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Verma T, Papadantonakis N, Peker Barclift D, Zhang L. Molecular Genetic Profile of Myelofibrosis: Implications in the Diagnosis, Prognosis, and Treatment Advancements. Cancers (Basel) 2024; 16:514. [PMID: 38339265 PMCID: PMC10854658 DOI: 10.3390/cancers16030514] [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: 12/30/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Myelofibrosis (MF) is an essential element of primary myelofibrosis, whereas secondary MF may develop in the advanced stages of other myeloid neoplasms, especially polycythemia vera and essential thrombocythemia. Over the last two decades, advances in molecular diagnostic techniques, particularly the integration of next-generation sequencing in clinical laboratories, have revolutionized the diagnosis, classification, and clinical decision making of myelofibrosis. Driver mutations involving JAK2, CALR, and MPL induce hyperactivity in the JAK-STAT signaling pathway, which plays a central role in cell survival and proliferation. Approximately 80% of myelofibrosis cases harbor additional mutations, frequently in the genes responsible for epigenetic regulation and RNA splicing. Detecting these mutations is crucial for diagnosing myeloproliferative neoplasms (MPNs), especially in cases where no mutations are present in the three driver genes (triple-negative MPNs). While fibrosis in the bone marrow results from the disturbance of inflammatory cytokines, it is fundamentally associated with mutation-driven hematopoiesis. The mutation profile and order of acquiring diverse mutations influence the MPN phenotype. Mutation profiling reveals clonal diversity in MF, offering insights into the clonal evolution of neoplastic progression. Prognostic prediction plays a pivotal role in guiding the treatment of myelofibrosis. Mutation profiles and cytogenetic abnormalities have been integrated into advanced prognostic scoring systems and personalized risk stratification for MF. Presently, JAK inhibitors are part of the standard of care for MF, with newer generations developed for enhanced efficacy and reduced adverse effects. However, only a minority of patients have achieved a significant molecular-level response. Clinical trials exploring innovative approaches, such as combining hypomethylation agents that target epigenetic regulators, drugs proven effective in myelodysplastic syndrome, or immune and inflammatory modulators with JAK inhibitors, have demonstrated promising results. These combinations may be more effective in patients with high-risk mutations and complex mutation profiles. Expanding mutation profiling studies with more sensitive and specific molecular methods, as well as sequencing a broader spectrum of genes in clinical patients, may reveal molecular mechanisms in cases currently lacking detectable driver mutations, provide a better understanding of the association between genetic alterations and clinical phenotypes, and offer valuable information to advance personalized treatment protocols to improve long-term survival and eradicate mutant clones with the hope of curing MF.
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Affiliation(s)
- Tanvi Verma
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Nikolaos Papadantonakis
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA 30322, USA
| | - Deniz Peker Barclift
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Linsheng Zhang
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
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Limsuwanachot N, Rerkamnuaychoke B, Niparuck P, Singdong R, Kongruang A, Hirunpatrawong P, Siriyakorn T, Yenchitsomanus PT, Siriboonpiputtana T. A customized mass array panel for BCR:: ABL1 tyrosine kinase domain mutation screening in chronic myeloid leukemia. J Mass Spectrom Adv Clin Lab 2023; 28:122-132. [PMID: 37128502 PMCID: PMC10148036 DOI: 10.1016/j.jmsacl.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 03/25/2023] [Accepted: 04/10/2023] [Indexed: 05/03/2023] Open
Abstract
Introduction The therapeutic strategy and management of chronic myeloid leukemia (CML) have rapidly improved with the discovery of effective tyrosine kinase inhibitors (TKIs) to target BCR::ABL1 oncoprotein. However, nearly 30% of patients develop TKI resistance due to acquired mutations on the tyrosine kinase domain (TKD) of BCR::ABL1. Methods We customized a mass array panel initially intended to detect and monitor the mutational burden of hotspot BCR::ABL1 TKD mutations accumulated in our database, including key mutations recently recommended by European LeukemiaNet. Additionally, we extended the feasibility of using the assay panel for the molecular classification of myeloproliferative neoplasms (MPNs) by incorporating primer sets specific for analyzing JAK2 V617F, MPL 515 K/L, and CALR types 1 and 2. Results We found that the developed mass array panel was superior for detecting and monitoring clinically significant BCR::ABL1 TKD mutations, especially in cases with low mutational burden and harboring compound/polyclonal mutations, compared with direct sequencing. Moreover, our customized mass array panel detected common genetic alterations in MPNs, and the findings were consistent with those of other comparable assays available in our laboratory. Conclusions Our customized mass array panel was practicably used as a routine robust assay for screening and monitoring BCR::ABL1 TKD mutations in patients with CML undergoing TKI treatment and feasible for analyzing common genetic mutations in MPNs.
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Affiliation(s)
- Nittaya Limsuwanachot
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Budsaba Rerkamnuaychoke
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pimjai Niparuck
- Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Roongrudee Singdong
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Adcharee Kongruang
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | | | - Pa-thai Yenchitsomanus
- Siriraj Center of Research Excellence for Cancer Immunotherapy (SiCORE-CIT), Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Teerapong Siriboonpiputtana
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Corresponding author at: Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok 10400, Thailand.
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Lee Tokar L, Crotty G, O'Keeffe D, Langabeer SE. Myeloproliferative neoplasms with a low (<5%) CALR mutation allele burden. Blood Cells Mol Dis 2021; 90:102593. [PMID: 34217938 DOI: 10.1016/j.bcmd.2021.102593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 06/25/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Lisa Lee Tokar
- Cancer Molecular Diagnostics, St. James's Hospital, Dublin, Ireland
| | - Gerard Crotty
- Department of Haematology, Midlands Regional Hospital, Tullamore, Ireland
| | - Denis O'Keeffe
- Department of Haematology, University Hospital Limerick, Limerick, Ireland
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Lemoine S, Renard M, Bouvier A, Orvain C, Giltat A, Cottin L, Blanchet O, Hunault-Berger M, Ugo V, Luque Paz D. No detection of atypical one-base deletion of CALR exon 9 with fragment analysis: A molecular trap to avoid. Blood Cells Mol Dis 2021; 90:102589. [PMID: 34214802 DOI: 10.1016/j.bcmd.2021.102589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 06/18/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Sandrine Lemoine
- Univ Angers, Inserm, CRCINA, F-49000 Angers, France; CHU Angers, Laboratoire d'hématologie, F-49000 Angers, France; Fédération Hospitalo-Universitaire 'Grand Ouest Against Leukemia' (FHU GOAL), France.
| | - Maxime Renard
- Univ Angers, Inserm, CRCINA, F-49000 Angers, France; CHU Angers, Laboratoire d'hématologie, F-49000 Angers, France; Fédération Hospitalo-Universitaire 'Grand Ouest Against Leukemia' (FHU GOAL), France
| | - Anne Bouvier
- Univ Angers, Inserm, CRCINA, F-49000 Angers, France; CHU Angers, Laboratoire d'hématologie, F-49000 Angers, France; Fédération Hospitalo-Universitaire 'Grand Ouest Against Leukemia' (FHU GOAL), France
| | - Corentin Orvain
- Univ Angers, Inserm, CRCINA, F-49000 Angers, France; Fédération Hospitalo-Universitaire 'Grand Ouest Against Leukemia' (FHU GOAL), France; CHU Angers, Service des maladies du sang, Angers, France
| | - Aurélien Giltat
- Fédération Hospitalo-Universitaire 'Grand Ouest Against Leukemia' (FHU GOAL), France; CHU Angers, Service des maladies du sang, Angers, France
| | - Laurane Cottin
- Univ Angers, Inserm, CRCINA, F-49000 Angers, France; CHU Angers, Laboratoire d'hématologie, F-49000 Angers, France; Fédération Hospitalo-Universitaire 'Grand Ouest Against Leukemia' (FHU GOAL), France
| | - Odile Blanchet
- Univ Angers, Inserm, CRCINA, F-49000 Angers, France; CHU Angers, Laboratoire d'hématologie, F-49000 Angers, France; Fédération Hospitalo-Universitaire 'Grand Ouest Against Leukemia' (FHU GOAL), France; CHU Angers, Centre de Ressources Biologiques, BB-0033-00038, Angers, France
| | - Mathilde Hunault-Berger
- Univ Angers, Inserm, CRCINA, F-49000 Angers, France; Fédération Hospitalo-Universitaire 'Grand Ouest Against Leukemia' (FHU GOAL), France; CHU Angers, Service des maladies du sang, Angers, France
| | - Valérie Ugo
- Univ Angers, Inserm, CRCINA, F-49000 Angers, France; CHU Angers, Laboratoire d'hématologie, F-49000 Angers, France; Fédération Hospitalo-Universitaire 'Grand Ouest Against Leukemia' (FHU GOAL), France
| | - Damien Luque Paz
- Univ Angers, Inserm, CRCINA, F-49000 Angers, France; CHU Angers, Laboratoire d'hématologie, F-49000 Angers, France; Fédération Hospitalo-Universitaire 'Grand Ouest Against Leukemia' (FHU GOAL), France
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Zakaria NA, Rosle NA, Siti Asmaa MJ, Aziee S, Haiyuni MY, Samat NA, Husin A, Hassan R, Ramli M, Mohamed Yusoff S, Ibrahim IK, Al-Jamal HAN, Johan MF. Conformation sensitive gel electrophoresis for the detection of calreticulin mutations in BCR-ABL1-negative myeloproliferative neoplasms. Int J Lab Hematol 2021; 43:1451-1457. [PMID: 34125992 DOI: 10.1111/ijlh.13628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 05/20/2021] [Accepted: 05/25/2021] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Calreticulin (CALR) mutations in myeloproliferative neoplasms (MPN) have been reported to be key markers in the molecular diagnosis, particularly in patients lacking JAK2 V617F mutation. In most current reports, CALR mutations were analysed by either allele-specific PCR (AS-PCR), or the more expensive quantitative real-time PCR, pyrosequencing and next-generation sequencing. Hence, we report the use of an alternative method, the conformation sensitive gel electrophoresis (CSGE) for the detection of CALR mutations in BCR-ABL1-negative MPN patients. METHODS Forty BCR-ABL1-negative MPN patients' DNA: 19 polycythemia vera (PV), 7 essential thrombocytosis (ET) and 14 primary myelofibrosis (PMF), were screened for CALR mutations by CSGE. PCR primers were designed to amplify sequences spanning between exons 8 and 9 to target the mutation hotspots in CALR. Amplicons displaying abnormal CSGE profiles by electrophoresis were directly sequenced, and results were analysed by BioEdit Sequence Alignment Editor v7.2.6. CSGE results were compared with AS-PCR and confirmed by Sanger sequencing. RESULTS CSGE identified 4 types of mutations; 2 PMF patients with either CALR type 1 (c.1099_1150del52) or type 2 (c.1155_1156insTTGTC), 1 ET patient with nucleotide deletion (c.1121delA) and insertion (c.1190insA) and 1 PV patient with p.K368del (c.1102_1104delAAG) and insertion (c.1135insA) inframe mutations. Three patients have an altered KDEL motif at the C-terminal of CALR protein. In comparison, AS-PCR only able to detect two PMF patients with mutations, either type 1 and type 2. CONCLUSION CSGE is inexpensive, sensitive and reliable alternative method for the detection of CALR mutations in BCR-ABL1-negative MPN patients.
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Affiliation(s)
- Nur Atikah Zakaria
- Department of Haematology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Norfifiana Alisa Rosle
- Department of Haematology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Mat Jusoh Siti Asmaa
- School of Health Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.,Universiti Sains Malaysia (USM)-RIKEN Interdisciplinary Collaboration for Advanced Sciences (URICAS), Penang, Malaysia
| | - Sudin Aziee
- Department of Haematology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Mohd Yassim Haiyuni
- Department of Haematology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Nurul Ameera Samat
- Department of Haematology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Azlan Husin
- Department of Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.,Hospital USM, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Rosline Hassan
- Department of Haematology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.,Hospital USM, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Marini Ramli
- Department of Haematology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.,Hospital USM, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Shafini Mohamed Yusoff
- Department of Haematology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.,Hospital USM, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Ibrahim Khidir Ibrahim
- Faculty of Medical Laboratory Sciences, Department of Haematology, Al-Neelain University, Khartoum, Sudan
| | - Hamid Ali Nagi Al-Jamal
- Diagnostic and Biomedicine, Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Terengganu, Malaysia
| | - Muhammad Farid Johan
- Department of Haematology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.,Hospital USM, Universiti Sains Malaysia, Kelantan, Malaysia
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Kiladjian JJ, Debureaux PE, Plessier A, Soret-Dulphy J, Valla D, Cassinat B, Rautou PE. Benefits of molecular profiling with next-generation sequencing for the diagnosis and prognosis of myeloproliferative neoplasms in splanchnic vein thrombosis. J Hepatol 2021; 74:251-252. [PMID: 32988658 DOI: 10.1016/j.jhep.2020.07.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 12/04/2022]
Affiliation(s)
- Jean-Jacques Kiladjian
- Centre d'Investigations Cliniques (Inserm CIC1427), Hôpital Saint-Louis, Université de Paris, Paris, France; Université de Paris, U1131 Inserm, IRSL, F-75010 Paris, France; Laboratoire d'Excellence GR-Ex, Paris, France.
| | - Pierre-Edouard Debureaux
- Centre d'Investigations Cliniques (Inserm CIC1427), Hôpital Saint-Louis, Université de Paris, Paris, France
| | - Aurélie Plessier
- Hôpital Beaujon, AP-HP, DHU Unity, Pôle des Maladies de l'Appareil Digestif, Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, Inserm U1149, Centre de Recherche sur l'Inflammation (CRI), Paris, Université de Paris, ERN Rare Liver Diseases, Clichy, France
| | - Juliette Soret-Dulphy
- Centre d'Investigations Cliniques (Inserm CIC1427), Hôpital Saint-Louis, Université de Paris, Paris, France
| | - Dominique Valla
- Hôpital Beaujon, AP-HP, DHU Unity, Pôle des Maladies de l'Appareil Digestif, Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, Inserm U1149, Centre de Recherche sur l'Inflammation (CRI), Paris, Université de Paris, ERN Rare Liver Diseases, Clichy, France
| | - Bruno Cassinat
- Université de Paris, U1131 Inserm, IRSL, F-75010 Paris, France; Laboratoire d'Excellence GR-Ex, Paris, France; AP-HP, Hôpital Saint-Louis, Laboratoire de Biologie Cellulaire, Paris, France
| | - Pierre-Emmanuel Rautou
- Hôpital Beaujon, AP-HP, DHU Unity, Pôle des Maladies de l'Appareil Digestif, Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, Inserm U1149, Centre de Recherche sur l'Inflammation (CRI), Paris, Université de Paris, ERN Rare Liver Diseases, Clichy, France
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