1
|
Yamato G, Tsumura Y, Muramatsu H, Shimada A, Imaizumi T, Tsukagoshi H, Kaburagi T, Shiba N, Yamada Y, Deguchi T, Kawai T, Terui K, Ito E, Watanabe K, Hayashi Y. Cytokine profiling in 128 patients with transient abnormal myelopoiesis: a report from the JPLSG TAM-10 trial. Blood Adv 2024; 8:3120-3129. [PMID: 38691583 PMCID: PMC11222942 DOI: 10.1182/bloodadvances.2023011628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 04/22/2024] [Accepted: 04/29/2024] [Indexed: 05/03/2024] Open
Abstract
ABSTRACT Transient abnormal myelopoiesis (TAM) occurs in 10% of neonates with Down syndrome (DS). Although most patients show spontaneous resolution of TAM, early death occurs in ∼20% of cases. Therefore, new biomarkers are needed to predict early death and determine therapeutic interventions. This study aimed to determine the association between clinical characteristics and cytokine levels in patients with TAM. A total of 128 patients with DS with TAM enrolled in the TAM-10 study conducted by the Japanese Pediatric Leukemia/Lymphoma Study Group were included in this study. Five cytokine levels (interleukin-1b [IL-1b], IL-1 receptor agonist, IL-6, IL-8, and IL-13) were significantly higher in patients with early death than in those with nonearly death. Cumulative incidence rates (CIRs) of early death were significantly associated with high levels of the 5 cytokines. Based on unsupervised consensus clustering, patients were classified into 3 cytokine groups: hot-1 (n = 37), hot-2 (n = 42), and cold (n = 49). The CIR of early death was significantly different between the cytokine groups (hot-1/2, n = 79; cold, n = 49; hot-1/2 CIR, 16.5% [95% confidence interval (CI), 7.9-24.2]; cold CIR, 2.0% [95% CI, 0.0-5.9]; P = .013). Furthermore, cytokine groups (hot-1/2 vs cold) were independent poor prognostic factors in the multivariable analysis for early death (hazard ratio, 15.53; 95% CI, 1.434-168.3; P = .024). These results provide valuable information that cytokine level measurement was useful in predicting early death in patients with TAM and might help to determine the need for therapeutic interventions. This trial was registered at UMIN Clinical Trials Registry as #UMIN000005418.
Collapse
Affiliation(s)
- Genki Yamato
- Department of Hematology/Oncology, Gunma Children's Medical Center, Shibukawa, Japan
- Department of Pediatrics, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yusuke Tsumura
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hideki Muramatsu
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akira Shimada
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Japan
| | - Takahiro Imaizumi
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Hiroyuki Tsukagoshi
- Department of Research Group, Gunma Prefectural Institute of Public Health and Environmental Sciences, Maebashi, Japan
| | - Taeko Kaburagi
- Department of Hematology/Oncology, Gunma Children's Medical Center, Shibukawa, Japan
| | - Norio Shiba
- Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yoshiyuki Yamada
- Department of Allergy and Immunology, Gunma Children's Medical Center, Shibukawa, Japan
- Department of Pediatrics, Tokai University School of Medicine, Isehara, Japan
| | - Takao Deguchi
- Children’s Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Tomoko Kawai
- Department of Maternal-Fetal Biology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Kiminori Terui
- Department of Pediatrics, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Etsuro Ito
- Department of Pediatrics, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kenichiro Watanabe
- Department of Hematology and Oncology, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Yasuhide Hayashi
- Department of Hematology/Oncology, Gunma Children's Medical Center, Shibukawa, Japan
- Institute of Physiology and Medicine, Jobu University, Takasaki, Japan
| |
Collapse
|
2
|
Alenchery AJ, Yeaney NK, Chen CB, Talati R, Vogelius E, Tan C, Radhakrishnan K. A rare case of hepatic sinusoidal occlusive syndrome in a premature neonate with trisomy 21. J Neonatal Perinatal Med 2023; 16:735-740. [PMID: 38073401 DOI: 10.3233/npm-230094] [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] [Indexed: 12/26/2023]
Abstract
Trisomy 21 (Down Syndrome) may lead to multiple hematological and hepatobiliary manifestations including the development of transient abnormal myelopoiesis. While many cases resolve, transient abnormal myelopoiesis may lead to significant morbidity and mortality in a small percentage of patients. This condition may present a diagnostic challenge for physicians and currently there is only limited data on effective treatments, particularly with low blast percent transient abnormal myelopoiesis. We present a case of a neonate with trisomy 21 and multiple congenital anomalies who consequently developed hepatic failure with evidence of non-cirrhotic portal hypertension likely due to transient abnormal myelopoiesis. This clinical scenario highlights the need for additional evaluation for transient abnormal myelopoiesis associated hepatic disorder and possibly hepatic sinusoidal occlusive syndrome among trisomy 21 neonates particularly with low blast percentage.
Collapse
Affiliation(s)
- A J Alenchery
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Children's, Cleveland, OH, USA
| | - N K Yeaney
- Neonatal Director, Fetal Care Center, Cleveland Clinic Children's, Cleveland, OH, USA
| | - C B Chen
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Children's, Cleveland, OH, USA
| | - R Talati
- Department of Pediatric Hematology/Oncology/Bone Marrow Transplantation, Cleveland Clinic, Cleveland, OH, USA
| | - E Vogelius
- Section Head, Pediatric Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - C Tan
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - K Radhakrishnan
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Children's, Cleveland, OH, USA
| |
Collapse
|
3
|
t(1;22)(p13;q13) Acute Megakaryoblastic Leukemia Complicated by Hepatic Fibrosis: Antifibrosis Therapy? J Pediatr Hematol Oncol 2021; 43:e1164-e1167. [PMID: 33122587 DOI: 10.1097/mph.0000000000001986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 09/30/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is no established effective treatment for patients with t(1;22)(p13;q13) acute megakaryoblastic leukemia (AMKL) and hepatic fibrosis. OBSERVATION Here we report the outcomes of 2 t(1;22)(p13;q13) AMKL patients with hepatic fibrosis. One patient died from liver failure despite the control of leukemia. The other patient was successfully treated with reduced-intensity chemotherapy and antifibrosis therapy with tretinoin and α-tocopheryl acetate, the hepatic fibrosis resolved and leukemia was in remission for 3 years. CONCLUSIONS Reduced-intensity chemotherapy plus antifibrosis therapy with tretinoin and α-tocopheryl acetate could be a treatment option for these patients with t(1;22)(p13;q13) AMKL and hepatic fibrosis.
Collapse
|