1
|
Pan X, Chang Y, Ruan G, Wei F, Jiang H, Jiang Q, Huang X, Zhao X. Prognostic impact of FLT3-ITD mutation on NPM1 + acute myeloid leukaemia patients and related molecular mechanisms. Br J Haematol 2023; 203:212-223. [PMID: 37621257 DOI: 10.1111/bjh.18973] [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: 04/23/2023] [Revised: 06/12/2023] [Accepted: 06/28/2023] [Indexed: 08/26/2023]
Abstract
The prognosis of acute myeloid leukaemia (AML) patients carrying NPM1 mutations is significantly worse when accompanied by FLT3-ITD mutations. However, accurate quantitative detection of FLT3-ITD mutations remains challenging. To identify a novel biomarker in NPM1+ FLT3-ITD+ AML patients for more accurate stratification, we analysed the differential gene expression between the NPM1+ FLT3-ITD+ and NPM1+ FLT3-ITD- groups in five public AML datasets and identified a biomarker by taking the intersection of differentially expressed genes. We validated this biomarker in bone marrow samples from NPM1+ AML patients at the Peking University Institute of Haematology and analysed its prognostic significance. BCAT1 expression was higher in the NPM1+ FLT3-ITD+ group than in the NPM1+ FLT3-ITD- group in all seven cohorts. BCAT1 was able to predict the prognosis of NPM1+ FLT3-ITD+ AML patients, and its predictive ability was superior to that of the FLT3-ITD allelic ratio (AR). FLT3-targeted inhibitor quizartinib reduced BCAT1 expression. BCAT1 knockdown using lentiviral vectors led to the downregulation of MYC expression. Thus, we identified BCAT1 as a novel biomarker for NPM1+ FLT3-ITD+ AML patients. The FLT3-ITD/BCAT1/MYC signalling pathway may play a biological role in promoting the occurrence and development of AML in FLT3-ITD+ cell lines.
Collapse
Affiliation(s)
- Xin'an Pan
- National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University Institute of Hematology, Peking University People's Hospital, Beijing, China
| | - Yingjun Chang
- National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University Institute of Hematology, Peking University People's Hospital, Beijing, China
| | - Guorui Ruan
- National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University Institute of Hematology, Peking University People's Hospital, Beijing, China
| | - Fangfang Wei
- National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University Institute of Hematology, Peking University People's Hospital, Beijing, China
| | - Hao Jiang
- National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University Institute of Hematology, Peking University People's Hospital, Beijing, China
| | - Qian Jiang
- National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University Institute of Hematology, Peking University People's Hospital, Beijing, China
| | - Xiaojun Huang
- National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University Institute of Hematology, Peking University People's Hospital, Beijing, China
- Peking-Tsinghua Center for Life Sciences, Beijing, China
- Research Unit of Key Technique for Diagnosis and Treatments of Hematologic Malignancies, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaosu Zhao
- National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University Institute of Hematology, Peking University People's Hospital, Beijing, China
- Research Unit of Key Technique for Diagnosis and Treatments of Hematologic Malignancies, Chinese Academy of Medical Sciences, Beijing, China
| |
Collapse
|
2
|
Weinberg OK, Dennis J, Zia H, Chen P, Chu A, Koduru P, Luu HS, Fuda F, Chen W. Adult mixed phenotype acute leukemia (MPAL): B/myeloid MPAL isoMPO is distinct from other MPAL subtypes. Int J Lab Hematol 2023; 45:170-178. [PMID: 36325594 DOI: 10.1111/ijlh.13988] [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: 07/03/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Myeloperoxidase (MPO) is considered a specific marker of myeloid/non-monocytic lineage in the diagnosis of mixed phenotype acute leukemia (MPAL). However, the clinical significance of isolated dim MPO expression in otherwise typical B lymphoblastic leukemia (B-ALL; referred to as B/myeloid MPALisoMPO ) in adult patients is unknown. METHODS We compared flow cytometric immunophenotype and clinicopathological findings among cases of B/myeloid MPALisoMPO (n = 13), other MPAL subtypes (n = 10, B/myeloid and T/myeloid MPAL), B-ALL (n = 64), and acute myeloid leukemia (AML, n = 58), using the 2016 WHO classification. For MPAL cases, MPO was reported as the percent of MPO positive blasts and its intensity (dim or moderate/strong). The pattern of heterogenous antigen expression (inversely coordinated expression between myeloid and lymphoid markers and cell size) was assessed. RESULTS Cases of B/myeloid MPALisoMPO showed a fairly homogenous single B-lineage blast population with dim MPO expression whereas cases of other MPAL subtypes displayed heterogeneous antigen expression and moderate/strong MPO expression. The percent of MPO positive blasts in these two groups was similar. Expressions of CD15, CD117, and monocytic markers were more common in other MPAL than in B/myeloid MPALisoMPO . B/myeloid MPALisoMPO patients had similar overall and leukemia free survivals as B-ALL patients and better than other MPAL patients. CONCLUSION This is the first study to investigate the clinical significance of adult B/myeloid MPALisoMPO using the 2016 WHO classification. Our results suggest that B/myeloid MPALisoMPO clinically behaves more similarly to B-ALL than to other MPAL subtypes, supporting the 2016 WHO classification to segregate this entity from other MPAL subtypes.
Collapse
Affiliation(s)
- Olga K Weinberg
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jake Dennis
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Hamid Zia
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Pu Chen
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Laboratory Medicine, Zhongshan Hospital Fudan University, Shanghai, China
| | - Andrew Chu
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Prasad Koduru
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Hung S Luu
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Franklin Fuda
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Weina Chen
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
3
|
Oertling E, Fuda F, Koduru P, Chen M, Weinberg O, Juntilla M, Jaso J, Vusirikala M, Chung S, Geethakumari PR, Madanat YF, Collins R, Gagan J, Chen W. Distinct mutational and clinicopathologic profiles characterize acute myeloid leukemia with cup-like nuclei. Leuk Res 2023; 124:106995. [PMID: 36459761 DOI: 10.1016/j.leukres.2022.106995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/20/2022] [Accepted: 11/24/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Estelle Oertling
- Departments of Pathology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Franklin Fuda
- Departments of Pathology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Prasad Koduru
- Departments of Pathology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Mingyi Chen
- Departments of Pathology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Olga Weinberg
- Departments of Pathology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Marisa Juntilla
- Departments of Pathology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Jesse Jaso
- Departments of Pathology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Madhuri Vusirikala
- Departments of Internal Medicine (Hematology and Oncology), University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Stephen Chung
- Departments of Internal Medicine (Hematology and Oncology), University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | | | - Yazan F Madanat
- Departments of Internal Medicine (Hematology and Oncology), University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Robert Collins
- Departments of Internal Medicine (Hematology and Oncology), University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Jeffrey Gagan
- Departments of Pathology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Weina Chen
- Departments of Pathology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
| |
Collapse
|
4
|
Alsuwaidan A, Koduru P, Fuda F, Manuel Jaso J, Chen M, Rosado F, Luu HS, Sweed N, Garcia R, Doucet M, Desai NB, Kumar KA, Awan FT, Ramakrishnan Geethakumari P, Chen W. A Combined Biomarker of Bright CD38 and MYC ≥55% Is Highly Predictive of Double-/Triple-Hit High-Grade B-Cell Lymphoma. Am J Clin Pathol 2022; 158:338-344. [PMID: 35511691 DOI: 10.1093/ajcp/aqac047] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/24/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Diagnosis of high-grade B-cell lymphoma with MYC and BCL2 or BCL6 rearrangements (double-/triple-hit lymphoma [DTHL]) appears to mandate fluorescence in situ hybridization (FISH) testing for all large B-cell lymphoma (LBCL). Given the low incidence of DTHL, we aimed to identify flow cytometry (FC) and immunohistochemistry (IHC) features of DTHL that could be used to develop an optimal screening strategy. This combined FC-IHC approach has not yet been studied. METHODS We compared features of 40 cases of DTHL and 39 cases of diffuse LBCL (DLBCL) without MYC rearrangement. RESULTS Bright CD38 expression (CD38bright) by FC, high MYC expression (≥55%), and double-expressor phenotype by IHC were significantly associated with DTHL. The biomarker combining FC and IHC, CD38bright and/or MYC ≥55%, was superior to FC and IHC markers alone in predicting DTHL. Restricting FISH testing to approximately 25% of LBCL based on CD38brightand/or MYC ≥55% would detect approximately 95% of DTHL-BCL2 and approximately 75% of DHL-BCL6. CONCLUSIONS Our study demonstrated that the novel biomarker of CD38bright and/or MYC ≥55% is highly predictive of DTHL. Awareness of the advantages and limitations of this screening strategy would facilitate development of a rational diagnostic workflow to provide high-quality patient care.
Collapse
Affiliation(s)
- Abdullah Alsuwaidan
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Prasad Koduru
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Franklin Fuda
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jesse Manuel Jaso
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mingyi Chen
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Flavia Rosado
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Hung S Luu
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nathan Sweed
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rolando Garcia
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Meggie Doucet
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Neil B Desai
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kiran A Kumar
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Farrukh T Awan
- Internal Medicine/Division of Hematologic Malignancies and Stem Cell Transplantation, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Praveen Ramakrishnan Geethakumari
- Internal Medicine/Division of Hematologic Malignancies and Stem Cell Transplantation, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Weina Chen
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|