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Park JH, Kim M, Kong SY, Yoon SS, Lee DS. Monitoring of the Clonal Fraction by Fluorescence In Situ Hybridization in Myelodysplastic Syndrome: Comparison With International Working Group Treatment Response Criteria. Arch Pathol Lab Med 2016; 140:560-9. [PMID: 27232348 DOI: 10.5858/arpa.2015-0150-oa] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT -At the initial diagnosis of myelodysplastic syndrome (MDS) and/or during follow-up, the evaluation of chromosomal abnormalities is based on standard G-banding, whereas the utility of fluorescence in situ hybridization (FISH) is still debated. OBJECTIVES -To investigate whether interphase fluorescence in situ hybridization (iFISH) clone size at initial diagnosis of MDS is correlated with survival and whether changes in clonal fraction by iFISH are concordant with the MDS International Working Group response criteria during follow-up. DESIGN -A tailored FISH panel (-5/5q-, -7/7q-, +8, -20/20q-, and +1/1q+), based on reported cytogenetic changes in Korean patients with MDS, was performed in 81 patients with MDS at initial diagnosis and in 28 patients during follow-up. RESULTS -During follow-up, absolute increases in the clone size by iFISH by 20% or more, with relative increases of 50% or more, compared with previous specimens, were associated with transformation to acute myeloid leukemia (P = .001 and P = .002, respectively). Of the 28 patients with abnormal iFISH results, 7 (25%) showed discordance between iFISH and MDS International Working Group responses. Concordance between clone size by G-banding and iFISH was higher in the refractory cytopenia with unilineage dysplasia/refractory cytopenia with multilineage dysplasia group during follow-up, whereas the group with refractory anemia with excess blasts showed higher correlation at initial diagnosis. CONCLUSIONS -We conclude that iFISH can provide additional prognostic information and can predict the response to therapy in MDS.
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Affiliation(s)
- Jae Hyeon Park
- From the Departments of Laboratory Medicine (Drs Park and Lee), Internal Medicine (Dr Yoon), and the Cancer Research Institute (Drs Yoon and Lee), Seoul National University College of Medicine, Seoul, Korea; Department of Laboratory Medicine, National Cancer Center, Goyang-si, Korea (Dr Kong); and the Department of Laboratory Medicine, Hallym University College of Medicine, Anyang, Korea (Dr Kim)
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Otrock ZK, Tiu RV, Maciejewski JP, Sekeres MA. The need for additional genetic markers for myelodysplastic syndrome stratification: what does the future hold for prognostication? Expert Rev Hematol 2013; 6:59-68. [PMID: 23373781 DOI: 10.1586/ehm.12.67] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Myelodysplastic syndromes (MDS) constitute a heterogeneous group of clonal hematopoietic disorders. Metaphase cytogenetics has been the gold standard for genetic testing in MDS, but it detects clonal cytogenetic abnormalities in only 50% of cases. New karyotyping tests include FISH, array-based comparative genomic hybridization and single-nucleotide polymorphism arrays. These techniques have increased the detected genetic abnormalities in MDS, many of which confer prognostic significance to overall and leukemia-free survival. This has eventually increased our understanding of MDS genetics. With the help of new technologies, we anticipate that the existing prognostic scoring systems will incorporate mutational data into their parameters. This review discusses the progress in MDS diagnosis through the use of array-based technologies. The authors also discuss the recently investigated genetic mutations in MDS and revisit the MDS classification and prognostic scoring systems.
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Affiliation(s)
- Zaher K Otrock
- Leukemia Program, Cleveland Clinic Taussig Cancer Institute, OH 44195, USA
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Kim M, Chung S, See CJ, Yoon SS, Kim BK, Kim HK, Lee DS. Quantity of clonal cells detected by conventional cytogenetic analysis correlates with bone marrow blasts and survival in myelodysplastic syndromes. Leuk Res 2011; 36:163-8. [PMID: 21920602 DOI: 10.1016/j.leukres.2011.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 08/22/2011] [Accepted: 08/23/2011] [Indexed: 11/19/2022]
Abstract
We performed quantitative and qualitative analyses of conventional cytogenetic analysis and interphase FISH results in 87 MDS patients. The quantity of clonal cells for each chromosome of CCA did not correlate with the result of iFISH (r, range 0.0761-1.0577). The clonal cell percentage in CCA was higher in patients with >5% bone marrow blasts than those with <5% (44.7% vs. 23.1%, p=0.017). Multivariate analysis showed that a high quantity of clonal cells in CCA analysis is an independent prognostic factor for overall survival in MDS (p=0.012).
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Affiliation(s)
- Miyoung Kim
- Department of Laboratory Medicine, Seoul National University College of Medicine, Jongno-gu, Seoul, South Korea
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Abstract
Cytogenetic information in patients with myelodysplastic syndrome (MDS) is important in predicting prognosis and therapeutic direction. In MDS, the detection of numerical type abnormalities, either whole chromosome or partial chromosomal segments, is important. In general, conventional banding chromosome analysis is useful in detecting chromosome changes in MDS and is able to predict prognosis. More recently, uniparental disomy at various loci has been found in some MDS patients and target genes located within the deleted chromosome regions; these deletions are either cytogenetically detectable resulting in partial monosomy, or cryptic. Further therapeutic approaches for MDS patients may require more precise cytogenetic information in the near future.
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Affiliation(s)
- Kazuma Ohyashiki
- First Department of Internal Medicine, Tokyo Medical University, Tokyo, Japan.
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Lee HR, Oh B, Hong DS, Zang DY, Yoon HJ, Kim HJ, Kim I, Ahn JS, Cheong JW, Lee KA, Cho KS, Lee MH, Bang SM, Kim TY, Yun YM, Min YH, Lee YK, Lee DS. Cytogenetic features of 5q deletion and 5q- syndrome in myelodysplastic syndrome in Korea; marker chromosomes proved to be chromosome 5 with interstitial deletion by fluorescence in situ hybridization. ACTA ACUST UNITED AC 2011; 203:193-202. [PMID: 21156233 DOI: 10.1016/j.cancergencyto.2010.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Revised: 07/12/2010] [Accepted: 08/01/2010] [Indexed: 11/24/2022]
Abstract
We characterized the cytogenetic changes and prognostic characteristics of 133 Korean patients with myelodysplastic syndrome (MDS), focusing on 5q- syndrome and MDS with chromosome abnormalities involving 5q deletion according to World Health Organization 2008 classification. In all patients, G banding and fluorescence in situ hybridization for 5q were performed, and in MDS patients with 5q deletion, the deleted region on chromosome 5 was mapped with fluorescence in situ hybridization for EGR1, CSF1R, and PDGFRB. The frequency of isolated del(5q) syndrome and 5q deletion was 2.2% (3 of 137 patients) and 15.3% (21 of 137 patients), respectively. International Prognostic Scoring System (IPSS) groups were low risk (5.8%), intermediate 1 (51.1%), intermediate 2 (27.8%), and high risk (15.3%). The patients with del(5q) were significantly older (62 years) and showed an unfavorable survival compared to patients without del(5q). Half (53%) of the patients with del(5q) also had complex chromosome abnormalities, including chromosome 7 abnormalities. Of the patients with del(5q), 93.3% were deleted for all three regions on 5q, compared to 66.7% of patients with isolated del(5q). Marker chromosomes proved to be chromosome 5 with interstitial deletion of q arm by fluorescence in situ hybridization in three patients. The biological characteristics of MDS in Korea seem to be markedly different from those of Caucasians, with Koreans having a younger age, lower frequencies of 5q- syndrome, higher frequencies of complex cytogenetic abnormalities including del(5q), and poorer prognosis. We infer that additional chromosome abnormalities contribute to the adverse prognostic impact in patients with del(5q).
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Affiliation(s)
- Hye Ryun Lee
- Department of Laboratory Medicine, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul 110-744, Korea
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Göhring G, Giagounidis A, Büsche G, Hofmann W, Kreipe HH, Fenaux P, Hellström-Lindberg E, Schlegelberger B. Cytogenetic follow-up by karyotyping and fluorescence in situ hybridization: implications for monitoring patients with myelodysplastic syndrome and deletion 5q treated with lenalidomide. Haematologica 2010; 96:319-22. [PMID: 21109690 DOI: 10.3324/haematol.2010.026658] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
In patients with low and intermediate risk myelodysplastic syndrome and deletion 5q (del(5q)) treated with lenalidomide, monitoring of cytogenetic response is mandatory, since patients without cytogenetic response have a significantly increased risk of progression. Therefore, we have reviewed cytogenetic data of 302 patients. Patients were analyzed by karyotyping and fluorescence in situ hybridization. In 85 patients, del(5q) was only detected by karyotyping. In 8 patients undergoing karyotypic evolution, the del(5q) and additional chromosomal aberrations were only detected by karyotyping. In 3 patients, del(5q) was only detected by fluorescence in situ hybridization, but not by karyotyping due to a low number of metaphases. Karyotyping was significantly more sensitive than fluorescence in situ hybridization in detecting the del(5q) clone. In conclusion, to optimize therapy control of myelodysplastic syndrome patients with del(5q) treated with lenalidomide and to identify cytogenetic non-response or progression as early as possible, fluorescence in situ hybridization alone is inadequate for evaluation. Karyotyping must be performed to optimally evaluate response.
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Affiliation(s)
- Gudrun Göhring
- Institute of Cell and Molecular Pathology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
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Adding FISH to karyotype in Myelodysplastic syndrome investigation diagnosis: Are all questions answered? Leuk Res 2010; 34:413-5. [DOI: 10.1016/j.leukres.2009.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 10/09/2009] [Accepted: 10/11/2009] [Indexed: 11/23/2022]
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Cocco L, Follo MY, Faenza I, Billi AM, Ramazzotti G, Martelli AM, Manzoli L, Weber G. Inositide signaling in the nucleus: From physiology to pathology. ACTA ACUST UNITED AC 2010; 50:2-11. [DOI: 10.1016/j.advenzreg.2009.10.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ou JJ, Bagg A. Diagnostic challenges in the myelodysplastic syndromes: the current and future role of genetic and immunophenotypic studies. EXPERT OPINION ON MEDICAL DIAGNOSTICS 2009; 3:275-91. [PMID: 23488463 DOI: 10.1517/17530050902813947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Myelodysplastic syndromes (MDS) comprise a clinically and pathologically diverse collection of hematopoietic neoplasms, most commonly presenting with peripheral cytopenias typically in the context of bone marrow hypercellularity. Mechanistically, at least in the early phases of the disease, this apparently paradoxical picture is primarily due to ineffective hematopoiesis, which is accompanied by a variety of morphologic abnormalities in hematopoietic cells. The identification of recurrent, clinically relevant cytogenetic defects in MDS has spurred the research of molecular mechanisms that contribute to its inception as well as to the development of heterogeneous subtypes. Although conventional cytogenetic analyses remain a diagnostic mainstay in MDS, the application of contemporary techniques including molecular cytogenetics, microarray technologies and multiparametric flow cytometry may ultimately reveal new diagnostic parameters that are theoretically more objective and sensitive than current morphologic approaches. This review aims to outline the role of genetic and immunophenotypic studies in the evaluation of MDS, including findings that may potentially influence future diagnostic classifications, which could refine prognostication and ultimately facilitate the growth of targeted therapies.
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Affiliation(s)
- Joyce J Ou
- University of Pennsylvania, Department of Pathology and Laboratory Medicine, 3400 Spruce Street, 6 Founders Pavilion, PA 19406-4283, USA
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Follo MY, Finelli C, Clissa C, Mongiorgi S, Bosi C, Martinelli G, Baccarani M, Manzoli L, Martelli AM, Cocco L. Phosphoinositide-Phospholipase C β1 Mono-Allelic Deletion Is Associated With Myelodysplastic Syndromes Evolution Into Acute Myeloid Leukemia. J Clin Oncol 2009; 27:782-790. [DOI: 10.1200/jco.2008.19.3748] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Purpose To evaluate the association between the presence of phosphoinositide-phospholipase C β1 (PI-PLCβ1) mono-allelic deletion with the clinical outcome of myelodysplastic syndromes (MDS) patients. Methods PI-PLCβ1, PI-PLCβ4, and PI-PLCγ1 cytogenetic investigations were performed on 80 newly diagnosed MDS patients (18 low risk, 26 intermediate 1, 18 intermediate 2, 18 high risk) comparing the results with the clinical outcome of the patients. Moreover, fluorescent in situ hybridization results were validated by real-time polymerase chain reaction (PCR). Finally, PI-PLCβ1 gene and protein expression were assessed by both real-time PCR and immunocytochemical experiments. Results Collectively, 35 (43.75%) of 80 of the MDS patients showed a specific mono-allelic deletion of PI-PLCβ1. Kaplan-Meier analysis revealed a significant association (P < .0001) between the PI-PLCβ1 mono-allelic deletion and a higher risk of evolution into acute myeloid leukemia (AML), since 23 of 35 MDS patients (65.7%) bearing the PI-PLCβ1 mono-allelic deletion evolved into AML. Even in multivariate analysis, the PI-PLCβ1 mono-allelic deletion retained a higher significance, with a P < .001, as a prognostic factor of evolution into AML (odds ratio [OR] 1.83; 95% CI, 2.26 to 17.24; P = .00045). Finally, PI-PLCβ1 deletion was related to an altered gene and protein expression. Conclusion PI-PLCβ1 mono-allelic deletion is associated with a worse clinical outcome in MDS patients, hinting at the identification of a new group at higher risk of AML evolution and representing a reliable prognostic tool. Moreover, targeting PI-PLCβ1 pathways might emerge as a new therapeutic strategy for MDS.
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Affiliation(s)
- Matilde Y. Follo
- From the Cellular Signalling Laboratory, Department of Human Anatomical Sciences; Institute of Hematology and Medical Oncology “L. e A. Seràgnoli”, University of Bologna; Hematology Unit, Ospedale Civile di Piacenza; and the Istituto per i Trapianti d'Organo e l'Immunocitologia del CNR, Sezione di Bologna, Bologna, Italy
| | - Carlo Finelli
- From the Cellular Signalling Laboratory, Department of Human Anatomical Sciences; Institute of Hematology and Medical Oncology “L. e A. Seràgnoli”, University of Bologna; Hematology Unit, Ospedale Civile di Piacenza; and the Istituto per i Trapianti d'Organo e l'Immunocitologia del CNR, Sezione di Bologna, Bologna, Italy
| | - Cristina Clissa
- From the Cellular Signalling Laboratory, Department of Human Anatomical Sciences; Institute of Hematology and Medical Oncology “L. e A. Seràgnoli”, University of Bologna; Hematology Unit, Ospedale Civile di Piacenza; and the Istituto per i Trapianti d'Organo e l'Immunocitologia del CNR, Sezione di Bologna, Bologna, Italy
| | - Sara Mongiorgi
- From the Cellular Signalling Laboratory, Department of Human Anatomical Sciences; Institute of Hematology and Medical Oncology “L. e A. Seràgnoli”, University of Bologna; Hematology Unit, Ospedale Civile di Piacenza; and the Istituto per i Trapianti d'Organo e l'Immunocitologia del CNR, Sezione di Bologna, Bologna, Italy
| | - Costanza Bosi
- From the Cellular Signalling Laboratory, Department of Human Anatomical Sciences; Institute of Hematology and Medical Oncology “L. e A. Seràgnoli”, University of Bologna; Hematology Unit, Ospedale Civile di Piacenza; and the Istituto per i Trapianti d'Organo e l'Immunocitologia del CNR, Sezione di Bologna, Bologna, Italy
| | - Giovanni Martinelli
- From the Cellular Signalling Laboratory, Department of Human Anatomical Sciences; Institute of Hematology and Medical Oncology “L. e A. Seràgnoli”, University of Bologna; Hematology Unit, Ospedale Civile di Piacenza; and the Istituto per i Trapianti d'Organo e l'Immunocitologia del CNR, Sezione di Bologna, Bologna, Italy
| | - Michele Baccarani
- From the Cellular Signalling Laboratory, Department of Human Anatomical Sciences; Institute of Hematology and Medical Oncology “L. e A. Seràgnoli”, University of Bologna; Hematology Unit, Ospedale Civile di Piacenza; and the Istituto per i Trapianti d'Organo e l'Immunocitologia del CNR, Sezione di Bologna, Bologna, Italy
| | - Lucia Manzoli
- From the Cellular Signalling Laboratory, Department of Human Anatomical Sciences; Institute of Hematology and Medical Oncology “L. e A. Seràgnoli”, University of Bologna; Hematology Unit, Ospedale Civile di Piacenza; and the Istituto per i Trapianti d'Organo e l'Immunocitologia del CNR, Sezione di Bologna, Bologna, Italy
| | - Alberto M. Martelli
- From the Cellular Signalling Laboratory, Department of Human Anatomical Sciences; Institute of Hematology and Medical Oncology “L. e A. Seràgnoli”, University of Bologna; Hematology Unit, Ospedale Civile di Piacenza; and the Istituto per i Trapianti d'Organo e l'Immunocitologia del CNR, Sezione di Bologna, Bologna, Italy
| | - Lucio Cocco
- From the Cellular Signalling Laboratory, Department of Human Anatomical Sciences; Institute of Hematology and Medical Oncology “L. e A. Seràgnoli”, University of Bologna; Hematology Unit, Ospedale Civile di Piacenza; and the Istituto per i Trapianti d'Organo e l'Immunocitologia del CNR, Sezione di Bologna, Bologna, Italy
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