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Kadia TM, Huang M, Pemmaraju N, Abbas HA, Ly C, Masarova L, Yilmaz M, Lyu MA, Zeng K, Sadeghi T, Cook R, DiNardo CD, Daver N, Issa GC, Jabbour E, Borthakur G, Jain N, Garcia-Manero G, Parmar S, Flowers C, Kantarjian H, Verstovsek S. Phase 1 Study of CK0801 in Treatment of Bone Marrow Failure Syndromes. NEJM EVIDENCE 2024; 3:EVIDoa2300362. [PMID: 38804782 DOI: 10.1056/evidoa2300362] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
BACKGROUND An inflammatory bone marrow microenvironment contributes to acquired bone marrow failure syndromes. CK0801, an allogeneic T regulatory (Treg) cell therapy product, can potentially interrupt this continuous loop of inflammation and restore hematopoiesis. METHODS In this phase 1 dose-escalation study of CK0801 Treg cells, we enrolled patients with bone marrow failure syndromes with suboptimal response to their prior therapy to determine the safety and efficacy of this treatment for bone marrow failure syndromes. RESULTS We enrolled nine patients with a median age of 57 years (range, 19 to 74) with an underlying diagnosis of aplastic anemia (n=4), myelofibrosis (n=4), or hypoplastic myelodysplasia (n=1). Patients had a median of three prior therapies for a bone marrow failure syndrome. Starting dose levels of CK0801 were 1 × 106 (n=3), 3 × 106 (n=3), and 10 × 106 (n=3) cells per kg of ideal body weight. No lymphodepletion was administered. CK0801 was administered in the outpatient setting with no infusion reactions, no grade 3 or 4 severe adverse reactions, and no dose-limiting toxicity. At 12 months, CK0801 induced objective responses in three of four patients with myelofibrosis (two had symptom response, one had anemia response, and one had stable disease) and three of four patients with aplastic anemia (three had partial response). Three of four transfusion-dependent patients at baseline achieved transfusion independence. Although the duration of observation was limited at 0.9 to 12 months, there were no observed increases in infections, no transformations to leukemia, and no deaths. CONCLUSIONS In previously treated patients, CK0801 demonstrated no dose-limiting toxicity and showed evidence of efficacy, providing proof of concept for targeting inflammation as a therapy for bone marrow failure. (Funded by Cellenkos Inc.; Clinicaltrials.gov number, NCT03773393.).
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Affiliation(s)
- Tapan M Kadia
- Department of Leukemia, MD Anderson Cancer Center, Houston
| | - Meixian Huang
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston
| | | | | | - Christopher Ly
- Department of Leukemia, MD Anderson Cancer Center, Houston
| | - Lucia Masarova
- Department of Leukemia, MD Anderson Cancer Center, Houston
| | - Musa Yilmaz
- Department of Leukemia, MD Anderson Cancer Center, Houston
| | - Mi-Ae Lyu
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston
| | - Ke Zeng
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston
| | | | - Robin Cook
- Department of Leukemia, MD Anderson Cancer Center, Houston
| | | | - Naval Daver
- Department of Leukemia, MD Anderson Cancer Center, Houston
| | - Ghayas C Issa
- Department of Leukemia, MD Anderson Cancer Center, Houston
| | - Elias Jabbour
- Department of Leukemia, MD Anderson Cancer Center, Houston
| | | | - Nitin Jain
- Department of Leukemia, MD Anderson Cancer Center, Houston
| | | | - Simrit Parmar
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston
| | | | | | - Srdan Verstovsek
- Department of Leukemia, MD Anderson Cancer Center, Houston
- Kartos Therapeutics, Redwood City, CA
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2
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Elshoeibi AM, Badr A, Elsayed B, Metwally O, Elshoeibi R, Elhadary MR, Elshoeibi A, Attya MA, Khadadah F, Alshurafa A, Alhuraiji A, Yassin M. Integrating AI and ML in Myelodysplastic Syndrome Diagnosis: State-of-the-Art and Future Prospects. Cancers (Basel) 2023; 16:65. [PMID: 38201493 PMCID: PMC10778500 DOI: 10.3390/cancers16010065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/24/2023] [Accepted: 10/27/2023] [Indexed: 01/12/2024] Open
Abstract
Myelodysplastic syndrome (MDS) is composed of diverse hematological malignancies caused by dysfunctional stem cells, leading to abnormal hematopoiesis and cytopenia. Approximately 30% of MDS cases progress to acute myeloid leukemia (AML), a more aggressive disease. Early detection is crucial to intervene before MDS progresses to AML. The current diagnostic process for MDS involves analyzing peripheral blood smear (PBS), bone marrow sample (BMS), and flow cytometry (FC) data, along with clinical patient information, which is labor-intensive and time-consuming. Recent advancements in machine learning offer an opportunity for faster, automated, and accurate diagnosis of MDS. In this review, we aim to provide an overview of the current applications of AI in the diagnosis of MDS and highlight their advantages, disadvantages, and performance metrics.
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Affiliation(s)
| | - Ahmed Badr
- College of Medicine, QU Health, Qatar University, Doha 2713, Qatar
| | - Basel Elsayed
- College of Medicine, QU Health, Qatar University, Doha 2713, Qatar
| | - Omar Metwally
- College of Medicine, QU Health, Qatar University, Doha 2713, Qatar
| | | | | | | | | | - Fatima Khadadah
- Kuwait Cancer Centre, Sabah Medical Region, Shuwaikh 1031, Kuwait
| | - Awni Alshurafa
- Hematology Section, Medical Oncology, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation, Doha 3050, Qatar
| | - Ahmad Alhuraiji
- Kuwait Cancer Centre, Sabah Medical Region, Shuwaikh 1031, Kuwait
| | - Mohamed Yassin
- College of Medicine, QU Health, Qatar University, Doha 2713, Qatar
- Hematology Section, Medical Oncology, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation, Doha 3050, Qatar
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3
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Wang M, Dong C, Gao Y, Li J, Han M, Wang L. A Deep Learning Model for the Automatic Recognition of Aplastic Anemia, Myelodysplastic Syndromes, and Acute Myeloid Leukemia Based on Bone Marrow Smear. Front Oncol 2022; 12:844978. [PMID: 35494077 PMCID: PMC9047549 DOI: 10.3389/fonc.2022.844978] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/22/2022] [Indexed: 11/21/2022] Open
Abstract
Aim Bone marrow biopsy is essential and necessary for the diagnosis of patients with aplastic anemia (AA), myelodysplastic syndromes (MDS), and acute myeloid leukemia (AML). However, the convolutional neural networks (CNN) model that automatically distinguished AA, MDS, and AML based on bone marrow smears has not been reported. Methods Image-net pretrained model of CNN was used to construct the recognition model. Data extracted from the American Society of Hematology (ASH) Image Bank were utilized to develop the model and data extracted from the clinic were used for external validation. The model had two output layers: whether the patient was MDS (two-classification) and which of AA, MDS, and AML the patient was (three-classification). Different outcome weights (two-classification/three-classification = 5:5, 2:8, 1:9) and epochs (30, 50, 200) were used to select the optimal model. The model performance was evaluated by the Accuracy-Loss curves and calculating the area under the curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results A total of 115 bone marrow smears from the ASH Image Bank and 432 bone marrow smears from the clinic were included in this study. The results of Accuracy-Loss curves showed that the best model training effect was observed in the model with the outcome weight and epoch of 1:9 and 200. Similarly, this model also performed well performances in the two-classification of MDS and the three-classification of AA, MDS, AML. The AUC, accuracy and sensitivity of the MDS two-classification model in the testing set were 0.985 [95% confidence interval (CI), 0.979-0.991], 0.914 (95%CI, 0.895-0.934), and 0.992 (95%CI, 0.980-1.000), respectively. The AUC, accuracy and sensitivity of the AA, MDS, AML three-classification model in the testing set were 0.968 (95%CI, 0.960-0.976), 0.929 (95%CI, 0.916-0.941), and 0.857 (95%CI, 0.828-0.886), respectively. Conclusion The image-net pretrained model was able to obtain high accuracy AA, MDS, AML distinction, and may provide clinicians with a convenient tool to distinguish AA, MDS, and AML.
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Affiliation(s)
- Meifang Wang
- Department of Hematology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Chunxia Dong
- Department of Hematology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Yan Gao
- Department of Hematology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Jianlan Li
- Department of Hematology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Mengru Han
- Department of Hematology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Lijun Wang
- Department of Hematology, The Second Hospital of Shanxi Medical University, Taiyuan, China
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4
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de Winter DTC, Langerak AW, Te Marvelde J, Dworzak MN, De Moerloose B, Starý J, Locatelli F, Hasle H, de Vries ACH, Schmugge M, Niemeyer CM, van den Heuvel-Eibrink MM, van der Velden VHJ. The variable biological signature of refractory cytopenia of childhood (RCC), a retrospective EWOG-MDS study. Leuk Res 2021; 108:106652. [PMID: 34301409 DOI: 10.1016/j.leukres.2021.106652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Demi T C de Winter
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
| | - Anton W Langerak
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jeroen Te Marvelde
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Michael N Dworzak
- Department of Pediatrics, St. Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria
| | - Barbara De Moerloose
- Department of Pediatric Hematology and Oncology, Ghent University Hospital, Ghent, Belgium; Cancer Research Institute Ghent, Belgium
| | - Jan Starý
- Department of Pediatric Hematology and Oncology, University Hospital Motol, Prague, Czech Republic
| | - Franco Locatelli
- Department of Pediatric Hematology and Oncology, IRCCS Bambino Gesù Children's Hospital, Sapienza, University of Rome, Italy
| | - Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Andrica C H de Vries
- Department of Pediatric Hematology and Oncology, Erasmus MC, Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Markus Schmugge
- Department of Hematology and Oncology, University Children's Hospital, Zurich, Switzerland
| | - Charlotte M Niemeyer
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, University of Freiburg, Freiburg, Germany
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5
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Hypoplastic Myelodysplastic Syndromes: Just an Overlap Syndrome? Cancers (Basel) 2021; 13:cancers13010132. [PMID: 33401595 PMCID: PMC7795441 DOI: 10.3390/cancers13010132] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 12/29/2020] [Accepted: 12/29/2020] [Indexed: 12/15/2022] Open
Abstract
Simple Summary Hypoplastic myelodysplastic syndromes (hMDS) represent a diagnostic conundrum. They share morphologic and clinical features of both MDS (dysplasia, genetic lesions and cytopenias) and aplastic anemia (AA; i.e., hypocellularity and autoimmunity) and are not comprised in the last WHO classification. In this review we recapitulate the main clinical, pathogenic and therapeutic aspects of hypo-MDS and discuss why they deserve to be distinguished from normo/hypercellular MDS and AA. We conclude that hMDS may present in two phenotypes: one more proinflammatory and autoimmune, more similar to AA, responding to immunosuppression; and one MDS-like dominated by genetic lesions, suppression of immune surveillance, and tumor escape, more prone to leukemic evolution. Abstract Myelodysplasias with hypocellular bone marrow (hMDS) represent about 10–15% of MDS and are defined by reduced bone marrow cellularity (i.e., <25% or an inappropriately reduced cellularity for their age in young patients). Their diagnosis is still an object of debate and has not been clearly established in the recent WHO classification. Clinical and morphological overlaps with both normo/hypercellular MDS and aplastic anemia include cytopenias, the presence of marrow hypocellularity and dysplasia, and cytogenetic and molecular alterations. Activation of the immune system against the hematopoietic precursors, typical of aplastic anemia, is reckoned even in hMDS and may account for the response to immunosuppressive treatment. Finally, the hMDS outcome seems more favorable than that of normo/hypercellular MDS patients. In this review, we analyze the available literature on hMDS, focusing on clinical, immunological, and molecular features. We show that hMDS pathogenesis and clinical presentation are peculiar, albeit in-between aplastic anemia (AA) and normo/hypercellular MDS. Two different hMDS phenotypes may be encountered: one featured by inflammation and immune activation, with increased cytotoxic T cells, increased T and B regulatory cells, and better response to immunosuppression; and the other, resembling MDS, where T and B regulatory/suppressor cells prevail, leading to genetic clonal selection and an increased risk of leukemic evolution. The identification of the prevailing hMDS phenotype might assist treatment choice, inform prognosis, and suggest personalized monitoring.
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6
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Shallis RM, Podoltsev NA, Gowda L, Zeidan AM, Gore SD. Cui bono? Finding the value of allogeneic stem cell transplantation for lower-risk myelodysplastic syndromes. Expert Rev Hematol 2020; 13:447-460. [PMID: 32182435 DOI: 10.1080/17474086.2020.1744433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Introduction: The myelodysplastic syndromes (MDS) vary in their risk of disease progression; progression includes increasingly severe bone marrow failure, reclassification as acute myeloid leukemia (AML), and death. Prognostic tools guide recommendations for allogeneic stem cell transplantation (alloSCT), the only curative option. AlloSCT is typically reserved for patients with higher-risk MDS as defined by existing prognostic tools, although additional clinical and biological factors in lower-risk patients may influence this dogma.Areas covered: This review discusses the current understanding of MDS risk stratification as it pertains to the use of alloSCT in subpopulations of MDS patients with a particular focus on the use of alloSCT in patients with lower-risk disease.Expert commentary: Though high-quality data are lacking, some lower-risk MDS patients may benefit from alloSCT, which offers the only prospect of cure. Understanding the etiologic role and prognostic impact of recurring genetic events may improve existing risk stratification and become integral facets of prognostic schemata. The identification of additional factors influencing the prognoses of patients currently lumped together as 'lower-risk' will likewise improve the selection of MDS patients for early intervention or aggressive therapies such as alloSCT.
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Affiliation(s)
- Rory M Shallis
- Section of Hematology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.,Yale Cancer Center, New Haven, CT, USA
| | - Nikolai A Podoltsev
- Section of Hematology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.,Yale Cancer Center, New Haven, CT, USA
| | - Lohith Gowda
- Section of Hematology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.,Yale Cancer Center, New Haven, CT, USA
| | - Amer M Zeidan
- Section of Hematology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.,Yale Cancer Center, New Haven, CT, USA
| | - Steven D Gore
- Section of Hematology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.,Yale Cancer Center, New Haven, CT, USA
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7
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Richards SJ, Dickinson AJ, Cullen MJ, Griffin M, Munir T, McKinley C, Mitchell LD, Newton DJ, Arnold L, Hill A, Hillmen P. Presentation clinical, haematological and immunophenotypic features of 1081 patients with GPI-deficient (paroxysmal nocturnal haemoglobinuria) cells detected by flow cytometry. Br J Haematol 2020; 189:954-966. [PMID: 32103498 DOI: 10.1111/bjh.16427] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/21/2019] [Indexed: 12/11/2022]
Abstract
A retrospective analysis of presentation clinical, laboratory and immunophenotypic features of 1 081 patients with paroxysmal nocturnal haemoglobinuria (PNH) clones [glycosylphosphatidylinositol (GPI)-deficient blood cells] identified at our hospital by flow cytometry over the past 25 years was undertaken. Three distinct clusters of patients were identified and significant correlations between presentation disease type and PNH clone sizes were evident. Smaller PNH clones predominate in cytopenic and myelodysplastic subtypes; large PNH clones were associated with haemolytic, thrombotic and haemolytic/thrombotic subtypes. Rare cases with an associated chronic myeloproliferative disorder had either large or small PNH clones. Cytopenia was a frequent finding, highlighting bone marrow failure as the major underlying feature associated with the detection of PNH clones in the peripheral blood. Red cell PNH clones showed significant correlations between the presence of type II (partial GPI deficiency) red cells and thrombotic disease. Haemolytic PNH was associated with type III (complete GPI deficiency) red cell populations of >20%. Those with both haemolytic and thrombotic features had major type II and type III red cell populations. Distinct patterns of presentation age decade were evident for clinical subtypes with a peak incidence of haemolytic PNH in the 30-49 year age group and a biphasic age distribution for the cytopenia group.
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Affiliation(s)
- Stephen J Richards
- Section of Experimental Haematology and Immunology, Leeds Institute of Medical Research at St. James's, School of Medicine, University of Leeds, Leeds, UK.,Haematological Malignancy Diagnostic Service, Leeds Teaching Hospitals NHS Trust, Level 3 Bexley Wing, St James's University Hospital, Leeds, UK
| | - Anita J Dickinson
- Haematological Malignancy Diagnostic Service, Leeds Teaching Hospitals NHS Trust, Level 3 Bexley Wing, St James's University Hospital, Leeds, UK
| | - Matthew J Cullen
- Haematopathology and Oncology Diagnostic Service (HODS), Box 234, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, UK
| | - Morag Griffin
- Department of Haematology, Leeds Teaching Hospitals NHS Trust, Level 3 Bexley Wing, St James's University Hospital, Leeds, UK
| | - Tahla Munir
- Department of Haematology, Leeds Teaching Hospitals NHS Trust, Level 3 Bexley Wing, St James's University Hospital, Leeds, UK
| | - Claire McKinley
- Section of Experimental Haematology and Immunology, Leeds Institute of Medical Research at St. James's, School of Medicine, University of Leeds, Leeds, UK
| | | | - Darren J Newton
- Section of Experimental Haematology and Immunology, Leeds Institute of Medical Research at St. James's, School of Medicine, University of Leeds, Leeds, UK
| | - Louise Arnold
- Department of Haematology, Leeds Teaching Hospitals NHS Trust, Level 3 Bexley Wing, St James's University Hospital, Leeds, UK
| | - Anita Hill
- Department of Haematology, Leeds Teaching Hospitals NHS Trust, Level 3 Bexley Wing, St James's University Hospital, Leeds, UK
| | - Peter Hillmen
- Section of Experimental Haematology and Immunology, Leeds Institute of Medical Research at St. James's, School of Medicine, University of Leeds, Leeds, UK.,Department of Haematology, Leeds Teaching Hospitals NHS Trust, Level 3 Bexley Wing, St James's University Hospital, Leeds, UK
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8
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Patel BJ, Barot SV, Kuzmanovic T, Kerr C, Przychodzen BP, Thota S, Lee S, Patel S, Radivoyevitch T, Lichtin A, Advani A, Kalaycio M, Sekeres MA, Carraway HE, Maciejewski JP. Distinctive and common features of moderate aplastic anaemia. Br J Haematol 2020; 189:967-975. [PMID: 32004386 PMCID: PMC8340733 DOI: 10.1111/bjh.16460] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 12/02/2019] [Indexed: 11/30/2022]
Abstract
The therapy algorithm for severe aplastic anaemia (sAA) is established but moderate AA (mAA), which likely reflects a more diverse pathogenic mechanism, often represents a treatment/management conundrum. A cohort of AA patients (n = 325) was queried for those with non‐severe disease using stringent criteria including bone marrow hypocellularity and chronic persistence of moderately depressed blood counts. As a result, we have identified and analyzed pathological and clinical features in 85 mAA patients. Progression to sAA and direct clonal evolution (paroxysmal nocturnal haemoglobinuria/acute myeloid leukaemia; PNH/AML) occurred in 16%, 11% and 1% of mAA cases respectively. Of the mAA patients who received immunosuppressive therapy, 67% responded irrespective of time of initiation of therapy while conservatively managed patients showed no spontaneous remissions. Genomic analysis of mAA identified evidence of clonal haematopoiesis with both persisting and remitting patterns at low allelic frequencies; with more pronounced mutational burden in sAA. Most of the mAA patients have autoimmune pathogenesis similar to those with sAA, but mAA contains a mix of patients with diverse aetiologies. Although progression rates differed between mAA and sAA (P = 0·003), cumulative incidences of mortalities were only marginally different (P = 0·095). Our results provide guidance for diagnosis/management of mAA, a condition for which no current standard of care is established.
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Affiliation(s)
- Bhumika J Patel
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.,Leukemia Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Shimoli V Barot
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Teodora Kuzmanovic
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Cassandra Kerr
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bartlomiej P Przychodzen
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Swapna Thota
- Department of Leukemia, Roswell Park Comprehensive Cancer Center, University of Buffalo, Buffalo, NY, USA
| | - Sarah Lee
- Leukemia Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Saurabh Patel
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.,Leukemia Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tomas Radivoyevitch
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alan Lichtin
- Leukemia Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Anjali Advani
- Leukemia Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Matt Kalaycio
- Leukemia Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mikkael A Sekeres
- Leukemia Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Hetty E Carraway
- Leukemia Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jaroslaw P Maciejewski
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.,Leukemia Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
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9
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Leimkühler NB, Schneider RK. Inflammatory bone marrow microenvironment. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2019; 2019:294-302. [PMID: 31808897 PMCID: PMC6913454 DOI: 10.1182/hematology.2019000045] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Self-renewing hematopoietic stem cells and their progeny, lineage-specific downstream progenitors, maintain steady-state hematopoiesis in the bone marrow (BM). Accumulating evidence over the last few years indicates that not only primitive hematopoietic stem and progenitor cells (HSPCs), but also cells defining the microenvironment of the BM (BM niche), sense hematopoietic stress signals. They respond by directing and orchestrating hematopoiesis via not only cell-intrinsic but also cell-extrinsic mechanisms. Inflammation has many beneficial roles by activating the immune system in tissue repair and as a defense mechanism. However, chronic inflammation can have detrimental effects by stressing HSPCs, leading to cell (DNA) damage resulting in BM failure or even to leukemia. Emerging data have demonstrated that the BM microenvironment plays a significant role in the pathogenesis of hematopoietic malignancies, in particular, through disrupted inflammatory signaling, specifically in niche (microenvironmental) cells. Clonal selection in the context of microenvironmental alterations can occur in the context of toxic insults (eg, chemotherapy), not only aging but also inflammation. In this review, we summarize mechanisms that lead to an inflammatory BM microenvironment and discuss how this affects normal hematopoiesis. We pay particular attention to the process of aging, which is known to involve low-grade inflammation and is also associated with age-related clonal hematopoiesis and potentially malignant transformation.
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Affiliation(s)
- Nils B Leimkühler
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Rebekka K Schneider
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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10
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Kimura K, Tabe Y, Ai T, Takehara I, Fukuda H, Takahashi H, Naito T, Komatsu N, Uchihashi K, Ohsaka A. A novel automated image analysis system using deep convolutional neural networks can assist to differentiate MDS and AA. Sci Rep 2019; 9:13385. [PMID: 31527646 PMCID: PMC6746738 DOI: 10.1038/s41598-019-49942-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 08/29/2019] [Indexed: 12/31/2022] Open
Abstract
Detection of dysmorphic cells in peripheral blood (PB) smears is essential in diagnostic screening of hematological diseases. Myelodysplastic syndromes (MDS) are hematopoietic neoplasms characterized by dysplastic and ineffective hematopoiesis, which diagnosis is mainly based on morphological findings of PB and bone marrow. We developed an automated diagnostic support system of MDS by combining an automated blood cell image-recognition system using a deep learning system (DLS) powered by convolutional neural networks (CNNs) with a decision-making system using extreme gradient boosting (XGBoost). The DLS of blood cell image-recognition has been trained using datasets consisting of 695,030 blood cell images taken from 3,261 PB smears including hematopoietic malignancies. The DLS simultaneously classified 17 blood cell types and 97 morphological features of such cells with >93.5% sensitivity and >96.0% specificity. The automated MDS diagnostic system successfully differentiated MDS from aplastic anemia (AA) with high accuracy; 96.2% of sensitivity and 100% of specificity (AUC 0.990). This is the first CNN-based automated initial diagnostic system for MDS using PB smears, which is applicable to develop new automated diagnostic systems for various hematological disorders.
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Affiliation(s)
- Konobu Kimura
- Department of Next Generation Hematology Laboratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Sysmex Corporation, Kobe, Japan
| | - Yoko Tabe
- Department of Next Generation Hematology Laboratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan. .,Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Tomohiko Ai
- Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | | | - Hiroshi Fukuda
- Department of General Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiromizu Takahashi
- Department of General Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Toshio Naito
- Department of General Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Norio Komatsu
- Department of Hematology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | | | - Akimichi Ohsaka
- Department of Next Generation Hematology Laboratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Transfusion Medicine and Stem Cell Regulation, Juntendo University Graduate School of Medicine, Tokyo, Japan
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11
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Clinical, histopathological and molecular characterization of hypoplastic myelodysplastic syndrome. Leukemia 2019; 33:2495-2505. [PMID: 30940907 DOI: 10.1038/s41375-019-0457-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/22/2019] [Accepted: 03/14/2019] [Indexed: 11/08/2022]
Abstract
Diagnostic criteria for hypoplastic myelodysplasic syndrome (h-MDS) have not been clearly established, making the differential diagnosis from other bone marrow failure syndromes (BMF) challenging. In this study, we aimed to delineate clinical, histopathological, and molecular features of h-MDS, based on a large and well-annotated cohort of patients with bone marrow (BM) hypocellularity. The study included 534 consecutive adult patients with hypocellular BM (278 h-MDS and 136 aplastic anemia), and 727 with normo- or hypercellular MDS (n-MDS). Comparison of clinical features of patients with h-MDS as defined by BM cellularity ≤25% (n = 204) or reduced age-adjusted cellularity (n = 74) did not reveal significant differences. We developed a diagnostic score to discriminate h-MDS from non-malignant BMF based on histological and cytological variables with the highest specificity for MDS (h-score). The information from chromosomal abnormalities and somatic mutation patterns was then integrated into a cyto-histological/genetic score (hg-score). This score was able to segregate two groups of h-MDS with a significantly different risk of blast progression (P < 0.001). The integration of cyto-histological and genetic features in adult patients with hypocellular BM facilitated segregation into two distinct groups, one with clinical and genetic features highly consistent with myeloid neoplasm, and one with features more consistent with non-malignant BMF.
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12
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Luzzatto L, Risitano AM. Advances in understanding the pathogenesis of acquired aplastic anaemia. Br J Haematol 2018; 182:758-776. [DOI: 10.1111/bjh.15443] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Lucio Luzzatto
- Muhimbili University of Health and Allied Sciences; Dar-es-Salaam Tanzania
| | - Antonio M. Risitano
- Department of Clinical Medicine and Surgery; Federico II University; Naples Italy
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13
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Abstract
PURPOSE OF REVIEW This review aimed to provide updated guidelines for the management of children with acquired aplastic anemia (AA), particularly focusing on hematopoietic stem cell transplantation (HSCT). RECENT FINDINGS Failure-free survival for children with aplastic anemia has been shown to be better after bone marrow transplantation (BMT) from matched or one-locus mismatched related donors (MRD/1MMRD) than after immunosuppressive therapy (IST). A combination of the absence of minor paroxysmal nocturnal hemoglobinuria clones and short telomere length was identified as a strong predictor of a poor response to IST. Upfront HSCT from matched unrelated donors (MUD) and MRD was recently demonstrated to have comparable outcomes. Moreover, unrelated cord blood transplantation (UCBT) and haploidentical HSCT have shown promising outcomes, and the fludarabine/melphalan-based regimen has resulted in excellent survival without poor graft function. BMT from MRD/1MMRD is the treatment of choice. When a MRD/1MMRD is not available, upfront BMT from a MUD should be considered for patients with only a slim chance of responding to IST. UCBT and haploidentical HSCT are promising options. This updated treatment algorithm should improve overall outcomes for children with AA.
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14
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Kobayashi T, Nannya Y, Ichikawa M, Oritani K, Kanakura Y, Tomita A, Kiyoi H, Kobune M, Kato J, Kawabata H, Shindo M, Torimoto Y, Yonemura Y, Hanaoka N, Nakakuma H, Hasegawa D, Manabe A, Fujishima N, Fujii N, Tanimoto M, Morita Y, Matsuda A, Fujieda A, Katayama N, Ohashi H, Nagai H, Terada Y, Hino M, Sato K, Obara N, Chiba S, Usuki K, Ohta M, Imataki O, Uemura M, Takaku T, Komatsu N, Kitanaka A, Shimoda K, Watanabe K, Tohyama K, Takaori-Kondo A, Harigae H, Arai S, Miyazaki Y, Ozawa K, Kurokawa M. A nationwide survey of hypoplastic myelodysplastic syndrome (a multicenter retrospective study). Am J Hematol 2017; 92:1324-1332. [PMID: 28891083 DOI: 10.1002/ajh.24905] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 09/04/2017] [Accepted: 09/07/2017] [Indexed: 11/06/2022]
Abstract
Hypoplastic myelodysplastic syndrome (hMDS) is a distinct entity with bone marrow (BM) hypocellularity and the risk of death from BM failure (BMF). To elucidate the characteristics of hMDS, the data of 129 patients diagnosed between April 2003 and March 2012 were collected from 20 institutions and the central review team of the National Research Group on Idiopathic Bone Marrow Failure Syndromes, and compared with 115 non-hMDS patients. More RA and fewer CMMoL and RAEB-t in French-American-British (FAB) and more RCUD and MDS-U and fewer RCMD in World Health Organization (WHO) classifications were found in hMDS than non-hMDS with significant differences. The overall survival (OS) and AML progression-free survival (AML-PFS) of hMDS were higher than those of non-hMDS, especially in patients at age ≥50 and of lower risk in Revised International Prognostic Scoring System (IPSS-R). In competing risks analysis, hMDS exhibited decreased risk of AML-progression in lower IPSS or IPSS-R risk patients, and higher risk of death from BMF in patients at age ≥50. Poor performance status (PS ≥2) and high karyotype risks in IPSS-R (high and very high) were significant risk factors of death and AML-progression in Cox proportional hazards analysis.
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Affiliation(s)
- Takashi Kobayashi
- Department of Hematology and Oncology; Graduate School of Medicine, The University of Tokyo; Tokyo Japan
| | - Yasuhito Nannya
- Department of Hematology and Oncology; Graduate School of Medicine, The University of Tokyo; Tokyo Japan
| | - Motoshi Ichikawa
- Department of Hematology and Oncology; Graduate School of Medicine, The University of Tokyo; Tokyo Japan
| | - Kenji Oritani
- Department of Hematology and Oncology; Graduate School of Medicine, Osaka University; Osaka Japan
| | - Yuzuru Kanakura
- Department of Hematology and Oncology; Graduate School of Medicine, Osaka University; Osaka Japan
| | - Akihiro Tomita
- Department of Hematology and Oncology; Nagoya University Graduate School of Medicine; Nagoya Japan
- Department of Hematology; Fujita Health University School of Medicine; Aichi Japan
| | - Hitoshi Kiyoi
- Department of Hematology and Oncology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - Masayoshi Kobune
- Department of Medical Oncology and Hematology; Sapporo Medical University School of Medicine; Sapporo Japan
| | - Junji Kato
- Department of Medical Oncology and Hematology; Sapporo Medical University School of Medicine; Sapporo Japan
| | - Hiroshi Kawabata
- Department of Hematology and Oncology; Graduate School of Medicine, Kyoto University; Kyoto Japan
| | - Motohiro Shindo
- Division of Gastroenterology and Hematology/Oncology; Department of Medicine, Asahikawa Medical University; Asahikawa Japan
| | | | - Yuji Yonemura
- Department of Transfusion Medicine and Cell Therapy; Kumamoto University Hospital; Kumamoto Japan
| | - Nobuyoshi Hanaoka
- Department of Hematology/Oncology; Wakayama Medical University; Wakayama Japan
| | - Hideki Nakakuma
- Department of Hematology/Oncology; Wakayama Medical University; Wakayama Japan
| | - Daisuke Hasegawa
- Department of Pediatrics; St. Luke's International Hospital; Tokyo Japan
| | - Atsushi Manabe
- Department of Pediatrics; St. Luke's International Hospital; Tokyo Japan
| | - Naohito Fujishima
- Division of Blood Transfusion; Akita University Hospital; Akita Japan
| | - Nobuharu Fujii
- Department of Hematology and Oncology; Okayama University Hospital; Okayama Japan
| | - Mitsune Tanimoto
- Department of Hematology and Oncology; Okayama University Hospital; Okayama Japan
| | - Yasuyoshi Morita
- Division of Hematology and Rheumatology; Department of Internal Medicine, Kindai University Faculty of Medicine; Osaka-Sayama Japan
| | - Akira Matsuda
- Department of Hemato-Oncology; Saitama International Medical Center, Saitama Medical University; Hidaka, Saitama Japan
| | - Atsushi Fujieda
- Department of Hematology and Oncology; Mie University Graduate School of Medicine; Tsu, Mie Japan
| | - Naoyuki Katayama
- Department of Hematology and Oncology; Mie University Graduate School of Medicine; Tsu, Mie Japan
| | - Haruhiko Ohashi
- Clinical Research Center; National Hospital Organization Nagoya Medical Center; Nagoya Japan
| | - Hirokazu Nagai
- Department of Hematology; National Hospital Organization Nagoya Medical Center; Nagoya Japan
| | - Yoshiki Terada
- Hematology, Graduate School of Medicine; Osaka City University; Osaka Japan
| | - Masayuki Hino
- Hematology, Graduate School of Medicine; Osaka City University; Osaka Japan
| | - Ken Sato
- Division of Hematology; Department of Internal Medicine, National Defense Medical College; Saitama Japan
| | - Naoshi Obara
- Department of Hematology; Faculty of Medicine, University of Tsukuba; Tsukuba Ibaraki Japan
| | - Shigeru Chiba
- Department of Hematology; Faculty of Medicine, University of Tsukuba; Tsukuba Ibaraki Japan
| | - Kensuke Usuki
- Department of Hematology; NTT Medical Center Tokyo; Tokyo Japan
| | - Masatsugu Ohta
- Department of Hematology; Fukushima Medical University Aizu Medical Center; Fukushima Japan
| | - Osamu Imataki
- Division of Hematology; Department of Internal Medicine, Faculty of Medicine, Kagawa University; Kagawa Japan
| | - Makiko Uemura
- Division of Hematology; Department of Internal Medicine, Faculty of Medicine, Kagawa University; Kagawa Japan
| | - Tomoiku Takaku
- Department of Hematology; Juntendo University School of Medicine; Tokyo Japan
| | - Norio Komatsu
- Department of Hematology; Juntendo University School of Medicine; Tokyo Japan
| | - Akira Kitanaka
- Department of Gastroenterology and Hematology; Faculty of Medicine, University of Miyazaki; Miyazaki Japan
| | - Kazuya Shimoda
- Department of Gastroenterology and Hematology; Faculty of Medicine, University of Miyazaki; Miyazaki Japan
| | - Kenichiro Watanabe
- Department of Pediatrics; Graduate School of Medicine, Kyoto University; Kyoto Japan
| | - Kaoru Tohyama
- Department of Laboratory Medicine (Laboratory Hematology); Kawasaki Medical School; Okayama Japan
| | - Akifumi Takaori-Kondo
- Department of Hematology and Oncology; Graduate School of Medicine, Kyoto University; Kyoto Japan
| | - Hideo Harigae
- Department of Hematology and Rheumatology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Shunya Arai
- Department of Hematology and Oncology; Graduate School of Medicine, The University of Tokyo; Tokyo Japan
| | - Yasushi Miyazaki
- Department of Hematology; Atomic Bomb Disease and Hibakusha Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Sciences; Nagasaki Japan
| | - Keiya Ozawa
- Division of Hematology; Jichi Medical University; Tochigi Japan
- IMSUT Hospital; The Institute of Medical Science, The University of Tokyo; Tokyo Japan
| | - Mineo Kurokawa
- Department of Hematology and Oncology; Graduate School of Medicine, The University of Tokyo; Tokyo Japan
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Treated secondary acute myeloid leukemia: a distinct high-risk subset of AML with adverse prognosis. Blood Adv 2017; 1:1312-1323. [PMID: 29296774 DOI: 10.1182/bloodadvances.2017008227] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 06/14/2017] [Indexed: 12/20/2022] Open
Abstract
Secondary acute myeloid leukemia (s-AML) includes therapy-related AML and AML evolving from antecedent hematological disorder (AHD). s-AML arising after treating AHD likely represents a prognostically distinct, high-risk disease category. In this study, treated s-AML (ts-AML) was defined by: (1) prior diagnosis of myelodysplasia, myeloproliferative neoplasm, or aplastic anemia and (2) at least 1 therapy for that diagnosis. ts-AML was categorized by age (< or ≥60 years), and each cohort assessed for response rates and overall survival (OS) on various treatment regimens. Survival outcomes were compared against other high-risk prognostic subsets. Results showed that complete response and 8-week mortality rates were 32% and 27% in the younger, and 24% and 19% in the older age groups, respectively. There was a significant OS difference within s-AML based on prior treatment of AHD (ie, ts-AML vs s-AML with untreated AHD, 4.2 vs 9.2 months; P < .001). Survival in ts-AML was poor across both cohorts (younger and older, 5 and 4.7 months, respectively). In younger AML, survival was significantly inferior in ts-AML when compared with deletion 5/7, TP53, 3q abnormality, and therapy-related AML groups (median, 5 vs 7.9, 7.8, 7.9, and 11.2 months, respectively; P < .01). Additional adverse karyotype within ts-AML was associated with even worse outcomes (OS range, 1.6-2.8 months). ts-AML represents a very high-risk category, even in younger AML patients. s-AML should be further classified to describe ts-AML, an entity less responsive to currently applied treatment approaches. Future AML trial designs should accommodate ts-AML as a distinct subgroup.
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16
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Grover S, Dhiman AK, Garg B, Sood N, Narang V. Acquired aplastic anemia associated with trisomy eight converting into acute myeloid leukemia. J Lab Physicians 2017; 9:207-209. [PMID: 28706392 PMCID: PMC5496300 DOI: 10.4103/0974-2727.208259] [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] [Indexed: 11/04/2022] Open
Abstract
Aplastic anemia (AA) is nowadays considered to be a clonal disorder arising from a defective hematopoietic stem cell developing after a generalized insult to bone marrow. Immunosuppressive treatment (IST) of AA causes suppression of the target dominant population of haematopoietic cells allowing the defective non targeted clones to expand. This may give rise to acute leukemia. Cytogenetic studies for chromosomal aberrations such as trisomy and monosomy may help in detecting such conversions. We present a case of acquired AA in a 60-year-old male presenting with pancytopenia and hypoplastic marrow treated with antithymocyte globulin, converting into myelodysplastic syndrome and later on acute promyelocytic leukemia after being in remission for 4 years. The patient was found to have trisomy 8 on fluorescence in situ hybridization and karyotyping.
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Affiliation(s)
- Sumit Grover
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Amit Kumar Dhiman
- Department of Medical Oncology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Bhavna Garg
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Neena Sood
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Vikram Narang
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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17
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Elmahdi S, Hama A, Manabe A, Hasegawa D, Muramatsu H, Narita A, Nishio N, Ismael O, Kawashima N, Okuno Y, Xu Y, Wang X, Takahashi Y, Ito M, Kojima S. A Cytokine-Based Diagnostic Program in Pediatric Aplastic Anemia and Hypocellular Refractory Cytopenia of Childhood. Pediatr Blood Cancer 2016; 63:652-8. [PMID: 26485171 DOI: 10.1002/pbc.25799] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 09/18/2015] [Indexed: 01/25/2023]
Abstract
BACKGROUND Distinguishing hypocellular refractory cytopenia of childhood (RCC) from aplastic anemia (AA) is challenging. Thus far, no studies have compared the cytokine profiles in patients with AA to those with hypocellular RCC. In the present study, we addressed whether thrombopoietin (TPO) and interleukin 17 (IL-17) plasma levels are useful for differentiating between the two diseases. METHODS We measured the endogenous plasma concentrations of TPO and IL-17 in 29 patients with AA, 34 patients with hypocellular RCC, and 31 healthy controls using sensitive enzyme-linked immunosorbent assays. RESULTS The TPO and IL-17 plasma levels were significantly lower in patients with hypocellular RCC than in patients with AA (P < 0.001 and P = 0.007, respectively). The multivariate logistic regression analysis identified moderate disease severity, TPO levels of <1,369.8 pg/ml (TPO-low group, n = 32; odds ratio (OR), 13.40; 95% confidence intervals (CI), 3.001-51.254; P < 0.001), and IL-17 levels of <22.2 pg/ml (IL-17-low group, n = 33; OR, 4.11; 95% CI, 1.033-19.404; P = 0.031) as independent factors discriminating hypocellular RCC from AA. Importantly, 25 (78.1%) of 32 patients in the TPO-low group and 25 (75.8%) of 33 patients in the IL-17-low group were diagnosed as having hypocellular RCC. Moreover, 22 (71%) of 31 patients in the TPO-high group and 21 (70%) of 30 patients in the IL-17-high group were diagnosed as having AA. CONCLUSIONS TPO and IL-17 levels are useful for differentiating hypocellular RCC from AA. Prospective studies are required to confirm our findings.
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Affiliation(s)
- Shaimaa Elmahdi
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Asahito Hama
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Atsushi Manabe
- Department of Pediatrics, St. Luke's International Hospital, Tokyo, Japan
| | - Daisuke Hasegawa
- Department of Pediatrics, St. Luke's International Hospital, Tokyo, Japan
| | - Hideki Muramatsu
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Atsushi Narita
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuhiru Nishio
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Olfat Ismael
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nozomu Kawashima
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yusuke Okuno
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yinyan Xu
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Xinan Wang
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshiyuki Takahashi
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masafumi Ito
- Department of Pathology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Seiji Kojima
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
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18
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Gondek LP, DeZern AE. I walk the line: how to tell MDS from other bone marrow failure conditions. Curr Hematol Malig Rep 2015; 9:389-99. [PMID: 25079655 DOI: 10.1007/s11899-014-0224-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Myelodysplastic syndromes (MDS) are clonal hematopoietic stem cell disorders characterized by peripheral cytopenias and ineffective hematopoiesis. MDS is an example of an age-related malignancy and its increasing prevalence and incidence can be attributed to a greater life expectancy in developed countries. Although frequently encountered in hematology/oncology clinics, MDS may constitute a diagnostic challenge especially with equivocal bone marrow morphology. Certain syndromes of bone marrow failure (BMF) may mimic MDS and formulating a correct diagnosis is vital for adequate prognostication as well as therapeutic approaches. Metaphase karyotyping (MK) is a very important diagnostic tool and marker of prognosis and can be an indicator of response to certain therapies. Unfortunately, chromosomal abnormalities may only be found in approximately 50 % of patients with MDS. In this review, we discuss the diagnostic approaches to patients with pancytopenia with a particular focus on the growing number of somatic mutations through new molecular testing.
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Affiliation(s)
- Lukasz P Gondek
- Department of Oncology, Division of Hematological Malignancies, Johns Hopkins University, 1650 Orleans St, CRB1-290, Baltimore, MD, 21231, USA,
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19
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Saumell S, Solé F, Arenillas L, Montoro J, Valcárcel D, Pedro C, Sanzo C, Luño E, Giménez T, Arnan M, Pomares H, De Paz R, Arrizabalaga B, Jerez A, Martínez AB, Sánchez-Castro J, Rodríguez-Gambarte JD, Raya JM, Ríos E, Rodríguez-Rivera M, Espinet B, Florensa L. Trisomy 8, a Cytogenetic Abnormality in Myelodysplastic Syndromes, Is Constitutional or Not? PLoS One 2015; 10:e0129375. [PMID: 26066831 PMCID: PMC4466575 DOI: 10.1371/journal.pone.0129375] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 05/07/2015] [Indexed: 02/02/2023] Open
Abstract
Isolated trisomy 8 is not considered presumptive evidence of myelodysplastic syndrome (MDS) in cases without minimal morphological criteria. One reason given is that trisomy 8 (+8) can be found as a constitutional mosaicism (cT8M). We tried to clarify the incidence of cT8M in myeloid neoplasms, specifically in MDS, and the diagnostic value of isolated +8 in MDS. Twenty-two MDS and 10 other myeloid neoplasms carrying +8 were studied. Trisomy 8 was determined in peripheral blood by conventional cytogenetics (CC) and on granulocytes, CD3+ lymphocytes and oral mucosa cells by fluorescence in situ hybridization (FISH). In peripheral blood CC, +8 was seen in 4/32 patients. By FISH, only one patient with chronic myelomonocytic leukemia showed +8 in all cell samples and was interpreted as a cT8M. In our series +8 was acquired in all MDS. Probably, once discarded cT8M by FISH from CD3+ lymphocytes and non-hematological cells, +8 should be considered with enough evidence to MDS.
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Affiliation(s)
- Sílvia Saumell
- Laboratori de Citologia Hematològica i Citogenètica Molecular, Servei de Patologia, Hospital del Mar, Barcelona, Spain
- GRETNHE, Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Department of Medicine, Medicine Faculty, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Francesc Solé
- Institut de Recerca Contra la Leucèmia Josep Carreras, Cytogenetics Platform, Badalona, Spain
| | - Leonor Arenillas
- Laboratori de Citologia Hematològica i Citogenètica Molecular, Servei de Patologia, Hospital del Mar, Barcelona, Spain
- GRETNHE, Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Julia Montoro
- Servicio de Hematología, Hospital Vall d’Hebrón, Barcelona, Spain
| | - David Valcárcel
- Servicio de Hematología, Hospital Vall d’Hebrón, Barcelona, Spain
| | - Carme Pedro
- GRETNHE, Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Servei de Hematologia Clínica, Hospital del Mar, Barcelona, Spain
| | - Carmen Sanzo
- Servicio de Hematología, Hospital Central de Asturias, Oviedo, Spain
| | - Elisa Luño
- Servicio de Hematología, Hospital Central de Asturias, Oviedo, Spain
| | - Teresa Giménez
- Servei d’Hematologia, Hospital Universitari Joan XXIII, Tarragona, Spain
| | - Montserrat Arnan
- Servei d’Hematologia, Hospital Duran i Reynals, Institut Català d’Oncologia, L’Hospitalet del Llobregat, Spain
| | - Helena Pomares
- Servei d’Hematologia, Hospital Duran i Reynals, Institut Català d’Oncologia, L’Hospitalet del Llobregat, Spain
| | - Raquel De Paz
- Servicio de Hematología, Hospital Universitario de La Paz, Madrid, Spain
| | | | - Andrés Jerez
- Servicio de Hematología, Hospital Morales Meseguer, Murcia, Spain
| | - Ana B. Martínez
- Servicio de Hematología, Hospital Morales Meseguer, Murcia, Spain
| | | | | | - José M. Raya
- Servicio de Hematología, Hospital Universitario de Canarias, La Laguna,Tenerife, Spain
| | - Eduardo Ríos
- Sevicio de Hematologia, Hospital Universitario de Valme, Sevilla, Spain
| | - María Rodríguez-Rivera
- Laboratori de Citologia Hematològica i Citogenètica Molecular, Servei de Patologia, Hospital del Mar, Barcelona, Spain
- GRETNHE, Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Blanca Espinet
- Laboratori de Citologia Hematològica i Citogenètica Molecular, Servei de Patologia, Hospital del Mar, Barcelona, Spain
- GRETNHE, Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Lourdes Florensa
- Laboratori de Citologia Hematològica i Citogenètica Molecular, Servei de Patologia, Hospital del Mar, Barcelona, Spain
- GRETNHE, Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- * E-mail:
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20
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Inagaki J, Fukano R, Kurauchi K, Noguchi M, Tanioka S, Okamura J. Hematopoietic Stem Cell Transplantation in Children with Refractory Cytopenia of Childhood: Single-Center Experience Using High-Dose Cytarabine Containing Myeloablative and Aplastic Anemia Oriented Reduced-Intensity Conditioning Regimens. Biol Blood Marrow Transplant 2015; 21:565-9. [DOI: 10.1016/j.bbmt.2014.12.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 12/01/2014] [Indexed: 11/15/2022]
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21
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DeZern AE, Sekeres MA. The challenging world of cytopenias: distinguishing myelodysplastic syndromes from other disorders of marrow failure. Oncologist 2014; 19:735-45. [PMID: 24899643 DOI: 10.1634/theoncologist.2014-0056] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Over the past decade, our understanding of bone marrow failure has advanced considerably. Marrow failure encompasses multiple overlapping diseases, and there is increasing availability of diagnostic tools to distinguish among the subtypes. Identification of genetic alterations that underlie marrow failure has also greatly expanded, especially for myelodysplastic syndromes. Molecular markers are increasingly used to guide the management of myelodysplasia and may distinguish this diagnosis from other marrow failure disorders. This review summarizes the current state of distinguishing among causes of marrow failure and discusses the potential uses of multiple diagnostic and prognostic indicators in the management of myelodysplastic syndromes and other bone marrow failure disorders.
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Affiliation(s)
- Amy E DeZern
- The Sidney Kimmel Comprehensive Cancer Center and Division of Hematology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Leukemia Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mikkael A Sekeres
- The Sidney Kimmel Comprehensive Cancer Center and Division of Hematology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Leukemia Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
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22
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Handigund RS, Malur PR, Dhumale AJ, Bali A, Roy M, Inumella S. Severe Aplastic Anemia Manifesting After Complete Remission of Acute Promyelocytic Leukemia: Is it a Fortuitous Association? Indian J Hematol Blood Transfus 2014; 30:64-7. [PMID: 24554829 DOI: 10.1007/s12288-012-0201-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 09/20/2012] [Indexed: 10/27/2022] Open
Abstract
Acute leukemia, secondary myelodysplasia and paroxysmal nocturnal hemoglobinuria evolving from severe aplastic anemia (AA) following immunosuppressive therapy are well recognized. However, severe AA occurring after complete remission of acute promyelocytic leukemia (APL) has been documented only once in 2009. We report a case of 30-year-old male diagnosed with APL who achieved complete cytogenetic remission with all-trans retinoic acid based induction regimen and developed severe AA few months later during maintenance therapy.
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Affiliation(s)
- Rajeshwari Satish Handigund
- Hi-Tech Laboratory, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum, Karnataka India ; Flat 3, Ruturaj Apartments, S P Office road, Kolhapur Circle, Belgaum, Karnataka 590016 India
| | - Prakash R Malur
- Hi-Tech Laboratory, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum, Karnataka India
| | - Annasaheb J Dhumale
- Department of Medicine, Jawaharlal Nehru Medical College, Belgaum, Karnataka India
| | - Akshay Bali
- Department of Pathology, Jawaharlal Nehru Medical College, Belgaum, Karnataka India
| | - Maitrayee Roy
- Department of Pathology, Jawaharlal Nehru Medical College, Belgaum, Karnataka India
| | - Suvarna Inumella
- Hi-Tech Laboratory, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum, Karnataka India
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GUO DONGMEI, LIU QINQIN, LI BANBAN, TENG QINGLIANG. Severe aplastic anemia preceding acute monocytic leukemia in an adult with acquired trisomy 21: A case report. Oncol Lett 2014; 7:565-567. [PMID: 24396488 PMCID: PMC3881932 DOI: 10.3892/ol.2013.1724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 11/19/2013] [Indexed: 11/05/2022] Open
Abstract
The current case report presents a patient with acute monocytic leukemia (AML-M5) occurring 14 years following the successful treatment of severe aplastic anemia (SAA) with immunosuppressants and androgens. The patient was treated with induction chemotherapy, but did not achieve remission. The patient succumbed to central nervous system bleeding 2 weeks following the first cycle of chemotherapy. Chromosomal examination revealed 47,XX,+21[10]/46,XX[1]. To the best of our knowledge the present case is the first to be reported of SAA 14 years preceding AML-M5 with acquired trisomy 21.
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Yoshimi A, van den Heuvel-Eibrink MM, Baumann I, Schwarz S, Simonitsch-Klupp I, de Paepe P, Campr V, Kerndrup GB, O'Sullivan M, Devito R, Leguit R, Hernandez M, Dworzak M, de Moerloose B, Stary J, Hasle H, Smith OP, Zecca M, Catala A, Schmugge M, Locatelli F, Führer M, Fischer A, Guderle A, Nöllke P, Strahm B, Niemeyer CM. Comparison of horse and rabbit antithymocyte globulin in immunosuppressive therapy for refractory cytopenia of childhood. Haematologica 2013; 99:656-63. [PMID: 24162791 DOI: 10.3324/haematol.2013.095786] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Refractory cytopenia of childhood is the most common subtype of myelodysplastic syndrome in children. In this study, we compared the outcome of immunosuppressive therapy using horse antithymocyte globulin (n=46) with that using rabbit antithymocyte globulin (n=49) in 95 patients with refractory cytopenia of childhood and hypocellular bone marrow. The response rate at 6 months was 74% for horse antithymocyte globulin and 53% for rabbit antithymocyte globulin (P=0.04). The inferior response in the rabbit antithymocyte globulin group resulted in lower 4-year transplantation-free (69% versus 46%; P=0.003) and failure-free (58% versus 48%; P=0.04) survival rates in this group compared with those in the horse antithymocyte globulin group. However, because of successful second-line hematopoietic stem cell transplantation, overall survival was comparable between groups (91% versus 85%; P=ns). The cumulative incidence of relapse (15% versus 9%; P=ns) and clonal evolution (12% versus 4%; P=ns) at 4 years was comparable between groups. Our results suggest that the outcome of immunosuppressive therapy with rabbit antithymocyte globulin is inferior to that of horse antithymocyte globulin. Although immunosuppressive therapy is an effective therapy in selected patients with refractory cytopenia of childhood, the long-term risk of relapse or clonal evolution remains. (ClinicalTrial.gov identifiers: NCT00662090).
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25
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Oka S, Muroi K, Matsuyama T, Sato K, Ueda M, Toshima M, Suzuki T, Ozaki K, Mori M, Takubo T, Nagai T, Hanafusa T, Ozawa K. Correlation between flow cytometric identification of CD33-positive cells and morphological evaluation of myeloblasts in bone marrow of patients with acute myeloblastic leukemia. Hematology 2013; 14:133-8. [DOI: 10.1179/102453309x402269] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Satoko Oka
- Division of HematologyDepartment of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Kazuo Muroi
- Division of HematologyDepartment of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Tomohiro Matsuyama
- Division of HematologyDepartment of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Kazuya Sato
- Division of HematologyDepartment of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Masuzu Ueda
- Division of HematologyDepartment of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Masaki Toshima
- Division of HematologyDepartment of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Takahiro Suzuki
- Division of HematologyDepartment of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Katsutoshi Ozaki
- Division of HematologyDepartment of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Masaki Mori
- Division of HematologyDepartment of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Takayuki Takubo
- Department of Internal Medicine (I)Osaka Medical College, Takatsuki, Oasaka, Japan
| | - Tadashi Nagai
- Division of HematologyDepartment of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Toshiaki Hanafusa
- Department of Internal Medicine (I)Osaka Medical College, Takatsuki, Oasaka, Japan
| | - Keiya Ozawa
- Division of HematologyDepartment of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
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26
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Parikh AR, Olnes MJ, Barrett AJ. Immunomodulatory treatment of myelodysplastic syndromes: antithymocyte globulin, cyclosporine, and alemtuzumab. Semin Hematol 2013; 49:304-11. [PMID: 23079060 DOI: 10.1053/j.seminhematol.2012.07.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
It is now well accepted that a subgroup of patients with myelodysplastic syndromes (MDS) can recover from pancytopenia following immunosuppressive treatment (IST). For many years immunosuppression with antilymphocyte antibodies has been a standard treatment approach for patients with severe aplastic anemia (SAA). The initial concept of using immunosuppression to treat pancytopenic patients with MDS was based on the premise that MDS might share with SAA an autoimmune basis for the bone marrow failure common to both conditions. The idea was supported by reports of favorable outcomes in occasional cases of MDS treated with antithymocyte globulin (ATG). Today, various forms of IST have been successfully used to restore hematopoiesis in MDS in many centers worldwide. In this review we outline the rationale for use of IST in MDS, and describe studies which help to define the patients with MDS likely to respond to IST. We summarize 18 published clinical trials using IST for MDS and discuss how these studies have helped to define the MDS subgroups likely to respond to treatment, the nature and durability of the response, the impact of IST on long-term outcome, and the best treatment approach.
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Affiliation(s)
- Ankur R Parikh
- Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892-1202, USA
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27
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Boveri E, Croci G, Gianelli U, Gambacorta M, Isimbaldi G, Moro A, Gianatti A, Ungari M, Morra E. Histopathological and immunohistochemical evaluation of bone marrow biopsy in myelodysplastic syndromes. Int J Hematol Oncol 2013. [DOI: 10.2217/ijh.13.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY In myelodysplastic syndromes (MDS), bone marrow biopsy (BMB) is now considered part of a multidisciplinary approach to bone marrow (BM) examination that must include cytological and cytogenetic assessment, while flow-cytometry and molecular studies can provide additional useful information. Undervalued in the past, BM histology has recently grown in importance in terms of diagnosis (i.e., MDS with BM fibrosis, hypoplastic MDS) and prognostic assessment (i.e., clusters of CD34+ blasts). Thus, BM histology must be considered complementary and not overlapping with the results of the other methods of BM study. Moreover, in recent years, numerous clinico-pathological studies have evidentiated, codified and standardized a series of histopathological parameters that are now considered essential for an effective and clinically useful histomorphological evaluation of the BMB. The aim of this work is to describe the histopathological and immunohistochemical approach to BMB that the pathologists of the Lombard Hematological Network (Rete Ematologica Lombarda [REL]; Italy) are carrying out on a standardized and shared basis in MDS patients.
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Affiliation(s)
- Emanuela Boveri
- Struttura Complessa di Anatomia Patologica, Fondazione IRCCS Policlinico San Matteo, Via Forlanini 14, Pavia, Italy
| | - Giorgio Croci
- Istituto di Anatomia Patologica, Dipartimento di Medicina Molecolare, Università di Pavia, Via Forlanini 14, Pavia, Italy
| | - Umberto Gianelli
- Unità Operativa Complessa di Anatomia Patologica, Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Fondazione IRCCS Cà Granda – Ospedale Maggiore Policlinico, Milano, Italy
| | - Marcello Gambacorta
- Struttura Complessa di Anatomia Istologia Patologica e Citogenetica, Ospedale Niguarda Ca’ Granda, Piazza Ospedale Maggiore 3, Milano, Italy
| | - Giuseppe Isimbaldi
- Unità Operativa di Anatomia Patologica, Citologia e Genetica Medica, Ospedale San Gerardo, Via Pergolesi 33, Monza, Italy
| | - Alessia Moro
- Unità Operativa Complessa di Anatomia Patologica, Università degli Studi di Milano, Dipartimento di Scienze della Salute, Azienda Ospedaliera San Paolo, Via Antonio di Rudinì 8, Milano, Italy
| | - Andrea Gianatti
- Unità di Struttura Complessa di Anatomia Patologica, Azienda Ospedaliera Papa Giovanni XXIII, Piazza OMS 1, Bergamo, Italy
| | - Marco Ungari
- Istituto di Anatomia Patologica, Spedali Civili, Piazzale Spedali Civili 1, Brescia, Italy
| | - Enrica Morra
- Struttura di Ematologia, Ospedale Niguarda Ca’ Granda, Piazza Ospedale Maggiore 3, Milano, Italy
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28
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Yamazaki H, Nakao S. Border between aplastic anemia and myelodysplastic syndrome. Int J Hematol 2013; 97:558-63. [PMID: 23613266 DOI: 10.1007/s12185-013-1324-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 04/03/2013] [Accepted: 04/03/2013] [Indexed: 11/26/2022]
Abstract
Distinguishing between acquired aplastic anemia (AA) and myelodysplastic syndrome (MDS) with a low blast cell percentage is often difficult and problematic, as both diseases are syndromes primarily defined by morphological findings, and their diagnostic criteria do not necessarily reflect the pathophysiology of their bone marrow (BM) failure. As a result, many patients with benign BM failure that should be managed as AA are diagnosed as having MDS, due to the absence of BM hypocellularity and the presence of dysplastic signs in the BM, and are treated inappropriately with toxic therapies, such as hypomethylating agents, and stem cell transplantation from unrelated donors. BM failure syndromes need to be managed in ways appropriate to their pathophysiology, which is more accurately determined by using markers such as the presence of glycosylphosphatidylinositol-anchored protein-deficient cells and HLA-A lacking leukocytes. We recently found that plasma thromobopoietin level is one of the most useful markers for distinguishing benign and pre-leukemic BM failure syndromes.
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Affiliation(s)
- Hirohito Yamazaki
- Cellular Transplantation Biology, Kanazawa University Graduate School of Medical Science, 13-1, Takaramachi, Kanazawa, Ishikawa 920-8641, Japan
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29
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Steensma DP. Dysplasia has A differential diagnosis: distinguishing genuine myelodysplastic syndromes (MDS) from mimics, imitators, copycats and impostors. Curr Hematol Malig Rep 2013; 7:310-20. [PMID: 23015360 DOI: 10.1007/s11899-012-0140-3] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Just as a pawnshop owner who is unable to distinguish a genuine Rolex™ watch from a cheap knockoff courts financial ruin, the physician who fails to discriminate between authentic myelodysplastic syndromes (MDS) and conditions resembling MDS risks misinforming or harming patients. This review summarizes minimal criteria for diagnosing MDS and discusses common diagnostic challenges. MDS needs to be separated from numerous neoplastic and non-clonal hematologic disorders that can mimic MDS, including other myeloid neoplasms, nutritional deficiencies, toxin exposures, aplastic anemia, and inherited disorders (e.g., congenital sideroblastic anemia). Some distinctions are more critical therapeutically than others; e.g., recognizing B12 deficiency is more important than parsing high-risk MDS from erythroleukemia. Diagnostically ambiguous cases may be assigned holding-pattern terms, "idiopathic cytopenia(s) of undetermined significance" (ICUS) or "idiopathic dysplasia of undetermined significance" (IDUS), while awaiting clarifying information or further clinical developments. In the future, advances in molecular pathology will improve diagnostic accuracy, especially in morphologically non-descript cases.
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Affiliation(s)
- David P Steensma
- Department of Medical Oncology, Dana-Farber Cancer Institute Harvard Medical School, 450 Brookline Ave, Suite D1B30, Mayer 1B21, Boston, MA, 02215, USA.
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30
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Seiki Y, Sasaki Y, Hosokawa K, Saito C, Sugimori N, Yamazaki H, Takami A, Nakao S. Increased plasma thrombopoietin levels in patients with myelodysplastic syndrome: a reliable marker for a benign subset of bone marrow failure. Haematologica 2013; 98:901-7. [PMID: 23403320 DOI: 10.3324/haematol.2012.066217] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Although myelodysplastic syndromes are heterogeneous disorders comprising a benign subset of bone marrow failure similar to aplastic anemia, no laboratory test has been established to distinguish it from bone marrow failures that can evolve into acute myeloid leukemia. Plasma thrombopoietin levels were measured in 120 patients who had myelodysplastic syndrome with thrombocytopenia (< 100 × 10(9)/L) to determine any correlation to markers associated with immune pathophysiology and outcome. Thrombopoietin levels were consistently low for patients with refractory anemia with excess of blasts, while patients with other myelodysplatic syndrome subsets had more variable results. Patients with thrombopoietin levels of 320 pg/mL and over had increased glycosylphosphatidylinositol-anchored protein-deficient blood cells (49.1% vs. 0%), were more likely to have a low International Prognostic Scoring System (IPSS) score (≤1.0, 100% vs. 65.5%), a higher response rate to immunosuppressive therapy (84.2% vs. 14.3%), and a better 5-year progression-free survival rate (94.1% vs. 63.6% for refractory cytopenia with unilineage dysplasia; 100.0% vs. 44.4% for refractory cytopenia with multilineage dysplasia). In conclusion, increased plasma thrombopoietin levels were associated with a favorable prognosis of bone marrow failure and could, therefore, represent a reliable marker for a benign subset of myelodysplastic syndrome.
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Affiliation(s)
- Yu Seiki
- Cellular Transplantation Biology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
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31
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Terrazzano G, Alfinito F, Palatucci AT, Rubino V, Della Pepa R, Giovazzino A, Ruggiero G. HLA-E and HLA class I molecules on bone marrow and peripheral blood polymorphonuclear cells of myelodysplatic patients. Leuk Res 2013; 37:169-74. [PMID: 23040534 DOI: 10.1016/j.leukres.2012.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 09/10/2012] [Accepted: 09/16/2012] [Indexed: 12/23/2022]
Abstract
Relevance of immune-dysregulation for emergence, dominance and progression of dysplastic clones in myelodysplastic syndromes (MDS) was suggested, but valuable or predictive criteria on this involvement are lacking. We previously reported that reduced T-regulatory cells (Treg) and high CD54 expression on T cell identify a sub-group of patients in whom an immune-pathogenesis might be inferred. Here, we suggest the occurrence of immune-selection of dysplastic clones in a subgroup of MDS patients, with reduced HLA-I and HLA-E on PMN, and propose that an altered immune profile might represent a valuable criterion to classify Low/Int-1 patients on the basis of immune-pathogenesis of MDS.
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32
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Weinzierl EP, Arber DA. The differential diagnosis and bone marrow evaluation of new-onset pancytopenia. Am J Clin Pathol 2013; 139:9-29. [PMID: 23270895 DOI: 10.1309/ajcp50aeeygrewuz] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
New-onset pancytopenia can be caused by a wide variety of etiologies, leading to a diagnostic dilemma. These etiologies range from congenital bone marrow failure to marrow space-occupying lesions, infection, and peripheral destruction, to name a few. Bone marrow examination, in addition to a detailed clinical history, is often required for an accurate diagnosis. The purpose of this review is to provide a brief overview of many of the causes of new-onset pancytopenia in adults and children, with emphasis on bone marrow findings and recommendations of additional testing and clinical evaluation when needed, with the overall aim of aiding the pathologist's role as a consultant to the patient's treating physician.
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33
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Toma A, Fenaux P, Dreyfus F, Cordonnier C. Infections in myelodysplastic syndromes. Haematologica 2012; 97:1459-70. [PMID: 22733024 PMCID: PMC3487546 DOI: 10.3324/haematol.2012.063420] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 05/17/2012] [Accepted: 06/13/2012] [Indexed: 12/19/2022] Open
Abstract
Myelodysplastic syndromes are associated with a risk of severe infections. While neutropenia is likely to be the main predisposing factor, several other immune defects have been reported, including impaired neutrophil function, B-, T- and NK-cell defects and the possible consequences of iron overload due to red blood cell transfusions. The advanced age of most patients, their frequent comorbidities, and the fact that drugs such as hypomethylating agents and lenalidomide, which are effective in myelodysplastic syndromes but can transiently worsen neutropenia, may increase the risk of infection and their severity in this context. The majority of infections in myelodysplastic syndromes are bacterial, while the incidence of fungal infections is not well known and viral infections seem to be rare. No prophylactic measures against infections have demonstrated efficacy in myelodysplastic syndromes. However, pending more data, we propose here some recommendations for the management of patients with myelodysplastic syndromes. In the future, an important contribution can be made by prospective trials testing the efficacy of prophylactic and therapeutic approaches to infection in these patients, especially in the context of the new drugs available for myelodysplastic syndromes.
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Affiliation(s)
- Andréa Toma
- Department of Hematology Henri Mondor University Hospital, 94000 Créteil, France.
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Peng H, Wen J, Zhang L, Li H, Chang CC, Zu Y, Zhou X. A systematic modeling study on the pathogenic role of p38 MAPK activation in myelodysplastic syndromes. MOLECULAR BIOSYSTEMS 2012; 8:1366-74. [PMID: 22327869 DOI: 10.1039/c2mb05184b] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/26/2024]
Abstract
Myelodysplastic syndromes (MDS) are a group of clonal hematopoietic stem cell diseases. In addition to intrinsic genetic alterations, the effects of the extrinsic microenvironment also play a pathological role in MDS development. The presence of increased inflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α), in marrow and abnormal activation of the p38 mitogen-activated protein kinase (MAPK) signaling pathway in hematopoietic cells are associated with the ineffective hematopoiesis in MDS. However, the molecular mechanism of p38 MAPK activation triggered by microenvironment cytokines remains poorly understood. To address this question, we combined computational modeling analysis and molecular biology studies to perform a systematic investigation of signaling events regulated by microenvironment cytokines in hematopoietic cells from MDS patients. We examined dynamic changes of key signaling events, including the p38 MAPK and the c-Jun N-terminal kinase (JNK) pathway in bone marrow mononuclear cells from MDS patients or normal donors in response to TNF-α stimulation using reverse phase protein array technology. The results were analyzed by a novel computational model and preliminarily validated by immunohistochemistry analysis of the bone marrow tissues from twelve MDS patients and normal donors. Our systematic model revealed that the dynamic response patterns of p38 MAPK and JNK to TNF-α stimulation in MDS were different from that observed in normal marrow cells. Particularly, B-cell lymphoma-X (BCL-XL) protein degradation was regulated by the JNK pathway in normal cells, but by p38 MAPK in MDS cells. By immunohistochemistry, BCL-XL was highly expressed in hematopoietic cells from normal marrow, but was minimally expressed in MDS marrow. Additionally, immunostaining for phosphorylated p38 MAPKα showed much higher p38 MAPK activation in MDS marrows, supporting over-activation of p38 MAPK-enhanced degradation of BCL-XL in MDS. The degradation of BCL-XL triggered by p38 MAPK over-activation may contribute to the increasing apoptosis of marrow cells, a phenomenon commonly observed in MDS, and lead to ineffective hematopoiesis. Our study suggests that the combination of molecular biological studies and systematic modeling is a powerful tool for comprehensive investigation of the complex cellular mechanisms involved in MDS pathogenesis.
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Affiliation(s)
- Huiming Peng
- Department of Radiology, The Methodist Hospital, The Methodist Hospital Research Institute, and Weill Cornell Medical College, Houston, TX, USA.
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Abstract
Sustained clinical cytopenia is a frequent laboratory finding in ambulatory and hospitalized patients. For pathologists and hematopathologists who examine the bone marrow (BM), a diagnosis of cytopenia secondary to an infiltrative BM process or acute leukemia can be readily established based on morphologic evaluation and flow cytometry immunophenotyping. However, it can be more challenging to establish a diagnosis of myelodysplastic syndrome (MDS). In this article, the practical approaches for establishing or excluding a diagnosis of MDS (especially low-grade MDS) in patients with clinical cytopenia are discussed along with the current diagnostic recommendations provided by the World Health Organization and the International Working Group for MDS.
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36
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Tong WG, Quintás-Cardama A, Kadia T, Borthakur G, Jabbour E, Ravandi F, Faderl S, Wierda W, Pierce S, Shan J, Bueso-Ramos C, Kantarjian H, Garcia-Manero G. Predicting survival of patients with hypocellular myelodysplastic syndrome: development of a disease-specific prognostic score system. Cancer 2012; 118:4462-70. [PMID: 22252728 DOI: 10.1002/cncr.27420] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 09/21/2011] [Accepted: 11/08/2011] [Indexed: 01/13/2023]
Abstract
BACKGROUND Although most patients with myelodysplastic syndrome (MDS) exhibit bone marrow hypercellularity, a subset of them present with a hypocellular bone marrow. Specific factors associated with poor prognosis have not been investigated in patients with hypocellular MDS. METHODS The authors studied a cohort of 253 patients with hypocellular MDS diagnosed at The University of Texas MD Anderson Cancer Center between 1993 and 2007 and a cohort of 1725 patients with hyper-/normocellular MDS diagnosed during the same time period. RESULTS Patients with hypocellular MDS presented more frequently with thrombocytopenia (P < .019), neutropenia (P < .001), low serum β-2 microglobulin (P < .001), increased transfusion dependency (P < .001), and intermediate-2/high-risk disease (57% vs 42%, P = .02) compared with patients with hyper-/normocellular MDS. However, no difference in overall survival was observed between the 2 groups (P = .28). Multivariate analysis identified poor performance status (Eastern Cooperative Oncology Group ≥2), low hemoglobin (<10 g/dL), unfavorable cytogenetics (-7/7q or complex), increased bone marrow blasts (≥5%), and high serum lactate dehydrogenase (>600 IU/L) as adverse independent factors for survival. CONCLUSIONS A new prognostic model based on these factors was built that segregated patients into 3 distinct risk categories independent of International Prognostic Scoring System (IPSS) score. This model is independent from the IPSS, further refines IPSS-based prognostication, and may be used to develop of risk-adapted therapeutic approaches for patients with hypocellular MDS.
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Affiliation(s)
- Wei-Gang Tong
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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38
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Cho SY, Oh SH, Suh JT, Lee HJ, Lee WI, Baek SK, Cho KS, Park TS. Hypoplastic myelodysplastic syndrome associated with der(1;7)(q10;p10) presenting as bone marrow failure. Acta Haematol 2011; 126:110-3. [PMID: 21646778 DOI: 10.1159/000328036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 03/21/2011] [Indexed: 01/02/2023]
Affiliation(s)
- Sun Young Cho
- Department of Laboratory Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
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39
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SNP array-based karyotyping: differences and similarities between aplastic anemia and hypocellular myelodysplastic syndromes. Blood 2011; 117:6876-84. [PMID: 21527527 DOI: 10.1182/blood-2010-11-314393] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
In aplastic anemia (AA), contraction of the stem cell pool may result in oligoclonality, while in myelodysplastic syndromes (MDS) a single hematopoietic clone often characterized by chromosomal aberrations expands and outcompetes normal stem cells. We analyzed patients with AA (N = 93) and hypocellular MDS (hMDS, N = 24) using single nucleotide polymorphism arrays (SNP-A) complementing routine cytogenetics. We hypothesized that clinically important cryptic clonal aberrations may exist in some patients with BM failure. Combined metaphase and SNP-A karyotyping improved detection of chromosomal lesions: 19% and 54% of AA and hMDS cases harbored clonal abnormalities including copy-neutral loss of heterozygosity (UPD, 7%). Remarkably, lesions involving the HLA locus suggestive of clonal immune escape were found in 3 of 93 patients with AA. In hMDS, additional clonal lesions were detected in 5 (36%) of 14 patients with normal/noninformative routine cytogenetics. In a subset of AA patients studied at presentation, persistent chromosomal genomic lesions were found in 10 of 33, suggesting that the initial diagnosis may have been hMDS. Similarly, using SNP-A, earlier clonal evolution was found in 4 of 7 AA patients followed serially. In sum, our results indicate that SNP-A identify cryptic clonal genomic aberrations in AA and hMDS leading to improved distinction of these disease entities.
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Ocheni S, Oyekunle A, Kröger N, Ayuk F, Klyuchnikov E, Arps S, Held K, Zabelina T, Adjallé R, Wolschke C, Zander AR, Bacher U. Second allogeneic stem cell transplantation in a patient with hypoplastic myelodysplastic syndrome following a primary diagnosis of aplastic anaemia. Acta Haematol 2011; 125:175-8. [PMID: 21196720 DOI: 10.1159/000322609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Accepted: 11/08/2010] [Indexed: 11/19/2022]
Affiliation(s)
- Sunday Ocheni
- Department for Stem Cell Transplantation, University Cancer Center Hamburg, Germany
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41
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Feng X, Scheinberg P, Wu CO, Samsel L, Nunez O, Prince C, Ganetzky RD, McCoy JP, Maciejewski JP, Young NS. Cytokine signature profiles in acquired aplastic anemia and myelodysplastic syndromes. Haematologica 2010; 96:602-6. [PMID: 21160069 DOI: 10.3324/haematol.2010.030536] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Although aplastic anemia and myelodysplasia have been extensively investigated, little is known about their circulating cytokine patterns. We compared plasma soluble cytokines in 33 aplastic anemia, 57 myelodysplasia patients, and 48 healthy controls. High levels of thrombopoietin and granulocyte colony-stimulating factor, with low levels of CD40 ligand, chemokine (C-X-C motif) ligand 5, chemokine (C-C motif) ligand 5, chemokine (C-X-C motif) ligand 11, epidermal growth factor, vascular endothelial growth factor, and chemokine (C-C motif) ligand 11 were a signature profile for aplastic anemia. High levels of tumor necrosis factor-α, interleukin-6, chemokine (C-C motif) ligand 3, interleukin-1 receptor antagonist, and hepatocyte growth factor were a cytokine signature for myelodysplasia. Despite similar clinical presentations, distinct cytokine profiles were observed between aplastic anemia and hypocellular myelodysplasia. Future studies focusing on cytokines that better discriminate these two entities such as thrombopoietin and chemokine (C-C motif) ligand 3 may be useful tools in clinical practice.
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Affiliation(s)
- Xingmin Feng
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA.
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Abstract
Sustained clinical cytopenia is a frequent laboratory finding in ambulatory and hospitalized patients. For pathologists and hematopathologists who examine the bone marrow (BM), a diagnosis of cytopenia secondary to an infiltrative BM process or acute leukemia can be readily established based on morphologic evaluation and flow cytometry immunophenotyping. However, it can be more challenging to establish a diagnosis of myelodysplastic syndrome (MDS). In this article, the practical approaches for establishing or excluding a diagnosis of MDS (especially low-grade MDS) in patients with clinical cytopenia are discussed along with the current diagnostic recommendations provided by the World Health Organization and the International Working Group for MDS.
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Affiliation(s)
- Sa A Wang
- Department of Hematopathology, University of Texas, MD Anderson Cancer Center, Unit 72, 1515 Holcombe Boulevard, Houston, TX 77030-4009, USA.
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Zheng Z, Feng X, Xiao L, Qianqiao Z, Qi H, Lingyun W. Removal of autologous activated CD4-positive T lymphocytes also results in increased colony-forming units in patients with low and intermediate-1 risk myelodysplastic syndromes. Eur J Haematol 2010; 86:47-56. [DOI: 10.1111/j.1600-0609.2010.01535.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
A 9-year-old girl with intractable anemia, rare mucocutaneous bleeding, and pallor was presented. Hemoglobin was 49 g/L; reticulocyte 0.79%, mean corpuscular volume 81 fL, platelet 37×10⁹/L; white blood cell count 3.2×10⁹/L with dysmorphic cells in peripheric blood. Further evaluation revealed 10% cellularity with grade IV reticulin fibrosis, immature, and/or dysplastic hematopoietic cells without sideroblasts, or blast increase in biopsy, Monosomy 8 was found in bone marrow aspiration material using FISH. Vitamin B12, folic acid, hemoglobin electrophoresis, immunoglobulin levels, CD55, CD59, complement 3, 4, abdominal ultrasonography, chest x-ray were normal; diepoxybutane, acid ham, sucrose lysis tests, viral serologies, antinuclear antibody, anti DNA were negative. On diagnosis of "Myelodysplastic Syndrome-refractory cytopenia with hypocellular fibrosis," she received a successful allogeneic BM transplantation from her full matched sibling.
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Barrett AJ, Sloand EM. Immunosuppressive therapy for myelodysplastic syndromes: refining the indications. Curr Hematol Malig Rep 2010; 3:23-8. [PMID: 20425443 DOI: 10.1007/s11899-008-0005-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Myelodysplastic syndromes (MDS) are often associated with autoimmune processes that contribute to the cytopenias that characterize this disease group. Ten years ago, several investigators described improvement in the cytopenia of MDS following immunosuppressive treatments (IST) with antithymocyte globulin or cyclosporine. These findings have since been widely confirmed. The consensus is that about 30% of unselected transfusion-dependent patients with MDS given IST have sustained hematologic responses and can regain transfusion independence. Over the past decade, prognostic features have been defined that accurately identify the subset of patients most likely to benefit from IST. With increasing knowledge about the pathophysiology of myelosuppression in MDS, we are beginning to define the immunosuppressive agents and schedules with the greatest chance of causing hematologic improvement. Significantly, long-term follow-up indicates that IST responders have a better progression-free survival than comparable patients with MDS who do not receive IST.
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Affiliation(s)
- A John Barrett
- Clinical Research Center, National Heart, Lung, and Blood Institute, Bethesda, MD 20892, USA.
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Alfinito F, Sica M, Luciano L, Pepa RD, Palladino C, Ferrara I, Giani U, Ruggiero G, Terrazzano G. Immune dysregulation and dyserythropoiesis in the myelodysplastic syndromes. Br J Haematol 2010; 148:90-8. [DOI: 10.1111/j.1365-2141.2009.07921.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Gross SA, Irons RD, Schnatter AR, Ryder J, Wang XQ, Copley GB, Armstrong TW. A hospital-based case control study of aplastic anemia in Shanghai, China. Chem Biol Interact 2009; 184:165-73. [PMID: 20026322 DOI: 10.1016/j.cbi.2009.12.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Revised: 12/10/2009] [Accepted: 12/14/2009] [Indexed: 11/17/2022]
Abstract
We report results of a hospital-based case control study of 137 consecutive patients diagnosed with aplastic anemia (AA) in participating hospitals over a 4-year period. Diagnoses were made by a single laboratory, subjects were age- and gender-matched to two controls and interviewed concerning previous disease, work histories and exposures to potential etiologic agents. Analysis was conducted on two distinct subgroups: severe aplastic anemia (SAA) and moderate aplastic anemia (MAA). In univariate regression models, the strongest associations were observed for exposure to benzene and SAA (OR=3.12, 95% CI=1.12-8.65) and life on a farm and MAA (OR=3.08, 95% CI=1.44-6.56). Benzene exposure did not show a strong dose-response relationship with either subtype. When accounting for all of the potential confounders we considered in conditional regression models, the previous relationships persisted. Other explanatory variables included hair-dye use for MAA and farm exposures, such as livestock for SAA, although most of these additional variables fell just short of statistical significance. Adjusted R-squared values were only 10% for each subtype, leaving 90% of AA occurrence unexplained. Our results suggest that: (a) benzene exposure is more strongly related to SAA than MAA, (b) farm and livestock exposures are related to both forms of AA, confirming some previous results, and (c) a large percentage of AA remains unexplained, which may indicate that individual susceptibility has a major influence on AA occurrence.
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Affiliation(s)
- Sherilyn A Gross
- Fudan-Cinpathogen Clinical and Molecular Research Center, Institutes of Biomedical Sciences, Fudan University, Shanghai, China
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HAMDI W, OGAWARA H, HANDA H, TSUKAMOTO N, MURAKAMI H. Clinical significance of Th1/Th2 ratio in patients with myelodysplastic syndrome. Int J Lab Hematol 2009; 31:630-8. [DOI: 10.1111/j.1751-553x.2008.01090.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Session 4 of the 2007 Workshop of the Society for Hematopathology/European Association for Haematopathology was devoted to myelodysplastic syndromes (MDSs). Submitted cases highlighted important issues and difficulties in relation to the diagnosis and classification of MDS. Much of the discussion focused on the correlation, or lack of it, between morphologic examination and other diagnostic techniques, cytogenetics in particular. The cases included examples of isolated del(5q) chromosomal abnormality, including the "classical" 5q- syndrome and other myeloid neoplasms. Other cytogenetic abnormalities in MDSs and the role of cytogenetics in diagnosing MDSs were addressed. Particularly challenging is the correct identification of fibrotic subtypes of MDSs and their separation from subsets of acute myeloid leukemia with myelofibrosis such as acute panmyelosis with myelofibrosis. The association and eventual relation of MDSs (hypoplastic in particular) with aplastic anemia, paroxysmal nocturnal hemoglobinuria, and other nonneoplastic disorders were illustrated. Novel cytogenetic and molecular genetic approaches are likely to revolutionize the classification of MDSs. However, it is unlikely that these new techniques will be capable, on their own, of adequately stratifying patients for treatment purposes. At least for the foreseeable future, the diagnosis of MDS requires integration of morphologic, immunophenotypic, and genetic features in the light of patient history and clinical manifestations.
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Garg R, Faderl S, Garcia-Manero G, Cortes J, Koller C, Huang X, York S, Pierce S, Brandt M, Beran M, Borthakur G, Kantarjian H, Ravandi F. Phase II study of rabbit anti-thymocyte globulin, cyclosporine and granulocyte colony-stimulating factor in patients with aplastic anemia and myelodysplastic syndrome. Leukemia 2009; 23:1297-302. [PMID: 19242494 PMCID: PMC4217203 DOI: 10.1038/leu.2009.28] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2008] [Revised: 01/09/2009] [Accepted: 01/26/2009] [Indexed: 11/09/2022]
Abstract
We investigated efficacy and safety of rabbit anti-thymocyte globulin (rATG), cyclosporine and granulocyte colony-stimulating factor (G-CSF) as first-line therapy for patients with aplastic anemia (AA) and low or intermediate-1 or hypoplastic myelodysplastic syndrome (MDS). rATG 3.5 mg/kg (or 2.5 mg/kg per day for patients >or=55 years with MDS) was given for 5 days. Cyclosporine (5 mg/kg) and G-CSF (5 microg/kg) were given daily and continued for up to 6 months or longer. Responses were assessed about 3 and 6 months after therapy. Thirty-six patients have been enrolled on study and 32 patients treated; 25 were evaluable for a response (13 with AA, 12 with MDS); the rest are too early. The median age was 62 years (range, 20-83) for patients with AA and 63 (range, 42-80) for patients with MDS. Of 13 patients, 12 (92%) patients with AA responded (5 complete response (CR), 7 partial response (PR)), whereas of 12 patients, 4 (33%) patients with MDS responded (1 CR, 3 PR). For patients with AA, the median time to response (TTR) was 93 days (range, 79-623), whereas in the MDS group the median TTR was 111 days (range, 77-139). Grade III/IV toxicities were mainly cytopenias and neutropenic fever. Combination of rATG, cyclosporine and G-CSF is safe and effective as first-line treatment of AA and has significant activity in low-risk MDS.
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Affiliation(s)
- R Garg
- Department of Leukemia, The University of Texas, MD Anderson Cancer Center, Houston, TX 77030, USA
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