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Rivera-Luna R, Perez-Vera P, Galvan-Diaz C, Velasco-Hidalgo L, Olaya-Vargas A, Cardenas-Cardos R, Aguilar-Ortiz M, Ponce-Cruz J. Triple-hit explanation for the worse prognosis of pediatric acute lymphoblastic leukemia among Mexican and Hispanic children. Front Oncol 2022; 12:1072811. [PMID: 36531028 PMCID: PMC9747921 DOI: 10.3389/fonc.2022.1072811] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 10/31/2022] [Indexed: 04/06/2024] Open
Abstract
Acute lymphoblastic leukemia (ALL) is the most common malignancy among Mexican and Hispanic children and the first cause of death by disease in Mexico. We propose a "triple-hit" explanation for the survival gap affecting this population. The first hit can be attributed to epidemiology and social, cultural, and economic burdens. The second hit refers to cancer biology, with a high incidence of unfavorable genetic characteristics associated with an unfavorable response to treatment and, subsequently, poor survival. Finally, the third hit relates to sub-optimal treatment and support. Society and culture, leukemia biology, and treatment approach limitations are key factors that should not be seen apart and must be considered comprehensively in any strategy to improve the prognosis of Mexican and Hispanic children with ALL.
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Affiliation(s)
- Roberto Rivera-Luna
- Department of Oncology, National Institute of Pediatrics, Mexico City, Mexico
- Progenitor and Hematopoietic Cell Transplant Unit, National Institute of Pediatrics, Mexico City, Mexico
| | - Patricia Perez-Vera
- Laboratory of Genetics and Cancer, National Institute of Pediatrics, Mexico City, Mexico
| | - Cesar Galvan-Diaz
- Department of Oncology, National Institute of Pediatrics, Mexico City, Mexico
| | | | - Alberto Olaya-Vargas
- Progenitor and Hematopoietic Cell Transplant Unit, National Institute of Pediatrics, Mexico City, Mexico
| | | | - Marco Aguilar-Ortiz
- Department of Oncology, National Institute of Pediatrics, Mexico City, Mexico
| | - Jesus Ponce-Cruz
- Pediatric Oncology Unit, ABC Medical Center, Mexico City, Mexico
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Mata-Rocha M, Rangel-López A, Jimenez-Hernandez E, Nuñez-Enríquez JC, Morales-Castillo BA, Sánchez-Escobar N, Sepúlveda-Robles OA, Bravata-Alcántara JC, Nájera-Cortés AS, Pérez-Saldivar ML, Flores-Lujano J, Duarte-Rodríguez DA, Oviedo de Anda NA, Romero Tlalolini MDLA, Alaez Verson C, Martín-Trejo JA, Muñoz Medina JE, Gonzalez-Bonilla CR, Hernandez Cueto MDLA, Bekker-Méndez VC, Jiménez-Morales S, Medina-Sansón A, Amador-Sánchez R, Peñaloza-González JG, Torres-Nava JR, Espinosa-Elizondo RM, Cortés-Herrera B, Flores-Villegas LV, Merino-Pasaye LE, Gutierrez-Rivera MDL, Velazquez-Aviña MM, Santillan-Juarez JD, Gurrola-Silva A, Hernández Echáurregui GA, Hidalgo-Miranda A, Arellano Galindo J, Rosas-Vargas H, Mejía-Aranguré JM. Low Prevalence of ETV6::RUNX1 Fusion Gene in a Hispanic Population. Front Pediatr 2022; 10:837656. [PMID: 35685921 PMCID: PMC9171364 DOI: 10.3389/fped.2022.837656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/06/2022] [Indexed: 11/13/2022] Open
Abstract
ETV6::RUNX1 is a genetic rearrangement of good prognosis in children with acute lymphoblastic leukemia (ALL). In Mexico, its prevalence is low in comparison with Caucasian populations. We developed a novel TaqMan one-step RT-qPCR approach to assess the prevalence of four genetic rearrangements in a cohort of Hispanic children with ALL from Mexico City. The prevalence of common fusion gene transcripts was as follows: TCF3::PBX1 7.7%; BCR::ABL1p 190 3.3%; and KMT2A::AFF1 2.8%, and ETV6::RUNX1was observed with low prevalence (10.5%) in comparison to that reported for developed countries. This is consistent with previous findings on Mexican children with ALL and similar to those reported on children from Hispanic populations. The confirmation of a low prevalence of ETV6::RUNX1 in children of a Hispanic origin represents an advancement in the description of genetic factors of ALL in these populations.
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Affiliation(s)
- Minerva Mata-Rocha
- CONACyT-Unidad de Investigacion Medica en Genetica Humana, Hospital de Pediatria, Centro Medico Nacional Siglo XXI, IMSS, Mexico City, Mexico
| | - Angelica Rangel-López
- Coordinacion de Investigacion en Salud, Unidad Habilitada de Apoyo al Predictamen, Centro Medico Siglo XXI, IMSS, Mexico City, Mexico
| | - Elva Jimenez-Hernandez
- Servicio de Hematologia Pediatrica, Hospital General “Gaudencio González Garza”, Centro Medico Nacional (CMN) “La Raza”, IMSS, Mexico City, Mexico
| | - Juan Carlos Nuñez-Enríquez
- Unidad de Investigacion Medica en Epidemiologia Clinica, Hospital de Pediatria, Centro Medico Nacional Siglo XXI, IMSS, Mexico City, Mexico
| | - Blanca Angélica Morales-Castillo
- Unidad de Investigacion Medica en Genética Humana, Hospital de Pediatria, Centro Medico Nacional Siglo XXI, IMSS, Mexico City, Mexico
| | - Norberto Sánchez-Escobar
- Unidad de Investigacion Medica en Genética Humana, Hospital de Pediatria, Centro Medico Nacional Siglo XXI, IMSS, Mexico City, Mexico
- Facultad de Medicina y Cirugía, UABJO, Oaxaca, Mexico
| | - Omar Alejandro Sepúlveda-Robles
- Unidad de Investigacion Medica en Genética Humana, Hospital de Pediatria, Centro Medico Nacional Siglo XXI, IMSS, Mexico City, Mexico
| | - Juan Carlos Bravata-Alcántara
- Laboratorio de Genética y Diagnóstico Molecular, Hospital Juárez de México, Secretaría de Salud (SSa), Mexico City, Mexico
| | - Alan Steve Nájera-Cortés
- Laboratorio de Genética y Diagnóstico Molecular, Hospital Juárez de México, Secretaría de Salud (SSa), Mexico City, Mexico
| | - María Luisa Pérez-Saldivar
- Unidad de Investigacion Medica en Epidemiologia Clinica, Hospital de Pediatria, Centro Medico Nacional Siglo XXI, IMSS, Mexico City, Mexico
| | - Janet Flores-Lujano
- Unidad de Investigacion Medica en Epidemiologia Clinica, Hospital de Pediatria, Centro Medico Nacional Siglo XXI, IMSS, Mexico City, Mexico
| | - David Aldebarán Duarte-Rodríguez
- Unidad de Investigacion Medica en Epidemiologia Clinica, Hospital de Pediatria, Centro Medico Nacional Siglo XXI, IMSS, Mexico City, Mexico
| | | | | | - Carmen Alaez Verson
- Laboratorio de Diagnóstico Genómico, Instituto Nacional de Medicina Genómica (INMEGEN), Mexico City, Mexico
| | - Jorge Alfonso Martín-Trejo
- Servicio de Hematologia, UMAE Hospital de Pediatria, Centro Medico Nacional Siglo XXI, IMSS, Mexico City, Mexico
| | - Jose Esteban Muñoz Medina
- Laboratorio Central de Epidemiología, Centro Médico Nacional “La Raza”, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | - Maria de los Angeles Hernandez Cueto
- Centro Médico Nacional La Raza, División de Laboratorios de Vigilancia e Investigación Epidemiológica, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - VC. Bekker-Méndez
- UIM en Inmunología e Infectología, Centro Médico Nacional “La Raza”, IMSS, Mexico City, Mexico
| | - Silvia Jiménez-Morales
- Laboratorio de Genomica del Cancer, Instituto Nacional de Medicina Genómica, Mexico City, Mexico
| | - Aurora Medina-Sansón
- Servicio de Oncología, Hospital Infantil de Mexico Federico Gómez, Secretaria de Salud, Mexico City, Mexico
| | - Raquel Amador-Sánchez
- Servicio de Hematologia Pediatrica, Hospital General Regional “Carlos McGregor Sanchez Navarro”, IMSS, Mexico City, Mexico
| | | | - José Refugio Torres-Nava
- Servicio de Oncología, Hospital Pediatrico de Moctezuma, Secretaria de Salud de la Ciudad de Mexico (SSCDMX), Mexico City, Mexico
| | | | - Beatriz Cortés-Herrera
- Servicio de Hematologia Pediatrica, Hospital General de Mexico, Secretaria de Salud, Mexico City, Mexico
| | | | | | | | | | | | - Alma Gurrola-Silva
- Servicio de Pediatría, Hospital Regional Tipo B de Alta Especialidad Bicentenario de la Independencia, Instituto de Seguridad Social al Servicio de los Trabajadores del Estado, Mexico City, Mexico
| | | | - Alfredo Hidalgo-Miranda
- Laboratorio de Genomica del Cancer, Instituto Nacional de Medicina Genómica, Mexico City, Mexico
| | - José Arellano Galindo
- Unidad de Investigación en Enfermedades Infecciosas, Laboratorio de Virologia Clínica y Experimental, Hospital Infantil de Mexico Federico Gómez, Secretaria de Salud, Mexico City, Mexico
| | - Haydeé Rosas-Vargas
- Unidad de Investigacion Medica en Genética Humana, Hospital de Pediatria, Centro Medico Nacional Siglo XXI, IMSS, Mexico City, Mexico
| | - Juan Manuel Mejía-Aranguré
- Unidad de Investigacion Medica en Genética Humana, Hospital de Pediatria, Centro Medico Nacional Siglo XXI, IMSS, Mexico City, Mexico
- Laboratorio de Genomica del Cancer, Instituto Nacional de Medicina Genómica, Mexico City, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
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Vinti L, Del Baldo G, Lodi M, Stocchi F, Cefalo MG, Pagliara D. Poor prognosis of B-cell acute lymphoblastic leukemia with TCF/PBX1 fusion gene and ovarian involvement at diagnosis: Two case reports and review of the literature. Pediatr Blood Cancer 2022; 69:e29299. [PMID: 34411424 DOI: 10.1002/pbc.29299] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Luciana Vinti
- Department of Paediatric Haematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giada Del Baldo
- Department of Paediatric Haematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Mariachiara Lodi
- Department of Paediatric Haematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesca Stocchi
- Department of Paediatric Haematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maria Giuseppina Cefalo
- Department of Paediatric Haematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Daria Pagliara
- Department of Paediatric Haematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Gupta DG, Varma N, Naseem S, Sachdeva MUS, Bose P, Binota J, Kumar A, Gupta M, Rana P, Sonam P, Malhotra P, Trehan A, Khadwal A, Varma S. Characterization of the immunophenotypic aberrancies with respect to common fusion transcripts in B-cell precursor acute lymphoblastic leukaemia - a report of 986 Indian patients. Turk J Haematol 2021; 39:1-12. [PMID: 34617433 PMCID: PMC8886275 DOI: 10.4274/tjh.galenos.2021.2021.0326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: Based on the immunophenotype, acute lymphoblastic leukemia (ALL) can be categorized into B-cell or T-cell lineages. B-cell precursor ALL (BCP-ALL) cases show various genetic/molecular abnormalities, and varying frequencies of chimeric fusion transcripts in BCP-ALL cases are reported from different parts of the world. We studied the immunophenotypic aberrancy profiles of a large number of BCP-ALL cases with respect to various common chimeric fusion transcripts. Materials and Methods: Flow cytometric immunophenotyping and multiplex reverse-transcription polymerase chain reaction assays were performed for 986 BCP-ALL cases. Results: Among 986 BCP-ALL cases, the incidence of various fusion transcripts was 38.36% in adult cases and 20.68% in pediatric cases. Adult BCP-ALL patients with t(9;22)(BCR-ABL1) fusion transcripts and expression of aberrant myeloid markers were significantly older at presentation (p=0.0218) with male preponderance (p=0.0246) compared to those without aberrant myeloid expression. In pediatric patients with the t(12;21)(ETV6-RUNX1) chimeric fusion transcript, aberrant expression of CD13 was observed in 39.13%, CD33 in 36.95%, and CD117 in 8.69% of patients, respectively. Pediatric BCP-ALL patients with the ETV6-RUNX1 fusion transcript and expression of aberrant myeloid markers were not significantly different compared to those without with respect to demographic and clinical/hematological characteristics (p=0.5955). Aberrant myeloid markers were rarely or never expressed in pediatric and adult BCP-ALL patients with the t(4;11)(KTM2A-AF4) and t(1;19)(TCF3-PBX1) fusion transcripts. Conclusion: Aberrant myeloid markers were frequently expressed among BCP-ALL patients with the t(9;22)(BCR-ABL1) and t(12;21)(ETV6-RUNX1) fusion transcripts. However, BCP-ALL patients with the t(4;11)(KTM2A-AF4) and t(1;19)(TCF3-PBX1) fusion transcripts rarely or never expressed aberrant myeloid markers. Aberrant myeloid CD markers can be used in predicting chimeric fusion transcripts at baseline so as to plan appropriate tyrosine kinase inhibitor therapy in cases of BCP-ALL with specific chimeric fusion transcripts. This study has delineated the relationship of chimeric fusion transcripts with the aberrant expression of myeloid markers in a large cohort of BCP-ALL cases.
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Affiliation(s)
- Dikshat Gopal Gupta
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Neelam Varma
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shano Naseem
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Parveen Bose
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jogeshwar Binota
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Kumar
- International Centre for Genetic Engineering and Biotechnology (ICGEB), New Delhi, India
| | - Minakshi Gupta
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Palak Rana
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Preeti Sonam
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amita Trehan
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Alka Khadwal
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Subhash Varma
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Jia M, Hu BF, Xu XJ, Zhang JY, Li SS, Tang YM. Clinical features and prognostic impact of TCF3-PBX1 in childhood acute lymphoblastic leukemia: A single-center retrospective study of 837 patients from China. Curr Probl Cancer 2021; 45:100758. [PMID: 34034913 DOI: 10.1016/j.currproblcancer.2021.100758] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/11/2021] [Accepted: 04/13/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Conflicting data have been published regarding the prognostic impact of the t(1;19)/TCF3-PBX1 translocation in childhood ALL. The objective of this study was to explore the correlation between the TCF3-PBX1 fusion gene and clinical outcome in Chinese children with newly diagnosed ALL. METHODS In order to address this issue in our setting, we summarized and analyzed the data of 837 Chinese children with ALL diagnosed between 2010 and 2017. All the patients were treated with the National Protocol of Childhood Leukemia in China (NPCLC)-ALL-2008 protocol. Clinical characteristics and prognosis of pediatric ALL patients with or without TCF3-PBX1 rearrangement were analyzed and compared retrospectively. RESULTS The TCF3-PBX1 fusion gene was identified in 48 (5.7%) of 837 children with ALL. Our results showed that TCF3-PBX1 positive patients had higher pretreatment white blood cell counts, higher PB blasts percentages and worse risk classification at diagnosis. No statistically significant differences in CR rates, response to prednisone and relapse rates were found between TCF3-PBX1-positive and -negative patients. The 5-year predicted EFS, RFS, and OS of the TCF3-PBX1 positive group compared with the control group were 86.2%±5.3% vs 85.4%±1.3% (P=0.657), 88.2%±5.1% vs 92.2%±1.0% (P=0.458) and 90.4%±4.6% vs 89.0%±1.1% (P=0.561), respectively. No differences were observed regarding clinical outcome between these two groups. When compared with standard risk, intermediate risk and high risk group patients, the long-term survival of TCF3/PBX1 positive group was approximately similar to that of the intermediate risk group under the same protocol in our single center. CONCLUSION In contrast to previous studies, childhood ALL patients with TCF3-PBX1 transcripts do not appear to show a better outcome than their negative counterparts. TCF3/PBX1 positive was a definitive intermediate risk factor with our NPCLC-ALL-2008 protocol.
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Affiliation(s)
- Ming Jia
- Department of Hematology-oncology, Children's Hospital of Zhejiang University School of Medicine, the Pediatric Leukemia Diagnostic and Therapeutic Technology Research Center of Zhejiang Province, Zhejiang University, Hangzhou, China
| | - Bo-Fei Hu
- Department of Infectious Diseases, Children's Hospital of Zhejiang University School of Medicine, the Pediatric Leukemia Diagnostic and Therapeutic Technology Research Center of Zhejiang Province, Zhejiang University, Hangzhou, China
| | - Xiao-Jun Xu
- Department of Hematology-oncology, Children's Hospital of Zhejiang University School of Medicine, the Pediatric Leukemia Diagnostic and Therapeutic Technology Research Center of Zhejiang Province, Zhejiang University, Hangzhou, China
| | - Jing-Ying Zhang
- Department of Hematology-oncology, Children's Hospital of Zhejiang University School of Medicine, the Pediatric Leukemia Diagnostic and Therapeutic Technology Research Center of Zhejiang Province, Zhejiang University, Hangzhou, China
| | - Si-Si Li
- Department of Hematology-oncology, Children's Hospital of Zhejiang University School of Medicine, the Pediatric Leukemia Diagnostic and Therapeutic Technology Research Center of Zhejiang Province, Zhejiang University, Hangzhou, China
| | - Yong-Min Tang
- Department of Hematology-oncology, Children's Hospital of Zhejiang University School of Medicine, the Pediatric Leukemia Diagnostic and Therapeutic Technology Research Center of Zhejiang Province, National Clinical Research Center for Child Health, Zhejiang University, Hangzhou, China.
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6
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Evaluation of Structural Factors Potentially Implicated in Acute Lymphoblastic Leukemia: A report of the MIGICCL. Arch Med Res 2017; 47:515-520. [PMID: 28262192 DOI: 10.1016/j.arcmed.2016.11.012] [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: 08/31/2016] [Accepted: 11/23/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Acute lymphoblastic leukemia (ALL) is the most common cancer in the pediatric population; ∼80% of the cases show some translocation. Translocations that result in ALL are due to chromosome breaks. However, the exact mechanisms that cause these breaks have not been well studied. A detailed search of the breakpoints associated with ALL reported in the NCBI database shows that some are concentrated in limited regions of the chromosome, whereas others are scattered throughout. Therefore, the objective of this study was to identify the structural factors involved in chromosomal breaks in ALL. METHODS We performed several bioinformatic studies on the sequences where chromosomal breakpoints have been reported in search of rearrangements: areas of high similarity, thermodynamic stability, composition and conformation of the DNA. RESULTS Certain factors may influence chromosome breaks and are capable of predicting the propensity towards these types of events. CONCLUSIONS These findings may be useful in the design of molecular techniques able to detect these changes in ALL.
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Hu Y, He H, Lu J, Wang Y, Xiao P, Li J, Li J, Sun Y, Lv H, Fan J, Yao Y, Chai Y, Hu S. E2A-PBX1 exhibited a promising prognosis in pediatric acute lymphoblastic leukemia treated with the CCLG-ALL2008 protocol. Onco Targets Ther 2016; 9:7219-7225. [PMID: 27920559 PMCID: PMC5125801 DOI: 10.2147/ott.s115257] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Objective The objective of this study was to observe the prognosis of pediatric patients with E2A-PBX1-positive acute lymphoblastic leukemia (ALL) from the treatment with the CCLG-ALL2008 protocol. Design and methods Three hundred and forty-nine Chinese pediatric patients with pre-B-cell ALL were enrolled in this study from December 2008 to September 2013. Of these, 20 patients with E2A-PBX1 expression and 223 without the gene expression were stratified into two cohorts. Clinical and biological characteristics and 5-year event-free survival (EFS), relapse-free survival (RFS), and overall survival (OS) were analyzed and compared between these two groups. Results The E2A-PBX1 fusion transcript was detected in 20 of 349 (5.7%) patients. Compared with the gene-negative subgroup, patients with E2A-PBX1 were younger in age but did not show significant differences in white blood cell (WBC) count or gender distribution at primary diagnosis. Moreover, there were more inferior karyotypes detected in the E2A-PBX1 subgroup (P=0.035). With the CCLG-ALL2008 treatment protocol, patients with E2A-PBX1 showed a favorable treatment response with lower minimal residual disease (MRD) levels (<10−4) at time point 1 (TP1, P=0.039) but no superior steroid response or histological remission. We also observed a promising survival outcome, with a 5-year EFS reaching 95.0%±4.9% versus 66.3%±3.9% in the gene-negative group (P=0.039). However, we did not find significant differences in RFS (P=0.061) and OS (P=0.113). Conclusion Our data provided clinical observation of Chinese pediatric patients. Patients with E2A-PBX1-positive ALL benefited well from the CCLG-ALL2008 protocol, a risk-based intensified treatment trial, with lower levels of MRD and longer RFS duration though they had no favorable characteristics at primary diagnosis.
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Affiliation(s)
- Yixin Hu
- Department of Hematology and Oncology, The Children's Hospital of Soochow University, Suzhou, People's Republic of China
| | - Hailong He
- Department of Hematology and Oncology, The Children's Hospital of Soochow University, Suzhou, People's Republic of China
| | - Jun Lu
- Department of Hematology and Oncology, The Children's Hospital of Soochow University, Suzhou, People's Republic of China
| | - Yi Wang
- Department of Hematology and Oncology, The Children's Hospital of Soochow University, Suzhou, People's Republic of China
| | - Peifang Xiao
- Department of Hematology and Oncology, The Children's Hospital of Soochow University, Suzhou, People's Republic of China
| | - Jianqin Li
- Department of Hematology and Oncology, The Children's Hospital of Soochow University, Suzhou, People's Republic of China
| | - Jie Li
- Department of Hematology and Oncology, The Children's Hospital of Soochow University, Suzhou, People's Republic of China
| | - Yina Sun
- Department of Hematology and Oncology, The Children's Hospital of Soochow University, Suzhou, People's Republic of China
| | - Hui Lv
- Department of Hematology and Oncology, The Children's Hospital of Soochow University, Suzhou, People's Republic of China
| | - Junjie Fan
- Department of Hematology and Oncology, The Children's Hospital of Soochow University, Suzhou, People's Republic of China
| | - Yanhua Yao
- Department of Hematology and Oncology, The Children's Hospital of Soochow University, Suzhou, People's Republic of China
| | - Yihuan Chai
- Department of Hematology and Oncology, The Children's Hospital of Soochow University, Suzhou, People's Republic of China
| | - Shaoyan Hu
- Department of Hematology and Oncology, The Children's Hospital of Soochow University, Suzhou, People's Republic of China
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8
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Iqbal Z, Akhtar T, Awan T, Aleem A, Sabir N, Rasool M, Absar M, Akram AM, Shammas MA, Shah IH, Khalid M, Taj AS, Jameel A, Alanazi A, Gill AT, Hashmi JA, Hussain A, Sabar MF, Khalid AM, Qazi MH, Karim S, Siddiqi MH, Mahmood A, Iqbal M, Saeed A, Irfan MI. High frequency and poor prognosis of late childhood BCR-ABL-positive and MLL-AF4-positive ALL define the need for advanced molecular diagnostics and improved therapeutic strategies in pediatric B-ALL in Pakistan. Mol Diagn Ther 2015; 19:277-87. [PMID: 26266519 DOI: 10.1007/s40291-015-0149-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Fusion oncogenes (FOs) resulting from chromosomal abnormalities have an important role in leukemogenesis in pediatric B cell acute lymphoblastic leukemia (ALL). The most common FOs are BCR-ABL, MLL-AF4, ETV6-RUNX1, and TCF3-PBX1, all of which have important prognostic and drug selection implications. Moreover, frequencies of FOs have ethnic variations. We studied Pakistani frequencies of FOs, clinical pattern, and outcome in pediatric B-ALL. METHODS FOs were studied in 188 patients at diagnosis using reverse transcriptase-polymerase chain reaction (RT-PCR) and interphase fluorescent in situ hybridization (FISH). Data were analyzed using SPSS version 17 (SPSS Inc., Chicago, IL, USA). RESULTS FOs were detected in 87.2 % of patients. Mean overall survival was 70.9 weeks, 3-year survival was 31.9 %, and 3-year relapse-free survival was 18.1 %. Four patients died of drug toxicities. ETV6-RUNX1 (19.14 %) had better survival (110.9 weeks; p = 0.03); TCF3-PBX1 (2.1 %) was associated with inferior outcome and higher central nervous system (CNS) relapse risk; MLL-AF4 (18.1 %) was more common in the 8- to 15-year age group (24/34; p = 0.001) and was associated with organomegaly, low platelet count, and poor survival; and BCR-ABL (47.9 %) was associated with older age (7-15 years, 52/90), lower remission rates, shorter survival (43.73 ± 4.24 weeks) and higher white blood cell count. Overall, MLL-AF4 and BCR-ABL were detected in 66 % of B-ALL, presented in later childhood, and were associated with poor prognosis and inferior survival. CONCLUSIONS This study reports the highest ethnic frequency of BCR-ABL FO in pediatric ALL, and is consistent with previous reports from our region. Poor prognosis BCR-ABL and MLL-AF4 was detected in two-thirds of pediatric B-ALL and is likely to be the reason for the already reported poor survival of childhood ALL in South-East Asia. Furthermore, MLL-AF4, usually most common in infants, presented in later childhood in most of the ALL patients, which was one of the unique findings in our study. The results presented here highlight the need for mandatory inclusion of molecular testing for pediatric ALL patients in clinical decision making, together with the incorporation of tyrosine kinase inhibitors, as well as hematopoietic stem cell transplantation facilities, to improve treatment outcome for patients in developing countries.
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Affiliation(s)
- Zafar Iqbal
- Medical Genetics/Hematology and Oncology, CLS, CAMS, King Saud Bin Abdulaziz University for Health Sciences/KAIMRC, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, 11426, Saudi Arabia. .,Hematology Oncology and Pharmacogenetic Engineering Sciences (HOPES) Group, Health Sciences/Parasitology Laboratories (HSL), Department of Zoology, University of the Punjab (ZPU), Lahore, Pakistan. .,Department of Biotechnology, University of Sargodha, Sargodha, Pakistan. .,Institute of Molecular Biology and Biotechnology (IMBB), Centre for Research in Molecular Medicine (CRiMM), The University of Lahore, Lahore, Pakistan. .,Pakistan Society for Molecular and Clinical Hematology (PSMH) & Hematology Oncology and Pharmacogenetic Engineering Sciences Group (HOPES), Lahore, Pakistan.
| | - Tanveer Akhtar
- Department of Zoology, Faculty of Biological Sciences, University of the Punjab, Lahore, Pakistan.,Pakistan Society for Molecular and Clinical Hematology, Lahore, Pakistan.,Hematology Oncology and Pharmacogenetic Engineering Sciences (HOPES) Group, Health Sciences/Parasitology Laboratories (HSL), Department of Zoology, University of the Punjab (ZPU), Lahore, Pakistan.,Pakistan Society for Molecular and Clinical Hematology (PSMH) & Hematology Oncology and Pharmacogenetic Engineering Sciences Group (HOPES), Lahore, Pakistan
| | - Tashfin Awan
- Hematology Oncology and Pharmacogenetic Engineering Sciences (HOPES) Group, Health Sciences/Parasitology Laboratories (HSL), Department of Zoology, University of the Punjab (ZPU), Lahore, Pakistan.,Pakistan Society for Molecular and Clinical Hematology (PSMH) & Hematology Oncology and Pharmacogenetic Engineering Sciences Group (HOPES), Lahore, Pakistan
| | - Aamer Aleem
- Division of Hematology/Oncology, Department of Medicine, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Noreen Sabir
- Hematology Oncology and Pharmacogenetic Engineering Sciences (HOPES) Group, Health Sciences/Parasitology Laboratories (HSL), Department of Zoology, University of the Punjab (ZPU), Lahore, Pakistan.,Pakistan Society for Molecular and Clinical Hematology (PSMH) & Hematology Oncology and Pharmacogenetic Engineering Sciences Group (HOPES), Lahore, Pakistan
| | - Mahmood Rasool
- Centre of Excellence in Genomic Medicine Research, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Muhammad Absar
- Hematology Oncology and Pharmacogenetic Engineering Sciences (HOPES) Group, Health Sciences/Parasitology Laboratories (HSL), Department of Zoology, University of the Punjab (ZPU), Lahore, Pakistan.,Pakistan Society for Molecular and Clinical Hematology (PSMH) & Hematology Oncology and Pharmacogenetic Engineering Sciences Group (HOPES), Lahore, Pakistan
| | - Afia M Akram
- Hematology Oncology and Pharmacogenetic Engineering Sciences (HOPES) Group, Health Sciences/Parasitology Laboratories (HSL), Department of Zoology, University of the Punjab (ZPU), Lahore, Pakistan.,Pakistan Society for Molecular and Clinical Hematology (PSMH) & Hematology Oncology and Pharmacogenetic Engineering Sciences Group (HOPES), Lahore, Pakistan
| | - Masood A Shammas
- Translational Genomic Instability Program, Harvard (Dana-Farber) Cancer Institute, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Ijaz H Shah
- Department of Oncology, Allied Hospital, Punjab Medical College, Faisalabad, Pakistan
| | - Muhammad Khalid
- Department of Oncology, Allied Hospital, Punjab Medical College, Faisalabad, Pakistan
| | - Abid S Taj
- Institute of Radiotherapy and Nuclear Medicine, Peshawar, Pakistan
| | - Abid Jameel
- Hayatabad Medical Complex, Peshawar, Pakistan.,Department of Oncology, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Abdullah Alanazi
- Medical Genetics/Hematology and Oncology, CLS, CAMS, King Saud Bin Abdulaziz University for Health Sciences/KAIMRC, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, 11426, Saudi Arabia
| | - Ammara T Gill
- Hematology Oncology and Pharmacogenetic Engineering Sciences (HOPES) Group, Health Sciences/Parasitology Laboratories (HSL), Department of Zoology, University of the Punjab (ZPU), Lahore, Pakistan.,Cox Health System, Springfield, MO, USA
| | - Jamil Amjad Hashmi
- Hematology Oncology and Pharmacogenetic Engineering Sciences (HOPES) Group, Health Sciences/Parasitology Laboratories (HSL), Department of Zoology, University of the Punjab (ZPU), Lahore, Pakistan
| | - Akhtar Hussain
- Department of Biotechnology, University of Peshawar, Peshawar, Pakistan.,Pakistan Society for Molecular and Clinical Hematology (PSMH) & Hematology Oncology and Pharmacogenetic Engineering Sciences Group (HOPES), Lahore, Pakistan
| | - Muhammad Farooq Sabar
- Core DNA Facilities, Centre for Advanced Molecular Biology, University of the Punjab, Lahore, Pakistan
| | - Ahmad M Khalid
- Hematology Oncology and Pharmacogenetic Engineering Sciences (HOPES) Group, Health Sciences/Parasitology Laboratories (HSL), Department of Zoology, University of the Punjab (ZPU), Lahore, Pakistan.,Department of Biotechnology, University of Sargodha, Sargodha, Pakistan
| | - Mehmood Hussain Qazi
- Institute of Molecular Biology and Biotechnology (IMBB), Centre for Research in Molecular Medicine (CRiMM), The University of Lahore, Lahore, Pakistan
| | - Sajjad Karim
- Centre of Excellence in Genomic Medicine Research, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Muhammad Hassan Siddiqi
- Hematology Oncology and Pharmacogenetic Engineering Sciences (HOPES) Group, Health Sciences/Parasitology Laboratories (HSL), Department of Zoology, University of the Punjab (ZPU), Lahore, Pakistan.,Pakistan Society for Molecular and Clinical Hematology (PSMH) & Hematology Oncology and Pharmacogenetic Engineering Sciences Group (HOPES), Lahore, Pakistan
| | - Aamir Mahmood
- Stem Cell Research Group, Department of Anatomy, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Mudassar Iqbal
- Hematology Oncology and Pharmacogenetic Engineering Sciences (HOPES) Group, Health Sciences/Parasitology Laboratories (HSL), Department of Zoology, University of the Punjab (ZPU), Lahore, Pakistan.,Asian Medical Institute and National Surgical Centre, Kant, Kyrgyzstan.,Pakistan Society for Molecular and Clinical Hematology (PSMH) & Hematology Oncology and Pharmacogenetic Engineering Sciences Group (HOPES), Lahore, Pakistan
| | - Anjum Saeed
- Prince Abdullah Bin Khalid Celiac Disease Research Chair, King Saud University, Riyadh, Saudi Arabia
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