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How can we incorporate molecular data into the IPSS? Best Pract Res Clin Haematol 2022; 35:101410. [DOI: 10.1016/j.beha.2022.101410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Chiereghin C, Travaglino E, Zampini M, Saba E, Saitta C, Riva E, Bersanelli M, Della Porta MG. The Genetics of Myelodysplastic Syndromes: Clinical Relevance. Genes (Basel) 2021; 12:genes12081144. [PMID: 34440317 PMCID: PMC8392119 DOI: 10.3390/genes12081144] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/05/2021] [Accepted: 07/22/2021] [Indexed: 12/27/2022] Open
Abstract
Myelodysplastic syndromes (MDS) are a clonal disease arising from hematopoietic stem cells, that are characterized by ineffective hematopoiesis (leading to peripheral blood cytopenia) and by an increased risk of evolution into acute myeloid leukemia. MDS are driven by a complex combination of genetic mutations that results in heterogeneous clinical phenotype and outcome. Genetic studies have enabled the identification of a set of recurrently mutated genes which are central to the pathogenesis of MDS and can be organized into a limited number of cellular pathways, including RNA splicing (SF3B1, SRSF2, ZRSR2, U2AF1 genes), DNA methylation (TET2, DNMT3A, IDH1/2), transcription regulation (RUNX1), signal transduction (CBL, RAS), DNA repair (TP53), chromatin modification (ASXL1, EZH2), and cohesin complex (STAG2). Few genes are consistently mutated in >10% of patients, whereas a long tail of 40-50 genes are mutated in <5% of cases. At diagnosis, the majority of MDS patients have 2-4 driver mutations and hundreds of background mutations. Reliable genotype/phenotype relationships were described in MDS: SF3B1 mutations are associated with the presence of ring sideroblasts and more recent studies indicate that other splicing mutations (SRSF2, U2AF1) may identify distinct disease categories with specific hematological features. Moreover, gene mutations have been shown to influence the probability of survival and risk of disease progression and mutational status may add significant information to currently available prognostic tools. For instance, SF3B1 mutations are predictors of favourable prognosis, while driver mutations of other genes (such as ASXL1, SRSF2, RUNX1, TP53) are associated with a reduced probability of survival and increased risk of disease progression. In this article, we review the most recent advances in our understanding of the genetic basis of myelodysplastic syndromes and discuss its clinical relevance.
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Affiliation(s)
- Chiara Chiereghin
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089 Rozzano, Italy; (C.C.); (E.T.); (M.Z.); (E.S.); (C.S.); (E.R.)
| | - Erica Travaglino
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089 Rozzano, Italy; (C.C.); (E.T.); (M.Z.); (E.S.); (C.S.); (E.R.)
| | - Matteo Zampini
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089 Rozzano, Italy; (C.C.); (E.T.); (M.Z.); (E.S.); (C.S.); (E.R.)
| | - Elena Saba
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089 Rozzano, Italy; (C.C.); (E.T.); (M.Z.); (E.S.); (C.S.); (E.R.)
| | - Claudia Saitta
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089 Rozzano, Italy; (C.C.); (E.T.); (M.Z.); (E.S.); (C.S.); (E.R.)
| | - Elena Riva
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089 Rozzano, Italy; (C.C.); (E.T.); (M.Z.); (E.S.); (C.S.); (E.R.)
| | - Matteo Bersanelli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Italy;
| | - Matteo Giovanni Della Porta
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089 Rozzano, Italy; (C.C.); (E.T.); (M.Z.); (E.S.); (C.S.); (E.R.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Italy;
- Correspondence: ; Tel.: +39-0282247668
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Ibrar W, Zhang W, Cox JL, Cushman-Vokoun A, Fu K, Greiner TC, Yuan J. The utility of a myeloid mutation panel for the diagnosis of myelodysplastic syndrome and myelodysplastic/myeloproliferative neoplasm. Int J Lab Hematol 2021; 43:1501-1509. [PMID: 34270867 DOI: 10.1111/ijlh.13659] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/03/2021] [Accepted: 06/29/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The diagnosis of myelodysplastic syndromes (MDS) and myelodysplastic/myeloproliferative neoplasms (MDS/MPN) is based on morphology and cytogenetics/FISH findings per 2017 WHO classification. With rare exceptions, somatic mutations have not been incorporated as the diagnostic criteria. METHODS We analyzed the utility of mutational analysis with a targeted 54-gene or 40-gene next-generation sequencing (NGS) panel in the diagnosis of MDS and MDS/MPN. RESULTS We retrospectively collected 92 patients who presented with unexplained cytopenia with or without cytosis, including 32 low-grade MDS (MDS-L), 18 high-grade MDS (MDS-H), 5 therapy-related MDS (MDS-TR), 19 MDS/MPN, and 18 negative cases. Of 92 patients, 197 somatic mutations involving 38 genes were detected and had variant allele frequency (VAF) ranging from 3% to 99%. The most common mutated genes were TET2, ASXL1, RUNX1, TP53, SRSF2, and SF3B1. MDS-L, MDS-H, MDS-TR, and MDS/MPN showed an average number of somatic mutations with a mean VAF of 1.9/33%, 2.6/30%, 2/36%, and 4/41%, respectively. SF3B1 mutations were exclusively observed in MDS-L and MDS/MPN. TP53 gene mutations were more frequently seen in MDS-H and MDS-TR. Among 34 patients with a diagnosis of MDS or MDS/MPN with normal cytogenetics, 31 patients (91%) had at least 1 mutation and 24 patients (71%) had ≥2 mutations with ≥10% VAF. CONCLUSION A myeloid mutational panel provides additional evidence of clonality besides cytogenetics/FISH studies in the diagnosis of cytopenia with or without cytosis. Two or more mutations with ≥10% VAF highly predicts MDS and MDS/MPN with a positive predictive value of 100%.
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Affiliation(s)
- Warda Ibrar
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Weiwei Zhang
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Jesse Lee Cox
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Allison Cushman-Vokoun
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kai Fu
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Timothy C Greiner
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ji Yuan
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
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Nagata Y, Zhao R, Awada H, Kerr CM, Mirzaev I, Kongkiatkamon S, Nazha A, Makishima H, Radivoyevitch T, Scott JG, Sekeres MA, Hobbs BP, Maciejewski JP. Machine learning demonstrates that somatic mutations imprint invariant morphologic features in myelodysplastic syndromes. Blood 2020; 136:2249-2262. [PMID: 32961553 PMCID: PMC7702479 DOI: 10.1182/blood.2020005488] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 08/13/2020] [Indexed: 12/19/2022] Open
Abstract
Morphologic interpretation is the standard in diagnosing myelodysplastic syndrome (MDS), but it has limitations, such as varying reliability in pathologic evaluation and lack of integration with genetic data. Somatic events shape morphologic features, but the complexity of morphologic and genetic changes makes clear associations challenging. This article interrogates novel clinical subtypes of MDS using a machine-learning technique devised to identify patterns of cooccurrence among morphologic features and genomic events. We sequenced 1079 MDS patients and analyzed bone marrow morphologic alterations and other clinical features. A total of 1929 somatic mutations were identified. Five distinct morphologic profiles with unique clinical characteristics were defined. Seventy-seven percent of higher-risk patients clustered in profile 1. All lower-risk (LR) patients clustered into the remaining 4 profiles: profile 2 was characterized by pancytopenia, profile 3 by monocytosis, profile 4 by elevated megakaryocytes, and profile 5 by erythroid dysplasia. These profiles could also separate patients with different prognoses. LR MDS patients were classified into 8 genetic signatures (eg, signature A had TET2 mutations, signature B had both TET2 and SRSF2 mutations, and signature G had SF3B1 mutations), demonstrating association with specific morphologic profiles. Six morphologic profiles/genetic signature associations were confirmed in a separate analysis of an independent cohort. Our study demonstrates that nonrandom or even pathognomonic relationships between morphology and genotype to define clinical features can be identified. This is the first comprehensive implementation of machine-learning algorithms to elucidate potential intrinsic interdependencies among genetic lesions, morphologies, and clinical prognostic in attributes of MDS.
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Affiliation(s)
- Yasunobu Nagata
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
- Department of Hematology, Nippon Medical School, Tokyo, Japan
| | - Ran Zhao
- Department of Quantitative Health Sciences and
| | - Hassan Awada
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Cassandra M Kerr
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Inom Mirzaev
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Sunisa Kongkiatkamon
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Aziz Nazha
- Leukemia Program, Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH; and
| | - Hideki Makishima
- Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Jacob G Scott
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Mikkael A Sekeres
- Leukemia Program, Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH; and
| | | | - Jaroslaw P Maciejewski
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
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Abstract
Acute myeloid leukemia (AML) has been shown to undergo multiple acquired mutations in hematopoietic cell lineages over years before becoming clinically apparent. The early stage of AML (before it becomes clinically recognizable) may be characterized by acquisition of some, but not all, leukemia-related somatic mutations in hematopoietic stem cells (HSCs). The physiological roles of these mutations remain puzzling. These HSCs have been termed as preleukemic HSCs. However, those frequent acquired somatic mutations are also found in healthy aging adults, namely, “age-related clonal hematopoiesis.” Multiple studies have demonstrated that the preleukemic HSCs survive through chemotherapy and then contribute to the relapse and the development of de novo AML. Whether preleukemic HSCs should be targeted or whether a preventive therapy should be considered for those individuals remains to be determined. This article aims to shed light on this special subject and to discuss the roles of preleukemic HSCs in leukemogenesis.
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Stein EM, DiNardo CD, Pollyea DA, Schuh AC. Response Kinetics and Clinical Benefits of Nonintensive AML Therapies in the Absence of Morphologic Response. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:e66-e75. [DOI: 10.1016/j.clml.2019.11.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/05/2019] [Accepted: 11/19/2019] [Indexed: 02/06/2023]
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Zhang G, Shi J, Yang X, Zhang X, Zhang L, Zhang J, Yang S, Wang J, Hu K, Ke X, Fu L. High expression of microRNA-500 is associated with poor prognosis in patients with acute myeloid leukemia receiving allogeneic hematopoietic stem cell transplantation. Oncol Lett 2019; 17:5815-5820. [PMID: 31186809 DOI: 10.3892/ol.2019.10250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 03/20/2019] [Indexed: 01/23/2023] Open
Abstract
MicroRNA-500 (miR-500) is a potential prognostic biomarker in a number of different types of cancer, such as prostate cancer and hepatocellular carcinoma. This study aimed to explore the clinical implications of miR-500 expression status in patients with acute myeloid leukemia (AML) that had received allogeneic hematopoietic stem cell transplantation (allo-HSCT). miR-500 expression status and clinical data were obtained from 74 patients with AML in the The Cancer Genome Atlas database receiving allo-HSCT. Patients with low expression level of miR-500 (miR-500low) were significantly more likely to present with a French-American-British classification M2 subtype (P=0.003), and less likely to have the M5 subtype (P=0.040) compared with patients with high expression levels (miR-500high). miR-500low patients were associated with low-risk AML (P=0.003) and core-binding factor subunit b-myosin heavy chain 11 translocation mutation (P=0.021). There was a significant difference in nucleophosmin 1 (P=0.009), NRAS proto-oncogene GTPase/KRAS proto-oncogene GTPase (P=0.047) and PHD finger protein 6 (P=0.040) expression levels between the two groups. miR-500high patients had a decreased overall survival (OS) time compared with the low expression group (P=0.035). Multivariate analysis revealed that miR-500 expression significantly affected OS time independent of other classical prognostic factors, such as age and common mutations. The analysis of survival curves further substantiated this result. The results obtained in the current study suggested that miR-500 may be a suitable prognostic marker for patients with AML receiving allo-HSCT.
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Affiliation(s)
- Gaoqi Zhang
- Department of Hematology and Lymphoma Research Center, Peking University, Third Hospital, Beijing 100191, P.R. China
| | - Jinlong Shi
- Department of Biomedical Engineering, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China.,Department of Medical Big Data, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China
| | - Xinrui Yang
- Department of Hematology and Lymphoma Research Center, Peking University, Third Hospital, Beijing 100191, P.R. China
| | - Xinpei Zhang
- Department of Hematology and Lymphoma Research Center, Peking University, Third Hospital, Beijing 100191, P.R. China
| | - Lingxiu Zhang
- Department of Hematology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan 453100, P.R. China
| | - Jilei Zhang
- Department of Hematology and Lymphoma Research Center, Peking University, Third Hospital, Beijing 100191, P.R. China
| | - Siyuan Yang
- Department of Hematology and Lymphoma Research Center, Peking University, Third Hospital, Beijing 100191, P.R. China
| | - Jing Wang
- Department of Hematology and Lymphoma Research Center, Peking University, Third Hospital, Beijing 100191, P.R. China
| | - Kai Hu
- Department of Hematology and Lymphoma Research Center, Peking University, Third Hospital, Beijing 100191, P.R. China
| | - Xiaoyan Ke
- Department of Hematology and Lymphoma Research Center, Peking University, Third Hospital, Beijing 100191, P.R. China
| | - Lin Fu
- Department of Hematology and Lymphoma Research Center, Peking University, Third Hospital, Beijing 100191, P.R. China
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Liu Y, Cheng Z, Li Q, Pang Y, Cui L, Qian T, Quan L, Dai Y, Jiao Y, Zhang Z, Ye X, Shi J, Fu L. Prognostic significance of the PANK family expression in acute myeloid leukemia. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:261. [PMID: 31355228 DOI: 10.21037/atm.2019.05.28] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background Acute myeloid leukemia (AML) is a highly heterogenous hematological malignancy and its prognostication depends on the genetic mutation and expression profile of each patient. Pantothenate kinase (PANK) is a regulatory enzyme that controls coenzyme A (CoA) biosynthesis. It has four isoforms encoded by PANK1-4, respectively. Whether the expression of the PANK family has prognostic significance in AML remains unclear. Methods We screened The Cancer Genome Atlas database for AML patients with complete PANK1-4 expression data. Eighty-four AML patients met the criteria and were included in this study. Clinical characteristics at diagnosis, including peripheral blood (PB) white blood cell counts (WBC), blast percentages in PB and bone marrow (BM), French-American-British (FAB) subtypes and the frequencies of common genetic mutations were described. Survival was estimated using the Kaplan-Meier method and the log-rank test. Multivariate Cox proportional hazard models were constructed for event-free survival (EFS) and overall survival (OS), using a limited backward elimination procedure. Results Patients with high PANK2 expression had significantly longer event-free survival (EFS) and overall survival (OS) than patients with low PANK2 expression (P=0.007, P=0.016, respectively), whereas patients with high PANK4 expression had shorter EFS and OS than patients with low PANK4 expression (P=0.022, P=0.015, respectively). Multivariate analysis confirmed that high PANK4 expression was an independent risk factor for EFS and OS (both P<0.05). Conclusions Our study suggested that high PANK2 expression might have favorable effects on AML, while high PANK4 expression was indicative of poor prognosis.
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Affiliation(s)
- Yan Liu
- Department of Hematology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China.,Translational Medicine Center, Huaihe Hospital of Henan University, Kaifeng 475000, China.,Department of Hematology and Lymphoma Research Center, Peking University, Third Hospital, Beijing 100191, China.,Translational Medicine Center, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China.,Department of Hematology, Huaihe Hospital of Henan University, Kaifeng 475000, China
| | - Zhiheng Cheng
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Qihui Li
- Department of Hematology and Lymphoma Research Center, Peking University, Third Hospital, Beijing 100191, China
| | - Yifan Pang
- Department of Medicine, William Beaumont Hospital, Royal Oak, MI 48073, USA
| | - Longzhen Cui
- Translational Medicine Center, Huaihe Hospital of Henan University, Kaifeng 475000, China
| | - Tingting Qian
- Department of Hematology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China.,Translational Medicine Center, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China
| | - Liang Quan
- Department of Hematology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China.,Translational Medicine Center, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China
| | - Yifeng Dai
- Immunoendocrinology, Division of Medical Biology, Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Yang Jiao
- Life Sciences Institute and Innovation Center for Cell Signaling Network, Zhejiang University, Hangzhou 310058, China
| | - Zhihui Zhang
- Department of Stomatology, Peking University Third Hospital, Beijing 100191, China
| | - Xu Ye
- Department of Hematology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China
| | - Jinlong Shi
- Department of Medical Big Data, Chinese PLA General Hospital, Beijing 100853, China
| | - Lin Fu
- Department of Hematology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China.,Translational Medicine Center, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China.,Department of Hematology, Huaihe Hospital of Henan University, Kaifeng 475000, China
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Fusarium solani infection as an initial manifestation of AML transformation in myelodysplastic syndrome: A case report. J Mycol Med 2018; 28:390-392. [PMID: 29724543 DOI: 10.1016/j.mycmed.2018.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 04/03/2018] [Accepted: 04/05/2018] [Indexed: 12/20/2022]
Abstract
Severely immunocompromised patients are at increased risk for uncommon infectious diseases with atypical presentations. Fusarium sp., has been reported in patients with hematological malignancies and prompt diagnosis is necessary due to high mortality. We report a myelodysplastic syndrome (MDS) patient who presented Fusarium solani infection associated with granulocytic sarcoma as an initial presentation of acute myeloid leukemia (AML) transformation. We performed histological examination, immunohistochemistry analysis, culture of the biopsy tissue and DNA sequencing to make a conclusive diagnosis of F. solani and granulocytic sarcoma, reinforcing the necessity of performing complete evaluation of skin lesions in immunocompromised patients.
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Cheng Z, Hu K, Tian L, Dai Y, Pang Y, Cui W, Zhao H, Qin T, Han Y, Hu N, Chen L, Wang C, Zhang Y, Wu D, Ke X, Shi J, Fu L. Clinical and biological implications of mutational spectrum in acute myeloid leukemia of FAB subtypes M4 and M5. Cancer Gene Ther 2018; 25:77-83. [PMID: 29491461 DOI: 10.1038/s41417-018-0013-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 12/01/2017] [Accepted: 12/15/2017] [Indexed: 02/05/2023]
Abstract
The mutational spectrum and molecular characteristics of acute myelomonocytic lineage leukemia, namely acute myeloid leukemia (AML) French-American-British (FAB) subtypes M4 and M5, are largely unknown. In order to explore the mutational spectrum and prognostic factors of FAB-M4 and -M5, next-generation sequencing (NGS) was performed to screen for mutated genes and fusion genes relevant to the pathogenesis of AML. Of the 63 patients enrolled in the study, 60% had more than three mutated genes. NPM1 had the highest mutation frequency, followed by DNMT3A, FLT3, NRAS, RUNX1, and TET2. Univariate analysis suggested that age ≥60 years was an independent factor for both poor event-free survival (EFS) and overall survival (OS, P = 0.009, 0.002, respectively), MYH11-CBFβ was associated with better EFS and OS (P = 0.029, 0.016, respectively). However, multivariate analysis was not able to identify any independent risk factor for survival in the cohort of FAB-M4 and -M5 patients, including peripheral white blood cell count, bone marrow blast percentage, MYH11-CBFβ, FLT3-ITD, mutations in NPM1 and DNMT3A, and allogeneic hematopoietic stem cell transplantation (allo-HSCT). Our study provided new insight into the mutational spectrum and molecular characteristics of FAB-M4 and -M5. The clinical implications of the genetic signature of FAB-M4 and -M5 need to be further elucidated by larger studies.
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Affiliation(s)
- Zhiheng Cheng
- Translational Medicine Center, Huaihe Hospital of Henan University, Kaifeng, 475000, China
| | - Kai Hu
- Department of Hematology and Lymphoma Research Center, Peking University Third Hospital, Beijing, 100191, China
| | - Lei Tian
- Department of Hematology and Lymphoma Research Center, Peking University Third Hospital, Beijing, 100191, China
| | - Yifeng Dai
- Laboratory of Environmental Medicine and Developmental Toxicology, Shantou University Medical College, Shantou, 515041, China
| | - Yifan Pang
- Department of Medicine, William Beaumont Hospital, Royal Oak, MI, 48073, USA
| | - Wei Cui
- Department of Clinical Laboratory, Beijing Haidian Hospital, Beijing Haidian Section of Peking University Third Hospital, Beijing, 100080, China
| | - Hongmian Zhao
- Department of Hematology, Huaihe Hospital of Henan University, Kaifeng, 475000, China
| | - Tong Qin
- Department of Hematology, Huaihe Hospital of Henan University, Kaifeng, 475000, China
| | - Yu Han
- Department of Hematology, Huaihe Hospital of Henan University, Kaifeng, 475000, China
| | - Ning Hu
- Department of Hematology, Huaihe Hospital of Henan University, Kaifeng, 475000, China
| | - Li Chen
- Department of Hematology, Huaihe Hospital of Henan University, Kaifeng, 475000, China
| | - Chao Wang
- Department of Hematology, Huaihe Hospital of Henan University, Kaifeng, 475000, China
| | - Yijie Zhang
- Department of Respiratory, Huaihe Hospital of Henan University, Kaifeng, 475000, China
| | - Depei Wu
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Xiaoyan Ke
- Department of Hematology and Lymphoma Research Center, Peking University Third Hospital, Beijing, 100191, China
| | - Jinlong Shi
- Translational Medicine Center, Huaihe Hospital of Henan University, Kaifeng, 475000, China.
- Department of Biomedical Engineering, Chinese PLA General Hospital, Beijing, 100853, China.
- Department of Medical Big Data, Chinese PLA General Hospital, Beijing, 100853, China.
| | - Lin Fu
- Department of Hematology and Lymphoma Research Center, Peking University Third Hospital, Beijing, 100191, China.
- Department of Hematology, Huaihe Hospital of Henan University, Kaifeng, 475000, China.
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Ganguly BB, Banerjee D, Agarwal MB. Impact of chromosome alterations, genetic mutations and clonal hematopoiesis of indeterminate potential (CHIP) on the classification and risk stratification of MDS. Blood Cells Mol Dis 2018; 69:90-100. [DOI: 10.1016/j.bcmd.2017.10.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 10/13/2017] [Indexed: 01/23/2023]
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12
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Jiang Y, Liu L, Wang J, Cao Z, Zhao Z. The Wilms' tumor gene-1 is a prognostic factor in myelodysplastic syndrome: a meta analysis. Oncotarget 2017; 9:16205-16212. [PMID: 29662637 PMCID: PMC5882328 DOI: 10.18632/oncotarget.23671] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 12/11/2017] [Indexed: 11/25/2022] Open
Abstract
Previous studies have suggested that Wilms’ tumor gene-1 (WT1) may be related to a decrease in both relapse-free survival (RFS) and overall survival (OS) for patients with myelodysplastic syndrome (MDS). Therefore, we conducted a meta-analysis on the utility of WT1 as a prognostic indicator of MDS. Published reports were searched in the following databases: Cochrane Library, PubMed, Embase, and Web of Science. The meta-analysis was conducted using the Cochrane Collaboration RevMan 5.2 software. Six publications with 450 total patients met the inclusion criteria and were subjected to further examination. The results showed a reduction in both overall survival (OS) and leukemia-free survival (LFS) with increasing WT1 expression levels: 1-year OS (odds ratio, OR = 0.16; 95% CI = 0.08–0.34, P < 0.001), 3-year OS (OR = 0.21; 95% CI = 0.09–0.47, P < 0.001), 5-year OS (OR = 0.24; 95% CI = 0.06–0.92, P = 0.04), 1-year LFS (OR = 0.06; 95% CI = 0.02–0.18; P < 0.001), 3-year LFS (OR = 0.20; 95% CI = 0.09–0.46; P < 0.001), and 5-year LFS (OR = 0.12; 95% CI = 0.04–0.38; P < 0.001). In terms of patients receiving hematopoietic stem cell transplantation, the cumulative incidence of relapse (CIR) was higher in the WT1 over-expression group than in the low-expression group: 1-year CIR (OR = 13.69; 95% CI = 2.99–62.62; P < 0.001), 3-year CIR (OR = 6.52; 95% CI = 2.31–18.40, P < 0.001). In conclusion, WT1 over-expression is a prognostic factor for MDS.
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Affiliation(s)
- Yanan Jiang
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Lin Liu
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Jinhuan Wang
- Department of Oncology, Second Hospital of Tianjin Medical University, Institute of Urology, Tianjin 300060, China
| | - Zeng Cao
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Zhigang Zhao
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
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13
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Malcovati L. Introduction. Semin Hematol 2017; 54:129-132. [PMID: 28958285 DOI: 10.1053/j.seminhematol.2017.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Luca Malcovati
- Department of Molecular Medicine, University of Pavia and; Department of Hematology Oncology, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy.
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14
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Xu Y, Li Y, Xu Q, Chen Y, Lv N, Jing Y, Dou L, Bo J, Hou G, Guo J, Wang X, Wang L, Li Y, Chen C, Yu L. Implications of mutational spectrum in myelodysplastic syndromes based on targeted next-generation sequencing. Oncotarget 2017; 8:82475-82490. [PMID: 29137279 PMCID: PMC5669905 DOI: 10.18632/oncotarget.19628] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 06/30/2017] [Indexed: 02/01/2023] Open
Abstract
Myelodysplastic syndromes (MDS) are a group of myeloid hematological malignancies, with a high risk of progression to acute myeloid leukemia (AML). To explore the role of acquired mutations in MDS, 111 MDS-associated genes were screened using next-generation sequencing (NGS), in 125 patients. One or more mutations were detected in 84% of the patients. Some gene mutations are specific for MDS and were associated with disease subtypes, and the patterns of mutational pathways could be associated with progressive MDS. The patterns, frequencies and functional pathways of gene mutations are different, but somehow related, between MDS and AML. Multivariate analysis suggested that patients with ≥ 2 mutations had poor progression-free survival, while GATA1/GATA2, DNMT3A and KRAS/NRAS mutations were associated with poor overall survival. Based on a novel system combining IPSS-R and molecular markers, these MDS patients were further divided into 3 more accurate prognostic subgroups. A panel of 11 target genes was proposed for genetic profiling of MDS. The study offers new insights into the molecular signatures of MDS and the genetic consistency between MDS and AML. Furthermore, results indicate that MDS could be classified by mutation combinations to guide the administration of individualized therapeutic interventions.
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Affiliation(s)
- Yuanyuan Xu
- Department of Hematology and BMT center, Chinese PLA General Hospital, Beijing 100853, China.,Department of Hematology, Hainan Branch of Chinese PLA General Hospital, Sanya 572013, Hainan Province, China
| | - Yan Li
- Department of Hematology and BMT center, Chinese PLA General Hospital, Beijing 100853, China.,Department of Hematology, Hainan Branch of Chinese PLA General Hospital, Sanya 572013, Hainan Province, China
| | - Qingyu Xu
- Department of Hematology and BMT center, Chinese PLA General Hospital, Beijing 100853, China.,Medical school of Nankai University, Tianjin 300071, China
| | - Yuelong Chen
- Annoroad Gene Technology Co. Ltd, Beijing 100176, China
| | - Na Lv
- Department of Hematology and BMT center, Chinese PLA General Hospital, Beijing 100853, China
| | - Yu Jing
- Department of Hematology and BMT center, Chinese PLA General Hospital, Beijing 100853, China
| | - Liping Dou
- Department of Hematology and BMT center, Chinese PLA General Hospital, Beijing 100853, China
| | - Jian Bo
- Department of Hematology and BMT center, Chinese PLA General Hospital, Beijing 100853, China
| | - Guangyuan Hou
- Annoroad Gene Technology Co. Ltd, Beijing 100176, China
| | - Jing Guo
- Annoroad Gene Technology Co. Ltd, Beijing 100176, China
| | - Xiuli Wang
- Annoroad Gene Technology Co. Ltd, Beijing 100176, China
| | - Lili Wang
- Department of Hematology and BMT center, Chinese PLA General Hospital, Beijing 100853, China
| | - Yonghui Li
- Department of Hematology and BMT center, Chinese PLA General Hospital, Beijing 100853, China
| | | | - Li Yu
- Department of Hematology and BMT center, Chinese PLA General Hospital, Beijing 100853, China.,Department of Hematology, General Hospital of Shenzhen University, Shenzhen 518060, China
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15
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Huang M, Zhao X, Xu H, Liu S, Wang Z, Sui X, Li J. Correlation Between Bone Marrow Blasts Counts With Flow Cytometry and Morphological Analysis in Myelodysplastic Syndromes. Ann Lab Med 2017. [PMID: 28643497 PMCID: PMC5500747 DOI: 10.3343/alm.2017.37.5.450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Min Huang
- Department of Clinical Laboratory, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China
| | - Xinya Zhao
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China.
| | - Hongzhi Xu
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China
| | - Suqing Liu
- Department of Nephrology, Shandong Provincial Hospital Group, Heze Municipal Hospital, Shandong, China
| | - Zie Wang
- Department of Clinical Laboratory, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China
| | - Xiaohui Sui
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China
| | - Jing Li
- Department of Clinical Laboratory, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China
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16
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Hiwase DK, Singhal D, Strupp C, Chhetri R, Kutyna MM, Wee LA, Harrison PB, Nath SV, Wickham N, Hui CH, Gray JX, Bardy P, Ross DM, Lewis ID, Reynolds J, To LB, Germing U. Dynamic assessment of RBC-transfusion dependency improves the prognostic value of the revised-IPSS in MDS patients. Am J Hematol 2017; 92:508-514. [PMID: 28247421 DOI: 10.1002/ajh.24704] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 02/18/2017] [Accepted: 02/22/2017] [Indexed: 01/22/2023]
Abstract
RBC-transfusion dependency (RBC-TD) is an independent prognostic factor for poor overall survival (OS) in the WHO classification-based prognostic scoring system (WPSS) for MDS patients. However, WPSS did not include cytopenia, whereas revised International Prognostic Scoring System (IPSS-R) did not include RBC-TD. Thus, neither of these prognostic scoring systems incorporates both cytopenia and RBC-TD. We aimed to test whether RBC-TD adds prognostic value to the IPSS-R. We analyzed MDS patients not treated with disease-modifying therapy, and enrolled in SA-MDS Registry (derivation cohort; n = 295) and Dusseldorf registry (Germany; validation cohort; n = 113) using time-dependent Cox proportional regression and serial landmark analyses. In the derivation cohort, RBC-TD patients had inferior OS compared to RBC transfusion-independent (RBC-TI) patients (P < 0.0001) at 6- (18 vs. 64 months), 12- (24 vs. 71 months), and 24-months (40 vs. 87 months). In a Cox proportional regression analysis, RBC-TD was an independent adverse prognostic marker in addition to age, sex, and IPSS-R variables (P < 0.0001). A prognostic index (PI) was derived using these Cox-proportional regression model variables. In the validation cohort, this PI classified patients into four prognostic groups with significantly different OS (P < 0.001) as in the derivation cohort. In conclusion, multivariate analysis by Cox proportional hazards regression and serial landmark analyses clearly demonstrates that development of RBC-TD at any time during the course of MDS is associated with poor OS, independent of IPSS-R. This study demonstrates that dynamic assessment of RBC-TD provides additional prognostic value to IPSS-R and should be included in treatment decision algorithms for MDS patients.
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Affiliation(s)
- Devendra K. Hiwase
- Haematology Department; SA Pathology; Adelaide Australia
- Cancer Centre, Royal Adelaide Hospital; Adelaide Australia
- School of Medicine; University of Adelaide; Adelaide Australia
- Cancer Research, Cancer Theme, South Australian Health and Medical Research Institute; Adelaide Australia
| | - Deepak Singhal
- Haematology Department; SA Pathology; Adelaide Australia
- Cancer Centre, Royal Adelaide Hospital; Adelaide Australia
- School of Medicine; University of Adelaide; Adelaide Australia
| | - Corinna Strupp
- Department of Hematology; Oncology, and Clinical Immunology, Heinrich Heine University; Düsseldorf Germany
| | | | | | - L. Amilia Wee
- Haematology Department; SA Pathology; Adelaide Australia
| | | | - Shriram V. Nath
- Adelaide Haematology Centre, Ashford Specialist Centre; Adelaide Australia
| | - Nicholas Wickham
- Adelaide Cancer Centre, Ashford Specialist Centre; Adelaide Australia
| | - Chi-Hung Hui
- Adelaide Cancer Centre, Ashford Specialist Centre; Adelaide Australia
| | - James X. Gray
- Department of Haematology/Oncology; The Queen Elizabeth Hospital; Adelaide Australia
| | - Peter Bardy
- Haematology Department; SA Pathology; Adelaide Australia
- Cancer Centre, Royal Adelaide Hospital; Adelaide Australia
- School of Medicine; University of Adelaide; Adelaide Australia
| | - David M. Ross
- Haematology Department; SA Pathology; Adelaide Australia
- Cancer Centre, Royal Adelaide Hospital; Adelaide Australia
- School of Medicine; University of Adelaide; Adelaide Australia
- Department of Haematology; Flinders University and Medical Centre; Adelaide Australia
| | - Ian D. Lewis
- Haematology Department; SA Pathology; Adelaide Australia
- Cancer Centre, Royal Adelaide Hospital; Adelaide Australia
- School of Medicine; University of Adelaide; Adelaide Australia
| | - John Reynolds
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University; Melbourne VIC Australia
| | - L. Bik To
- Haematology Department; SA Pathology; Adelaide Australia
- Cancer Centre, Royal Adelaide Hospital; Adelaide Australia
- School of Medicine; University of Adelaide; Adelaide Australia
| | - Ulrich Germing
- Department of Hematology; Oncology, and Clinical Immunology, Heinrich Heine University; Düsseldorf Germany
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17
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Ribeiro HL, Maia ARS, de Oliveira RTG, Costa MB, Farias IR, de Paula Borges D, de Sousa JC, Magalhães SMM, Pinheiro RF. DNA repair gene expressions are related to bone marrow cellularity in myelodysplastic syndrome. J Clin Pathol 2017; 70:970-980. [DOI: 10.1136/jclinpath-2016-204269] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 02/21/2017] [Accepted: 04/07/2017] [Indexed: 12/18/2022]
Abstract
ObjectiveTo evaluate the expression of genes related to nuclear excision (ERCC8, XPA and XPC), homologous recombination and non-homologous end-joining (ATM, BRCA1, BRCA2 and LIG4) repair mechanisms, using quantitative PCR methodologies, and it relation with bone marrow cellularity in myelodysplastic syndrome (MDS).Methods and resultsA total of 51 adult de novo patients with MDS (3 refractory anaemia (RA), 11 refractory anaemia with ringed sideroblasts (RARS), 28 refractory cytopenia with multilineage dysplasia (RCMD), 3 refractory anaemia with excess blasts type I (RAEB-I), 5 refractory anaemia with excess blasts type II (RAEB-II), and 1 chronic myelomonocytic leukaemia (CMML) were evaluated. For karyotype, 16.2% patients were defined as very low prognosis, 59.5% low risk, 8.1% intermediate risk, 5.4% high risk and 10.8% very high risk. For bone marrow cellularity, 17.6%, 17.6% and 64.7% presented as hypocellular, normocellular and hypercellular, respectively. Patients with hypocellular MDS had significantly decreased expression of ATM (p=0.000), BRCA1 (p=0.014), BRCA2 (p=0.003), LIG4 (p=0.004) and ERCC8 (p=0.000) than those with normocellular/hypercellular bone marrow, whereas XPA (p=0.049) and XPC (p=0.000) genes were increased. In patients with hypoplastic MDS, a low expression of ATM (p=0.0268), LIG4 (p=0.0199) and ERCC8 (p=0.0493) was significantly associated with the presence of chromosomal abnormalities. We detected positive correlations between BRCA1 and BRCA2 (r=0.416; p=0.007), ATM and LIG4 (r=0.472; p=0.001), LIG4 and BRCA1 (r=0.333; p=0.026), LIG4 and BRCA2 (r=0.334; p=0.025), ATM and XPA (r=0.377; p=0.008), ATM and XPC (r=0.287; p=0.046), LIG4 and XPC (r=0.371; p=0.007) and XPA and XPC genes (r=0.895; p=0.0000). We also found among all patients evaluated that correlation with LIG4 occurred most often.ConclusionsThese correlations demonstrate the important intrinsic relations between single and double DNA strand breaks genes in MDS, emphasising that these genes are related to MDS pathogenesis.
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18
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Decision analysis of allogeneic hematopoietic stem cell transplantation for patients with myelodysplastic syndrome stratified according to the revised International Prognostic Scoring System. Leukemia 2017; 31:2449-2457. [PMID: 28321120 DOI: 10.1038/leu.2017.88] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 02/03/2017] [Accepted: 03/03/2017] [Indexed: 12/14/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-SCT) represents the only curative treatment for patients with myelodysplastic syndrome (MDS), but involves non-negligible morbidity and mortality. Crucial questions in clinical decision-making include the definition of optimal timing of the procedure and the benefit of cytoreduction before transplant in high-risk patients. We carried out a decision analysis on 1728 MDS who received supportive care, transplantation or hypomethylating agents (HMAs). Risk assessment was based on the revised International Prognostic Scoring System (IPSS-R). We used a continuous-time multistate Markov model to describe the natural history of disease and evaluate the effect of different treatment policies on survival. Life expectancy increased when transplantation was delayed from the initial stages to intermediate IPSS-R risk (gain-of-life expectancy 5.3, 4.7 and 2.8 years for patients aged ⩽55, 60 and 65 years, respectively), and then decreased for higher risks. Modeling decision analysis on IPSS-R versus original IPSS changed transplantation policy in 29% of patients, resulting in a 2-year gain in life expectancy. In advanced stages, HMAs given before transplant is associated with a 2-year gain-of-life expectancy, especially in older patients. These results provide a preliminary evidence to maximize the effectiveness of allo-SCT in MDS.
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19
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Diagnostic Utility of Flow Cytometry in Myelodysplastic Syndromes. Mediterr J Hematol Infect Dis 2017; 9:e2017017. [PMID: 28293405 PMCID: PMC5333741 DOI: 10.4084/mjhid.2017.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/20/2017] [Indexed: 12/19/2022] Open
Abstract
The pathological hallmark of myelodysplastic syndromes (MDS) is marrow dysplasia, which represents the basis of the WHO classification of these disorders. This classification provides clinicians with a useful tool for defining the different subtypes of MDS and individual prognosis. The WHO proposal has raised some concern regarding minimal diagnostic criteria particularly in patients with normal karyotype without robust morphological markers of dysplasia (such as ring sideroblasts or excess of blasts). Therefore, there is clearly need to refine the accuracy to detect marrow dysplasia. Flow cytometry (FCM) immunophenotyping has been proposed as a tool to improve the evaluation of marrow dysplasia. The rationale for the application of FCM in the diagnostic work up of MDS is that immunophenotyping is an accurate method for quantitative and qualitative evaluation of hematopoietic cells and that MDS have been found to have abnormal expression of several cellular antigens. To become applicable in clinical practice, FCM analysis should be based on parameters with sufficient specificity and sensitivity, data should be reproducible between different operators, and the results should be easily understood by clinicians. In this review, we discuss the most relevant progresses in detection of marrow dysplasia by FCM in MDS
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20
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Wang W, Zhu P, Gu JW, Wang XQ. [Optimal cut-off points of CD34 and CD117 in the differential diagnosis between hypocellular myelodysplastic syndrome and aplastic anemia]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2017; 38:75-77. [PMID: 28219233 PMCID: PMC7348400 DOI: 10.3760/cma.j.issn.0253-2727.2017.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Indexed: 11/21/2022]
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21
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Koeffler HP, Leong G. Preleukemia: one name, many meanings. Leukemia 2016; 31:534-542. [PMID: 27899806 PMCID: PMC5339433 DOI: 10.1038/leu.2016.364] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 11/11/2016] [Accepted: 11/14/2016] [Indexed: 12/15/2022]
Abstract
Definition of preleukemia has evolved. It was first used to describe the myelodysplastic syndrome (MDS) with a propensity to progress to acute myeloid leukemia (AML). Individuals with germline mutations of either RUNX1, CEBPA, or GATA2 can also be called as preleukemic because they have a markedly increased incidence of evolution into AML. Also, alkylating chemotherapy or radiation can cause MDS/preleukemia, which nearly always progress to AML. More recently, investigators noted that AML patients who achieved complete morphological remission after chemotherapy often have clonal hematopoiesis predominantly marked by either DNMT3A, TET2 or IDH1/2 mutations, which were also present at diagnosis of AML. This preleukemic clone represents involvement of an early hematopoietic stem cells, which is resistant to standard therapy. The same clonal hematopoietic mutations have been identified in older ‘normal' individuals who have a modest increased risk of developing frank AML. These individuals have occasionally been said, probably inappropriately, to have a preleukemia clone. Our evolving understanding of the term preleukemia has occurred by advancing technology including studies of X chromosome inactivation, cytogenetics and more recently deep nucleotide sequencing.
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Affiliation(s)
- H P Koeffler
- Department of Hematology and Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Cancer Science Institute of Singapore, National University of Singapore, Singapore.,National University Cancer Institute of Singapore, National University Hospital, Singapore
| | - G Leong
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
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22
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Vasekova P, Plank L. The Differencies in Adult and Pediatric Myelodysplastic Syndrome: A Review. ACTA MEDICA MARTINIANA 2016. [DOI: 10.1515/acm-2016-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Myelodysplastic syndrome (MDS) represent very heterogenous group of clonal stem cell bone marrow disorders with ineffective haematopoesis leading to cytopenias in peripheral blood and increased risk of blastic transformation and evolution of acute myeloid leukemia. MDS is a disease of older age mostly, in children it seems to be very rare. There are several significant morphological, cytogenetic and prognostic differencies of the disease in adults and in children. Adult MDS patients most commonly manifest with symptoms of anemia, bleeding and infection are uncommon. In childhood, MDS manifests predominantly by neutropenia and thrombocytopenia. In addition, some pediatric MDS patients present also with constitutional disease’s signs and symptoms. Early and correct diagnosis in both age groups is essential for the choice of appropriate therapy and also for next life of patients. However, the diagnosis of MDS is challenging, complex and requiring close correlation of clinical symptoms, laboratory parameters and standardized examination of BM biopsies. The authors present an overview focused on biology of MDS in adults and children, on the differences in the incidence, clinical presentation and treatment. They summarize the possibilities and limits of histopathological diagnosis and differential diagnosis of the disease in different age groups. A major problem in the morphological diagnosis of MDS remains the determination, whether the myelodysplasia is due to clonal disorder. It might result also from some other factors, as significant dysplasia can also occur in reactive conditions, and vice versa, only discrete dysplasia is sometimes observed in MDS patients. Although histomorphological and immunohistochemical analysis of BM biopsy is invasive and time-consuming examination, it has its value in the diagnosis, differential diagnosis and evaluation of therapeutic effect.
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Affiliation(s)
- P Vasekova
- Comenius University in Bratislava, Jessenius Faculty of Medicine and University Hospital in Martin, Department of Pathological Anatomy, Slovakia
| | - L Plank
- Comenius University in Bratislava, Jessenius Faculty of Medicine and University Hospital in Martin, Department of Pathological Anatomy, Slovakia
- Martin s Biopsy Center, Ltd in Martin, Slovakia
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23
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Influence of functional polymorphisms in DNA repair genes of myelodysplastic syndrome. Leuk Res 2016; 48:62-72. [DOI: 10.1016/j.leukres.2016.06.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 06/24/2016] [Accepted: 06/27/2016] [Indexed: 11/17/2022]
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Mutations of myelodysplastic syndromes (MDS): An update. MUTATION RESEARCH-REVIEWS IN MUTATION RESEARCH 2016; 769:47-62. [DOI: 10.1016/j.mrrev.2016.04.009] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 04/11/2016] [Indexed: 01/08/2023]
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25
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Yue QF, Chen L, She XM, Hu B, Hu Y, Zou P, Liu XY. Clinical Prognostic Factors in 86 Chinese Patients with Primary Myelodysplastic Syndromes and Trisomy 8: A Single Institution Experience. Yonsei Med J 2016; 57:358-64. [PMID: 26847287 PMCID: PMC4740527 DOI: 10.3349/ymj.2016.57.2.358] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 12/01/2014] [Accepted: 01/08/2015] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The objective was to determine the characteristics and prognostic factors of 86 Chinese patients with trisomy 8 aberrations and compare the prognostic value of International Prognostic System (IPSS) and Revised IPSS (IPSS-R) in this cohort. MATERIALS AND METHODS A total of 86 cases diagnosed with primary myelodysplastic syndromes (MDS) with isolated tr8 or with tr8 and other additional cytogenetic aberrations diagnosed and treated at the Union Hospital, Tongji Medical College of Huazhong University of Science and Technology between July 2002 and March 2013 were reviewed. RESULTS The median survival of the entire group was 23.0 months, and acute myeloid leukemia (AML) developed in 43% (37/86) patients within the follow up time. The univariate analysis revealed that overall survival (OS) was correlated with age, thrombocytopenia, absolute neutrophil count, marrow blasts, cytogenetic status and red blood cell transfusion at diagnosis, and the multivariate analysis revealed that age, marrow blasts, cytogenetic status and transfusion dependence were independent parameters for the OS. The cytogenetic complexity and marrow blasts had the strongest impact on the AML transformation by multivariate analysis. Comparing the two prognostic systems, both two systems could successfully discriminate risk groups for survival. IPSS-R was more refined than IPSS for predicting OS, but had no advantage in predicting the risk of AML development. CONCLUSION This study confirmed the influence of clinical factors on the prognosis of 86 Chinese MDS patients with trisomy 8. In addition, IPSS-R can further refine prognostic discrimination in the IPSS risk categories.
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Affiliation(s)
- Qing Fang Yue
- Department of Medical Oncology, ShaanXi Provincial People's Hospital, Xi'an, Shaanxi, P.R. China
| | - Lei Chen
- Department of Hematology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Xiao Mei She
- Department of Hematology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Bin Hu
- Department of Hematology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Yu Hu
- Department of Hematology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Ping Zou
- Department of Hematology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Xin Yue Liu
- Department of Hematology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China.
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26
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Lee EJ, Podoltsev N, Gore SD, Zeidan AM. The evolving field of prognostication and risk stratification in MDS: Recent developments and future directions. Blood Rev 2016; 30:1-10. [DOI: 10.1016/j.blre.2015.06.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 06/08/2015] [Accepted: 06/15/2015] [Indexed: 01/01/2023]
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27
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Gao J, Swaminathan S, Pai N, Johnson Z, Chen YH, Peterson L, Goolsby C. Flow cytometric detection of altered signaling in myelodysplastic syndrome and cytopenia. Leuk Res 2015; 39:1396-404. [PMID: 26410459 DOI: 10.1016/j.leukres.2015.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 08/17/2015] [Accepted: 09/06/2015] [Indexed: 10/23/2022]
Abstract
Multiparameter flow cytometric analysis allows for precise evaluation of growth factor stimulated intracellular signaling in distinct immunophenotype defined hematopoetic populations. Our analysis of intracellular phosphoprotein in response to major hematopoietic growth factors or cytokines showed several interesting findings. Although there was no characteristic signaling abnormality that was diagnostic for MDS, MDS cases were often associated with more signaling aberrancies involving more cellular populations. Higher than average response in the CD34(+)CD117(+) progenitor cells to Flt3 ligand and stem cell factor stimulation was frequently associated with high risk features or disease progression in MDS. Although preliminary results hint an adverse prognostic role of dysregulated FLT3 pathway in MDS cases, whether this observation adds independent prognostic value to the existing prognostic system needs to be further explored in future prospective studies.
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Affiliation(s)
- Juehua Gao
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Feinberg 7-209A, 251 E. Huron Street, Chicago, IL 60611, USA.
| | - Suchitra Swaminathan
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Feinberg 7-209A, 251 E. Huron Street, Chicago, IL 60611, USA
| | - Navin Pai
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Feinberg 7-209A, 251 E. Huron Street, Chicago, IL 60611, USA
| | - Zachary Johnson
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Feinberg 7-209A, 251 E. Huron Street, Chicago, IL 60611, USA
| | - Yi-Hua Chen
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Feinberg 7-209A, 251 E. Huron Street, Chicago, IL 60611, USA
| | - LoAnn Peterson
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Feinberg 7-209A, 251 E. Huron Street, Chicago, IL 60611, USA
| | - Charles Goolsby
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Feinberg 7-209A, 251 E. Huron Street, Chicago, IL 60611, USA
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Zeidan AM, Gore SD, Padron E, Komrokji RS. Current state of prognostication and risk stratification in myelodysplastic syndromes. Curr Opin Hematol 2015; 22:146-54. [PMID: 25575032 DOI: 10.1097/moh.0000000000000110] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Myelodysplastic syndromes (MDS) are characterized by significant biologic and clinical heterogeneity. Because of the wide outcome variability, accurate prognostication is vital to high-quality risk-adaptive care of MDS patients. In this review, we discuss the current state of prognostic schemes for MDS and overview efforts aimed at utilizing molecular aberrations for prognostication in clinical practice. RECENT FINDINGS Several prognostic instruments have been developed and validated with increasing accuracy and complexity. Oncologists should be aware of the inherent limitations of these prognostic tools as they counsel patients and make clinical decisions. As more therapies are becoming available for MDS, the focus of model development is shifting from prognostic to treatment-specific predictive instruments. In addition to providing additional prognostic data beyond traditional clinical and pathologic parameters, the improved understanding of the genetic landscape and pathophysiologic consequences in MDS may allow the construction of treatment-specific predictive instruments. SUMMARY How to best use the results of molecular mutation testing to inform clinical decision making in MDS is still a work in progress. Important steps in this direction include standardization in performance and interpretation of assays and better understanding of the independent prognostic importance of the recurrent mutations, especially the less frequent ones.
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Affiliation(s)
- Amer M Zeidan
- aSection of Hematology, Department of Internal Medicine, Yale University, New Haven, Connecticut bDepartment of Malignant Hematology, H Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
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29
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Toll-like receptor signaling in hematopoietic homeostasis and the pathogenesis of hematologic diseases. Front Med 2015; 9:288-303. [DOI: 10.1007/s11684-015-0412-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 06/10/2015] [Indexed: 02/07/2023]
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Bektaş Ö, Üner A, Eliaçık E, Uz B, Işık A, Etgül S, Bozkurt S, Haznedaroğlu İC, Göker H, Sayınalp N, Aksu S, Demiroğlu H, Özcebe Oİ, Büyükaşık Y. Comparison of Myelodysplastic Syndrome Prognostic Scoring Systems. Turk J Haematol 2015; 33:119-26. [PMID: 26376664 PMCID: PMC5100722 DOI: 10.4274/tjh.2014.0455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Objective: Myelodysplastic syndrome (MDS) is a clonal hematopoietic stem cell disease. Patients are at risk of developing cytopenias or progression to acute myeloid leukemia. Different classifications and prognostic scoring systems have been developed. The aim of this study was to compare the different prognostic scoring systems. Materials and Methods: One hundred and one patients who were diagnosed with primary MDS in 2003-2011 in a tertiary care university hospital’s hematology department were included in the study. Results: As the International Prognostic Scoring System (IPSS), World Health Organization Classification-Based Prognostic Scoring System (WPSS), MD Anderson Prognostic Scoring System (MPSS), and revised IPSS (IPSS-R) risk categories increased, leukemia-free survival and overall survival decreased (p<0.001). When the IPSS, WPSS, MPSS, and IPSS-R prognostic systems were compared by Cox regression analysis, the WPSS was the best in predicting leukemia-free survival (p<0.001), and the WPSS (p<0.001) and IPSS-R (p=0.037) were better in predicting overall survival. Conclusion: All 4 prognostic systems were successful in predicting overall survival and leukemia-free survival (p<0.001). The WPSS was found to be the best predictor for leukemia-free survival, while the WPSS and IPSS-R were found to be the best predictors for overall survival.
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Affiliation(s)
- Özlen Bektaş
- Hacettepe University Faculty of Medicine, Department of Hematology, Ankara, Turkey, Phone : +90 532 543 05 75, E-mail :
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Nazha A, Sekeres MA, Gore SD, Zeidan AM. Molecular Testing in Myelodysplastic Syndromes for the Practicing Oncologist: Will the Progress Fulfill the Promise? Oncologist 2015. [PMID: 26194858 DOI: 10.1634/theoncologist.2015-0067] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
UNLABELLED Myelodysplastic syndromes (MDS) are heterogeneous hematopoietic neoplasms that are driven by somatically acquired genetic mutations and epigenetic alterations. Accurate risk stratification is essential for delivery of risk-adaptive therapeutic interventions. The current prognostic tools sum the impact of clinical, pathologic, and laboratory parameters. Newer technologies with next-generation targeted deep sequencing and whole-genome and -exome sequencing have identified several recurrent mutations that play a vital role in the pathophysiology of MDS and the impact of these genetic changes on disease phenotype. Equally important, well-annotated databases of MDS patients with paired clinicopathologic and genetic data have enabled better understanding of the independent prognostic impact of several molecular mutations on important clinical endpoints such as overall survival and probability of leukemic progression. Cumulative evidence suggests that genomic data can also be used clinically to aid with the diagnosis, prognosis, prediction of response to specific therapies, and the development of novel and rationally targeted therapies. However, the optimal use of this mutational profiling remains a work in progress and currently there is no standard set of genes or techniques that are recommended for routine use in the clinic. In this review, we discuss the genomic revolution and its impact on our understanding of MDS biology and risk stratification. We also discuss the current role and the challenges of the application of genetic mutational data into daily clinical practice and how future research could help improve the prognostication precision and specific therapy selection for patients with MDS. IMPLICATIONS FOR PRACTICE Heterogeneity in clinical outcomes of MDS is partly related to interpatient variability of recurrent somatic mutations that drive disease phenotype and progression. Although clinical risk stratification tools have functioned well in prognostication for patients with MDS, their ability to predict clinical benefits of specific MDS therapies is limited. Molecular testing shows promise in aiding diagnosis, risk stratification, and therapy-specific benefit prediction for MDS patients. Nonetheless, logistical issues related to assay performance standardization, validation, interpretation, and development of guidelines for how to use the results to inform clinical decisions are yet to be resolved.
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Affiliation(s)
- Aziz Nazha
- Leukemia Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mikkael A Sekeres
- Leukemia Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Steven D Gore
- Section of Hematology, Department of Internal Medicine, Yale University and Yale Comprehensive Cancer Center, New Haven, Connecticut, USA
| | - Amer M Zeidan
- Section of Hematology, Department of Internal Medicine, Yale University and Yale Comprehensive Cancer Center, New Haven, Connecticut, USA
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Della Porta MG, Tuechler H, Malcovati L, Schanz J, Sanz G, Garcia-Manero G, Solé F, Bennett JM, Bowen D, Fenaux P, Dreyfus F, Kantarjian H, Kuendgen A, Levis A, Cermak J, Fonatsch C, Le Beau MM, Slovak ML, Krieger O, Luebbert M, Maciejewski J, Magalhaes SMM, Miyazaki Y, Pfeilstöcker M, Sekeres MA, Sperr WR, Stauder R, Tauro S, Valent P, Vallespi T, van de Loosdrecht AA, Germing U, Haase D, Greenberg PL, Cazzola M. Validation of WHO classification-based Prognostic Scoring System (WPSS) for myelodysplastic syndromes and comparison with the revised International Prognostic Scoring System (IPSS-R). A study of the International Working Group for Prognosis in Myelodysplasia (IWG-PM). Leukemia 2015; 29:1502-13. [PMID: 25721895 DOI: 10.1038/leu.2015.55] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 02/10/2015] [Accepted: 02/16/2015] [Indexed: 02/03/2023]
Abstract
A risk-adapted treatment strategy is mandatory for myelodysplastic syndromes (MDS). We refined the World Health Organization (WHO)-classification-based Prognostic Scoring System (WPSS) by determining the impact of the newer clinical and cytogenetic features, and we compared its prognostic power to that of the revised International Prognostic Scoring System (IPSS-R). A population of 5326 untreated MDS was considered. We analyzed single WPSS parameters and confirmed that the WHO classification and severe anemia provide important prognostic information in MDS. A strong correlation was found between the WPSS including the new cytogenetic risk stratification and WPSS adopting original criteria. We then compared WPSS with the IPSS-R prognostic system. A highly significant correlation was found between the WPSS and IPSS-R risk classifications. Discrepancies did occur among lower-risk patients in whom the number of dysplastic hematopoietic lineages as assessed by morphology did not reflect the severity of peripheral blood cytopenias and/or increased marrow blast count. Moreover, severe anemia has higher prognostic weight in the WPSS versus IPSS-R model. Overall, both systems well represent the prognostic risk of MDS patients defined by WHO morphologic criteria. This study provides relevant in formation for the implementation of risk-adapted strategies in MDS.
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Affiliation(s)
- M G Della Porta
- 1] Department of Hematology Oncology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy [2] Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - H Tuechler
- Hanusch Hospital, Boltzmann Institute for Leukemia Research, Vienna, Austria
| | - L Malcovati
- 1] Department of Hematology Oncology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy [2] Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - J Schanz
- Georg August Universität, Göttingen, Germany
| | - G Sanz
- Hospital Universitario La Fe, Valencia, Spain
| | - G Garcia-Manero
- The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - F Solé
- Institut de Recerca contra la Leucèmia Josep Carreras, Barcelona, Spain
| | - J M Bennett
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - D Bowen
- St James's University Hospital, Leeds, UK
| | - P Fenaux
- Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris (AP-HP)/University Paris XIII, Bobigny, France
| | - F Dreyfus
- Hôpital Cochin, AP-HP University of Paris V, Paris, France
| | - H Kantarjian
- The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - A Kuendgen
- Heinrich-Heine University Hospital, Düsseldorf, Germany
| | - A Levis
- Fondazione Italiana Sindromi Mielodisplastiche c/o SS Antonio e Biagio Hospital, Alessandria, Italy
| | - J Cermak
- Institute of Hematology and Blood Transfusion, Praha, Czech Republic
| | - C Fonatsch
- Medical University of Vienna, Vienna, Austria
| | - M M Le Beau
- University of Chicago Comprehensive Cancer Research Center, Chicago, IL, USA
| | - M L Slovak
- Quest Diagnostics Nichols Institute, Chantilly, VA, USA
| | - O Krieger
- Elisabethinen Hospital, Linz, Austria
| | - M Luebbert
- University of Freiburg Medical Center, Freiburg, Germany
| | | | | | - Y Miyazaki
- Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - M Pfeilstöcker
- Hanusch Hospital and L. Boltzmann Cluster Oncology, Vienna, Austria
| | | | - W R Sperr
- Medical University of Vienna, Vienna, Austria
| | - R Stauder
- Hanusch Hospital and L. Boltzmann Cluster Oncology, Vienna, Austria
| | - S Tauro
- University of Dundee, Dundee, Scotland, UK
| | - P Valent
- Medical University of Vienna, Vienna, Austria
| | - T Vallespi
- Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | - U Germing
- Heinrich-Heine University Hospital, Düsseldorf, Germany
| | - D Haase
- Georg August Universität, Göttingen, Germany
| | - P L Greenberg
- Division of Hematology, Stanford University Cancer Center, Stanford, CA, USA
| | - M Cazzola
- 1] Department of Hematology Oncology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy [2] Department of Molecular Medicine, University of Pavia, Pavia, Italy
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Importance of classical morphology in the diagnosis of myelodysplastic syndrome. Mediterr J Hematol Infect Dis 2015; 7:e2015035. [PMID: 25960863 PMCID: PMC4418392 DOI: 10.4084/mjhid.2015.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 04/23/2015] [Indexed: 01/16/2023] Open
Abstract
Myelodysplastic syndromes (MDS) are hematopoietic stem cell disorders characterized by dysplastic, ineffective, clonal and neoplastic hematopoiesis. MDS represent a complex hematological problem: differences in disease presentation, progression and outcome have necessitated the use of classification systems to improve diagnosis, prognostication, and treatment selection. However, since a single biological or genetic reliable diagnostic marker has not yet been discovered for MDS, quantitative and qualitative dysplastic morphological alterations of bone marrow precursors and peripheral blood cells are still fundamental for diagnostic classification. In this paper, World Health Organization (WHO) classification refinements and current minimal diagnostic criteria proposed by expert panels are highlighted, and related problematic issues are discussed. The recommendations should facilitate diagnostic and prognostic evaluations in MDS and selection of patients for new effective targeted therapies. Although, in the future, morphology should be supplemented with new molecular techniques, the morphological approach, at least for the moment, is still the cornerstone for the diagnosis and classification of these disorders.
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Abstract
Myelodysplastic syndromes are a collection of clonal hematopoietic disorders with a wide range of clinical manifestations and eventual outcomes. Accurate prediction of a patient's prognosis is useful to define the risk posed by the disease and which treatment options are most appropriate. Several models have been created to help predict the prognosis for patients with myelodysplastic syndromes. The International Prognostic Scoring System (IPSS) has been the standard tool used to risk stratify MDS patients since its publication in 1997. Other models have since been created to improve upon the IPSS, including the recent Revised International Prognostic Scoring System. Most models include the presence or severity of peripheral blood cytopenias, the proportion of bone marrow blasts, and specific karyotype abnormalities. Other factors including age, performance status, co-morbidities, transfusion dependence, and molecular biomarkers can further refine the prediction of prognosis in some models. Novel, disease specific biomarkers with prognostic value in myelodysplastic syndromes including cell surface markers, gene expression profiles, and high resolution copy number analyses have been proposed but not yet adopted clinically. Somatic abnormalities in recurrently mutated genes are the most informative prognostic biomarkers not currently considered by clinical risk models. Mutations in specific genes have independent prognostic significance and, unlike cytogenetic abnormalities, are present in the majority of myelodysplastic syndrome cases. However, mutational information can be complex and there are challenges to its clinical implementation. Despite these limitations, DNA sequencing can refine the prediction of prognosis for myelodysplastic syndrome patients and has become increasingly available in the clinic where it will help improve the care of patients with myelodysplastic syndromes.
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Affiliation(s)
- Rafael Bejar
- Moores Cancer Center, Division of Hematology and Oncology, University of California, San Diego, La Jolla, CA, USA
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35
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Ribeiro HL, de Oliveira RTG, Maia ARS, Pires Ferreira Filho LI, de Sousa JC, Heredia FF, Magalhães SMM, Pinheiro RF. Polymorphisms of DNA repair genes are related to the pathogenesis of myelodysplastic syndrome. Hematol Oncol 2014; 33:220-8. [DOI: 10.1002/hon.2175] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 07/08/2014] [Accepted: 09/09/2014] [Indexed: 12/22/2022]
Affiliation(s)
- Howard Lopes Ribeiro
- Post-Graduate Program in Medical Science; Federal University of Ceara; Fortaleza Ceara Brazil
- Cancer Cytogenomic Laboratory; Federal University of Ceara; Fortaleza Ceara Brazil
| | | | - Allan Rodrigo Soares Maia
- Post-Graduate Program in Medical Science; Federal University of Ceara; Fortaleza Ceara Brazil
- Cancer Cytogenomic Laboratory; Federal University of Ceara; Fortaleza Ceara Brazil
| | - Luiz Ivando Pires Ferreira Filho
- Post-Graduate Program in Medical Science; Federal University of Ceara; Fortaleza Ceara Brazil
- Cancer Cytogenomic Laboratory; Federal University of Ceara; Fortaleza Ceara Brazil
| | - Juliana Cordeiro de Sousa
- Post-Graduate Program in Medical Science; Federal University of Ceara; Fortaleza Ceara Brazil
- Cancer Cytogenomic Laboratory; Federal University of Ceara; Fortaleza Ceara Brazil
| | | | - Silvia Maria Meira Magalhães
- Post-Graduate Program in Medical Science; Federal University of Ceara; Fortaleza Ceara Brazil
- Cancer Cytogenomic Laboratory; Federal University of Ceara; Fortaleza Ceara Brazil
| | - Ronald Feitosa Pinheiro
- Post-Graduate Program in Medical Science; Federal University of Ceara; Fortaleza Ceara Brazil
- Post-Graduate Program of Pathology; Federal University of Ceara; Fortaleza Ceara Brazil
- Cancer Cytogenomic Laboratory; Federal University of Ceara; Fortaleza Ceara Brazil
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36
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Aberrant overexpression of CD14 on granulocytes sensitizes the innate immune response in mDia1 heterozygous del(5q) MDS. Blood 2014; 124:780-90. [PMID: 24891322 DOI: 10.1182/blood-2014-01-552463] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The myelodysplastic syndromes (MDSs) include a spectrum of stem cell malignancies characterized by an increased risk of developing acute myeloid leukemia. Heterozygous loss of chromosome 5q (del[5q]) is the most common cytogenetic abnormality in MDS. DIAPH1 is localized to 5q31 and encodes one of the formin proteins, mDia1, which is involved in linear actin polymerization. Mice with mDia1 deficiency develop hematologic features with age mimicking human myeloid neoplasm, but its role in the pathogenesis of MDS is unclear. Here we report that mDia1 heterozygous and knockout mice develop MDS phenotypes with age. In these mice, CD14 was aberrantly overexpressed on granulocytes in a cell-autonomous manner, leading to a hypersensitive innate immune response to lipopolysaccharide (LPS) stimuli through CD14/Toll-like receptor 4 signaling. Chronic stimulation with LPS accelerated the development of MDS in mDia1 heterozygous and knockout mice that can be rescued by lenalidomide. Similar findings of CD14 overexpression were observed on the bone marrow granulocytes of del(5q) MDS patients. Mechanistically, mDia1 deficiency led to a downregulation of membrane-associated genes and a specific upregulation of CD14 messenger RNA in granulocytes, but not in other lineages. These results underscore the significance of mDia1 heterozygosity in deregulated innate immune responses in del(5q) MDS.
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Della Porta MG, Travaglino E, Boveri E, Ponzoni M, Malcovati L, Papaemmanuil E, Rigolin GM, Pascutto C, Croci G, Gianelli U, Milani R, Ambaglio I, Elena C, Ubezio M, Da Via’ MC, Bono E, Pietra D, Quaglia F, Bastia R, Ferretti V, Cuneo A, Morra E, Campbell PJ, Orazi A, Invernizzi R, Cazzola M. Minimal morphological criteria for defining bone marrow dysplasia: a basis for clinical implementation of WHO classification of myelodysplastic syndromes. Leukemia 2014; 29:66-75. [DOI: 10.1038/leu.2014.161] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 04/19/2014] [Accepted: 05/07/2014] [Indexed: 02/08/2023]
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Pavlaki K, Pontikoglou CG, Demetriadou A, Batsali AK, Damianaki A, Simantirakis E, Kontakis M, Galanopoulos A, Kotsianidis I, Kastrinaki MC, Papadaki HA. Impaired proliferative potential of bone marrow mesenchymal stromal cells in patients with myelodysplastic syndromes is associated with abnormal WNT signaling pathway. Stem Cells Dev 2014; 23:1568-81. [PMID: 24617415 DOI: 10.1089/scd.2013.0283] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
It has been shown that bone marrow mesenchymal stromal cells (MSCs) from patients with myelodysplastic syndromes (MDSs) display defective proliferative potential. We have probed the impaired replicative capacity of culture-expanded MSCs in MDS patients (n=30) compared with healthy subjects (n=32) by studying senescence characteristics and gene expression associated with WNT/transforming growth factor-β1 (TGFB1) signaling pathways. We have also explored the consequences of the impaired patient MSC proliferative potential by investigating their differentiation potential and the capacity to support normal CD34(+) cell growth under coculture conditions. Patient MSCs displayed decreased gene expression of the senescence-associated cyclin-dependent kinase inhibitors CDKN1A, CDKN2A, and CDKN2B, along with PARG1, whereas the mean telomere length was upregulated in patient MSCs. MDS-derived MSCs exhibited impaired capacity to support normal CD34(+) myeloid and erythroid colony formation. No significant changes were observed between patients and controls in gene expression related to TGFB1 pathway. Patient MSCs displayed upregulated non-canonical WNT expression, combined with downregulated canonical WNT expression and upregulated canonical WNT inhibitors. MDS-derived MSCs displayed defective osteogenic and adipogenic lineage priming under non-differentiating culture conditions. Pharmacological activation of canonical WNT signaling in patient MDSs led to an increase in cell proliferation and upregulation in the expression of early osteogenesis-related genes. This study indicates abnormal WNT signaling in MSCs of MDS patients and supports the concept of a primary MSC defect that might have a contributory effect in MDS natural history.
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Affiliation(s)
- Konstantia Pavlaki
- 1 Department of Haematology, University of Crete School of Medicine , Heraklion, Greece
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Bedekovics J, Méhes G. [Pathomechanism and clinical impact of myelofibrosis in neoplastic diseases of the bone marrow]. Orv Hetil 2014; 155:367-75. [PMID: 24583557 DOI: 10.1556/oh.2014.29823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Polyclonal mesenchymal cells (fibroblasts, endothelial cells, pericytes, osteoblasts, reticular cells, adipocytes, etc.) of the bone marrow create a functional microenvironment, which actively contributes to the maintenance of hemopoesis. This takes place through cellular interactions via growth factors, cytokines, adhesion molecules and extracellular matrix components, as well as through the control of calcium and oxygen concentration. Inflammatory and neoplastic diseases of the bone marrow result in pathologic interaction between hemopoietic progenitors and stromal cells. This may lead to the activation and expansion of the stroma and to the accumulation of reticulin and collagen fibers produced by mesenchymal cells. Clinically relevant fiber accumulation, termed as myelofibrosis accompanies many diseases, although, the extent and the consequence of myelofibrosis are variable in different disorders. The aim of this review is to summarize basic features of the normal bone marrow mesenchymal environment and the pathological process leading to myelofibrosis. In addition, the special features of myelofibrosis in bone marrow diseases, including myeloproliferative neoplasia, myelodysplastic syndrome and other neoplastic conditions are discussed.
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Affiliation(s)
- Judit Bedekovics
- Debreceni Egyetem, Általános Orvostudományi Kar Pathologiai Intézet Debrecen Nagyerdei krt. 98. 4012
| | - Gábor Méhes
- Debreceni Egyetem, Általános Orvostudományi Kar Pathologiai Intézet Debrecen Nagyerdei krt. 98. 4012
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40
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Zeidan AM, Komrokji RS. There's risk, and then there's risk: The latest clinical prognostic risk stratification models in myelodysplastic syndromes. Curr Hematol Malig Rep 2013; 8:351-60. [PMID: 23979829 PMCID: PMC4133773 DOI: 10.1007/s11899-013-0172-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Myelodysplastic syndromes (MDS) include a diverse group of clonal hematopoietic disorders characterized by progressive cytopenias and propensity for leukemic progression. The biologic heterogeneity that underlies MDS translates clinically in wide variations of clinical outcomes. Several prognostic schemes were developed to predict the natural course of MDS, counsel patients, and allow evidence-based, risk-adaptive implementation of therapeutic strategies. The prognostic schemes divide patients into subgroups with similar prognosis, but the extent to which the prognostic prediction applies to any individual patient is more variable. None of these instruments was designed to predict the clinical benefit in relation to any specific MDS therapy. The prognostic impact of molecular mutations is being more recognized and attempts at incorporating it into the current prognostic schemes are ongoing.
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Affiliation(s)
- Amer M Zeidan
- Department of Oncology, the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, CRB1 building, room 186, Baltimore, MD, 21287, USA,
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41
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Haferlach T, Nagata Y, Grossmann V, Okuno Y, Bacher U, Nagae G, Schnittger S, Sanada M, Kon A, Alpermann T, Yoshida K, Roller A, Nadarajah N, Shiraishi Y, Shiozawa Y, Chiba K, Tanaka H, Koeffler HP, Klein HU, Dugas M, Aburatani H, Kohlmann A, Miyano S, Haferlach C, Kern W, Ogawa S. Landscape of genetic lesions in 944 patients with myelodysplastic syndromes. Leukemia 2013; 28:241-7. [PMID: 24220272 PMCID: PMC3918868 DOI: 10.1038/leu.2013.336] [Citation(s) in RCA: 1169] [Impact Index Per Article: 106.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 10/21/2013] [Accepted: 10/30/2013] [Indexed: 02/07/2023]
Abstract
High-throughput DNA sequencing significantly contributed to diagnosis and prognostication in patients with myelodysplastic syndromes (MDS). We determined the biological and prognostic significance of genetic aberrations in MDS. In total, 944 patients with various MDS subtypes were screened for known/putative mutations/deletions in 104 genes using targeted deep sequencing and array-based genomic hybridization. In total, 845/944 patients (89.5%) harbored at least one mutation (median, 3 per patient; range, 0-12). Forty-seven genes were significantly mutated with TET2, SF3B1, ASXL1, SRSF2, DNMT3A, and RUNX1 mutated in >10% of cases. Many mutations were associated with higher risk groups and/or blast elevation. Survival was investigated in 875 patients. By univariate analysis, 25/48 genes (resulting from 47 genes tested significantly plus PRPF8) affected survival (P<0.05). The status of 14 genes combined with conventional factors revealed a novel prognostic model ('Model-1') separating patients into four risk groups ('low', 'intermediate', 'high', 'very high risk') with 3-year survival of 95.2, 69.3, 32.8, and 5.3% (P<0.001). Subsequently, a 'gene-only model' ('Model-2') was constructed based on 14 genes also yielding four significant risk groups (P<0.001). Both models were reproducible in the validation cohort (n=175 patients; P<0.001 each). Thus, large-scale genetic and molecular profiling of multiple target genes is invaluable for subclassification and prognostication in MDS patients.
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Affiliation(s)
- T Haferlach
- Munich Leukemia Laboratory (MLL), Munich, Germany
| | - Y Nagata
- 1] Cancer Genomics Project, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan [2] Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - V Grossmann
- Munich Leukemia Laboratory (MLL), Munich, Germany
| | - Y Okuno
- Cancer Genomics Project, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - U Bacher
- Munich Leukemia Laboratory (MLL), Munich, Germany
| | - G Nagae
- Genome Science Division, Research Center for Advanced Science and Technology, The University of Tokyo, Tokyo, Japan
| | - S Schnittger
- Munich Leukemia Laboratory (MLL), Munich, Germany
| | - M Sanada
- 1] Cancer Genomics Project, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan [2] Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - A Kon
- 1] Cancer Genomics Project, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan [2] Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - T Alpermann
- Munich Leukemia Laboratory (MLL), Munich, Germany
| | - K Yoshida
- 1] Cancer Genomics Project, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan [2] Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - A Roller
- Munich Leukemia Laboratory (MLL), Munich, Germany
| | - N Nadarajah
- Munich Leukemia Laboratory (MLL), Munich, Germany
| | - Y Shiraishi
- Laboratory of DNA Information Analysis, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Y Shiozawa
- 1] Cancer Genomics Project, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan [2] Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - K Chiba
- Laboratory of DNA Information Analysis, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - H Tanaka
- Laboratory of Sequence Data Analysis, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - H P Koeffler
- 1] Department of Hematology/Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA [2] Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - H-U Klein
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - M Dugas
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - H Aburatani
- Genome Science Division, Research Center for Advanced Science and Technology, The University of Tokyo, Tokyo, Japan
| | - A Kohlmann
- Munich Leukemia Laboratory (MLL), Munich, Germany
| | - S Miyano
- 1] Laboratory of Sequence Data Analysis, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan [2] Laboratory of DNA Information Analysis, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - C Haferlach
- Munich Leukemia Laboratory (MLL), Munich, Germany
| | - W Kern
- Munich Leukemia Laboratory (MLL), Munich, Germany
| | - S Ogawa
- 1] Cancer Genomics Project, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan [2] Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Abstract
Myelodysplasia is a diagnostic feature of myelodysplastic syndromes (MDSs) but is also found in other myeloid neoplasms. Its molecular basis has been recently elucidated by means of massive parallel sequencing studies. About 90% of MDS patients carry ≥1 oncogenic mutations, and two thirds of them are found in individuals with a normal karyotype. Driver mutant genes include those of RNA splicing (SF3B1, SRSF2, U2AF1, and ZRSR2), DNA methylation (TET2, DNMT3A, and IDH1/2), chromatin modification (ASXL1 and EZH2), transcription regulation (RUNX1), DNA repair (TP53), signal transduction (CBL, NRAS, and KRAS), and cohesin complex (STAG2). Only 4 to 6 genes are consistently mutated in ≥10% MDS patients, whereas a long tail of ∼50 genes are mutated less frequently. At presentation, most patients typically have 2 or 3 driver oncogenic mutations and hundreds of background mutations. MDS driver genes are also frequently mutated in other myeloid neoplasms. Reliable genotype/phenotype relationships include the association of the SF3B1 mutation with refractory anemia with ring sideroblasts, TET2/SRSF2 comutation with chronic myelomonocytic leukemia, and activating CSF3R mutation with chronic neutrophilic leukemia. Although both founding and subclonal driver mutations have been shown to have prognostic significance, prospective clinical trials that include the molecular characterization of the patient's genome are now needed.
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Acquired myelodysplasia or myelodysplastic syndrome: clearing the fog. Adv Hematol 2013; 2013:309637. [PMID: 24194760 PMCID: PMC3806348 DOI: 10.1155/2013/309637] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 08/28/2013] [Indexed: 12/20/2022] Open
Abstract
Myelodysplastic syndromes (MDS) are clonal myeloid disorders characterized by progressive peripheral blood cytopenias associated with ineffective myelopoiesis. They are typically considered neoplasms because of frequent genetic aberrations and patient-limited survival with progression to acute myeloid leukemia (AML) or death related to the consequences of bone marrow failure including infection, hemorrhage, and iron overload. A progression to AML has always been recognized among the myeloproliferative disorders (MPD) but occurs only rarely among those with essential thrombocythemia (ET). Yet, the World Health Organization (WHO) has chosen to apply the designation myeloproliferative neoplasms (MPN), for all MPD but has not similarly recommended that all MDS become the myelodysplastic neoplasms (MDN). This apparent dichotomy may reflect the extremely diverse nature of MDS. Moreover, the term MDS is occasionally inappropriately applied to hematologic disorders associated with acquired morphologic myelodysplastic features which may rather represent potentially reversible hematological responses to immune-mediated factors, nutritional deficiency states, and disordered myelopoietic responses to various pharmaceutical, herbal, or other potentially myelotoxic compounds. We emphasize the clinical settings, and the histopathologic features, of such AMD that should trigger a search for a reversible underlying condition that may be nonneoplastic and not MDS.
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Hanumanthu VS, Pirruccello SJ. GCSF-R expression in myelodysplastic and myeloproliferative disorders and blast dysmaturation in CML. Am J Clin Pathol 2013; 140:155-64. [PMID: 23897249 DOI: 10.1309/ajcpclhzr5kuhubm] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To characterize granulocyte colony-stimulating factor receptor (CD114) expression in normal (n = 20), myelodysplastic (n = 34), and chronic myelogenous leukemia (CML; n = 5) bone marrow by flow cytometry. METHODS Clinical bone marrow samples were analyzed using CD33/CD114/CD34/CD117/CD45. CD114 density (mean fluorescence intensity) and cellular distribution were evaluated on early blasts (CD33-), late blasts (CD33+), promyelocytes, and granulocytes. RESULTS Normal CD114 acquisition occurred on early blasts, peaked on promyelocytes, and decreased on granulocytes. Forty percent of CD34+ blasts expressed CD114 and one-third were early blasts. In myelodysplastic syndromes, altered CD114 distribution was more informative than density changes. In CML, CD114 density was significantly decreased on early blasts and expression was essentially limited to late blasts. We observed a specific blast dysmaturation pattern in CML involving CD33, CD34, and CD114 that was 83% sensitive and 100% specific in initial diagnosis. CONCLUSIONS CD114 provides useful additional detail in phenotypic assessment of hematopoietic precursor maturation.
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Affiliation(s)
- Vidya Sagar Hanumanthu
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Samuel J. Pirruccello
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
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Velegraki M, Papakonstanti E, Mavroudi I, Psyllaki M, Tsatsanis C, Oulas A, Iliopoulos I, Katonis P, Papadaki HA. Impaired clearance of apoptotic cells leads to HMGB1 release in the bone marrow of patients with myelodysplastic syndromes and induces TLR4-mediated cytokine production. Haematologica 2013; 98:1206-15. [PMID: 23403315 DOI: 10.3324/haematol.2012.064642] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Excessive pro-inflammatory cytokine production in the bone marrow has been associated with the pathogenesis of myelodysplastic syndromes. We herein investigated the involvement of toll-like receptors and their endogenous ligands in the induction/maintenance of the inflammatory process in the marrow of patients with myelodysplastic syndromes. We evaluated the expression of toll-like receptors in marrow monocytes of patients (n=27) and healthy controls (n=25) by flow-cytometry and also assessed the activation of the respective signaling using a real-time polymerase chain reaction-based array. We measured the high mobility group box-1 protein, a toll-like receptor-4 ligand, in marrow plasma and long-term bone marrow culture supernatants by an enzyme-linked immunosorbent assay and we performed cross-over experiments using marrow plasma from patients and controls in the presence/absence of a toll-like receptor-4 inhibitor to evaluate the pro-inflammatory cytokine production by chemiluminescence. We assessed the apoptotic cell clearance capacity of patients' macrophages using a fluorescence microscopy-based assay. We found over-expression of toll-like receptor-4 in patients' marrow monocytes compared to that in controls; this over-expression was associated with up-modulation of 53 genes related to the respective signaling. Incubation of patients' monocytes with autologous, but not with normal, marrow plasma resulted in over-production of pro-inflammatory cytokines, an effect that was abrogated by the toll-like receptor-4 inhibitor suggesting that the pro-inflammatory cytokine production in myelodysplastic syndromes is largely mediated through toll-like receptor-4. The levels of high mobility group box-1 protein were increased in patients' marrow plasma and culture supernatants compared to the levels in controls. Patients' macrophages displayed an impaired capacity to engulf apoptotic cells and this defect was associated with excessive release of high mobility group box-1 protein by dying cells. A primary apoptotic cell clearance defect of marrow macrophages in myelodysplastic syndromes may contribute to the induction/maintenance of the inflammatory process through aberrant release of molecules inducing toll-like receptor-4 such as high mobility group box-1 protein.
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Affiliation(s)
- Maria Velegraki
- Department of Hematology, University of Crete School of Medicine, Heraklion, Greece
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Ribeiro HL, Oliveira RTGD, Maia ARS, Sousa JCD, Heredia FF, Magalhães SMM, Pinheiro RF. ATM polymorphism is associated with low risk myelodysplastic syndrome. DNA Repair (Amst) 2012; 12:87-9. [PMID: 23246256 DOI: 10.1016/j.dnarep.2012.10.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 10/31/2012] [Indexed: 01/23/2023]
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47
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Vardiman J. The classification of MDS: From FAB to WHO and beyond. Leuk Res 2012; 36:1453-8. [DOI: 10.1016/j.leukres.2012.08.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Revised: 08/04/2012] [Accepted: 08/06/2012] [Indexed: 11/17/2022]
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Abstract
Hematopoietic cell transplantation (HCT) is currently the only treatment with curative potential for patients with myelodysplastic syndrome (MDS). However, treatment-related mortality and relapse have remained major barriers to uniform success. Therefore, important questions remain to be answered, such as whom to transplant, when and how. With reduced intensity conditioning (RIC) regimens, patients in their 70s and patients with comorbid conditions have been transplanted successfully, although the relapse incidence with this approach tends to be increased in comparison to high intensity regimens. Success rates are higher in patients transplanted at an early stage of their disease. Encouraging is the fact, that results with unrelated donors who are HLA-matched by high resolution typing are comparable to those achieved with HLA genotypically identical siblings. The establishment of cord blood as a source of stem cells, and the recent success with HLA-haploidentical related donors will allow the offering of HCT to virtually all patients. Dependent upon disease stage and characteristics, some 25% to 75% of transplanted patients will be cured. While 20%-30% of patients experience chronic medical problems after HCT, 70% report a "good to excellent" quality of life. New studies must focus on further reducing GVHD for all patients and on overcoming high relapse rates in patients with high risk disease.
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Affiliation(s)
- Boglarka Gyurkocza
- Fred Hutchinson Cancer Research Center, Seattle, WA
- University of Washington School of Medicine, Seattle, WA
| | - H. Joachim Deeg
- Fred Hutchinson Cancer Research Center, Seattle, WA
- University of Washington School of Medicine, Seattle, WA
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Five-group cytogenetic risk classification, monosomal karyotype, and outcome after hematopoietic cell transplantation for MDS or acute leukemia evolving from MDS. Blood 2012; 120:1398-408. [PMID: 22767498 DOI: 10.1182/blood-2012-04-423046] [Citation(s) in RCA: 125] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Clonal cytogenetic abnormalities are a major risk factor for relapse after hematopoietic cell transplantation (HCT) for myelodysplastic syndrome (MDS). We determined the impact of the recently established 5-group cytogenetic classification of MDS on outcome after HCT. Results were compared with the impact of the International Prognostic Scoring System (IPSS) 3 cytogenetic risk groups, and the additional effect of a monosomal karyotype was assessed. The study included data on 1007 patients, 1-75 years old (median 45 years), transplanted from related (n = 547) or unrelated (n = 460) donors. Various conditioning regimens were used, and marrow, peripheral blood, or cord blood served as stem cell source. Both IPSS and 5-group cytogenetic risk classifications were significantly associated with post-HCT relapse and mortality, but the 5-group classification discriminated more clearly among the lowest- and highest-risk patients. A monosomal karyotype tended to further increase the rates of relapse and mortality, even after considering the IPSS or 5-group classifications. In addition, the pathologic disease category correlated with both relapse and mortality. Mortality was also impacted by patient age, donor type, conditioning regimen, platelet count, and etiology of MDS. Although mortality declined significantly in recent years, novel strategies are needed to overcome the barrier of high-risk cytogenetics.
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de Castro CCM, Gondim Gomes CB, Martins MRA, de Sousa JC, Magalhaes SMM, Pinheiro RF. Tissue doppler echocardiography detects preclinical markers of cardiac lesion in MDS patients. J Hematol Oncol 2012; 5:30. [PMID: 22709732 PMCID: PMC3418154 DOI: 10.1186/1756-8722-5-30] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 06/07/2012] [Indexed: 11/27/2022] Open
Abstract
Myelodysplastic syndrome (MDS) is a clonal hematopoietic stem cell disorder of elderly people. Cardiac dysfunction is a marker of grim prognosis in MDS. We evaluated cardiac dysfunction of MDS patients with or without transfusion dependency by tissue doppler echocardiography. We found the average values of ventricular end-systolic and end-diastolic volumes in transfusion dependency MDS group higher than others. These results were strongly correlated to hemoglobin levels. Tissue Doppler Echocardiography should be routinely performed in MDS patients to detect preclinical cardiac alterations and prevent more heart insults in this group of chronic anemic aged patients.
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