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Li VWK, Yim R, Lee P, Chin L, Au L, Leung GMK, Sim J, Lie AKW, Tse E, Kwong YL, Gill H. Allogeneic haematopoietic stem cell transplantation for myelofibrosis: prognostic indicators and the role of JAK2V617F measurable-residual disease monitoring by droplet-digital polymerase chain reaction. Ann Hematol 2023; 102:2517-2527. [PMID: 37329451 DOI: 10.1007/s00277-023-05312-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 06/04/2023] [Indexed: 06/19/2023]
Abstract
Relapse after allogeneic haematopoietic stem cell transplantation (HSCT) is one of the key determinants of outcome in myelofibrosis (MF) and remains an important unmet need. In this retrospective single-centre study, we evaluated 35 consecutive patients with MF receiving allogeneic HSCT. At 30 days post-HSCT, full donor chimerism was achieved in 31 patients (88.6%). The median time to neutrophil engraftment was 16.8 (10-42) days and the median time to platelet engraftment was 26 (12-245) days. Four patients (11.4%) experienced primary graft failure. With a median duration of follow-up of 33 (1-223) months, with the 5-year overall survival (OS) and progression-free survival (PFS) were 51.6% and 46.3%, respectively. Relapse after HSCT (P < 0.001), leucocyte count ≥ 18 × 109/L at HSCT (P = 0.003) and accelerated/blast phase disease at HSCT (P < 0.001) were significantly associated with worse OS. Age at HSCT ≥ 54 years (P = 0.01), mutated ETV6 (P = 0.03), leucocyte count ≥ 18 × 109/L (P = 0.02), accelerated/blast phase MF (P = 0.001), and grade 2-3 bone marrow reticulin fibrosis at 12 months post-HSCT (P = 0.002) were significantly associated with worse PFS. JAK2V617F MRD ≥ 0.047 [sensitivity 85.7%; positive predictive value (PPV) 100%; AUC 0.984; P = 0.001] at 6 months and JAK2V617F MRD ≥ 0.009 (sensitivity 100%; PPV 100%; AUC 1.0; P = 0.001) at 12 months were highly predictive of post-HSCT relapse. Inferior OS and PFS were significantly associated with detectable JAK2V617F MRD at 12 months (P = 0.003 and P = 0.0001, respectively).
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Affiliation(s)
- Vivian W K Li
- Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - Rita Yim
- Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - Paul Lee
- Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - Lynn Chin
- Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - Lester Au
- Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - Garret M K Leung
- Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - Joycelyn Sim
- Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - Albert K W Lie
- Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - Eric Tse
- Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - Yok-Lam Kwong
- Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - Harinder Gill
- Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China.
- Department of Medicine, Professorial Block, Queen Mary Hospital, Pokfulam, Road, Hong Kong, China.
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Tamari R, McLornan DP, Ahn KW, Estrada-Merly N, Hernández-Boluda JC, Giralt S, Palmer J, Gale RP, DeFilipp Z, Marks DI, van der Poel M, Verdonck LF, Battiwalla M, Diaz MA, Gupta V, Ali H, Litzow MR, Lazarus HM, Gergis U, Bashey A, Liesveld J, Hashmi S, Pu JJ, Beitinjaneh A, Bredeson C, Rizzieri D, Savani BN, Abid MB, Ganguly S, Agrawal V, Ulrike Bacher V, Wirk B, Jain T, Cutler C, Aljurf M, Kindwall-Keller T, Kharfan-Dabaja MA, Hildebrandt GC, Pawarode A, Solh MM, Yared JA, Grunwald MR, Nathan S, Nishihori T, Seo S, Scott BL, Nakamura R, Oran B, Czerw T, Yakoub-Agha I, Saber W. A simple prognostic system in patients with myelofibrosis undergoing allogeneic stem cell transplantation: a CIBMTR/EBMT analysis. Blood Adv 2023; 7:3993-4002. [PMID: 37134306 PMCID: PMC10410129 DOI: 10.1182/bloodadvances.2023009886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/17/2023] [Accepted: 04/17/2023] [Indexed: 05/05/2023] Open
Abstract
To develop a prognostic model for patients undergoing allogeneic hematopoietic cell transplantation (allo-HCT) for myelofibrosis (MF), we examined the data of 623 patients undergoing allo-HCT between 2000 and 2016 in the United States (the Center for International Blood and Marrow Transplant Research [CIBMTR] cohort). A Cox multivariable model was used to identify factors prognostic of mortality. A weighted score using these factors was assigned to patients who received transplantation in Europe (the European Bone Marrow Transplant [EBMT] cohort; n = 623). Patient age >50 years (hazard ratio [HR], 1.39; 95% confidence interval [CI], 0.98-1.96), and HLA-matched unrelated donor (HR, 1.29; 95% CI, 0.98-1.7) were associated with an increased hazard of death and were assigned 1 point. Hemoglobin levels <100 g/L at time of transplantation (HR, 1.63; 95% CI, 1.2-2.19) and a mismatched unrelated donor (HR, 1.78; 95% CI, 1.25-2.52) were assigned 2 points. The 3-year overall survival (OS) in patients with a low (1-2 points), intermediate (3-4 points), and high score (5 points) were 69% (95% CI, 61-76), 51% (95% CI, 46-56.4), and 34% (95% CI, 21-49), respectively (P < .001). Increasing score was predictive of increased transplant-related mortality (TRM; P = .0017) but not of relapse (P = .12). The derived score was predictive of OS (P < .001) and TRM (P = .002) but not of relapse (P = .17) in the EBMT cohort as well. The proposed system was prognostic of survival in 2 large cohorts, CIBMTR and EBMT, and can easily be applied by clinicians consulting patients with MF about the transplantation outcomes.
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Affiliation(s)
- Roni Tamari
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Donal P. McLornan
- Department of Medicine, University College Hospital, London, United Kingdom
| | - Kwang Woo Ahn
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
| | - Noel Estrada-Merly
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
| | | | - Sergio Giralt
- Department of Internal Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jeanne Palmer
- Department of Medicine, Mayo Clinic Arizona and Phoenix Children’s Hospital, Phoenix, AZ
| | - Robert Peter Gale
- Department of Immunology and Inflammation, Haematology Centre, Imperial College London, London, United Kingdom
| | - Zachariah DeFilipp
- Department of Medicine, Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital, Boston, MA
| | - David I. Marks
- Adult Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, United Kingdom
| | - Marjolein van der Poel
- Division of Hematology, Department of Internal Medicine, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Leo F. Verdonck
- Department of Hematology/Oncology, Isala Clinic, Zwolle, The Netherlands
| | - Minoo Battiwalla
- Outcomes Research, Sarah Cannon Blood Cancer Network, Nashville, TN
| | - Miguel Angel Diaz
- Department of Hematology/Oncology, Hospital Infantil Universitario Niño Jesus, Madrid, Spain
| | - Vikas Gupta
- Department of Internal Medicine, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Haris Ali
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
| | - Mark Robert Litzow
- Division of Hematology and Transplant Center, Mayo Clinic, Rochester, MN
| | - Hillard M. Lazarus
- Department of Hematology and Internal Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
| | - Usama Gergis
- Division of Hematological Malignancies, Department of Medicine Oncology, Thomas Jefferson University, Philadelphia, PA
| | - Asad Bashey
- Department of Medicine, Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA
| | - Jane Liesveld
- Department of Medicine, University of Rochester Medical Center, Rochester, NY
| | - Shahrukh Hashmi
- Department of Internal Medicine, Mayo Clinic, Rochester, MN
- Department of Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Jeffrey J. Pu
- Department of Medicine, Banner University Medical Center Tucson, Syracuse, NY
| | - Amer Beitinjaneh
- Divison of Transplantation and Cellular Therapy, University of Miami Hospital and Clinics, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Christopher Bredeson
- Department of Medicine, The Ottawa Hospital Transplant & Cellular Therapy Program, Ottawa, ON, Canada
| | | | - Bipin N. Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Muhammad Bilal Abid
- Divisions of Hematology/Oncology & Infectious Diseases, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Siddhartha Ganguly
- Department of Medicine, Houston Methodist Hospital and Cancer Center, Houston, TX
| | - Vaibhav Agrawal
- Division of Leukemia, Department of Hematology & Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Vera Ulrike Bacher
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Baldeep Wirk
- Department of Medicine, Bone Marrow Transplant Program, Penn State Cancer Institute, Hershey, PA
| | - Tania Jain
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Corey Cutler
- Stem Cell Transplantation and Cellular Therapy, Dana-Farber Cancer Institute, Boston, MA
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia
| | - Tamila Kindwall-Keller
- Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA
| | - Mohamed A. Kharfan-Dabaja
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL
| | | | - Attaphol Pawarode
- Division of Hematology/Oncology, Department of Internal Medicine, Blood and Marrow Transplantation Program, University of Michigan Medical School, Ann Arbor, MI
| | - Melhem M. Solh
- The Blood and Marrow Transplant Program, Northside Hospital Cancer Institute, Atlanta, GA
| | - Jean A. Yared
- Division of Hematology/Oncology, Department of Medicine, Transplantation & Cellular Therapy Program, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD
| | - Michael R. Grunwald
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Sunita Nathan
- Department of Internal Medicine, Section of Bone Marrow Transplant and Cell Therapy, Rush University Medical Center, Chicago, IL
| | - Taiga Nishihori
- Department of Blood & Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL
| | - Sachiko Seo
- Department of Hematology and Oncology, Dokkyo Medical University, Tochigi, Japan
| | - Bart L. Scott
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Ryotaro Nakamura
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
| | - Betul Oran
- Division of Cancer Medicine, Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tomasz Czerw
- Department of Haematology and BMT, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | | | - Wael Saber
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
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Ayala R, Fernández RA, García‐Gutiérrez V, Alvarez‐Larrán A, Osorio S, Sánchez‐Pina JM, Carreño‐Tarragona G, Álvarez N, Gómez‐Casares MT, Duran A, Gorrochategi J, Hernández‐Boluda JC, Martínez‐López J. Janus kinase inhibitor ruxolitinib in combination with nilotinib and prednisone in patients with myelofibrosis (RuNiC study): A phase Ib, multicenter study. EJHAEM 2023; 4:401-409. [PMID: 37206258 PMCID: PMC10188506 DOI: 10.1002/jha2.685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/16/2023] [Accepted: 03/22/2023] [Indexed: 05/21/2023]
Abstract
This phase Ib, non-randomized, open-label study evaluates the safety and tolerability of ruxolitinib in combination with nilotinib and prednisone in patients with naïve or ruxolitinib-resistant myelofibrosis (MF). A total of 15 patients with primary or secondary MF received the study treatment; 13 patients had received prior ruxolitinib treatment (86.7%). Eight patients completed seven cycles (53.3%) and six patients completed twelve cycles of treatment (40%). All the patients experienced at least one adverse event (AE) during the study (the most common AEs were hyperglycemia, asthenia, and thrombocytopenia), and 14 patients registered at least one treatment-related AE (the most common treatment-related AEs were hyperglycemia (22.2%; three grade 3 cases). Five treatment-related serious AEs (SAEs) were reported in two patients (13.3%). No deaths were registered throughout the study. No dose-limiting toxicity was observed. Four out of fifteen (27%) patients experienced a 100% spleen size reduction at Cycle 7, and two additional patients achieved a >50% spleen size reduction, representing an overall response rate of 40% at Cycle 7. In conclusion, the tolerability of this combination was acceptable, and hyperglycemia was the most frequent treatment-related AE. Ruxolitinib in combination with nilotinib and prednisone showed relevant clinical activity in patients with MF. This trial was registered with EudraCT Number 2016-005214-21.
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Affiliation(s)
- Rosa Ayala
- Haematological Malignancies Clinical Research UnitHospital Universitario 12 de Octubre, Universidad Complutense, CNIO, CIBERONCMadridSpain
| | | | | | | | - Santiago Osorio
- Hematology Department Hospital General UGregorio MarañónMadridSpain
| | | | | | - Noemi Álvarez
- Department of Translational HematologyResearch Institute Hospital 12 de Octubre (i+12)MadridSpain
| | | | - Antonia Duran
- Hematology Department Hospital Universitario Son EspasesPalma de MallorcaSpain
| | | | | | - Joaquín Martínez‐López
- Haematological Malignancies Clinical Research UnitHospital Universitario 12 de Octubre, Universidad Complutense, CNIO, CIBERONCMadridSpain
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Ghit A. Myelofibrosis treatment history and future prospects. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2022. [DOI: 10.1186/s43162-022-00169-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractMyelofibrosis (MF) is a haematopoietic stem cell tumour caused by the lack of BCR-ABL translocation due to point mutations in Janus kinases (JAKs). In previous years, dealing with MF included several protocols such as traditional drugs that control general symptoms, splenectomy, blood transfusion, and allogeneic haematopoietic stem-cell transplantation (HSCT). Allogeneic HSCT is remaining the only treatment that has the potential to alter MF’s progression. However, clinical trials of JAK inhibitors and non-JAK targeted therapies have been increasingly carried out in earlier years. The most prominent JAK inhibitors for the treatment of MF are ruxolitinib, fedratinib, momelotinib, pacritinib, gandotinib, ilginatinib, itacitinib, and lestaurtinib. On the other hand, the non-JAK targeted therapies that showed strong efficacy and safety are alisertib, imetelstat, pembrolizumab, nivolumab, and sotatercept. In this review, we summarized the recent clinical trials carried out on these drugs to understand their efficacy and safety. Also, we talked briefly about allogeneic HSCT as powerful therapy until the present for patients suffering from MF.
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Hsu CC, Wang YH, Chen YY, Chen YJ, Lu CH, Wu YY, Yang YR, Tsou HY, Li CP, Huang CE, Chen CC. The Genomic Landscape in Philadelphia-Negative Myeloproliferative Neoplasm Patients with Second Cancers. Cancers (Basel) 2022; 14:cancers14143435. [PMID: 35884495 PMCID: PMC9316742 DOI: 10.3390/cancers14143435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/01/2022] [Accepted: 07/11/2022] [Indexed: 02/04/2023] Open
Abstract
Patients with myeloproliferative neoplasms (MPNs) are characterized by systemic inflammation. With the indolent nature of the diseases, second cancers (SCs) have emerged as a challenging issue in afflicted patients. Epidemiological studies have confirmed the excessive risk of SCs in MPNs, but little is known about their molecular basis. To explore further, we used whole exome sequencing to explore the genetic changes in the granulocytes of 26 paired MPN patients with or without SC. We noticed that MPN−SC patients harbor genomic variants of distinct genes, among which a unique pattern of co-occurrence or mutual exclusiveness could be identified. We also found that mutated genes in MPN−SC samples were enriched in immune-related pathways and inflammatory networks, an observation further supported by their increased plasma levels of TGF-β and IL-23. Noteworthily, variants of KRT6A, a gene capable of mediating tumor-associate macrophage activity, were more commonly detected in MPN−SC patients. Analysis through OncodriveCLUST disclosed that KRT6A replaces JAK2V617F as the more prominent disease driver in MPN−SC, whereas a major mutation in this gene (KRT6A c.745T>C) in our patients is linked to human carcinoma and predicted to be pathogenic in COSMIC database. Overall, we demonstrate that inflammation could be indispensable in MPN−SC pathogenesis.
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Affiliation(s)
- Chia-Chen Hsu
- Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (C.-C.H.); (Y.-H.W.); (Y.-Y.C.); (Y.-J.C.); (C.-H.L.); (Y.-Y.W.); (Y.-R.Y.); (H.-Y.T.); (C.-P.L.)
| | - Ying-Hsuan Wang
- Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (C.-C.H.); (Y.-H.W.); (Y.-Y.C.); (Y.-J.C.); (C.-H.L.); (Y.-Y.W.); (Y.-R.Y.); (H.-Y.T.); (C.-P.L.)
| | - Yi-Yang Chen
- Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (C.-C.H.); (Y.-H.W.); (Y.-Y.C.); (Y.-J.C.); (C.-H.L.); (Y.-Y.W.); (Y.-R.Y.); (H.-Y.T.); (C.-P.L.)
| | - Ying-Ju Chen
- Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (C.-C.H.); (Y.-H.W.); (Y.-Y.C.); (Y.-J.C.); (C.-H.L.); (Y.-Y.W.); (Y.-R.Y.); (H.-Y.T.); (C.-P.L.)
| | - Chang-Hsien Lu
- Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (C.-C.H.); (Y.-H.W.); (Y.-Y.C.); (Y.-J.C.); (C.-H.L.); (Y.-Y.W.); (Y.-R.Y.); (H.-Y.T.); (C.-P.L.)
- College of Medicine, Chang Gung University, Tao-Yuan 33302, Taiwan
| | - Yu-Ying Wu
- Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (C.-C.H.); (Y.-H.W.); (Y.-Y.C.); (Y.-J.C.); (C.-H.L.); (Y.-Y.W.); (Y.-R.Y.); (H.-Y.T.); (C.-P.L.)
| | - Yao-Ren Yang
- Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (C.-C.H.); (Y.-H.W.); (Y.-Y.C.); (Y.-J.C.); (C.-H.L.); (Y.-Y.W.); (Y.-R.Y.); (H.-Y.T.); (C.-P.L.)
| | - Hsing-Yi Tsou
- Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (C.-C.H.); (Y.-H.W.); (Y.-Y.C.); (Y.-J.C.); (C.-H.L.); (Y.-Y.W.); (Y.-R.Y.); (H.-Y.T.); (C.-P.L.)
| | - Chian-Pei Li
- Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (C.-C.H.); (Y.-H.W.); (Y.-Y.C.); (Y.-J.C.); (C.-H.L.); (Y.-Y.W.); (Y.-R.Y.); (H.-Y.T.); (C.-P.L.)
| | - Cih-En Huang
- Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (C.-C.H.); (Y.-H.W.); (Y.-Y.C.); (Y.-J.C.); (C.-H.L.); (Y.-Y.W.); (Y.-R.Y.); (H.-Y.T.); (C.-P.L.)
- College of Medicine, Chang Gung University, Tao-Yuan 33302, Taiwan
- Correspondence: (C.-E.H.); (C.-C.C.)
| | - Chih-Cheng Chen
- Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (C.-C.H.); (Y.-H.W.); (Y.-Y.C.); (Y.-J.C.); (C.-H.L.); (Y.-Y.W.); (Y.-R.Y.); (H.-Y.T.); (C.-P.L.)
- College of Medicine, Chang Gung University, Tao-Yuan 33302, Taiwan
- Correspondence: (C.-E.H.); (C.-C.C.)
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Alsalman Z, Alsalman M, Albesher M, Alsalman A, Saif S, Aldandan A, Alsuliman A. Primary myelofibrosis with concurrent paroxysmal nocturnal haemoglobinuria presenting with erectile dysfunction. Oxf Med Case Reports 2022; 2022:omac047. [PMID: 35619683 PMCID: PMC9127941 DOI: 10.1093/omcr/omac047] [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: 11/19/2021] [Revised: 04/05/2022] [Indexed: 11/13/2022] Open
Abstract
Primary myelofibrosis and paroxysmal nocturnal haemoglobinuria (PNH) are uncommon clonal blood disorders that are rarely found together. We report a case of primary myelofibrosis (PMF) with concomitant subtle PNH in a 42-year-old man who presented with a 4-week history of fatigue, unexplained chest pain, and new-onset erectile dysfunction. Bone marrow biopsy showed severe fibrosis consistent with PMF. However, smooth muscle dystonia symptoms in the form of new-onset erectile dysfunction and oesophageal spasm were not fully explained by PMF but were clues for PNH, confirmed by flow cytometric assays. Routine PNH testing for patients with new-onset PMF and clinical symptoms suggestive of PNH, as well as those with refractory anaemia despite effective therapy, is crucial since these two conditions can coexist. As a result, a lack of early testing may cause a delay in diagnosis, increasing the patient's transfusion load and the facility's costs.
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Affiliation(s)
- Zaenb Alsalman
- Departments of Family Medicine, King Faisal University, Eastern Province, Saudi Arabia
| | - Mortadah Alsalman
- Departments of Medicine, King Faisal University, Eastern Province, Saudi Arabia
| | - Mohammed Albesher
- Departments of Medicine, Prince Saud Bin Jalawi Hospital, Eastern Province, Saudi Arabia
| | - Alaa Alsalman
- Departments of Medicine, Prince Saud Bin Jalawi Hospital, Eastern Province, Saudi Arabia
| | - Sultan Saif
- Departments of Pathology, Prince Saud Bin Jalawi Hospital, Eastern Province, Saudi Arabia
| | - Ali Aldandan
- Departments of Pathology, Prince Saud Bin Jalawi Hospital, Eastern Province, Saudi Arabia
| | - Ahmed Alsuliman
- Departments of Medicine, Prince Saud Bin Jalawi Hospital, Eastern Province, Saudi Arabia
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Mead AJ, Butt NM, Nagi W, Whiteway A, Kirkpatrick S, Rinaldi C, Roughley C, Ackroyd S, Ewing J, Neelakantan P, Garg M, Tucker D, Murphy J, Patel H, Bains R, Chiu G, Hickey J, Harrison C, Somervaille TCP. A retrospective real-world study of the current treatment pathways for myelofibrosis in the United Kingdom: the REALISM UK study. Ther Adv Hematol 2022; 13:20406207221084487. [PMID: 35371428 PMCID: PMC8966129 DOI: 10.1177/20406207221084487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 02/15/2022] [Indexed: 02/02/2023] Open
Abstract
Background Myelofibrosis (MF) is a blood cancer associated with splenomegaly, blood count abnormalities, reduced life expectancy and high prevalence of disease-associated symptoms. Current treatment options for MF are diverse, with limited data on management strategies in real-world practice in the United Kingdom. Methods The REALISM UK study was a multi-center, retrospective, non-interventional study, which documented the early management of patients with MF. The primary endpoint was the time from diagnosis to active treatment. Discussion Two hundred patients were included (63% [n = 126/200] with primary MF; 37% [n = 74/200] with secondary MF). Symptoms and prognostic scores at diagnosis were poorly documented, with infrequent use of patient reported outcome measures. 'Watch and wait' was the first management strategy for 53.5% (n = 107/200) of patients, while the most commonly used active treatments were hydroxycarbamide and ruxolitinib. Only 5% of patients proceeded to allogeneic transplant. The median (IQR) time to first active treatment was 46 days (0-350); patients with higher risk disease were prescribed active treatment sooner. Conclusion These results provide insight into real-world clinical practice for patients with MF in the United Kingdom. Despite the known high prevalence of disease-associated symptoms in MF, symptoms were poorly documented. Most patients were initially observed or received hydroxycarbamide, and ruxolitinib was used as first-line management strategy in only a minority of patients. Plain Language Summary Background: Myelofibrosis is a rare blood cancer associated with symptoms that can seriously affect a patient's daily life, such as enlarged spleen and decreased white and red blood cells. Although several treatments are available for patients with myelofibrosis, it is not clear which ones clinicians use most frequently.Methods: We aimed to review which treatments are usually given to patients with myelofibrosis in the UK, by collecting information from the medical records of 200 patients with myelofibrosis treated in different centres across the UK.Results: The results showed that the symptoms patients experienced were not always written down in the medical records. Similarly, clinical scores based on patient characteristics (which clinicians use to try to predict if a patient will respond to treatment well or not) were also missing from the medical records. Clinicians also rarely asked patients to complete questionnaires that try to measure the impact of myelofibrosis and its treatment on their health. The most common approach for patients with myelofibrosis in the UK was 'watch and wait', which over half of patients received. The most common drugs used for treatment were hydroxycarbamide and ruxolitinib; only a very small proportion of patients received a bone marrow transplant. On average, patients waited for 46 days before receiving a treatment, although patients considered to have a more aggressive type of disease received treatment sooner.Conclusion: The results of this study suggest that medical records can be missing key information, which is needed to decide which is the best way to treat a patient with myelofibrosis. They also suggest that clinicians in the UK prefer observation to treatment for a large number of patients with myelofibrosis. This could mean that the approach used for many patients with myelofibrosis does not help them to control symptoms that have an impact on their daily lives.
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Affiliation(s)
- Adam J. Mead
- NIHR Oxford Biomedical Research Centre and MRC Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Headington, Oxford OX3 9DS, UK
| | - Nauman M. Butt
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - Waseem Nagi
- Mid Essex Hospital Services NHS Trust, Chelmsford, UK
| | | | | | - Ciro Rinaldi
- United Lincolnshire Hospitals NHS Trust, Boston, UK
| | | | - Sam Ackroyd
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Joanne Ewing
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Mamta Garg
- University Hospitals Leicester NHS Trust, Leicester, UK
| | | | - John Murphy
- University Hospital Monklands, NHS Lanarkshire, Airdrie, UK
| | - Hitesh Patel
- Royal Albert Edward Infirmary, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | | | - Gavin Chiu
- Novartis Pharmaceuticals UK Limited, Camberley, UK
| | | | | | - Tim C. P. Somervaille
- Cancer Research UK Manchester Institute, Manchester, UK
- The Christie NHS Foundation Trust, Manchester, UK
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8
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Cheng CK, Lai JWY, Yung YL, Chan HY, Wong RSM, Chan NPH, Cheung JS, Luo X, Pitts HA, Ng MHL. Mutational spectrum and prognosis in Chinese patients with prefibrotic primary myelofibrosis. EJHAEM 2022; 3:184-190. [PMID: 35846205 PMCID: PMC9176118 DOI: 10.1002/jha2.361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/17/2021] [Accepted: 11/19/2021] [Indexed: 01/19/2023]
Abstract
Prefibrotic primary myelofibrosis (Pre‐PMF) has been classified as a separate entity of myeloproliferative neoplasms (MPNs). Pre‐PMF is clinically heterogeneous but a specific prognostic model is lacking. Gene mutations have emerged as useful tools for stratification of myelofibrosis patients. However, there have been limited studies comprehensively investigating the mutational spectrum and its clinicopathological significance in pre‐PMF subjects. In this study, we addressed these issues by profiling the mutation status of 141 genes in 172 Chinese MPN patients including 72 pre‐PMF cases. Our findings corroborated the clinical/molecular distinctiveness of pre‐PMF and suggested a refined risk classification strategy for this entity.
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Affiliation(s)
- Chi-Keung Cheng
- Blood Cancer Cytogenetics and Genomics Laboratory Department of Anatomical and Cellular Pathology Prince of Wales Hospital The Chinese University of Hong Kong Hong Kong China
| | - Jennifer W Y Lai
- Department of Medicine and Therapeutics, Prince of Wales Hospital The Chinese University of Hong Kong Hong Kong China
| | - Yuk-Lin Yung
- Blood Cancer Cytogenetics and Genomics Laboratory Department of Anatomical and Cellular Pathology Prince of Wales Hospital The Chinese University of Hong Kong Hong Kong China
| | - Hoi-Yun Chan
- Blood Cancer Cytogenetics and Genomics Laboratory Department of Anatomical and Cellular Pathology Prince of Wales Hospital The Chinese University of Hong Kong Hong Kong China
| | - Raymond S M Wong
- Department of Medicine and Therapeutics, Prince of Wales Hospital The Chinese University of Hong Kong Hong Kong China.,Sir Y. K. Pao Centre for Cancer, Prince of Wales Hospital Hong Kong China
| | - Natalie P H Chan
- Blood Cancer Cytogenetics and Genomics Laboratory Department of Anatomical and Cellular Pathology Prince of Wales Hospital The Chinese University of Hong Kong Hong Kong China
| | - Joyce S Cheung
- Blood Cancer Cytogenetics and Genomics Laboratory Department of Anatomical and Cellular Pathology Prince of Wales Hospital The Chinese University of Hong Kong Hong Kong China
| | - Xi Luo
- Blood Cancer Cytogenetics and Genomics Laboratory Department of Anatomical and Cellular Pathology Prince of Wales Hospital The Chinese University of Hong Kong Hong Kong China
| | - Herbert-Augustus Pitts
- Blood Cancer Cytogenetics and Genomics Laboratory Department of Anatomical and Cellular Pathology Prince of Wales Hospital The Chinese University of Hong Kong Hong Kong China
| | - Margaret H L Ng
- Blood Cancer Cytogenetics and Genomics Laboratory Department of Anatomical and Cellular Pathology Prince of Wales Hospital The Chinese University of Hong Kong Hong Kong China.,State Key Laboratory of Translational Oncology The Chinese University of Hong Kong Hong Kong China
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9
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Healy FM, Dahal LN, Jones JRE, Floisand Y, Woolley JF. Recent Progress in Interferon Therapy for Myeloid Malignancies. Front Oncol 2021; 11:769628. [PMID: 34778087 PMCID: PMC8586418 DOI: 10.3389/fonc.2021.769628] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/13/2021] [Indexed: 12/29/2022] Open
Abstract
Myeloid malignancies are a heterogeneous group of clonal haematopoietic disorders, caused by abnormalities in haematopoietic stem cells (HSCs) and myeloid progenitor cells that originate in the bone marrow niche. Each of these disorders are unique and present their own challenges with regards to treatment. Acute myeloid leukaemia (AML) is considered the most aggressive myeloid malignancy, only potentially curable with intensive cytotoxic chemotherapy with or without allogeneic haematopoietic stem cell transplantation. In comparison, patients diagnosed with chronic myeloid leukaemia (CML) and treated with tyrosine kinase inhibitors (TKIs) have a high rate of long-term survival. However, drug resistance and relapse are major issues in both these diseases. A growing body of evidence suggests that Interferons (IFNs) may be a useful therapy for myeloid malignancies, particularly in circumstances where patients are resistant to existing front-line therapies and have risk of relapse following haematopoietic stem cell transplant. IFNs are a major class of cytokines which are known to play an integral role in the non-specific immune response. IFN therapy has potential as a combination therapy in AML patients to reduce the impact of minimal residual disease on relapse. Alongside this, IFNs can potentially sensitize leukaemic cells to TKIs in resistant CML patients. There is evidence also that IFNs have a therapeutic role in myeloproliferative neoplasms (MPNs) such as polycythaemia vera (PV) and primary myelofibrosis (PMF), where they can restore polyclonality in patients. Novel formulations have improved the clinical effectiveness of IFNs. Low dose pegylated IFN formulations improve pharmacokinetics and improve patient tolerance to therapies, thereby minimizing the risk of haematological toxicities. Herein, we will discuss recent developments and the current understanding of the molecular and clinical implications of Type I IFNs for the treatment of myeloid malignancies.
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Affiliation(s)
- Fiona M Healy
- Department of Pharmacology & Therapeutics, University of Liverpool, Liverpool, United Kingdom
| | - Lekh N Dahal
- Department of Pharmacology & Therapeutics, University of Liverpool, Liverpool, United Kingdom
| | - Jack R E Jones
- Department of Pharmacology & Therapeutics, University of Liverpool, Liverpool, United Kingdom
| | - Yngvar Floisand
- Department of Molecular & Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom.,The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - John F Woolley
- Department of Pharmacology & Therapeutics, University of Liverpool, Liverpool, United Kingdom
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10
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Easwar A, Siddon AJ. Genetic Landscape of Myeloproliferative Neoplasms with an Emphasis on Molecular Diagnostic Laboratory Testing. Life (Basel) 2021; 11:1158. [PMID: 34833034 PMCID: PMC8625510 DOI: 10.3390/life11111158] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/18/2021] [Accepted: 10/27/2021] [Indexed: 12/27/2022] Open
Abstract
Chronic myeloproliferative neoplasms (MPNs) are hematopoietic stem cell neoplasms with driver events including the BCR-ABL1 translocation leading to a diagnosis of chronic myeloid leukemia (CML), or somatic mutations in JAK2, CALR, or MPL resulting in Philadelphia-chromosome-negative MPNs with constitutive activation of the JAK-STAT signaling pathway. In the Philadelphia-chromosome-negative MPNs, modern sequencing panels have identified a vast molecular landscape including additional mutations in genes involved in splicing, signal transduction, DNA methylation, and chromatin modification such as ASXL1, SF3B1, SRSF2, and U2AF1. These additional mutations often influence prognosis in MPNs and therefore are increasingly important for risk stratification. This review focuses on the molecular alterations within the WHO classification of MPNs and laboratory testing used for diagnosis.
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Affiliation(s)
- Arti Easwar
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT 06510, USA;
| | - Alexa J. Siddon
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT 06510, USA;
- Department of Pathology, Yale School of Medicine, New Haven, CT 06510, USA
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11
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Shide K. Calreticulin mutations in myeloproliferative neoplasms. INTERNATIONAL REVIEW OF CELL AND MOLECULAR BIOLOGY 2021; 365:179-226. [PMID: 34756244 DOI: 10.1016/bs.ircmb.2021.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Calreticulin (CALR) is a chaperone present in the endoplasmic reticulum, which is involved in the quality control of N-glycosylated proteins and storage of calcium ions. In 2013, the C-terminal mutation in CALR was identified in half of the patients with essential thrombocythemia and primary myelofibrosis who did not have a JAK2 or MPL mutation. The results of 8 years of intensive research are changing the clinical practice associated with treating myeloproliferative neoplasms (MPNs). The presence or absence of CALR mutations and their mutation types already provide important information for diagnosis and treatment decision making. In addition, the interaction with the thrombopoietin receptor MPL, which is the main mechanism of transformation by CALR mutation, and the expression of the mutant protein on the cell surface have a great potential as targets for molecular-targeted drugs and immunotherapy. This chapter presents recent findings on the clinical significance of the CALR mutation and the molecular basis by which this mutation drives MPNs.
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Affiliation(s)
- Kotaro Shide
- Division of Haematology, Diabetes, and Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
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12
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Gene expression profile correlates with molecular and clinical features in patients with myelofibrosis. Blood Adv 2021; 5:1452-1462. [PMID: 33666652 DOI: 10.1182/bloodadvances.2020003614] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/05/2021] [Indexed: 12/18/2022] Open
Abstract
Myelofibrosis (MF) belongs to the family of classic Philadelphia-negative myeloproliferative neoplasms (MPNs). It can be primary myelofibrosis (PMF) or secondary myelofibrosis (SMF) evolving from polycythemia vera (PV) or essential thrombocythemia (ET). Despite the differences, PMF and SMF patients are currently managed in the same way, and prediction of survival is based on the same clinical and genetic features. In the last few years, interest has grown concerning the ability of gene expression profiles (GEPs) to provide valuable prognostic information. Here, we studied the GEPs of granulocytes from 114 patients with MF, using a microarray platform to identify correlations with patient characteristics and outcomes. Cox regression analysis led to the identification of 201 survival-related transcripts characterizing patients who are at high risk for death. High-risk patients identified by this gene signature displayed an inferior overall survival and leukemia-free survival, together with clinical and molecular detrimental features included in contemporary prognostic models, such as the presence of high molecular risk mutations. The high-risk group was enriched in post-PV and post-ET MF and JAK2V617F homozygous patients, whereas pre-PMF was more frequent in the low-risk group. These results demonstrate that GEPs in MF patients correlate with their molecular and clinical features, particularly their survival, and represent the proof of concept that GEPs might provide complementary prognostic information to be applied in clinical decision making.
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13
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Survival following allogeneic transplant in patients with myelofibrosis. Blood Adv 2021; 4:1965-1973. [PMID: 32384540 DOI: 10.1182/bloodadvances.2019001084] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 03/08/2020] [Indexed: 01/17/2023] Open
Abstract
Allogeneic hematopoietic cell transplantation (HCT) is the only curative therapy for myelofibrosis (MF). In this large multicenter retrospective study, overall survival (OS) in MF patients treated with allogeneic HCT (551 patients) and without HCT (non-HCT) (1377 patients) was analyzed with Cox proportional hazards model. Survival analysis stratified by the Dynamic International Prognostic Scoring System (DIPSS) revealed that the first year of treatment arm assignment, due to upfront risk of transplant-related mortality (TRM), HCT was associated with inferior OS compared with non-HCT (non-HCT vs HCT: DIPSS intermediate 1 [Int-1]: hazard ratio [HR] = 0.26, P < .0001; DIPSS-Int-2 and higher: HR, 0.39, P < .0001). Similarly, in the DIPSS low-risk MF group, due to upfront TRM risk, OS was superior with non-HCT therapies compared with HCT in the first-year post treatment arm assignment (HR, 0.16, P = .006). However, after 1 year, OS was not significantly different (HR, 1.38, P = .451). Beyond 1 year of treatment arm assignment, an OS advantage with HCT therapy in Int-1 and higher DIPSS score patients was observed (non-HCT vs HCT: DIPSS-Int-1: HR, 2.64, P < .0001; DIPSS-Int-2 and higher: HR, 2.55, P < .0001). In conclusion, long-term OS advantage with HCT was observed for patients with Int-1 or higher risk MF, but at the cost of early TRM. The magnitude of OS benefit with HCT increased as DIPSS risk score increased and became apparent with longer follow-up.
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14
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Shahin OA, Chifotides HT, Bose P, Masarova L, Verstovsek S. Accelerated Phase of Myeloproliferative Neoplasms. Acta Haematol 2021; 144:484-499. [PMID: 33882481 DOI: 10.1159/000512929] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/09/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Myeloproliferative neoplasms (MPNs) can transform into blast phase MPN (leukemic transformation; MPN-BP), typically via accelerated phase MPN (MPN-AP), in ∼20-25% of the cases. MPN-AP and MPN-BP are characterized by 10-19% and ≥20% blasts, respectively. MPN-AP/BP portend a dismal prognosis with no established conventional treatment. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the sole modality associated with long-term survival. SUMMARY MPN-AP/BP has a markedly different mutational profile from de novo acute myeloid leukemia (AML). In MPN-AP/BP, TP53 and IDH1/2 are more frequent, whereas FLT3 and DNMT3A are rare. Higher incidence of leukemic transformation has been associated with the most aggressive MPN subtype, myelofibrosis (MF); other risk factors for leukemic transformation include rising blast counts above 3-5%, advanced age, severe anemia, thrombocytopenia, leukocytosis, increasing bone marrow fibrosis, type 1 CALR-unmutated status, lack of driver mutations (negative for JAK2, CALR, or MPL genes), adverse cytogenetics, and acquisition of ≥2 high-molecular risk mutations (ASXL1, EZH2, IDH1/2, SRSF2, and U2AF1Q157). The aforementioned factors have been incorporated in several novel prognostic scoring systems for MF. Currently, elderly/unfit patients with MPN-AP/BP are treated with hypomethylating agents with/without ruxolitinib; these regimens appear to confer comparable benefit to intensive chemotherapy but with lower toxicity. Retrospective studies in patients who acquired actionable mutations during MPN-AP/BP showed positive outcomes with targeted AML treatments, such as IDH1/2 inhibitors, and require further evaluation in clinical trials. Key Messages: Therapy for MPN-AP patients represents an unmet medical need. MF patients, in particular, should be appropriately stratified regarding their prognosis and the risk for transformation. Higher-risk patients should be monitored regularly and treated prior to progression to MPN-BP. MPN-AP patients may be treated with hypomethylating agents alone or in combination with ruxolitinib; also, patients can be provided with the option to enroll in rationally designed clinical trials exploring combination regimens, including novel targeted drugs, with an ultimate goal to transition to transplant.
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Affiliation(s)
- Omar A Shahin
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Helen T Chifotides
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Prithviraj Bose
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lucia Masarova
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Srdan Verstovsek
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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15
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Li W, Yuan B, Zhao Y, Lu T, Zhang S, Ding Z, Wang D, Zhong S, Gao G, Yan M. Transcriptome profiling reveals target in primary myelofibrosis together with structural biology study on novel natural inhibitors regarding JAK2. Aging (Albany NY) 2021; 13:8248-8275. [PMID: 33686952 PMCID: PMC8034969 DOI: 10.18632/aging.202635] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 12/18/2020] [Indexed: 02/07/2023]
Abstract
This study aimed to identify effective targets for carcinogenesis of primary myelofibrosis (PMF), as well as to screen ideal lead compounds with potential inhibition effect on Janus kinase 2 to contribute to the medication design and development. Gene expression profiles of GSE26049, GSE53482, GSE61629 were obtained from the Gene Expression Omnibus database. The differentially expressed genes were identified, and functional enrichment analyses such as Gene Ontology, protein-protein interaction network etc., were performed step by step. Subsequently, highly-precise computational techniques were conducted to identify potential inhibitors of JAK2. A series of structural biology methods including virtual screening, ADMET (absorption, distribution, metabolism, excretion, and toxicity) prediction, molecule docking, molecular dynamics simulation etc., were implemented to discover novel natural compounds. Results elucidated that PMF patients had abnormal LCN2, JAK2, MMP8, CAMP, DEFA4, LTF, MPO, HBD, STAT4, EBF1 mRNA expression compared to normal patients. Functional enrichment analysis revealed that these genes were mainly enriched in erythrocyte differentiation, neutrophil degranulation and killing cells of other organisms. Two novel natural compounds, ZINC000013513540 and ZINC000004099068 were found binding to JAK2 with favorable interaction energy together with high binding affinity. They were predicted with non-Ames mutagenicity, low-rodent carcinogenicity, less developmental toxicity potential as well as non-toxicity with liver. Molecular dynamics simulation demonstrated that these two complexes: ZINC000013513540-JAK2 and ZINC000004099068-JAK2 could exist stably under natural circumstances. In conclusion, this study revealed hub genes in the carcinogenesis of PMF. ZINC000013513540 and ZINC000004099068 were promising drugs in dealing with PMF. This study may also accelerate exploration of new drugs.
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Affiliation(s)
- Weihang Li
- Department of Orthopaedics, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Bin Yuan
- Department of Orthopaedics, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.,Department of Orthopaedics, Daxing Hospital, Xi'an, China
| | - Yingjing Zhao
- College of Clinical Medicine, Jilin University, Changchun, China
| | - Tianxing Lu
- Hou Zonglian Medical Experimental Class, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Shilei Zhang
- Department of Orthopaedics, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Ziyi Ding
- Department of Orthopaedics, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Dong Wang
- Department of Orthopaedics, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Sheng Zhong
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Guangxun Gao
- Department of Hematology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Ming Yan
- Department of Orthopaedics, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
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16
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Lehmann U, Stark H, Bartels S, Schlue J, Büsche G, Kreipe H. Genome-wide DNA methylation profiling is able to identify prefibrotic PMF cases at risk for progression to myelofibrosis. Clin Epigenetics 2021; 13:28. [PMID: 33541399 PMCID: PMC7860011 DOI: 10.1186/s13148-021-01010-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients suffering from the BCR-ABL1-negative myeloproliferative disease prefibrotic primary myelofibrosis (pre-PMF) have a certain risk for progression to myelofibrosis. Accurate risk estimation for this fibrotic progression is of prognostic importance and clinically relevant. Commonly applied risk scores are based on clinical, cytogenetic, and genetic data but do not include epigenetic modifications. Therefore, we evaluated the assessment of genome-wide DNA methylation patterns for their ability to predict fibrotic progression in PMF patients. RESULTS For this purpose, the DNA methylation profile was analyzed genome-wide in a training set of 22 bone marrow trephines from patients with either fibrotic progression (n = 12) or stable disease over several years (n = 10) using the 850 k EPIC array from Illumina. The DNA methylation classifier constructed from this data set was validated in an independently measured test set of additional 11 bone marrow trephines (7 with stable disease, 4 with fibrotic progress). Hierarchical clustering of methylation β-values and linear discriminant classification yielded very good discrimination between both patient groups. By gene ontology analysis, the most differentially methylated CpG sites are primarily associated with genes involved in cell-cell and cell-matrix interactions. CONCLUSIONS In conclusion, we could show that genome-wide DNA methylation profiling of bone marrow trephines is feasible under routine diagnostic conditions and, more importantly, is able to predict fibrotic progression in pre-fibrotic primary myelofibrosis with high accuracy.
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Affiliation(s)
- Ulrich Lehmann
- Institute of Pathology, Medical School Hannover, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Helge Stark
- Institute of Pathology, Medical School Hannover, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Stephan Bartels
- Institute of Pathology, Medical School Hannover, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Jerome Schlue
- Institute of Pathology, Medical School Hannover, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Guntram Büsche
- Institute of Pathology, Medical School Hannover, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Hans Kreipe
- Institute of Pathology, Medical School Hannover, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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17
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Genthon A, Killian M, Mertz P, Cathebras P, Gimenez De Mestral S, Guyotat D, Chalayer E. [Myelofibrosis: A review]. Rev Med Interne 2020; 42:101-109. [PMID: 33243417 DOI: 10.1016/j.revmed.2020.08.018] [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: 01/19/2020] [Revised: 08/28/2020] [Accepted: 08/30/2020] [Indexed: 11/28/2022]
Abstract
Myelofibrosis is a BCR-ABL1-negative chronic myeloproliferative neoplasm that includes primary myelofibrosis, post-polycythemia vera myelofibrosis, and post-essential thrombocythemia myelofibrosis. It is characterized by stem cell-derived clonal proliferation that is often, but not always, accompanied by somatic mutations, which are classified into driver mutations (JAK2, CALR, or MPL), subclonal mutations and fibrosis on bone marrow biopsy. Myelofibrosis commonly demonstrates splenomegaly, constitutional symptoms, anemia, thrombocytosis, or thrombocytopenia. Patients may also be asymptomatic. Complications as thromboembolic or hemorrhagic events can reveal the disease. Primary myelofibrosis is the least common myeloproliferative neoplasm but is associated with poor survival and acute leukemic transformation. In contrast to the significant progress made in understanding the disease's pathogenesis, treatment for myelofibrosis remains largely palliative. The JAK2 inhibitor, ruxolitinib is not sufficient in eliminating the underlying myeloid progenitor clone, as disease inevitably returns with therapy discontinuation. Allogeneic hematopoietic stem cell transplantation is the only therapeutic option that offers potential cure. The development of novel treatment strategies aimed at slowing or even reversing disease progression, prolonging patient survival and preventing evolution to blast-phase are still lacking.
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Affiliation(s)
- A Genthon
- Service d'hématologie clinique et de thérapie cellulaire, hôpital Saint-Antoine, AP-HP, Paris, France; Médecine Sorbonne université, Paris, France
| | - M Killian
- Service de médecine interne, hôpital Nord, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 02, France
| | - P Mertz
- Service de rhumatologie, hôpitaux universitaires de Strasbourg, Strasbourg, France; Inserm UMR_S1109, laboratoire d'immunorhumatologie moléculaire, Centre national de référence des maladies systémiques et autoimmunes rares Est Sud-Ouest (RESO), université de Strasbourg, 67000 Strasbourg, France
| | - P Cathebras
- Service de médecine interne, hôpital Nord, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 02, France
| | - S Gimenez De Mestral
- Pathology department, Sorbonne université, hôpital Saint-Antoine, AP-HP, 75012 Paris, France
| | - D Guyotat
- Département d'hématologie et thérapie cellulaire, institut de cancérologie Lucien-Neuwirth, Saint-Étienne, France
| | - E Chalayer
- Département d'hématologie et thérapie cellulaire, institut de cancérologie Lucien-Neuwirth, Saint-Étienne, France; Inserm, SAINBIOSE, U1059, dysfonction vasculaire et hémostase, université Jean-Monnet, Saint-Étienne, France.
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18
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Gupta V, Griesshammer M, Martino B, Foltz L, Tavares R, Al-Ali HK, Giraldo P, Guglielmelli P, Lomaia E, Bouard C, Paley C, Tiwari R, Zor E, Raanani P. Analysis of predictors of response to ruxolitinib in patients with myelofibrosis in the phase 3b expanded-access JUMP study. Leuk Lymphoma 2020; 62:918-926. [DOI: 10.1080/10428194.2020.1845334] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Vikas Gupta
- Princess Margaret Cancer Centre, Toronto, Canada
| | | | - Bruno Martino
- Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Hematology Unit, Reggio Calabria, Italy
| | | | | | | | - Pilar Giraldo
- Miguel Servet University Hospital and Centro de Investigacion Biomedica en Red de Enfermadades Raras (CIBERER), Zaragoza, Spain
| | - Paola Guglielmelli
- Azienda Ospedaliero-Universitaria Careggi Center for Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Elza Lomaia
- Almazov National Medical Research Centre, St Petersburg, Russia
| | | | | | | | | | - Pia Raanani
- Rabin Medical Center, Petah Tikva & Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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19
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MPN: The Molecular Drivers of Disease Initiation, Progression and Transformation and their Effect on Treatment. Cells 2020; 9:cells9081901. [PMID: 32823933 PMCID: PMC7465511 DOI: 10.3390/cells9081901] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/07/2020] [Accepted: 08/11/2020] [Indexed: 02/07/2023] Open
Abstract
Myeloproliferative neoplasms (MPNs) constitute a group of disorders identified by an overproduction of cells derived from myeloid lineage. The majority of MPNs have an identifiable driver mutation responsible for cytokine-independent proliferative signalling. The acquisition of coexisting mutations in chromatin modifiers, spliceosome complex components, DNA methylation modifiers, tumour suppressors and transcriptional regulators have been identified as major pathways for disease progression and leukemic transformation. They also confer different sensitivities to therapeutic options. This review will explore the molecular basis of MPN pathogenesis and specifically examine the impact of coexisting mutations on disease biology and therapeutic options.
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20
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Genomic characterization and prognostication applied to a Brazilian cohort of patients with myelofibrosis. Int J Hematol 2020; 112:361-368. [PMID: 32535855 DOI: 10.1007/s12185-020-02906-w] [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] [Received: 04/29/2020] [Revised: 05/20/2020] [Accepted: 05/29/2020] [Indexed: 12/20/2022]
Abstract
Genomic characterization of patients with myeloproliferative neoplasms (MPN) may lead to better diagnostic classification, prognostic assessment, and treatment decisions. These goals are particularly important in myelofibrosis (MF). We performed target Next Generation Sequencing for a panel of 255 genes and Chromosome Microarray Analysis (CMA) in 27 patients with MF. Patients were classified according to genomic findings and we compared the performance of a personalized prognostication system with IPSS, MIPSS70 and MIPSS70 + v2. Twenty-six patients presented mutations: 11.1% had single driver mutations in either JAK2, CALR or MPL; 85.2% had mutations in non-restricted genes (median: 2 per patient). CMA was abnormal in 91.7% of the 24 cases with available data. Copy-Number-Neutral Loss-of-Heterozygosity was the most common finding (66.7%). Del13q was the most frequent copy number variation, and we could define a 2.4 Mb minimally affected region encompassing RB1, SUCLA2 and CLLS2 loci. The largest genomic subgroup consisted of patients with mutations in genes involved with chromatin organization and splicing control (40.7%) and the personalized system showed better concordance and accuracy than the other prognostic systems. Comprehensive genomic characterization reveals the striking genetic complexity of MF and, when combined with clinical data, led, in our cohort, to better prognostication performance.
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21
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Garmezy B, Schaefer JK, Mercer J, Talpaz M. A provider's guide to primary myelofibrosis: pathophysiology, diagnosis, and management. Blood Rev 2020; 45:100691. [PMID: 32354563 DOI: 10.1016/j.blre.2020.100691] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 03/20/2020] [Accepted: 04/02/2020] [Indexed: 12/23/2022]
Abstract
Although understanding of the pathogenesis and molecular biology of primary myelofibrosis continues to improve, treatment options are limited, and several biological features remain unexplained. With an appropriate clinical history, exam, laboratory evaluation, and bone marrow biopsy, the diagnosis can often be established. Recent studies have better characterized prognostic factors and driver mutations in myelofibrosis, facilitated by use of next-generation sequencing. These advances have facilitated development of a management strategy that is based on both risk factors and clinical phenotype. For low-risk patients, treatment will depend on symptom severity. For patients with higher-risk disease, several treatments are available including JAK inhibitors, allogeneic hematopoietic stem cell transplant, and clinical trials using novel molecularly targeted therapies and rational drug combinations. In this review, we outline what is known about the disease pathogenesis, discuss an approach to reaching the diagnosis, review the prognosis of myelofibrosis, and detail current therapeutic strategies.
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Affiliation(s)
- Benjamin Garmezy
- Division of Cancer Medicine, UT MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Jordan K Schaefer
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Jessica Mercer
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Moshe Talpaz
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI 48109, USA.
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22
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Mutant calreticulin in myeloproliferative neoplasms. Blood 2020; 134:2242-2248. [PMID: 31562135 DOI: 10.1182/blood.2019000622] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 09/19/2019] [Indexed: 01/03/2023] Open
Abstract
Recurrent mutations in calreticulin are present in ∼20% of patients with myeloproliferative neoplasms (MPNs). Since its discovery in 2013, we now have a more precise understanding of how mutant CALR, an endoplasmic reticulum chaperone protein, activates the JAK/STAT signaling pathway via a pathogenic binding interaction with the thrombopoietin receptor MPL to induce MPNs. In this Spotlight article, we review the current understanding of the biology underpinning mutant CALR-driven MPNs, discuss clinical implications, and highlight future therapeutic approaches.
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23
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Vainchenker W, Plo I, Marty C, Varghese LN, Constantinescu SN. The role of the thrombopoietin receptor MPL in myeloproliferative neoplasms: recent findings and potential therapeutic applications. Expert Rev Hematol 2019; 12:437-448. [PMID: 31092065 DOI: 10.1080/17474086.2019.1617129] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction: Classical Myeloproliferative Neoplasms (MPNs) include three disorders: Polycythemia Vera (PV), Essential Thrombocythemia (ET) and Primary Myelofibrosis (PMF). MPNs are associated with constitutive activation of JAK2 leading to persistent cell signaling downstream of the dimeric myeloid cytokine receptors due to mutations in three genes encoding JAK2, calreticulin (CALR) and the thrombopoietin (TPO) receptor (MPL or TPOR). CALR and MPL mutants induce JAK2 activation that depends on MPL expression, thus explaining why they induce megakaryocyte pathologies including ET and PMF, but not PV. In contrast, JAK2 V617F drives all three diseases as it induces persistent signaling via EPOR, G-CSFR (CSF3R) and MPL. Areas Covered: Here, we review how different pathogenic mutations of MPL are translated into active receptors by inducing stable dimerization. We focus on the unique role of MPL on the hematopoietic stem cell (HSC), explaining why MPL is indispensable for the development of all MPNs. Last but not least, we describe how CALR mutants are pathogenic via binding and activation of MPL. Expert Opinion: Altogether, we believe that MPL is an important, but challenging, therapeutic target in MPNs that requires novel strategies to interrupt the specific conformational changes induced by each mutation or pathologic interaction without compromising the key functions of wild type MPL.
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Affiliation(s)
- William Vainchenker
- a UMR1170 , INSERM , Villejuif , France.,b Université Paris-Saclay , Villejuif , France
| | - Isabelle Plo
- a UMR1170 , INSERM , Villejuif , France.,b Université Paris-Saclay , Villejuif , France
| | - Caroline Marty
- a UMR1170 , INSERM , Villejuif , France.,b Université Paris-Saclay , Villejuif , France
| | - Leila N Varghese
- c Ludwig Institute for Cancer Research Brussels , Brussels , Belgium.,d de Duve Institute, Université catholique de Louvain , Brussels , Belgium
| | - Stefan N Constantinescu
- c Ludwig Institute for Cancer Research Brussels , Brussels , Belgium.,d de Duve Institute, Université catholique de Louvain , Brussels , Belgium.,e WELBIO (Walloon Excellence in Life Sciences and Biotechnology) , Brussels , Belgium
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24
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Gangat N, Marinaccio C, Swords R, Watts JM, Gurbuxani S, Rademaker A, Fought AJ, Frankfurt O, Altman JK, Wen QJ, Farnoud N, Famulare CA, Patel A, Tapia R, Vallapureddy RR, Barath S, Graf A, Handlogten A, Zblewski D, Patnaik MM, Al-Kali A, Dinh YT, Englund Prahl K, Patel S, Nobrega JC, Tejera D, Thomassen A, Gao J, Ji P, Rampal RK, Giles FJ, Tefferi A, Stein B, Crispino JD. Aurora Kinase A Inhibition Provides Clinical Benefit, Normalizes Megakaryocytes, and Reduces Bone Marrow Fibrosis in Patients with Myelofibrosis: A Phase I Trial. Clin Cancer Res 2019; 25:4898-4906. [PMID: 31061068 DOI: 10.1158/1078-0432.ccr-19-1005] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 04/10/2019] [Accepted: 04/30/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Myelofibrosis is characterized by bone marrow fibrosis, atypical megakaryocytes, splenomegaly, constitutional symptoms, thrombotic and hemorrhagic complications, and a risk of evolution to acute leukemia. The JAK kinase inhibitor ruxolitinib provides therapeutic benefit, but the effects are limited. The purpose of this study was to determine whether targeting AURKA, which has been shown to increase maturation of atypical megakaryocytes, has potential benefit for patients with myelofibrosis. PATIENTS AND METHODS Twenty-four patients with myelofibrosis were enrolled in a phase I study at three centers. The objective of the study was to evaluate the safety and preliminary efficacy of alisertib. Correlative studies involved assessment of the effect of alisertib on the megakaryocyte lineage, allele burden, and fibrosis. RESULTS In addition to being well tolerated, alisertib reduced splenomegaly and symptom burden in 29% and 32% of patients, respectively, despite not consistently reducing the degree of inflammatory cytokines. Moreover, alisertib normalized megakaryocytes and reduced fibrosis in 5 of 7 patients for whom sequential marrows were available. Alisertib also decreased the mutant allele burden in a subset of patients. CONCLUSIONS Given the limitations of ruxolitinib, novel therapies are needed for myelofibrosis. In this study, alisertib provided clinical benefit and exhibited the expected on-target effect on the megakaryocyte lineage, resulting in normalization of these cells and reduced fibrosis in the majority of patients for which sequential marrows were available. Thus, AURKA inhibition should be further developed as a therapeutic option in myelofibrosis.See related commentary by Piszczatowski and Steidl, p. 4868.
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Affiliation(s)
| | | | | | - Justin M Watts
- Sylvester Cancer Center, University of Miami, Miami, Florida
| | - Sandeep Gurbuxani
- Section of Hematopathology, University of Chicago, Chicago, Illinois
| | - Alfred Rademaker
- Division of Hematology/Oncology, Northwestern University, Chicago, Illinois
| | - Angela J Fought
- Division of Hematology/Oncology, Northwestern University, Chicago, Illinois
| | - Olga Frankfurt
- Division of Hematology/Oncology, Northwestern University, Chicago, Illinois
| | - Jessica K Altman
- Division of Hematology/Oncology, Northwestern University, Chicago, Illinois
| | - Qiang Jeremy Wen
- Division of Hematology/Oncology, Northwestern University, Chicago, Illinois
| | - Noushin Farnoud
- Center for Hematologic Malignancies, Memorial Sloan Kettering, New York, New York
| | | | - Akshar Patel
- Center for Hematologic Malignancies, Memorial Sloan Kettering, New York, New York
| | - Roberto Tapia
- Division of Hematology/Oncology, Northwestern University, Chicago, Illinois
| | | | - Stephanie Barath
- Division of Hematology/Oncology, Northwestern University, Chicago, Illinois
| | - Amy Graf
- Division of Hematology/Oncology, Northwestern University, Chicago, Illinois
| | | | | | | | | | | | | | - Shradha Patel
- Sylvester Cancer Center, University of Miami, Miami, Florida
| | | | - Dalissa Tejera
- Sylvester Cancer Center, University of Miami, Miami, Florida
| | - Amber Thomassen
- Sylvester Cancer Center, University of Miami, Miami, Florida
| | - Juehua Gao
- Department of Pathology, Northwestern University, Chicago, Illinois
| | - Peng Ji
- Department of Pathology, Northwestern University, Chicago, Illinois
| | - Raajit K Rampal
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering, New York, New York
| | | | | | - Brady Stein
- Division of Hematology/Oncology, Northwestern University, Chicago, Illinois.
| | - John D Crispino
- Division of Hematology/Oncology, Northwestern University, Chicago, Illinois.
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25
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Mondello P, Di Mirto C, Cuzzocrea S, Arrigo C, Mian M, Pitini V. Interferon Alpha Has a Strong Anti-tumor Effect in Philadelphia-negative Myeloproliferative Neoplasms. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:e489-e495. [PMID: 31231012 DOI: 10.1016/j.clml.2019.03.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/12/2019] [Accepted: 03/25/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Despite the important progress in the research of myeloproliferative neoplasms (MPN), treatment options are still limited. Currently, a cytoreductive approach is the backbone treatment, with hydroxyurea (HU) being the most important agent. However, this drug is not always well-tolerated and has been questionably linked to a potential leukemogenic effect. A valid alternative is interferon alfa (IFN-α), but it is reserved for selected patients owing to the more frequent side effects and the lack of final results from the studies directly comparing IFN-α with HU, which is why we provided the results of the so far largest real-life analysis. PATIENTS AND METHODS From 2000 to 2016, 63 patients with Philadelphia-negative MPN prospectively received either HU or IFN-α. RESULTS During a median follow-up period of 121 months (range, 88-168 months), 97% of the patients treated with IFN-α achieved a hematologic response (60% complete, 37% partial) compared with 78% in the HU group (56% complete, 20% partial; P < .01). Molecular responses were limited to patients treated with IFN-α. IFN-α was well-tolerated with no secondary malignancy, whereas HU was associated with more toxic events and cases of leukemic transformation. A significantly longer progression-free survival (5.0 vs. 3.1 years; P < .001) and overall survival (7.8 vs. 5.8 years; P = .006) were observed in the IFN-α group compared with the HU cohort. CONCLUSION Our data support IFN-α as a more valid therapeutic option owing to its more profound hematologic responses, durable molecular remissions, long-term disease control, and reduced risk of leukemic transformation with a favorable toxicity profile.
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Affiliation(s)
- Patrizia Mondello
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York, NY; Department of Human Pathology, University of Messina, Messina, Italy; Department of Biological and Environmental Sciences, University of Messina, Messina, Italy.
| | - Cristian Di Mirto
- Department of Human Pathology, University of Messina, Messina, Italy
| | - Salvatore Cuzzocrea
- Department of Biological and Environmental Sciences, University of Messina, Messina, Italy
| | - Carmela Arrigo
- Department of Human Pathology, University of Messina, Messina, Italy
| | - Michael Mian
- Internal Medicine V, Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria; Department of Hematology and CBMT, Ospedale di Bolzano, Bolzano, Italy
| | - Vincenzo Pitini
- Department of Human Pathology, University of Messina, Messina, Italy
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26
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Gill H, Ip HW, Yim R, Tang WF, Pang HH, Lee P, Leung GMK, Li J, Tang K, So JCC, Leung RYY, Li J, Panagioutou G, Lam CCK, Kwong YL. Next-generation sequencing with a 54-gene panel identified unique mutational profile and prognostic markers in Chinese patients with myelofibrosis. Ann Hematol 2018; 98:869-879. [PMID: 30515541 DOI: 10.1007/s00277-018-3563-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 11/19/2018] [Indexed: 01/01/2023]
Abstract
Current prognostication in myelofibrosis (MF) is based on clinicopathological features and mutations in a limited number of driver genes. The impact of other genetic mutations remains unclear. We evaluated for mutations in a myeloid panel of 54 genes using next-generation sequencing. Multivariate Cox regression analysis was used to determine prognostic factors for overall survival (OS) and leukaemia-free survival (LFS), based on mutations of these genes and relevant clinical and haematological features. One hundred and one patients (primary MF, N = 70; secondary MF, N = 31) with a median follow-up of 49 (1-256) months were studied. For the entire cohort, inferior OS was associated with male gender (P = 0.04), age > 65 years (P = 0.04), haemoglobin < 10 g/dL (P = 0.001), CUX1 mutation (P = 0.003) and TP53 mutation (P = 0.049); and inferior LFS was associated with male gender (P = 0.03), haemoglobin < 10 g/dL (P = 0.04) and SRSF2 mutations (P = 0.008). In primary MF, inferior OS was associated with male gender (P = 0.03), haemoglobin < 10 g/dL (P = 0.002), platelet count < 100 × 109/L (P = 0.02), TET2 mutation (P = 0.01) and CUX1 mutation (P = 0.01); and inferior LFS was associated with haemoglobin < 10 g/dL (P = 0.02), platelet count < 100 × 109/L (P = 0.02), TET2 mutations (P = 0.01) and CUX1 mutations (P = 0.04). These results showed that clinical and haematological features and genetic mutations should be considered in MF prognostication.
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Affiliation(s)
- Harinder Gill
- Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Ho-Wan Ip
- Department of Pathology, Queen Mary Hospital, Hong Kong, China
| | - Rita Yim
- Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Wing-Fai Tang
- Department of Pathology, Queen Mary Hospital, Hong Kong, China
| | - Herbert H Pang
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Paul Lee
- Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Garret M K Leung
- Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Jamilla Li
- Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Karen Tang
- Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Jason C C So
- Department of Pathology, Queen Mary Hospital, Hong Kong, China
| | - Rock Y Y Leung
- Department of Pathology, Queen Mary Hospital, Hong Kong, China
| | - Jun Li
- The Department of Infectious Diseases and Public Health, City University of Hong Kong, Hong Kong, China
| | - Gianni Panagioutou
- Systems Biology Group, School of Biological Sciences, The University of Hong Kong, Hong Kong, China.,Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute, Jena, Germany
| | | | - Yok-Lam Kwong
- Department of Medicine, The University of Hong Kong, Hong Kong, China. .,Department of Medicine, Professorial Block, Queen Mary Hospital, Pokfulam Road, Hong Kong, China.
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