1
|
Kim SW, Kim N, Choi YJ, Lee ST, Choi JR, Shin S. Real-World Clinical Utility of Targeted RNA Sequencing in Leukemia Diagnosis and Management. Cancers (Basel) 2024; 16:2467. [PMID: 39001529 PMCID: PMC11240350 DOI: 10.3390/cancers16132467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 07/02/2024] [Accepted: 07/04/2024] [Indexed: 07/16/2024] Open
Abstract
Gene fusions are key drivers in acute leukemia, impacting diagnosis and treatment decisions. We analyzed 264 leukemia patients using targeted RNA sequencing with conventional karyotyping and reverse transcription polymerase chain reaction (RT-PCR). Leukemic fusions were detected in 127 patients (48.1%). The new guidelines introduced additional diagnostic criteria, expanding the spectrum of gene fusions. We discovered three novel fusions (RUNX1::DOPEY2, RUNX1::MACROD2, and ZCCHC7::LRP1B). We analyzed recurrent breakpoints for the KMT2A and NUP98 rearrangements. Targeted RNA sequencing showed consistent results with RT-PCR in all tested samples. However, when compared to conventional karyotyping, we observed an 83.3% concordance rate, with 29 cases found only in targeted RNA sequencing, 7 cases with discordant results, and 5 cases found only in conventional karyotyping. For the five cases where known leukemic gene rearrangements were suspected only in conventional karyotyping, we conducted additional messenger RNA sequencing in four cases and proved no pathogenic gene rearrangements. Targeted RNA sequencing proved advantageous for the rapid and accurate interpretation of gene rearrangements. The concurrent use of multiple methods was essential for a comprehensive evaluation. Comprehensive molecular analysis enhances our understanding of leukemia's genetic basis, aiding diagnosis and classification. Advanced molecular techniques improve clinical decision-making, offering potential benefits.
Collapse
Affiliation(s)
- Seo Wan Kim
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea (J.R.C.)
| | - Namsoo Kim
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea (J.R.C.)
| | - Yu Jeong Choi
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea (J.R.C.)
| | - Seung-Tae Lee
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea (J.R.C.)
- Dxome Co., Ltd., Seongnam-si 13558, Republic of Korea
| | - Jong Rak Choi
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea (J.R.C.)
- Dxome Co., Ltd., Seongnam-si 13558, Republic of Korea
| | - Saeam Shin
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea (J.R.C.)
| |
Collapse
|
2
|
Qiao Y, Zhang Y, Liu N, Chen P, Liu Y. An End-to-End Pipeline for Early Diagnosis of Acute Promyelocytic Leukemia Based on a Compact CNN Model. Diagnostics (Basel) 2021; 11:diagnostics11071237. [PMID: 34359320 PMCID: PMC8304210 DOI: 10.3390/diagnostics11071237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 01/31/2023] Open
Abstract
Timely microscopy screening of peripheral blood smears is essential for the diagnosis of acute promyelocytic leukemia (APL) due to the occurrence of early death (ED) before or during the initial therapy. Screening manually is time-consuming and tedious, and may lead to missed diagnosis or misdiagnosis because of subjective bias. To address these problems, we develop a three-step pipeline to help in the early diagnosis of APL from peripheral blood smears. The entire pipeline consists of leukocytes focusing, cell classification and diagnostic opinions. As the key component of the pipeline, a compact classification model based on attention embedded convolutional neural network blocks is proposed to distinguish promyelocytes from normal leukocytes. The compact classification model is validated on both the combination of two public datasets, APL-Cytomorphology_LMU and APL-Cytomorphology_JHH, as well as the clinical dataset, to yield a precision of 96.53% and 99.20%, respectively. The results indicate that our model outperforms the other evaluated popular classification models owing to its better accuracy and smaller size. Furthermore, the entire pipeline is validated on realistic patient data. The proposed method promises to act as an assistant tool for APL diagnosis.
Collapse
Affiliation(s)
- Yifan Qiao
- The College of Computer Science, Sichuan University, Chengdu 610065, China; (Y.Q.); (Y.Z.)
| | - Yi Zhang
- The College of Computer Science, Sichuan University, Chengdu 610065, China; (Y.Q.); (Y.Z.)
| | - Nian Liu
- The College of Electrical Engineering, Sichuan University, Chengdu 610065, China;
| | - Pu Chen
- The Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Correspondence: (P.C.); (Y.L.); Tel.: +86-021-64041990 (ext. 2435) (P.C.); +86-028-85120790 (Y.L.)
| | - Yan Liu
- The College of Electrical Engineering, Sichuan University, Chengdu 610065, China;
- Correspondence: (P.C.); (Y.L.); Tel.: +86-021-64041990 (ext. 2435) (P.C.); +86-028-85120790 (Y.L.)
| |
Collapse
|
3
|
Varghese C, Liu VY, Immanuel T, Chien N, Green T, Chan G, Theakston E, Kalev-Zylinska M. Ethnic differences in acute promyelocytic leukaemia between New Zealand Polynesian and European patients. ACTA ACUST UNITED AC 2021; 26:215-224. [PMID: 33594940 DOI: 10.1080/16078454.2021.1882146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Ethnic differences in haematologic malignancies remain poorly elucidated, hence research in this area is important. This was a retrospective study into potential ethnic disparity in the presentation and outcomes of acute promyelocytic leukaemia (APL) between New Zealand (NZ) Polynesian and European patients. Data were analysed for patients treated at Auckland City Hospital (ACH; n = 55) and recorded in the New Zealand Cancer Registry (NZCR; n = 173), both for the period 2000-2017. We found that Polynesian patients treated at ACH presented at a younger age than European (P = 0.005), showed higher blast counts (P = 0.033), and a marginally higher prothrombin ratio (P = 0.02). Treatment with all-trans retinoic acid (ATRA) was started faster in Polynesian patients than European (P = 0.021), suggesting Polynesians were sicker at presentation but were managed accordingly. There were no differences in bleeding events, transfusion requirements and early deaths during the first month of treatment. Long-term survival was also similar. Data extracted from the NZCR confirmed NZ Polynesian patients with APL were younger than European (P < 0.001), but long-term survival was similar (P = 0.920). In summary, this study indicates a discrepancy in the presentation and severity of APL between NZ Polynesian and European patients but treatment initiation was rapid with no difference in outcomes. The distinctive features of APL in NZ Polynesians raise the possibility of a predisposing genetic factor or a different risk factor profile, elucidation of which is important for all patients with APL.
Collapse
Affiliation(s)
- Chris Varghese
- Blood and Cancer Biology Laboratory, Department of Molecular Medicine & Pathology, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | | | - Tracey Immanuel
- Blood and Cancer Biology Laboratory, Department of Molecular Medicine & Pathology, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - Nicole Chien
- Department of Haematology, Auckland City Hospital, Auckland, New Zealand.,Department of Pathology and Laboratory Medicine, LabPlus Haematology, Auckland City Hospital, Auckland, New Zealand
| | - Taryn Green
- Blood and Cancer Biology Laboratory, Department of Molecular Medicine & Pathology, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - George Chan
- Blood and Cancer Biology Laboratory, Department of Molecular Medicine & Pathology, School of Medical Sciences, University of Auckland, Auckland, New Zealand.,Department of Haematology, Auckland City Hospital, Auckland, New Zealand.,Department of Pathology and Laboratory Medicine, LabPlus Haematology, Auckland City Hospital, Auckland, New Zealand
| | - Edward Theakston
- Department of Pathology and Laboratory Medicine, LabPlus Haematology, Auckland City Hospital, Auckland, New Zealand
| | - Maggie Kalev-Zylinska
- Blood and Cancer Biology Laboratory, Department of Molecular Medicine & Pathology, School of Medical Sciences, University of Auckland, Auckland, New Zealand.,Department of Pathology and Laboratory Medicine, LabPlus Haematology, Auckland City Hospital, Auckland, New Zealand
| |
Collapse
|
4
|
Chien N, Varghese C, Green TN, Chan G, Theakston E, Eaddy N, Doocey R, Berkahn L, Hawkins T, Browett PJ, Kalev-Zylinska ML. Treatment outcomes of patients with acute promyelocytic leukaemia between 2000 and 2017, a retrospective, single centre experience. Leuk Res 2020; 93:106358. [PMID: 32380366 DOI: 10.1016/j.leukres.2020.106358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/19/2020] [Accepted: 04/20/2020] [Indexed: 02/06/2023]
Abstract
All-trans retinoic acid (ATRA) and arsenic trioxide (ATO) are effective induction therapy for acute promyelocytic leukaemia (APL). However, early thrombo-haemorrhagic complications and mortality remain high. We aimed to investigate how the timing of ATRA initiation and the inclusion of ATO influence patient outcomes. Clinical records were retrospectively reviewed for all patients treated for APL in a single, tertiary centre during 2000-2017. Among 70 patients with APL, 36 (51.4%) presented with thrombo-haemorrhagic complications, and four (5.8%) died within 30 days. The median time to ATRA initiation was 11.2 (range 0-104) h from the time of admission. Patients requiring more transfusions started on ATRA sooner (P = 0.04). Patients with adverse early events did not start ATRA later (P = 0.99). Nevertheless, patients that required additional tests for diagnosis (PML immunofluorescence or molecular) started on ATRA later (28.5 versus 5.3 h; P < 0.0001), and had more thrombo-haemorrhagic complications (P = 0.04). Long-term survival was actually better in patients who started ATRA later (P = 0.03), which is likely explained by higher proportion of low risk patients in this group. Patients treated with ATO (n = 23) maintained higher fibrinogen levels and required less transfusions during induction (P < 0.05), with no disease-related deaths in this group over a median follow-up time of 37.8 months (interquartile range 44.9 months). In summary, fast ATRA initiation reduces early but not late adverse events in APL patients, and the inclusion of ATO helps further improve both early and late outcomes in APL.
Collapse
Affiliation(s)
- Nicole Chien
- Department of Haematology, Auckland City Hospital, Auckland, New Zealand
| | - Chris Varghese
- Department of Molecular Medicine and Pathology, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - Taryn N Green
- Department of Molecular Medicine and Pathology, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - George Chan
- Department of Haematology, Auckland City Hospital, Auckland, New Zealand; Department of Molecular Medicine and Pathology, School of Medical Sciences, University of Auckland, Auckland, New Zealand; Department of Pathology and Laboratory Medicine, LabPlus Haematology, Auckland City Hospital, Auckland, New Zealand
| | - Edward Theakston
- Department of Pathology and Laboratory Medicine, LabPlus Haematology, Auckland City Hospital, Auckland, New Zealand
| | - Nicola Eaddy
- Department of Haematology, Auckland City Hospital, Auckland, New Zealand
| | - Richard Doocey
- Department of Haematology, Auckland City Hospital, Auckland, New Zealand
| | - Leanne Berkahn
- Department of Haematology, Auckland City Hospital, Auckland, New Zealand
| | - Timothy Hawkins
- Department of Haematology, Auckland City Hospital, Auckland, New Zealand
| | - Peter J Browett
- Department of Haematology, Auckland City Hospital, Auckland, New Zealand; Department of Molecular Medicine and Pathology, School of Medical Sciences, University of Auckland, Auckland, New Zealand; Department of Pathology and Laboratory Medicine, LabPlus Haematology, Auckland City Hospital, Auckland, New Zealand
| | - Maggie L Kalev-Zylinska
- Department of Molecular Medicine and Pathology, School of Medical Sciences, University of Auckland, Auckland, New Zealand; Department of Pathology and Laboratory Medicine, LabPlus Haematology, Auckland City Hospital, Auckland, New Zealand.
| |
Collapse
|