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Sayed NH, Hammad M, Abdelrahman SA, Abdelgawad HM. Association of long non-coding RNAs and ABO blood groups with acute lymphoblastic leukemia in Egyptian children. Noncoding RNA Res 2024; 9:307-317. [PMID: 38505304 PMCID: PMC10945145 DOI: 10.1016/j.ncrna.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/26/2023] [Accepted: 01/14/2024] [Indexed: 03/21/2024] Open
Abstract
Acute lymphoblastic leukemia (ALL) is the most prevailing cancer among children. Despite extensive studies, ALL etiology is still an unsolved puzzle. Long non-coding RNAs (lncRNAs) emerged as key mediators in cancer etiology. Several lncRNAs are dysregulated in ALL, leading to oncogenic or tumor-suppressive activities. Additionally, a relation between ABO blood groups and hematological malignancies was proposed. The current study intended to explore the association of lncRNAs, ANRIL and LINC-PINT, and their downstream targets, CDKN2A and heme oxygenase-1 (HMOX1), with the incidence of ALL and treatment response, and to determine the distribution of blood groups across different childhood ALL phenotypes. Blood samples were taken from 66 ALL patients (at diagnosis and at the end of remission induction phase) and 39 healthy children. Whole blood was used for blood group typing. Expression of ANRIL, LINC-PINT and CDKN2A was analyzed in plasma by qRT-PCR. Serum HMOX1 was measured using ELISA. ANRIL and CDKN2A were upregulated, while LINC-PINT and HMOX1 were downregulated in newly diagnosed patients. All of which showed remarkable diagnostic performance, where HMOX1 was superior. HMOX1 was independent predictor of ALL as well. LINC-PINT and HMOX1 were significantly upregulated after treatment. Notably, ANRIL and LINC-PINT were associated with poor outcome. No significant difference in the distribution of ABO blood groups was observed between patients and controls. In conclusion, our results suggested an association of ANRIL and LINC-PINT with childhood ALL predisposition, at least in part, through altering CDKN2A and HMOX1 production. Furthermore, the impact of remission induction treatment was newly revealed.
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Affiliation(s)
- Noha H. Sayed
- Biochemistry Department, Faculty of Pharmacy, Cairo University, Egypt
| | - Mahmoud Hammad
- Pediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
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2
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Antigen Receptors Gene Analysis for Minimal Residual Disease Detection in Acute Lymphoblastic Leukemia: The Role of High Throughput Sequencing. HEMATO 2023. [DOI: 10.3390/hemato4010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The prognosis of adult acute lymphoblastic leukemia (ALL) is variable but more often dismal. Indeed, its clinical management is challenging, current therapies inducing complete remission in 65–90% of cases, but only 30–40% of patients being cured. The major determinant of treatment failure is relapse; consequently, measurement of residual leukemic blast (minimal residual disease, MRD) has become a powerful independent prognostic indicator in adults. Numerous evidences have also supported the clinical relevance of MRD assessment for risk class assignment and treatment selection. MRD can be virtually evaluated in all ALL patients using different technologies, such as polymerase chain reaction amplification of fusion transcripts and clonal rearrangements of antigen receptor genes, flow cytometric study of leukemic immunophenotypes and, the most recent, high throughput sequencing (HTS). In this review, the authors focused on the latest developments on MRD monitoring with emphasis on the use of HTS, as well as on the clinical impact of MRD monitoring.
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3
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Singh K, Tiwari D, Boddu R, Somasundarum V, Mishra K. Hematogones: The Supreme Mimicker and a Cytomorphological Confounder in Acute Lymphoblastic Leukemia. J Lab Physicians 2022. [DOI: 10.1055/s-0042-1757586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Abstract
Objective B-lymphocyte progenitors, namely the hematogones (HGs), may pose problems in morphological assessment of bone marrow, not only during the diagnostic workup but also while evaluating bone marrow for remission status following chemotherapy. Here, we describe a series of 12 cases of acute lymphoblastic leukemia (ALL) that included both B-ALL and T-ALL cases, which were evaluated for remission status and revealed blast-like mononuclear cells in bone marrow in the range of 6 to 26%, which on immunophenotypic analysis turned out to be HGs.
Materials and Methods This is a case series of 12 ALL cases who were undergoing treatment at the Army Hospital (Referral and Research), New Delhi. All these cases were under workup for post-induction status (day 28) and to check for suspected ALL relapse. Bone marrow aspirate (BMA), biopsy, and immunophenotyping were performed. Multicolored flow cytometry was performed using CD10, CD20, CD22, CD34, CD19, and CD38 antibodies panel.
Results BMA assessment of 12 cases revealed a maximum of 26% blastoid cells and a minimum of up to 6%, raising the suspicion of hematological relapse. However, on clinical assessment, these patients were well preserved, with preserved peripheral counts. Hence, marrow aspirates were subjected to flow cytometry using the CD markers panel, as discussed above, which revealed HGs. These cases were followed by minimal residual disease (MRD) analysis that revealed MRD-negative status, further confirming our findings.
Conclusion This case series highlights the importance of morphology and bone marrow immunophenotyping in unveiling the diagnostic dilemma in post-induction ALL patients.
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Affiliation(s)
- Kanwaljeet Singh
- Department of Laboratory Sciences and Molecular Medicine, Army Hospital (R&R), Delhi Cantt, Delhi, India
| | - Dwarika Tiwari
- Department of Laboratory Sciences and Molecular Medicine, Army Hospital (R&R), Delhi Cantt, Delhi, India
| | - Revanth Boddu
- Department of Laboratory Sciences and Molecular Medicine, Army Hospital (R&R), Delhi Cantt, Delhi, India
| | - Venkatesan Somasundarum
- Department of Laboratory Sciences and Molecular Medicine, Army Hospital (R&R), Delhi Cantt, Delhi, India
| | - Kundan Mishra
- Department of Laboratory Sciences and Molecular Medicine, Army Hospital (R&R), Delhi Cantt, Delhi, India
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4
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Yurttaş NÖ, Eşkazan AE. Clinical Application of Biomarkers for Hematologic Malignancies. Biomark Med 2022. [DOI: 10.2174/9789815040463122010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Over the last decade, significant advancements have been made in the
molecular mechanisms, diagnostic methods, prognostication, and treatment options in
hematologic malignancies. As the treatment landscape continues to expand,
personalized treatment is much more important.
With the development of new technologies, more sensitive evaluation of residual
disease using flow cytometry and next generation sequencing is possible nowadays.
Although some conventional biomarkers preserve their significance, novel potential
biomarkers accurately detect the mutational landscape of different cancers, and also,
serve as prognostic and predictive biomarkers, which can be used in evaluating therapy
responses and relapses. It is likely that we will be able to offer a more targeted and
risk-adapted therapeutic approach to patients with hematologic malignancies guided by
these potential biomarkers. This chapter summarizes the biomarkers used (or proposed
to be used) in the diagnosis and/or monitoring of hematologic neoplasms.;
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Affiliation(s)
- Nurgül Özgür Yurttaş
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine,
Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ahmet Emre Eşkazan
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine,
Istanbul University-Cerrahpasa, Istanbul, Turkey
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5
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Bartram J, Wright G, Adams S, Archer P, Brooks T, Edwards D, Hancock J, Knecht H, Inglott S, Mountjoy E, Roynane M, Wakeman S, Moppett J, Hubank M, Goulden N. High-throughput sequencing of peripheral blood for minimal residual disease monitoring in childhood precursor B-cell acute lymphoblastic leukemia: A prospective feasibility study. Pediatr Blood Cancer 2022; 69:e29513. [PMID: 34971078 DOI: 10.1002/pbc.29513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/28/2021] [Accepted: 11/20/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Minimal residual disease (MRD) measured on end-of-induction bone marrow (BM) is the most important biomarker for guiding therapy in pediatric acute lymphoblastic leukemia (ALL). Due to limited sensitivity of current approaches, peripheral blood (PB) is not a reliable source for identifying patients needing treatment changes. We sought to determine if high-throughput sequencing (HTS) (next-generation sequencing) of rearranged immunoglobulin and T-cell receptor genes can overcome this and be used to measure MRD in PB. PROCEDURE We employed a quantitative HTS approach to accurately measure MRD from one million cell equivalents of DNA from 17 PB samples collected at day 29 after induction therapy in patients with precursor B-cell ALL. We compared these results to the gold-standard real-time PCR result obtained from their paired BM samples, median follow-up 49 months. RESULTS With the increased sensitivity, detecting up to one abnormal cell in a million normal cells, we were able to detect MRD in the PB by HTS in all those patients requiring treatment intensification (MRD ≥ 0.005% in BM). CONCLUSION This is proof of principle that using the increased sensitivity of HTS, PB can be used to measure MRD and stratify children with ALL. The method is cost effective, rapid, accurate, and reproducible, with inherent advantages in children. Importantly, increasing the frequency testing by PB as opposed to intermittent BM sampling may allow extension of the dynamic range of MRD, giving a more complete picture of the kinetics of disease remission while improving relapse prediction and speed of detection.
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Affiliation(s)
- Jack Bartram
- Depatment of Haematology, Great Ormond Street Hospital for Children, London, UK.,Cancer Section, Institute of Child Health, University College London, UK
| | - Gary Wright
- Depatment of Haematology, Great Ormond Street Hospital for Children, London, UK
| | - Stuart Adams
- Depatment of Haematology, Great Ormond Street Hospital for Children, London, UK
| | - Paul Archer
- Bristol Genetics Laboratory, Southmead Hospital, North Bristol NHS Trust, UK
| | - Tony Brooks
- UCL Genomics, Institute of Child Health, University College London, UK
| | - Darren Edwards
- Cancer Section, Institute of Child Health, University College London, UK
| | - Jerry Hancock
- Bristol Genetics Laboratory, Southmead Hospital, North Bristol NHS Trust, UK
| | - Henrik Knecht
- Department of Hematology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Sarah Inglott
- Depatment of Haematology, Great Ormond Street Hospital for Children, London, UK
| | - Edward Mountjoy
- School of Social and Community Medicine, University of Bristol, UK
| | - Marie Roynane
- Depatment of Haematology, Great Ormond Street Hospital for Children, London, UK
| | - Stephanie Wakeman
- Bristol Genetics Laboratory, Southmead Hospital, North Bristol NHS Trust, UK
| | - John Moppett
- Department of Paediatric Haematology/Oncology, Royal Hospital for Children, Bristol, UK
| | - Mike Hubank
- Centre for Molecular Pathology, The Royal Marsden, Sutton, UK
| | - Nick Goulden
- Depatment of Haematology, Great Ormond Street Hospital for Children, London, UK.,Trapehade, Monferran-Plavès, France
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6
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Ceppi F, Rizzati F, Colombini A, Conter V, Cazzaniga G. Utilizing the prognostic impact of minimal residual disease in treatment decisions for pediatric acute lymphoblastic leukemia. Expert Rev Hematol 2021; 14:795-807. [PMID: 34374613 DOI: 10.1080/17474086.2021.1967137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Acute lymphoblastic leukemia (ALL) is the first pediatric cancer where the assessment of early response to therapy by minimal residual disease (MRD) monitoring has demonstrated its importance to improve risk-based treatment approaches. The most standardized tools to study MRD in ALL are multiparametric flow cytometry and realtime-quantitative polymerase chain reaction amplification-based methods. In recent years, MRD measurement has reached greater levels of sensitivity and standardization through international laboratory networks collaboration. AREAS COVERED We herewith describe how to assess and apply the prognostic impact of MRD in treatment decisions, with specific focus on pediatric ALL. We also highlight the role of MRD monitoring in the context of genetically homogeneous subgroups of pediatric ALL. However, some queries remain to be addressed and emerging technologies hold the promise of improving MRD detection in ALL patients. EXPERT OPINION Emerging technologies, like next generation flow cytometry, droplet digital PCR, and next generation sequencing appear to be important methods for assessing MRD in pediatric ALL. These more specific and/or sensitive MRD monitoring methods may help to predict relapse with greater accuracy, and are currently being used in clinical trials to improve pediatric ALL outcome by optimizing patient stratification and earlier MRD-based interventional therapy.
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Affiliation(s)
- Francesco Ceppi
- Pediatric Hematology-Oncology Unit, Division of Pediatrics, Woman-Mother-Child Department, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Frida Rizzati
- Pediatric Hematology-Oncology Unit, Division of Pediatrics, Woman-Mother-Child Department, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Antonella Colombini
- Pediatric Hematology-Oncology, University Milano Bicocca, Fondazione MBBM/Ospedale San Gerardo, Monza, Italy
| | - Valentino Conter
- Pediatric Hematology-Oncology, University Milano Bicocca, Fondazione MBBM/Ospedale San Gerardo, Monza, Italy
| | - Giovanni Cazzaniga
- Centro Ricerca Tettamanti, Pediatrics, School of Medicine, University of Milano Bicocca, Fondazione MBBM/Ospedale San Gerardo, Monza, Italy.,Medical Genetics, School of Medicine, University of Milano Bicocca, Monza, Italy
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7
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Why Do Children with Acute Lymphoblastic Leukemia Fare Better Than Adults? Cancers (Basel) 2021; 13:cancers13153886. [PMID: 34359787 PMCID: PMC8345615 DOI: 10.3390/cancers13153886] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/25/2021] [Accepted: 07/30/2021] [Indexed: 11/17/2022] Open
Abstract
It is a new and exciting time for acute lymphoblastic leukemia (ALL). While nearly 50 years ago, only one in nine children with ALL survived with chemotherapy, nowadays nearly 90% of children have a chance of long-term survival. Adults with ALL, as well as the special category of adolescents and young adult (AYA) patients, are catching up with the new developments seen in children, but still their prognosis is much worse. A plethora of factors are regarded as responsible for the differences in treatment response, such as age, ethnicity, disease biology, treatment regimens and toxicities, drug tolerance and resistance, minimal residual disease evaluation, hematopoietic stem cell transplantation timing and socio-economic factors. Taking these factors into account, bringing pediatric-like protocols to adult patient management and incorporating new agents into frontline treatment could be the key to improve the survival rates in adults and AYA.
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8
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Integrin α6 mediates the drug resistance of acute lymphoblastic B-cell leukemia. Blood 2021; 136:210-223. [PMID: 32219444 DOI: 10.1182/blood.2019001417] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 03/12/2020] [Indexed: 02/06/2023] Open
Abstract
Resistance to multimodal chemotherapy continues to limit the prognosis of acute lymphoblastic leukemia (ALL). This occurs in part through a process called adhesion-mediated drug resistance, which depends on ALL cell adhesion to the stroma through adhesion molecules, including integrins. Integrin α6 has been implicated in minimal residual disease in ALL and in the migration of ALL cells to the central nervous system. However, it has not been evaluated in the context of chemotherapeutic resistance. Here, we show that the anti-human α6-blocking Ab P5G10 induces apoptosis in primary ALL cells in vitro and sensitizes primary ALL cells to chemotherapy or tyrosine kinase inhibition in vitro and in vivo. We further analyzed the underlying mechanism of α6-associated apoptosis using a conditional knockout model of α6 in murine BCR-ABL1+ B-cell ALL cells and showed that α6-deficient ALL cells underwent apoptosis. In vivo deletion of α6 in combination with tyrosine kinase inhibitor (TKI) treatment was more effective in eradicating ALL than treatment with a TKI (nilotinib) alone. Proteomic analysis revealed that α6 deletion in murine ALL was associated with changes in Src signaling, including the upregulation of phosphorylated Lyn (pTyr507) and Fyn (pTyr530). Thus, our data support α6 as a novel therapeutic target for ALL.
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9
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Correia RP, Bento LC, de Sousa FA, Barroso RDS, Campregher PV, Bacal NS. How I investigate minimal residual disease in acute lymphoblastic leukemia. Int J Lab Hematol 2021; 43:354-363. [PMID: 33423385 DOI: 10.1111/ijlh.13463] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 12/21/2020] [Accepted: 12/27/2020] [Indexed: 10/22/2022]
Abstract
Minimal Residual Disease (MRD) is the most important independent prognostic factor in acute lymphoblastic leukemia (ALL) and refers to the deep level of measurable disease in cases with complete remission by conventional pathologic analysis, especially by cytomorphology. MRD can be detected by multiparametric flow cytometry, molecular approaches such as quantitative polymerase chain reaction for immunoglobulin and T-cell receptor (IG/TR) gene rearrangements or fusion genes transcript, and high-throughput sequencing for IG/TR. Despite the proven clinical usefulness in detecting MRD, these methods have differences in sensitivity, specificity, applicability, turnaround time and cost. Knowing and understanding these differences, as well as the principles and limitations of each technology, is essential to laboratory standardization and correct interpretation of MRD results in line with treatment time points, therapeutic settings, and clinical trials. Here, we review the methodological approaches to measure MRD in ALL and discuss the advantages and limitations of the most commonly used techniques.
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Affiliation(s)
- Rodolfo P Correia
- Clinical Pathology Laboratory, Flow Cytometry Division, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Laiz C Bento
- Clinical Pathology Laboratory, Flow Cytometry Division, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Flávia A de Sousa
- Clinical Pathology Laboratory, Flow Cytometry Division, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Rodrigo de S Barroso
- Clinical Pathology Laboratory, Flow Cytometry Division, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Paulo V Campregher
- Clinical Pathology Laboratory, Molecular Genetics Division, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Nydia S Bacal
- Clinical Pathology Laboratory, Flow Cytometry Division, Hospital Israelita Albert Einstein, São Paulo, Brazil.,Centro de Hematologia de São Paulo, São Paulo, Brazil
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10
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Kim HN, Ruan Y, Ogana H, Kim YM. Cadherins, Selectins, and Integrins in CAM-DR in Leukemia. Front Oncol 2020; 10:592733. [PMID: 33425742 PMCID: PMC7793796 DOI: 10.3389/fonc.2020.592733] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/22/2020] [Indexed: 12/12/2022] Open
Abstract
The interaction between leukemia cells and the bone microenvironment is known to provide drug resistance in leukemia cells. This phenomenon, called cell adhesion-mediated drug resistance (CAM-DR), has been demonstrated in many subsets of leukemia including B- and T-acute lymphoblastic leukemia (B- and T-ALL) and acute myeloid leukemia (AML). Cell adhesion molecules (CAMs) are surface molecules that allow cell-cell or cell-extracellular matrix (ECM) adhesion. CAMs not only recognize ligands for binding but also initiate the intracellular signaling pathways that are associated with cell proliferation, survival, and drug resistance upon binding to their ligands. Cadherins, selectins, and integrins are well-known cell adhesion molecules that allow binding to neighboring cells, ECM proteins, and soluble factors. The expression of cadherin, selectin, and integrin correlates with the increased drug resistance of leukemia cells. This paper will review the role of cadherins, selectins, and integrins in CAM-DR and the results of clinical trials targeting these molecules.
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Affiliation(s)
- Hye Na Kim
- Children's Hospital Los Angeles, Keck School of Medicine of University of Southern California, Cancer and Blood Disease Institute, Los Angeles, CA, United States
| | - Yongsheng Ruan
- Children's Hospital Los Angeles, Keck School of Medicine of University of Southern California, Cancer and Blood Disease Institute, Los Angeles, CA, United States.,Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Heather Ogana
- Children's Hospital Los Angeles, Keck School of Medicine of University of Southern California, Cancer and Blood Disease Institute, Los Angeles, CA, United States
| | - Yong-Mi Kim
- Children's Hospital Los Angeles, Keck School of Medicine of University of Southern California, Cancer and Blood Disease Institute, Los Angeles, CA, United States
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11
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Panda SS, Radhakrishnan V, Ganesan P, Rajendranath R, Ganesan TS, Rajalekshmy KR, Bhola RK, Das H, Sagar TG. Flow Cytometry Based MRD and Its Impact on Survival Outcome in Children and Young Adults with ALL: A Prospective Study from a Tertiary Cancer Centre in Southern India. Indian J Hematol Blood Transfus 2020; 36:300-308. [PMID: 32425381 PMCID: PMC7229125 DOI: 10.1007/s12288-019-01228-0] [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: 09/01/2019] [Accepted: 11/02/2019] [Indexed: 11/24/2022] Open
Abstract
Presence of minimal residual disease (MRD) following induction chemotherapy is a well-recognized risk factor to predict relapse in acute lymphoblastic leukemia (ALL). There is paucity of data on MRD and outcome in ALL from India. We share our experience in establishing a flow cytometry-based MRD assay for ALL with emphasis on determination of the number of patients who had MRD on day 35 of induction therapy and its correlation with outcome and other prognostic factors. We prospectively studied MRD in patients with ALL less than 25 years who achieved morphological complete remission with induction therapy. The initial series consisted of 104 patients with ALL. Ninety-two patients had bone marrow samples collected on day 35 of remission induction chemotherapy that was adequate for MRD. Strategy of monitoring MRD was based on flow cytometry using six color staining according the leukemia associated immunophenotype found at diagnosis. Data analysis was done using Fisher exact test. The median age was 8.5 years (range 0.9-22 years). Thirty-seven out of ninety-two patients (40.2%) had MRD at end of induction. MRD on day 35 was between 0.01 and 0.1% in 18.9% of patients, between 0.1 and 1% in 59.5% and more than 1% in 21.6% patients. Among the patients who had MRD, 16.7% had favourable cytogenetics, 60% had intermediate and 13.3% had high-risk cytogenetics. The presence or absence of residual leukemia by flow cytometry at day 35 was not significantly related to age (p = 1.0), male gender (p = 0.08) hyperleukocytosis (p = 0.25) or day 8 blast clearance (p = 0.21). However, T cell phenotype (p < 0.001) was significantly associated with MRD. The 5-year event free survival (EFS) for patients who had MRD versus those who did not was 69% and 61.1% respectively (p = 0.41). The 5-year overall survival (OS) for patients who had MRD versus those who did not was 72.5% and 61.1% respectively (p = 0.33). Flow cytometric techniques can be applied to monitor MRD in patients of ALL undergoing induction therapy. Our results suggest MRD correlates with certain known prognostic factors. Though the EFS and OS was lower in MRD positive patients, the results were not statistically significant probably because of the small sample size.
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Affiliation(s)
- Soumya Surath Panda
- Department of Medical Oncology, IMS and SUM Hospital, Siksha O Anusandhan University, Bhubaneswar, Odisha India
| | | | - Prasanth Ganesan
- Departments of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu 600020 India
| | - Rejiv Rajendranath
- Departments of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu 600020 India
| | - Trivadi S. Ganesan
- Departments of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu 600020 India
| | | | - Rajesh Kumar Bhola
- Department of Medical Oncology, IMS and SUM Hospital, Siksha O Anusandhan University, Bhubaneswar, Odisha India
| | - Hemlata Das
- Department of Medical Oncology, IMS and SUM Hospital, Siksha O Anusandhan University, Bhubaneswar, Odisha India
| | - Tenali Gnana Sagar
- Departments of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu 600020 India
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12
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Wang X, Fan Q, Xu L, Wang Y, Zhang X, Chen H, Chen Y, Wang F, Han W, Sun Y, Yan C, Tang F, Liu Y, Mo X, Liu K, Huang X, Chang Y. The Quantification of Minimal Residual Disease Pre‐ and Post‐Unmanipulated Haploidentical Allograft by Multiparameter Flow Cytometry in Pediatric Acute Lymphoblastic Leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019; 98:75-87. [PMID: 31424628 DOI: 10.1002/cyto.b.21840] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/24/2019] [Accepted: 07/30/2019] [Indexed: 01/02/2023]
Affiliation(s)
- Xin‐Yu Wang
- Peking University People's Hospital & Peking University Institute of HematologyBeijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing People's Republic of China
| | - Qiao‐Zhen Fan
- Peking University People's Hospital & Peking University Institute of HematologyBeijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing People's Republic of China
| | - Lan‐Ping Xu
- Peking University People's Hospital & Peking University Institute of HematologyBeijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing People's Republic of China
| | - Yu Wang
- Peking University People's Hospital & Peking University Institute of HematologyBeijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing People's Republic of China
| | - Xiao‐Hui Zhang
- Peking University People's Hospital & Peking University Institute of HematologyBeijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing People's Republic of China
| | - Huan Chen
- Peking University People's Hospital & Peking University Institute of HematologyBeijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing People's Republic of China
| | - Yu‐Hong Chen
- Peking University People's Hospital & Peking University Institute of HematologyBeijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing People's Republic of China
| | - Feng‐Rong Wang
- Peking University People's Hospital & Peking University Institute of HematologyBeijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing People's Republic of China
| | - Wei Han
- Peking University People's Hospital & Peking University Institute of HematologyBeijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing People's Republic of China
| | - Yu‐Qian Sun
- Peking University People's Hospital & Peking University Institute of HematologyBeijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing People's Republic of China
| | - Chen‐Hua Yan
- Peking University People's Hospital & Peking University Institute of HematologyBeijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing People's Republic of China
| | - Fei‐Fei Tang
- Peking University People's Hospital & Peking University Institute of HematologyBeijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing People's Republic of China
| | - Yan‐Rong Liu
- Peking University People's Hospital & Peking University Institute of HematologyBeijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing People's Republic of China
| | - Xiao‐Dong Mo
- Peking University People's Hospital & Peking University Institute of HematologyBeijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing People's Republic of China
| | - Kai‐Yan Liu
- Peking University People's Hospital & Peking University Institute of HematologyBeijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing People's Republic of China
| | - Xiao‐Jun Huang
- Peking University People's Hospital & Peking University Institute of HematologyBeijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing People's Republic of China
- National Clinical Research Center for Hematologic Disease Beijing People's Republic of China
| | - Ying‐Jun Chang
- Peking University People's Hospital & Peking University Institute of HematologyBeijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing People's Republic of China
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13
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Wright G, Watt E, Inglott S, Brooks T, Bartram J, Adams SP. Clinical benefit of a high-throughput sequencing approach for minimal residual disease in acute lymphoblastic leukemia. Pediatr Blood Cancer 2019; 66:e27787. [PMID: 31034760 DOI: 10.1002/pbc.27787] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/27/2019] [Accepted: 04/17/2019] [Indexed: 11/08/2022]
Abstract
The molecular detection of minimal residual disease (MRD) is standard of care in acute lymphoblastic leukemia to personalize the stratification of patients to appropriate intensity chemotherapy regimens. High-throughput sequencing (HTS) techniques are driving changes to MRD methodologies. Our study demonstrates HTS can identify suitable diagnostic markers, even in cases where traditional screening has been unsuccessful. Markers identified by HTS were used to track MRD using standard real-time quantitative PCR. We show, with six patient examples, clinical benefits of utilizing HTS to screen diagnostic samples and its necessity when traditional screening techniques fail. This is practical evidence that current MRD diagnostic marker screening should be replaced by an HTS approach.
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Affiliation(s)
- Gary Wright
- SIHMDS-Haematology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Eleanor Watt
- SIHMDS-Haematology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Infection, Immunity and Inflammation Section, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Sarah Inglott
- SIHMDS-Haematology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Tony Brooks
- UCL Genomics, Institute of Child Health, University College London, London, UK
| | - Jack Bartram
- Department of Haematology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Stuart P Adams
- SIHMDS-Haematology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Infection, Immunity and Inflammation Section, UCL Great Ormond Street Institute of Child Health, London, UK
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14
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Takam Kamga P, Dal Collo G, Midolo M, Adamo A, Delfino P, Mercuri A, Cesaro S, Mimiola E, Bonifacio M, Andreini A, Chilosi M, Krampera M. Inhibition of Notch Signaling Enhances Chemosensitivity in B-cell Precursor Acute Lymphoblastic Leukemia. Cancer Res 2018; 79:639-649. [PMID: 30563887 DOI: 10.1158/0008-5472.can-18-1617] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 10/23/2018] [Accepted: 12/14/2018] [Indexed: 11/16/2022]
Abstract
Notch3 and Notch4 support survival of primary B-cell acute lymphoblastic leukemia (B-ALL) cells, suggesting a role for Notch signaling in drug response. Here we used in vitro, in silico, and in vivo mouse xenograft model-based approaches to define the role of the Notch pathway in B-ALL chemosensitivity. We observed significant Notch receptor and ligand expression in B-ALL primary cells and cell lines. Primary leukemia cells from high-risk patients overexpressed Notch3, Notch4, and Jagged2 while displaying a reduction in expression levels of Notch1-4 following chemotherapy. We then analyzed in vitro cell survival of B-ALL cells treated with conventional chemotherapeutic agents alone or in combination with Notch signaling inhibitors. Gamma-secretase inhibitors (GSI) and anti-Notch4 were all capable of potentiating drug-induced cell death in B-ALL cells by upregulating intracellular levels of reactive oxygen species, which in turn modulated mTOR, NF-κB, and ERK expression. In NOG-mouse-based xenograft models of B-ALL, co-administration of the Notch inhibitor GSI-XII with the chemotherapeutic agent Ara-C lowered bone marrow leukemic burden compared with DMSO or Ara-C alone, thus prolonging mouse survival. Overall, our results support the potential effectiveness of Notch inhibitors in patients with B-ALL.Significance: Inhibition of Notch signaling enhances the chemosensitivity of B-ALL cells, suggesting Notch inhibition as a potential therapeutic strategy to improve the outcome of patients with B-ALL.
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Affiliation(s)
- Paul Takam Kamga
- Stem Cell Research Laboratory, Section of Hematology, Department of Medicine, University of Verona, Verona, Italy.,EA4340-BCOH: Biomarker in Cancerology and Onco-Hematology, Université de Versailles Saint-Quentin-en-Yvelines, Versailles, France
| | - Giada Dal Collo
- Stem Cell Research Laboratory, Section of Hematology, Department of Medicine, University of Verona, Verona, Italy
| | - Martina Midolo
- Stem Cell Research Laboratory, Section of Hematology, Department of Medicine, University of Verona, Verona, Italy
| | - Annalisa Adamo
- Stem Cell Research Laboratory, Section of Hematology, Department of Medicine, University of Verona, Verona, Italy
| | - Pietro Delfino
- Department of Biotechnology, University of Verona, Verona, Italy
| | - Angela Mercuri
- Stem Cell Research Laboratory, Section of Hematology, Department of Medicine, University of Verona, Verona, Italy.,Pediatric Onco-Hematology Unit, University of Verona, Verona, Italy
| | - Simone Cesaro
- Pediatric Onco-Hematology Unit, University of Verona, Verona, Italy
| | - Elda Mimiola
- Stem Cell Research Laboratory, Section of Hematology, Department of Medicine, University of Verona, Verona, Italy
| | - Massimiliano Bonifacio
- Stem Cell Research Laboratory, Section of Hematology, Department of Medicine, University of Verona, Verona, Italy
| | - Angelo Andreini
- Stem Cell Research Laboratory, Section of Hematology, Department of Medicine, University of Verona, Verona, Italy
| | - Marco Chilosi
- Section of Pathology, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Mauro Krampera
- Stem Cell Research Laboratory, Section of Hematology, Department of Medicine, University of Verona, Verona, Italy.
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15
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Wang YZ, Hao L, Chang Y, Jiang Q, Jiang H, Zhang LP, He LL, Yuan XY, Qin YZ, Huang XJ, Liu YR. A seven-color panel including CD34 and TdT could be applied in >97% patients with T cell lymphoblastic leukemia for minimal residual disease detection independent of the initial phenotype. Leuk Res 2018; 72:12-19. [DOI: 10.1016/j.leukres.2018.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/25/2018] [Accepted: 07/12/2018] [Indexed: 12/27/2022]
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16
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Neuropilin-1/CD304 Expression by Flow Cytometry in Pediatric Precursor B-Acute Lymphoblastic Leukemia: A Minimal Residual Disease and Potential Prognostic Marker. J Pediatr Hematol Oncol 2018; 40:200-207. [PMID: 29200164 DOI: 10.1097/mph.0000000000001008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Flow cytometry (FCM) is used for quantification of minimal residual disease (MRD) in acute lymphoblastic leukemia (ALL) through discriminating leukemic B-lymphoblasts from normal B-cell precursor counterparts "hematogones." Neuropilin-1 (NRP-1)/CD304 is a vascular endothelial growth factor receptor implicated in the progression of hematological malignancies. We evaluated NRP-1/CD304 as MRD and prognostic marker in pediatric precursor B-ALL using FCM. Seventy children with precursor B-ALL and 40 control children were enrolled. CD304 percentage and fluorescence intensity were significantly higher in precursor B-ALL at diagnosis compared with controls. In total, 28 of 70 (40%) precursor B-ALL patients at diagnosis were CD304 (group A), whereas 42/70 (60%) patients were CD304 (group B). Group A showed higher incidence of lymphadenopathy and TEL-AML1 fusion gene than group B. CD304 was reevaluated in group A patients at day 28 postinduction chemotherapy which revealed 12/28 (42.9%) patients with persistent CD304 expression (MRD; group A1) and 16/28 (57.1%) patients who turned CD304 (MRD; group A2). At diagnosis, group A1 showed lower incidence of TEL-AML1 fusion gene and higher risk stratification than group A2. NRP-1/CD304 expression by FCM is efficient in discriminating leukemic B-lymphoblasts from hematogones, a stable leukemia-associated phenotype for MRD monitoring, and a putative poor prognostic marker in pediatric precursor B-ALL.
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17
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Sędek Ł, Theunissen P, Sobral da Costa E, van der Sluijs-Gelling A, Mejstrikova E, Gaipa G, Sonsala A, Twardoch M, Oliveira E, Novakova M, Buracchi C, van Dongen JJM, Orfao A, van der Velden VHJ, Szczepański T. Differential expression of CD73, CD86 and CD304 in normal vs. leukemic B-cell precursors and their utility as stable minimal residual disease markers in childhood B-cell precursor acute lymphoblastic leukemia. J Immunol Methods 2018. [PMID: 29530508 DOI: 10.1016/j.jim.2018.03.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Optimal discrimination between leukemic blasts and normal B-cell precursors (BCP) is critical for treatment monitoring in BCP acute lymphoblastic leukemia (ALL); thus identification of markers differentially expressed on normal BCP and leukemic blasts is required. METHODS Multicenter analysis of CD73, CD86 and CD304 expression levels was performed in 282 pediatric BCP-ALL patients vs. normal bone marrow BCP, using normalized median fluorescence intensity (nMFI) values. RESULTS CD73 was expressed at abnormally higher levels (vs. pooled normal BCP) at diagnosis in 71/108 BCP-ALL patients (66%), whereas CD304 and CD86 in 119/202 (59%) and 58/100 (58%) patients, respectively. Expression of CD304 was detected at similar percentages in common-ALL and pre-B-ALL, while found at significantly lower frequencies in pro-B-ALL. A significant association (p = 0.009) was found between CD304 expression and the presence of the ETV6-RUNX1 fusion gene. In contrast, CD304 showed an inverse association with MLL gene rearrangements (p = 0.01). The expression levels of CD73, CD86 and CD304 at day 15 after starting therapy (MRD15) were stable or higher than at diagnosis in 35/37 (95%), 40/56 (71%) and 19/41 (46%) cases investigated, respectively. This was also associated with an increased mean nMFI at MRD15 vs. diagnosis of +24 and +3 nMFI units for CD73 and CD86, respectively. In addition, gain of expression of CD73 and CD86 at MRD15 for cases that were originally negative for these markers at diagnosis was observed in 16% and 18% of cases, respectively. Of note, CD304 remained aberrantly positive in 63% of patients, despite its levels of expression decreased at follow-up in 54% of cases. CONCLUSIONS Here we show that CD73, CD86 and CD304 are aberrantly (over)expressed in a substantial percentage of BCP-ALL patients and that their expression profile remains relatively stable early after starting therapy, supporting their potential contribution to improved MRD analysis by flow cytometry.
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Affiliation(s)
- Łukasz Sędek
- Department of Microbiology and Immunology, Medical University of Silesia in Katowice (SUM), ul. Jordana 19, 41-808 Zabrze, Poland
| | - Prisca Theunissen
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam (Erasmus MC), Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Elaine Sobral da Costa
- Pediatrics Institute IPPMG, Faculty of Medicine, Federal University of Rio de Janeiro, Av. Horacio Macedo, Predio do CT, CEP 21941-914 Rio de Janeiro, Brazil
| | - Alita van der Sluijs-Gelling
- Department of Immunohematology and Blood Transfusion (IHB), Leiden University Medical Center (LUMC), Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Ester Mejstrikova
- Department of Pediatric Hematology and Oncology, 2nd Faculty of Medicine, Charles University (CU), V Uvalu 84, 15006 Prague 5, Czech Republic
| | - Giuseppe Gaipa
- Centro Ricerca Tettamanti, Clinica Pediatrica Università di Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy
| | - Alicja Sonsala
- Department of Pediatric Hematology and Oncology, Medical University of Silesia in Katowice (SUM), ul. 3 Maja 13-15, 41-800 Zabrze, Poland
| | - Magdalena Twardoch
- Department of Pediatric Hematology and Oncology, Medical University of Silesia in Katowice (SUM), ul. 3 Maja 13-15, 41-800 Zabrze, Poland
| | - Elen Oliveira
- Pediatrics Institute IPPMG, Faculty of Medicine, Federal University of Rio de Janeiro, Av. Horacio Macedo, Predio do CT, CEP 21941-914 Rio de Janeiro, Brazil
| | - Michaela Novakova
- Department of Pediatric Hematology and Oncology, 2nd Faculty of Medicine, Charles University (CU), V Uvalu 84, 15006 Prague 5, Czech Republic
| | - Chiara Buracchi
- Centro Ricerca Tettamanti, Clinica Pediatrica Università di Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy
| | - Jacques J M van Dongen
- Department of Immunohematology and Blood Transfusion (IHB), Leiden University Medical Center (LUMC), Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Alberto Orfao
- Cancer Research Center (IBMCC-CSIC), Department of Medicine and Cytometry Service (Nucleus), University of Salamanca (USAL), 37007 Salamanca, Spain; CIBERONC and Institute of Biomedical Research of Salamanca (IBSAL), Paseo de la Universidad de Coimbra, s/n, Campus Miguel de Unamuno, 37007 Salamanca, Spain.
| | - Vincent H J van der Velden
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam (Erasmus MC), Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Tomasz Szczepański
- Department of Pediatric Hematology and Oncology, Medical University of Silesia in Katowice (SUM), ul. 3 Maja 13-15, 41-800 Zabrze, Poland
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18
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Shahkarami S, Mehrasa R, Younesian S, Yaghmaie M, Chahardouli B, Vaezi M, Rezaei N, Nikbakht M, Alimoghaddam K, Ghavamzadeh A, Tavakkoly-Bazzaz J, Ghaffari SH. Minimal residual disease (MRD) detection using rearrangement of immunoglobulin/T cell receptor genes in adult patients with acute lymphoblastic leukemia (ALL). Ann Hematol 2018; 97:585-595. [PMID: 29392424 DOI: 10.1007/s00277-018-3230-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 12/28/2017] [Indexed: 12/20/2022]
Abstract
MRD detection with allele-specific oligonucleotide-quantitative polymerase chain reaction (ASO-qPCR) and using clone-specific immunoglobulin/T cell receptor rearrangements is considered as a powerful prognostic factor in acute lymphoblastic leukemia (ALL). In the present study, we evaluated an ASO-qPCR assay for MRD quantification in peripheral blood (PB) samples of adult patients with ALL. DNA was isolated from PB samples of patients with newly diagnosed ALL. They were first investigated by multiplex-PCR assay to identify V/J usage. An ASO-qPCR technique was then applied for 2.5-year monthly MRD quantification for detection of patient-specific Ig/TCR receptor rearrangements as a molecular target. From 98 patients who were diagnosed as ALL, 72 (73.5%) were enrolled in the present study for MRD detection. MRD was successfully quantified in patients with 1-month interval time. MRD level at the end of induction therapy up to day 88 was the only significant prognostic factor. Regarding MRD level, patients were categorized into two groups of low and high-risk. 2.5-year OS in all three time points (days 28, 58 and 88) were significantly lower in high-risk group (P < 0.008). The results of the 2.5-year MRD detection indicate that MRD level at the end of induction up to about 6 months after the first diagnosis was associated with clinical outcome. This study may highlight the usefulness of PB and the definitions of cut-off level for early prediction of relapse and for stratifying ALL patients. Short-interval time points and frequent PB sampling to monitor MRD level is suggested for early clinical relapse prediction and clinical management of the disease.
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Affiliation(s)
- Sepideh Shahkarami
- Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Hematologic Malignancies Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Roya Mehrasa
- Hematologic Malignancies Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Samareh Younesian
- Hematologic Malignancies Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjan Yaghmaie
- Hematologic Malignancies Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahram Chahardouli
- Hematologic Malignancies Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Vaezi
- Hematologic Malignancies Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Nikbakht
- Hematologic Malignancies Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kamran Alimoghaddam
- Hematologic Malignancies Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ardeshir Ghavamzadeh
- Hematologic Malignancies Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Javad Tavakkoly-Bazzaz
- Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Seyed H Ghaffari
- Hematologic Malignancies Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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19
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Wang Y, Liu Q, Yu JN, Wang HX, Gao LL, Dai YL, Jin X, Zuo F, Liu J, Bai CF, Mu GX, Chai XM, Zhang YJ, Li YX, Yu JQ. Perceptions of parents and paediatricians on pain induced by bone marrow aspiration and lumbar puncture among children with acute leukaemia: a qualitative study in China. BMJ Open 2017; 7:e015727. [PMID: 28939570 PMCID: PMC5623544 DOI: 10.1136/bmjopen-2016-015727] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To obtain in-depth insight into the perceptions of parents and paediatricians in China regarding current procedural pain management on bone marrow aspirations and lumbar punctures in paediatric haemato-oncology department. DESIGN, SETTING AND PARTICIPANTS This qualitative study was conducted in a 4500-bed university hospital in northwest China. To collect data, in-depth semistructured interviews were conducted with parents of children with acute leukaemia (n=12) and haemato-oncology paediatricians (n=11) using purposive sampling. Interviews were audiotaped and transcribed and subjected to thematic analysis. RESULTS The suffering of procedural pain among paediatric patients was not adequately recognised and properly treated at the paediatric haemato-oncology department. The current paediatric procedural pain management is inadequate for paediatric patients. Crucial factors were identified including lack of awareness about the damage of uncontrolled pain in children, parents' low supportive ability, the limited capacity to provide general analgesia by anaesthetists, inadequate knowledge in the usage of analgesia and sedation and lack of efficient analgesic for children's procedural pain. The participants strongly expected optimal interventions to improve paediatric procedural pain management. CONCLUSIONS The result suggested a perceived and actual poor management of paediatric procedural pain in haemato-oncology department in northwest China. A relevant pain management education programme for paediatricians and parents as well as an effective pain medication are urgently needed in northwest China. TRIAL REGISTRATION Chinese Clinical Trial Registry. Identifier: ChiCTR-INR-16007989.
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Affiliation(s)
- Yu Wang
- Nursing School, Ningxia Medical University, Yinchuan, China
| | - Qiang Liu
- Nursing School, Ningxia Medical University, Yinchuan, China
| | - Jia-Ning Yu
- Department of Paediatric Hematology-Oncology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Hai-Xia Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lu-Lu Gao
- Nursing School, Ningxia Medical University, Yinchuan, China
| | - Ya-Liang Dai
- Nursing School, Ningxia Medical University, Yinchuan, China
| | - Xin Jin
- Neurological Surgery Department, Ningxia People’s Hospital, Yinchuan, China
| | - Feng Zuo
- Department of Paediatric Hematology-Oncology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Juan Liu
- Nursing School, Ningxia Medical University, Yinchuan, China
| | - Cai-Feng Bai
- Nursing School, Ningxia Medical University, Yinchuan, China
| | - Guo-Xia Mu
- Nursing School, Ningxia Medical University, Yinchuan, China
| | - Xiao-Min Chai
- Nursing School, Ningxia Medical University, Yinchuan, China
| | - Yin-Juan Zhang
- Nursing School, Ningxia Medical University, Yinchuan, China
| | - Yu-Xiang Li
- Nursing School, Ningxia Medical University, Yinchuan, China
| | - Jian-Qiang Yu
- Department of Pharmacology, College of Pharmacy, Ningxia Medical University, Yinchuan, China
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20
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Nunes V, Cazzaniga G, Biondi A. An update on PCR use for minimal residual disease monitoring in acute lymphoblastic leukemia. Expert Rev Mol Diagn 2017; 17:953-963. [PMID: 28891364 DOI: 10.1080/14737159.2017.1377073] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Acute lymphoblastic leukemia (ALL) is the first neoplasm where the assessment of early response to therapy by minimal residual disease (MRD) monitoring has proven to be a fundamental tool for guiding therapeutic choices. In recent years, thanks to real-time quantitative PCR (qPCR), MRD monitoring has further achieved higher levels of sensitivity and standardization. However, some outstanding issues still remain to be addressed and emerging technologies hold the promise of improving MRD detection in ALL patients. Areas covered: Through a comprehensive review of the literature, we analyze the state-of-the-art of molecular MRD assessment in ALL to better understand how, in the upcoming years, some of its limitations could be tackled by emerging molecular technologies. Furthermore, we highlight the future role of molecular MRD monitoring in the context of personalized protocols, taking into account the growing genetic complexity in ALL. Expert commentary: Although new molecular technologies are promising tools for MRD assessment, qPCR still remains the gold standard for evaluating MRD in ALL. High-throughput sequencing and droplet digital PCR allow to identify new prognostic factors and/or MRD targets at diagnosis and to perform earlier MRD evaluations, thereby optimizing patient stratification and earlier MRD-based clinical intervention to improve ALL patient outcomes.
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Affiliation(s)
- Vittorio Nunes
- a Tettamanti Research Center, Department of Pediatrics , University of Milano Bicocca , Monza , Italy
| | - Gianni Cazzaniga
- a Tettamanti Research Center, Department of Pediatrics , University of Milano Bicocca , Monza , Italy
| | - A Biondi
- a Tettamanti Research Center, Department of Pediatrics , University of Milano Bicocca , Monza , Italy
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21
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Lamble A, Phelan R, Burke M. When Less Is Good, Is None Better? The Prognostic and Therapeutic Significance of Peri-Transplant Minimal Residual Disease Assessment in Pediatric Acute Lymphoblastic Leukemia. J Clin Med 2017; 6:E66. [PMID: 28686179 PMCID: PMC5532574 DOI: 10.3390/jcm6070066] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 06/26/2017] [Accepted: 07/03/2017] [Indexed: 02/06/2023] Open
Abstract
The measurement of minimal residual disease (MRD) in pediatric acute lymphoblastic leukemia (ALL) has become the most important prognostic tool of, and the backbone to, upfront risk stratification. While MRD assessment is the standard of care for assessing response and predicting outcomes for pediatric patients with ALL receiving chemotherapy, its use in allogeneic hematopoietic stem cell transplant (HSCT) has been less clearly defined. Herein, we discuss the importance of MRD assessment during the peri-HSCT period and its role in prognostication and management.
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Affiliation(s)
- Adam Lamble
- Pediatric Hematology/Oncology, Oregon Health & Science University, Portland, OR 97239, USA.
| | - Rachel Phelan
- Pediatric Hematology/Oncology/Blood and Marrow Transplant, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
| | - Michael Burke
- Pediatric Hematology/Oncology/Blood and Marrow Transplant, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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22
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Sarrawi TH, Zayyat I, Barakat F, Rezeq M, Jmaian SA, Madanat F. End of therapy minimal residual disease (MRD) measurement in children with ALL does not predict relapse. Hematol Oncol Stem Cell Ther 2017. [PMID: 28648946 DOI: 10.1016/j.hemonc.2017.05.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Ismael Zayyat
- Department of Pediatric Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Fareed Barakat
- Department of Pathology, King Hussein Cancer Center, Amman, Jordan
| | - Maha Rezeq
- Department of Pediatric Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Salam Abu Jmaian
- Department of Pediatric Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Faris Madanat
- Department of Pediatric Oncology, King Hussein Cancer Center, Amman, Jordan.
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23
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Gajendra S, Misra R, Dorwal P, Sharma R, Sachdev R. Significant Haematogone Proliferation Mimicking Relapse in Acute Lymphoblastic Leukaemia on Therapy. J Clin Diagn Res 2017; 11:ED01-ED03. [PMID: 28384870 DOI: 10.7860/jcdr/2017/23650.9190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 10/29/2016] [Indexed: 11/24/2022]
Abstract
Haematogones are benign B lymphoid precursors which may mimic neoplastic lymphoblasts and pose diagnostic difficulty especially when the percentage of haematogones exceeds 10% in the bone marrow. Flow cytometric analysis with combination of CD19/CD10/CD20/CD34/CD38/CD58 can be used to differentiate the two depending upon the difference in the fluorescence intensity between blasts and haematogones. We hereby present a case of Common Acute Lymphoblastic Leukaemia Associated Antigen (CALLA) positive Acute Lymphoblastic Leukaemia (ALL), in which patient presented with haematogone proliferation in bone marrow after 6 months of chemotherapy mimicking relapse. The distinction was made on flow cytometric immunophenotyping by using optimal antibody combination. Distinction of benign haematogones from neoplastic lymphoblasts is essential for disease management in cases of post chemotherapy or post marrow transplant, especially in patients of ALL. Flow cytometric immunophenotyping is reliable to distinguish haematogones from residual lymphoblasts in almost all cases when optimal antibody combinations are used.
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Affiliation(s)
- Smeeta Gajendra
- Associate Consultant, Department of Pathology and Laboratory Medicine, Medanta - The Medicity , Gurgaon, Haryana, India
| | - Ruchira Misra
- Consultant, Department of Paediatric Hemat-Oncology, Medanta - The Medicity , Gurgaon, Haryana, India
| | - Pranav Dorwal
- Associate Consultant, Department of Pathology and Laboratory Medicine, Medanta - The Medicity , Gurgaon, Haryana, India
| | - Rashi Sharma
- Senior Resident, Department of Pathology and Laboratory Medicine, Medanta - The Medicity , Gurgaon, Haryana, India
| | - Ritesh Sachdev
- Senior Consultant, Department of Pathology and Laboratory Medicine, Medanta - The Medicity , Gurgaon, Haryana, India
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24
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Atfy M, Sherif L, Azab M, Al-Akad G, Zakaria M, Sorour S. Cluster of differentiation 97 as a biomarker for the detection of minimal residual disease in common acute lymphoblastic leukemia. THE EGYPTIAN JOURNAL OF HAEMATOLOGY 2017. [DOI: 10.4103/ejh.ejh_18_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Tembhare PR, Ghogale S, Ghatwai N, Badrinath Y, Kunder N, Patkar NV, Bibi AR, Chatterjee G, Arora B, Narula G, Banawali S, Deshpande N, Amare P, Gujral S, Subramanian PG. Evaluation of new markers for minimal residual disease monitoring in B-cell precursor acute lymphoblastic leukemia: CD73 and CD86 are the most relevant new markers to increase the efficacy of MRD 2016; 00B: 000-000. CYTOMETRY PART B-CLINICAL CYTOMETRY 2016; 94:100-111. [PMID: 27718302 DOI: 10.1002/cyto.b.21486] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 10/02/2016] [Accepted: 10/05/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND Multiparametric flow cytometry (MFC) is a popular technique for minimal residual disease (MRD) analysis. However, its applicability is still limited to 90% of B-cell precursor acute lymphoblastic leukemia (BCPALL) due to two major issues, i.e. a proportion of cases do not express adequate leukemia associated immunophenotype (LAIPs) with currently used markers and drug-induced antigen modulation. Hence, the incorporation of additional reliable markers is required for the further improvement of MFC-based MRD evaluation. We studied the utility of new markers in improvising MFC-based MRD detection in BCPALL. METHODS Expression-patterns of six new markers, i.e. CD24, CD44, CD72, CD73, CD86, and CD200 were studied in leukemic-blasts from ninety childhood BCPALL patients and in hematogones from 20 uninvolved staging bone marrow (BM) and ten postinduction non-BCPALL BM samples using eight-color MFC. The utility of these new markers in the day 35 postinduction MRD evaluation was determined. RESULTS Frequencies of LAIPs of CD73, CD86, CD72, CD44, CD200, and CD24 in diagnostic samples were 76.7, 56.7, 55.6, 50, 28.9, and 20%, respectively. Differential expression of all new markers was highly significant (P < 0.01) between early (CD10+ CD19+ CD34+) hematogones, late (CD10+ CD19+ CD34-) hematogones and BCPALL blasts except between early hematogones and BCPALL blasts for CD200 (P = 0.1). In MRD-positive samples, CD73 showed the maximum (83%) frequency of LAIP and CD86 showed the highest (100%) stability of aberrant expression. Inclusion of CD73 and CD86 increased the applicability of MFC-MRD assay to 98.9% MRD samples. CONCLUSION CD73 and CD86 are the most relevant markers to incorporate in the routine MRD evaluation of BCPALL. © 2016 International Clinical Cytometry Society.
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Affiliation(s)
- Prashant R Tembhare
- Hematopathology Laboratory, Tata Memorial Center, Mumbai, Room 727, Hematopathology Laboratory, Annexe Building, 7th Floor, Tata Memorial Hospital, Parel, 400012, Mumbai, India
| | - Sitaram Ghogale
- Hematopathology Laboratory, Tata Memorial Center, Mumbai, Room 727, Hematopathology Laboratory, Annexe Building, 7th Floor, Tata Memorial Hospital, Parel, 400012, Mumbai, India
| | - Nisha Ghatwai
- Hematopathology Laboratory, Tata Memorial Center, Mumbai, Room 727, Hematopathology Laboratory, Annexe Building, 7th Floor, Tata Memorial Hospital, Parel, 400012, Mumbai, India
| | - Yajamanam Badrinath
- Hematopathology Laboratory, Tata Memorial Center, Mumbai, Room 727, Hematopathology Laboratory, Annexe Building, 7th Floor, Tata Memorial Hospital, Parel, 400012, Mumbai, India
| | - Nikesh Kunder
- Hematopathology Laboratory, Tata Memorial Center, Mumbai, Room 727, Hematopathology Laboratory, Annexe Building, 7th Floor, Tata Memorial Hospital, Parel, 400012, Mumbai, India
| | - Nikhil V Patkar
- Hematopathology Laboratory, Tata Memorial Center, Mumbai, Room 727, Hematopathology Laboratory, Annexe Building, 7th Floor, Tata Memorial Hospital, Parel, 400012, Mumbai, India
| | - Asma R Bibi
- Hematopathology Laboratory, Tata Memorial Center, Mumbai, Room 727, Hematopathology Laboratory, Annexe Building, 7th Floor, Tata Memorial Hospital, Parel, 400012, Mumbai, India
| | - Gaurav Chatterjee
- Hematopathology Laboratory, Tata Memorial Center, Mumbai, Room 727, Hematopathology Laboratory, Annexe Building, 7th Floor, Tata Memorial Hospital, Parel, 400012, Mumbai, India
| | - Brijesh Arora
- Department of Pediatric Oncology, Tata Memorial Center, Main Building, Ground floor, Tata Memorial Hospital, Parel, 400012, Mumbai, India
| | - Gaurav Narula
- Department of Pediatric Oncology, Tata Memorial Center, Main Building, Ground floor, Tata Memorial Hospital, Parel, 400012, Mumbai, India
| | - Shripad Banawali
- Department of Pediatric Oncology, Tata Memorial Center, Main Building, Ground floor, Tata Memorial Hospital, Parel, 400012, Mumbai, India
| | - Nilesh Deshpande
- Hematopathology Laboratory, Tata Memorial Center, Mumbai, Room 727, Hematopathology Laboratory, Annexe Building, 7th Floor, Tata Memorial Hospital, Parel, 400012, Mumbai, India
| | - Prathibha Amare
- Department of Cancer Cytogenetics, Tata Memorial Center, Mumbaim, Room 726, Annexe Building, 7th Floor, Tata Memorial Hospital, Parel, 400012, Mumbai, India
| | - Sumeet Gujral
- Hematopathology Laboratory, Tata Memorial Center, Mumbai, Room 727, Hematopathology Laboratory, Annexe Building, 7th Floor, Tata Memorial Hospital, Parel, 400012, Mumbai, India
| | - Papagudi G Subramanian
- Hematopathology Laboratory, Tata Memorial Center, Mumbai, Room 727, Hematopathology Laboratory, Annexe Building, 7th Floor, Tata Memorial Hospital, Parel, 400012, Mumbai, India
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Bartram J, Mountjoy E, Brooks T, Hancock J, Williamson H, Wright G, Moppett J, Goulden N, Hubank M. Accurate Sample Assignment in a Multiplexed, Ultrasensitive, High-Throughput Sequencing Assay for Minimal Residual Disease. J Mol Diagn 2016; 18:494-506. [PMID: 27183494 DOI: 10.1016/j.jmoldx.2016.02.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 01/14/2016] [Accepted: 02/01/2016] [Indexed: 10/21/2022] Open
Abstract
High-throughput sequencing (HTS) (next-generation sequencing) of the rearranged Ig and T-cell receptor genes promises to be less expensive and more sensitive than current methods of monitoring minimal residual disease (MRD) in patients with acute lymphoblastic leukemia. However, the adoption of new approaches by clinical laboratories requires careful evaluation of all potential sources of error and the development of strategies to ensure the highest accuracy. Timely and efficient clinical use of HTS platforms will depend on combining multiple samples (multiplexing) in each sequencing run. Here we examine the Ig heavy-chain gene HTS on the Illumina MiSeq platform for MRD. We identify errors associated with multiplexing that could potentially impact the accuracy of MRD analysis. We optimize a strategy that combines high-purity, sequence-optimized oligonucleotides, dual indexing, and an error-aware demultiplexing approach to minimize errors and maximize sensitivity. We present a probability-based, demultiplexing pipeline Error-Aware Demultiplexer that is suitable for all MiSeq strategies and accurately assigns samples to the correct identifier without excessive loss of data. Finally, using controls quantified by digital PCR, we show that HTS-MRD can accurately detect as few as 1 in 10(6) copies of specific leukemic MRD.
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Affiliation(s)
- Jack Bartram
- Genetics and Genomic Medicine Program, Institute of Child Health, University College London, London, United Kingdom; Department of Haematology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Edward Mountjoy
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Tony Brooks
- UCL Genomics Centre, Institute of Child Health, University College London, London, United Kingdom
| | - Jeremy Hancock
- Bristol Genetics Laboratory, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Helen Williamson
- Bristol Genetics Laboratory, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Gary Wright
- Department of Haematology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - John Moppett
- Department of Paediatric Haematology/Oncology, Royal Hospital for Children, Bristol, United Kingdom
| | - Nick Goulden
- Department of Haematology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Mike Hubank
- Genetics and Genomic Medicine Program, Institute of Child Health, University College London, London, United Kingdom; UCL Genomics Centre, Institute of Child Health, University College London, London, United Kingdom.
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Bartram J, Wade R, Vora A, Hancock J, Mitchell C, Kinsey S, Steward C, Moppett J, Goulden N. Excellent outcome of minimal residual disease-defined low-risk patients is sustained with more than 10 years follow-up: results of UK paediatric acute lymphoblastic leukaemia trials 1997-2003. Arch Dis Child 2016; 101:449-54. [PMID: 26865705 DOI: 10.1136/archdischild-2015-309617] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 01/20/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND Minimal residual disease (MRD) is defined as the presence of sub-microscopic levels of leukaemia. Measurement of MRD from bone marrow at the end of induction chemotherapy (day 28) for childhood acute lymphoblastic leukaemia (ALL) can highlight a large group of patients (>40%) with an excellent (>90%) short-term event-free survival (EFS). However, follow-up in recent published trials is relatively short, raising concerns about using this result to infer the safety of further therapy reduction in the future. METHODS We examined MRD data on 225 patients treated on one of three UKALL trials between 1997 and 2003 to assess the long-term (>10 years follow-up) outcome of those patients who had low-risk MRD (<0.01%) at day 28. RESULTS Our pilot data define a cohort of 53% of children with MRD <0.01% at day 28 who have an EFS of 91% and long-term overall survival of 97%. Of 120 patients with day-28 MRD <0.01% and extended follow-up, there was one death due to treatment-related toxicity, one infectious death while in complete remission, and four relapse deaths. CONCLUSIONS The excellent outcome for childhood ALL in patients with MRD <0.01% after induction chemotherapy is sustained for more than 10 years from diagnosis. This supports the potential exploration of further reduction of therapy in this group, in an attempt to reduce treatment-related mortality and late effects.
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Affiliation(s)
- Jack Bartram
- Department of Haematology, Great Ormond Street Hospital for Children, London, UK
| | - Rachel Wade
- Clinical Trial Service Unit, University of Oxford, Oxford, UK
| | - Ajay Vora
- Department of Haematology, Sheffield Children's Hospital, Sheffield, UK
| | - Jeremy Hancock
- Bristol Genetics Laboratory, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Chris Mitchell
- Paediatric Haematology and Oncology, John Radcliffe Hospital, Oxford, UK
| | - Sally Kinsey
- Department of Paediatric Haematology, St James' University Hospital, Leeds, UK
| | - Colin Steward
- Department of Paediatric Haematology/Oncology, Royal Hospital for Children, Bristol, UK
| | - John Moppett
- Department of Paediatric Haematology/Oncology, Royal Hospital for Children, Bristol, UK
| | - Nick Goulden
- Department of Haematology, Great Ormond Street Hospital for Children, London, UK
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Minimal Residual Disease Evaluation in Childhood Acute Lymphoblastic Leukemia: A Clinical Evidence Review. ONTARIO HEALTH TECHNOLOGY ASSESSMENT SERIES 2016; 16:1-52. [PMID: 27099643 PMCID: PMC4808716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Leukemia accounts for nearly a third of childhood cancers in Canada, with acute lymphoblastic leukemia (ALL) comprising nearly 80% of cases. Identification of prognostic factors that allow risk stratification and tailored treatment have improved overall survival. However, nearly a quarter of patients considered standard risk on the basis of conventional prognostic factors still relapse, and relapse is associated with increased morbidity and mortality. Relapse is thought to result from extremely low levels of leukemic cells left over once complete remission is reached, termed minimal residual disease (MRD). Poor event-free survival (EFS) as well as overall survival for those who are classified as MRD-positive have been substantiated in seminal studies demonstrating the prognostic value of MRD for EFS in the past few decades. This review sought to further elucidate the relationship between MRD and EFS by looking at relapse, the primary determinant of EFS and the biological mechanism through which MRD is thought to act. This evidence review aimed to ascertain whether MRD is an independent prognostic factor for relapse and to assess the effect of MRD-directed treatment on patient-important outcomes in childhood ALL. METHODS Large prospective cohort studies with a priori multivariable analysis that includes potential confounders are required to draw confirmatory conclusions about the independence of a prognostic factor. Data on the prognostic value of MRD for relapse measured by molecular methods (polymerase chain reaction [PCR] of immunoglobulin or T-cell receptor rearrangements) or flow cytometry for leukemia-associated immunophenotypes or difference-from-normal approach were abstracted from included studies. Relevant data on relapse, EFS, and overall survival were abstracted from randomized controlled trials (RCTs) evaluating the effect of MRD-directed treatment. RESULTS A total of 2,832 citations were reviewed, of which 12 studies were included in this review. All cohort studies evaluating MRD as a prognostic factor for relapse found significant independent value when added to various existing prognostic factors. Seven studies showed prognostic value of MRD measured at the end of induction therapy and two at the end of consolidation therapy in de novo ALL, one study in relapsed ALL after re-induction therapy, and three studies before hematopoietic stem cell transplant. One large RCT in standard-risk patients found no compromise to outcomes when reducing treatment in MRD-negative patients, and also showed a 45% reduction in relapse risk and nearly 40% benefit in EFS when escalating treatment in MRD-positive patients. CONCLUSIONS Minimal residual disease is an independent prognostic factor for relapse in childhood ALL. Relapse is a key determinant of EFS and patients' quality of life. Treatment selected on the basis of MRD status appears to improve outcomes.
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Prognostic Impact of WT-1 Gene Expression in Egyptian Children with Acute Lymphoblastic Leukemia. Mediterr J Hematol Infect Dis 2016; 8:e2016008. [PMID: 26740869 PMCID: PMC4696468 DOI: 10.4084/mjhid.2016.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 11/11/2015] [Indexed: 11/18/2022] Open
Abstract
Background Acute lymphoblastic leukemia (ALL) is the most common childhood cancer representing 23% of pediatric cancers. Wilms’ tumor -1 gene is a novel prognostic factor, minimal residual disease marker and therapeutic target in acute leukemia. Aim of the work The aim of this work was to study the impact of WT-1 gene expression in the prognosis of ALL. Patients and methods This study was conducted on 40 Egyptian children with newly diagnosed ALL who were subjected to full history taking, thorough clinical examination and laboratory investigations including; complete blood count, LDH, BM aspiration, cytochemistry, immunophenotyping, FISH technique for detection of t(12;21) and t(9;22) and assessment of WT-1 Gene by real-time PCR in BM samples at time of diagnosis. Results Positive WT-1 gene expression was found in 22 cases (55%) and negative expression in 18 cases (45%). Positive WT-1 gene expression group (n=22) includes 14 males and 8 females with mean age at presentation of 5.261 ± 0.811 while negative WT-1 gene expression group (n=18) includes 12 males and 6 females with mean age at diagnosis of 9.669 ± 3.731 with significantly older age in negative WT-1 gene expression group but no significant differences between positive and negative WT-1 gene expression groups regarding sex and clinical presentations. There were no significant differences in platelets and WBCs counts, hemoglobin and LDH levels and the number of peripheral blood and BM blast cells at diagnosis between positive and negative WT-1 gene expression groups but after induction therapy there were significantly lower BM blast cells in positive WT-1 gene expression group. There were no statistically significant differences between positive and negative WT-1 gene expression groups regarding immunophenotyping and chromosomal translocations including t(12;21) and t(9;22). There were a significantly higher relapse and death rate and a lower rate of CR, DFS, and OAS in negative WT-1 gene expression group. MRD at end of induction therapy was found in 14 cases out of 40 patients. There were significantly higher number of patients with MRD+ in negative WT-1 gene expression group (After the therapy 20 out of 22 (89%) patients with positive WT-1 gene expression attained a negative MRD, while only 6 out of 18 (33%) with negative WT-1 attained a negative MRD) (p-value = 0.006). Conclusions and Recommendation WT-1 gene expression is an important prognostic factor in patients with ALL, being able to prognosticate a negative MRD. Therefore, we can recommend its incorporation into novel risk-adapted therapeutic strategies in patients with ALL.
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Wang W, Gao L, Li Y, Li ZL, Gong M, Huang FZ, Chen YR, Zhang CX, Gao YY, Ma YG. The application of CD73 in minimal residual disease monitoring using flow cytometry in B-cell acute lymphoblastic leukemia. Leuk Lymphoma 2015; 57:1174-81. [PMID: 26436205 DOI: 10.3109/10428194.2015.1070153] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The expression of CD73 by flow cytometry (FC) in bone marrow (BM) specimens of B-cell acute lymphoblastic leukemia (B-ALL) with or without minimal residual disease (MRD) was studied, and its advantages were evaluated using the MRD assay. This study also detected the expression profile of CD73 in hematogones and mature B cells in BM specimens of 18 healthy donors. Results showed that the mean value of CD73 expression in MRD-positive B cells was 6-fold greater than that in the MRD negative ones. Also, 41.82% MRD-positive B-ALL cases expressed high CD73 and the sensitivity of CD73-based MRD detection reached 10(-4). Since the expression of CD73 increases with the maturation of normal B cells, it is better to mix it with CD34, CD10 and CD20 in one tube to prevent the disturbance of mature B cells. CD73 is recommended as an optional MRD marker for B-ALL patients by using FC.
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Affiliation(s)
- Wei Wang
- a Department of Hematology , China-Japan Friendship Hospital , Beijing , PR China
| | - Li Gao
- a Department of Hematology , China-Japan Friendship Hospital , Beijing , PR China
| | - Yan Li
- a Department of Hematology , China-Japan Friendship Hospital , Beijing , PR China
| | - Zhen-Ling Li
- a Department of Hematology , China-Japan Friendship Hospital , Beijing , PR China
| | - Ming Gong
- a Department of Hematology , China-Japan Friendship Hospital , Beijing , PR China
| | - Fan-Zhou Huang
- a Department of Hematology , China-Japan Friendship Hospital , Beijing , PR China
| | - Yan-Rong Chen
- a Department of Hematology , China-Japan Friendship Hospital , Beijing , PR China
| | - Chun-Xia Zhang
- a Department of Hematology , China-Japan Friendship Hospital , Beijing , PR China
| | - Ya-Yue Gao
- a Department of Hematology , China-Japan Friendship Hospital , Beijing , PR China
| | - Yi-Gai Ma
- a Department of Hematology , China-Japan Friendship Hospital , Beijing , PR China
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Ikoma MRV, Beltrame MP, Ferreira SIACP, Souto EX, Malvezzi M, Yamamoto M. Proposal for the standardization of flow cytometry protocols to detect minimal residual disease in acute lymphoblastic leukemia. Rev Bras Hematol Hemoter 2015; 37:406-13. [PMID: 26670404 PMCID: PMC4678914 DOI: 10.1016/j.bjhh.2015.07.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 07/23/2015] [Accepted: 07/27/2015] [Indexed: 01/26/2023] Open
Abstract
Minimal residual disease is the most powerful predictor of outcome in acute leukemia and is useful in therapeutic stratification for acute lymphoblastic leukemia protocols. Nowadays, the most reliable methods for studying minimal residual disease in acute lymphoblastic leukemia are multiparametric flow cytometry and polymerase chain reaction. Both provide similar results at a minimal residual disease level of 0.01% of normal cells, that is, detection of one leukemic cell in up to 10,000 normal nucleated cells. Currently, therapeutic protocols establish the minimal residual disease threshold value at the most informative time points according to the appropriate methodology employed. The expertise of the laboratory in a cancer center or a cooperative group could be the most important factor in determining which method should be used. In Brazil, multiparametric flow cytometry laboratories are available in most leukemia treatment centers, but multiparametric flow cytometry processes must be standardized for minimal residual disease investigations in order to offer reliable and reproducible results that ensure quality in the clinical application of the method. The Minimal Residual Disease Working Group of the Brazilian Society of Bone Marrow Transplantation (SBTMO) was created with that aim. This paper presents recommendations for the detection of minimal residual disease in acute lymphoblastic leukemia based on the literature and expertise of the laboratories who participated in this consensus, including pre-analytical and analytical methods. This paper also recommends that both multiparametric flow cytometry and polymerase chain reaction are complementary methods, and so more laboratories with expertise in immunoglobulin/T cell receptor (Ig/TCR) gene assays are necessary in Brazil.
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Affiliation(s)
| | | | | | | | | | - Mihoko Yamamoto
- Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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Seitz V, Schaper S, Dröge A, Lenze D, Hummel M, Hennig S. A new method to prevent carry-over contaminations in two-step PCR NGS library preparations. Nucleic Acids Res 2015; 43:e135. [PMID: 26152304 PMCID: PMC4787772 DOI: 10.1093/nar/gkv694] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 06/25/2015] [Indexed: 11/12/2022] Open
Abstract
Two-step PCR procedures are an efficient and well established way to generate amplicon libraries for NGS sequencing. However, there is a high risk of cross-contamination by carry-over of amplicons from first to second amplification rounds, potentially leading to severe misinterpretation of results. Here we describe a new method able to prevent and/or to identify carry-over contaminations by introducing the K-box, a series of three synergistically acting short sequence elements. Our K-boxes are composed of (i) K1 sequences for suppression of contaminations, (ii) K2 sequences for detection of possible residual contaminations and (iii) S sequences acting as separators to avoid amplification bias. In order to demonstrate the effectiveness of our method we analyzed two-step PCR NGS libraries derived from a multiplex PCR system for detection of T-cell receptor beta gene rearrangements. We used this system since it is of high clinical relevance and may be affected by very low amounts of contaminations. Spike-in contaminations are effectively blocked by the K-box even at high rates as demonstrated by ultra-deep sequencing of the amplicons. Thus, we recommend implementation of the K-box in two-step PCR-based NGS systems for research and diagnostic applications demanding high sensitivity and accuracy.
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Affiliation(s)
- Volkhard Seitz
- Institute of Pathology, Charité-University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany HS Diagnomics GmbH, Berlin, Germany
| | | | | | - Dido Lenze
- Institute of Pathology, Charité-University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Michael Hummel
- Institute of Pathology, Charité-University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
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Ma X, Edmonson M, Yergeau D, Muzny DM, Hampton OA, Rusch M, Song G, Easton J, Harvey RC, Wheeler DA, Ma J, Doddapaneni H, Vadodaria B, Wu G, Nagahawatte P, Carroll WL, Chen IM, Gastier-Foster JM, Relling MV, Smith MA, Devidas M, Auvil JMG, Downing JR, Loh ML, Willman CL, Gerhard DS, Mullighan CG, Hunger SP, Zhang J. Rise and fall of subclones from diagnosis to relapse in pediatric B-acute lymphoblastic leukaemia. Nat Commun 2015; 6:6604. [PMID: 25790293 PMCID: PMC4377644 DOI: 10.1038/ncomms7604] [Citation(s) in RCA: 235] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 02/11/2015] [Indexed: 12/30/2022] Open
Abstract
There is incomplete understanding of genetic heterogeneity and clonal evolution during cancer progression. Here we use deep whole-exome sequencing to describe the clonal architecture and evolution of 20 pediatric B-acute lymphoblastic leukaemias from diagnosis to relapse. We show that clonal diversity is comparable at diagnosis and relapse and clonal survival from diagnosis to relapse is not associated with mutation burden. Six pathways were frequently mutated, with NT5C2, CREBBP, WHSC1, TP53, USH2A, NRAS and IKZF1 mutations enriched at relapse. Half of the leukaemias had multiple subclonal mutations in a pathway or gene at diagnosis, but mostly with only one, usually minor clone, surviving therapy to acquire additional mutations and become the relapse founder clone. Relapse-specific mutations in NT5C2 were found in nine cases, with mutations in four cases being in descendants of the relapse founder clone. These results provide important insights into the genetic basis of treatment failure in ALL and have implications for the early detection of mutations driving relapse.
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Affiliation(s)
- Xiaotu Ma
- Computational Biology, St Jude Children’s Research Hospital, Memphis, Tennessee 38105, USA
| | - Michael Edmonson
- Computational Biology, St Jude Children’s Research Hospital, Memphis, Tennessee 38105, USA
| | - Donald Yergeau
- Pediatric Cancer Genome Project Validation Lab, St Jude Children’s Research Hospital, Memphis, Tennessee 38105, USA
| | - Donna M. Muzny
- Cancer Genomics, Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Oliver A. Hampton
- Cancer Genomics, Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Michael Rusch
- Computational Biology, St Jude Children’s Research Hospital, Memphis, Tennessee 38105, USA
| | - Guangchun Song
- Pathology, St Jude Children’s Research Hospital, Memphis, Tennessee 38105, USA
| | - John Easton
- Pediatric Cancer Genome Project Validation Lab, St Jude Children’s Research Hospital, Memphis, Tennessee 38105, USA
| | - Richard C. Harvey
- University of New Mexico Cancer Center, Albuquerque, New Mexico 87131, USA
| | - David A. Wheeler
- Cancer Genomics, Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Jing Ma
- Pathology, St Jude Children’s Research Hospital, Memphis, Tennessee 38105, USA
| | - HarshaVardhan Doddapaneni
- Cancer Genomics, Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Bhavin Vadodaria
- Pediatric Cancer Genome Project Validation Lab, St Jude Children’s Research Hospital, Memphis, Tennessee 38105, USA
| | - Gang Wu
- Computational Biology, St Jude Children’s Research Hospital, Memphis, Tennessee 38105, USA
| | - Panduka Nagahawatte
- Computational Biology, St Jude Children’s Research Hospital, Memphis, Tennessee 38105, USA
| | - William L. Carroll
- Perlmutter Cancer Center, NYU Langone Medical Center, New York, NY 10016, USA
| | - I-Ming Chen
- University of New Mexico Cancer Center, Albuquerque, New Mexico 87131, USA
| | - Julie M. Gastier-Foster
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio 43205, USA
- Departments of Pathology and Pediatrics, The Ohio State University, Columbus, Ohio 43210, USA
| | - Mary V. Relling
- Department of Pharmaceutical Sciences, St Jude Children’s Research Hospital, Memphis, Tennessee 38105, USA
| | - Malcolm A. Smith
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland 20892, USA
| | - Meenakshi Devidas
- Department of Biostatistics, Colleges of Medicine, Public Health & Health Professions, University of Florida, Gainesville, Florida 32607, USA
| | | | - James R. Downing
- Pathology, St Jude Children’s Research Hospital, Memphis, Tennessee 38105, USA
| | - Mignon L. Loh
- Department of Pediatrics, Benioff Children’s Hospital and the Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California 94143, USA
| | - Cheryl L. Willman
- University of New Mexico Cancer Center, Albuquerque, New Mexico 87131, USA
| | - Daniela S. Gerhard
- Office of Cancer Genomics, National Cancer Institute, Bethesda, Maryland 20892, USA
| | | | - Stephen P. Hunger
- Division of Oncology and The Center for Childhood Cancer Research, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA
| | - Jinghui Zhang
- Computational Biology, St Jude Children’s Research Hospital, Memphis, Tennessee 38105, USA
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Ben Lassoued A, Nivaggioni V, Gabert J. Minimal residual disease testing in hematologic malignancies and solid cancer. Expert Rev Mol Diagn 2015; 14:699-712. [PMID: 24938122 DOI: 10.1586/14737159.2014.927311] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Minimal residual disease (MRD) assays are of a great value to assess treatment efficacy and may provide prognostic information. This is particularly relevant in the era of targeted therapy where the introduction of MRD monitoring has fundamentally transformed the way in which cancer patients are managed. While MRD guidelines are well-established for chronic myeloid leukemia, acute promyelocytic leukemia and acute lymphoblastic leukemia, areas for continuing development are available. High level of standardization and regular external quality control rounds and recommendations for data interpretation remain essential to improve MRD monitoring. In this review, we describe the different applications of MRD assays in most frequent hematologic malignancies and solid cancer and provide an overview of the strengths and potential weaknesses of each method.
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Affiliation(s)
- Amin Ben Lassoued
- Laboratoire de Biochimie et de Biologie Moléculaire, Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital NORD, Marseille, France
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35
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Ceppi F, Cazzaniga G, Colombini A, Biondi A, Conter V. Risk factors for relapse in childhood acute lymphoblastic leukemia: prediction and prevention. Expert Rev Hematol 2014; 8:57-70. [PMID: 25367188 DOI: 10.1586/17474086.2015.978281] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
With current treatment regimens, survival rates for acute lymphoblastic leukemia (ALL) have improved dramatically since the 1980s, with current 5-year overall survival rates estimated at greater than 85%. This success was achieved, in part, through the implementation of risk-stratified therapy. Nevertheless, for a subgroup of patients (15-20%) with newly diagnosed ALL who will ultimately relapse, traditional risk assessment remains inadequate. The risk of relapse may be estimated on the basis of diagnostic features or early treatment response findings. Further progress in this field may thus come from refinement of predictive factors for relapse and treatment adaptation and from the identification of biological subsets of ALL patients who could benefit from specific target therapies. This article summarizes the aspects associated with the identification of predictive factors for relapse in childhood ALL and options available for prevention of disease recurrence.
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Affiliation(s)
- Francesco Ceppi
- Division of Haematology/Oncology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
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36
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Shishido S, Bönig H, Kim YM. Role of integrin alpha4 in drug resistance of leukemia. Front Oncol 2014; 4:99. [PMID: 24904821 PMCID: PMC4033044 DOI: 10.3389/fonc.2014.00099] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 04/22/2014] [Indexed: 11/20/2022] Open
Abstract
Chemotherapeutic drug resistance in acute lymphoblastic leukemia (ALL) is a significant problem, resulting in poor responsiveness to first-line treatment or relapse after transient remission. Classical anti-leukemic drugs are non-specific cell cycle poisons; some more modern drugs target oncogenic pathways in leukemia cells, although in ALL these do not play a very significant role. By contrast, the molecular interactions between microenvironment and leukemia cells are often neglected in the design of novel therapies against drug resistant leukemia. It was shown however, that chemotherapy resistance is promoted in part through cell–cell contact of leukemia cells with bone marrow (BM) stromal cells, also called cell adhesion-mediated drug resistance (CAM-DR). Incomplete response to chemotherapy results in persistence of resistant clones with or without detectable minimal residual disease (MRD). Approaches for how to address CAM-DR and MRD remain elusive. Specifically, studies using anti-functional antibodies and genetic models have identified integrin alpha4 as a critical molecule regulating BM homing and active retention of normal and leukemic cells. Pre-clinical evidence has been provided that interference with alpha4-mediated adhesion of ALL cells can sensitize them to chemotherapy and thus facilitate eradication of ALL cells in an MRD setting. To this end, Andreeff and colleagues recently provided evidence of stroma-induced and alpha4-mediated nuclear factor-κB signaling in leukemia cells, disruption of which depletes leukemia cells of strong survival signals. We here review the available evidence supporting the targeting of alpha4 as a novel strategy for treatment of drug resistant leukemia.
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Affiliation(s)
- Stephanie Shishido
- Division of Hematology and Oncology, Department of Pediatrics, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine , Los Angeles, CA , USA
| | - Halvard Bönig
- Institute for Transfusion Medicine and Immunohematology, German Red Cross Blood Service Baden-Wuerttemberg-Hessen, Goethe University , Frankfurt , Germany
| | - Yong-Mi Kim
- Division of Hematology and Oncology, Department of Pediatrics, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine , Los Angeles, CA , USA
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Herrera D, Rojas OL, Duarte-Rey C, Mantilla RD, Ángel J, Franco MA. Simultaneous assessment of rotavirus-specific memory B cells and serological memory after B cell depletion therapy with rituximab. PLoS One 2014; 9:e97087. [PMID: 24819618 PMCID: PMC4018270 DOI: 10.1371/journal.pone.0097087] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 04/15/2014] [Indexed: 01/05/2023] Open
Abstract
The mechanisms that contribute to the maintenance of serological memory are still unclear. Rotavirus (RV) memory B cells (mBc) are enriched in IgM+ and CD27- subpopulations, which are associated with autoimmune diseases pathogenesis. In patients with autoimmune diseases treated with Rituximab (RTX), some autoantibodies (auto-Abs) decrease after treatment, but other auto-Abs and pathogen-specific IgG Abs remain unchanged. Thus, maintenance of autoimmune and pathogen-specific serological memory may depend on the type of antigen and/or Ab isotype evaluated. Antigen-specific mBc and antigen-specific Abs of different isotypes have not been simultaneously assessed in patients after RTX treatment. To study the relationship between mBc subpopulations and serological memory we characterized total, RV- and tetanus toxoid (TT)-specific mBc by flow cytometry in patients with autoimmune diseases before and after treatment with RTX. We also measured total, RV- and TT-Abs, and some auto-Abs by kinetic nephelometry, ELISA, and EliA tests, respectively. Minor differences were observed between the relative frequencies of RV-mBc in healthy controls and patients with autoimmune disease. After RTX treatment, naïve Bc and total, RV- and TT-specific mBc [IgM+, switched (IgA+/IgG+), IgM+ only, IgD+ only, and CD27- (IgA+/IgG+/IgM+)] were significantly diminished. An important decrease in total plasma IgM and minor decreases in total IgG and IgA levels were also observed. IgM rheumatoid factor, IgG anti-CCP, and IgG anti-dsDNA were significantly diminished. In contrast, RV-IgA, RV-IgG and RV-IgG1, and TT-IgG titers remained stable. In conclusion, in patients with autoimmunity, serological memory against RV and TT seem to be maintained by long-lived plasma cells, unaffected by RTX, and an important proportion of total IgM and serological memory against some auto-antigens seem to be maintained by short-lived plasma cells, dependent on mBc precursors depleted by RTX.
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Affiliation(s)
- Daniel Herrera
- Instituto de Genética Humana, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Olga L. Rojas
- Unidad de Inmunología, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | | | | | - Juana Ángel
- Instituto de Genética Humana, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Manuel A. Franco
- Instituto de Genética Humana, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
- * E-mail:
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Clinical significance of minimal residual disease in young adults with standard-risk/Ph-negative precursor B-acute lymphoblastic leukemia: results of prospective study. Med Oncol 2014; 31:938. [PMID: 24692146 DOI: 10.1007/s12032-014-0938-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 03/21/2014] [Indexed: 01/08/2023]
Abstract
Clinical risk classification is inaccurate in predicting outcome in adult patients with acute lymphoblastic leukemia (ALL), sometimes resulting in patients receiving inappropriate chemotherapy or stem cell transplantation. To identify complementary markers suitable for further treatment stratification in patients with standard-risk (SR)/philadelphia-negative (Ph-negative) precursor B-ALL, we evaluated the predictive value of minimal residual disease (MRD) after induction and consolidation chemotherapy in strictly defined SR/Ph-negative precursor B-ALL patients who were treated with a standard protocol using quantitative real-time polymerase chain reaction with the rearranged immunoglobulin heavy chain gene as a molecular marker. The cytologic complete response (CR) rate was 92.3 % after induction. At this time point, the molecular CR rate was 73.9%. Patients with molecular CR (MolCR) after induction had a significantly higher probability of disease-free survival (DFS; 78.8 vs 30.8%; P = .001) and of overall survival (OS; 82.4 vs 41.7%; P < .0001) compared to patients with molecular failure (MolFail). MRD at end consolidation had the same significance. Quantitative MRD assessment identified patients with MolFail after induction and/or consolidation as a high-risk group, with 3-year DFS and OS rates of 28.6 and 35.7%, respectively. Patients with MolCR after induction and consolidation were classified as low-risk and had 3-year DFS rate of 89.7% and OS rate of 93.3%. Thus, MRD quantification during treatment identified prognostic subgroups within the otherwise homogeneous SR/Ph-negative precursor B-ALL population who may benefit from individualized treatment.
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Dos Santos GA, Kats L, Pandolfi PP. Synergy against PML-RARa: targeting transcription, proteolysis, differentiation, and self-renewal in acute promyelocytic leukemia. ACTA ACUST UNITED AC 2014; 210:2793-802. [PMID: 24344243 PMCID: PMC3865469 DOI: 10.1084/jem.20131121] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Pandolfi et al. provide an in-depth discussion on the synergism between all-trans-retinoic acid and arsenic trioxide treatment and their mechanisms of action on acute promyelocytic leukemia. Acute promyelocytic leukemia (APL) is a hematological malignancy driven by a chimeric oncoprotein containing the C terminus of the retinoic acid receptor-a (RARa) fused to an N-terminal partner, most commonly promyelocytic leukemia protein (PML). Mechanistically, PML-RARa acts as a transcriptional repressor of RARa and non-RARa target genes and antagonizes the formation and function of PML nuclear bodies that regulate numerous signaling pathways. The empirical discoveries that PML-RARa–associated APL is sensitive to both all-trans-retinoic acid (ATRA) and arsenic trioxide (ATO), and the subsequent understanding of the mechanisms of action of these drugs, have led to efforts to understand the contribution of molecular events to APL cell differentiation, leukemia-initiating cell (LIC) clearance, and disease eradication in vitro and in vivo. Critically, the mechanistic insights gleaned from these studies have resulted not only in a better understanding of APL itself, but also carry valuable lessons for other malignancies.
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Affiliation(s)
- Guilherme Augusto Dos Santos
- Cancer Genetics Program, Beth Israel Deaconess Cancer Center; and 2 Department of Medicine and 3 Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215
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40
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Ladetto M, Brüggemann M, Monitillo L, Ferrero S, Pepin F, Drandi D, Barbero D, Palumbo A, Passera R, Boccadoro M, Ritgen M, Gökbuget N, Zheng J, Carlton V, Trautmann H, Faham M, Pott C. Next-generation sequencing and real-time quantitative PCR for minimal residual disease detection in B-cell disorders. Leukemia 2013. [PMID: 24342950 DOI: 10.1038/leu.2013.375.[epub] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In this study, we compared immunoglobulin heavy-chain-gene-based minimal residual disease (MRD) detection by real-time quantitative PCR (RQ-PCR) and next-generation sequencing (NGS) to assess whether NGS could overcome some limitations of RQ-PCR and further increase sensitivity, specificity, accuracy and reproducibility. In total, 378 samples from 55 patients with acute lymphoblastic leukemia (ALL), mantle cell lymphoma (MCL) or multiple myeloma (MM) were investigated for clonotype identification, clonotype identity and comparability of MRD results. Forty-five clonotypes were identified by RQ-PCR and 49 by NGS. Clonotypes identified by both tools were identical or >97% homologous in 96% of cases. Both tools were able to routinely reach a sensitivity level of 1 × E-05. A good correlation of MRD results was observed (R=0.791, P<0.001), with excellent concordance in 79.6% of cases. Few discordant cases were observed across all disease subtypes. NGS showed at least the same level of sensitivity as allele-specific oligonucleotides-PCR, without the need for patient-specific reagents. We conclude that NGS is an effective tool for MRD monitoring in ALL, MCL and MM. Prospective comparative analysis of unselected cases is required to validate the clinical impact of NGS-based MRD assessment.
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Affiliation(s)
- M Ladetto
- Division of Hematology, A.O. Azienda Ospedaliera Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - M Brüggemann
- Second Medical Department, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - L Monitillo
- Division of Hematology, A.O. Azienda Ospedaliera Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - S Ferrero
- Division of Hematology, A.O. Azienda Ospedaliera Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - F Pepin
- Sequenta Inc, San Francisco, CA, USA
| | - D Drandi
- Division of Hematology, A.O. Azienda Ospedaliera Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - D Barbero
- Division of Hematology, A.O. Azienda Ospedaliera Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - A Palumbo
- Division of Hematology, A.O. Azienda Ospedaliera Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - R Passera
- Division of Nuclear Medicine, Statistical Consultant, University of Torino, Torino, Italy
| | - M Boccadoro
- Division of Hematology, A.O. Azienda Ospedaliera Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - M Ritgen
- Second Medical Department, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - N Gökbuget
- Department of Internal Medicine II, Hematology and Oncology, Goethe University Hospital, Frankfurt, Germany
| | - J Zheng
- Sequenta Inc, San Francisco, CA, USA
| | - V Carlton
- Sequenta Inc, San Francisco, CA, USA
| | - H Trautmann
- Second Medical Department, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - M Faham
- Sequenta Inc, San Francisco, CA, USA
| | - C Pott
- Second Medical Department, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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41
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Ladetto M, Brüggemann M, Monitillo L, Ferrero S, Pepin F, Drandi D, Barbero D, Palumbo A, Passera R, Boccadoro M, Ritgen M, Gökbuget N, Zheng J, Carlton V, Trautmann H, Faham M, Pott C. Next-generation sequencing and real-time quantitative PCR for minimal residual disease detection in B-cell disorders. Leukemia 2013; 28:1299-307. [PMID: 24342950 DOI: 10.1038/leu.2013.375] [Citation(s) in RCA: 230] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 11/20/2013] [Accepted: 11/21/2013] [Indexed: 01/21/2023]
Abstract
In this study, we compared immunoglobulin heavy-chain-gene-based minimal residual disease (MRD) detection by real-time quantitative PCR (RQ-PCR) and next-generation sequencing (NGS) to assess whether NGS could overcome some limitations of RQ-PCR and further increase sensitivity, specificity, accuracy and reproducibility. In total, 378 samples from 55 patients with acute lymphoblastic leukemia (ALL), mantle cell lymphoma (MCL) or multiple myeloma (MM) were investigated for clonotype identification, clonotype identity and comparability of MRD results. Forty-five clonotypes were identified by RQ-PCR and 49 by NGS. Clonotypes identified by both tools were identical or >97% homologous in 96% of cases. Both tools were able to routinely reach a sensitivity level of 1 × E-05. A good correlation of MRD results was observed (R=0.791, P<0.001), with excellent concordance in 79.6% of cases. Few discordant cases were observed across all disease subtypes. NGS showed at least the same level of sensitivity as allele-specific oligonucleotides-PCR, without the need for patient-specific reagents. We conclude that NGS is an effective tool for MRD monitoring in ALL, MCL and MM. Prospective comparative analysis of unselected cases is required to validate the clinical impact of NGS-based MRD assessment.
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Affiliation(s)
- M Ladetto
- Division of Hematology, A.O. Azienda Ospedaliera Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - M Brüggemann
- Second Medical Department, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - L Monitillo
- Division of Hematology, A.O. Azienda Ospedaliera Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - S Ferrero
- Division of Hematology, A.O. Azienda Ospedaliera Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - F Pepin
- Sequenta Inc, San Francisco, CA, USA
| | - D Drandi
- Division of Hematology, A.O. Azienda Ospedaliera Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - D Barbero
- Division of Hematology, A.O. Azienda Ospedaliera Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - A Palumbo
- Division of Hematology, A.O. Azienda Ospedaliera Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - R Passera
- Division of Nuclear Medicine, Statistical Consultant, University of Torino, Torino, Italy
| | - M Boccadoro
- Division of Hematology, A.O. Azienda Ospedaliera Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - M Ritgen
- Second Medical Department, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - N Gökbuget
- Department of Internal Medicine II, Hematology and Oncology, Goethe University Hospital, Frankfurt, Germany
| | - J Zheng
- Sequenta Inc, San Francisco, CA, USA
| | - V Carlton
- Sequenta Inc, San Francisco, CA, USA
| | - H Trautmann
- Second Medical Department, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - M Faham
- Sequenta Inc, San Francisco, CA, USA
| | - C Pott
- Second Medical Department, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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42
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Woo J, Baumann A, Arguello V. Recent advancements of flow cytometry: new applications in hematology and oncology. Expert Rev Mol Diagn 2013; 14:67-81. [DOI: 10.1586/14737159.2014.862153] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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43
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Early assessment of minimal residual disease identifies patients at very high relapse risk in NPM-ALK-positive anaplastic large-cell lymphoma. Blood 2013; 123:334-7. [PMID: 24297868 DOI: 10.1182/blood-2013-09-526202] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Detection of minimal disseminated disease (MDD) at diagnosis correlates with relapse risk in children with anaplastic lymphoma kinase (ALK)-positive anaplastic large-cell lymphoma (ALCL). We investigated whether minimal residual disease (MRD) positivity by qualitative reverse-transcriptase polymerase chain reaction (RT-PCR) for Nucleophosmin (NPM)-ALK during treatment identifies patients at the highest relapse risk. Blood and/or bone marrow of 180 patients with NPM-ALK-positive ALCL treated with Berlin-Frankfurt-Münster-type protocols were screened for NPM-ALK transcripts at diagnosis; 103 were found to be MDD-positive. MRD before the second therapy course could be evaluated in 52 MDD-positive patients. MRD positivity correlated with uncommon histology. The cumulative incidence of relapses (CIR) of 26 MDD-positive/MRD-positive patients (81% ± 8%) was significantly higher than the CIR of 26 MDD-positive/MRD-negative (31% ± 9%) and 77 MDD-negative patients (15% ± 5%) (P < .001). Five-year survival of MDD-negative and MDD-positive/MRD-negative patients was 91% ± 3% and 92% ± 5%, respectively, compared with 65% ± 9% of MDD-positive/MRD-positive patients (P < .001). Early evaluation of MRD in NPM-ALK-positive ALCL identifies patients with a very high relapse risk and inferior survival.
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44
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Samra MA, Mahmoud HK, Abdelhamid TM, El Sharkawy NM, Elnahass YH, Elgammal M, Abdelfattah RM, Eid S, Ghaleb FM, Kamel AM. The prognostic significance of minimal residual disease in adult Egyptian patients with precursor acute lymphoblastic leukemia. J Egypt Natl Canc Inst 2013; 25:135-42. [DOI: 10.1016/j.jnci.2013.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Revised: 05/19/2013] [Accepted: 05/20/2013] [Indexed: 12/31/2022] Open
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Prognostic significance of monitoring leukemia-associated immunophenotypes by eight-color flow cytometry in adult B-acute lymphoblastic leukemia. Blood Cancer J 2013; 3:e133. [PMID: 23955588 PMCID: PMC3763385 DOI: 10.1038/bcj.2013.31] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 06/17/2013] [Accepted: 07/01/2013] [Indexed: 12/24/2022] Open
Abstract
Minimal residual disease (MRD) is of the most important factor for predicting prognosis and guiding treatment of acute lymphoblastic leukemia (ALL). In this study, we investigated the prognostic significance of leukemia-associated immunophenotypes (LAIPs) as assessment of index of MRD in 125 adult B-lineage ALL (B-ALL) patients by eight-color flow cytometry. The LAIPs could be identified in 96% and 81.6% of patients with the sensitivity of 10(-4) and 10(-5), respectively. MRD-negative status could clearly predict a favorable 2-year relapse-free survival (RFS) and overall survival (OS) at the end of induction of complete remission and one cycle of consolidation treatment. Moreover, we identified a group of cases with MRD of 0.001% to <0.01%, which showed significantly higher 2-year relapse rate than those with undetectable one. In multivariate analysis, MRD status was associated with RFS or OS independently. Furthermore, MRD assessed by LAIPs and RQ-PCR assay for patients with BCR-ABL fusion gene yielded concordant results in 89.7% of cases. In conclusion, MRD evaluated by eight-color flow cytometry could provide an important tool to assess treatment response and prognosis precisely in adult B-ALL.
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46
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Ardjmand A, de Bock CE, Shahrokhi S, Lincz LF, Boyd AW, Burns GF, Thorne RF. Fat1 cadherin provides a novel minimal residual disease marker in acute lymphoblastic leukemia. ACTA ACUST UNITED AC 2013; 18:315-22. [PMID: 23433465 DOI: 10.1179/1607845413y.0000000080] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Measurement of minimal residual disease (MRD) maintains an important role in the clinical management of acute lymphoblastic leukemia (ALL). Recently, we identified Fat1 cadherin as a unique and independent prognostic factor for relapse-free and overall survival in pediatric pre-B-ALL. Here, we analyzed Fat1 mRNA for its potential as a novel marker of MRD in cases of pre-B- and T-ALL. Analyses of microarray data from 125 matched diagnosis/relapse samples across three independent datasets indicate that Fat1 mRNA is detectable in an average of 31.3% of diagnosed pre-B-ALL, of which 67.5% of cases remained positive at relapse. Furthermore, some 20% of cases with undetectable levels of Fat1 mRNA at diagnosis became positive upon relapse. T-ALL cases were 83.3% positive for Fat1 expression at diagnosis with 77.7% remaining positive at relapse. Towards proof of concept, we developed a quantitative polymerase chain reaction assay and demonstrate detection of Fat1 mRNA in leukemic cells mixed with normal peripheral blood cells at a sensitivity of 1 in 10 000 to 100 000 cells. Fat1 may therefore provide a new marker of MRD for patients with ALL lacking known genomic aberrations or within a multiplex approach to MRD detection.
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Affiliation(s)
- Alireza Ardjmand
- University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
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47
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Angelescu S, Berbec NM, Colita A, Barbu D, Lupu AR. Value of multifaced approach diagnosis and classification of acute leukemias. MAEDICA 2012; 7:254-260. [PMID: 23401730 PMCID: PMC3566891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 08/11/2012] [Indexed: 06/01/2023]
Affiliation(s)
- Silvana Angelescu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest ; Hematology Department, Coltea Clinical Hospital, Bucharest
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48
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Liew E, Atenafu EG, Schimmer AD, Yee KWL, Schuh AC, Minden MD, Gupta V, Brandwein JM. Outcomes of adult patients with relapsed acute lymphoblastic leukemia following frontline treatment with a pediatric regimen. Leuk Res 2012; 36:1517-20. [PMID: 22940259 DOI: 10.1016/j.leukres.2012.08.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 07/06/2012] [Accepted: 08/13/2012] [Indexed: 11/27/2022]
Abstract
We analyzed the outcome of 46 patients with acute lymphoblastic leukemia (ALL) who relapsed following treatment with a pediatric-based protocol; 34 received intensive re-induction chemotherapy, with a CR2 rate of 62%, median overall survival (OS) 7.8 months, median relapse-free survival 5.2 months and one year OS 19%. Allogeneic HSCT was performed in 8 patients in CR2/3, with a median OS 2.2 months. OS was superior in patients who relapsed after completion of chemotherapy, compared to those relapsing on treatment. The outcome of adult ALL relapsing after treatment was therefore poor, and novel salvage strategies are needed to improve outcomes.
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Affiliation(s)
- Elena Liew
- Department of Medical Oncology and Hematology, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
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49
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Xu XJ, Tang YM, Shen HQ, Song H, Yang SL, Shi SW, Xu WQ. Day 22 of induction therapy is important for minimal residual disease assessment by flow cytometry in childhood acute lymphoblastic leukemia. Leuk Res 2012; 36:1022-7. [DOI: 10.1016/j.leukres.2012.03.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 03/12/2012] [Accepted: 03/14/2012] [Indexed: 12/27/2022]
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50
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Prognostic and therapeutic implications of minimal residual disease at the time of transplantation in acute leukemia. Bone Marrow Transplant 2012; 48:630-41. [PMID: 22825427 DOI: 10.1038/bmt.2012.139] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Relapse remains the major cause of treatment failure after hematopoietic cell transplantation (HCT) in acute leukemia, even in patients transplanted in morphologic CR. Various techniques now enable the sensitive quantification of 'minimal' amounts of residual disease (MRD) in patients with acute leukemia in remission. Numerous studies convincingly demonstrate that MRD at the time of transplantation is a powerful, independent predictor of subsequent relapse, with current detection levels of one leukemic cell in 10(5)-10(6) normal cells being prognostically relevant. This recognition provides the rationale to assign patients with detectable MRD (that is, 'MRD(+)' patients) to intensified therapies before, during, or after transplantation, although data supporting these strategies are still sparse. Limited evidence from observational studies suggests that outcomes with autologous HCT are so poor that MRD(+) patients should preferentially be assigned to allogeneic HCT, which can cure a subgroup of these patients, particularly if unmanipulated (T-cell replete) grafts and/or minimized immunosuppression are used to optimize the graft-vs-leukemia effect. Emerging data suggest that additional therapy with non-cross-resistant agents to decrease residual tumor burden before transplantation in MRD(+) patients might be beneficial. Further, other studies hint at immunotherapy (for example, rapid withdrawal of immunosuppression and/or donor lymphocyte infusions) as a means to prevent overt relapse if patients remain, or become, MRD(+) after HCT. Ultimately, controlled clinical studies are needed to define the value of MRD-directed therapies, and patients should be encouraged to enter such trials.
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