1
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Oliveira AF, Tansini A, Toledo T, Balceiro R, Lee MLM, Villela N, Ikeuty P, Metze K, Lopes LF, Lorand-Metze I. Immunophenotypic changes in juvenile myelomonocytic leukaemia after treatment with hypomethylating agent: Do they help to evaluate dept of response? Br J Haematol 2022; 197:339-348. [PMID: 35187646 DOI: 10.1111/bjh.18089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/27/2022] [Accepted: 01/30/2022] [Indexed: 11/29/2022]
Abstract
5-Azacitidine has been used before stem cell transplantation in juvenile myelomonocytic leukaemia (JMML) patients. Recently, we have described immunophenotypic features in JMML at diagnosis. Here, our aim was to examine the changes in the immunophenotypic features during azacitidine treatment, correlating it with clinical response. Patients treated with 5-azacitidine were evaluated at diagnosis and after three and six cycles of medication. Among 32 patients entering the study, 28 patients were examined after three cycles and 25 patients after six. Patients showed a reduction in CD34/CD117+ cells: median 3.35% at diagnosis, 2.8% after three cycles and 1.63% after six. B-cell progenitors were decreased at diagnosis and decreased after treatment. Monocytes decreased: 11.91% to 6.4% and 4.18% respectively. Complete response was associated with increase in classical monocytes. T lymphocytes, reduced at diagnosis, increased in patients responding to 5-azacitidine. Immunophenotypic aberrancies including expression of CD7 in myeloid progenitors remained after treatment. This feature was associated with a worse response to treatment, as well as presence of NF1. Immunophenotyping was feasible in all patients. Clinical response was associated with a decrease of myeloid progenitors and monocytes and a rise in T lymphocytes although phenotypic aberrancies persisted. The largest effect was observed after three cycles.
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Affiliation(s)
- Anita Frisanco Oliveira
- Barretos Children´s Cancer Hospital, Barretos, Brazil.,Brazilian Co-operative Group of Pediatric Myelodysplastic Syndrome (GCB-SMD-PED), Myeloproliferative Diseases Committee, Barretos, Brazil
| | - Aline Tansini
- Barretos Children´s Cancer Hospital, Barretos, Brazil.,Brazilian Co-operative Group of Pediatric Myelodysplastic Syndrome (GCB-SMD-PED), Morfology and Flow Cytometry Committee, Barretos, Brazil
| | - Thais Toledo
- Barretos Children´s Cancer Hospital, Barretos, Brazil.,Brazilian Co-operative Group of Pediatric Myelodysplastic Syndrome (GCB-SMD-PED), Morfology and Flow Cytometry Committee, Barretos, Brazil
| | | | - Maria Lucia Martino Lee
- Brazilian Co-operative Group of Pediatric Myelodysplastic Syndrome (GCB-SMD-PED), Myeloproliferative Diseases Committee, Barretos, Brazil
| | - Neysimelia Villela
- Barretos Children´s Cancer Hospital, Hematopoietic Stem Cell Transplantation, Barretos, Brazil.,Brazilian Co-operative Group of Pediatric Myelodysplastic Syndrome (GCB-SMD-PED), HSCT Committee, Barretos, Brazil
| | - Patricia Ikeuty
- Brazilian Co-operative Group of Pediatric Myelodysplastic Syndrome (GCB-SMD-PED), HSCT Committee, Barretos, Brazil
| | - Konradin Metze
- Department of Pathology, Faculty Medical Sciences, State University of Campinas, Campinas, Brazil
| | - Luiz Fernando Lopes
- Barretos Children´s Cancer Hospital, Barretos, Brazil.,Brazilian Co-operative Group of Pediatric Myelodysplastic Syndrome (GCB-SMD-PED), Barretos, Brazil
| | - Irene Lorand-Metze
- Brazilian Co-operative Group of Pediatric Myelodysplastic Syndrome (GCB-SMD-PED), Morfology and Flow Cytometry Committee, Barretos, Brazil.,Department of Internal Medicine, Faculty Medical Sciences, State University of Campinas, Campinas, Brazil
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2
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Elevated blood MxA protein levels in children with newly diagnosed B-ALL: A prospective case-control study. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.1033655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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3
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Chang YH. Myelodysplastic syndromes and overlap syndromes. Blood Res 2021; 56:S51-S64. [PMID: 33935036 PMCID: PMC8094000 DOI: 10.5045/br.2021.2021010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 12/11/2022] Open
Abstract
Myelodysplastic syndromes (MDS) are a heterogeneous group of clonal hematological neoplasms characterized by ineffective hematopoiesis, morphologic dysplasia, and cytopenia. MDS overlap syndromes include various disorders, such as myelodysplastic/myeloproliferative neoplasms and hypoplastic MDS with aplastic anemia characteristics. MDS overlap syndromes share the characteristics of other diseases, which make differential diagnoses challenging. Advances in genomic studies have led to the discovery of frequent mutations in MDS and overlap syndromes; however, most of the mutations are not specific for the diagnosis of these diseases. The molecular characteristics of the overlap syndromes usually do not show a just “in-between” form but rather heterogeneous features. Established diagnostic criteria for these diseases based on clinical, morphologic, and laboratory features are still useful when combined with genomic data. It is expected that further studies for MDS and overlap syndromes will place emphasis on the roles of mutations as therapeutic targets and prognostic indicators.
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Affiliation(s)
- Yoon Hwan Chang
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Korea
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4
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Mai K, Chen X, Wang C, Wu S, Yang L, Huang Z, Zhang G, Zhang VW, Wang J, Chen D. B-lymphocyte deficiency and recurrent respiratory infections in a 6-month-old female infant with mosaic monosomy 7. Immunobiology 2020; 225:152005. [PMID: 32962823 DOI: 10.1016/j.imbio.2020.152005] [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: 02/12/2020] [Revised: 05/24/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
Monosomy 7 is generally considered as an acquired cytogenetic abnormality within hematopoietic cells, and indicates an especially high risk of progression to bone marrow failure, myelodysplastic syndrome (MDS) or juvenile myelomonocytic leukemia (JMML). We report a case of a 6-month-old female infant with mosaic monosomy 7 who presented with clinical and laboratory evidences of immunodeficiency. The patient had suffered from recurrent respiratory infections since she was born. Peripheral blood lymphocyte subsets revealed an extremely low level of CD19+ B lymphocytes (0.3∼0.8%, normal range: 6.4∼22.6%) and a decreased CD4/CD8 ratio (0.67∼1.12, normal range: 1.4∼2.0). Decreased serum levels of IgG (1.53 g/L, normal range: 4.09∼7.03 g/L), IgA (0.10 g/L, normal range: 0.21∼0.47 g/L) and IgM (0.26 g/L, normal range: 0.33∼0.73 g/L) were detected, while complements were normal. Excepting transient neutropenia, routine blood tests were within normal limits. Clinical exome sequencing identified a de novo mosaic monosomy 7, while no pathogenic mutation associated with immunodeficiency was detected. However, peripheral blood cytogenetic analysis was failure to detect monosomy 7 due to the very few cell mitosis. Subsequent fluorescence in situ hybridization (FISH) identified a mosaic monosomy 7 in 58 cells within a total number of 100 cells, which was consistent with clinical exome sequencing. Therefore, the patient was diagnosed with primary immunodeficiency disease (PID) due to mosaic monosomy 7. Intravenous treatment with multiple antibiotic agents and infusion of gamma globulin could control the patient's respiratory infections effectively. A better understanding of PIDs will enable effective treatments and prevention of infections in these patients.
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Affiliation(s)
- Kailin Mai
- Department of Pediatrics, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaowen Chen
- Department of Pediatrics, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chunli Wang
- AmCare Genomics Lab (V.W.Z.), Guangzhou, China
| | - Shangzhi Wu
- Department of Pediatrics, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Liying Yang
- Department of Pediatrics, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhanhang Huang
- Department of Pediatrics, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | | | - Victor Wei Zhang
- Department of Human and Molecular Genetics, Baylor College of Medicine, Houston, USA
| | - Jing Wang
- AmCare Genomics Lab (V.W.Z.), Guangzhou, China
| | - Dehui Chen
- Department of Pediatrics, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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5
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Frisanco Oliveira A, Tansini A, Toledo TR, Balceiro R, Onofre Vidal D, de Martino Lee ML, Lorand-Metze I, Lopes LF. Immunophenotypic characteristics of juvenile myelomonocytic leukaemia and their relation with the molecular subgroups of the disease. Br J Haematol 2020; 192:129-136. [PMID: 32966606 DOI: 10.1111/bjh.17098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 08/18/2020] [Indexed: 11/30/2022]
Abstract
The diagnosis of juvenile myelomonocytic leukaemia (JMML) is based on clinical, laboratory and molecular features but immunophenotyping [multiparametric flow cytometry (MFC)] has not been used routinely. In the present study, we describe the flow cytometric features at diagnosis with special attention to the distribution of monocytic subsets and the relation between MFC and molecular subgroups. MFC was performed with an eight-colour platform based on Euroflow. We studied 33 JMML cases. CD34+ /CD117+ /CD13+ cells >2% was found in 25 cases, and 51·5% presented an aberrant expression of CD7. A decrease of CD34+ /CD19+ /CD10+ cells was seen in eight cases and in four they were absent. The granulocytic population had a decreased side scatter in 29 cases. Bone marrow monocytic precursors were increased in 28 patients, with a decrease in classical monocytes (median 80·7%) and increase in CD16+ (intermediate and non-classical). A more pronounced increase in myeloid CD34+ cells was seen in patients with Neurofibromatosis type 1 (NF1) and tyrosine-protein phosphatase non-receptor type 11 (PTPN11), with aberrant CD7 expression in four of six and 10/12 patients respectively. Thus, JMML shows an immunophenotypic profile similar to myelodysplastic syndromes, and a different monocyte subset distribution when compared with chronic MML. MFC proved to be an important diagnostic tool that can help in differential diagnosis with other clonal diseases with monocytosis.
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Affiliation(s)
- Anita Frisanco Oliveira
- Barretos Children's Cancer Hospital, Barretos, São Paulo, Brazil.,Brazilian Co-operative Study Group for Paediatric Myelodysplastic Syndrome (GCB-SMD-PED) - Morphology and Flow Cytometry Committee, Barretos, São Paulo, Brazil
| | - Aline Tansini
- Barretos Children's Cancer Hospital, Barretos, São Paulo, Brazil.,GCB-SMD-PED - Flow cytometry Committee, Barretos, São Paulo, Brazil
| | - Thais Regina Toledo
- Barretos Children's Cancer Hospital, Barretos, São Paulo, Brazil.,GCB-SMD-PED - Flow cytometry Committee, Barretos, São Paulo, Brazil
| | - Rafael Balceiro
- Barretos Children's Cancer Hospital, Barretos, São Paulo, Brazil.,Brazilian Co-operative Study Group for Paediatric Myelodysplastic Syndrome (GCB-SMD-PED) - Morphology and Flow Cytometry Committee, Barretos, São Paulo, Brazil
| | - Daniel Onofre Vidal
- GCB-SMD-PED - Molecular Biology and Genetic Committee, Barretos, São Paulo, Brazil
| | - Maria Lucia de Martino Lee
- Barretos Children's Cancer Hospital, Barretos, São Paulo, Brazil.,GCB-SMD-PED - Morphology and Myeloproliferative Diseases Committee, Barretos, São Paulo, Brazil
| | - Irene Lorand-Metze
- Brazilian Co-operative Study Group for Paediatric Myelodysplastic Syndrome (GCB-SMD-PED) - Morphology and Flow Cytometry Committee, Barretos, São Paulo, Brazil.,GCB-SMD-PED - Chairman, Barretos, São Paulo, Brazil
| | - Luiz Fernando Lopes
- Barretos Children's Cancer Hospital, Barretos, São Paulo, Brazil.,GCB-SMD-PED - Chairman, Barretos, São Paulo, Brazil
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6
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Patel PA, Weinzierl EP, Wechsler DS. Leukoerythroblastosis as an Unusual Presentation of Parvovirus B19 Infection in a Sickle Cell Patient. Case Rep Pediatr 2020; 2020:8841607. [PMID: 33029441 PMCID: PMC7528142 DOI: 10.1155/2020/8841607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 11/17/2022] Open
Abstract
Parvovirus B19 infection in pediatrics most commonly causes fifth disease, a mild viral illness. Hematologic manifestations include severe anemia, especially in patients with chronic hemolytic anemias or who are immunocompromised. Because of the shortened life span of erythrocytes in patients with sickle cell disease, parvovirus infection can cause transient aplastic crisis which can be life-threatening. However, leukocytosis and thrombocytosis are rarely seen. We report leukoerythroblastosis as an unusual presentation of acute parvovirus B19 infection in a previously splenectomized 12-year-old boy with sickle cell disease.
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Affiliation(s)
- Pratik A. Patel
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Elizabeth P. Weinzierl
- Department of Pathology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Daniel S. Wechsler
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
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7
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Liao XY, Qiu KY, Fang JP, Wu RH, Guo SY, Huang K, Zhou DH. Diagnosis and treatment of juvenile myelomonocytic leukemia. ACTA ACUST UNITED AC 2019; 24:577-582. [PMID: 31389303 DOI: 10.1080/16078454.2019.1651548] [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] [Indexed: 10/26/2022]
Abstract
Objective: To investigate clinical features, diagnosis, treatment strategies and prognosis of juvenile myelomonocytic leukemia (JMML). Methods: The clinical data of 21 patients with JMML who were diagnosed in our hospital from January 2013 to May 2018 were retrospectively analyzed. Results: Among the 21 children with JMML, 16 were male and 5 were female. Out of the 21 children who were diagnosed with JMML, 7 were lost after treatment while the remaining 14 received A-3V chemotherapy regimen of South Korea. The effective response rate was 78.5%. The three-year overall survival (OS) rate and three-year disease-free survival (DFS) rate were (76.2 ± 14.8)% and (66.2 ± 14)%, respectively. Single factor analysis showed that PLT count ≤33×109/L, LDH level >500 U/L and HbF level >10% and chemotherapy only were the significant factors that lead to poor prognosis in children. Cox multivariate analysis showed that the choice of treatment options affected the prognosis of JMML children. By taking prognostic factors for long-term efficacy into account, patients with treatment strategy of chemotherapy alongside hematopoietic stem cell transplantation (HSCT) have a better prognosis. Conclusion: The PLT count, LDH level, HbF level and choice of treatment plan are important for the evaluation of prognosis for children with JMML. Although there is a lack of consistency in terms of donors but the A-3V scheme is relatively stable, so HSCT should be preferred for children with poor prognostic factors.
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Affiliation(s)
- Xiong-Yu Liao
- a Department of Paediatrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University , Guangzhou , People's Republic of China.,b Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou , People's Republic of China
| | - Kun-Yin Qiu
- a Department of Paediatrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University , Guangzhou , People's Republic of China.,b Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou , People's Republic of China
| | - Jian-Pei Fang
- a Department of Paediatrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University , Guangzhou , People's Republic of China.,b Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou , People's Republic of China
| | - Ruo-Hao Wu
- a Department of Paediatrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University , Guangzhou , People's Republic of China.,b Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou , People's Republic of China
| | - Shu-Yi Guo
- a Department of Paediatrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University , Guangzhou , People's Republic of China.,b Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou , People's Republic of China
| | - Ke Huang
- a Department of Paediatrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University , Guangzhou , People's Republic of China.,b Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou , People's Republic of China
| | - Dun-Hua Zhou
- a Department of Paediatrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University , Guangzhou , People's Republic of China.,b Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou , People's Republic of China
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8
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Flotho C. Gene mutations do not operate in a vacuum: the increasing importance of epigenetics in juvenile myelomonocytic leukemia. Epigenetics 2019; 14:236-244. [PMID: 30773984 DOI: 10.1080/15592294.2019.1583039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Juvenile myelomonocytic leukemia (JMML) stands out among malignant neoplasms of childhood in several ways. First, JMML is a model condition to elucidate the relevance of deregulated Ras signal transduction in human cancer. Second, the identification of Ras pathway mutations in JMML has informed the field of germline cancer predisposition and advanced the understanding of molecular mechanisms underlying the progression from predisposition to neoplasia. Third and not least, genomic DNA methylation was discovered to play a salient role in the classification and prognostication of the disease. This article discusses the evolution of epigenetic research on JMML over the past years and reviews the relevance of aberrant DNA methylation in the diagnosis, concept, and clinical decision-making of JMML.
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Affiliation(s)
- Christian Flotho
- a Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine , University of Freiburg , Freiburg , Germany.,b German Cancer Consortium (DKTK), partner site Freiburg , German Cancer Research Center (DKFZ) , Freiburg , Heidelberg , Germany
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9
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Chen YF, Xia Y. Convergent perturbation of the human domain-resolved interactome by viruses and mutations inducing similar disease phenotypes. PLoS Comput Biol 2019; 15:e1006762. [PMID: 30759076 PMCID: PMC6373925 DOI: 10.1371/journal.pcbi.1006762] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/07/2019] [Indexed: 12/14/2022] Open
Abstract
An important goal of systems medicine is to study disease in the context of genetic and environmental perturbations to the human interactome network. For diseases with both genetic and infectious contributors, a key postulate is that similar perturbations of the human interactome by either disease mutations or pathogens can have similar disease consequences. This postulate has so far only been tested for a few viral species at the level of whole proteins. Here, we expand the scope of viral species examined, and test this postulate more rigorously at the higher resolution of protein domains. Focusing on diseases with both genetic and viral contributors, we found significant convergent perturbation of the human domain-resolved interactome by endogenous genetic mutations and exogenous viral proteins inducing similar disease phenotypes. Pan-cancer, pan-oncovirus analysis further revealed that domains of human oncoproteins either physically targeted or structurally mimicked by oncoviruses are enriched for cancer driver rather than passenger mutations, suggesting convergent targeting of cancer driver pathways by diverse oncoviruses. Our study provides a framework for high-resolution, network-based comparison of various disease factors, both genetic and environmental, in terms of their impacts on the human interactome. Cellular function and behaviour are driven by highly coordinated biomolecular interaction networks. A prime example is the protein-protein interaction network, often simply referred to as the “interactome”. Recent advances in systems biology have spawned the view of human disease as a manifestation of genetic and environmental perturbations to the human interactome, a key postulate being that similar perturbation patterns lead to similar disease phenotypes. Here, we took a structural systems biology approach to compare mutation-induced and virus-induced perturbations of the human interactome in diseases with both genetic and viral contributors. Specifically, we constructed a domain-resolved human-virus protein interactome and characterized the distribution of genetic disease mutations with respect to human domains either physically targeted or structurally mimicked by virus. Overall, we found significant convergent perturbation of the human domain-resolved interactome by viruses and mutations inducing similar disease phenotypes. Structure-guided, integrated analysis of host genetic variation and host-pathogen protein interaction data may help elucidate the molecular mechanisms of infection and reveal its connections to genetic diseases such as cancer, autoimmunity, and neurodegeneration. On a broader note, our finding implies that similar perturbations of the human interactome at the domain level can have similar phenotypic consequences, regardless of the source of perturbation.
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Affiliation(s)
| | - Yu Xia
- Department of Bioengineering, McGill University, Montreal, Quebec, Canada
- * E-mail:
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10
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Locatelli F, Algeri M, Merli P, Strocchio L. Novel approaches to diagnosis and treatment of Juvenile Myelomonocytic Leukemia. Expert Rev Hematol 2018; 11:129-143. [DOI: 10.1080/17474086.2018.1421937] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Franco Locatelli
- Department of Pediatric Hematology/Oncology, IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
- Department of Pediatric Science, University of Pavia, Pavia, Italy
| | - Mattia Algeri
- Department of Pediatric Hematology/Oncology, IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
| | - Pietro Merli
- Department of Pediatric Hematology/Oncology, IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
| | - Luisa Strocchio
- Department of Pediatric Hematology/Oncology, IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
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11
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Flotho C, Sommer S, Lübbert M. DNA-hypomethylating agents as epigenetic therapy before and after allogeneic hematopoietic stem cell transplantation in myelodysplastic syndromes and juvenile myelomonocytic leukemia. Semin Cancer Biol 2017; 51:68-79. [PMID: 29129488 DOI: 10.1016/j.semcancer.2017.10.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/20/2017] [Accepted: 10/30/2017] [Indexed: 11/15/2022]
Abstract
Myelodysplastic syndrome (MDS) is a clonal bone marrow disorder, typically of older adults, which is characterized by ineffective hematopoiesis, peripheral blood cytopenias and risk of progression to acute myeloid leukemia. Juvenile myelomonocytic leukemia (JMML) is an aggressive myeloproliferative neoplasm occurring in young children. The common denominator of these malignant myeloid disorders is the limited benefit of conventional chemotherapy and a particular responsiveness to epigenetic therapy with the DNA-hypomethylating agents 5-azacytidine (azacitidine) or decitabine. However, hypomethylating therapy does not eradicate the malignant clone in MDS or JMML and allogeneic hematopoietic stem cell transplantation (HSCT) remains the only curative treatment option. An emerging concept with intriguing potential is the combination of hypomethylating therapy and HSCT. Possible advantages include disease control with good tolerability during donor search and HSCT preparation, improved antitumoral alloimmunity, and reduced risk of relapse even with non-myeloablative regimens. Herein we review the current role of pre- and post-transplant therapy with hypomethylating agents in MDS and JMML.
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Affiliation(s)
- Christian Flotho
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK), Freiburg, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Sebastian Sommer
- Department of Hematology-Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Lübbert
- Department of Hematology-Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK), Freiburg, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
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12
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Avanzi S, Alvisi G, Ripalti A. How virus persistence can initiate the tumorigenesis process. World J Virol 2013; 2:102-9. [PMID: 24175234 PMCID: PMC3785046 DOI: 10.5501/wjv.v2.i2.102] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 04/04/2013] [Accepted: 04/10/2013] [Indexed: 02/05/2023] Open
Abstract
Human oncogenic viruses are defined as necessary but not sufficient to initiate cancer. Experimental evidence suggests that the oncogenic potential of a virus is effective in cells that have already accumulated a number of genetic mutations leading to cell cycle deregulation. Current models for viral driven oncogenesis cannot explain why tumor development in carriers of tumorigenic viruses is a very rare event, occurring decades after virus infection. Considering that viruses are mutagenic agents per se and human oncogenic viruses additionally establish latent and persistent infections, we attempt here to provide a general mechanism of tumor initiation both for RNA and DNA viruses, suggesting viruses could be both necessary and sufficient in triggering human tumorigenesis initiation. Upon reviewing emerging evidence on the ability of viruses to induce DNA damage while subverting the DNA damage response and inducing epigenetic disturbance in the infected cell, we hypothesize a general, albeit inefficient hit and rest mechanism by which viruses may produce a limited reservoir of cells harboring permanent damage that would be initiated when the virus first hits the cell, before latency is established. Cells surviving virus generated damage would consequently become more sensitive to further damage mediated by the otherwise insufficient transforming activity of virus products expressed in latency, or upon episodic reactivations (viral persistence). Cells with a combination of genetic and epigenetic damage leading to a cancerous phenotype would emerge very rarely, as the probability of such an occurrence would be dependent on severity and frequency of consecutive hit and rest cycles due to viral reinfections and reactivations.
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13
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Yoshimi A, Kamachi Y, Imai K, Watanabe N, Nakadate H, Kanazawa T, Ozono S, Kobayashi R, Yoshida M, Kobayashi C, Hama A, Muramatsu H, Sasahara Y, Jakob M, Morio T, Ehl S, Manabe A, Niemeyer C, Kojima S. Wiskott-Aldrich syndrome presenting with a clinical picture mimicking juvenile myelomonocytic leukaemia. Pediatr Blood Cancer 2013; 60:836-41. [PMID: 23023736 DOI: 10.1002/pbc.24359] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Accepted: 09/11/2012] [Indexed: 01/12/2023]
Abstract
BACKGROUND Wiskott-Aldrich syndrome (WAS) is a rare X-linked immunodeficiency caused by defects of the WAS protein (WASP) gene. Patients with WAS typically demonstrate micro-thrombocytopenia. PROCEDURES The report describes seven male infants with WAS that initially presented with leukocytosis, monocytosis, and myeloid and erythroid precursors in the peripheral blood (PB) and dysplasia in the bone marrow (BM), which was initially indistinguishable from juvenile myelomonocytic leukaemia (JMML). RESULTS The median age of affected patients was 1 month (range, 1-4 months). Splenomegaly was absent in four of these patients, which was unusual for JMML. A mutation analysis of genes in the RAS-signalling pathway did not support a diagnosis of JMML. Non-haematological features, such as eczema (n = 7) and bloody stools (n = 6), ultimately led to the diagnosis of WAS at a median age of 4 months (range, 3-8 months), which was confirmed by absent (n = 6) or reduced (n = 1) WASP expression in lymphocytes by flow cytometry (FCM) and a WASP gene mutation. Interestingly, mean platelet volume (MPV) was normal in three of five patients and six of seven patients demonstrated occasional giant platelets, which was not compatible with WAS. CONCLUSIONS These data suggest that WAS should be considered in male infants presenting with JMML-like features if no molecular markers of JMML can be detected.
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Affiliation(s)
- Ayami Yoshimi
- Department of Paediatrics and Adolescent Medicine, University of Freiburg, Freiburg, Germany.
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14
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Yoshida N, Doisaki S, Kojima S. Current management of juvenile myelomonocytic leukemia and the impact of RAS mutations. Paediatr Drugs 2012; 14:157-63. [PMID: 22480363 DOI: 10.2165/11631360-000000000-00000] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Juvenile myelomonocytic leukemia (JMML) is a rare clonal myelodysplastic/myeloproliferative disorder that affects young children. It is characterized by hypersensitivity of JMML cells to granulocyte-macrophage colony-stimulating factor (GM-CSF) in vitro. The pathogenesis of JMML seems to arise from constitutional activation of the GM-CSF/RAS (a GTPase) signaling pathway, a result of mutations in RAS, NF1, PTPN11, and CBL that interfere with downstream components of the pathway. Most patients with JMML usually experience an aggressive clinical course, and hematopoietic stem cell transplantation (HSCT) is currently the only curative treatment, although the high rates of relapses and graft failures are of great concern. In contrast, a certain proportion of patients experience a stable clinical course for a considerable period of time, and sometimes the disease even spontaneously resolves without any treatment. Recent studies have provided us with increased knowledge of genotype-phenotype correlations in JMML, and suggested that differences in clinical courses may reflect genetic status. Thus, genotype-based management is of current international interest, especially for JMML with RAS mutations. Cumulative evidence suggests that RAS mutations can be related to favorable clinical outcomes, and HSCT may not have to be a mandatory therapeutic option for a portion of patients with this mutation, although a consensus regarding genotype-based management has not yet been achieved. Further efforts toward identifying which patients who will do well without HSCT are required.
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Affiliation(s)
- Nao Yoshida
- Department of Hematology and Oncology, Childrens Medical Center, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
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15
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Nishio N, Takahashi Y, Tanaka M, Xu Y, Yoshida N, Sakaguchi H, Doisaki S, Hama A, Muramatsu H, Shimada A, Kojima S. Aberrant phosphorylation of STAT5 by granulocyte-macrophage colony-stimulating factor in infant cytomegalovirus infection mimicking juvenile myelomonocytic leukemia. Leuk Res 2011; 35:1261-4. [PMID: 21571368 DOI: 10.1016/j.leukres.2011.04.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2010] [Revised: 04/16/2011] [Accepted: 04/16/2011] [Indexed: 11/24/2022]
Abstract
Juvenile myelomonocytic leukemia (JMML) progenitor cells exhibit in vitro hypersensitivity to granulocyte-macrophage colony-stimulating factor (GM-CSF). Phospho-specific flow cytometry using anti-phosphorylated STAT5 antibody is a new method recently reported to detect GM-CSF hypersensitivity of cells. However, colony assays using methylcellulose medium to measure GM-CSF-hypersensitivity remain as the current gold standard. Interestingly, cytomegalovirus (CMV) infection in infancy often presents with a variety of clinical symptoms that mimic JMML, with CMV giving a positive result by colony assay. We wanted to determine whether aberrant STAT5 activation occurs in CMV infection by using phospho-specific flow cytometry, and to ascertain whether this method is effective at discriminating CMV infection from JMML. Peripheral blood mononuclear cells from patients with JMML and CMV infection displayed an elevated proportion of p-STAT5 cells after low-dose GM-CSF stimulation when compared with cells from normal individuals. However, we found no significant differences in the percentage of p-STAT5 positive cells from patients with CMV infection and JMML at any doses of the GM-CSF doses used. We conclude that patients with CMV infection cannot be discriminated from patients with JMML by this new diagnostic method.
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Affiliation(s)
- Nobuhiro Nishio
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Shouwa-ku, Nagoya, Japan
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16
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Puri K, Singh P, Das RR, Seth R, Gupta R. Diagnostic dilemma of JMML coexisting with CMV infection. Indian J Pediatr 2011; 78:485-7. [PMID: 21193971 DOI: 10.1007/s12098-010-0355-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 12/08/2010] [Indexed: 10/18/2022]
Abstract
Juvenile myelomonocytic leukemia (JMML) is a rare mixed myeloproliferative and myelodysplastic disorder of early childhood, characterized by excessive proliferation of monocytic and granulocytic cells, along with myelodysplastic features. There are reports of viral infections mimicking JMML, with all clinical and hematological parameters normalizing on resolution of infection. The authors describe a 1- year- old boy with concomitant JMML and CMV infection. The diagnostic dilemma, the significance of distinguishing it from a mimicking viral infection, as well as potential synergistic effect of concomitant infections on the presentation or actual disease severity of underlying JMML will be discussed.
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Affiliation(s)
- Kriti Puri
- Department of Pediatrics, AIIMS, New Delhi, India
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17
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Juvenile myelomonocytic leukemia presenting with coexistent cytomegalovirus infection--a case report. J Pediatr Hematol Oncol 2010; 32:e153-4. [PMID: 20445410 DOI: 10.1097/mph.0b013e3181d7ade2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report a case of juvenile myelomonocytic leukemia (JMML) with coexistent cytomegalovirus (CMV) infection in a 10-month-old child that caused initial diagnostic dilemma. The patient presented with fever, anemia, lymphadenopathy, and hepatosplenomegaly. The peripheral blood smear and bone marrow aspirate examination showed monocytosis, leukoerythroblastosis, myeloid hyperplasia, and increased blasts. Serologic test for CMV was positive and thus the hematologic picture was attributed to CMV infection and gancyclovir was started. The patient, however, did not improve clinically. A repeat peripheral smear and marrow showed persistence of the above picture and a diagnosis of JMML was made. Viral infections in young children may present with hematologic features overlapping with JMML and simultaneous occurrence of both may cause diagnostic dilemma.
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18
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Yoshimi A, Kojima S, Hirano N. Juvenile myelomonocytic leukemia: epidemiology, etiopathogenesis, diagnosis, and management considerations. Paediatr Drugs 2010; 12:11-21. [PMID: 20034338 DOI: 10.2165/11316200-000000000-00000] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Juvenile myelomonocytic leukemia (JMML) is a rare hematopoietic malignancy of early childhood with features characteristic of both myelodysplastic and myeloproliferative disorders. Recent studies clearly show that the deregulated activation of the RAS signaling pathway plays a central role in the pathogenesis of JMML. Somatic defects in either RAS, PTPN11 or NF1 genes involved in this pathway are detected in 70-80% of JMML patients, allowing a molecular diagnosis to be made in the majority of cases. Patients with JMML respond poorly to chemotherapy, and the probability of survival without allogeneic hematopoietic stem cell transplantation (HSCT) is less than 10%. Recent studies show that the event-free survival after HSCT is between 24 and 54%, with no difference between transplants using matched family donors and those using unrelated donors. The use of therapies such as intensive chemotherapy and splenectomy prior to HSCT does not improve the outcome. The relapse rate following HSCT is over 30%, which is unacceptably high. Cumulative evidence suggests that a graft-versus-leukemia effect occurs in JMML. Donor leukocyte infusion is not usually successful in JMML, but the outcome of second HSCT is generally favorable. Based on recent advances in the understanding of the pathogenesis of JMML, the development of novel targeted therapies, which might improve the outcome of patients, is keenly awaited.
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Affiliation(s)
- Ayami Yoshimi
- Department of HSCT Data Management, Nagoya University, Japan.
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19
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Unal S, Cetin M, Kutlay NY, Elmas SA, Gumruk F, Tukun A, Tuncer M, Gurgey A. Hemophagocytosis associated with leukemia: a striking association with juvenile myelomonocytic leukemia. Ann Hematol 2009; 89:359-64. [DOI: 10.1007/s00277-009-0837-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Accepted: 09/16/2009] [Indexed: 02/05/2023]
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20
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Morphologic differential diagnosis of juvenile myelomonocytic leukemia--pitfalls apart from viral infection. J Pediatr Hematol Oncol 2009; 31:380. [PMID: 19415027 DOI: 10.1097/mph.0b013e31819ed260] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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21
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Urs L, Qualman SJ, Kahwash SB. Juvenile myelomonocytic leukemia: report of seven cases and review of literature. Pediatr Dev Pathol 2009; 12:136-42. [PMID: 18721005 DOI: 10.2350/08-04-0456.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Accepted: 08/11/2008] [Indexed: 11/20/2022]
Abstract
Juvenile myelomonocytic leukemia (JMML) is a rare, aggressive, clonal hematopoietic disorder of childhood with features of both myelodysplasia (thrombocytopenia, anemia) and myeloproliferation (leukocytosis, monocytosis). In most cases there is marrow hypercellularity, splenomegaly, and extramedullary involvement. In 1997 an international consensus on terminology was reached and guidelines/criteria for diagnosis were proposed. A recent World Health Organization classification described the current diagnostic criteria of JMML. Although the diagnosis of JMML has been facilitated, it can be challenging, especially in the early stages or when it 1st presents as an extramedullary tumor. We report a series of 7 cases diagnosed over a period of 10 years (from January 1, 1996, to December 31, 2005). Two cases had interesting associated findings that would potentially lead to delay in diagnosis or misdiagnosis. Two other cases had extramedullary involvement with symptoms referable to the organs of involvement at presentation. Clinical and pathologic findings are summarized with a review of relevant literature.
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Affiliation(s)
- Latha Urs
- Department of Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH 43205, USA
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22
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Abstract
Juvenile myelomonocytic leukemia (JMML) is a rare blood cell malignancy occurring in very young children. Yet, just as has been proven in other rare diseases, the study of JMML has provided us great insights into aberrant and dysregulated signal transduction through the Ras pathway, with the ultimate development of malignancy. Further, JMML investigations have also revealed to us much about the genetic predisposition to cancer.
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Affiliation(s)
- Peter D Emanuel
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR 72205-7199, USA.
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24
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Janik-Moszant A, Barć-Czarnecka M, van der Burg M, Langerak AW, Hartwig NG, Vossen ACTM, Niemeyer CM, Wachowiak J, Sońta-Jakimczyk D, Szczepański T. Concomitant EBV-related B-cell proliferation and juvenile myelomonocytic leukemia in a 2-year-old child. Leuk Res 2008; 32:181-4. [PMID: 17618684 DOI: 10.1016/j.leukres.2007.05.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2007] [Revised: 05/14/2007] [Accepted: 05/17/2007] [Indexed: 11/25/2022]
Abstract
We present a case of a 2-year-old girl, who developed concomitant EBV-related B-cell proliferation and juvenile myelomonocytic leukemia (JMML). JMML was initially not recognized because of predominant B-cell proliferation. The activating N-RAS mutation was retrospectively already detectable at this early stage. Our findings support the hypothesis that EBV may contribute to JMML pathogenesis by stimulating pre-existing malignant clones. However, such stimulation of leukemic clone does not require the direct incorporation of the virus into myeloid progenitors. Most probably a cytokine burst resulting from EBV infection allows expansion of pre-existing malignant myeloid progenitors. Further studies are required to delineate exact mechanisms of EBV-related promotion of the JMML clone.
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Affiliation(s)
- Anna Janik-Moszant
- Department of Pediatric Hematology and Oncology, Silesian Medical Academy, Zabrze, Poland
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26
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Wiskott-Aldrich syndrome is an important differential diagnosis in male infants with juvenile myelomonocytic leukemialike features. J Pediatr Hematol Oncol 2007; 29:836-8. [PMID: 18090932 DOI: 10.1097/mph.0b013e3181580ec5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A newborn presented with thrombocytopenia at birth and subsequently developed leukocytosis, monocytosis, and mild hepatomegaly. The bone marrow was normocellular with dysplasia and spontaneous granulocyte-monocyte colony formation was demonstrated. These findings fulfilled the diagnostic criteria of juvenile myelomonocytic leukemia. Then he developed atopic dermatitislike eczema, which led to the consideration of Wiskott-Aldrich syndrome (WAS). Lack of intracellular WASP expression and WASP gene mutation confirmed the diagnosis of WAS. After stem cell transplantation, he is alive in good condition with normal WASP expression. WAS should be considered as a differential diagnosis in male infants with juvenile myelomonocytic leukemialike features.
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27
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Metzler M, Bruch J, Stachel D, Langer T, Borkhardt A, Harbott J, Rascher W, Holter W. Temporary blast reduction after immunoglobulin administration for congenital cytomegalovirus infection masking infant leukemia with cryptic MLL rearrangement. Leuk Res 2006; 31:553-7. [PMID: 16814860 DOI: 10.1016/j.leukres.2006.05.020] [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: 03/19/2006] [Revised: 05/15/2006] [Accepted: 05/19/2006] [Indexed: 11/24/2022]
Abstract
Differentiation between reactive bone marrow suppression due to viral infection and early stages of leukemia can be difficult particularly in young infants. We report on a 2-month-old girl presenting with pancytopenia and positive markers for congenital cytomegalovirus (CMV) infection. Definitive diagnosis of coexisting pro-B cell infant leukemia with cryptic MLL rearrangement was delayed by the transient regeneration of normal hematopoiesis and reduction of abnormal blastoid cells in the bone marrow following immunoglobulin administration. Molecular diagnosis could only be established using interphase fluorescence in situ hybridization (FISH) analysis which may be considered as a valuable additional diagnostic tool in similar cases.
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Affiliation(s)
- Markus Metzler
- Department of Pediatrics, University of Erlangen-Nuremberg, Erlangen, Germany.
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