1
|
Craven KE, Ewalt MD. Premalignant Clonal Hematopoiesis (Clonal Hematopoiesis of Indeterminate Potential and Clonal Cytopenia of Undetermined Significance). Clin Lab Med 2023; 43:565-576. [PMID: 37865503 DOI: 10.1016/j.cll.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Premalignant clonal hematopoiesis is the presence of somatic alterations in the blood of otherwise healthy individuals. Although the condition is not considered as a cancer, it carries an increased risk of developing a hematologic malignancy, particularly in those with large neoplastic clones, multiple pathogenic mutations, and high-risk mutations. In addition to the increased risk of malignancy, clonal hematopoiesis carries a markedly increased risk of cardiovascular events and death. Appropriate identification of this entity is critical to mitigate cardiovascular risk factors and ensure appropriate monitoring for the emergence of blood cancer.
Collapse
Affiliation(s)
- Kelly E Craven
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Box 36, New York, NY 10065, USA
| | - Mark D Ewalt
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Box 36, New York, NY 10065, USA.
| |
Collapse
|
2
|
Hasserjian RP, Orazi A, Orfao A, Rozman M, Wang SA. The International Consensus Classification of myelodysplastic syndromes and related entities. Virchows Arch 2023; 482:39-51. [PMID: 36287260 DOI: 10.1007/s00428-022-03417-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The International Consensus Classification (ICC) of myeloid neoplasms and acute leukemia has updated the classification of myelodysplastic syndromes (MDSs) and placed MDS in a broader group of clonal cytopenias that includes clonal cytopenia of undetermined significance (CCUS) and related entities. Although subject to some interobserver variability and lack of specificity, morphologic dysplasia remains the main feature that distinguishes MDS from other clonal cytopenias and defines MDS as a hematologic malignancy. The ICC has introduced some changes in the definition of MDS whereby some cases categorized as MDS based on cytogenetic abnormalities are now classified as CCUS, while SF3B1 and multi-hit TP53 mutations are now considered to be MDS-defining in a cytopenic patient. The ICC has also recognized several cytogenetic and molecular abnormalities that reclassify some cases of MDS with excess blasts as acute myeloid leukemia (AML) and has introduced a new MDS/AML entity that encompasses cases with 10-19% blasts that lie on the continuum between MDS and AML. Two new genetically defined categories of MDS have been introduced: MDS with mutated SF3B1 and MDS with mutated TP53, the latter requiring bi-allelic aberrations in the TP53 gene. The entity MDS, unclassifiable has been eliminated. These changes have resulted in an overall simplification of the MDS classification scheme from 8 separate entities (including 1 that was genetically defined) in the revised 4th edition WHO classification to 7 separate entities (including 3 that are genetically defined) in the ICC.
Collapse
Affiliation(s)
- Robert P Hasserjian
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Warren 244, Boston, MA, 02114, USA.
| | - Attilio Orazi
- Department of Pathology, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Alberto Orfao
- Department of Medicine, Cytometry Service, Cancer Research Center (IBMCC-CSIC/USAL), Institute for Biomedical Research of Salamanca (IBSAL) and CIBERONC, University of Salamanca, Salamanca, Spain
| | - Maria Rozman
- Hematopathology Section, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Sa A Wang
- Department of Hematopathology, MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
3
|
Todisco E, Gigli F, Ronchini C, Amato V, Sammassimo S, Pastano R, Parma G, Lapresa MT, Bertolini F, Corsini C, Gregato G, Poletti C, Pelicci PG, Alcalay M, Colombo N, Tarella C. Hematological disorders after salvage PARPi treatment for ovarian cancer: Cytogenetic and molecular defects and clinical outcomes. Int J Cancer 2022; 151:1791-1803. [PMID: 35695283 PMCID: PMC9796966 DOI: 10.1002/ijc.34162] [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] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/27/2022] [Accepted: 05/10/2022] [Indexed: 01/07/2023]
Abstract
Inhibitors of poly(ADP-ribose) polymerase (PARPi) are increasingly employed as salvage therapy in epithelial ovarian cancer (EOC), but cytotoxic drug exposure along with PARP inhibition may favor development of hematological disorders. In our study, of 182 women with EOC treated with PARPi, 16 (8.7%) developed therapy-related myeloid neoplasms (t-MNs), with 12 cases of myelodysplasia and 4 of acute myeloid leukemia. All experienced persistent cytopenia after PARPi discontinuation. Seven patients had del(5q)/-5 and/or del(7q)/-7, nine had a complex karyotype and TP53 mutations, recently reported as risk factor for t-MNs in EOC post-PARPi, were found in 12 out of 13 tested patients. Four patients had a rapid and fatal outcome, one had stable disease, eleven underwent induction therapy, followed by allogeneic hematopoietic cell transplantation in seven. Three of these 11 patients experienced refractory disease, and 8 had complete remission. During a 6.8 months (range 2.3-49) median observation time, 3 out of 16 patients were alive, with one surviving patient free of both solid and hematological tumors. Ten patients died because of leukemia, two because of transplant-related events, one from heart failure. Five more patients experienced persistent cell blood count abnormalities following PARPi discontinuation, without reaching MDS diagnostic criteria. A customized Myelo-panel showed clonal hematopoiesis in all five patients. These findings confirm the actual risk of t-MNs in EOC patients after chemotherapy and prolonged PARPi therapy. The management of these patients is complex and outcomes are extremely poor. Careful diagnostic procedures are strongly recommended whenever unusual cytopenias develop in patients receiving PARPi therapy.
Collapse
Affiliation(s)
- Elisabetta Todisco
- Onco‐Hematology DivisionIEO, European Institute of Oncology IRCCSMilanItaly,Ospedale di Busto Arsizio, ASST Valle OlonaBusto ArsizioItaly
| | - Federica Gigli
- Onco‐Hematology DivisionIEO, European Institute of Oncology IRCCSMilanItaly
| | - Chiara Ronchini
- Laboratory of Clinical GenomicsIEO, European Institute of Oncology IRCCSMilanItaly
| | - Viviana Amato
- Onco‐Hematology DivisionIEO, European Institute of Oncology IRCCSMilanItaly
| | - Simona Sammassimo
- Onco‐Hematology DivisionIEO, European Institute of Oncology IRCCSMilanItaly
| | - Rocco Pastano
- Onco‐Hematology DivisionIEO, European Institute of Oncology IRCCSMilanItaly
| | - Gabriella Parma
- Department of GynecologyIEO, European Institute of Oncology IRCCSMilanItaly
| | | | - Francesco Bertolini
- Laboratory of Hematology‐OncologyIEO, European Institute of Oncology IRCCSMilanItaly
| | - Chiara Corsini
- Laboratory of Hematology‐OncologyIEO, European Institute of Oncology IRCCSMilanItaly
| | - Giuliana Gregato
- Laboratory of Hematology‐OncologyIEO, European Institute of Oncology IRCCSMilanItaly
| | - Claudia Poletti
- Laboratory of Hematology‐OncologyIEO, European Institute of Oncology IRCCSMilanItaly
| | - Pier Giuseppe Pelicci
- Department of Experimental OncologyEuropean Institute of Oncology IRCCSMilanItaly,Department of Oncology and Hemato‐OncologyUniversity of MilanMilanItaly
| | - Myriam Alcalay
- Department of Experimental OncologyEuropean Institute of Oncology IRCCSMilanItaly,Department of Oncology and Hemato‐OncologyUniversity of MilanMilanItaly
| | - Nicoletta Colombo
- Department of GynecologyIEO, European Institute of Oncology IRCCSMilanItaly,Gynecologic Cancer ProgramEuropean Institute of Oncology IRCCS and University of Milan‐BicoccaMilanItaly
| | - Corrado Tarella
- Onco‐Hematology DivisionIEO, European Institute of Oncology IRCCSMilanItaly,Department of Health SciencesUniversity of MilanMilanItaly
| |
Collapse
|
4
|
Nikitina V, Nugis V, Astrelina T, Zheglo D, Kobzeva I, Kozlova M, Galstyan I, Lomonosova E, Zhanataev A, Karaseva T, Samoylov AS. Pattern of chromosomal aberrations persisting over 30 years in a Chernobyl Nuclear Power Plant accident survivor: study using mFISH. JOURNAL OF RADIATION RESEARCH 2022; 63:202-212. [PMID: 35146520 PMCID: PMC8944318 DOI: 10.1093/jrr/rrab131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/21/2021] [Indexed: 06/14/2023]
Abstract
The long-term in vivo cytogenetic effects of high-dose radiation exposure can be traced in accidentally irradiated persons, and particularly useful for developing strategies of monitoring and therapy of such patients, as well as for elucidating the fundamental aspects of hematopoiesis and radiobiology. Using 24-color fluorescent in situ hybridization (mFISH), we analysed the frequency and the spectrum of chromosomal aberrations (CA) in peripheral blood lymphocytes of the Chernobyl Nuclear Power Plant (NPP) accident victim 30, 31, 32 and 33 years after acute accidental exposure to high-dose gamma radiation of the whole body. Totally, 993 metaphase cells were analyzed (or 219, 272, 258, 244 cells each year), of which 297 were aberrant. Our study demonstrated a constant aberrant cell frequency at 28% in 2016-2018 years, while in 2019, a significant increase up to 35% occurred due to contribution of significantly elevated frequency of simple aberrations in the absence of evident recent genotoxic factors. Four clonal aberrations were detected, three of which persisted for more than one year at a frequency up to 2.5% of analyzed cells. The distribution of 731 breakpoints per individual chromosomes was nearly proportional to their physical length, excepting Chromosomes 13 and 20, which were significantly breakpoint-deficient compared to the genome median rate. Monitoring of the long-term effects on chromosomal instability caused by radiation exposure is important for understanding and predicting the long-term effects of ionizing radiation.
Collapse
Affiliation(s)
- Victoriya Nikitina
- State Research Center Burnasyan Federal Medical Biophysical Center of Federal Medical Biology Agency of Russia, 123128 Zhivopisnaya str., 46, Moscow, Russia
| | - Vladimir Nugis
- State Research Center Burnasyan Federal Medical Biophysical Center of Federal Medical Biology Agency of Russia, 123128 Zhivopisnaya str., 46, Moscow, Russia
| | - Tatiyana Astrelina
- State Research Center Burnasyan Federal Medical Biophysical Center of Federal Medical Biology Agency of Russia, 123128 Zhivopisnaya str., 46, Moscow, Russia
| | - Diana Zheglo
- Federal State Budgetary Scientific Institution "Research Centre for Medical Genetics", 115522, Moskvorechye str., 1, Moscow, Russia
| | - Irina Kobzeva
- State Research Center Burnasyan Federal Medical Biophysical Center of Federal Medical Biology Agency of Russia, 123128 Zhivopisnaya str., 46, Moscow, Russia
| | - Mariya Kozlova
- State Research Center Burnasyan Federal Medical Biophysical Center of Federal Medical Biology Agency of Russia, 123128 Zhivopisnaya str., 46, Moscow, Russia
| | - Irina Galstyan
- State Research Center Burnasyan Federal Medical Biophysical Center of Federal Medical Biology Agency of Russia, 123128 Zhivopisnaya str., 46, Moscow, Russia
| | - Elena Lomonosova
- State Research Center Burnasyan Federal Medical Biophysical Center of Federal Medical Biology Agency of Russia, 123128 Zhivopisnaya str., 46, Moscow, Russia
| | - Aliy Zhanataev
- Research Zakusov Institute of Pharmacology, 125315 Baltyiskaya str., 8, Moscow, Russia
| | - Tatiyana Karaseva
- State Research Center Burnasyan Federal Medical Biophysical Center of Federal Medical Biology Agency of Russia, 123128 Zhivopisnaya str., 46, Moscow, Russia
| | - Alexander S Samoylov
- State Research Center Burnasyan Federal Medical Biophysical Center of Federal Medical Biology Agency of Russia, 123128 Zhivopisnaya str., 46, Moscow, Russia
| |
Collapse
|
5
|
Toruner GA, Thakral B, Tang Z, Tang G, Medeiros LJ, Oran B. Clonal cytogenetic abnormalities in donor-derived cells after sex mismatched allogeneic stem cell transplantation. Cancer Genet 2021; 258-259:120-130. [PMID: 34715428 DOI: 10.1016/j.cancergen.2021.10.004] [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: 07/09/2021] [Revised: 09/28/2021] [Accepted: 10/11/2021] [Indexed: 11/30/2022]
Abstract
Clonal cytogenetic abnormalities (CCA) in donor-derived cells after stem cell transplant (SCT) are typically reported in donor-derived cell neoplasms, but CCA also may reflect a constitutional abnormality in the donor or may be present in a recipient without overt hematological malignancy. We reviewed 8515 tests on 2035 patients, who had allogenic sex mismatched SCT and underwent serial cytogenetic analysis between 2006 and 2020 in our institution. A constitutional CCA was observed in 3 patients: inv(10), t(1;5), and t(13;14). A somatic CCA without overt neoplasia was detected in 12 patients: del(7q) (n = 6), del(20q) (n = 3), der(11)t(11;11) (n = 1), t(1;9) (n = 1), dup(6p)(n = 1). In this group, four patients with cytopenia had del(7q), and an association between del(7q) and an adverse overall survival (OS) was observed [HR:5.99; 95%CI 1.23-29.92). Four patients had a donor-derived cell neoplasm: myelodysplastic syndrome (n = 3) and acute myeloid leukemia (n = 1), and all four neoplasms had loss of 7q. In our cohort, ∼1% of the patients (19/2,035) had CCA in donor-derived cells. Balanced constitutional CCA can pose a reproductive risk to donor. Loss of 7q is the most common somatic CCA, in donor-derived cells.
Collapse
Affiliation(s)
- Gokce A Toruner
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Beenu Thakral
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Zhenya Tang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Guilin Tang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Betul Oran
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
6
|
Wang MJ, Liu WY, Wang XY, Li YM, Xiao HY, Quan RC, Huang G, Hu XM. Autophagy Gene Panel-Based Prognostic Model in Myelodysplastic Syndrome. Front Oncol 2021; 10:606928. [PMID: 33614490 PMCID: PMC7894207 DOI: 10.3389/fonc.2020.606928] [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] [Received: 09/16/2020] [Accepted: 11/19/2020] [Indexed: 01/18/2023] Open
Abstract
Abnormal autophagy is related to the pathogenesis and clinical symptoms of myelodysplastic syndrome (MDS). However, the effect of autophagy-related genes (ARGs) on the prognosis of MDS remains unclear. Here, we examined the expression profile of 108 patients with MDS from the GSE58831 dataset, and identified 22 genes that were significantly associated with overall survival. Among them, seven ARGs were screened and APIs were calculated for all samples based on the expression of the seven ARGs, and then, MDS patients were categorized into high- and low-risk groups based on the median APIs. The overall survival of patients with high-risk scores based on these seven ARGs was shorter than patients with low-risk scores in both the training cohort (P = 2.851e-06) and the validation cohort (P = 9.265e-03). Additionally, API showed an independent prognostic indicator for survival in the training samples [hazard ratio (HR) = 1.322, 95% confidence interval (CI): 1.158–1.51; P < 0.001] and the validation cohort (HR = 1.05, 95% CI: 1–1.1; P < 0.01). The area under the receiver operating characteristic curve (AUROC) of API and IPSS were 43.0137 and 66.0274 in the training cohorts and the AUC of the validation cohorts were 41.5361 and 72.0219. Our data indicate these seven ARGs can predict prognosis in patients with MDS and could guide individualized treatment.
Collapse
Affiliation(s)
- Ming-Jing Wang
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Graduate School, China Academy of Chinese Medical Sciences, Beijing, China
| | - Wei-Yi Liu
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xue-Ying Wang
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Yu-Meng Li
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Hai-Yan Xiao
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ri-Cheng Quan
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Gang Huang
- Divisions of Pathology and Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Xiao-Mei Hu
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| |
Collapse
|
7
|
Zhang W, Fu R. [Progress in pre-myelodysplastic syndrome conditions]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2021; 41:603-607. [PMID: 32810971 PMCID: PMC7449764 DOI: 10.3760/cma.j.issn.0253-2727.2020.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- W Zhang
- Department of Hematology, General Hospital, Tianjin Medical University, Tianjin 300052, China
| | - R Fu
- Department of Hematology, General Hospital, Tianjin Medical University, Tianjin 300052, China
| |
Collapse
|
8
|
Persistent clonal cytogenetic abnormality with del(20q) from an initial diagnosis of acute promyelocytic leukemia. Int J Hematol 2019; 111:311-316. [PMID: 31515708 DOI: 10.1007/s12185-019-02731-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 09/03/2019] [Accepted: 09/04/2019] [Indexed: 12/20/2022]
Abstract
A 68-year-old male was diagnosed with acute promyelocytic leukemia (APL). A G-banding chromosomal analysis revealed the co-existence of two clones: one with del(20q) and t(15;17)(q22;q12) and another with del(20q) alone. During the remission of APL following treatment with all-trans-retinoic acid, del(20q) was persistently identified, indicating a diagnosis of cytogenetic abnormalities of undetermined significance (CCAUS) with isolated del(20q). Bicytopenia developed 48 months after the remission of APL. The presence of isolated del(20q) was detected in the G-banding analysis, whereas morphological dysplasia of hematopoietic cells was not confirmed. This case showed indolent progression from CCAUS after the remission of APL to clonal cytopenia of undetermined significance (CCUS). CCUS with isolated del(20q) persisted for 24 months without any finding of hematological malignancies. At the most recent follow-up, targeted capture sequencing showed the U2AF1 S34F mutation. Considerable attention needs to be paid in follow-ups for CCAUS with del(20q) after the treatment of leukemia.
Collapse
|
9
|
Yoon J, Yun JW, Jung CW, Kim HJ, Kim SH. Clonal dominance of a donor-derived del(20q) clone after allogeneic hematopoietic stem cell transplantation in an acute myeloid leukemia patient with del(20q). J Clin Lab Anal 2019; 33:e22951. [PMID: 31187545 PMCID: PMC6757114 DOI: 10.1002/jcla.22951] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 11/25/2022] Open
Abstract
Del(20q) is the most frequently detected large structural genetic mosaicism alteration in the healthy aging population, occurring in approximately 0.1% of older persons. Age‐related clonal hematopoiesis of copy number variations (CNVs) is linked to an increased risk of hematologic malignancies, but the clinical impact of hematopoietic stem cells (HSCs) harboring such CNVs, such as del(20q), is not clearly understood. Here, we report an acute myeloid leukemia (AML) patient with known del(20q) who acquired donor‐derived del(20q) after allogeneic hematopoietic stem cell transplantation (HSCT). The HSCs with del(20q) engrafted and expanded over time, but the patient did not clinically progress to myeloid neoplasm. Although donor‐derived del(20q) from a healthy donor has been reported previously, our case is the first to review the clonal dynamics of a del(20q) clone and its post‐transplantation impact. Since recurrent hematology neoplasm‐associated CNVs, including del(20q), may not be rare among aged HSCT donors, identifying the origin of such a CNV is necessary for clinical decisions when clonal abnormality appears after HSCT, even in recipients who previously had the same abnormality.
Collapse
Affiliation(s)
- Jung Yoon
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Won Yun
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chul Won Jung
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee-Jin Kim
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun-Hee Kim
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
10
|
Capo-Chichi JM, Michaels P, Tremblay-Le May R, Abelson S, Hasserjian RP, Xia D. Emerging patterns in clonal haematopoiesis. J Clin Pathol 2019; 72:453-459. [PMID: 31164443 DOI: 10.1136/jclinpath-2019-205851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 03/21/2019] [Indexed: 12/31/2022]
Abstract
Clonal haematopoiesis (CH) is defined by the presence of acquired mutations and/or cytogenetic abnormalities in haematopoietic cells. By definition, these premalignant clones do not meet criteria for haematopoietic neoplasms listed in the Revised Fourth Edition of the WHO classification. CH is fairly common in elderly individuals and is associated with higher risks for haematological cancers, in particular myelodysplastic syndrome and acute myeloid leukaemia (AML), as well as cardiovascular events. Similar small clones have also been detected during follow-up in patients with AML in morphological remission, in individuals with aplastic anaemia, and in pre-chemotherapy blood samples from patients with other types of cancers. In each of these contexts, the presence of mutations carries different clinical implications, and sometimes demonstrates unique genetic profiles. Emerging research suggests that the number and identity of mutations, the size of the mutant clones and various other factors, including age, immune status and history of exogenous drugs/toxins, are important for disease biology and progression. This review focuses specifically on the subset of CH with gene mutations detected by sequencing, and includes discussions of nomenclature and molecular technologies that detect and quantify gene mutations.
Collapse
Affiliation(s)
| | - Phillip Michaels
- Department of Pathology, University Health Network, Toronto, Ontario, Canada
| | | | - Sagi Abelson
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | | | - Daniel Xia
- Department of Pathology, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
11
|
Rai S, Espinoza JL, Morita Y, Tanaka H, Matsumura I. Severe Eosinophilia in Myelodysplastic Syndrome With a Defined and Rare Cytogenetic Abnormality. Front Immunol 2019; 9:3031. [PMID: 30687305 PMCID: PMC6334338 DOI: 10.3389/fimmu.2018.03031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 12/07/2018] [Indexed: 12/22/2022] Open
Abstract
Myelodysplastic syndromes (MDS) are a heterogeneous group clonal disorders of hematopoietic stem cells (HSC) characterized by ineffective hematopoiesis that lead to variable grades of impaired blood cell production. Chromosomal aberrations are often detected in MDS patients and thus cytogenetic analysis is useful for the diagnosis of these disorders. Common recurring chromosomal defects, such as the −5/5q- and −7/7q- are relatively well characterized cytogenetic abnormalities in MDS, however, the biological significance of uncommon cytogenetic alterations is unknown. We report here, two cases of peripheral blood and bone marrow hypereosinophilia in patients with MDS harboring the unbalanced translocation der(1;7)(q10;p10), a poorly characterized cytogenetic abnormality that is found in certain myeloid malignancies, including MDS. The patients reported here presented hypereosinophilia that was refractory to steroids and cytotoxic therapy, leading to severe target tissue damage that ultimately resulted in fatal end-organ failure. Potential roles of the der(1;7)(q10;p10) aberrations in the pathogenesis of aggressive eosinophilia and disease prognosis are discussed here.
Collapse
Affiliation(s)
- Shinya Rai
- Department of Hematology and Rheumatology, Faculty of Medicine, Kindai University Hospital, Osaka-Sayama, Japan
| | - J Luis Espinoza
- Department of Hematology and Rheumatology, Faculty of Medicine, Kindai University Hospital, Osaka-Sayama, Japan
| | - Yasuyoshi Morita
- Department of Hematology and Rheumatology, Faculty of Medicine, Kindai University Hospital, Osaka-Sayama, Japan
| | - Hirokazu Tanaka
- Department of Hematology and Rheumatology, Faculty of Medicine, Kindai University Hospital, Osaka-Sayama, Japan
| | - Itaru Matsumura
- Department of Hematology and Rheumatology, Faculty of Medicine, Kindai University Hospital, Osaka-Sayama, Japan
| |
Collapse
|
12
|
Bastida JM, López-Godino O, Vicente-Sánchez A, Bonanad-Boix S, Xicoy-Cirici B, Hernández-Sánchez JM, Such E, Cervera J, Caballero-Berrocal JC, López-Cadenas F, Arnao-Herráiz M, Rodríguez I, Llopis-Calatayud I, Jiménez MJ, Del Cañizo-Roldán MC, Díez-Campelo M. Hidden myelodysplastic syndrome (MDS): A prospective study to confirm or exclude MDS in patients with anemia of uncertain etiology. Int J Lab Hematol 2018; 41:109-117. [PMID: 30290085 DOI: 10.1111/ijlh.12933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 08/30/2018] [Accepted: 09/07/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Diagnosis of myelodysplastic syndromes (MDSs) when anemia is the only abnormality can be complicated. The aim of our study was to investigate the primary causes of anemia and/or macrocytosis of uncertain etiology. METHODS We conducted a multicenter, prospective study over 4 months in three hematology laboratories. In step 1, we used an automated informatics system to screen 137 453 hemograms for cases of anemia and/or macrocytosis (n = 2702). In step 2, we excluded all patients whose anemia appeared to be due to a known cause. This left 290 patients had anemia of uncertain etiology. In step 3, we conducted further investigations, including a peripheral blood smear, and analysis of iron, vitamin B12, folate, and thyroid hormone levels. RESULTS A differential diagnosis was obtained in 139 patients (48%). The primary causes of anemia were iron deficiency (n = 59) and megaloblastic anemia (n = 39). In total, 25 hematologic disorders were diagnosed, including 14 patients with MDS (56%). The median age of MDS patients was 80 years, 12 had anemia as an isolated cytopenia, and most (n = 10) had lower-risk disease (IPSS-R ≤ 3.5). SF3B1 mutations were most frequent (n = 6) and correlated with the presence of ring sideroblasts (100%) and associated with better prognosis (P = 0.001). CONCLUSIONS Our prospective, four-step approach is an efficient and logical strategy to facilitate the diagnosis of MDS on the basis of unexplained anemia and/or macrocytosis, and may allow the early diagnosis of the most serious causes of anemia. Molecular analysis of genes related to MDS could be a promising diagnostic and prognostic approach.
Collapse
Affiliation(s)
| | | | | | | | - Blanca Xicoy-Cirici
- Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Badalona, Spain
| | - Jesus M Hernández-Sánchez
- Instituto de Investigacion Biomedica de Salamanca, IBMCC, Centro de Investigacion del Cancer, Universidad de Salamanca-CSIC, Salamanca, Spain
| | - Esperanza Such
- Hematology, Laboratorio de Citogenética y Biología Molecular, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Jose Cervera
- Hematology, Laboratorio de Citogenética y Biología Molecular, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | | | | | - Inés Rodríguez
- Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Badalona, Spain
| | | | - María J Jiménez
- Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Badalona, Spain
| | | | | |
Collapse
|