. [PMID: 20053328 DOI: 10.1016/j.bbmt.2009.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Accepted: 08/10/2009] [Indexed: 11/18/2022]
Abstract
The rates of allogeneic stem cell transplantation (SCT) to treat the myelodysplastic syndromes (MDS) is continually increasing. However, given the growing arsenal of therapeutic options in parallel to deeper insight into the heterogeneity of this disorder, determining the indications for SCT in MDS remains a difficult task. The International Prognostic Scoring System (IPSS) serves as a guideline for therapeutic decisions, but many aspects (eg, interpretation of rare cytogenetic abnormalities, combinations of chromosomal alterations and/or molecular markers, variant clinical courses within distinct biological subgroups) remain the subject of continuous investigation. In an effort to achieve a more well-differentiated risk categorization, attempts have been made to perform a more detailed cytogenetic categorization, and the use of various fluorescein in situ hybridization (FISH) techniques has improved the description of aberrations. Multicenter initiatives have standardized multiparameter flow cytometry techniques for diagnosis of MDS. In advanced MDS, screening for molecular mutations can identify cases with a high transformation risk. Finally, the new World Health Organization classification system provides a more homogenous morphological categorization of MDS compared with the former French-American-British system. Consequently, in the near future, risk stratification in MDS might incorporate additional diagnostic tools and categorization systems aimed at improving the timing and indication for SCT in this complex disorder.
Collapse
Affiliation(s)
- Ulrike Bacher
- Interdisciplinary Clinic for Stem Cell Transplantation, University Cancer Center Hamburg, Hamburg, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Huang HH, Zhu JY, Han JY, Shen LJ, Xu L, Chen XL, Zheng LY, Chen FY. Co-existent de novo myelodysplastic syndrome and T-cell non-Hodgkin lymphoma: a common origin or not? J Int Med Res 2009; 37:270-6. [PMID: 19215701 DOI: 10.1177/147323000903700134] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The co-existence of de novo myelodysplastic syndrome (MDS) and non-Hodgkin lymphoma (NHL) prior to therapy is an extremely unusual finding. We report here a case of co-existent de novo MDS-refractory cytopenia with multilineage dysplasia and T-cell NHL, including clinical features, histopathological findings, molecular assessment, treatment course and outcomes. Other cases from the literature showing co-existence of both disorders are also reviewed; to date 19 similar cases have been reported. Among all cases (including the present patient), eight cases were diagnosed with de novo MDS and NHL simultaneously, which were considered to be true coincidences. The mechanisms responsible for the appearance of co-existence have not yet been ascertained, however in the present case a common chromosomal abnormality (20q deletion) was found in bone marrow and lymph node preparations. We conclude, therefore, that the co-existent de novo MDS and T-cell NHL seen in the present case may have a common origin.
Collapse
Affiliation(s)
- H-H Huang
- Department of Haematology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Silveira CGT, Oliveira FM, Valera ET, Ikoma MRV, Borgonovo T, Cavalli IJ, Tone LG, Rogatto SR. New recurrent deletions in the PPARgamma and TP53 genes are associated with childhood myelodysplastic syndrome. Leuk Res 2008; 33:19-27. [PMID: 18789822 DOI: 10.1016/j.leukres.2008.07.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2007] [Revised: 07/04/2008] [Accepted: 07/05/2008] [Indexed: 11/26/2022]
Abstract
Myelodysplastic syndrome (MDS) is a rare hematological malignancy in children. It was performed FISH analysis in 19 pediatric MDS patients to investigate deletions involving the PPARgamma and TP53 genes. Significant losses in the PPARgamma gene and deletions in the tumor suppressor gene TP53 were observed in 17 and 18 cases, respectively. Using quantitative RT-PCR, it was detected PPARgamma transcript downexpression in a subset of these cases. G-banding analysis revealed 17p deletions in a small number of these cases. One MDS therapy-related patient had neither a loss of PPARgamma nor TP53. These data suggest that the PPARgamma and TP53 genes may be candidates for molecular markers in pediatric MDS, and that these potentially recurrent deletions could contribute to the identification of therapeutic approaches in primary pediatric MDS.
Collapse
Affiliation(s)
- Cássia G T Silveira
- Department of Genetics, Institute of Biosciences, Sao Paulo State University-UNESP, Botucatu, Sao Paulo, Brazil
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Burgess DJ, Doles J, Zender L, Xue W, Ma B, McCombie WR, Hannon GJ, Lowe SW, Hemann MT. Topoisomerase levels determine chemotherapy response in vitro and in vivo. Proc Natl Acad Sci U S A 2008; 114:689-94. [PMID: 18574145 DOI: 10.3171/2010.2.jns09719] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Topoisomerase poisons are chemotherapeutic agents that are used extensively for treating human malignancies. These drugs can be highly effective, yet tumors are frequently refractory to treatment or become resistant upon tumor relapse. Using a pool-based RNAi screening approach and a well characterized mouse model of lymphoma, we explored the genetic basis for heterogeneous responses to topoisomerase poisons in vitro and in vivo. These experiments identified Top2A expression levels as major determinants of response to the topoisomerase 2 poison doxorubicin and showed that suppression of Top2A produces resistance to doxorubicin in vitro and in vivo. Analogously, using a targeted RNAi approach, we demonstrated that suppression of Top1 produces resistance to the topoisomerase 1 poison camptothecin yet hypersensitizes cancer cells to doxorubicin. Importantly, lymphomas relapsing after treatment display spontaneous changes in topoisomerase levels as predicted by in vitro gene knockdown studies. These results highlight the utility of pooled shRNA screens for identifying genetic determinants of chemotherapy response and suggest strategies for improving the effectiveness of topoisomerase poisons in the clinic.
Collapse
Affiliation(s)
- Darren J Burgess
- Cold Spring Harbor Laboratory and Howard Hughes Medical Institute, 1 Bungtown Road, Cold Spring Harbor, NY 11724, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Topoisomerase levels determine chemotherapy response in vitro and in vivo. Proc Natl Acad Sci U S A 2008; 105:9053-8. [PMID: 18574145 DOI: 10.1073/pnas.0803513105] [Citation(s) in RCA: 238] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Topoisomerase poisons are chemotherapeutic agents that are used extensively for treating human malignancies. These drugs can be highly effective, yet tumors are frequently refractory to treatment or become resistant upon tumor relapse. Using a pool-based RNAi screening approach and a well characterized mouse model of lymphoma, we explored the genetic basis for heterogeneous responses to topoisomerase poisons in vitro and in vivo. These experiments identified Top2A expression levels as major determinants of response to the topoisomerase 2 poison doxorubicin and showed that suppression of Top2A produces resistance to doxorubicin in vitro and in vivo. Analogously, using a targeted RNAi approach, we demonstrated that suppression of Top1 produces resistance to the topoisomerase 1 poison camptothecin yet hypersensitizes cancer cells to doxorubicin. Importantly, lymphomas relapsing after treatment display spontaneous changes in topoisomerase levels as predicted by in vitro gene knockdown studies. These results highlight the utility of pooled shRNA screens for identifying genetic determinants of chemotherapy response and suggest strategies for improving the effectiveness of topoisomerase poisons in the clinic.
Collapse
|
18
|
Douet-Guilbert N, Basinko A, Morel F, Le Bris MJ, Ugo V, Morice P, Berthou C, De Braekeleer M. Chromosome 20 deletions in myelodysplastic syndromes and Philadelphia-chromosome-negative myeloproliferative disorders: characterization by molecular cytogenetics of commonly deleted and retained regions. Ann Hematol 2008; 87:537-44. [DOI: 10.1007/s00277-008-0462-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2007] [Accepted: 02/04/2008] [Indexed: 11/28/2022]
|
19
|
Sreekantaiah C. FISH panels for hematologic malignancies. Cytogenet Genome Res 2007; 118:284-96. [DOI: 10.1159/000108312] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Accepted: 06/18/2007] [Indexed: 11/19/2022] Open
|
20
|
Galili N, Cerny J, Raza A. Current Treatment Options: Impact of Cytogenetics on the Course of Myelodysplasia. Curr Treat Options Oncol 2007; 8:117-28. [PMID: 17634837 DOI: 10.1007/s11864-007-0017-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The heterogeneity of myelodysplastic syndromes (MDS) has driven the search for unifying biologic and clinical features that would stratify patients into distinct prognostic and therapeutic subgroups. Cytogenetics has been shown to impact the course of myelodysplasia. Despite the presence of non-random cytogenetic abnormalities in approximately 50% of MDS patients, it is significant that only a proportion of metaphases may contain the abnormality. Clonality studies however show that the karyotypically normal metaphases are still part of the MDS clone. This would suggest that the chromosomal abnormality may not be the initiating lesion in MDS, and that the gross karyotypic changes represent clonal evolution in a genetically unstable population. Yet, as will be described below, specific cytogenetic abnormalities are associated with clinically and biologically distinct forms of the disease, most notable in the response of del(5q) patients to lenalidomide. One possible explanation for the appearance of non-random mutational events could relate to the interaction of MDS cells with their microenvironment. Whatever the initiating lesion in the MDS stem cell, the end result is a clonal expansion where the marrow becomes populated by the monoclonal progeny of this cell. Interaction of these cells with a microenvironment which has been shown to be rich in pro-apoptotic cytokines such as tumor necrosis factor alpha (TNFa), leads to increased genetic instability. Hypoxia mediated decrease in DNA repair enzymes could further accelerate mutational events culminating in accumulation of multiple chromosomal abnormalities. Some of these chromosomal changes are associated with increased sensitivity to specific drugs. Lenalidomide has shown a high degree of efficacy in MDS patients with del(5q), although the target for the drug is unknown since a small but significant subset of MDS patients without del(5q) abnormality also respond to the drug. In contrast, the molecular target for imatinib mesylate is known; mutations in tyrosine kinase receptor family of genes found in patients with t(5;12) and del(4q12) make these individuals sensitive to the drug. Patients with isolated trisomy 8 have an immune component to the disease phenotype which can be targeted by cyclosporine and or anti-thymocyte globulin (ATG), especially in the presence of a PNH (paroxysmal nocturnal hemoglobinurea) clone. In the absence of these specific cytogenetic abnormalities described above, the two FDA approved hypomethylating agents 5 azacytidine and decitabine should be considered as therapeutic alternatives.
Collapse
Affiliation(s)
- Naomi Galili
- Radhey Khanna MDS Center, Division of Hematology, University of Massachusetts Medical Center, 364 Plantation Street, Worcester, MA 01605, USA
| | | | | |
Collapse
|
21
|
Panani AD. Cytogenetic and molecular aspects of Philadelphia negative chronic myeloproliferative disorders: clinical implications. Cancer Lett 2007; 255:12-25. [PMID: 17383090 DOI: 10.1016/j.canlet.2007.02.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2007] [Revised: 02/12/2007] [Accepted: 02/13/2007] [Indexed: 12/25/2022]
Abstract
Chronic myeloproliferative disorders (CMPD) are clonal disorders of the hematopoietic stem cell. The myeloid lineage shows increased proliferation with effective maturation, while peripheral leukocytosis, thrombocytosis or elevated red blood cell mass are found. In Philadelphia negative CMPD recurrent cytogenetic abnormalities occur, but no specific abnormality has been defined to date. The spectrum of cytogenetic aberrations is heterogeneous ranging from numerical gains and losses to structural changes including unbalanced translocations. The most common chromosomal abnormalities are 20q-, 13q-, 12p-, +8, +9, partial duplication of 1q, balanced translocations involving 8p11 and gains in 9p. Cytogenetic analysis of CMPD by conventional or molecular techniques has an important role in establishing the diagnosis of a malignant disease, adding also more information for disease outcome. Molecular studies may detect the possible role of candidate genes implicated in the neoplastic process, addressing new molecular target therapies. FIP1L1/PDGFRalpha rearrangements, as well as alterations of PDGFRbeta or FGFR1 gene have been found to be associated with specific types of CMPD. Recently, a novel somatic mutation, JAK2V617F, has been reported in most of the polycthemia vera (PV) patients, as well as in a lower percentage in essential thrombocythemia (ET) or idiopathic myelofibrosis (IMF) patients. This finding represents the most important advance in understanding of the molecular mechanisms underlined the pathogenesis of CMPD, contributing to the classification and management of patients.
Collapse
Affiliation(s)
- Anna D Panani
- Critical Care Department, Research Unit, Medical School of Athens University, Evangelismos Hospital, Ipsilandou 45-47, Athens, Greece.
| |
Collapse
|
22
|
Galanopoulos AG, Symeonidis A, Kourakli A, Papadaki EA, Tsaftaridis P, Terpos E, Aktipi A, Roussou P, Protopappa M, Pappaioannou M, Zikos P, Speletas M, Parcharidou A, Laoutaris N, Anagnostopoulos NI, Meletis J, Pangalis GA, Zoumbos N, Viniou N. Prognostic significance of deletion of the long arm of chromosome 20 in patients with myelodysplastic syndrome (MDS): a study of the Greek MDS Study Group. Eur J Haematol 2007; 78:89-90. [PMID: 17302860 DOI: 10.1111/j.1600-0609.2006.00764.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
23
|
Liu YC, Ito Y, Hsiao HH, Sashida G, Kodama A, Ohyashiki JH, Ohyashiki K. Risk factor analysis in myelodysplastic syndrome patients with del(20q): prognosis revisited. ACTA ACUST UNITED AC 2006; 171:9-16. [PMID: 17074585 DOI: 10.1016/j.cancergencyto.2006.06.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2006] [Revised: 06/06/2006] [Accepted: 06/08/2006] [Indexed: 11/20/2022]
Abstract
The deletion of the long arm of chromosome 20, or del(20q), is a common cytogenetic abnormality in various myeloid disorders and is known to be a favorable prognostic factor in myelodysplastic syndromes (MDS) when it is the sole change. However, del(20q) occurs with one or more cytogenetic changes when it is associated with disease progression. Here, we analyzed 33 patients with MDS and del(20q) to ascertain the risk factors in MDS. We categorized del(20q) into two groups: one with the del(20q) clone (> or =50% marrow metaphases), corresponding to genomic integrity, and the other with a late appearance of a minor del(20q) clone (<50% metaphases) with additional cytogenetic changes, representing genomic instability. Of the MDS patients with del(20q) at initial presentation, the negative factors in predicting prognosis on survival are (i) INT-2/High risk according to the International Prognostic Scoring System, (ii) any additional cytogenetic changes, or (iii) minor del(20q) clone. The late appearance of del(20q) at any phase is linked to a significantly unfavorable prognosis, thus indicating the clinical and biological heterogeneity of del(20q) in MDS.
Collapse
Affiliation(s)
- Yi-Chang Liu
- First Department of Internal Medicine, Hematology/Oncology Division, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Tokyo, Japan
| | | | | | | | | | | | | |
Collapse
|
24
|
Brozova M, Kleibl Z, Netikova I, Sevcik J, Scholzova E, Brezinova J, Chaloupkova A, Vesely P, Dundr P, Zadinova M, Krasna L, Matouskova E. Establishment, growth and in vivo differentiation of a new clonal human cell line, EM-G3, derived from breast cancer progenitors. Breast Cancer Res Treat 2006; 103:247-57. [PMID: 17063277 DOI: 10.1007/s10549-006-9358-x] [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] [Received: 04/13/2006] [Accepted: 07/31/2006] [Indexed: 11/27/2022]
Abstract
A new clonal cell line, EM-G3, was derived from a primary lesion of human infiltrating ductal breast carcinoma. The line consisted of cuboidal cells with occasional appearance of more differentiated branched cells apparently involved in cell-to-cell communication. The EM-G3 cells, population doubling time 34 h, are dependent on the epidermal growth factor. Multicolor fluorescence in situ hybridization (mFISH) analysis demonstrated a stable diploid genome with several genetic changes. Immunocytochemical analysis of EM-G3 in vitro revealed positivity for keratins (K) K5, K14, K18, nuclear protein p63, epithelial membrane antigen (EMA) and other proteins indicative of a pattern of mammary epithelium bipotent progenitors. Detection of integrins alpha-6, beta-1, and protein CD44 by cDNA array also pointed to the character of basal/stem cells. In contrast, dominant cells in the human original tumor showed the luminal character (K18+, K19+, K5-, K14-, and p63-). However, cells with the immunocytochemical profile similar to that of cultured EM-G3 cells were found in minor clusters in the patient's tumor sections. The EM-G3 cells formed limited tumors in nu/nu mice. The cells in mouse tumors were organized in primitive ductal-like structures consisting of 1-3 large central luminal-like cells (EMA+) surrounded by peripheral myoepithelial-like cells (p63+/EMA-). The large central cells gradually disintegrated, forming a pseudolumen. Apparently, EM-G3 cells are able to partially differentiate in vivo as well as in vitro. Our results indicate that EM-G3 cells were derived from a premalignant population of common progenitors of luminal and myoepithelial cells that were immortalized in an early stage of tumorigenesis.
Collapse
Affiliation(s)
- Marketa Brozova
- Department of Cell Biology, Institute of Molecular Genetics, Academy of Sciences of the Czech Republic, Flemingovo nam. 2, Prague 6, Czech Republic
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Galili NB, Mehdi M, Mumtaz M, Miron P, Woda B, Al-Homsi S, Westervelt P, Raza A. Can molecular profiling of cytogenetic subgroups draw a roadmap for individualizing therapy in myelodysplastic syndromes? Future Oncol 2006; 2:407-15. [PMID: 16787120 DOI: 10.2217/14796694.2.3.407] [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: 11/21/2022] Open
Abstract
Therapeutic options for the heterogeneous hematopoietic disorders grouped under the myelodysplastic syndromes (MDS) have been difficult to develop, even though the incidence of this disease is increasing because of the ageing population. Several drugs have now been shown to have therapeutic efficacy in subgroups of patients, but the main challenge is still the preselection of the patient for a given strategy. To state the problem simply, effective therapies may already exist for a substantial number of MDS patients, but we do not know how to match the right drug to the right patient. Cytogenetic abnormalities have provided some treatment guidance, however these are generally restricted to patients known to have a better prognosis. To develop reliable predictive assays in patients with complex or more advanced diseases, we will have to delve deeper than cytogenetics. This review summarizes what is known about the clinical and biological characteristics of various karyotypic subgroups of MDS, and proposes a roadmap for combining the bedside-to-bench approach with the use of DNA microarray analysis in developing expression profiles that can serve as a guide in the preselection of treatment options for individual MDS patients.
Collapse
Affiliation(s)
- Naomi Bruce Galili
- The Radhey Khanna Center for MDS Research, Division of Hematology, University of Massachusetts Medical Center, 364 Plantation Street, MA 01605, USA
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Current Awareness in Hematological Oncology. Hematol Oncol 2005. [DOI: 10.1002/hon.731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|