1
|
Castaño-Díez S, López-Guerra M, Zugasti I, Calvo X, Schulz FI, Avendaño A, Mora E, Falantes J, Azaceta G, Ibáñez M, Chen T, Notario C, Amer N, Palomo L, Pomares H, Vila J, Bernal Del Castillo T, Jiménez-Vicente C, Esteban D, Guijarro F, Álamo J, Cortés-Bullich A, Torrecillas-Mayayo V, Triguero A, Mont-de Torres L, Carcelero E, Cardús A, Germing U, Betz B, Rozman M, Arenillas L, Zamora L, Díez-Campelo M, Xicoy B, Esteve J, Díaz-Beyá M. AML typical mutations (CEBPA, FLT3, NPM1) identify a high-risk chronic myelomonocytic leukemia independent of CPSS molecular. Blood Adv 2025; 9:39-53. [PMID: 39388660 DOI: 10.1182/bloodadvances.2024013648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 08/30/2024] [Accepted: 09/29/2024] [Indexed: 10/12/2024] Open
Abstract
ABSTRACT Mutations commonly associated with acute myeloid leukemia (AML), such as CEBPA, FLT3, IDH1/2, and NPM1, are rarely found in chronic myelomonocytic leukemia (CMML), and their prognostic significance in CMML has not been clearly identified. In 127 patients with CMML, we have retrospectively analyzed next-generation sequencing and polymerase chain reaction data from bone marrow samples collected at the time of CMML diagnosis. Seven patients harbored CEBPA mutations, 8 FLT3 mutations, 12 IDH1 mutations, 26 IDH2 mutations, and 11 NPM1 mutations. Patients with CMML harboring CEBPA, FLT3, and/or NPM1 mutations (mutCFN) more frequently had the myeloproliferative subtype, a high prevalence of severe cytopenia, and elevated blast counts. Regardless of their CMML Prognostic Scoring System molecular classification, mutCFN patients with CMML had a poor prognosis, and the multivariate analysis identified mutCFN as an independent marker of overall survival. The genetic profile of these mutCFN patients with CMML closely resembled that of patients with AML, with higher-risk clinical characteristics. Our findings lead us to suggest including the assessment of these mutations in CMML prognostic models and treating these patients with AML-type therapies, including intensive chemotherapy and allogeneic stem cell transplantation, whenever feasible. Furthermore, certain targeted therapies approved for use in AML should be considered.
Collapse
MESH Headings
- Humans
- Nucleophosmin
- Mutation
- Leukemia, Myelomonocytic, Chronic/genetics
- Leukemia, Myelomonocytic, Chronic/diagnosis
- Leukemia, Myelomonocytic, Chronic/mortality
- fms-Like Tyrosine Kinase 3/genetics
- Male
- Female
- Middle Aged
- Aged
- Nuclear Proteins/genetics
- CCAAT-Enhancer-Binding Proteins/genetics
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/mortality
- Leukemia, Myeloid, Acute/therapy
- Prognosis
- Adult
- Aged, 80 and over
- Retrospective Studies
Collapse
Affiliation(s)
- Sandra Castaño-Díez
- Department of Hematopathology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Grupo Español de Síndromes Mielodisplásicos, Madrid, Spain
| | - Mònica López-Guerra
- Department of Hematopathology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer, Madrid, Spain
| | - Inés Zugasti
- Grupo Español de Síndromes Mielodisplásicos, Madrid, Spain
- Department of Hematology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Spain
| | - Xavier Calvo
- Grupo Español de Síndromes Mielodisplásicos, Madrid, Spain
- Department of Hematology, Hospital del Mar, Barcelona, Spain
| | - Felicitas Isabel Schulz
- Department of Hematology, Oncology and Clinical Immunology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Alejandro Avendaño
- Grupo Español de Síndromes Mielodisplásicos, Madrid, Spain
- Department of Hematology, Hospital Universitario de Salamanca, Spain
| | - Elvira Mora
- Grupo Español de Síndromes Mielodisplásicos, Madrid, Spain
- Department of Hematology, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - José Falantes
- Grupo Español de Síndromes Mielodisplásicos, Madrid, Spain
- Department of Hematology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Gemma Azaceta
- Grupo Español de Síndromes Mielodisplásicos, Madrid, Spain
- Department of Hematology, Hospital Clínico Universitario Lozano Blesa de Zaragoza, Spain
| | - Mariam Ibáñez
- Grupo Español de Síndromes Mielodisplásicos, Madrid, Spain
- Department of Hematology, Hospital General Universitario de Valencia, grupo de Investigación de Hematología y Hemoterapia de la Fundación de Investigación del Hospital General Universitario de Valencia, Spain
| | - Tzu Chen
- Grupo Español de Síndromes Mielodisplásicos, Madrid, Spain
- Department of Hematology, Hospital General Universitario Morales Meseguer, Murcia, Spain
| | - Cristina Notario
- Grupo Español de Síndromes Mielodisplásicos, Madrid, Spain
- Department of Hematology, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Neus Amer
- Grupo Español de Síndromes Mielodisplásicos, Madrid, Spain
- Department of Hematology, Hospital Universitario Son Llàtzer, Palma de Mallorca, Spain
| | - Laura Palomo
- Grupo Español de Síndromes Mielodisplásicos, Madrid, Spain
- Department of Hematology, Experimental Hematology Group, Vall d'Hebron Institute of Oncology, University Hospital Vall d'Hebron, Barcelona, Spain. Myelodysplastic Syndromes Research Group, Josep Carreras Leukaemia Research Institute, Barcelona, Spain
| | - Helena Pomares
- Grupo Español de Síndromes Mielodisplásicos, Madrid, Spain
- Department of Hematology, Institut Català d'Oncologia - Hospital Duran i Reynals, L'Hospitalet de LLobregat, LLobregat, Institut d'Investigació Biomèdica de Bellvitge, Universitat de Barcelona, Spain
| | - Jordi Vila
- Grupo Español de Síndromes Mielodisplásicos, Madrid, Spain
- Department of Hematology, Institut Català d'Oncologia - Hospital Dr. Josep Trueta, Girona, Spain
| | - Teresa Bernal Del Castillo
- Grupo Español de Síndromes Mielodisplásicos, Madrid, Spain
- Department of Hematology, Hospital Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain
| | - Carlos Jiménez-Vicente
- Department of Hematology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Spain
| | - Daniel Esteban
- Department of Hematology, Institut Català d'Oncologia-Hospital Universitari Germans Trias i Pujol, Institut de Recerca contra la Leucèmia Josep Carreras, Badalona, Barcelona, Spain
| | - Francesca Guijarro
- Department of Hematopathology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - José Álamo
- Department of Hematopathology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Grupo Español de Síndromes Mielodisplásicos, Madrid, Spain
| | - Albert Cortés-Bullich
- Department of Hematology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Spain
| | | | - Ana Triguero
- Department of Hematology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Spain
| | | | - Ester Carcelero
- Department of Pharmacy, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Aina Cardús
- Department of Hematopathology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Ulrich Germing
- Department of Hematology, Oncology and Clinical Immunology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Beate Betz
- Institute for Human Genetics, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Maria Rozman
- Department of Hematopathology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Grupo Español de Síndromes Mielodisplásicos, Madrid, Spain
| | - Leonor Arenillas
- Grupo Español de Síndromes Mielodisplásicos, Madrid, Spain
- Department of Hematology, Hospital del Mar, Barcelona, Spain
| | - Lurdes Zamora
- Grupo Español de Síndromes Mielodisplásicos, Madrid, Spain
- Department of Hematology, Institut Català d'Oncologia-Hospital Universitari Germans Trias i Pujol, Institut de Recerca contra la Leucèmia Josep Carreras, Badalona, Barcelona, Spain
| | - María Díez-Campelo
- Grupo Español de Síndromes Mielodisplásicos, Madrid, Spain
- Department of Hematology, Hospital Universitario de Salamanca, Spain
| | - Blanca Xicoy
- Grupo Español de Síndromes Mielodisplásicos, Madrid, Spain
- Department of Hematology, Institut Català d'Oncologia-Hospital Universitari Germans Trias i Pujol, Institut de Recerca contra la Leucèmia Josep Carreras, Badalona, Barcelona, Spain
| | - Jordi Esteve
- Department of Hematology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Spain
| | - Marina Díaz-Beyá
- Grupo Español de Síndromes Mielodisplásicos, Madrid, Spain
- Department of Hematology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Spain
| |
Collapse
|
2
|
Castaño-Díez S, Álamo JR, López-Guerra M, Gómez-Hernando M, Zugasti I, Jiménez-Vicente C, Guijarro F, López-Oreja I, Esteban D, Charry P, Torrecillas V, Mont-de Torres L, Cortés-Bullich A, Bataller Á, Guardia A, Munárriz D, Carcelero E, Riu G, Triguero A, Tovar N, Vela D, Beà S, Costa D, Colomer D, Rozman M, Esteve J, Díaz-Beyá M. Chronic myelomonocytic leukemia with NPM1 mutation or acute myeloid leukemia? Oncologist 2024:oyae246. [PMID: 39349391 DOI: 10.1093/oncolo/oyae246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 04/20/2024] [Indexed: 10/02/2024] Open
Abstract
The 2022 WHO revision and the ICC classification have recently modified the diagnostic criteria for chronic myelomonocytic leukemia (CMML) and acute myeloid leukemia. However, there is no consensus on whether CMML with NPM1 mutation (NPM1mut) should be diagnosed as AML. Nowadays, it is a subject of discussion because of its diagnostic and therapeutic implications. Therefore, we describe a case of a patient diagnosed with CMML NPM1mut and briefly review the literature to highlight the uncertainty about how to classify a CMML with NPM1 mutation. We emphasize the importance of a comprehensive molecular study, which is crucial to optimize the individualized treatment of patients, enabling them to access targeted therapies.
Collapse
Affiliation(s)
- Sandra Castaño-Díez
- Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Universitat Barcelona, Barcelona, Spain
| | - José Ramón Álamo
- Hematopathology Section, Pathology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - Mònica López-Guerra
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Hematopathology Section, Pathology Department, Hospital Clínic Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Marta Gómez-Hernando
- Hematopathology Section, Pathology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - Inés Zugasti
- Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | | | - Francesca Guijarro
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Universitat Barcelona, Barcelona, Spain
- Hematopathology Section, Pathology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - Irene López-Oreja
- Hematopathology Section, Pathology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - Daniel Esteban
- Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - Paola Charry
- Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | | | | | | | - Álex Bataller
- Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Universitat Barcelona, Barcelona, Spain
- Josep Carreras Leukemia Research Institute, Badalona, Spain
| | - Ares Guardia
- Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - Daniel Munárriz
- Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | | | - Gisela Riu
- Pharmacy Service, Hospital Clínic Barcelona, Barcelona, Spain
| | - Ana Triguero
- Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - Natalia Tovar
- Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - Dolors Vela
- Hematology Department, Hospital General de Granollers, Granollers, Spain
| | - Silvia Beà
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Hematopathology Section, Pathology Department, Hospital Clínic Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Dolors Costa
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Hematopathology Section, Pathology Department, Hospital Clínic Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Dolors Colomer
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Hematopathology Section, Pathology Department, Hospital Clínic Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Maria Rozman
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Hematopathology Section, Pathology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - Jordi Esteve
- Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Universitat Barcelona, Barcelona, Spain
- Josep Carreras Leukemia Research Institute, Badalona, Spain
| | - Marina Díaz-Beyá
- Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Josep Carreras Leukemia Research Institute, Badalona, Spain
| |
Collapse
|