1
|
Kouroukli O, Symeonidis A, Foukas P, Maragkou MK, Kourea EP. Bone Marrow Immune Microenvironment in Myelodysplastic Syndromes. Cancers (Basel) 2022; 14:cancers14225656. [PMID: 36428749 PMCID: PMC9688609 DOI: 10.3390/cancers14225656] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 11/19/2022] Open
Abstract
The BM, the major hematopoietic organ in humans, consists of a pleiomorphic environment of cellular, extracellular, and bioactive compounds with continuous and complex interactions between them, leading to the formation of mature blood cells found in the peripheral circulation. Systemic and local inflammation in the BM elicit stress hematopoiesis and drive hematopoietic stem cells (HSCs) out of their quiescent state, as part of a protective pathophysiologic process. However, sustained chronic inflammation impairs HSC function, favors mutagenesis, and predisposes the development of hematologic malignancies, such as myelodysplastic syndromes (MDS). Apart from intrinsic cellular mechanisms, various extrinsic factors of the BM immune microenvironment (IME) emerge as potential determinants of disease initiation and evolution. In MDS, the IME is reprogrammed, initially to prevent the development, but ultimately to support and provide a survival advantage to the dysplastic clone. Specific cellular elements, such as myeloid-derived suppressor cells (MDSCs) are recruited to support and enhance clonal expansion. The immune-mediated inhibition of normal hematopoiesis contributes to peripheral cytopenias of MDS patients, while immunosuppression in late-stage MDS enables immune evasion and disease progression towards acute myeloid leukemia (AML). In this review, we aim to elucidate the role of the mediators of immune response in the initial pathogenesis of MDS and the evolution of the disease.
Collapse
Affiliation(s)
- Olga Kouroukli
- Department of Pathology, University Hospital of Patras, 26504 Patras, Greece
| | - Argiris Symeonidis
- Hematology Division, Department of Internal Medicine, School of Medicine, University of Patras, 26332 Patras, Greece
| | - Periklis Foukas
- 2nd Department of Pathology, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Myrto-Kalliopi Maragkou
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 54124 Thessaloniki, Greece
| | - Eleni P. Kourea
- Department of Pathology, School of Medicine, University of Patras, 26504 Patras, Greece
- Correspondence: ; Tel.: +30-2610-969191
| |
Collapse
|
2
|
Retuning the immune system in myelodysplastic syndromes: from immunomodulatory approaches to vaccination strategies and non myeloablative hemopoietic cell transplant. Crit Rev Oncol Hematol 2019; 133:112-119. [DOI: 10.1016/j.critrevonc.2018.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/09/2018] [Accepted: 11/05/2018] [Indexed: 12/24/2022] Open
|
3
|
Abstract
OBJECTIVE Due to the sparse data on benzene exposure and myelodysplastic syndrome (MDS) subtypes, we studied this relationship in patients from 29 hospitals in Shanghai, China. METHODS We recruited 604 cases of MDS and 1193 controls matched on age, sex, and admission date. We interviewed subjects for information on workplace and lifestyle exposures, and developed semi-quantitative exposure estimates. RESULTS Benzene exposure showed a direct exposure-response pattern with refractory cytopenia with multilineage dysplasia, a less certain association with refractory cytopenia with unilineage dysplasia, and no association with other MDS subtypes. A different pattern was observed with farm residence and smoking, which was primarily related to refractory anemias. CONCLUSIONS This research demonstrates the importance of MDS subtype specification for more robust etiologic insights. Our data suggests that subtypes with non-erythroid dysplasia are associated with benzene exposure.
Collapse
|
4
|
Zhang HF, Huang ZD, Wu XR, Li Q, Yu ZF. Comparison of T lymphocyte subsets in aplastic anemia and hypoplastic myelodysplastic syndromes. Life Sci 2017; 189:71-75. [PMID: 28935248 DOI: 10.1016/j.lfs.2017.09.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 09/14/2017] [Accepted: 09/18/2017] [Indexed: 12/26/2022]
Abstract
AIMS This study aims to compare the proportion of peripheral blood T lymphocyte subsets and related blood cell and bone marrow cytology indexes between patients with aplastic anemia (AA) and hypoplastic myelodysplastic syndrome (hypo-MDS), and investigate the clinical identification significance. MATERIALS AND METHODS A total of 41 patients with AA and 46 patients with hypo-MDS were collected, and the proportions of peripheral blood T lymphocyte subsets, CD3-CD16/CD56+NK cells, CD3+CD57+T-LGL cells and CD19+B lymphocytes were detected by flow cytometry. KEY FINDINGS The CD4+/CD8+ ratio decreased in the AA and hypo-MDS groups, and the difference was statistically significant when compared with that in the control group (P<0.05). However, there was no significant difference between AA and hypo-MDS groups (P>0.05). The proportions of CD3-CD16/CD56+NK cells and CD3+CD57+T-LGL cells in the hypo-MDS group were distinctly higher than those in the AA group (P<0.05). However, the proportion of CD19+B lymphocyte was obviously lower than that in the AA group (P<0.05). Furthermore, the proportions of reticulocytes, bone marrow progenitor cells and immature red blood cells in the hypo-MDS group were significantly more than those in the AA group (P<0.05), and the proportion of mature lymphocytes in the hypo-MDS group was distinctly lower than that in the AA group (P<0.05). SIGNIFICANCE Changes of T lymphocyte subsets and the proportions of large granular lymphocytes and B lymphocytes can be utilized as indexes in the differential diagnosis between AA and hypo-MDS.
Collapse
Affiliation(s)
- Hai-Fang Zhang
- Department of Chinese Medicine, School of Chinese Medicine Engineering, Tianjin University of Traditional Chinese Medicine, Tianjin 300193, PR China
| | - Zhen-Dong Huang
- Department of Hematology, Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science, Tianjin 300020, PR China
| | - Xue-Run Wu
- Department of Chinese Medicine, School of Chinese Medicine Engineering, Tianjin University of Traditional Chinese Medicine, Tianjin 300193, PR China
| | - Qian Li
- Department of Chinese Medicine, School of Chinese Medicine Engineering, Tianjin University of Traditional Chinese Medicine, Tianjin 300193, PR China
| | - Zhi-Feng Yu
- Department of Chinese Medicine, School of Chinese Medicine Engineering, Tianjin University of Traditional Chinese Medicine, Tianjin 300193, PR China.
| |
Collapse
|
5
|
Yin C, He N, Li P, Zhang C, Yu J, Hua M, Ji C, Ma D. Polymorphisms of Interlukin-1β rs16944 confer susceptibility to myelodysplastic syndromes. Life Sci 2016; 165:109-112. [PMID: 27693669 DOI: 10.1016/j.lfs.2016.09.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 09/17/2016] [Accepted: 09/24/2016] [Indexed: 01/01/2023]
Abstract
Genetic factors have been shown to be associated with Myelodysplastic syndromes (MDS) susceptibility. In recent years, the role of inflammation in the promotion of tumor growth is supported by a broad range of experimental and clinical evidence. But the relationship between polymorphisms in NOD-like receptor protein 3 (NLRP3) inflammasome and MDS is rarely reported. Thus, we conducted a case-control study, and genotyped five single nucleotide polymorphisms (SNPs) (NLRP3, IL-1β, IL-18, CARD8, and NF-κB) in MDS patients and healthy controls. The association of different genotypes with patient characteristics was analyzed. Comparing MDS patients with controls, GG genotype of IL-1β (rs16944) was observed to be associated with a significantly increased risk of MDS 78/166 (48.8%) vs 26/96 (27.0%), OR=2.1, CI (1.0-4.4). No significant association was identified regarding the rest of investigated polymorphisms and MDS susceptibility. Complex karyotypes were more frequent in patients with GG genotype of IL-1β (rs16944). Patients with IL-1β polymorphisms (rs16944) GG and GA had lower hemoglobin than those without. Patients with IL-1β polymorphisms (rs16944) GG had higher IPSS scores than those without IL-1β polymorphisms. In conclusion, our present data shows that the IL-1β polymorphisms (rs16944) GG were frequently occurred in MDS. IL-1β (rs16944) GG genotype might serve as a novel biomarker and potential targets for MDS.
Collapse
Affiliation(s)
- Congcong Yin
- Department of Hematology, Qilu Hospital, Shandong University, Jinan 250012, China
| | - Na He
- Department of Hematology, Qilu Hospital, Shandong University, Jinan 250012, China
| | - Peng Li
- Department of Hematology, Qilu Hospital, Shandong University, Jinan 250012, China
| | - Chen Zhang
- Department of Hematology, Qilu Hospital, Shandong University, Jinan 250012, China
| | - Jie Yu
- Department of Hematology, Qilu Hospital, Shandong University, Jinan 250012, China; Department of Hematology, Weihai Municipal Hospital, Weihai, 264200, China
| | - Mingqiang Hua
- Department of Hematology, Qilu Hospital, Shandong University, Jinan 250012, China
| | - Chunyan Ji
- Department of Hematology, Qilu Hospital, Shandong University, Jinan 250012, China
| | - Daoxin Ma
- Department of Hematology, Qilu Hospital, Shandong University, Jinan 250012, China.
| |
Collapse
|
6
|
Fozza C, Crobu V, Isoni MA, Dore F. The immune landscape of myelodysplastic syndromes. Crit Rev Oncol Hematol 2016; 107:90-99. [PMID: 27823655 DOI: 10.1016/j.critrevonc.2016.08.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 08/15/2016] [Accepted: 08/31/2016] [Indexed: 12/25/2022] Open
Abstract
Even though the pathogenesis of myelodysplastic syndromes (MDS) is dominated by specific molecular defects involving hematopoietic precursors, also immune mechanisms seem to play a fundamental functional role. In this review we will first describe the clinical and laboratory autoimmune manifestations often detectable in MDS patients. We will then focus on studies addressing the possible influence of different immune cell subpopulations on the disease onset and evolution. We will finally consider therapeutic approaches based on immunomodulation, ranging from immunosuppressants to vaccination and transplantation strategies.
Collapse
Affiliation(s)
- Claudio Fozza
- Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 12, 07100 Sassari, Italy.
| | - Valeria Crobu
- Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 12, 07100 Sassari, Italy
| | - Maria Antonia Isoni
- Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 12, 07100 Sassari, Italy
| | - Fausto Dore
- Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 12, 07100 Sassari, Italy
| |
Collapse
|
7
|
Glenthøj A, Ørskov AD, Hansen JW, Hadrup SR, O'Connell C, Grønbæk K. Immune Mechanisms in Myelodysplastic Syndrome. Int J Mol Sci 2016; 17:ijms17060944. [PMID: 27314337 PMCID: PMC4926477 DOI: 10.3390/ijms17060944] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 05/31/2016] [Accepted: 06/08/2016] [Indexed: 12/12/2022] Open
Abstract
Myelodysplastic syndrome (MDS) is a spectrum of diseases, characterized by debilitating cytopenias and a propensity of developing acute myeloid leukemia. Comprehensive sequencing efforts have revealed a range of mutations characteristic, but not specific, of MDS. Epidemiologically, autoimmune diseases are common in patients with MDS, fueling hypotheses of common etiological mechanisms. Both innate and adaptive immune pathways are overly active in the hematopoietic niche of MDS. Although supportive care, growth factors, and hypomethylating agents are the mainstay of MDS treatment, some patients—especially younger low-risk patients with HLA-DR15 tissue type—demonstrate impressive response rates after immunosuppressive therapy. This is in contrast to higher-risk MDS patients, where several immune activating treatments, such as immune checkpoint inhibitors, are in the pipeline. Thus, the dual role of immune mechanisms in MDS is challenging, and rigorous translational studies are needed to establish the value of immune manipulation as a treatment of MDS.
Collapse
Affiliation(s)
- Andreas Glenthøj
- Epi-/Genome Laboratory, Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen 2100, Denmark.
| | - Andreas Due Ørskov
- Epi-/Genome Laboratory, Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen 2100, Denmark.
| | - Jakob Werner Hansen
- Epi-/Genome Laboratory, Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen 2100, Denmark.
| | - Sine Reker Hadrup
- Section for Immunology and Vaccinology, National Veterinary Institute, Technical University of Denmark, Frederiksberg 1870, Denmark.
| | - Casey O'Connell
- Jane Anne Nohl Division of Hematology, USC Norris Comprehensive Cancer Center, Los Angeles, CA 90033, USA.
- Stand up to Cancer Epigenetics Dream Team, Van Andel Research Institute, Grand Rapids, MI 49503, USA.
| | - Kirsten Grønbæk
- Epi-/Genome Laboratory, Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen 2100, Denmark.
- Stand up to Cancer Epigenetics Dream Team, Van Andel Research Institute, Grand Rapids, MI 49503, USA.
| |
Collapse
|
8
|
Song MM, Fang S, Tanaka S, Sugiyama K, Kiyomi A, Kato R, Onda K, Yuan B, Takagi N, Hu X, Hirano T. Effects of arsenic disulfide on proliferation, cytokine production, and frequencies of CD4(+), CD8(+), and regulatory T cells in mitogen-activated human peripheral blood mononuclear cells. Int Immunopharmacol 2015; 29:832-838. [PMID: 26359544 DOI: 10.1016/j.intimp.2015.08.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 08/25/2015] [Accepted: 08/28/2015] [Indexed: 01/08/2023]
Abstract
Influence of arsenic disulfide (As2S2) on human immune cells has little been investigated. Effects of As2S2 on proliferation, cytokine production, and frequencies of CD4(+) T, CD8(+) T and CD4(+)CD25(+)Foxp3(+) regulatory T cells in mitogen-activated human peripheral blood mononuclear cells were examined. Anti-proliferative effects of As2S2 on peripheral blood mononuclear cells activated by T-cell mitogen were assessed by a colorimetric assay. Cytokine concentrations in the culture medium were measured with beads-array procedures followed by flow cytometry. CD4(+) T cells, CD8(+) T cells and CD4(+)CD25(+)Foxp3(+) regulatory T cells were stained with fluorescence-labeled specific antibodies followed by flow cytometry analysis. As2S2 at 1-10μM significantly suppressed mitogen-activated proliferation of peripheral blood mononuclear cells (p<0.05). As2S2 at 10μM inhibited production of IL-6, -10, -17A, tumor necrosis factor-α, and interferon-γ from the activated peripheral blood mononuclear cells, though the effects were not statistically significant. As2S2 at 10μM significantly suppressed the frequencies of CD4(+) T and CD8(+) T cells (p<0.05), whereas significantly enhanced the frequency of CD4(+)CD25(+)Foxp3(+) regulatory T cells (p<0.05). The data suggest that As2S2 attenuates T cell-mediated immunity by not only suppressing the proliferation of T cells and cytokine release but also increasing the frequency of regulatory T cells. T cell-mediated autoimmunity contributes to bone marrow failure in myelodysplastic syndrome (MDS), and thus the above As2S2 effects are beneficial for the treatment of MDS patients.
Collapse
Affiliation(s)
- Min-Min Song
- Department of Clinical Pharmacology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo 192-0392, Japan; National Therapeutic Center of Hematology of Traditional Chinese Medicine, XiYuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, PR China; Beijing University of Chinese Medicine, Beijing, 100091, PR China
| | - Su Fang
- Department of Clinical Pharmacology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo 192-0392, Japan; National Therapeutic Center of Hematology of Traditional Chinese Medicine, XiYuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, PR China
| | - Sachiko Tanaka
- Department of Clinical Pharmacology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo 192-0392, Japan
| | - Kentaro Sugiyama
- Department of Clinical Pharmacology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo 192-0392, Japan
| | - Anna Kiyomi
- Department of Clinical Pharmacology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo 192-0392, Japan
| | - Rei Kato
- Department of Clinical Pharmacology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo 192-0392, Japan
| | - Kenji Onda
- Department of Clinical Pharmacology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo 192-0392, Japan
| | - Bo Yuan
- Department of Applied Biochemistry, School of Pharmacy, Tokyo University of Pharmacy & Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo 192-0392, Japan
| | - Norio Takagi
- Department of Applied Biochemistry, School of Pharmacy, Tokyo University of Pharmacy & Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo 192-0392, Japan
| | - Xiaomei Hu
- National Therapeutic Center of Hematology of Traditional Chinese Medicine, XiYuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, PR China
| | - Toshihiko Hirano
- Department of Clinical Pharmacology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo 192-0392, Japan.
| |
Collapse
|
9
|
Fozza C, Corda G, Barraqueddu F, Virdis P, Contini S, Galleu A, Isoni A, Dore F, Angelucci E, Longinotti M. Azacitidine improves the T-cell repertoire in patients with myelodysplastic syndromes and acute myeloid leukemia with multilineage dysplasia. Leuk Res 2015. [DOI: 10.1016/j.leukres.2015.06.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
10
|
Anämien mit Panzytopenie. Monatsschr Kinderheilkd 2015. [DOI: 10.1007/s00112-014-3189-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
11
|
T-cell receptor Vβ skewing frequently occurs in refractory cytopenia of childhood and is associated with an expansion of effector cytotoxic T cells: a prospective study by EWOG-MDS. Blood Cancer J 2014; 4:e209. [PMID: 24786393 PMCID: PMC4042298 DOI: 10.1038/bcj.2014.28] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 03/14/2014] [Indexed: 01/20/2023] Open
Abstract
Immunosuppressive therapy (IST), consisting of antithymocyte globulin and cyclosporine A, is effective in refractory cytopenia of childhood (RCC), suggesting that, similar to low-grade myelodysplastic syndromes in adult patients, T lymphocytes are involved in suppressing hematopoiesis in a subset of RCC patients. However, the potential role of a T-cell-mediated pathophysiology in RCC remains poorly explored. In a cohort of 92 RCC patients, we prospectively assessed the frequency of T-cell receptor (TCR) β-chain variable (Vβ) domain skewing in bone marrow and peripheral blood by heteroduplex PCR, and analyzed T-cell subsets in peripheral blood by flow cytometry. TCRVβ skewing was present in 40% of RCC patients. TCRVβ skewing did not correlate with bone marrow cellularity, karyotype, transfusion history, HLA-DR15 or the presence of a PNH clone. In 28 patients treated with IST, TCRVβ skewing was not clearly related with treatment response. However, TCRVβ skewing did correlate with a disturbed CD4(+)/CD8(+) T-cell ratio, a reduction in naive CD8(+) T cells, an expansion of effector CD8(+) T cells and an increase in activated CD8(+) T cells (defined as HLA-DR(+), CD57(+) or CD56(+)). These data suggest that T lymphocytes contribute to RCC pathogenesis in a proportion of patients, and provide a rationale for treatment with IST in selected patients with RCC.
Collapse
|
12
|
Komrokji RS, Mailloux AW, Chen DT, Sekeres MA, Paquette R, Fulp WJ, Sugimori C, Paleveda-Pena J, Maciejewski JP, List AF, Epling-Burnette PK. A phase II multicenter rabbit anti-thymocyte globulin trial in patients with myelodysplastic syndromes identifying a novel model for response prediction. Haematologica 2014; 99:1176-83. [PMID: 24488560 DOI: 10.3324/haematol.2012.083345] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Immune dysregulation is a mechanism contributing to ineffective hematopoiesis in a subset of myelodysplastic syndrome patients. We report the first US multicenter non-randomized, phase II trial examining the efficacy of rabbit(r)-anti-thymocyte globulin using 2.5 mg/kg/day administered daily for 4 doses. The primary end point was hematologic response; secondary end points included duration of response, time to response, time to progression, and tolerance. Nine (33%;95% confidence interval=17%-54%) of the 27 patients treated experienced durable hematologic improvement in an intent-to-treat analysis with a median time to response and median response duration of 75 and 245 days, respectively. While younger age is the most significant factor favoring equine(e)-anti-thymocyte globulin response, treatment outcome on this study was independent of age (P=0.499). A shorter duration between diagnosis and treatment showed a positive trend (P=0.18), but International Prognostic Scoring System score (P=0.150), karyotype (P=0.319), and age-adjusted bone marrow cellularity (P=0.369) were not associated with response classification. Since activated T-lymphocytes are the primary cellular target of anti-thymocyte globulin, a T-cell expression profiling was conducted in a cohort of 38 patients consisting of rabbit and equine-antithymocyte globulin-treated patients. A model containing disease duration, CD8 terminal memory T cells and T-cell proliferation-associated-antigen expression predicted response with the greatest accuracy using a leave-one-out cross validation approach. This profile categorized patients independent of other covariates, including treatment type and age using a leave-one-out-cross-validation approach (75.7%). Therefore, rabbit-anti-thymocyte globulin has hematologic remitting activity in myelodysplastic syndrome and a T-cell activation profile has potential utility classifying those who are more likely to respond (NCT00466843 clinicaltrials.gov).
Collapse
Affiliation(s)
- Rami S Komrokji
- Malignant Hematology Division, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Adam W Mailloux
- Immunology Program, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Dung-Tsa Chen
- Biostatistics Program, H. Lee H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | | | | | - William J Fulp
- Biostatistics Program, H. Lee H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Chiharu Sugimori
- Ishikawa Prefectural Central Hospital, Kuratsukihigashi, Kanazawa, Japan
| | | | | | - Alan F List
- Malignant Hematology Division, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | | |
Collapse
|
13
|
Heredia FF, de Sousa JC, Ribeiro Junior HL, Carvalho AF, Magalhaes SMM, Pinheiro RF. Proteins related to the spindle and checkpoint mitotic emphasize the different pathogenesis of hypoplastic MDS. Leuk Res 2013; 38:218-24. [PMID: 24314588 DOI: 10.1016/j.leukres.2013.11.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 10/21/2013] [Accepted: 11/02/2013] [Indexed: 10/26/2022]
Abstract
Some studies show that alterations in expression of proteins related to mitotic spindle (AURORAS KINASE A and B) and mitotic checkpoint (CDC20 and MAD2L1) are involved in chromosomal instability and tumor progression in various solid and hematologic malignancies. This study aimed to evaluate these genes in MDS patients. The cytogenetics analysis was carried out by G-banding, AURKA and AURKB amplification was performed using FISH, and AURKA, AURKB, CDC20 and MAD2L1 gene expression was performed by qRT-PCR in 61 samples of bone marrow from MDS patients. AURKA gene amplification was observed in 10% of the cases, which also showed higher expression levels than the control group (p=0.038). Patients with normo/hypercellular BM presented significantly higher expression levels than hypocellular BM patients, but normo and hypercellular BM groups did not differ. After logistic regression analysis, our results showed that HIGH expression levels were associated with increased risk of developing normo/hypercellular MDS. It also indicated that age is associated with AURKA, CDC20 and MAD2L1 HIGH expression levels. The distinct expression of hypocellular patients emphasizes the prognostic importance of cellularity to MDS. The amplification/high expression of AURKA suggests that the increased expression of this gene may be related to the pathogenesis of disease.
Collapse
Affiliation(s)
| | | | | | | | - Silvia Maria Meira Magalhaes
- Department of Clinical Medicine, Division of Hematology, Walter Cantidio Hospital, Federal University of Ceará, Brazil
| | - Ronald Feitosa Pinheiro
- Department of Clinical Medicine, Division of Hematology, Walter Cantidio Hospital, Federal University of Ceará, Brazil.
| |
Collapse
|
14
|
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).
Collapse
|
15
|
Faltas B, Zeidan A, Gergis U. Myelodysplastic syndromes: toward a risk-adapted treatment approach. Expert Rev Hematol 2013; 6:611-24. [PMID: 24094045 DOI: 10.1586/17474086.2013.840997] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Several classification and scoring systems have been developed in myelodysplastic syndromes (MDS to predict the risk of progression to acute myeloid leukemia and survival. These prognostication models have been also used to inform therapeutic decision-making in a risk-adapted fashion. Patient-related factors such as age, comorbidities, and functional status have to be considered as well. Here we review a risk-guided therapeutic approach for the management of MDS patients. It is anticipated that the improved understanding of the complex pathogenesis of MDS and the recent discovery of important molecular lesions will be translated into novel therapeutic approaches. Additionally, some prognostic aberrations are expected to be incorporated into the prognostic tools with the goal of improving their prognostic precision and therefore allow for a more informed therapeutic decision-making based on the individual's risk profile.
Collapse
Affiliation(s)
- Bishoy Faltas
- Division of Hematology and Medical Oncology, Weill-Medical College of Cornell University/New York Presbyterian Hospital, NY 10065, USA
| | | | | |
Collapse
|
16
|
Pickman Y, Dunn-Walters D, Mehr R. BCR CDR3 length distributions differ between blood and spleen and between old and young patients, and TCR distributions can be used to detect myelodysplastic syndrome. Phys Biol 2013; 10:056001. [PMID: 23965732 DOI: 10.1088/1478-3975/10/5/056001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Complementarity-determining region 3 (CDR3) is the most hyper-variable region in B cell receptor (BCR) and T cell receptor (TCR) genes, and the most critical structure in antigen recognition and thereby in determining the fates of developing and responding lymphocytes. There are millions of different TCR Vβ chain or BCR heavy chain CDR3 sequences in human blood. Even now, when high-throughput sequencing becomes widely used, CDR3 length distributions (also called spectratypes) are still a much quicker and cheaper method of assessing repertoire diversity. However, distribution complexity and the large amount of information per sample (e.g. 32 distributions of the TCRα chain, and 24 of TCRβ) calls for the use of machine learning tools for full exploration. We have examined the ability of supervised machine learning, which uses computational models to find hidden patterns in predefined biological groups, to analyze CDR3 length distributions from various sources, and distinguish between experimental groups. We found that (a) splenic BCR CDR3 length distributions are characterized by low standard deviations and few local maxima, compared to peripheral blood distributions; (b) healthy elderly people's BCR CDR3 length distributions can be distinguished from those of the young; and (c) a machine learning model based on TCR CDR3 distribution features can detect myelodysplastic syndrome with approximately 93% accuracy. Overall, we demonstrate that using supervised machine learning methods can contribute to our understanding of lymphocyte repertoire diversity.
Collapse
Affiliation(s)
- Yishai Pickman
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | | | | |
Collapse
|
17
|
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.
Collapse
Affiliation(s)
- Ankur R Parikh
- Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892-1202, USA
| | | | | |
Collapse
|
18
|
Bone marrow dendritic cells are reduced in patients with high-risk myelodysplastic syndromes. Leuk Res 2013; 37:266-73. [DOI: 10.1016/j.leukres.2012.10.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Revised: 10/14/2012] [Accepted: 10/15/2012] [Indexed: 12/19/2022]
|
19
|
Shao LL, Zhang L, Hou Y, Yu S, Liu XG, Huang XY, Sun YX, Tian T, He N, Ma DX, Peng J, Hou M. Th22 cells as well as Th17 cells expand differentially in patients with early-stage and late-stage myelodysplastic syndrome. PLoS One 2012; 7:e51339. [PMID: 23236476 PMCID: PMC3517399 DOI: 10.1371/journal.pone.0051339] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 11/07/2012] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Immunological mechanisms are increasingly recognized in the progression of myelodysplastic syndrome (MDS). Early-stage MDS (E-MDS) is characterized by autoimmune-mediated myelosuppression whereas late-stage MDS (L-MDS) involves immune evasion, giving dysplastic cells growth potential to progress into acute myeloid leukemia. T-helper (Th) 22 is involved in the pathogenesis of inflammatory autoimmunity and tumorigenesis. The roles of Th22 cells in the pathophysiology of E-MDS and L-MDS remain unsettled. DESIGN AND METHODS We studied 37 MDS patients (E-MDS, n = 17; L-MDS, n = 20) and 20 healthy controls to characterize their peripheral blood (PB), as well as 25 MDS patients and 10 healthy controls to characterize their bone marrow(BM). The expression of Interleukin-22 (IL-22), IL-17 or interferon gamma (IFN-γ) was examined in E-MDS, L-MDS patients and controls by flow cytometry. The mRNA expression levels of RAR-related orphan receptor C (RORC), IL-6, tumor necrosis factor alpha (TNF-α) and IL-23 in peripheral blood mononuclear cells (PBMCs) were determined by real-time quantitative polymerase chain reaction. The levels of IL-22 and IL-17 both in PB and BM plasma were examined by enzyme-linked immunosorbent assay. RESULTS In E-MDS, peripheral Th17 cells were significantly elevated and correlated with peripheral Th22 cells compared with healthy controls and L-MDS. Significantly higher levels of peripheral Th22 expansion, mRNA expression of IL-6, TNF-α and lower level of RORC mRNA expression were observed in L-MDS compared with E-MDS. No statistical difference was found in IL-23 mRNA expression or plasma IL-22, IL-17 levels among E-MDS, L-MDS and controls. CONCLUSIONS Our data demonstrated that L-MDS cohort had increased frequencies of peripheral Th22 cells and higher mRNA expression levels of IL-6 and TNF-α, indicating that Th22 cells along with Th17 cells or not are involved in the dynamic immune responses of MDS.
Collapse
Affiliation(s)
- Lin-lin Shao
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, China
| | - Lei Zhang
- Department of Orthopedics, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Yu Hou
- Medical College, Shandong University, Jinan, China
| | - Shuang Yu
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, China
| | - Xin-guang Liu
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, China
| | - Xiao-yang Huang
- Department of Pediatrics, Qilu Hospital, Shandong University, Jinan, China
| | - Yuan-xin Sun
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, China
| | - Tian Tian
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, China
| | - Na He
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, China
| | - Dao-xin Ma
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, China
| | - Jun Peng
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, China
| | - Ming Hou
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, China
| |
Collapse
|
20
|
Fozza C, Longinotti M. The role of T-cells in the pathogenesis of myelodysplastic syndromes: passengers and drivers. Leuk Res 2012; 37:201-3. [PMID: 23218025 DOI: 10.1016/j.leukres.2012.11.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 11/12/2012] [Accepted: 11/13/2012] [Indexed: 12/23/2022]
Abstract
Although a burden of clinical and experimental data suggest the involvement of T-lymphocytes in the pathogenesis of myelodysplastic syndromes (MDS), the actual weight exerted by T-cells in this scenario is yet to be conclusively dissected. This brief review will try to further address this point, by running through the most relevant studies exploring the T-cell repertoire of MDS patients as well as the potential role of specific T-cell subsets such as regulatory T-cells and Th17 T-cells.
Collapse
Affiliation(s)
- Claudio Fozza
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
| | | |
Collapse
|
21
|
Epling-Burnette PK, McDaniel J, Wei S, List AF. Emerging immunosuppressive drugs in myelodysplastic syndromes. Expert Opin Emerg Drugs 2012; 17:519-41. [PMID: 23163589 DOI: 10.1517/14728214.2012.736487] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Myelodysplastic syndromes (MDS) are characterized by dysplastic morphologic features and ineffective hematopoiesis. Pathophysiological characteristics change over time making therapeutic development a major challenge. In early MDS, cytopenias arise or are exacerbated by humoral and cellular immune-mediators that suppress hematopoietic progenitor survival and alter the bone marrow microenvironment. AREAS COVERED In this review, current immunosuppressive regimens are described. To identify new therapies that may enhance immunosuppressive therapy (IST) response and identify pharmacodynamic biomarkers for patient selection, the inflammasome, cytokines, metabolic pathways and signaling events are described. EXPERT OPINION Agents with the potential to induce early, durable hematologic remissions are needed and many new immunosuppressive agents are available for investigation. An immune-mediated mechanism is likely to contribute to MDS early after diagnosis. New approaches that interfere with inflammatory pathways in the bone marrow microenvironment may move closer toward sustained disease control in MDS.
Collapse
Affiliation(s)
- Pearlie K Epling-Burnette
- H. Lee Moffitt Cancer Center & Research Institute, Immunology Department, SRB 23033, 12902 Magnolia Dr, Tampa, FL 33612, USA.
| | | | | | | |
Collapse
|
22
|
Sugimori C, List AF, Epling-Burnette PK. Immune dysregulation in myelodysplastic syndrome. Hematol Rep 2012; 2:e1. [PMID: 22184512 PMCID: PMC3222262 DOI: 10.4081/hr.2010.e1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Accepted: 10/09/2009] [Indexed: 11/22/2022] Open
Abstract
Myelodysplastic syndrome (MDS) represents one of the most challenging health-related problems in the elderly. Characterized by dysplastic morphology in the bone marrow in association with ineffective hematopoiesis, pathophysiological causes of this disease are diverse including genetic abnormalities within myeloid progenitors, altered epigenetics, and changes in the bone marrow microenvironment. The concept that T-cell mediated autoimmunity contributes to bone marrow failure has been widely accepted due to hematologic improvement after immunosuppressive therapy (IST) in a subset of patients. Currently, IST for MDS primarily involves anti-thymocyte globulin (ATG)-based regimens in which responsiveness is strongly associated with younger (under 60 years) age at disease onset. In such cases, progressive cytopenia may occur as a consequence of expanded self-reactive CD8+ cytotoxic T lymphocytes (CTLs) that suppress hematopoietic progenitors. Although most hematologists agree that IST can offer durable hematologic remission in younger patients with MDS, an international clinical study and a better understanding of the molecular mechanisms contributing to the expansion of self-reactive CTLs is crucial. In this review, data accumulated in the US, Europe, and Asia will be summarized to provide insight and direction for a multi-center international trial.
Collapse
Affiliation(s)
- Chiharu Sugimori
- Immunology Program and Malignant Hematology Division, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | | | | |
Collapse
|
23
|
Mailloux AW, Sugimori C, Komrokji RS, Yang L, Maciejewski JP, Sekeres MA, Paquette R, Loughran TP, List AF, Epling-Burnette PK. Expansion of effector memory regulatory T cells represents a novel prognostic factor in lower risk myelodysplastic syndrome. THE JOURNAL OF IMMUNOLOGY 2012; 189:3198-208. [PMID: 22875800 DOI: 10.4049/jimmunol.1200602] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Myelodysplastic syndromes are premalignant diseases characterized by cytopenias, myeloid dysplasia, immune dysregulation with association to autoimmunity, and variable risk for acute myeloid leukemia transformation. Studies of FOXP3(+) regulatory T cells (Tregs) indicate that the number and/or activation state may influence cancer progression in these patients. Focusing on patients with a lower risk for leukemia transformation, 18 (34.6%) of 52 patients studied displayed an altered Treg compartment compared with age-matched controls. Delineation of unique Treg subsets revealed that an increase in the absolute number of CD4(+)FOXP3(+)CD25(+)CD127(low)CD45RA(-)CD27(-) Tregs (effector memory Tregs [Treg(EM)]) was significantly associated with anemia (p = 0.046), reduced hemoglobin (p = 0.038), and blast counts ≥5% (p = 0.006). In healthy donors, this Treg(EM) population constitutes only 2% of all Tregs (one to six Tregs per microliter) in peripheral blood but, when isolated, exhibit greater suppressive activity in vitro. With a median follow-up of 3.1 y (range 2.7-4.9 y) from sample acquisition, increased numbers of Treg(EM) cells proved to have independent prognostic importance in survival estimates, suggesting that enumeration of this Treg subset may be a more reliable indicator of immunological escape than FOXP3(+) T cells as a whole. Based on multivariate analyses, Treg(EM) impacted survival independently from myeloblast characteristics, cytopenias, karyotype, and comorbidities. Based on these findings, Treg(EM) cell expansion may be synonymous with human Treg activation and indicate microenvironmental changes conducive to transformation in myelodysplastic syndromes.
Collapse
Affiliation(s)
- Adam W Mailloux
- Immunology Department, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Pülhorn H, Herrmann M, Harms H, Jung A, Baumann I. Apoptotic cells and clonally expanded cytotoxic T cells in bone marrow trephines of patients with myelodysplastic syndrome. Histopathology 2012; 61:200-11. [PMID: 22690734 DOI: 10.1111/j.1365-2559.2012.04209.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIMS There is increasing evidence that autoimmunity is involved in the pathogenesis of myelodysplastic syndromes (MDS). We examined the number of apoptotic cells, and analysed the T cells and the T cell receptor gene rearrangements in bone marrow trephines of patients with low-grade MDS [refractory anaemia (RA), refractory anaemia with ringed sideroblasts (RAS) and refractory cytopenia with multilineage dysplasia (RCMD)] to investigate the correlation between T cells and apoptosis. METHODS AND RESULTS Bone marrow trephines from 30 patients with RA, seven patients with RCMD, four patients with RAS and 11 normal bone marrow donors were stained for CD3 and for apoptotic cells using immunohistochemistry and terminal deoxynucleotidyl transferase 2'-deoxyuridine, 5'-triphosphate (dUTP) nick end labelling (TUNEL) technique, respectively. The positive cells were quantified by computer-assisted image analysis. In addition, CD 8 and T cell-restricted intracellular antigen-1 (TIA-1)-positive cells were analysed by single staining and evaluated semiquantitatively by light microscopy. Junctional diversity of the T cell receptor (TCR) α-, β- and γ-chains were analysed in 24 cases of RA and RCMD by reverse transcription-polymerase chain reaction (RT-PCR). In all cases of RA, RCMD and RAS an increase of apoptotic cells was accompanied by an increase of T cells, when compared to normal donors (P < 0.001). Expression of TIA-1 was found in 33 of 41 patients with low-grade MDS. In contrast, normal controls showed either no or only very weak expression. Furthermore, 14 of 24 cases with low-grade MDS showed clonal TCR gene rearrangement. CONCLUSION These findings provide evidence that increased apoptosis in low-grade MDS correlates with increased numbers of cytotoxic T cells. A considerable proportion of the MDS cases showed clonal TCR rearrangement suggesting an antigen-driven selection of the T cells. We therefore speculate that cases of MDS can be accompanied by a presumably autoreactive T cell-mediated apoptosis induction in bone marrow cells.
Collapse
Affiliation(s)
- Heinke Pülhorn
- Institute of Pathology, University of Erlangen-Nuremberg, Erlangen, Germany
| | | | | | | | | |
Collapse
|
25
|
Ridgeway JA, Fechter L, Murray C, Borràs N. Update on the science of myelodysplastic syndromes. Clin J Oncol Nurs 2012; 16 Suppl:9-22. [PMID: 22641281 DOI: 10.1188/12.cjon.s1.9-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Scientific research is only just beginning to shed light on the pathobiology underlying the various subtypes of myelodysplastic syndromes (MDS), a heterogeneous group of clonal stem cell disorders characterized by cytopenias that can progress to acute myeloid leukemia. Increased understanding of the disease and prognostic implications of specific clinical features has aided in the development of prescribing guidelines and new treatments for MDS. Because oncology nurses have frequent interactions with patients during diagnostic and therapeutic evaluations, an understanding of the science behind disease classification, prognostic scoring, and the goals of treatment for low- and high-risk disease is important to answer questions regarding diagnostic results, treatment outcomes, and adverse event monitoring.
Collapse
Affiliation(s)
- Jean A Ridgeway
- Adult Hematologic Malignancies/Stem Cell Transplant Program, University of Chicago Medical Center, Illinois, USA.
| | | | | | | |
Collapse
|
26
|
Gough SM, Chung YJ, Aplan PD. Depletion of cytotoxic T-cells does not protect NUP98-HOXD13 mice from myelodysplastic syndrome but reveals a modest tumor immunosurveillance effect. PLoS One 2012; 7:e36876. [PMID: 22606303 PMCID: PMC3350481 DOI: 10.1371/journal.pone.0036876] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 04/13/2012] [Indexed: 12/20/2022] Open
Abstract
Myelodysplastic syndrome (MDS) and aplastic anemia (AA) patients both present with symptoms of bone marrow failure. In many AA patients, these features are thought to result from an oligoclonal expansion of cytotoxic T-cells that destroy haematopoietic stem or progenitor cells. This notion is supported by the observation that AA patients respond to immunosuppressive therapy. A fraction of MDS patients also respond well to immunosuppressive therapy suggesting a similar role for cytotoxic T-cells in the etiology of MDS, however the role of cytotoxic T-cells in MDS remains unclear. Mice that express a NUP98-HOXD13 (NHD13) transgene develop a MDS that closely mimics the human condition in terms of dysplasia, ineffective hematopoiesis, and transformation to acute myeloid leukemia (AML). We followed a cohort of NHD13 mice lacking the Rag1 protein (NHD13/Rag1KO) to determine if the absence of lymphocytes might 1) delay the onset and/or diminish the severity of the MDS, or 2) effect malignant transformation and survival of the NHD13 mice. No difference was seen in the onset or severity of MDS between the NHD13 and NHD13/Rag1KO mice. However, NHD13/Rag1KO mice had decreased survival and showed a trend toward increased incidence of transformation to AML compared to the NHD13 mice, suggesting protection from AML transformation by a modest immuno-surveillance effect. In the absence of functional Tcrb signaling in the NHD13/Rag1KO T-cell tumors, Pak7 was identified as a potential Tcrb surrogate survival signal.
Collapse
MESH Headings
- Animals
- Cell Survival/genetics
- Cell Survival/immunology
- Disease Models, Animal
- Genes, T-Cell Receptor beta
- Homeodomain Proteins/genetics
- Homeodomain Proteins/immunology
- Humans
- Immunologic Surveillance
- Leukemia, Experimental/etiology
- Leukemia, Experimental/immunology
- Leukemia, Experimental/pathology
- Lymphocyte Depletion
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- Mice, Transgenic
- Myelodysplastic Syndromes/etiology
- Myelodysplastic Syndromes/immunology
- Myelodysplastic Syndromes/pathology
- Myelodysplastic Syndromes/therapy
- Oncogene Proteins, Fusion/genetics
- Oncogene Proteins, Fusion/immunology
- T-Lymphocytes/immunology
- T-Lymphocytes/pathology
- T-Lymphocytes, Cytotoxic/immunology
- p21-Activated Kinases/immunology
Collapse
Affiliation(s)
- Sheryl M. Gough
- Leukemia Biology Section, Genetics Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Yang Jo Chung
- Leukemia Biology Section, Genetics Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Peter D. Aplan
- Leukemia Biology Section, Genetics Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
- * E-mail:
| |
Collapse
|
27
|
|
28
|
High frequency of human leukocyte antigen class II DRB1*1602 haplotype in Greek patients with myelodysplastic syndrome and of DRB1*1501 in the low-risk subgroup. Hum Immunol 2012; 73:278-81. [DOI: 10.1016/j.humimm.2011.12.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 12/15/2011] [Accepted: 12/21/2011] [Indexed: 12/23/2022]
|
29
|
Fozza C, Longinotti M. Are T-cell dysfunctions the other side of the moon in the pathogenesis of myelodysplastic syndromes? Eur J Haematol 2012; 88:380-7. [PMID: 22296182 DOI: 10.1111/j.1600-0609.2012.01762.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Even though the pathogenesis of myelodysplastic syndromes (MDS) is dominated by an inefficient maturation of haematopoietic precursors, also immune mechanisms seem to play a crucial functional role. In this review, we will first describe the clinical and laboratory autoimmune manifestations often detectable in MDS patients. We will then focus on studies addressing the mechanisms of T-cell activation and their implications in the disease history. The potential impact of specific cell subsets, such as regulatory T-cells, Th17 cells and natural killer cells, will be also described. We will finally focus on potential therapeutic approaches based on immunomodulation, ranging from more classical immunosuppressive drugs to vaccination and transplantation strategies.
Collapse
Affiliation(s)
- Claudio Fozza
- Hematology Section, Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
| | | |
Collapse
|
30
|
Abstract
Recent studies suggest a powerful prognostic value for plasma cytokine levels in primary myelofibrosis (interleukin (IL)-2R, IL-8, IL-12, IL-15 and C–X–C motif chemokine 10 (CXCL10)) and large-cell lymphoma (IL-2R, IL-8, IL-10, IL-12, CXCL9 and CXCL10). To examine the possibility of a similar phenomenon in myelodysplastic syndromes (MDS), we used multiplex enzyme-linked immunosorbent assay to measure 30 plasma cytokines in 78 patients with primary MDS. Compared with normal controls (n=35), the levels of 19 cytokines were significantly altered. Multivariable analysis identified increased levels of CXCL10 (P<0.01), IL-7 (P=0.02) and IL-6 (P=0.07) as predictors of shortened survival; the survival association remained significant when the Cox model was adjusted for the International Prognostic Scoring System, age, transfusion-need or thrombocytopenia. MDS patients with normal plasma levels of CXCL10, IL-7 and IL-6 lived significantly longer (median survival 76 months) than those with elevated levels of at least one of the three cytokines (median survival 25 months) (P<0.01). Increased levels of IL-6 were associated with inferior leukemia-free survival, independent of other prognostic factors (P=0.01). Comparison of plasma cytokines between MDS (n=78) and primary myelofibrosis (n=127) revealed a significantly different pattern of abnormalities. These observations reinforce the concept of distinct and prognostically relevant plasma cytokine signatures in hematological malignancies.
Collapse
|
31
|
Warlick ED, Miller JS. Myelodysplastic syndromes: the role of the immune system in pathogenesis. Leuk Lymphoma 2011; 52:2045-9. [PMID: 21663505 DOI: 10.3109/10428194.2011.584002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The myelodysplastic syndromes (MDS) represent a complex spectrum of clonal hematopoietic stem cell disorders manifested by cytopenias, risk of infection, and variable risk of progression to acute myelogenous leukemia. Several theories of MDS pathogenesis exist, with contributions of genetic, epigenetic, apoptotic, differentiation, and cytokine milieu abnormalities. Immune dysregulation has also been implicated in MDS pathogenesis. In some forms of MDS it is evident that immune dysregulation may be a primary pathophysiologic abnormality, while in others the abnormal immune function may represent only a small part of the pathologic puzzle. We review the current literature regarding natural killer (NK) cell, T cell, and myeloid derived suppressor cell abnormalities in the spectrum of MDS.
Collapse
Affiliation(s)
- Erica D Warlick
- Division of Hematology, Oncology, and Transplantation, University of Minnesota Medical School, Minneapolis, MN, USA.
| | | |
Collapse
|
32
|
Porwit A, Saft L. The AML–MDS interface—leukemic transformation in myelodysplastic syndromes. J Hematop 2011. [DOI: 10.1007/s12308-011-0088-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
|
33
|
Aggarwal S, van de Loosdrecht AA, Alhan C, Ossenkoppele GJ, Westers TM, Bontkes HJ. Role of immune responses in the pathogenesis of low-risk MDS and high-risk MDS: implications for immunotherapy. Br J Haematol 2011; 153:568-81. [DOI: 10.1111/j.1365-2141.2011.08683.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
34
|
Passweg JR, Giagounidis AA, Simcock M, Aul C, Dobbelstein C, Stadler M, Ossenkoppele G, Hofmann WK, Schilling K, Tichelli A, Ganser A. Immunosuppressive Therapy for Patients With Myelodysplastic Syndrome: A Prospective Randomized Multicenter Phase III Trial Comparing Antithymocyte Globulin Plus Cyclosporine With Best Supportive Care—SAKK 33/99. J Clin Oncol 2011; 29:303-9. [PMID: 21149672 DOI: 10.1200/jco.2010.31.2686] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Purpose Immunosuppressive treatment is reported to improve cytopenia in some patients with myelodysplastic syndrome (MDS). Combined antithymocyte globulin (ATG) and cyclosporine (CSA) is most effective in patients with immune-mediated marrow failure. Patients and Methods This trial was designed to assess the impact of immunosuppression on hematopoiesis, transfusion requirements, transformation, and survival in patients with MDS randomly assigned to 15 mg/kg of horse ATG for 5 days and oral CSA for 180 days (ATG+CSA) or best supportive care (BSC), stratified by treatment center and International Prognostic Scoring System (IPSS) risk score. Primary end point was best hematologic response at 6 months. Eligible patients had an Eastern Cooperative Oncology Group performance status of ≤ 2 and transfusion dependency of less than 2 years in duration. Results Between 2000 and 2006, 45 patients received ATG+CSA (median age, 62 years; range, 23 to 75 years; 56% men) and 43 patients received BSC (median age, 65 years; range, 24 to 76 years; 81% men). IPSS score was low, intermediate-1, intermediate-2, high, and not evaluable in eight, 24, seven, one, and five patients on ATG+CSA, respectively, and eight, 25, five, zero, and five patients on BSC, respectively. Refractory anemia, refractory anemia with ringed sideroblasts, refractory anemia with excess of blasts (RAEB) -I, RAEB-II, and hypoplastic disease were present in 21, six, nine, zero, and nine patients on ATG+CSA, respectively, and 18, eight, 11, two, and four patients on BSC, respectively. By month 6, 13 of 45 patients on ATG+CSA had a hematologic response compared with four of 43 patients on BSC (P = .0156). Two-year transformation-free survival (TFS) rates were 46% (95% CI, 28% to 62%) and 55% (95% CI, 34% to 70%) for ATG+CSA and BSC patients, respectively (P = .730), whereas overall survival (OS) estimates were 49% (95% CI, 31% to 66%) and 63% (95% CI, 42% to 78%), respectively (P = .828). Conclusion This open-label randomized phase III trial demonstrates that ATG+CSA treatment seems to be associated with hematologic response in a subset of patients without apparent impact on TFS and OS.
Collapse
Affiliation(s)
- Jakob R. Passweg
- From the Hôpitaux Universitaires de Geneve, Geneva; Swiss Group for Clinical Cancer Research, Bern; Basel University Hospital, Basel, Switzerland; Medizinische Klinik II, St Johannes Hospital, Duisburg; Hannover Medical School, Hannover; University Hospital Mannheim, Mannheim; Friedrich-Schiller-Universität Jena, Jena, Germany; and Vrije Universiteit University Medical Center, Amsterdam, the Netherlands
| | - Aristoteles A.N. Giagounidis
- From the Hôpitaux Universitaires de Geneve, Geneva; Swiss Group for Clinical Cancer Research, Bern; Basel University Hospital, Basel, Switzerland; Medizinische Klinik II, St Johannes Hospital, Duisburg; Hannover Medical School, Hannover; University Hospital Mannheim, Mannheim; Friedrich-Schiller-Universität Jena, Jena, Germany; and Vrije Universiteit University Medical Center, Amsterdam, the Netherlands
| | - Mathew Simcock
- From the Hôpitaux Universitaires de Geneve, Geneva; Swiss Group for Clinical Cancer Research, Bern; Basel University Hospital, Basel, Switzerland; Medizinische Klinik II, St Johannes Hospital, Duisburg; Hannover Medical School, Hannover; University Hospital Mannheim, Mannheim; Friedrich-Schiller-Universität Jena, Jena, Germany; and Vrije Universiteit University Medical Center, Amsterdam, the Netherlands
| | - Carlo Aul
- From the Hôpitaux Universitaires de Geneve, Geneva; Swiss Group for Clinical Cancer Research, Bern; Basel University Hospital, Basel, Switzerland; Medizinische Klinik II, St Johannes Hospital, Duisburg; Hannover Medical School, Hannover; University Hospital Mannheim, Mannheim; Friedrich-Schiller-Universität Jena, Jena, Germany; and Vrije Universiteit University Medical Center, Amsterdam, the Netherlands
| | - Christiane Dobbelstein
- From the Hôpitaux Universitaires de Geneve, Geneva; Swiss Group for Clinical Cancer Research, Bern; Basel University Hospital, Basel, Switzerland; Medizinische Klinik II, St Johannes Hospital, Duisburg; Hannover Medical School, Hannover; University Hospital Mannheim, Mannheim; Friedrich-Schiller-Universität Jena, Jena, Germany; and Vrije Universiteit University Medical Center, Amsterdam, the Netherlands
| | - Michael Stadler
- From the Hôpitaux Universitaires de Geneve, Geneva; Swiss Group for Clinical Cancer Research, Bern; Basel University Hospital, Basel, Switzerland; Medizinische Klinik II, St Johannes Hospital, Duisburg; Hannover Medical School, Hannover; University Hospital Mannheim, Mannheim; Friedrich-Schiller-Universität Jena, Jena, Germany; and Vrije Universiteit University Medical Center, Amsterdam, the Netherlands
| | - Gert Ossenkoppele
- From the Hôpitaux Universitaires de Geneve, Geneva; Swiss Group for Clinical Cancer Research, Bern; Basel University Hospital, Basel, Switzerland; Medizinische Klinik II, St Johannes Hospital, Duisburg; Hannover Medical School, Hannover; University Hospital Mannheim, Mannheim; Friedrich-Schiller-Universität Jena, Jena, Germany; and Vrije Universiteit University Medical Center, Amsterdam, the Netherlands
| | - Wolf-Karsten Hofmann
- From the Hôpitaux Universitaires de Geneve, Geneva; Swiss Group for Clinical Cancer Research, Bern; Basel University Hospital, Basel, Switzerland; Medizinische Klinik II, St Johannes Hospital, Duisburg; Hannover Medical School, Hannover; University Hospital Mannheim, Mannheim; Friedrich-Schiller-Universität Jena, Jena, Germany; and Vrije Universiteit University Medical Center, Amsterdam, the Netherlands
| | - Kristina Schilling
- From the Hôpitaux Universitaires de Geneve, Geneva; Swiss Group for Clinical Cancer Research, Bern; Basel University Hospital, Basel, Switzerland; Medizinische Klinik II, St Johannes Hospital, Duisburg; Hannover Medical School, Hannover; University Hospital Mannheim, Mannheim; Friedrich-Schiller-Universität Jena, Jena, Germany; and Vrije Universiteit University Medical Center, Amsterdam, the Netherlands
| | - André Tichelli
- From the Hôpitaux Universitaires de Geneve, Geneva; Swiss Group for Clinical Cancer Research, Bern; Basel University Hospital, Basel, Switzerland; Medizinische Klinik II, St Johannes Hospital, Duisburg; Hannover Medical School, Hannover; University Hospital Mannheim, Mannheim; Friedrich-Schiller-Universität Jena, Jena, Germany; and Vrije Universiteit University Medical Center, Amsterdam, the Netherlands
| | - Arnold Ganser
- From the Hôpitaux Universitaires de Geneve, Geneva; Swiss Group for Clinical Cancer Research, Bern; Basel University Hospital, Basel, Switzerland; Medizinische Klinik II, St Johannes Hospital, Duisburg; Hannover Medical School, Hannover; University Hospital Mannheim, Mannheim; Friedrich-Schiller-Universität Jena, Jena, Germany; and Vrije Universiteit University Medical Center, Amsterdam, the Netherlands
| |
Collapse
|
35
|
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]
|
36
|
Zheng Z, Qianqiao Z, Qi H, Feng X, Chunkang C, Xiao L. In vitro deprivation of CD8+CD57+T cells promotes the malignant growth of bone marrow colony cells in patients with lower-risk myelodysplastic syndrome. Exp Hematol 2010; 38:677-84. [DOI: 10.1016/j.exphem.2010.04.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2009] [Revised: 03/27/2010] [Accepted: 04/06/2010] [Indexed: 11/27/2022]
|
37
|
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.
Collapse
Affiliation(s)
- A John Barrett
- Clinical Research Center, National Heart, Lung, and Blood Institute, Bethesda, MD 20892, USA.
| | | |
Collapse
|
38
|
Xiao L, Qiong L, Yan Z, Zheng Z, Luxi S, Li X, Ying T, Yizhi L, Quan P. Experimental and clinical characteristics in myelodysplastic syndrome patients with or without HLA-DR15 allele. Hematol Oncol 2010; 28:98-103. [PMID: 19593744 DOI: 10.1002/hon.907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We studied the effects of the presence of the HLA-DR15 allele on the experimental and clinical features of myelodysplastic syndrome (MDS) by assessing the clinical data of 136 patients with MDS. We observed that the frequency of HLA-DR15 expression in MDS patients (38.7%) was significantly higher than that in the healthy controls (p < 0.01). We noted the following observations with regard to disease progression: None of the 46 HLA-DR15 positive patients with international prognostic scoring system (IPSS) scores <or=1 developed acute myeloid leukaemia (AML) during the follow-up period, while six of the 63 DR15-negative patients with the same IPSS score developed AML within a shorter follow-up period (p = 0.039). Furthermore, the incidence of poor chromosomal abnormalities, the percentage of patients with IPSS scores >or=1.5 and the presence of >or=5% blasts in the bone marrow in the DR15-positive patients were lower than the corresponding findings in the DR15-negative patients. In addition, we also recorded the following observations with regard to bone marrow (BM) failure: The bicytopenia/pancytopenia ratio in the DR15-positive patients was higher than that in the DR15-negative patients (92.4 vs. 78.3%; p = 0.029). The peripheral-neutrophil count and the platelet count in the DR15-positive patients were lower than those in the DR15-negative patients (p = 0.028 and p = 0.011, respectively). Moreover, hypocellularity was more easily detectable in the DR15-positive patients (26.4 vs. 16.9%). In addition, the BM CD4+ lymphocyte count and the CD4/CD8 ratio in the DR15-positive patients were higher than the corresponding values in the DR15-negative patients (p < 0.05 for both). However, there were no significant differences between the polarization of T-helper (T(h)) and T-cytotoxic (T(c)) cells and the cytokine levels in these two patient groups. We concluded that the presence of the HLA-DR15 allele is indicative of a genetic susceptibility to MDS and, the presence of the HLA-DR15 allele showed less association with disease progression and greater association with BM failure.
Collapse
Affiliation(s)
- Li Xiao
- Department of Hematology, Sixth Hospital affiliated to Shanghai Jiaotong University, Shanghai, China.
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Sloand EM, Barrett AJ. Immunosuppression for myelodysplastic syndrome: how bench to bedside to bench research led to success. Hematol Oncol Clin North Am 2010; 24:331-41. [PMID: 20359629 PMCID: PMC3793398 DOI: 10.1016/j.hoc.2010.02.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Laboratory evidence and clinical evidence suggest that some patients with myelodysplastic syndrome (MDS) have immunologically mediated disease. This article describes the laboratory evidence supporting a role for the immune system in the marrow failure of MDS and clinical trials using IST in these patients.
Collapse
Affiliation(s)
- Elaine M Sloand
- Hematology Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, 10 Center Drive, Bethesda, MD 20892, USA.
| | | |
Collapse
|
40
|
Scott BL, Ramakrishnan A, Fosdal M, Storer B, Becker P, Petersdorf S, Deeg HJ. Anti-thymocyte globulin plus etanercept as therapy for myelodysplastic syndromes (MDS): a phase II study. Br J Haematol 2010; 149:706-10. [PMID: 20331464 DOI: 10.1111/j.1365-2141.2010.08145.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Immunosuppressive therapies have proven valuable in treating patients with myelodysplastic syndromes (MDS). We evaluated the combination of equine anti-thymocyte globulin (ATGAM) and the soluble tumour necrosis factor receptor, etanercept (Enbrel), in a phase II trial. Twenty-five patients with MDS [4-refractory anaemia (RA), 2-RA with ring sideroblasts, 15-refractory cytopenia with multilineage dysplasia (RCMD), 3-RCMD and ring sideroblasts, 1-RA with excess blasts type 1] in International Prognostic Staging System risk groups low (n = 11) or intermediate-1 (n = 14) were enrolled. All patients were platelet or red cell transfusion-dependent. Nineteen patients completed therapy with ATG at 40 mg/kg per day for four consecutive days, followed by etanercept, 25 mg subcutaneous twice a week for 2 weeks, every month for 4 months. Thirteen patients had haematological improvement (HI)-erythroid, 2 HI-neutrophil, and 6 HI-platelet. One patient with a co-existing diagnosis of multiple sclerosis and rheumatoid arthritis had a complete remission. The overall response by intent to treat analysis among the 25 patients was 56% (95% confidence interval 35-56%). Four patients did not complete their first course of therapy and one patient did not survive to the 8-week post-treatment assessment. Among patients who completed treatment and survived to the 8-week assessment, 70% had at least haematological responses lasting for at least 5 to more than 36 months. Thus, combination therapy with ATG and etanercept was active and safe in patients with MDS.
Collapse
Affiliation(s)
- Bart L Scott
- Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA.
| | | | | | | | | | | | | |
Collapse
|
41
|
Campregher PV, Srivastava SK, Deeg HJ, Robins HS, Warren EH. Abnormalities of the alphabeta T-cell receptor repertoire in advanced myelodysplastic syndrome. Exp Hematol 2009; 38:202-12. [PMID: 20035823 DOI: 10.1016/j.exphem.2009.12.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Revised: 11/22/2009] [Accepted: 12/15/2009] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Analysis of the alphabeta T-cell receptor (TCR) repertoire in patients with myelodysplastic syndrome (MDS) using the technique of TCR beta-chain spectratyping has provided valuable insight into the pathophysiology of cytopenias in a subset of patients with this heterogeneous disorder. TCR beta-chain spectratypes are complex data sets, however, and statistical tools for their comprehensive analysis are limited. The objective of the present work was to develop a method to enable quantitative evaluation and global comparison of spectratype data from different individuals and to study the prevalence of TCR beta repertoire abnormalities in MDS patients. MATERIALS AND METHODS We developed a robust statistical method based on k-means clustering analysis, and applied this method to analysis of the alphabeta TCR repertoires in 50 MDS patients and 23 age-matched healthy controls. RESULTS Cluster analysis identified a subset of 11 MDS patients with profoundly abnormal alphabeta TCR repertoires. This group of patients was characterized by advanced disease by International Prognostic Scoring System and World Health Organization criteria, increased expression of the Wilms' tumor-1 oncogene, increased bone marrow myeloblast count, and older age. CONCLUSIONS We have developed a robust analytic algorithm that enables the comparison of alphabeta TCR repertoires between individuals and have shown that abnormal alphabeta TCR repertoire is a feature of a subset of patients with advanced MDS.
Collapse
Affiliation(s)
- Paulo V Campregher
- Program in Immunology, Fred Hutchinson Cancer Research Center, Seattle, Wash. 98109-1024, USA
| | | | | | | | | |
Collapse
|
42
|
Garderet L, Kobari L, Mazurier C, De Witte C, Giarratana MC, Pérot C, Gorin NC, Lapillonne H, Douay L. Unimpaired terminal erythroid differentiation and preserved enucleation capacity in myelodysplastic 5q(del) clones: a single cell study. Haematologica 2009; 95:398-405. [PMID: 19815832 DOI: 10.3324/haematol.2009.012773] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Anemia is a characteristic of myelodysplastic syndromes, such as the rare 5q- syndrome, but its mechanism remains unclear. In particular, data are lacking on the terminal phase of differentiation of erythroid cells (enucleation) in myelodysplastic syndromes. DESIGN AND METHODS We used a previously published culture model to generate mature red blood cells in vitro from human hematopoietic progenitor cells in order to study the pathophysiology of the 5q- syndrome. Our model enables analysis of cell proliferation and differentiation at a single cell level and determination of the enucleation capacity of erythroid precursors. RESULTS The erythroid commitment of 5q(del) clones was not altered and their terminal differentiation capacity was preserved since they achieved final erythroid maturation (enucleation stage). The drop in red blood cell production was secondary to the decrease in the erythroid progenitor cell pool and to impaired proliferative capacity. RPS14 gene haploinsufficiency was related to defective erythroid proliferation but not to differentiation capacity. CONCLUSIONS The 5q- syndrome should be considered a quantitative rather than qualitative bone marrow defect. This observation might open the way to new therapeutic concepts.
Collapse
|
43
|
Barrett AJ, Sloand E. Autoimmune mechanisms in the pathophysiology of myelodysplastic syndromes and their clinical relevance. Haematologica 2009; 94:449-51. [PMID: 19336747 DOI: 10.3324/haematol.2009.006080] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- A John Barrett
- Stem Cell Allotransplantation Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
| | | |
Collapse
|
44
|
Patients with myelodysplastic syndromes display several T-cell expansions, which are mostly polyclonal in the CD4+ subset and oligoclonal in the CD8+ subset. Exp Hematol 2009; 37:947-55. [PMID: 19409953 DOI: 10.1016/j.exphem.2009.04.009] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Revised: 04/10/2009] [Accepted: 04/22/2009] [Indexed: 11/21/2022]
|
45
|
Zou JX, Rollison DE, Boulware D, Chen DT, Sloand EM, Pfannes LV, Goronzy JJ, Bai F, Painter JS, Wei S, Cosgrove D, List AF, Epling-Burnette PK. Altered naive and memory CD4+ T-cell homeostasis and immunosenescence characterize younger patients with myelodysplastic syndrome. Leukemia 2009; 23:1288-96. [PMID: 19282834 PMCID: PMC3252820 DOI: 10.1038/leu.2009.14] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2008] [Revised: 12/16/2008] [Accepted: 12/31/2008] [Indexed: 01/10/2023]
Abstract
Response to immunosuppressive therapy (IST) in younger patients with myelodysplastic syndrome (MDS) has been linked to a T-cell-dominant autoimmune process that impairs hematopoiesis. Analysis of the age-adjusted CD4:CD8 ratio in 76 MDS patients compared with 54 healthy controls showed that inadequate CD4+, rather than expansion of CD8+ T cells, was associated with a lower ratio in a group that included both lower and higher risk MDS patients defined by the International Prognostic Scoring System. In younger MDS patients, naive and memory phenotypes defined by CD45RA and CD62L display showed depletion of naive CD4+ and CD8+ T cells, suggesting a possible relationship to IST responsiveness. To determine the correlation between T-cell subset distribution, T-cell turnover and autoimmunity, a cohort of 20 patients were studied before and after IST. The CD4:CD8 ratio correlated inversely with the proliferative T-cell index before treatment in IST-responsive patients, suggesting that proliferation may be linked to accelerated CD4+ T-cell turnover and hematopoietic failure. Our data show seminal findings that both CD4+ and CD8+ T-cell subsets are dysregulated in MDS. Association between these T-cell defects and response to IST suggests that aberrant T-cell homeostasis and chronic activation are critical determinants influencing autoimmune hematopoietic suppression in younger patients.
Collapse
Affiliation(s)
- JX Zou
- Immunology Program at the H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - DE Rollison
- Division of Cancer Prevention and Control at the H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - D Boulware
- Biostatistics Program at the H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - D-T Chen
- Biostatistics Program at the H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - EM Sloand
- NIH, NHLBI, Hematology Branch, Bethesda, MD, USA
| | - LV Pfannes
- NIH, NHLBI, Hematology Branch, Bethesda, MD, USA
| | - JJ Goronzy
- Lowance Center for Human Immunology, Emory University School of Medicine, Atlanta, GA, USA
| | - F Bai
- Immunology Program at the H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - JS Painter
- Immunology Program at the H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - S Wei
- Immunology Program at the H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - D Cosgrove
- Division of Hematologic Malignancies, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - AF List
- Division of Hematologic Malignancies, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - PK Epling-Burnette
- Immunology Program at the H. Lee Moffitt Cancer Center, Tampa, FL, USA
- Lowance Center for Human Immunology, Emory University School of Medicine, Atlanta, GA, USA
- James A. Haley VA Hospital, Tampa, FL, USA
| |
Collapse
|
46
|
|
47
|
Abstract
Optimal management of patients with myelodysplastic syndromes (MDS) requires an insight into the biology of the disease and the mechanisms of action of the available therapies. This review focuses on low-risk MDS, for which chronic anaemia and eventual progression to acute myeloid leukaemia are the main concerns. We cover the updated World Health Organization classification, the latest prognostic scoring system, and describe novel findings in the pathogenesis of 5q- syndrome. We perform in depth analyses of two of the most widely used treatments, erythropoietin and lenalidomide, discussing mechanisms of action, reasons for treatment failure and influence on survival.
Collapse
Affiliation(s)
- M Jädersten
- Division of Hematology and Center of Experimental Hematology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
| | | |
Collapse
|
48
|
Cukrová V, Neuwirtová R, Doležalová L, Beličková M, Jiřina Bartůňková, Jonášová A, Jaroslav Čermák, Homolková H, Malíková I. Defective cytotoxicity of T lymphocytes in myelodysplastic syndrome. Exp Hematol 2009; 37:386-94. [DOI: 10.1016/j.exphem.2008.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Revised: 10/29/2008] [Accepted: 11/03/2008] [Indexed: 11/24/2022]
|
49
|
Chamuleau MED, Westers TM, van Dreunen L, Groenland J, Zevenbergen A, Eeltink CM, Ossenkoppele GJ, van de Loosdrecht AA. Immune mediated autologous cytotoxicity against hematopoietic precursor cells in patients with myelodysplastic syndrome. Haematologica 2009; 94:496-506. [PMID: 19229054 DOI: 10.3324/haematol.13612] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND An activated immune system has been observed in patients with myelodysplastic syndrome but its exact contribution to disease development and control is not fully clarified. On the one hand an activated and skewed T-cell repertoire has been reported, but on the other hand, decreased natural killer cell function has been found. Immune activation could reflect undesired autoimmune reactions against normal hematopoietic precursor cells as well as effective immune-surveillance against dysplastic clones. DESIGN AND METHODS We have investigated immune effector cells (lymphocyte subsets, lymphocyte activation markers, and natural killer cells) of 40 low and intermediate risk myelodysplastic syndrome patients and compared them to those of 10 age-matched healthy donors. Furthermore, we have analyzed the cytotoxic capacity of effector cells against autologous bone marrow hematopoietic precursor cells of 8 myelodysplastic syndrome patients and 2 healthy donors. RESULTS In myelodysplastic syndrome patients, we have found an activated state of lymphocytes, determined by increased percentages of effector T cells with cytotoxic profile, more skewing of the T-cell receptor Vbeta (TCR-Vbeta) repertoire, and decreased frequencies of regulatory T cells, when compared to healthy donors. The percentage of natural killer cells did not differ between myelodysplastic syndrome patients and healthy donors, but natural killer cells of myelodysplastic syndrome patients expressed increased levels of granzyme B. Finally, we have demonstrated non-MHC restricted autologous cytotoxicity up to 90% against aberrant hematopoietic precursor cells, presumably mediated by natural killer cells. CONCLUSIONS Our data point to a role for active immune-surveillance in myelodysplastic syndrome, as demonstrated by activated T cells and TCR-Vss skewing. Autologous cytotoxicity against hematopoietic precursor cells was natural killer cell dependent, which points to an additional role for the innate immune system in immune-surveillance of myelodysplastic syndrome patients.
Collapse
Affiliation(s)
- Martine E D Chamuleau
- Department of Hematology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Kim H, Min YJ, Baek JH, Shin SJ, Lee EH, Noh EK, Kim MY, Park JH. A pilot dose-escalating study of alemtuzumab plus cyclosporine for patients with bone marrow failure syndrome. Leuk Res 2009; 33:222-31. [DOI: 10.1016/j.leukres.2008.08.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Revised: 06/26/2008] [Accepted: 08/04/2008] [Indexed: 10/21/2022]
|