1
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DeWolf S, Tallman MS, Rowe JM, Salman MY. What Influences the Decision to Proceed to Transplant for Patients With AML in First Remission? J Clin Oncol 2023; 41:4693-4703. [PMID: 37611216 PMCID: PMC10564290 DOI: 10.1200/jco.22.02868] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/12/2023] [Accepted: 06/14/2023] [Indexed: 08/25/2023] Open
Abstract
Although allogeneic hematopoietic cell transplantation (allo-HCT) remains the backbone of curative treatment for the majority of fit adults diagnosed with AML, there is indeed a subset of patients for whom long-term remission may be achieved without transplantation. Remarkable changes in our knowledge of AML biology in recent years has transformed the landscape of diagnosis, management, and treatment of AML. Specifically, markedly increased understanding of molecular characteristics of AML, the expanded application of minimal/measurable residual diseases testing, and an increased armamentarium of leukemia-directed therapeutic agents have created a new paradigm for the medical care of patients with AML. An attempt is herein made to decipher the decision to proceed to transplant for patients with AML in first complete remission on the basis of the current best available evidence. The focus is on factors affecting the biology and treatment of AML itself, rather than on variables related to allo-HCT, an area characterized by significant advancements that have reduced overall therapy-related complications. This review seeks to focus on areas of particular complexity, while simultaneously providing clarity on how our current knowledge and treatment strategies may, or may not, influence the decision to pursue allo-HCT in patients with AML.
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Affiliation(s)
- Susan DeWolf
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Martin S. Tallman
- Division of Hematology and Oncology Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jacob M. Rowe
- Rambam Health Care Campus and Technion, Israel Institute of Technology, Haifa, Israel
- Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel
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2
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Zhang W, Liu B, Wu S, Zhao L. TMT-based comprehensive proteomic profiling identifies serum prognostic signatures of acute myeloid leukemia. Open Med (Wars) 2023; 18:20220602. [PMID: 37016705 PMCID: PMC10066874 DOI: 10.1515/med-2022-0602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/19/2022] [Accepted: 10/16/2022] [Indexed: 04/06/2023] Open
Abstract
Acute myeloid leukemia (AML) is classified into favorable-risk, intermediate-risk, and poor-risk subtypes. This study aimed to compare the serum proteomic signatures of the three AML subtypes and identify prognostic biomarkers for AML. Serum samples from patients with favorable-risk (n = 14), intermediate-risk (n = 19), and poor-risk AMLs (n = 18) were used for the analysis of tandem mass tag (TMT) labeling-based quantitative proteomics. Comparative analysis was performed to identify differentially expressed proteins (DEPs) between groups. Prognostic proteins were screened using binary logistics regression analysis. TMT-MS/MS proteomics analysis identified 138 DEPs. Fumarate hydratase (FH), isocitrate dehydrogenase 2 (IDH2), and enolase 1 (ENO1) were significantly upregulated in poor-risk patients compared with favorable-risk patients. ELISA assay confirmed that patients with poor-risk AMLs had higher levels of IDH2, ENO1, and FH compared with intermediate-risk AML patients. Logistics analysis identified that proteins 3-hydroxyacyl-CoA dehydrogenase type-2 (HADH, odds ratio (OR) = 1.035, p = 0.010), glutamine synthetase (GLUL, OR = 1.022, p = 0.039), and lactotransferrin (LTF, OR = 1.1224, p = 0.016) were associated with poor prognosis, and proteins ENO1 (OR = 1.154, p = 0.053), FH (OR = 1.043, p = 0.059), and IDH2 (OR = 3.350, p = 0.055) were associated with AML prognosis. This study showed that AML patients had elevated levels of FH, IDH2, ENO1, LTF, and GLUL proteins and might be at high risk of poor prognosis.
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Affiliation(s)
- Wei Zhang
- Department of Central Laboratory, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Bei Liu
- Department of Hematology, The First Hospital of Lanzhou University, Lanzhou 730000, China
| | - Shiwen Wu
- Department of Laboratory Medicine, The First Hospital of Lanzhou University, Lanzhou 730000, China
| | - Li Zhao
- Department of Central Laboratory, The First Hospital of Lanzhou University, #1 Donggang West Road, Lanzhou 730000, Gansu Province, China
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3
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Jacobs JW, Ramaswamy R, States V, Reppucci J, Oluwole OO, Mason EF, Thompson MA. Chronic myeloid leukemia with pure erythroid leukemia blast crisis. Leuk Lymphoma 2021; 63:212-216. [PMID: 34486918 DOI: 10.1080/10428194.2021.1975191] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Chronic myeloid leukemia (CML), a myeloproliferative neoplasm defined by the presence of the BCR-ABL1 oncogene created by the reciprocal translocation t(9;22)(q34.1;q11.2), can often be controlled by medications that inhibit this constitutive tyrosine kinase. However, if these therapies fail, the disease may progress to a form resembling an acute leukemia. While most of these CML 'blast crises' are characterized by blasts with a myeloid (granulocytic) or lymphoid lineage, these blasts may rarely be predominantly erythroid. Cases of CML erythroid blast crises have been reported; however, secondary pure erythroid leukemia arising from a CML blast crisis has only been definitively reported once before. We report the second definitive case of pure erythroid leukemia with the t(9;22)(q34.1;q11.2) presenting as a CML blast crisis and characterize the morphologic, immunophenotypic, flow cytometric, cytogenetic, and molecular findings.
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Affiliation(s)
- Jeremy W Jacobs
- Department of Pathology, Microbiology, & Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rahul Ramaswamy
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Vanessa States
- Department of Pathology, Microbiology, & Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jennifer Reppucci
- Department of Pathology, Microbiology, & Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Olalekan O Oluwole
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Emily F Mason
- Department of Pathology, Microbiology, & Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mary Ann Thompson
- Department of Pathology, Microbiology, & Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
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4
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Carbonell D, Suárez-González J, Chicano M, Andrés-Zayas C, Díez-Díez M, Rodríguez-Macías G, Muñiz P, Kwon M, Anguita J, Díez-Martín JL, Buño I, Martínez-Laperche C. Genetic biomarkers identify a subgroup of high-risk patients within low-risk NPM1-mutated acute myeloid leukemia. Leuk Lymphoma 2020; 62:1178-1186. [PMID: 33372822 DOI: 10.1080/10428194.2020.1863400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Although acute myeloid leukemia (AML) with NPM1mut/FLT3-ITDneg is a low-risk entity, its relapse rate remains high. Out of 333 AML patients, 27 were NPM1mut, and were analyzed in greater detail in order to find associations between clinical and molecular features and cumulative incidence of relapse. Next-generation sequencing (NGS) was performed on diagnosis and remission samples using two capture-based panels. The presence of the FLT3D835 variant at diagnosis and a qPCR value of NPM1mut ≥0.1% after induction chemotherapy were associated with an increased probability of relapse, especially if both conditions are present together. By contrast, patients in which the main clone found at diagnosis harbored NPM1 variant had a lower risk of relapse. Nineteen of the 85 variants found at diagnosis were detected by NGS in remission. AML Subgroup with NPM1mut/FLT3-ITDneg is a heterogeneous entity, which can be further risk-stratified based on molecular biomarkers.
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Affiliation(s)
- Diego Carbonell
- Department of Hematology, Gregorio Marañón General University Hospital, Madrid, Spain.,Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain
| | - Julia Suárez-González
- Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain.,Genomics Unit, Gregorio Marañón General University Hospital, IiSGM, Madrid, Spain
| | - María Chicano
- Department of Hematology, Gregorio Marañón General University Hospital, Madrid, Spain.,Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain
| | - Cristina Andrés-Zayas
- Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain.,Genomics Unit, Gregorio Marañón General University Hospital, IiSGM, Madrid, Spain
| | - Miriam Díez-Díez
- Genomics Unit, Gregorio Marañón General University Hospital, IiSGM, Madrid, Spain
| | | | - Paula Muñiz
- Department of Hematology, Gregorio Marañón General University Hospital, Madrid, Spain.,Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain
| | - Mi Kwon
- Department of Hematology, Gregorio Marañón General University Hospital, Madrid, Spain.,Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain
| | - Javier Anguita
- Department of Hematology, Gregorio Marañón General University Hospital, Madrid, Spain.,Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain
| | - José Luis Díez-Martín
- Department of Hematology, Gregorio Marañón General University Hospital, Madrid, Spain.,Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain.,Department of Medicine, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Ismael Buño
- Department of Hematology, Gregorio Marañón General University Hospital, Madrid, Spain.,Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain.,Genomics Unit, Gregorio Marañón General University Hospital, IiSGM, Madrid, Spain.,Department of Cell Biology, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Carolina Martínez-Laperche
- Department of Hematology, Gregorio Marañón General University Hospital, Madrid, Spain.,Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain
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5
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Liu M, Ren Y, Wang X, Lu X, Li M, Kim YM, Li S, Zhang L. Two rare cases of acute myeloid leukemia with t(8;16)(p11.2;p13.3) and 1q duplication: case presentation and literature review. Mol Cytogenet 2020; 13:37. [PMID: 32863883 PMCID: PMC7448493 DOI: 10.1186/s13039-020-00507-0] [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: 04/22/2020] [Accepted: 08/12/2020] [Indexed: 11/18/2022] Open
Abstract
Background Acute myeloid leukemia (AML) is a complex hematological disease characterized by genetic and clinical heterogeneity. The identification and understanding of chromosomal abnormalities are important for the diagnosis and management of AML patients. Compared with recurrent chromosomal translocations in AML, t(8;16)(p11.2;p13.3) can be found in any age group but is very rare and typically associated with poor prognosis. Methods Conventional cytogenetic studies were performed among 1,824 AML patients recorded in our oncology database over the last 20 years. Fluorescence in situ hybridization (FISH) was carried out to detect the translocation fusion. Array comparative genome hybridization (aCGH) was carried out to further characterize the duplication of chromosomes. Results We identified three AML patients with t(8;16)(p11.2;p13.3) by chromosome analysis. Two of the three patients, who harbored an additional 1q duplication, were detected by FISH and aCGH. aCGH characterized a 46.7 Mb and 49.9 Mb gain in chromosome 1 at band q32.1q44 separately in these two patients. One patient achieved complete remission (CR) but relapsed 3 months later. The other patient never experienced CR and died 2 years after diagnosis. Conclusion A 1q duplication was detected in two of three AML patients with t(8;16)(p11.2;p13.3), suggesting that 1q duplication can be a recurrent event in AML patients with t(8;16). In concert with the findings of previous studies on similar patients, our work suggests that 1q duplication may also be an unfavorable prognostic factor of the disease.
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Affiliation(s)
- Meng Liu
- Department of Hematology, The First Hospital of China Medical University, 155 Nanjing North Street, Shenyang, 110000 Liaoning People's Republic of China.,Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK USA
| | - Yuan Ren
- Department of Hematology, The First Hospital of China Medical University, 155 Nanjing North Street, Shenyang, 110000 Liaoning People's Republic of China.,Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK USA
| | - Xianfu Wang
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK USA
| | - Xianglan Lu
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK USA
| | - Ming Li
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK USA.,Department of Neurology, The Second Hospital of Jilin University, Jilin, People's Republic of China
| | - Young Mi Kim
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK USA
| | - Shibo Li
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK USA
| | - Lijun Zhang
- Department of Hematology, The First Hospital of China Medical University, 155 Nanjing North Street, Shenyang, 110000 Liaoning People's Republic of China
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6
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Quan X, Deng J. Core binding factor acute myeloid leukemia: Advances in the heterogeneity of KIT, FLT3, and RAS mutations (Review). Mol Clin Oncol 2020; 13:95-100. [PMID: 32714530 DOI: 10.3892/mco.2020.2052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 02/05/2020] [Indexed: 12/20/2022] Open
Abstract
Core binding factor (CBF) is a heterodimer protein complex involved in the transcriptional regulation of normal hematopoietic process. In addition, CBF molecular aberrations represent approximately 20% of all adult Acute Myeloid Leukemia (AML) patients. Treated with standard therapy, adult CBF AML has higher complete remission (CR) rate, longer CR duration, and better prognosis than that of AML patients with normal karyotype or other chromosomal aberrations. Although the prognosis of CBF AML is better than other subtypes of adult AML, it is still a group of heterogeneous diseases, and the prognosis is often different. Recurrence and relapse-related death are the main challenges to be faced following treatment. Mounting research shows the gene heterogeneity of CBF AML. Therefore, to achieve an improved clinical outcome, the differences in clinical and genotypic characteristics should be taken into account in the evaluation and management of such patients, so as to further improve the risk stratification of prognosis and develop targeted therapy. The present article is a comprehensive review of the differences in some common mutant genes between two subtypes of CBF AML.
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Affiliation(s)
- Xi Quan
- Department of Hematology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, P.R. China
| | - Jianchuan Deng
- Department of Hematology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, P.R. China
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7
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Prieto-Conde MI, Jiménez C, García-Álvarez M, Ramos F, Medina A, Cuello R, Balanzategui A, Alonso JM, Sarasquete ME, Queizán JA, Alcoceba M, Bárez A, Puig N, Cantalapiedra A, Gutiérrez NC, García-Sanz R, González-Díaz M, Chillón MC. Identification of relapse-associated gene mutations by next-generation sequencing in low-risk acute myeloid leukaemia patients. Br J Haematol 2020; 189:718-730. [PMID: 32124426 DOI: 10.1111/bjh.16420] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 11/08/2019] [Indexed: 12/11/2022]
Abstract
Recommended genetic categorization of acute myeloid leukaemias (AML) includes a favourable-risk category, but not all these patients have good prognosis. Here, we used next-generation sequencing to evaluate the mutational profile of 166 low-risk AML patients: 30 core-binding factor (CBF)-AMLs, 33 nucleophosmin (NPM1)-AMLs, 4 biCEBPα-AMLs and 101 acute promyelocytic leukaemias (APLs). Functional categories of mutated genes differed among subgroups. NPM1-AMLs showed frequent variations in DNA-methylation genes (DNMT3A, TET2, IDH1/2) (79%), although without prognostic impact. Within this group, splicing-gene mutations were an independent factor for relapse-free (RFS) and overall survival (OS). In CBF-AML, poor independent factors for RFS and OS were mutations in RAS pathway and cohesin genes, respectively. In APL, the mutational profile differed according to the risk groups. High-risk APLs showed a high mutation rate in cell-signalling genes (P = 0·002), highlighting an increased incidence of FLT3 internal tandem duplication (ITD) (65%, P < 0·0001). Remarkably, in low-risk APLs (n = 28), NRAS mutations were strongly correlated with a shorter five-year RFS (25% vs. 100%, P < 0·0001). Overall, a high number of mutations (≥3) was the worst prognostic factor RFS (HR = 2·6, P = 0·003). These results suggest that gene mutations may identify conventional low-risk AML patients with poor prognosis and might be useful for better risk stratification and treatment decisions.
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Affiliation(s)
- María Isabel Prieto-Conde
- Department of Hematology, IBSAL, CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), University Hospital of Salamanca, Salamanca, Spain
| | - Cristina Jiménez
- Department of Hematology, IBSAL, CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), University Hospital of Salamanca, Salamanca, Spain
| | - María García-Álvarez
- Department of Hematology, IBSAL, CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), University Hospital of Salamanca, Salamanca, Spain
| | - Fernando Ramos
- Department of Hematology, Hospital Virgen Blanca de León, León, Spain
| | - Alejandro Medina
- Department of Hematology, IBSAL, CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), University Hospital of Salamanca, Salamanca, Spain
| | - Rebeca Cuello
- Department of Hematology, Hospital Clínico de Valladolid, Valladolid, Spain
| | - Ana Balanzategui
- Department of Hematology, IBSAL, CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), University Hospital of Salamanca, Salamanca, Spain
| | - José M Alonso
- Department of Hematology, Hospital Río Carrión de Palencia, Palencia, Spain
| | - Maria Eugenia Sarasquete
- Department of Hematology, IBSAL, CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), University Hospital of Salamanca, Salamanca, Spain
| | | | - Miguel Alcoceba
- Department of Hematology, IBSAL, CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), University Hospital of Salamanca, Salamanca, Spain
| | - Abelardo Bárez
- Department of Hematology, Hospital Nuestra Señora de Sonsoles de Ávila, Avila, Spain
| | - Noemí Puig
- Department of Hematology, IBSAL, CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), University Hospital of Salamanca, Salamanca, Spain
| | | | - Norma C Gutiérrez
- Department of Hematology, IBSAL, CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), University Hospital of Salamanca, Salamanca, Spain
| | - Ramón García-Sanz
- Department of Hematology, IBSAL, CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), University Hospital of Salamanca, Salamanca, Spain
| | - Marcos González-Díaz
- Department of Hematology, IBSAL, CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), University Hospital of Salamanca, Salamanca, Spain
| | - María Carmen Chillón
- Department of Hematology, IBSAL, CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), University Hospital of Salamanca, Salamanca, Spain
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8
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Abstract
OBJECTIVE To describe the interdisciplinary management of acute leukemias across the continuum of care. DATA SOURCE Literature review and experiential knowledge. CONCLUSION Acute leukemia, including acute myelogenous leukemia, acute promyelocytic leukemia, and acute lymphoblastic leukemia, represent a heterogeneous group of hematologic malignancies with complex diagnostic requirements that drive risk-adapted treatment selection. Involvement of clinicians from a variety of specialties and disciplines is required to ensure safe and effective treatment, mitigate adverse events, and maintain or improve quality of life. Patient-centered communication, shared decision-making, and interdisciplinary communication are integral to patient outcomes. IMPLICATIONS FOR NURSING PRACTICE Oncology clinicians play a primary role in coordinating the interdisciplinary team and navigating the patient and caregiver experience across the acute leukemia continuum.
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Affiliation(s)
- Sandra Kurtin
- The University of Arizona Cancer Center, Tucson, AZ.
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9
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Turner SA, Shaver AC, Kovach AE, Oluwole OO, Mason EF. Myelodysplastic/myeloproliferative neoplasm with eosinophilia as a manifestation of Li Fraumeni Syndrome. Leuk Lymphoma 2019; 60:3312-3315. [DOI: 10.1080/10428194.2019.1630619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Scott A. Turner
- Department of Pathology, Virginia Commonwealth University, Richmond, VA, USA
| | - Aaron C. Shaver
- Division of Hematopathology, Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alexandra E. Kovach
- Division of Hematopathology, Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Olalekan O. Oluwole
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Emily F. Mason
- Division of Hematopathology, Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
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