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Genomic Alterations, Gene Expression Profiles and Functional Enrichment of Normal-Karyotype Acute Myeloid Leukaemia Based on Targeted Next-Generation Sequencing. Cancers (Basel) 2023; 15:cancers15051386. [PMID: 36900179 PMCID: PMC10000176 DOI: 10.3390/cancers15051386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/08/2023] [Accepted: 02/16/2023] [Indexed: 02/24/2023] Open
Abstract
Characterising genomic variants is paramount in understanding the pathogenesis and heterogeneity of normal-karyotype acute myeloid leukaemia (AML-NK). In this study, clinically significant genomic biomarkers were ascertained using targeted DNA sequencing and RNA sequencing on eight AML-NK patients' samples collected at disease presentation and after complete remission. In silico and Sanger sequencing validations were performed to validate variants of interest, and they were followed by the performance of functional and pathway enrichment analyses for overrepresentation analysis of genes with somatic variants. Somatic variants involving 26 genes were identified and classified as follows: 18/42 (42.9%) as pathogenic, 4/42 (9.5%) as likely pathogenic, 4/42 (9.5%) as variants of unknown significance, 7/42 (16.7%) as likely benign and 9/42 (21.4%) as benign. Nine novel somatic variants were discovered, of which three were likely pathogenic, in the CEBPA gene with significant association with its upregulation. Transcription misregulation in cancer tops the affected pathways involving upstream genes (CEBPA and RUNX1) that were deregulated in most patients during disease presentation and were closely related to the most enriched molecular function gene ontology category, DNA-binding transcription activator activity RNA polymerase II-specific (GO:0001228). In summary, this study elucidated putative variants and their gene expression profiles along with functional and pathway enrichment in AML-NK patients.
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2
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Hanbazazh M, Harada S, Reddy V, Mackinnon AC, Harbi D, Morlote D. The Interpretation of Sequence Variants in Myeloid Neoplasms. Am J Clin Pathol 2021; 156:728-748. [PMID: 34155503 DOI: 10.1093/ajcp/aqab039] [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: 11/12/2022] Open
Abstract
OBJECTIVES To provide an overview of the challenges encountered during the interpretation of sequence variants detected by next-generation sequencing (NGS) in myeloid neoplasms, as well as the limitations of the technology with the goal of preventing the over- or undercalling of alterations that may have a significant effect on patient management. METHODS Review of the peer-reviewed literature on the interpretation, reporting, and technical challenges of NGS assays for myeloid neoplasms. RESULTS NGS has been integrated widely and rapidly into the standard evaluating of myeloid neoplasms. Review of the literature reveals that myeloid sequence variants are challenging to detect and interpret. Large insertions and guanine-cytosine-heavy areas prove technically challenging while frameshift and truncating alterations may be classified as variants of uncertain significance by tertiary analysis informatics pipelines due to their absence in the literature and databases. CONCLUSIONS The analysis and interpretation of NGS results in myeloid neoplasia are challenging due to the varied number of detectable gene alterations. Familiarity with the genomic landscape of myeloid malignancies and knowledge of the tools available for the interpretation of sequence variants are essential to facilitate translation into clinical and therapy decisions.
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Affiliation(s)
- Mehenaz Hanbazazh
- Department of Pathology, Division of Genomic Diagnostics and Bioinformatics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Shuko Harada
- Department of Pathology, Division of Genomic Diagnostics and Bioinformatics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Vishnu Reddy
- Department of Pathology, Division of Genomic Diagnostics and Bioinformatics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alexander Craig Mackinnon
- Department of Pathology, Division of Genomic Diagnostics and Bioinformatics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Djamel Harbi
- Department of Pathology, Division of Genomic Diagnostics and Bioinformatics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Diana Morlote
- Department of Pathology, Division of Genomic Diagnostics and Bioinformatics, University of Alabama at Birmingham, Birmingham, AL, USA
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3
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Nie Y, Su L, Li W, Gao S. Novel insights of acute myeloid leukemia with CEBPA deregulation: Heterogeneity dissection and re-stratification. Crit Rev Oncol Hematol 2021; 163:103379. [PMID: 34087345 DOI: 10.1016/j.critrevonc.2021.103379] [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: 07/18/2020] [Revised: 03/21/2021] [Accepted: 05/29/2021] [Indexed: 12/17/2022] Open
Abstract
Acute myeloid leukemia with bi-allelic CEBPA mutation was categorized as an independent disease entity with favorable prognosis, however, recent researches have revealed huge heterogeneity within this disease group, and for some patients, relapse remained a major cause of treatment failure. Further risk stratification is essentially needed. Here by reviewing the latest literature, we summarized the characteristics of CEBPA mutation profiles and clinical features, with a special intention of dissecting the heterogeneity within the seemingly homogeneous AML with bi-allelic CEBPA mutations. Specifically, non-classical CEBPA mutation, miscellaneous companion genetic aberrations and the presence of germline CEBPA mutation are three major sources of heterogeneity. Identifying these factors can help us predict patients at a higher risk of relapse, for whom aggressive treatment may be recommended. Novel therapeutic approaches regarding manipulating potentially druggable targets as well as the debate over post remission consolidation regimens has also been discussed.
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Affiliation(s)
- Yuanyuan Nie
- Department of Hematology, The First Hospital of Jilin University, Changchun, 130012, China
| | - Long Su
- Department of Hematology, The First Hospital of Jilin University, Changchun, 130012, China
| | - Wei Li
- Department of Hematology, The First Hospital of Jilin University, Changchun, 130012, China; Stem Cell and Cancer Center, The First Hospital of Jilin University, Changchun, 130012, China
| | - Sujun Gao
- Department of Hematology, The First Hospital of Jilin University, Changchun, 130012, China.
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4
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Arindrarto W, Borràs DM, de Groen RAL, van den Berg RR, Locher IJ, van Diessen SAME, van der Holst R, van der Meijden ED, Honders MW, de Leeuw RH, Verlaat W, Jedema I, Kroes WGM, Knijnenburg J, van Wezel T, Vermaat JSP, Valk PJM, Janssen B, de Knijff P, van Bergen CAM, van den Akker EB, Hoen PAC', Kiełbasa SM, Laros JFJ, Griffioen M, Veelken H. Comprehensive diagnostics of acute myeloid leukemia by whole transcriptome RNA sequencing. Leukemia 2020; 35:47-61. [PMID: 32127641 PMCID: PMC7787979 DOI: 10.1038/s41375-020-0762-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 01/17/2020] [Accepted: 02/12/2020] [Indexed: 01/12/2023]
Abstract
Acute myeloid leukemia (AML) is caused by genetic aberrations that also govern the prognosis of patients and guide risk-adapted and targeted therapy. Genetic aberrations in AML are structurally diverse and currently detected by different diagnostic assays. This study sought to establish whole transcriptome RNA sequencing as single, comprehensive, and flexible platform for AML diagnostics. We developed HAMLET (Human AML Expedited Transcriptomics) as bioinformatics pipeline for simultaneous detection of fusion genes, small variants, tandem duplications, and gene expression with all information assembled in an annotated, user-friendly output file. Whole transcriptome RNA sequencing was performed on 100 AML cases and HAMLET results were validated by reference assays and targeted resequencing. The data showed that HAMLET accurately detected all fusion genes and overexpression of EVI1 irrespective of 3q26 aberrations. In addition, small variants in 13 genes that are often mutated in AML were called with 99.2% sensitivity and 100% specificity, and tandem duplications in FLT3 and KMT2A were detected by a novel algorithm based on soft-clipped reads with 100% sensitivity and 97.1% specificity. In conclusion, HAMLET has the potential to provide accurate comprehensive diagnostic information relevant for AML classification, risk assessment and targeted therapy on a single technology platform.
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Affiliation(s)
- Wibowo Arindrarto
- Center for Computational Biology, Leiden University Medical Center, 2300RC, Leiden, The Netherlands.,Department of Human Genetics, Leiden University Medical Center, 2300RC, Leiden, The Netherlands
| | - Daniel M Borràs
- GenomeScan B.V, 2333 BZ, Leiden, The Netherlands.,Department of Chemical Cell Biology, Leiden University Medical Center, 2300RC, Leiden, The Netherlands
| | - Ruben A L de Groen
- Department of Hematology, Leiden University Medical Center, 2300RC, Leiden, The Netherlands
| | - Redmar R van den Berg
- Department of Human Genetics, Leiden University Medical Center, 2300RC, Leiden, The Netherlands
| | - Irene J Locher
- Department of Hematology, Leiden University Medical Center, 2300RC, Leiden, The Netherlands
| | | | - Rosalie van der Holst
- Department of Hematology, Leiden University Medical Center, 2300RC, Leiden, The Netherlands
| | | | - M Willy Honders
- Department of Hematology, Leiden University Medical Center, 2300RC, Leiden, The Netherlands
| | - Rick H de Leeuw
- Forensic Laboratory for DNA Research, Department of Human Genetics, Leiden University Medical Center, 2300RC, Leiden, The Netherlands
| | - Wina Verlaat
- Department of Hematology, Leiden University Medical Center, 2300RC, Leiden, The Netherlands
| | - Inge Jedema
- Department of Hematology, Leiden University Medical Center, 2300RC, Leiden, The Netherlands
| | - Wilma G M Kroes
- Department of Clinical Genetics, Leiden University Medical Center, 2300RC, Leiden, The Netherlands
| | - Jeroen Knijnenburg
- Department of Clinical Genetics, Leiden University Medical Center, 2300RC, Leiden, The Netherlands
| | - Tom van Wezel
- Department of Pathology, Leiden University Medical Center, 2300RC, Leiden, The Netherlands
| | - Joost S P Vermaat
- Department of Hematology, Leiden University Medical Center, 2300RC, Leiden, The Netherlands
| | - Peter J M Valk
- Department of Hematology, Erasmus University Medical Center, 3015CN, Rotterdam, The Netherlands
| | - Bart Janssen
- GenomeScan B.V, 2333 BZ, Leiden, The Netherlands
| | - Peter de Knijff
- Forensic Laboratory for DNA Research, Department of Human Genetics, Leiden University Medical Center, 2300RC, Leiden, The Netherlands
| | | | - Erik B van den Akker
- Center for Computational Biology, Leiden University Medical Center, 2300RC, Leiden, The Netherlands.,The Delft Bioinformatics Lab, Delft University of Technology, 2628CD, Delft, The Netherlands.,Section of Molecular Epidemiology, Leiden University Medical Center, 2300RC, Leiden, The Netherlands
| | - Peter A C 't Hoen
- Department of Human Genetics, Leiden University Medical Center, 2300RC, Leiden, The Netherlands.,The Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 GA, Nijmegen, The Netherlands
| | - Szymon M Kiełbasa
- Center for Computational Biology, Leiden University Medical Center, 2300RC, Leiden, The Netherlands
| | - Jeroen F J Laros
- Department of Human Genetics, Leiden University Medical Center, 2300RC, Leiden, The Netherlands
| | - Marieke Griffioen
- Department of Hematology, Leiden University Medical Center, 2300RC, Leiden, The Netherlands.
| | - Hendrik Veelken
- Department of Hematology, Leiden University Medical Center, 2300RC, Leiden, The Netherlands
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5
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Mustafa MI, Mohammed ZO, Murshed NS, Elfadol NM, Abdelmoneim AH, Hassan MA. In Silico Genetics Revealing 5 Mutations in CEBPA Gene Associated With Acute Myeloid Leukemia. Cancer Inform 2019; 18:1176935119870817. [PMID: 31621694 PMCID: PMC6777061 DOI: 10.1177/1176935119870817] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 07/30/2019] [Indexed: 12/11/2022] Open
Abstract
Background: Acute myeloid leukemia (AML) is an extremely heterogeneous malignant
disorder; AML has been reported as one of the main causes of death in
children. The objective of this work was to classify the most deleterious
mutation in CCAAT/enhancer-binding protein-alpha (CEBPA)
and to predict their influence on the functional, structural, and expression
levels by various Bioinformatics analysis tools. Methods: The single nucleotide polymorphisms (SNPs) were claimed from the National
Center for Biotechnology Information (NCBI) database and then submitted into
various functional analysis tools, which were done to predict the influence
of each SNP, followed by structural analysis of modeled protein followed by
predicting the mutation effect on energy stability; the most damaging
mutations were chosen for additional investigation by Mutation3D, Project
hope, ConSurf, BioEdit, and UCSF Chimera tools. Results: A total of 5 mutations out of 248 were likely to be responsible for the
structural and functional variations in CEBPA protein, whereas in the
3′-untranslated region (3′-UTR) the result showed that among 350 SNPs in the
3′-UTR of CEBPA gene, about 11 SNPs were predicted. Among
these 11 SNPs, 65 alleles disrupted a conserved miRNA site and 22 derived
alleles created a new site of miRNA. Conclusions: In this study, the impact of functional mutations in the CEBPA gene was
investigated through different bioinformatics analysis techniques, which
determined that R339W, R288P, N292S, N292T, and D63N are pathogenic
mutations that have a possible functional and structural influence,
therefore, could be used as genetic biomarkers and may assist in genetic
studies with a special consideration of the large heterogeneity of AML.
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Affiliation(s)
- Mujahed I Mustafa
- Department of Biotechnology, Africa City of Technology, Khartoum North, Sudan
| | - Zainab O Mohammed
- Department of Haematology, Ribat University Hospital, Khartoum, Sudan
| | - Naseem S Murshed
- Department of Biotechnology, Africa City of Technology, Khartoum North, Sudan
| | - Nafisa M Elfadol
- Department of Biotechnology, Africa City of Technology, Khartoum North, Sudan
| | | | - Mohamed A Hassan
- Department of Biotechnology, Africa City of Technology, Khartoum North, Sudan
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6
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Mannelli F, Ponziani V, Bencini S, Bonetti MI, Benelli M, Cutini I, Gianfaldoni G, Scappini B, Pancani F, Piccini M, Rondelli T, Caporale R, Gelli AMG, Peruzzi B, Chiarini M, Borlenghi E, Spinelli O, Giupponi D, Zanghì P, Bassan R, Rambaldi A, Rossi G, Bosi A. CEBPA-double-mutated acute myeloid leukemia displays a unique phenotypic profile: a reliable screening method and insight into biological features. Haematologica 2016; 102:529-540. [PMID: 28250006 PMCID: PMC5394975 DOI: 10.3324/haematol.2016.151910] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 10/28/2016] [Indexed: 11/09/2022] Open
Abstract
Mutations in CCAAT/enhancer binding protein α (CEBPA) occur in 5-10% of cases of acute myeloid leukemia. CEBPA-double-mutated cases usually bear biallelic N- and C-terminal mutations and are associated with a favorable clinical outcome. Identification of CEBPA mutants is challenging because of the variety of mutations, intrinsic characteristics of the gene and technical issues. Several screening methods (fragment-length analysis, gene expression array) have been proposed especially for large-scale clinical use; although efficient, they are limited by specific concerns. We investigated the phenotypic profile of blast and maturing bone marrow cell compartments at diagnosis in 251 cases of acute myeloid leukemia. In this cohort, 16 (6.4%) patients had two CEBPA mutations, whereas ten (4.0%) had a single mutation. First, we highlighted that the CEBPA-double-mutated subset displays recurrent phenotypic abnormalities in all cell compartments. By mutational analysis after cell sorting, we demonstrated that this common phenotypic signature depends on CEBPA-double-mutated multi-lineage involvement. From a multidimensional study of phenotypic data, we developed a classifier including ten core and widely available parameters. The selected markers on blasts (CD34, CD117, CD7, CD15, CD65), neutrophil (SSC, CD64), monocytic (CD14, CD64) and erythroid (CD117) compartments were able to cluster CEBPA-double-mutated cases. In a validation set of 259 AML cases from three independent centers, our classifier showed excellent performance with 100% specificity and 100% sensitivity. We have, therefore, established a reliable screening method, based upon multidimensional analysis of widely available phenotypic parameters. This method provides early results and is suitable for large-scale detection of CEBPA-double-mutated status, allowing gene sequencing to be focused in selected cases.
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Affiliation(s)
- Francesco Mannelli
- Unità Funzionale di Ematologia, Università degli Studi, AOU Careggi, Firenze, Italy .,Istituto Toscano Tumori, Firenze, Italy
| | - Vanessa Ponziani
- Unità Funzionale di Ematologia, Università degli Studi, AOU Careggi, Firenze, Italy.,Istituto Toscano Tumori, Firenze, Italy
| | - Sara Bencini
- Unità Funzionale di Ematologia, Università degli Studi, AOU Careggi, Firenze, Italy.,Istituto Toscano Tumori, Firenze, Italy
| | - Maria Ida Bonetti
- Unità Funzionale di Ematologia, Università degli Studi, AOU Careggi, Firenze, Italy.,Istituto Toscano Tumori, Firenze, Italy
| | | | - Ilaria Cutini
- Unità Funzionale di Ematologia, Università degli Studi, AOU Careggi, Firenze, Italy.,Istituto Toscano Tumori, Firenze, Italy
| | - Giacomo Gianfaldoni
- Unità Funzionale di Ematologia, Università degli Studi, AOU Careggi, Firenze, Italy.,Istituto Toscano Tumori, Firenze, Italy
| | - Barbara Scappini
- Unità Funzionale di Ematologia, Università degli Studi, AOU Careggi, Firenze, Italy.,Istituto Toscano Tumori, Firenze, Italy
| | - Fabiana Pancani
- Unità Funzionale di Ematologia, Università degli Studi, AOU Careggi, Firenze, Italy.,Istituto Toscano Tumori, Firenze, Italy
| | - Matteo Piccini
- Unità Funzionale di Ematologia, Università degli Studi, AOU Careggi, Firenze, Italy.,Istituto Toscano Tumori, Firenze, Italy
| | - Tommaso Rondelli
- SOD Laboratorio Centrale, Settore Citometria Clinica, AOU Careggi, Firenze, Italy
| | - Roberto Caporale
- SOD Laboratorio Centrale, Settore Citometria Clinica, AOU Careggi, Firenze, Italy
| | | | - Benedetta Peruzzi
- SOD Laboratorio Centrale, Settore Citometria Clinica, AOU Careggi, Firenze, Italy
| | - Marco Chiarini
- Centro di Ricerca Emato-Oncologica AIL (CREA), Spedali Civili, Brescia, Italy
| | | | - Orietta Spinelli
- Unità Strutturale Complessa di Ematologia, Ospedali Riuniti, Bergamo, Italy
| | - Damiano Giupponi
- Unità Strutturale Complessa di Ematologia, Ospedali Riuniti, Bergamo, Italy
| | - Pamela Zanghì
- Unità Strutturale Complessa di Ematologia, Ospedali Riuniti, Bergamo, Italy
| | - Renato Bassan
- Divisione di Ematologia, Ospedale dell'Angelo & Ospedale SS. Giovanni e Paolo, Mestre-Venezia, Italy
| | | | | | - Alberto Bosi
- Unità Funzionale di Ematologia, Università degli Studi, AOU Careggi, Firenze, Italy.,Istituto Toscano Tumori, Firenze, Italy
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7
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Nomdedéu JF, Puigdecanet E, Bussaglia E, Hernández JJ, Carricondo M, Estivill C, Martí-Tutusaus JM, Tormo M, Zamora L, Serrano E, Perea G, de Llano MPQ, García A, Sánchez-Ortega I, Ribera JM, Nonell L, Aventin A, Solé F, Brunet MS, Sierra J. Feasibility of the AML profiler (Skyline™ Array) for patient risk stratification in a multicentre trial: a preliminary comparison with the conventional approach. Hematol Oncol 2016; 35:778-788. [PMID: 27140599 DOI: 10.1002/hon.2304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 03/15/2016] [Accepted: 03/31/2016] [Indexed: 12/11/2022]
Abstract
Deoxyribonucleic acid microarrays allow researchers to measure mRNA levels of thousands of genes in a single experiment and could be useful for diagnostic purposes in patients with acute myeloid leukaemia (AML). We assessed the feasibility of the AML profiler (Skyline™ Array) in genetic stratification of patients with de novo AML and compared the results with those obtained using the standard cytogenetic and molecular approach. Diagnostic bone marrow from 31 consecutive de novo AML cases was used to test MLL-PTD, FLT3-ITD and TKD, NPM1 and CEBPAdm mutations. Purified RNA was used to assess RUNX1-RUNX1T1, PML-RARα and CBFβ-MYH11 rearrangements. RNA remnants underwent gene expression profiling analysis using the AML profiler, which detects chromosomal aberrations: t(8;21), t(15;17), inv(16), mutations (CEBPAdm, ABD-NPM1) and BAALC and EVI1 expression. Thirty cases were successfully analysed with both methods. Five cases had FLT3-ITD. In one case, a t(8;21) was correctly detected by both methods. Four cases had inv(16); in one, the RNA quality was unsatisfactory and it was not hybridized, and in the other three, the AML profiler detected the genetic lesion - this being a rare type I translocation in one case. Two cases with acute promyelocytic leukaemia were diagnosed by both methods. Results for NPM1 mutations were concordant in all but two cases (2/11, non-ABD mutations). Analysis of costs and turnaround times showed that the AML profiler was no more expensive than the conventional molecular approach. These results suggest that the AML profiler could be useful in multicentre trials to rapidly identify patients with AML with a good prognosis. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Josep F Nomdedéu
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Eulalia Puigdecanet
- Servei d'Analisi de Microarrays, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Elena Bussaglia
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Maite Carricondo
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Camino Estivill
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Mar Tormo
- Hematology Department, Hospital Clínico de Valencia, INCLIVA, Valencia, Spain
| | - Lurdes Zamora
- Hematology Department, Institut Recerca contra la Leucemia Josep Carreras (IJC), ICO Badalona Hospital Germans Trias i Pujol, Badalona, Spain
| | - Elena Serrano
- Bioinformatic Platform, IIB Sant Pau, Barcelona, Spain
| | - Granada Perea
- Laboraotory Service, UDIAT-CD, Parc Taulí Hospital Universitari, Sabadell, Spain
| | | | - Antoni García
- Hematology Department, Hospital Arnau de Vilanova, Lleida, Spain
| | | | - Josep Maria Ribera
- Hematology Department, Institut Recerca contra la Leucemia Josep Carreras (IJC), ICO Badalona Hospital Germans Trias i Pujol, Badalona, Spain
| | - Lara Nonell
- Servei d'Analisi de Microarrays, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Anna Aventin
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Francesc Solé
- Hematology Department, Institut Recerca contra la Leucemia Josep Carreras (IJC), ICO Badalona Hospital Germans Trias i Pujol, Badalona, Spain
| | - Maria Salut Brunet
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jorge Sierra
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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