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Ding Y, Liu Z, Wang H, Xiong S, Zhai Z. Prognostic value of combined WT1 and multiparameter flow cytometry assessment for measurable residual disease after induction in non-APL acute myeloid leukemia. Scand J Clin Lab Invest 2023; 83:340-347. [PMID: 37355341 DOI: 10.1080/00365513.2023.2227946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/14/2023] [Accepted: 06/18/2023] [Indexed: 06/26/2023]
Abstract
The objective of this study was to investigate the expression pattern of Wilms tumor 1 (WT1) gene at diagnosis, complete remission (CR) and relapse status in non-acute promyelocytic leukemia (non-APL) acute myeloid leukemia (AML) patients, and further explore the prognostic value of measurable residual disease (MRD) assessment by WT1 gene and multiparameter flow cytometry (MFC). Our results showed that the average expression level of WT1 was 4026 ± 616.1 copies/104 ABL at diagnosis, 155.3 ± 36.03 copies/104 ABL at CR, and 1766 ± 238.8 copies/104 ABL at relapse, with statistically significant differences (p = .000). ROC analysis showed that WT1 expression levels were 118.1 copies/104 ABL and MFC-MRD was 0.155%, which had good predictive efficacy for relapse of patients during consolidation therapy. Both WT1-MRD and MFC-MRD had a significant impact on relapse-free survival (RFS) and overall survival (OS). Patients with WT1-MRD positive or MFC-MRD positive were associated with worse RFS (HR 3.840, 95% CI 1.582-9.320, p = .003), (HR 4.464, 95% CI 1.841-10.984, p = .001) and worse OS (HR 2.963, 95% CI 1.058-8.295, p = .039), (HR 3.590, 95% CI 1.254-10.280, p = .017). Besides, compared with patients who were negative for both WT1-MRD and MFC-MRD, patients who were positive both WT1-MRD and MFC-MRD were associated with worse RFS (HR 6.200, 95% CI 2.206-17.430, p = .001) and worse OS (HR 4.886, 95% CI 1.388-17.197, p = .013). This study demonstrates that combined assessment of MRD by WT1 and MFC improves relapse and prognosis prediction in non-APL AML patients, and may help guide interventions for disease relapse.
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Affiliation(s)
- Yangyang Ding
- Department of Hematology/Hematological Lab, The Second Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Zelin Liu
- Department of Hematology/Hematological Lab, The Second Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Huiping Wang
- Department of Hematology/Hematological Lab, The Second Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Shudao Xiong
- Department of Hematology/Hematological Lab, The Second Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Zhimin Zhai
- Department of Hematology/Hematological Lab, The Second Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
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Ramos Elbal E, Fuster JL, Campillo JA, Galera AM, Cortés MB, Llinares ME, Jiménez I, Plaza M, Banaclocha HM, Galián JA, Blanquer Blanquer M, Martínez Sánchez MV, Muro M, Minguela A. Measurable residual disease study through three different methods can anticipate relapse and guide pre-emptive therapy in childhood acute myeloid leukemia. CLINICAL & TRANSLATIONAL ONCOLOGY : OFFICIAL PUBLICATION OF THE FEDERATION OF SPANISH ONCOLOGY SOCIETIES AND OF THE NATIONAL CANCER INSTITUTE OF MEXICO 2023; 25:1446-1454. [PMID: 36598635 DOI: 10.1007/s12094-022-03042-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 12/04/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Although outcomes of children with acute myeloid leukemia (AML) have improved over the last decades, around one-third of patients relapse. Measurable (or minimal) residual disease (MRD) monitoring may guide therapy adjustments or pre-emptive treatments before overt hematological relapse. METHODS In this study, we review 297 bone marrow samples from 20 real-life pediatric AML patients using three MRD monitoring methods: multiparametric flow cytometry (MFC), fluorescent in situ hybridization (FISH) and polymerase chain reaction (PCR). RESULTS Patients showed a 3-year overall survival of 73% and a 3-year event-free survival of 68%. Global relapse rate was of 25%. All relapses were preceded by the reappearance of MRD detection by: (1) MFC (p = 0.001), (2) PCR and/or FISH in patients with an identifiable chromosomal translocation (p = 0.03) and/or (3) one log increase of Wilms tumor gene 1 (WT1) expression in two consecutive samples (p = 0.02). The median times from MRD detection to relapse were 26, 111, and 140 days for MFC, specific PCR and FISH, and a one log increment of WT1, respectively. CONCLUSIONS MFC, FISH and PCR are complementary methods that can anticipate relapse of childhood AML by weeks to several months. However, in our series, pre-emptive therapies were not able to prevent disease progression. Therefore, more sensitive MRD monitoring methods that further anticipate relapse and more effective pre-emptive therapies are needed.
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Affiliation(s)
- Eduardo Ramos Elbal
- Pediatric Oncohematology Department, Clinic University Hospital Virgen de la Arrixaca and Biomedical Research Institute of Murcia Pascual Parrilla (IMIB), 30120, Murcia, Spain
| | - José Luis Fuster
- Pediatric Oncohematology Department, Clinic University Hospital Virgen de la Arrixaca and Biomedical Research Institute of Murcia Pascual Parrilla (IMIB), 30120, Murcia, Spain
| | - José Antonio Campillo
- Immunology Service, Clinic University Hospital Virgen de la Arrixaca and Biomedical Research Institute of Murcia Pascual Parrilla (IMIB), 30120, Murcia, Spain
| | - Ana María Galera
- Pediatric Oncohematology Department, Clinic University Hospital Virgen de la Arrixaca and Biomedical Research Institute of Murcia Pascual Parrilla (IMIB), 30120, Murcia, Spain
| | - Mar Bermúdez Cortés
- Pediatric Oncohematology Department, Clinic University Hospital Virgen de la Arrixaca and Biomedical Research Institute of Murcia Pascual Parrilla (IMIB), 30120, Murcia, Spain
| | - María Esther Llinares
- Pediatric Oncohematology Department, Clinic University Hospital Virgen de la Arrixaca and Biomedical Research Institute of Murcia Pascual Parrilla (IMIB), 30120, Murcia, Spain
| | - Irene Jiménez
- Pediatric Oncohematology Department, Clinic University Hospital Virgen de la Arrixaca and Biomedical Research Institute of Murcia Pascual Parrilla (IMIB), 30120, Murcia, Spain
| | - Mercedes Plaza
- Pediatric Oncohematology Department, Clinic University Hospital Virgen de la Arrixaca and Biomedical Research Institute of Murcia Pascual Parrilla (IMIB), 30120, Murcia, Spain
| | - Helios Martínez Banaclocha
- Immunology Service, Clinic University Hospital Virgen de la Arrixaca and Biomedical Research Institute of Murcia Pascual Parrilla (IMIB), 30120, Murcia, Spain
| | - José Antonio Galián
- Immunology Service, Clinic University Hospital Virgen de la Arrixaca and Biomedical Research Institute of Murcia Pascual Parrilla (IMIB), 30120, Murcia, Spain
| | - Miguel Blanquer Blanquer
- Haematology Service, Clinic University Hospital Virgen de la Arrixaca and Biomedical Research Institute of Murcia Pascual Parrilla (IMIB), 30120, Murcia, Spain
| | - María Victoria Martínez Sánchez
- Immunology Service, Clinic University Hospital Virgen de la Arrixaca and Biomedical Research Institute of Murcia Pascual Parrilla (IMIB), 30120, Murcia, Spain
| | - Manuel Muro
- Immunology Service, Clinic University Hospital Virgen de la Arrixaca and Biomedical Research Institute of Murcia Pascual Parrilla (IMIB), 30120, Murcia, Spain
| | - Alfredo Minguela
- Immunology Service, Clinic University Hospital Virgen de la Arrixaca and Biomedical Research Institute of Murcia Pascual Parrilla (IMIB), 30120, Murcia, Spain.
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3
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Hassan S, Shehzad A, Khan SA, Miran W, Khan S, Lee YS. Diagnostic and Therapeutic Potential of Circulating-Free DNA and Cell-Free RNA in Cancer Management. Biomedicines 2022; 10:biomedicines10082047. [PMID: 36009594 PMCID: PMC9405989 DOI: 10.3390/biomedicines10082047] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/27/2022] [Accepted: 07/31/2022] [Indexed: 11/20/2022] Open
Abstract
Over time, molecular biology and genomics techniques have been developed to speed up the early diagnosis and clinical management of cancer. These therapies are often most effective when administered to the subset of malignancies harboring the target identified by molecular testing. Important advances in applying molecular testing involve circulating-free DNA (cfDNA)- and cell-free RNA (cfRNA)-based liquid biopsies for the diagnosis, prognosis, prediction, and treatment of cancer. Both cfDNA and cfRNA are sensitive and specific biomarkers for cancer detection, which have been clinically proven through multiple randomized and prospective trials. These help in cancer management based on the noninvasive evaluation of size, quantity, and point mutations, as well as copy number alterations at the tumor site. Moreover, personalized detection of ctDNA helps in adjuvant therapeutics and predicts the chances of recurrence of cancer and resistance to cancer therapy. Despite the controversial diagnostic values of cfDNA and cfRNA, many clinical trials have been completed, and the Food and Drug Administration has approved many multigene assays to detect genetic alterations in the cfDNA of cancer patients. In this review, we underpin the recent advances in the physiological roles of cfDNA and cfRNA, as well as their roles in cancer detection by highlighting recent clinical trials and their roles as prognostic and predictive markers in cancer management.
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Affiliation(s)
- Sadia Hassan
- Department of Biomedical Engineering and Sciences, School of Mechanical and Manufacturing Engineering (SMME), National University of Sciences and Technology (NUST), Islamabad 44000, Pakistan
| | - Adeeb Shehzad
- Department of Biomedical Engineering and Sciences, School of Mechanical and Manufacturing Engineering (SMME), National University of Sciences and Technology (NUST), Islamabad 44000, Pakistan
- Correspondence: (A.S.); (Y.-S.L.)
| | - Shahid Ali Khan
- Department of Chemistry, School of Natural Sciences (SNS), National University of Sciences and Technology (NUST), Islamabad 44000, Pakistan
| | - Waheed Miran
- Department of Chemical Engineering, School of Chemical and Materials Engineering National University of Sciences and Technology (NUST), Islamabad 44000, Pakistan
| | - Salman Khan
- Department of pharmacy, Quaid-i-Azam University, Islamabad 44000, Pakistan
| | - Young-Sup Lee
- School of Life Sciences, College of Natural Sciences, Kyungpook National University, Daegu 41566, Korea
- Correspondence: (A.S.); (Y.-S.L.)
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The Role of Wilms' Tumor Gene (WT1) Expression as a Marker of Minimal Residual Disease in Acute Myeloid Leukemia. J Clin Med 2022; 11:jcm11123306. [PMID: 35743376 PMCID: PMC9225390 DOI: 10.3390/jcm11123306] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/02/2022] [Accepted: 06/07/2022] [Indexed: 12/17/2022] Open
Abstract
The Minimal Residual Disease(MRD) monitoring in acute myeloid leukemia (AML) is crucial to guide treatment after morphologic complete remission, to define the need for consolidation with allogeneic stem cell transplantation (Allo-SCT), and to detect impending relapse allowing early intervention. However, more than 50% of patients with AML lack a specific or measurable molecular marker to monitor MRD. We reviewed the key studies on WT1 overexpression as a marker of MRD in AML patients undergoing an intensive chemotherapy program, including Allo-SCT. In addition, we provided some practical considerations on how to properly use WT1 expression as an MRD marker, considering its strengths and weaknesses. In order to achieve the best sensitivity and specificity, it is recommended to refer to the standardized method of European LeukemiaNet and its defined threshold (250 WT1 copies/104 Abelson (ABL) on Bone Marrow-BM and 50 WT1 copies/104 ABL on Peripheral Blood-PB), which has been validated in a large and multicenter cohort of patients and normal controls.
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Valkova V, Vydra J, Markova M, Cerovska E, Vrana M, Marinov I, Cechova H, Cetkovsky P, Vitek A, Salek C. WT1 Gene Expression in Peripheral Blood Before and After Allogeneic Stem Cell Transplantation is a Clinically Relevant Prognostic Marker in AML - A Single-center 14-year Experience. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 21:e145-e151. [PMID: 33160932 DOI: 10.1016/j.clml.2020.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/17/2020] [Accepted: 09/23/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND This work summarizes our experience with WT1 monitoring before and after allogeneic hematopoietic stem cell transplantation (allo-HSCT). PATIENTS AND METHODS The expression of WT1 gene was measured by real-time polymerase chain reaction in peripheral blood according to the European Leukemia Net recommendations. Between May 2005 and August 2019, we analyzed 147 consecutive patients with acute myeloid leukemia with high WT1 expression at diagnosis, transplanted in first (CR1) or second (CR2) complete remission. RESULTS At the time of allo-HSCT, 107 patients had WT1-normal expression (WT1 ≤ 50 copies), and 40 patients had WT1-high expression. The median follow-up was 21 months. The estimated 5-year overall survival and event-free survival was significantly better in the WT1-normal cohort (65% and 57% vs. 37% and 25%; P = .0003 and P < .0001, respectively) and 5-year cumulative incidence of relapse was significantly lower in the WT1-normal group (19% vs. 53%; P < .0001). Five-year non-relapse mortality was not significantly different (20% and 23%). Multivariate analysis revealed WT1-high expression and acute graft-versus-host disease grade 3/4 as significantly negative prognostic factors for OS. Overall, 49 patients developed WT1 molecular relapse in the post-transplant period; in 14 cases, the therapeutic intervention was done. In all but 1 relapsed patient where WT1 minimal residual disease (MRD) was monitored (38 patients), we detected WT1-high levels (sensitivity of 97%). CONCLUSION The results of the analysis confirmed our previous experience that WT1 status before allo-HSCT is a strong prognostic factor for both OS and relapse risk. In addition, we confirmed the usefulness of this marker for MRD monitoring after allo-HSCT. The main advantage is the possibility of frequent MRD monitoring in peripheral blood and early bone marrow examination based on WT1-high expression.
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MESH Headings
- Adult
- Aged
- Biomarkers, Tumor/blood
- Biomarkers, Tumor/metabolism
- Disease-Free Survival
- Feasibility Studies
- Female
- Follow-Up Studies
- Gene Expression Profiling
- Gene Expression Regulation, Leukemic
- Graft vs Host Disease/diagnosis
- Graft vs Host Disease/epidemiology
- Hematopoietic Stem Cell Transplantation/adverse effects
- Humans
- Incidence
- Leukemia, Myeloid, Acute/blood
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/mortality
- Leukemia, Myeloid, Acute/therapy
- Male
- Middle Aged
- Neoplasm Recurrence, Local/epidemiology
- Neoplasm Recurrence, Local/genetics
- Neoplasm, Residual
- Prognosis
- Risk Assessment/methods
- Risk Factors
- Severity of Illness Index
- WT1 Proteins/blood
- WT1 Proteins/metabolism
- Young Adult
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Affiliation(s)
- Veronika Valkova
- Department of Bone Marrow Transplant, Institute of Hematology and Blood Transfusion, Prague, Czech Republic; Institute of Clinical and Experimental Hematology, First Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Jan Vydra
- Department of Bone Marrow Transplant, Institute of Hematology and Blood Transfusion, Prague, Czech Republic; Institute of Clinical and Experimental Hematology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marketa Markova
- Department of Bone Marrow Transplant, Institute of Hematology and Blood Transfusion, Prague, Czech Republic; Institute of Clinical and Experimental Hematology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ela Cerovska
- Department of Bone Marrow Transplant, Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Milena Vrana
- Department of Bone Marrow Transplant, Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Iuri Marinov
- Department of Bone Marrow Transplant, Institute of Hematology and Blood Transfusion, Prague, Czech Republic; Institute of Clinical and Experimental Hematology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Hana Cechova
- Department of Bone Marrow Transplant, Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Petr Cetkovsky
- Department of Bone Marrow Transplant, Institute of Hematology and Blood Transfusion, Prague, Czech Republic; Institute of Clinical and Experimental Hematology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Antonin Vitek
- Department of Bone Marrow Transplant, Institute of Hematology and Blood Transfusion, Prague, Czech Republic; Institute of Clinical and Experimental Hematology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Cyril Salek
- Department of Bone Marrow Transplant, Institute of Hematology and Blood Transfusion, Prague, Czech Republic; Institute of Clinical and Experimental Hematology, First Faculty of Medicine, Charles University, Prague, Czech Republic
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6
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Malagola M, Bernardi S, Polverelli N, Russo D. Minimal residual disease monitoring in acute myeloid leukaemia: are we ready to move from bone marrow to peripheral blood? Br J Haematol 2020; 190:135-136. [PMID: 32191348 DOI: 10.1111/bjh.16579] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Michele Malagola
- Chair of Hematology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Unit of Blood Disease and Stem Cell Transplantation, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Simona Bernardi
- Chair of Hematology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Unit of Blood Disease and Stem Cell Transplantation, ASST Spedali Civili of Brescia, Brescia, Italy.,CREA Laboratory (Hematological-Research AIL Centre), ASST-Spedali Civili Brescia, Brescia, Italy
| | - Nicola Polverelli
- Chair of Hematology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Unit of Blood Disease and Stem Cell Transplantation, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Domenico Russo
- Chair of Hematology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Unit of Blood Disease and Stem Cell Transplantation, ASST Spedali Civili of Brescia, Brescia, Italy
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7
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Rossi G, Giambra V, Minervini MM, De Waure C, Mancinelli S, Ciavarella M, Sinisi NP, Scalzulli PR, Carella AM, Cascavilla N. Leukemia‐associated immunophenotypes subdivided in “categories of specificity” improve the sensitivity of minimal residual disease in predicting relapse in acute myeloid leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019; 98:216-225. [DOI: 10.1002/cyto.b.21855] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/09/2019] [Accepted: 10/22/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Giovanni Rossi
- Department of Hematology and Stem Cell Transplant Unit, Fondazione IRCCS “Casa Sollievo della Sofferenza” San Giovanni Rotondo Italy
| | - Vincenzo Giambra
- Institute of Stem Cells Biology, Regenerative Medicine and Innovative Therapies (ISBReMIT), Fondazione IRCCS "Casa Sollievo della Sofferenza‐IRCCS" San Giovanni Rotondo Italy
| | - Maria M. Minervini
- Department of Hematology and Stem Cell Transplant Unit, Fondazione IRCCS “Casa Sollievo della Sofferenza” San Giovanni Rotondo Italy
| | - Chiara De Waure
- Department of Experimental MedicineUniversity of Perugia Perugia Italy
| | - Silvia Mancinelli
- Department of Experimental MedicineUniversity of Perugia Perugia Italy
| | - Michele Ciavarella
- Institute of Stem Cells Biology, Regenerative Medicine and Innovative Therapies (ISBReMIT), Fondazione IRCCS "Casa Sollievo della Sofferenza‐IRCCS" San Giovanni Rotondo Italy
| | - Nicola P. Sinisi
- Department of Hematology and Stem Cell Transplant Unit, Fondazione IRCCS “Casa Sollievo della Sofferenza” San Giovanni Rotondo Italy
| | - Potito R. Scalzulli
- Department of Hematology and Stem Cell Transplant Unit, Fondazione IRCCS “Casa Sollievo della Sofferenza” San Giovanni Rotondo Italy
| | - Angelo M. Carella
- Department of Hematology and Stem Cell Transplant Unit, Fondazione IRCCS “Casa Sollievo della Sofferenza” San Giovanni Rotondo Italy
| | - Nicola Cascavilla
- Department of Hematology and Stem Cell Transplant Unit, Fondazione IRCCS “Casa Sollievo della Sofferenza” San Giovanni Rotondo Italy
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8
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Mashima K, Oh I, Ikeda T, Toda Y, Ito S, Umino K, Minakata D, Nakano H, Morita K, Yamasaki R, Kawasaki Y, Sugimoto M, Yamamoto C, Ashizawa M, Fujiwara SI, Hatano K, Sato K, Omine K, Muroi K, Kanda Y. Role of Sequential Monitoring of WT1 Gene Expression in Patients With Acute Myeloid Leukemia for the Early Detection of Leukemia Relapse. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:e521-e527. [DOI: 10.1016/j.clml.2018.07.298] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/20/2018] [Accepted: 07/27/2018] [Indexed: 01/13/2023]
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9
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Automated analysis of acute myeloid leukemia minimal residual disease using a support vector machine. Oncotarget 2018; 7:71915-71921. [PMID: 27713120 PMCID: PMC5342132 DOI: 10.18632/oncotarget.12430] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 09/29/2016] [Indexed: 11/29/2022] Open
Abstract
We investigated the ability of support vector machines (SVM) to analyze minimal residual disease (MRD) in flow cytometry data from patients with acute myeloid leukemia (AML) automatically, objectively and standardly. The initial disease data and MRD review data in the form of 159 flow cytometry standard 3.0 files from 36 CD7-positive AML patients in whom MRD was detected more than once were exported. SVM was used for training with setting the initial disease data to 1 as the flag and setting 15 healthy persons to set 0 as the flag. Based on the two training groups, parameters were optimized, and a predictive model was built to analyze MRD data from each patient. The automated analysis results from the SVM model were compared to those obtained through conventional analysis to determine reliability. Automated analysis results based on the model did not differ from and were correlated with results obtained through conventional analysis (correlation coefficient c = 0.986, P > 0.05). Thus the SVM model could potentially be used to analyze flow cytometry-based AML MRD data automatically, objectively, and in a standardized manner.
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10
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Hao Y, Cheng Y, Wu Q, Zhang A, Jiang X, Xu X. Combined usage of Wilms' tumor gene quantitative analysis and multiparameter flow cytometry for minimal residual disease monitoring of acute myeloid leukemia patients after allogeneic hematopoietic stem cells transplantation. Exp Ther Med 2018; 15:1403-1409. [PMID: 29434724 PMCID: PMC5774438 DOI: 10.3892/etm.2017.5547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 07/07/2017] [Indexed: 12/22/2022] Open
Abstract
High expression of the Wilms' tumor gene (WT1) in acute myeloid leukemia (AML) has been considered as a sensitive marker of minimal residual disease (MRD). The present study investigated the significance of quantitative analysis of WT1 mRNA, combined with multiparameter flow cytometry (MFC) regarding its efficacy and prognostic as well as relapse prediction value for leukemia patients with hematopoietic stem cell transplantation. Reverse-transcription quantitative polymerase chain reaction analysis demonstrated that the expression of WT1 in the initial and relapse group was significant higher than that in the complete remission (CR) group (P<0.01). WT1 and the donor chimerism were negatively correlated (r=-0.73, P<0.05). In all AML patients, WT1 was the highest in the M3 subtype and the lowest in the M1 subtype. Follow-up of 12 AML patients demonstrated that WT1 gene expression levels markedly decreased after CR, but obviously increased after relapse, as did the rate of the leukemia cells detected by MFC. The combined usage of MFC and WT1 monitoring contributed to an improved detection rate of relapse (91.7%), and may be used to monitor MRD, assess the treatment efficacy and prognosis, and predict the risk of recurrence in leukemia patients without specific molecular markers after allogeneic hematopoietic stem cell transplantation.
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Affiliation(s)
- Yingchan Hao
- Central Laboratory, The Affiliated Provincial Hospital, Anhui Medical University, Hefei, Anhui 230001, P.R. China
| | - Yanhong Cheng
- Central Laboratory, The Affiliated Provincial Hospital, Anhui Medical University, Hefei, Anhui 230001, P.R. China
| | - Quan Wu
- Central Laboratory, The Affiliated Provincial Hospital, Anhui Medical University, Hefei, Anhui 230001, P.R. China
| | - Aimei Zhang
- Central Laboratory, The Affiliated Provincial Hospital, Anhui Medical University, Hefei, Anhui 230001, P.R. China
| | - Xiaoxiao Jiang
- Central Laboratory, The Affiliated Provincial Hospital, Anhui Medical University, Hefei, Anhui 230001, P.R. China
| | - Xiucai Xu
- Central Laboratory, The Affiliated Provincial Hospital, Anhui Medical University, Hefei, Anhui 230001, P.R. China
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11
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Chen X, Wood BL. Monitoring minimal residual disease in acute leukemia: Technical challenges and interpretive complexities. Blood Rev 2017; 31:63-75. [DOI: 10.1016/j.blre.2016.09.006] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 09/20/2016] [Accepted: 09/30/2016] [Indexed: 01/04/2023]
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12
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Malagola M, Skert C, Borlenghi E, Chiarini M, Cattaneo C, Morello E, Cancelli V, Cattina F, Cerqui E, Pagani C, Passi A, Ribolla R, Bernardi S, Giustini V, Lamorgese C, Ruggeri G, Imberti L, Caimi L, Russo D, Rossi G. Postremission sequential monitoring of minimal residual disease by WT1 Q-PCR and multiparametric flow cytometry assessment predicts relapse and may help to address risk-adapted therapy in acute myeloid leukemia patients. Cancer Med 2015; 5:265-74. [PMID: 26715369 PMCID: PMC4735778 DOI: 10.1002/cam4.593] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 10/21/2015] [Accepted: 10/22/2015] [Indexed: 11/26/2022] Open
Abstract
Risk stratification in acute myeloid leukemia (AML) patients using prognostic parameters at diagnosis is effective, but may be significantly improved by the use of on treatment parameters which better define the actual sensitivity to therapy in the single patient. Minimal residual disease (MRD) monitoring has been demonstrated crucial for the identification of AML patients at high risk of relapse, but the best method and timing of MRD detection are still discussed. Thus, we retrospectively analyzed 104 newly diagnosed AML patients, consecutively treated and monitored by quantitative polymerase chain reactions (Q‐PCR) on WT1 and by multiparametric flow cytometry (MFC) on leukemia‐associated immunophenotypes (LAIPs) at baseline, after induction, after 1st consolidation and after 1st intensification. By multivariate analysis, the factors independently associated with adverse relapse‐free survival (RFS) were: bone marrow (BM)‐WT1 ≥ 121/104ABL copies (P = 0.02) and LAIP ≥ 0.2% (P = 0.0001) (after 1st consolidation) (RFS at the median follow up of 12.5 months: 51% vs. 82% [P < 0.0001] and 57% vs. 81%, respectively [P = 0.0003]) and PB‐WT1 ≥ 16/104ABL copies (P = 0.0001) (after 1st intensification) (RFS 43% vs. 95% [P < 0.0001]) Our data confirm the benefits of sequential MRD monitoring with both Q‐PCR and MFC. If confirmed by further prospective trials, they may significantly improve the possibility of a risk‐adapted, postinduction therapy of AML.
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Affiliation(s)
- Michele Malagola
- Unit of Blood Disease and Stem Cell Transplantation, Department of Clinical and Experimental Sciences, University of Brescia, AO Spedali Civili di Brescia, Brescia, Italy
| | - Cristina Skert
- Unit of Blood Disease and Stem Cell Transplantation, Department of Clinical and Experimental Sciences, University of Brescia, AO Spedali Civili di Brescia, Brescia, Italy
| | - Erika Borlenghi
- Division of Hematology, AO Spedali Civili di Brescia, Brescia, Italy
| | - Marco Chiarini
- Centro di Ricerca Emato-oncologica AIL (CREA) Brescia, AO Spedali Civili di Brescia, Brescia, Italy
| | - Chiara Cattaneo
- Division of Hematology, AO Spedali Civili di Brescia, Brescia, Italy
| | - Enrico Morello
- Division of Hematology, AO Spedali Civili di Brescia, Brescia, Italy
| | - Valeria Cancelli
- Unit of Blood Disease and Stem Cell Transplantation, Department of Clinical and Experimental Sciences, University of Brescia, AO Spedali Civili di Brescia, Brescia, Italy
| | - Federica Cattina
- Unit of Blood Disease and Stem Cell Transplantation, Department of Clinical and Experimental Sciences, University of Brescia, AO Spedali Civili di Brescia, Brescia, Italy
| | - Elisa Cerqui
- Unit of Blood Disease and Stem Cell Transplantation, Department of Clinical and Experimental Sciences, University of Brescia, AO Spedali Civili di Brescia, Brescia, Italy
| | - Chiara Pagani
- Unit of Blood Disease and Stem Cell Transplantation, Department of Clinical and Experimental Sciences, University of Brescia, AO Spedali Civili di Brescia, Brescia, Italy
| | - Angela Passi
- Unit of Blood Disease and Stem Cell Transplantation, Department of Clinical and Experimental Sciences, University of Brescia, AO Spedali Civili di Brescia, Brescia, Italy
| | - Rossella Ribolla
- Unit of Blood Disease and Stem Cell Transplantation, Department of Clinical and Experimental Sciences, University of Brescia, AO Spedali Civili di Brescia, Brescia, Italy
| | - Simona Bernardi
- Unit of Blood Disease and Stem Cell Transplantation, Department of Clinical and Experimental Sciences, University of Brescia, AO Spedali Civili di Brescia, Brescia, Italy.,Centro di Ricerca Emato-oncologica AIL (CREA) Brescia, AO Spedali Civili di Brescia, Brescia, Italy
| | - Viviana Giustini
- Centro di Ricerca Emato-oncologica AIL (CREA) Brescia, AO Spedali Civili di Brescia, Brescia, Italy
| | - Cinzia Lamorgese
- Division of Hematology, AO Spedali Civili di Brescia, Brescia, Italy
| | - Giuseppina Ruggeri
- Laboratorio Analisi, Department of Molecular and Translational Medicin, University of Brescia, AO Spedali Civili di Brescia, Brescia, Italy
| | - Luisa Imberti
- Centro di Ricerca Emato-oncologica AIL (CREA) Brescia, AO Spedali Civili di Brescia, Brescia, Italy
| | - Luigi Caimi
- Centro di Ricerca Emato-oncologica AIL (CREA) Brescia, AO Spedali Civili di Brescia, Brescia, Italy.,Laboratorio Analisi, Department of Molecular and Translational Medicin, University of Brescia, AO Spedali Civili di Brescia, Brescia, Italy
| | - Domenico Russo
- Unit of Blood Disease and Stem Cell Transplantation, Department of Clinical and Experimental Sciences, University of Brescia, AO Spedali Civili di Brescia, Brescia, Italy
| | - Giuseppe Rossi
- Division of Hematology, AO Spedali Civili di Brescia, Brescia, Italy
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The role of multiparametric flow cytometry in the detection of minimal residual disease in acute leukaemia. Pathology 2015; 47:609-21. [DOI: 10.1097/pat.0000000000000319] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Abstract
PURPOSE OF REVIEW Acute myeloid leukemia (AML) is a heterogeneous disease. Detection of minimal residual disease (MRD) has the potential to improve risk stratification, and its routine monitoring may allow timely therapeutic actions such as allogeneic hematopoietic stem cell transplantation. The current review will discuss challenges and available evidence for clinical application of MRD detection in AML management. RECENT FINDINGS The heterogeneous nature of AML, variations in genetic aberrations and immunophenotypes among patients and between malignant subclones coexisting within a single patient, is a challenge for the development of a reliable MRD test in AML. MRD value was demonstrated in subtypes of AML in which reliable leukemia-specific genetic marker is present (e.g., core-binding leukemia, AML positive for NPM1 mutation). Multicolor flow cytometry and quantitative PCR monitoring for Wilms tumor 1 gene transcript have also been shown to correlate with disease progression. MRD results should always be interpreted within patient-specific clinical context considering other risk factors and timing of MRD eradication. SUMMARY Introduction of MRD testing into routine clinical practice is a challenge in AML. An improvement in laboratory techniques along with identification of additional leukemia-specific markers is required.
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15
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Picciolini S, Mehn D, Morasso C, Vanna R, Bedoni M, Pellacani P, Marchesini G, Valsesia A, Prosperi D, Tresoldi C, Ciceri F, Gramatica F. Polymer nanopillar-gold arrays as surface-enhanced Raman spectroscopy substrate for the simultaneous detection of multiple genes. ACS NANO 2014; 8:10496-10506. [PMID: 25280123 DOI: 10.1021/nn503873d] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In our study, 2D nanopillar arrays with plasmonic crystal properties are optimized for surface-enhanced Raman spectroscopy (SERS) application and tested in a biochemical assay for the simultaneous detection of multiple genetic leukemia biomarkers. The special fabrication process combining soft lithography and plasma deposition techniques allows tailoring of the structural and chemical parameters of the crystal surfaces. In this way, it has been possible to tune the plasmonic resonance spectral position close to the excitation wavelength of the monochromatic laser light source in order to maximize the enhancing properties of the substrate. Samples are characterized by scanning electron microscopy and reflectance measurements and tested for SERS activity using malachite green. Besides, as the developed substrate had been prepared on a simple glass slide, SERS detection from the support side is also demonstrated. The optimized substrate is functionalized with thiol-modified capture oligonucleotides, and concentration-dependent signal of the target nucleotide is detected in a sandwich assay with labeled gold nanoparticles. Gold nanoparticles functionalized with different DNA and various Raman reporters are applied in a microarray-based assay recognizing a disease biomarker (Wilms tumor gene) and housekeeping gene expressions in the same time on spatially separated microspots. The multiplexing performance of the SERS-based bioassay is illustrated by distinguishing Raman dyes based on their complex spectral fingerprints.
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Affiliation(s)
- Silvia Picciolini
- Fondazione Don Carlo Gnocchi ONLUS , Piazzale Morandi 6, 20121 Milan, Italy
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Israyelyan A, Goldstein L, Tsai W, Aquino L, Forman SJ, Nakamura R, Diamond DJ. Real-time assessment of relapse risk based on the WT1 marker in acute leukemia and myelodysplastic syndrome patients after hematopoietic cell transplantation. Bone Marrow Transplant 2014; 50:26-33. [PMID: 25243629 PMCID: PMC4286541 DOI: 10.1038/bmt.2014.209] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 08/07/2014] [Accepted: 08/13/2014] [Indexed: 02/04/2023]
Abstract
Relapse is the major cause of treatment failure after allogeneic hematopoietic cell transplantation (alloHCT) for acute leukemia and myelodysplastic syndrome (MDS). Wilms' tumor Ag (WT1) is overexpressed in the majority of acute leukemia and MDS patients and has been proposed as a universal diagnostic marker for detection of impending relapse. Comprehensive studies have shown that WT1 transcript levels have predictive value in acute leukemia patients in CR after chemotherapy. However, the focus of this study is the period after alloHCT for predicting relapse onset. We analyzed the accumulation of WT1 mRNA transcripts in PB of 82 leukemia and MDS patients and defined specific molecular ratios for relapse prediction. The extensively validated WT1/c-ABL ratio was used to normalize increases in WT1 transcript levels. The observed lead time of crossing or exceeding set WT1 levels is presented along with linear interpolation to estimate the calculated day the WT1 thresholds were crossed. The WT1/c-ABL transcript ratio of 50 or above yielded 100% specificity and 75% sensitivity reliably predicting future relapse with an observed average of 29.4 days (s.d.=19.8) and a calculated average of 63 days (s.d.=29.3) lead time before morphologic confirmation. A lower ratio of 20 or above gave lower specificity, but higher sensitivity (84.8% and 87.5%, respectively) identified more patients who relapsed, at earlier times, providing an earlier warning with actual average lead time of 49.1 days (s.d.=30.8) and calculated average of 78 days (s.d.=28.8). WT1 transcript levels serve as a diagnostic relapse test with greater sensitivity than the morphologic approach used in the clinic as a readout.
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Affiliation(s)
- A Israyelyan
- Division of Translational Vaccine Research, Beckman Research Institute of City of Hope, Duarte, CA, USA
| | - L Goldstein
- Division of Biostatistics, Department of Information Sciences, Duarte, CA, USA
| | - W Tsai
- Department of Hematology/Hematopoietic Cell Transplantation, Duarte, CA, USA
| | - L Aquino
- Clinical Trials Office, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - S J Forman
- Department of Hematology/Hematopoietic Cell Transplantation, Duarte, CA, USA
| | - R Nakamura
- Department of Hematology/Hematopoietic Cell Transplantation, Duarte, CA, USA
| | - D J Diamond
- Division of Translational Vaccine Research, Beckman Research Institute of City of Hope, Duarte, CA, USA
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Woehlecke C, Wittig S, Arndt C, Gruhn B. Prognostic impact of WT1 expression prior to hematopoietic stem cell transplantation in children with malignant hematological diseases. J Cancer Res Clin Oncol 2014; 141:523-9. [PMID: 25238704 DOI: 10.1007/s00432-014-1832-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Accepted: 09/09/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Malignant hematological diseases represent the most common pediatric cancer. As they cannot always be cured by chemotherapy alone, leukemia and myelodysplastic syndrome (MDS) are frequent medical indications for hematopoietic stem cell transplantation, yet even this treatment is not capable of preventing relapse for certain. Therefore, molecular markers are used to monitor minimal residual disease (MRD) to be enabled to react early to an impeding relapse. As specific markers are not always available, Wilms' tumor gene 1 (WT1) has been suggested as a universal marker, but has not yet been established clinically. METHODS We determined the level of WT1 gene expression in 130 children, adolescents and young adults with malignant hematological diseases prior to transplantation and evaluated its impact on patients' outcome. A real-time quantitative RT-PCR was used for this purpose. RESULTS The relationship between a high level of WT1 and the cumulative incidence of relapse, event-free survival and overall survival proved to be highly significant in univariate and multivariate analyses. Forty-eight percent of all patients with high WT1 levels suffered from a relapse, whereas only eight percent showing normal WT1 levels before transplantation relapsed. The most convincing result was found for acute myeloid leukemia (AML) and MDS. CONCLUSION We conclude that WT1 expression prior to transplantation qualifies as an independent prognostic factor and should be further evaluated for MRD monitoring. It might especially be useful for patients with AML or MDS missing specific markers.
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Affiliation(s)
- Caroline Woehlecke
- Department of Pediatrics, Jena University Hospital, Kochstr. 2, 07743, Jena, Germany
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18
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Qiao SK, Guo XN, Ren JH, Zhang JN, Wang Y. Quantitative detection of the human cervical cancer oncogene for monitoring the minimal residual disease in acute leukemia. Exp Biol Med (Maywood) 2014; 240:128-34. [PMID: 25034723 DOI: 10.1177/1535370214543067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The human cervical cancer oncogene (HCCR) has been shown to be over-expressed in some solid tumors, and its function is involved in negative regulation of p53 tumor suppressor gene. However, the roles of HCCR in leukemia remain unclear. The present study is to investigate whether the expression levels of HCCR mRNA are associated with clinical prognosis in patients with acute leukemia (AL) and to explore the potential use as a biomarker for monitoring minimal residual disease (MRD) in AL. The mRNA levels of HCCR1 and HCCR2 were quantified by real-time reverse transcription polymerase chain reaction in bone marrow samples from 80 adult de novo AL patients and 20 normal healthy donors. The expressions of HCCR1 and HCCR2 were significantly higher in patients with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) than those in healthy donors (P < 0.01), but there was no significant difference between AML and ALL (P > 0.05). Besides white blood cell count, we did not find any significant correlation between HCCR expression and clinical characteristics, such as age, sex, CD34 antigen expression, and response to chemotherapy. HCCR was monitored in 12 cases during remission and/or relapse. Significant reductions of both HCCR1 and HCCR2 mRNA levels were observed in patients who had achieved complete remission after chemotherapy but not in patients with non-responsive. However, an increased HCCR expression was detected in these patients who relapsed. Our findings suggest that HCCR gene is over-expressed in AL patients and may be as a useful biomarker for monitoring MRD in AL.
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Affiliation(s)
- Shu-Kai Qiao
- Department of Hematology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China
| | - Xiao-Nan Guo
- Department of Hematology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China
| | - Jin-Hai Ren
- Department of Hematology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China
| | - Jing-Nan Zhang
- Department of Hematology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China
| | - Ying Wang
- Department of Hematology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China
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Jancuskova T, Plachy R, Zemankova L, Hardekopf DW, Stika J, Zejskova L, Praulich I, Kreuzer KA, Rothe A, Othman MA, Kosyakova N, Pekova S. Molecular characterization of the rare translocation t(3;10)(q26;q21) in an acute myeloid leukemia patient. Mol Cytogenet 2014; 7:47. [PMID: 25071866 PMCID: PMC4113123 DOI: 10.1186/1755-8166-7-47] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 07/02/2014] [Indexed: 01/17/2023] Open
Abstract
Background In acute myeloid leukemia (AML), the MDS1 and EVI1 complex locus - MECOM, also known as the ecotropic virus integration site 1 - EVI1, located in band 3q26, can be rearranged with a variety of partner chromosomes and partner genes. Here we report on a 57-year-old female with AML who presented with the rare translocation t(3;10)(q26;q21) involving the MECOM gene. Our aim was to identify the fusion partner on chromosome 10q21 and to characterize the precise nucleotide sequence of the chromosomal breakpoint. Methods Cytogenetic and molecular-cytogenetic techniques, chromosome microdissection, next generation sequencing, long-range PCR and direct Sanger sequencing were used to map the chromosomal translocation. Results Using a combination of cytogenetic and molecular approaches, we mapped the t(3;10)(q26;q21) to the single nucleotide level, revealing a fusion of the MECOM gene (3q26.2) and C10orf107 (10q21.2). Conclusions The approach described here opens up new possibilities in characterizing acquired as well as congenital chromosomal aberrations. In addition, DNA sequences of chromosomal breakpoints may be a useful tool for unique molecular minimal residual disease target identification in acute leukemia patients.
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Affiliation(s)
- Tereza Jancuskova
- Laboratory for Molecular Diagnostics, synlab genetics s.r.o., Evropska 176/16, Prague 6 16000, Czech Republic
| | - Radek Plachy
- Laboratory for Molecular Diagnostics, synlab genetics s.r.o., Evropska 176/16, Prague 6 16000, Czech Republic
| | - Lucie Zemankova
- Laboratory for Molecular Diagnostics, synlab genetics s.r.o., Evropska 176/16, Prague 6 16000, Czech Republic
| | - David Warren Hardekopf
- Laboratory for Molecular Diagnostics, synlab genetics s.r.o., Evropska 176/16, Prague 6 16000, Czech Republic
| | - Jiri Stika
- Laboratory for Molecular Diagnostics, synlab genetics s.r.o., Evropska 176/16, Prague 6 16000, Czech Republic
| | - Lenka Zejskova
- Laboratory for Molecular Diagnostics, synlab genetics s.r.o., Evropska 176/16, Prague 6 16000, Czech Republic
| | - Inka Praulich
- Department I of Internal Medicine, University at Cologne, Kerpener Str., Cologne, Germany
| | - Karl-Anton Kreuzer
- Department I of Internal Medicine, University at Cologne, Kerpener Str., Cologne, Germany
| | - Achim Rothe
- Oncological Therapy Center, Buchforststr., Cologne, Germany
| | - Moneeb Ak Othman
- Jena University Hospital, Institute of Human Genetics, Kollegiengasse 10, Jena, Germany
| | - Nadezda Kosyakova
- Jena University Hospital, Institute of Human Genetics, Kollegiengasse 10, Jena, Germany
| | - Sona Pekova
- Laboratory for Molecular Diagnostics, synlab genetics s.r.o., Evropska 176/16, Prague 6 16000, Czech Republic
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Mehn D, Morasso C, Vanna R, Schiumarini D, Bedoni M, Ciceri F, Gramatica F. Surface Enhanced Raman Spectroscopy-Based Method for Leukemia Biomarker Detection Using Magnetic Core @ Gold Shell Nanoparticles. BIONANOSCIENCE 2014. [DOI: 10.1007/s12668-014-0134-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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21
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Rossi G, Minervini MM, Melillo L, di Nardo F, de Waure C, Scalzulli PR, Perla G, Valente D, Sinisi N, Cascavilla N. Predictive role of minimal residual disease and log clearance in acute myeloid leukemia: a comparison between multiparameter flow cytometry and Wilm's tumor 1 levels. Ann Hematol 2014; 93:1149-57. [PMID: 24554303 DOI: 10.1007/s00277-014-2029-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 02/03/2014] [Indexed: 11/29/2022]
Abstract
In acute myeloid leukemia (AML), the detection of minimal residual disease (MRD) as well as the degree of log clearance similarly identifies patients with poor prognosis. No comparison was provided between the two approaches in order to identify the best one to monitor follow-up patients. In this study, MRD and clearance were assessed by both multiparameter flow cytometry (MFC) and WT1 expression at different time points on 45 AML patients achieving complete remission. Our results by WT1 expression showed that log clearance lower than 1.96 after induction predicted the recurrence better than MRD higher than 77.0 copies WT1/10(4) ABL. Conversely, on MFC, MRD higher than 0.2 % after consolidation was more predictive than log clearance below 2.64. At univariate and multivariate analysis, positive MRD values and log clearance below the optimal cutoffs were associated with a shorter disease-free survival (DFS). At the univariate analysis, positive MRD values were also associated with overall survival (OS). Therefore, post-induction log clearance by WT1 and post-consolidation MRD by MFC represented the most informative approaches to identify the relapse. At the optimal timing of assessment, positive MRD and log-clearance values lower than calculated thresholds similarly predicted an adverse prognosis in AML.
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Affiliation(s)
- Giovanni Rossi
- Department of Hematology and Stem Cell Transplant Unit, IRCCS "Casa Sollievo della Sofferenza" Hospital, v.le Cappuccini 1, 71013, San Giovanni Rotondo, Italy,
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Miyazaki T. Minimal residual disease-based risk stratification in acute myeloid leukemia. Leuk Res 2013; 37:1603-4. [PMID: 24135309 DOI: 10.1016/j.leukres.2013.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 09/20/2013] [Indexed: 11/24/2022]
Affiliation(s)
- Takuya Miyazaki
- Department of Internal Medicine and Clinical Immunology, Graduate School of Medicine & Faculty of Medicine, Yokohama City University, Yokohama, Japan.
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Integrating post induction WT1 quantification and flow-cytometry results improves minimal residual disease stratification in acute myeloid leukemia. Leuk Res 2013; 37:1606-11. [PMID: 23891447 DOI: 10.1016/j.leukres.2013.07.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 07/01/2013] [Indexed: 11/21/2022]
Abstract
Fifty uniformly treated adult AML patients were analyzed with respect to pre-treatment and post-induction risk factors. Forty-two patients achieving complete hematological remission were assessed for minimal residual disease (MRD) by WT1 gene expression; 34 by flow-cytometry (flow-MRD). Patients who were flow-MRD negative had a better 3-year disease-free (DFS; 79.5% vs. 27.3%; p=.032) compared with patients who were still positive after induction. Interestingly, DFS of flow-MRD positive patients was not related to the amount of flow-detected clone population (≥ or <1%, p=.41) but to WT1 reduction (ΔWT1, 3-year DFS; 46.2% vs. 0% if ΔWT1 was ≥ or < of 1.5 log, p=.001). In AML, combining MRD results provided by WT1 quantification and flow-cytometry improves the reliability of MRD-based prognostic stratification. Similar analyses by further larger studies should be advocated.
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Jancuskova T, Plachy R, Stika J, Zemankova L, Hardekopf DW, Liehr T, Kosyakova N, Cmejla R, Zejskova L, Kozak T, Zak P, Zavrelova A, Havlikova P, Karas M, Junge A, Ramel C, Pekova S. A method to identify new molecular markers for assessing minimal residual disease in acute leukemia patients. Leuk Res 2013; 37:1363-73. [PMID: 23870092 DOI: 10.1016/j.leukres.2013.06.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 05/20/2013] [Accepted: 06/05/2013] [Indexed: 01/13/2023]
Abstract
Acute leukemias (AL) comprise a heterogeneous group of hematologic malignancies, and individual patient responses to treatment can be difficult to predict. Monitoring of minimal residual disease (MRD) is thus very important and holds great potential for improving treatment strategies. Common MRD targets include recurrent cytogenetic abnormalities and mutations in important hematological genes; unfortunately well-characterized targets are lacking in many AL patients. Here we demonstrate a technical approach for the identification and mapping of novel clone-specific chromosomal abnormalities down to the nucleotide level. We used molecular cytogenetics, chromosome microdissection, amplification of the microdissected material, and next-generation sequencing to develop PCR-based MRD assays based on unique breakpoint sequences.
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Affiliation(s)
- Tereza Jancuskova
- Chambon, Laboratory for Molecular Diagnostics, Prague, Czech Republic
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Abstract
Technological advances in the laboratory have led to substantial improvements in clinical decision making through the introduction of pretreatment prognostic risk stratification factors in acute myeloid leukaemia (AML). Unfortunately, similar progress has not been made in treatment response criteria, with the definition of 'complete remission' in AML largely unchanged for over half a century. Several clinical trials have demonstrated that high-sensitivity measurements of residual disease burden during or after treatment can be performed, that results are predictive for clinical outcome and can be used to improve outcomes by guiding additional therapeutic intervention to patients in clinical complete remission, but at increased relapse risk. We review these recent trials, the characteristics and challenges of the modalities currently used to detect minimal residual disease (MRD), and outline opportunities to both refine detection and improve clinical use of MRD measurements. MRD measurement is already the standard of care in other myeloid malignancies, such as chronic myelogenous leukaemia and acute promyelocytic leukaemia (APL). It is our belief that response criteria for non-APL AML should be updated to include assessment for molecular complete remission and recommendations for post-consolidation surveillance should include regular monitoring for molecular relapse as standard of care.
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Affiliation(s)
- Christopher S Hourigan
- Myeloid Malignancies Section, Hematology Branch, National Heart, Lung and Blood Institute, 10 Centre Drive, Bethesda, MD 20892-1583, USA.
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Rossi G, Carella AM, Minervini MM, Savino L, Fontana A, Pellegrini F, Greco MM, Merla E, Quarta G, Loseto G, Capalbo S, Palumbo G, Cascavilla N. Minimal residual disease after allogeneic stem cell transplant: a comparison among multiparametric flow cytometry, Wilms tumor 1 expression and chimerism status (Complete chimerism versus Low Level Mixed Chimerism) in acute leukemia. Leuk Lymphoma 2013; 54:2660-6. [PMID: 23547840 DOI: 10.3109/10428194.2013.789508] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Relapse represents the main cause of treatment failure after allogeneic stem cell transplant (allo-SCT). The detection of minimal residual disease (MRD) by multiparametric flow cytometry (MFC), chimerism, cytogenetics and molecular analysis may be critical to prevent relapse. Therefore, we assessed the overall agreement among chimerism (low level mixed chimerism [LL-MC] vs. complete chimerism [CC]), MFC and Wilms tumor 1 (WT1) mRNA to detect MRD and investigated the impact of MRD obtained from the three methods on patient outcome. Sixty-seven fresh bone marrow (BM) samples from 24 patients (17 acute myeloid leukemia [AML], seven acute lymphoblastic leukemia [ALL]) in complete remission (CR) after allo-SCT were investigated at different time points. A moderate agreement was found among the three techniques investigated. A higher concordance between positive results from MFC (75.0% vs. 32.7%, p = 0.010) and WT1 (58.3% vs. 29.1%, p = 0.090) was detected among LL-MC rather than CC samples. Relapse-free survival (RFS) and overall survival (OS) were found to be higher in MRD negative patients than in MRD positive patients analyzed with MFC and WT1. Our results discourage the use of low autologous signals as the only marker of MRD, and suggest the usefulness of MFC and WT1 real-time quantitative polymerase chain reaction (RQ-PCR) in stratifying patients with respect to risk of relapse.
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Affiliation(s)
- Giovanni Rossi
- Department of Hematology and Stem Cell Transplantation Unit
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Bone marrow WT1 levels at diagnosis, post-induction and post-intensification in adult de novo AML. Leukemia 2013; 27:2157-64. [PMID: 23584566 DOI: 10.1038/leu.2013.111] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Revised: 03/25/2013] [Accepted: 04/10/2013] [Indexed: 11/08/2022]
Abstract
We retrospectively assessed whether normalized bone marrow WT1 levels could be used for risk stratification in a consecutive series of 584 acute myeloid leukemia (AML) patients. A cutoff value of 5065 copies at diagnosis identified two prognostic groups (overall survival (OS): 44 ± 3 vs 36 ± 3%, P=0.023; leukemia-free survival (LFS): 47 ± 3 vs 36 ± 4%, P=0.038; and cumulative incidence of relapse (CIR): 37 ± 3 vs 47 ± 4%, P=:0.043). Three groups were identified on the basis of WT1 levels post-induction: Group 0 (WT1 between 0 and 17.5 copies, 134 patients, OS: 59 ± 4%, LFS:59 ± 4% and CIR: 26 ± 4%); Group 1 (WT1 between 17.6 and 170.5 copies, 160 patients, OS: 48 ± 5%, LFS:41 ± 4% and CIR: 45 ± 4%); and Group 2 (WT1 >170.5 copies, 71 patients, OS: 23 ± 6%, LFS: 19 ± 7% and CIR: 68 ± 8%) (P<0.001). Post-intensification samples distinguished three groups: patients with WT1 >100 copies (47 patients, 16%); an intermediate group of patients with WT1 between 10 and 100 copies (148 patients, 52%); and a third group with WT1 <10 copies (92 patients, 32%). Outcomes differed significantly in terms of OS (30 ± 7%, 59 ± 4%, 72 ± 5%), LFS (24 ± 7%, 46 ± 4%, 65 ± 5%) and relapse probability (CIR 72 ± 7%, 45 ± 4%, 25 ± 5%), all P<0.001. WT1 levels in bone marrow assayed using the standardized ELN method provide relevant prognostic information in de novo AML.
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Estey EH. Acute myeloid leukemia: 2013 update on risk-stratification and management. Am J Hematol 2013; 88:318-27. [PMID: 23526416 DOI: 10.1002/ajh.23404] [Citation(s) in RCA: 194] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 01/23/2013] [Indexed: 12/11/2022]
Abstract
DISEASE OVERVIEW Acute myeloid leukemia (AML) results from accumulation of abnormal blasts in the marrow. These cells interfere with normal hematopoiesis, can escape into the peripheral blood, and infiltrate CSF and lung. It is likely that many different mutations, epigenetic aberrations, or abnormalities in micro RNA expression can produce the same morphologic disease with these differences responsible for the very variable response to therapy, which is AMLs principal feature. DIAGNOSIS This rests on demonstration that the marrow or blood has > 20% blasts of myeloid lineage. Blast lineage is assessed by multiparameter flow cytometry, with CD33 and CD13 being surface markers typically expressed by myeloid blasts. It should be realized that clinical/prognostic considerations, not the blast % per se, should be the main factor determining how a patient is treated. RISK STRATIFICATION Two features determine risk: the probability of treatment-related mortality (TRM) and, more important, even in patients aged >75 with Zubrod performance status 1, the probability of resistance to standard therapy despite not incurring TRM. The chief predictor of resistance is cytogenetics, with a monosomal karyotype (MK) denoting the disease is essentially incurable with standard therapy even if followed by a standard allogeneic transplant (HCT). The most common cytogentic finding is a normal karyotype(NK) and those of such patients with an NPM1 mutation but no FLT3 internal tandem duplication (ITD), or with a CEBPA mutation, have a prognosis similar to that of patients with the most favorable cytogenetics (inv 16 or t[8;21]) (60-70% cure rate). In contrast, NK patients with a FLT3 ITD have only a 30-40% chance of cure even after HCT. Accordingly analyses of NPM1, FLT3, and CEBPA should be part of routine evaluation, much as is cytogenetics. Risk is best assessed considering several variables simultaneously rather than, for example, only age. Increasing evidence indicates that other mutations and abnormalities in microRNA (miRNA) expression also affect resistance as do post treatment factors, in particular the presence of minimal residual disease. These newer mutations and MRD are discussed in this update. RISK-ADAPTED THERAPY Patients with inv (16) or t(8;21) or who are NPM1+/FLT3ITD-can receive standard therapy (daunorubicin + cytarabine) and should not receive HCT in first CR. It seems likely that use of a daily daunorubicin dose of 90 mg/m(2) will further improve outcome in these patients. There appears no reason to use doses of cytarabine > 1 g/m(2) (for example bid X 6 days), as opposed to the more commonly used 3 g/m(2) . Patients with an unfavorable karyotype (particularly MK) are unlikely to benefit from standard therapy (even with dose escalation) and are thus prime candidates for clinical trials of new drugs or new approaches to HCT; the latter should be done in first CR. Patients with intermediate prognoses (for example NK and NPM and FLT3ITD negative) should also receive HCT in first CR and can plausibly receive either investigational or standard induction therapy, with the same prognostic information about standard therapy leading one patient to choose the standard and another an investigational option. This update discusses results with newer agents: quizartinib and crenolanib, gemtuzumab ozogamicin, clofarabine and cladribine, azacitidine and decitabine, volasertib, and means to prevent relapse after allogeneic transplant. The diagnosis of AML essentially is made as it was in 2012. Thus this review will emphasize new developments in risk stratification and treatment using as references many papers published in 2012.
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Affiliation(s)
- Elihu H. Estey
- Division of Hematology; University of Washington
- Clinical Research Division; Fred Hutchinson Cancer Research Center, Seattle, WA
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Abstract
Abstract
The achievement of complete hematologic remission (CR) is a prerequisite for cure in acute myeloid leukemia (AML). The conventional definition of CR, based on the morphologic recognition of ≤ 5% of leukemic blasts in the BM, does not provide sufficient insight into the quality of the response. Despite CR rates of 50%-80% (depending on age), the majority of patients with AML relapse within 3-5 years from diagnosis. Therefore, there is great need of more sensitive prognostic factors that can predict relapse. Minimal residual disease (MRD), defined as any measurable disease or leukemia detectable above a certain threshold (defined by the methodology applied), predicts failure to maintain a morphologic CR and affects survival negatively. AML is lagging behind acute lymphoblastic leukemia with respect to the implementation of MRD criteria for guidance during therapy. AML is particularly disadvantaged compared with acute lymphoblastic leukemia in that approximately half of AML patients lack a molecular target suitable for MRD monitoring. The detection of altered antigen (Ag) expression by leukemic myeloblasts is a valid alternative to DNA- or RNA-based MRD assays. Although associated with presenting prognostic factors (eg, cytogenetics and genotype), MRD represents the collective end result of all of the cellular mechanisms that determine a patient's response to a given therapy. Therefore, MRD has 2 potential roles in AML treatment: (1) as a posttherapy prognosticator used to assign patients to optimal postinduction/consolidation therapy, and (2) as an early surrogate end point for the evaluation of therapy efficacy.
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The minimal residual disease concept coming of age - now for the direct comparison of methodologies. Leuk Res 2012; 36:392-3. [PMID: 22261230 DOI: 10.1016/j.leukres.2011.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Revised: 12/28/2011] [Accepted: 12/29/2011] [Indexed: 11/22/2022]
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