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Hoshino Y, Moriya K, Mitsui-Sekinaka K, Hashimoto Y, Nakayama S, Sajiki D, Muramatsu H, Hagiwara H, Suzuki S, Sekinaka Y, Wakamatsu H, Kawaguchi H, Imai K. Noonan Syndrome-related Myeloproliferative Disorder Occurring in the Neonatal Period: Case Report and Literature Review. J Pediatr Hematol Oncol 2024; 46:e176-e179. [PMID: 38132703 DOI: 10.1097/mph.0000000000002803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 11/06/2023] [Indexed: 12/23/2023]
Abstract
Noonan syndrome-related myeloproliferative disorder (NS/MPD) and juvenile myelomonocytic leukemia (JMML) are rare MPDs that occur in young children. We herein report a case of NS/MPD with neonatal onset. The patient had a characteristic appearance and high monocyte count in the peripheral blood and bone marrow. Genetic testing showed the E139D mutation in PTPN11 ; however, the patient did not meet all the diagnostic criteria for JMML, and we thus diagnosed him with NS/MPD. Eight other cases of NS/MPD with neonatal onset are also summarized. The initial presentation varied, and the prognosis was considered poor compared with previous reports of NS/MPD.
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Affiliation(s)
| | | | | | | | | | - Daichi Sajiki
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Hideki Muramatsu
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Aichi, Japan
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2
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Juvenile myelomonocytic leukemia presenting in an infant with a subdural hematoma. Childs Nerv Syst 2021; 37:2075-2079. [PMID: 33404720 DOI: 10.1007/s00381-020-05013-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Juvenile myelomonocytic leukemia (JMML) is a rare childhood hematopoietic disorder typically presenting with hepatosplenomegaly, lymphadenopathy, pallor, fever, and cutaneous findings. The authors report the first case, to our knowledge, of JMML presenting in a pediatric patient with a subdural hematoma. CASE DESCRIPTION A 7-month old male with recurrent respiratory infections and a low-grade fever presented with a full fontanelle and an increasing head circumference and was found to have chronic bilateral subdural collections. Abusive head trauma, infectious, and coagulopathy workups were unremarkable, and the patient underwent bilateral burr holes for evacuation of the subdural collections. The postoperative course was complicated by the development of thrombocytopenia, anemia, and an acute subdural hemorrhage which required evacuation. Cytologic analysis of the subdural fluid demonstrated atypical cells, which prompted flow cytometric analysis, a bone marrow biopsy, and ultimately a diagnosis of JMML. Following chemotherapy, the patient's counts improved, and he subsequently underwent a hematopoietic stem cell transplant. CONCLUSION Subdural collections may rarely represent the first presenting sign of hematologic malignancies. In patients with a history of recurrent infections and a negative workup for abusive head trauma, clinicians should include neoplastic etiologies in the differential for chronic subdural collections and have a low threshold for fluid analysis.
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Hasegawa A, Saito S, Narimatsu S, Nakano S, Nagai M, Ohnota H, Inada Y, Morokawa H, Nakashima I, Morita D, Ide Y, Matsuda K, Tashiro H, Yagyu S, Tanaka M, Nakazawa Y. Mutated GM-CSF-based CAR-T cells targeting CD116/CD131 complexes exhibit enhanced anti-tumor effects against acute myeloid leukaemia. Clin Transl Immunology 2021; 10:e1282. [PMID: 33976880 PMCID: PMC8102137 DOI: 10.1002/cti2.1282] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/28/2021] [Accepted: 03/21/2021] [Indexed: 11/24/2022] Open
Abstract
Objectives As the prognosis of relapsed/refractory (R/R) acute myeloid leukaemia (AML) remains poor, novel treatment strategies are urgently needed. Clinical trials have shown that chimeric antigen receptor (CAR)‐T cells for AML are more challenging than those targeting CD19 in B‐cell malignancies. We recently developed piggyBac‐modified ligand‐based CAR‐T cells that target CD116/CD131 complexes, also known as the GM‐CSF receptor (GMR), for the treatment of juvenile myelomonocytic leukaemia. This study therefore aimed to develop a novel therapeutic method for R/R AML using GMR CAR‐T cells. Methods To further improve the efficacy of the original GMR CAR‐T cells, we have developed novel GMR CAR vectors incorporating a mutated GM‐CSF for the antigen‐binding domain and G4S spacer. All GMR CAR‐T cells were generated using a piggyBac‐based gene transfer system. The anti‐tumor effect of GMR CAR‐T cells was tested in mouse AML xenograft models. Results Nearly 80% of the AML cells predominant in myelomonocytic leukaemia were found to express CD116. GMR CAR‐T cells exhibited potent cytotoxic activities against CD116+ AML cells in vitro. Furthermore, GMR CAR‐T cells incorporating a G4S spacer significantly improved long‐term in vitro and in vivo anti‐tumor effects. By employing a mutated GM‐CSF at residue 21 (E21K), the anti‐tumor effects of GMR CAR‐T cells were also improved especially in long‐term in vitro settings. Although GMR CAR‐T cells exerted cytotoxic effects on normal monocytes, their lethality on normal neutrophils, T cells, B cells and NK cells was minimal. Conclusions GMR CAR‐T cell therapy represents a promising strategy for CD116+ R/R AML.
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Affiliation(s)
- Aiko Hasegawa
- Department of Pediatrics Shinshu University School of Medicine Matsumoto Japan
| | - Shoji Saito
- Department of Pediatrics Shinshu University School of Medicine Matsumoto Japan.,Center for Advanced Research of Gene and Cell Therapy Shinshu University Matsumoto Japan
| | - Shogo Narimatsu
- Department of Drug Discovery Science Shinshu University Matsumoto Japan.,Frontier Technology Research Laboratory Kissei Pharmaceutical Co., Ltd Azumino Japan
| | - Shigeru Nakano
- Department of Drug Discovery Science Shinshu University Matsumoto Japan.,Frontier Technology Research Laboratory Kissei Pharmaceutical Co., Ltd Azumino Japan
| | - Mika Nagai
- Department of Pediatrics Shinshu University School of Medicine Matsumoto Japan
| | - Hideki Ohnota
- Department of Drug Discovery Science Shinshu University Matsumoto Japan
| | - Yoichi Inada
- Department of Pediatrics Shinshu University School of Medicine Matsumoto Japan.,Department of Drug Discovery Science Shinshu University Matsumoto Japan
| | - Hirokazu Morokawa
- Department of Pediatrics Shinshu University School of Medicine Matsumoto Japan
| | - Ikumi Nakashima
- Department of Pediatrics Shinshu University School of Medicine Matsumoto Japan
| | - Daisuke Morita
- Department of Pediatrics Shinshu University School of Medicine Matsumoto Japan.,Institute for Biomedical Sciences Interdisciplinary Cluster for Cutting Edge Research Shinshu University Matsumoto Japan
| | - Yuichiro Ide
- Department of Laboratory Medicine Shinshu University Hospital Matsumoto Japan
| | - Kazuyuki Matsuda
- Department of Health and Medical Sciences Graduate School of Medicine Shinshu University Matsumoto Japan
| | - Haruko Tashiro
- Department of Hematology/Oncology Teikyo University School of Medicine Itabashi Japan
| | - Shigeki Yagyu
- Center for Advanced Research of Gene and Cell Therapy Shinshu University Matsumoto Japan.,Department of Pediatrics Kyoto Prefectural Medical University Kyoto Japan
| | - Miyuki Tanaka
- Department of Pediatrics Shinshu University School of Medicine Matsumoto Japan.,Center for Advanced Research of Gene and Cell Therapy Shinshu University Matsumoto Japan
| | - Yozo Nakazawa
- Department of Pediatrics Shinshu University School of Medicine Matsumoto Japan.,Center for Advanced Research of Gene and Cell Therapy Shinshu University Matsumoto Japan.,Institute for Biomedical Sciences Interdisciplinary Cluster for Cutting Edge Research Shinshu University Matsumoto Japan
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4
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Hamdy N, Bokhary H, Elsayed A, Hozayn W, Soliman S, Salem S, Alsheshtawi K, Abdalla A, Hafez H, Hammad M. RAS Pathway Mutation Patterns in Patients With Juvenile Myelomonocytic Leukemia: A Developing Country Single-center Experience. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:e368-e374. [PMID: 32209330 DOI: 10.1016/j.clml.2020.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 02/04/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Juvenile myelomonocytic leukemia (JMML) is a rare clonal myelodysplastic/myeloproliferative neoplasm of early childhood. Historically, it was difficult to diagnose clinically, as patients present with manifestations shared with other hematologic malignancies or viral infections. It is now clear that JMML is a disease of hyperactive RAS signaling. PATIENTS AND METHODS We examined the bone marrow of 41 Egyptian children with JMML by direct sequencing for mutations in the RAS pathway genes. RESULTS Mutations were detected in 33 (80%) of 41 patients. We identified 12 (29%) of 41 patients with PTPN11 mutation; 18 (44%) of 41 with RAS mutation; 9 (22%) of 41 with NRAS mutation; 9 (22%) of 41 with KRAS mutation; and 3 (7%) of 41 with CBL mutation. Eleven (92%) of the PTPN11 mutations were detected in exon 3 and 1 (8%) in exon 13. Seven of the NRAS mutations were in exon 2, and 2 were in exon 3. All KRAS mutations were in exon 2. The 3 cases with CBL mutation were homozygous mutations in exon 8. All the mutations detected in PTPN11, NRAS/KRAS, and the CBL genes were previously reported missense mutations in JMML. CONCLUSION Our results demonstrate that Egyptian children diagnosed with JMML have high frequency of NRAS/KRAS mutations and lower frequency of PTPN11 mutations as compared with previous studies. The concept of mutually exclusive RAS pathway mutations was clearly observed in our patients. All cancer centers in our region should start implementing molecular diagnostic methods before confirming the diagnosis of JMML and before offering hematopoietic stem cell transplantation.
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Affiliation(s)
- Nayera Hamdy
- Department of Clinical Pathology, National Cancer Institute (NCI), Cairo University, Cairo, Egypt; Department of Clinical Pathology, Children's Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
| | - Hossam Bokhary
- Department of Clinical Pathology, Children's Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt; Department of Biotechnology, Faculty of Postgraduate Studies for Advanced Science, Beni-Suef University, Beni-Suef, Egypt
| | - Amr Elsayed
- Department of Biotechnology, Faculty of Postgraduate Studies for Advanced Science, Beni-Suef University, Beni-Suef, Egypt
| | - Walaa Hozayn
- Department of Biotechnology, Faculty of Postgraduate Studies for Advanced Science, Beni-Suef University, Beni-Suef, Egypt
| | - Sonya Soliman
- Department of Clinical Pathology, National Cancer Institute (NCI), Cairo University, Cairo, Egypt; Department of Clinical Pathology, Children's Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
| | - Sherine Salem
- Department of Clinical Pathology, National Cancer Institute (NCI), Cairo University, Cairo, Egypt; Department of Clinical Pathology, Children's Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
| | - Khaled Alsheshtawi
- Department of Clinical Research, Children's Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
| | - Amr Abdalla
- Department of Pediatric Oncology, National Cancer Institute (NCI), Cairo University, Cairo, Egypt; Department of Pediatric Oncology, Children's Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
| | - Hanafy Hafez
- Department of Pediatric Oncology, National Cancer Institute (NCI), Cairo University, Cairo, Egypt; Department of Pediatric Oncology, Children's Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
| | - Mahmoud Hammad
- Department of Pediatric Oncology, National Cancer Institute (NCI), Cairo University, Cairo, Egypt; Department of Pediatric Oncology, Children's Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt.
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Shigemura T, Matsuda K, Kurata T, Sakashita K, Okuno Y, Muramatsu H, Yue F, Ebihara Y, Tsuji K, Sasaki K, Nakahata T, Nakazawa Y, Koike K. Essential role of PTPN11 mutation in enhanced haematopoietic differentiation potential of induced pluripotent stem cells of juvenile myelomonocytic leukaemia. Br J Haematol 2019; 187:163-173. [PMID: 31222725 DOI: 10.1111/bjh.16060] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 05/03/2019] [Indexed: 12/13/2022]
Abstract
We established mutated and non-mutated induced pluripotent stem cell (iPSC) clones from a patient with PTPN11 (c.226G>A)-mutated juvenile myelomonocytic leukaemia (JMML). Both types of iPSCs fulfilled the quality criteria. Mutated iPSC colonies generated significantly more CD34+ and CD34+ CD45+ cells compared to non-mutated iPSC colonies in a culture coated with irradiated AGM-S3 cells to which four growth factors were added sequentially or simultaneously. The haematopoietic differentiation potential of non-mutated JMML iPSC colonies was similar to or lower than that of iPSC colonies from a healthy individual. The PTPN11 mutation coexisted with the OSBP2 c.389C>T mutation. Zinc-finger nuclease-mediated homologous recombination revealed that correction of PTPN11 mutation in iPSCs with PTPN11 and OSBP2 mutations resulted in reduced CD34+ cell generation to a level similar to that obtained with JMML iPSC colonies with the wild-type of both genes, and interestingly, to that obtained with normal iPSC colonies. Transduction of the PTPN11 mutation into JMML iPSCs with the wild-type of both genes increased CD34+ cell production to a level comparable to that obtained with JMML iPSC colonies harbouring the two genetic mutations. Thus, PTPN11 mutation may be the most essential abnormality to confer an aberrant haematopoietic differentiation potential in this disorder.
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Affiliation(s)
- Tomonari Shigemura
- Department of Paediatrics, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kazuyuki Matsuda
- Department of Health and Medical Sciences, Graduate School of Medicine, Shinshu University, Matsumoto, Japan
| | - Takashi Kurata
- Department of Paediatrics, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kazuo Sakashita
- Department of Haematology/Oncology, Nagano Children's Hospital, Azumino, Japan
| | - Yusuke Okuno
- Department of Paediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hideki Muramatsu
- Department of Paediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Fengming Yue
- Department of Anatomy and Organ Technology, Institute of Organ Transplants, Reconstructive Medicine and Tissue Engineering, Shinshu University Graduate School of Medicine, Matsumoto, Japan
| | - Yasuhiro Ebihara
- Department of Laboratory Medicine, International Medical Centre, Saitama Medical University, Hidaka, Japan
| | - Kohichiro Tsuji
- Department of Paediatrics, Komoro Kogen Hospital, Komoro, Japan
| | - Katsunori Sasaki
- Department of Anatomy and Organ Technology, Institute of Organ Transplants, Reconstructive Medicine and Tissue Engineering, Shinshu University Graduate School of Medicine, Matsumoto, Japan
| | - Tatsutoshi Nakahata
- Department of Clinical Application, Centre for iPS Cell Research and Application (CiRA), Kyoto University, Kyoto, Japan
| | - Yozo Nakazawa
- Department of Paediatrics, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kenichi Koike
- Department of Paediatrics, Shinshu University School of Medicine, Matsumoto, Japan.,Minami Nagano Medical Centre, Shinonoi General Hospital, Nagano, Japan
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6
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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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7
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Nakazawa Y, Matsuda K, Kurata T, Sueki A, Tanaka M, Sakashita K, Imai C, Wilson MH, Koike K. Anti-proliferative effects of T cells expressing a ligand-based chimeric antigen receptor against CD116 on CD34(+) cells of juvenile myelomonocytic leukemia. J Hematol Oncol 2016; 9:27. [PMID: 26983639 PMCID: PMC4793548 DOI: 10.1186/s13045-016-0256-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 03/08/2016] [Indexed: 11/17/2022] Open
Abstract
Background Juvenile myelomonocytic leukemia (JMML) is a fatal, myelodysplastic/myeloproliferative neoplasm of early childhood. Patients with JMML have mutually exclusive genetic abnormalities in granulocyte-macrophage colony-stimulating factor (GM-CSF) receptor (GMR, CD116) signaling pathway. Allogeneic hematopoietic stem cell transplantation is currently the only curative treatment option for JMML; however, disease recurrence is a major cause of treatment failure. We investigated adoptive immunotherapy using GMR-targeted chimeric antigen receptor (CAR) for JMML. Methods We constructed a novel CAR capable of binding to GMR via its ligand, GM-CSF, and generated piggyBac transposon-based GMR CAR-modified T cells from three healthy donors and two patients with JMML. We further evaluated the anti-proliferative potential of GMR CAR T cells on leukemic CD34+ cells from six patients with JMML (two NRAS mutations, three PTPN11 mutations, and one monosomy 7), and normal CD34+ cells. Results GMR CAR T cells from healthy donors suppressed the cytokine-dependent growth of MO7e cells, but not the growth of K562 and Daudi cells. Co-culture of healthy GMR CAR T cells with CD34+ cells of five patients with JMML at effector to target ratios of 1:1 and 1:4 for 2 days significantly decreased total colony growth, regardless of genetic abnormality. Furthermore, GMR CAR T cells from a non-transplanted patient and a transplanted patient inhibited the proliferation of respective JMML CD34+ cells at onset to a degree comparable to healthy GMR CAR T cells. Seven-day co-culture of GMR CAR T cells resulted in a marked suppression of JMML CD34+ cell proliferation, particularly CD34+CD38− cell proliferation stimulated with stem cell factor and thrombopoietin on AGM-S3 cells. Meanwhile, GMR CAR T cells exerted no effects on normal CD34+ cell colony growth. Conclusions Ligand-based GMR CAR T cells may have anti-proliferative effects on stem and progenitor cells in JMML. Electronic supplementary material The online version of this article (doi:10.1186/s13045-016-0256-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yozo Nakazawa
- Department of Pediatrics, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, 390-8621, Japan
| | - Kazuyuki Matsuda
- Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan
| | - Takashi Kurata
- Department of Pediatrics, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, 390-8621, Japan
| | - Akane Sueki
- Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan
| | - Miyuki Tanaka
- Department of Pediatrics, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, 390-8621, Japan
| | - Kazuo Sakashita
- Department of Pediatrics, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, 390-8621, Japan.,Division of Hematology/Oncology, Nagano Children's Hospital, Azumino, Japan
| | - Chihaya Imai
- Department of Pediatrics, Niigata University School of Medicine, Niigata, Japan
| | - Matthew H Wilson
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Kenichi Koike
- Department of Pediatrics, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, 390-8621, Japan.
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8
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Sakashita K, Kato I, Daifu T, Saida S, Hiramatsu H, Nishinaka Y, Ebihara Y, Ma F, Matsuda K, Saito S, Hirabayashi K, Kurata T, Uyen LTN, Nakazawa Y, Tsuji K, Heike T, Nakahata T, Koike K. In vitro expansion of CD34(+)CD38(-) cells under stimulation with hematopoietic growth factors on AGM-S3 cells in juvenile myelomonocytic leukemia. Leukemia 2015; 29:606-14. [PMID: 25102944 DOI: 10.1038/leu.2014.239] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 07/09/2013] [Accepted: 07/24/2014] [Indexed: 12/11/2022]
Abstract
Using serum-containing culture, we examined whether AGM-S3 stromal cells, alone or in combination with hematopoietic growth factor(s), stimulated the proliferation of CD34(+) cells from patients with juvenile myelomonocytic leukemia (JMML). AGM-S3 cells in concert with stem cell factor plus thrombopoietin increased the numbers of peripheral blood CD34(+) cells to approximately 20-fold of the input value after 2 weeks in nine JMML patients with either PTPN11 mutations or RAS mutations, who received allogeneic hematopoietic transplantation. Granulocyte-macrophage colony-stimulating factor (GM-CSF) also augmented the proliferation of JMML CD34(+) cells on AGM-S3 cells. The expansion potential of CD34(+) cells was markedly low in four patients who achieved spontaneous hematological improvement. A large proportion of day-14-cultured CD34(+) cells were negative for CD38 and cryopreservable. Cultured JMML CD34(+)CD38(-) cells expressed CD117, CD116, c-mpl, CD123, CD90, but not CXCR4, and formed GM and erythroid colonies. Day-7-cultured CD34(+) cells from two of three JMML patients injected intrafemorally into immunodeficient mice stimulated with human GM-CSF after transplantation displayed significant hematopoietic reconstitution. The abilities of OP9 cells and MS-5 cells were one-third and one-tenth, respectively, of the value obtained with AGM-S3 cells. Our culture system may provide a useful tool for elucidating leukemogenesis and for therapeutic approaches in JMML.
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MESH Headings
- ADP-ribosyl Cyclase 1/genetics
- ADP-ribosyl Cyclase 1/metabolism
- Adolescent
- Animals
- Antigens, CD34/genetics
- Antigens, CD34/metabolism
- Cell Proliferation/drug effects
- Clone Cells
- Coculture Techniques
- Embryonic Stem Cells/drug effects
- Embryonic Stem Cells/metabolism
- Embryonic Stem Cells/pathology
- GTP Phosphohydrolases/genetics
- GTP Phosphohydrolases/metabolism
- Gene Expression Regulation, Leukemic
- Granulocyte-Macrophage Colony-Stimulating Factor/pharmacology
- Hematopoietic Stem Cells/drug effects
- Hematopoietic Stem Cells/metabolism
- Hematopoietic Stem Cells/pathology
- Humans
- Leukemia, Myelomonocytic, Juvenile/genetics
- Leukemia, Myelomonocytic, Juvenile/metabolism
- Leukemia, Myelomonocytic, Juvenile/pathology
- Membrane Proteins/genetics
- Membrane Proteins/metabolism
- Mice
- Mice, Inbred NOD
- Mice, SCID
- Mutation
- Neoplastic Stem Cells/metabolism
- Neoplastic Stem Cells/pathology
- Neoplastic Stem Cells/transplantation
- Protein Tyrosine Phosphatase, Non-Receptor Type 11/genetics
- Protein Tyrosine Phosphatase, Non-Receptor Type 11/metabolism
- Proto-Oncogene Proteins/genetics
- Proto-Oncogene Proteins/metabolism
- Proto-Oncogene Proteins p21(ras)
- Signal Transduction
- Stromal Cells/drug effects
- Stromal Cells/metabolism
- Stromal Cells/pathology
- ras Proteins/genetics
- ras Proteins/metabolism
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Affiliation(s)
- K Sakashita
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
| | - I Kato
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - T Daifu
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - S Saida
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - H Hiramatsu
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Y Nishinaka
- Department of Clinical Application, Center for iPS Cell Research and Application, Kyoto University, Kyoto, Japan
| | - Y Ebihara
- 1] Department of Pediatric Hematology/Oncology, Research Hospital, Institute of Medical Science, University of Tokyo, Minato-ku, Japan [2] Division of Stem Cell Processing, Center for Stem Cell Biology and Regenerative Medicine, Institute of Medical Science, University of Tokyo, Minato-ku, Japan
| | - F Ma
- 1] Division of Stem Cell Processing, Center for Stem Cell Biology and Regenerative Medicine, Institute of Medical Science, University of Tokyo, Minato-ku, Japan [2] Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, China
| | - K Matsuda
- Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan
| | - S Saito
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
| | - K Hirabayashi
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
| | - T Kurata
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
| | - L T N Uyen
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
| | - Y Nakazawa
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
| | - K Tsuji
- 1] Department of Pediatric Hematology/Oncology, Research Hospital, Institute of Medical Science, University of Tokyo, Minato-ku, Japan [2] Division of Stem Cell Processing, Center for Stem Cell Biology and Regenerative Medicine, Institute of Medical Science, University of Tokyo, Minato-ku, Japan [3] Department of Pediatrics, Shinshu Ueda Medical Center, National Hospital Organization, Ueda, Japan
| | - T Heike
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - T Nakahata
- Department of Clinical Application, Center for iPS Cell Research and Application, Kyoto University, Kyoto, Japan
| | - K Koike
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
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9
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Abstract
Juvenile myelomonocytic leukemia (JMML), a rare myeloid malignancy that occurs in young children, is considered a clonal disease originating in pluripotent stem cells of the hematopoietic system. The pathogenesis of JMML involves disruption of signal transduction through the RAS pathway, with resultant selective hypersensitivity of JMML cells to granulocyte-macrophage colony-stimulating factor. Progress has been made in understanding aspects of the molecular basis of JMML. How these molecular mechanisms may lead to targeted therapeutics and improved outcomes remains to be elucidated. Allogeneic hematopoietic stem cell transplant is the only curative option for children with JMML, and it is fraught with frequent relapse and significant toxicity.
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Affiliation(s)
- Prakash Satwani
- Division of Pediatric Hematology/Oncology and Stem Cell Transplantation, Columbia University Medical Center Morgan Stanley Children's Hospital of New York-Presbyterian, 3959 Broadway, CHN-1002, New York, NY 10032, USA.
| | - Justine Kahn
- Division of Pediatric Hematology/Oncology and Stem Cell Transplantation, Columbia University Medical Center Morgan Stanley Children's Hospital of New York-Presbyterian, 3959 Broadway, CHN-1002, New York, NY 10032, USA
| | - Christopher C Dvorak
- Division of Pediatric Allergy, Immunology, and Bone Marrow Transplant, Benioff Children's Hospital, University of California San Francisco, 505 Parnassus Ave., M-659, San Francisco, CA, 94143-1278, USA
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10
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Yeşilipek MA. Hematopoetic stem cell transplantation in children. Turk Arch Pediatr 2014; 49:91-8. [PMID: 26078642 DOI: 10.5152/tpa.2014.2010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 04/25/2013] [Indexed: 11/22/2022]
Abstract
Bone marrow transplantation is called hematopoetic stem cell transplantation (HSCT), since peripheral blood and umbilical cord blood can also be used as sources of stem cell currently. In children, bone marrow transplantation is used as a definite treatment method in many diseases including hemoglobinopaties, immune deficiencies, bone marrow failure and congenital metabolic diseases in addition to hematological malignancies. In addition to the underlying disease, the most important factors which have an impact on prognosis include infections which develop during the process of transplantation and graft-versus-host disease. In this article, it was aimed to give brief information on stem cell sources, preparation therapies, HSCT indications and post-transplantation complications in children.
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Affiliation(s)
- Mehmet Akif Yeşilipek
- Department of Pediatric Hematology Oncology, Bahçeşehir University Faculty of Medicine, İstanbul, Turkey
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11
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Tokuda K, Eguchi-Ishimae M, Iwabuki H, Kawakami S, Tauchi H, Ishii E, Eguchi M. Lineage-dependent skewing of loss of heterozygosity (LOH) of KRAS gene in a case of juvenile myelomonocytic leukemia. Eur J Haematol 2014; 94:177-81. [PMID: 24766281 DOI: 10.1111/ejh.12355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2014] [Indexed: 11/30/2022]
Abstract
Juvenile myelomonocytic leukemia (JMML) is a clonal disease arising from abnormal hematopoietic stem cells, although the involvement of lymphoid lineage differs among reported cases. Here, we present a case of JMML with a KRAS G13D mutation. The mutation was detected in various hematopoietic lineages, including T and B lymphocytes and also in lineage(-) CD34(+) CD38(-) hematopoietic stem cells, showing a different percentage of affected cells in each lineage. Single cell-based analysis of hematopoietic cells revealed the loss of wild-type KRAS in a significant proportion of G13D-harboring cells. The percentage of loss of heterozygosity (LOH)/non-LOH cells showed lineage-dependent skewing in hematopoietic cells. The loss of the wild-type KRAS allele may be a common secondary genetic change in KRAS-related JMML and may affect the differentiation behavior of early JMML progenitors.
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Affiliation(s)
- Kiriko Tokuda
- Department of Pediatrics, Ehime University Graduate School of Medicine, Ehime, Japan
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12
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Honda Y, Tsuchida M, Zaike Y, Masunaga A, Yoshimi A, Kojima S, Ito M, Kikuchi A, Nakahata T, Manabe A. Clinical characteristics of 15 children with juvenile myelomonocytic leukaemia who developed blast crisis: MDS Committee of Japanese Society of Paediatric Haematology/Oncology. Br J Haematol 2014; 165:682-7. [DOI: 10.1111/bjh.12796] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 01/08/2014] [Indexed: 02/03/2023]
Affiliation(s)
- Yuko Honda
- Department of Paediatrics; University of Occupational and Environmental Health; Kitakyusyu Japan
| | | | - Yuji Zaike
- Clinical Laboratory; Research Hospital; The Institution of Medical Science; The University of Tokyo; Tokyo Japan
| | - Atsuko Masunaga
- Department of Diagnostic Pathology; Showa University Fujigaoka Hospital; Yokohama Japan
| | - Ayami Yoshimi
- Department of Paediatrics and Adolescent Medicine; University of Freiburg; Freiburg Germany
| | - Seiji Kojima
- Department of Paediatrics; Graduate School of Medicine; Nagoya University; Nagoya Japan
| | - Masafumi Ito
- Department of Pathology; Nagoya Daiichi Red Cross Hospital; Nagoya Japan
| | - Akira Kikuchi
- Department of Paediatrics; School of Medicine; Teikyo University; Tokyo Japan
| | - Tatsutoshi Nakahata
- Department of Clinical Application; Center for iPS Cell Research and Application; Kyoto University; Kyoto Japan
| | - Atsushi Manabe
- Department of Paediatrics; St. Luke's International Hospital; Tokyo Japan
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13
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Matsuda K, Nakazawa Y, Iwashita C, Kurata T, Hirabayashi K, Saito S, Tanaka M, Yoshikawa K, Yanagisawa R, Sakashita K, Sasaki S, Honda T, Koike K. Myeloid progenitors with PTPN11 and nonRAS pathway gene mutations are refractory to treatment with 6-mercaptopurine in juvenile myelomonocytic leukemia. Leukemia 2014; 28:1545-8. [PMID: 24496301 DOI: 10.1038/leu.2014.58] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- K Matsuda
- Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan
| | - Y Nakazawa
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
| | - C Iwashita
- Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan
| | - T Kurata
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
| | - K Hirabayashi
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
| | - S Saito
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
| | - M Tanaka
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
| | - K Yoshikawa
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
| | - R Yanagisawa
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
| | - K Sakashita
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
| | - S Sasaki
- Department of Pediatrics, Hirosaki University School of Medicine, Hirosaki, Japan
| | - T Honda
- Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan
| | - K Koike
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
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14
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Ksionda O, Limnander A, Roose JP. RasGRP Ras guanine nucleotide exchange factors in cancer. FRONTIERS IN BIOLOGY 2013; 8:508-532. [PMID: 24744772 PMCID: PMC3987922 DOI: 10.1007/s11515-013-1276-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
RasGRP proteins are activators of Ras and other related small GTPases by the virtue of functioning as guanine nucleotide exchange factors (GEFs). In vertebrates, four RasGRP family members have been described. RasGRP-1 through -4 share many structural domains but there are also subtle differences between each of the different family members. Whereas SOS RasGEFs are ubiquitously expressed, RasGRP proteins are expressed in distinct patterns, such as in different cells of the hematopoietic system and in the brain. Most studies have concentrated on the role of RasGRP proteins in the development and function of immune cell types because of the predominant RasGRP expression profiles in these cells and the immune phenotypes of mice deficient for Rasgrp genes. However, more recent studies demonstrate that RasGRPs also play an important role in tumorigenesis. Examples are skin- and hematological-cancers but also solid malignancies such as melanoma or prostate cancer. These novel studies bring up many new and unanswered questions related to the molecular mechanism of RasGRP-driven oncogenesis, such as new receptor systems that RasGRP appears to respond to as well as regulatory mechanism for RasGRP expression that appear to be perturbed in these cancers. Here we will review some of the known aspects of RasGRP biology in lymphocytes and will discuss the exciting new notion that RasGRP Ras exchange factors play a role in oncogenesis downstream of various growth factor receptors.
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Affiliation(s)
- Olga Ksionda
- Department of Anatomy, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Andre Limnander
- Department of Anatomy, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Jeroen P. Roose
- Department of Anatomy, University of California, San Francisco, San Francisco, CA 94143, USA
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15
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Wu H, Bian S, Chu J, Zhong X, Sun H, Zhang B, Lu Z. Characteristics of the four subtypes of myelodysplastic/myeloproliferative neoplasms. Exp Ther Med 2013; 5:1332-1338. [PMID: 23737874 PMCID: PMC3671785 DOI: 10.3892/etm.2013.975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 01/15/2013] [Indexed: 11/07/2022] Open
Abstract
The aim of the present study was to investigate the characteristics of the four subtypes of myelodysplastic/myeloproliferative neoplasms (MDS/MPNs) in order to improve current knowledge and to aid their diagnosis. A total of 53 cases of MDS/MPNs were analyzed using routine blood cell analysis and morphological, cytogenetic and molecular genetic characteristics were investigated. Numerical data for several groups were compared using a single-factor analysis of variance. The Student-Newman-Keuls test was used to compare the means of two groups. The proportions were compared using a Chi-square test or Fisher’s exact test. Analysis of the patients with MDS/MPNs revealed that 46 patients (86.8%) had paleness and fatigue, and blood analysis revealed hemoglobin (Hb) levels of 83.1±24.6 g/l, a white blood cell (WBC) count of 19.8±8.1×109/l and a platelet (PLT) count of 158.7±108.2×1012/l. Immature neutrophils and monocytes were identified in the peripheral blood at levels of 0.058±0.031 and 0.152±0.034%, respectively. There were 23 cases (43.4%) with dyserythropoiesis and 36 cases (67.9%) had dysgranulopoiesis. Fifteen cases were immunologically characterized using flow cytometry (FCM), of which 13 cases showed abnormalities on blasts and myelocytes. Karyotyping was performed in 27 cases of MDS/MPN and 12 (44.4%) were identified as abnormal. In 23 cases, testing for BCR/ABL1, AML-ETO, CBF-MYH11A, PML-RARA, E2A-PBX1, TEL-AML1, SIL-TAL1 returned negative results. The JAK2V617F mutation was positive in one of five cases. The majority of MDS/MPN cases had anemia, cytosis, low-grade blasts and immature neutrophils in the peripheral blood and dysplasia in the bone marrow. Immunological abnormalities and abnormal karyotypes occurred frequently in MDS/MPNs and although there were no statistical differences between the four subtypes, these were able to aid diagnosis. No specific molecular abnormalities were identified in MDS/MPNs.
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Affiliation(s)
- Huanling Wu
- Clinical Laboratory of Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021
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16
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Inagaki J, Fukano R, Nishikawa T, Nakashima K, Sawa D, Ito N, Okamura J. Outcomes of immunological interventions for mixed chimerism following allogeneic stem cell transplantation in children with juvenile myelomonocytic leukemia. Pediatr Blood Cancer 2013; 60:116-20. [PMID: 22847790 DOI: 10.1002/pbc.24259] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Accepted: 06/18/2012] [Indexed: 11/12/2022]
Abstract
BACKGROUND For children with juvenile myelomonocytic leukemia (JMML) who undergo stem cell transplantation (SCT), the role of immunological interventions including withdrawal of immunosuppressive therapy (IST) and donor lymphocyte infusion (DLI) for treatment of disease recurrence remains uncertain. PROCEDURE We analyzed serial chimerism status following SCT and evaluated the efficacy of immunological interventions for the management of mixed chimerism (MC) in children with JMML. RESULTS Chimerism analysis was available in 26 SCT cases following the first and second SCT. MC was observed in 16 cases and withdrawal of IST was performed in 14 cases immediately after identification of MC. Donor lymphocyte infusion (DLI) was performed in five MC cases. Eight MC cases were observed at the time of neutrophil recovery. Following withdrawal of IST, three cases achieved complete chimerism (CC) while the proportion of autologous cells increased rapidly in the remaining five cases. Six MC cases were observed after achievement of hematological remission (HR) and responses to withdrawal of IST were observed in two cases. In the remaining four cases, despite withdrawal of IST, the proportion of autologous cells increased. Five cases received DLI but only one case responded. CONCLUSION Although the benefits of immunological interventions for MC after SCT in JMML were limited, some patients did achieve HR as a result of these treatment modalities without a second SCT. Close monitoring of donor chimerism and early detection of MC is helpful in guiding treatment after SCT in children with JMML.
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Affiliation(s)
- Jiro Inagaki
- Department of Pediatrics, National Kyushu Cancer Center, Fukuoka, Japan.
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17
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Abstract
A 16-year-old man with splenomegaly presented with ascites and bilateral leg eschars. Although he had intermittently elevated absolute monocyte counts, a diagnosis of juvenile myelomonocytic leukemia (JMML) was discounted because of his age and lack of persistent leukocytosis. Detailed examination demonstrated features consistent with Noonan syndrome (NS), including typical facies, growth retardation, a cardiac defect, and a history of a coagulopathy. He underwent a splenectomy where the surgeons encountered a rind of tissue composed of monocytes encasing the abdominal organs. After splenectomy, his leukocytes rose to over 100×10(9)/L with a monocytosis, suggesting JMML. On the basis of the clinical suspicion of NS, mutation analysis revealed a KRAS mutation, which is known to be common to both NS and JMML. Clinicians should have high index of suspicion for JMML in patients with Noonan features, regardless of a patient's age.
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18
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Wolf S, Rudolph C, Morgan M, Büsche G, Salguero G, Stripecke R, Schlegelberger B, Baum C, Modlich U. Selection for Evi1 activation in myelomonocytic leukemia induced by hyperactive signaling through wild-type NRas. Oncogene 2012; 32:3028-38. [PMID: 22847614 DOI: 10.1038/onc.2012.329] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Activation of NRas signaling is frequently found in human myeloid leukemia and can be induced by activating mutations as well as by mutations in receptors or signaling molecules upstream of NRas. To study NRas-induced leukemogenesis, we retrovirally overexpressed wild-type NRas in a murine bone marrow transplantation (BMT) model in C57BL/6J mice. Overexpression of wild-type NRas caused myelomonocytic leukemias ∼3 months after BMT in the majority of mice. A subset of mice (30%) developed malignant histiocytosis similar to mice that received mutationally activated NRas(G12D)-expressing bone marrow. Aberrant Ras signaling was demonstrated in cells expressing mutationally active or wild-type NRas, as increased activation of Erk and Akt was observed in both models. However, more NRas(G12D) were found to be in the activated, GTP-bound state in comparison with wild-type NRas. Consistent with observations reported for primary human myelomonocytic leukemia cells, Stat5 activation was also detected in murine leukemic cells. Furthermore, clonal evolution was detected in NRas wild-type-induced leukemias, including expansion of clones containing activating vector insertions in known oncogenes, such as Evi1 and Prdm16. In vitro cooperation of NRas and Evi1 improved long-term expansion of primary murine bone marrow cells. Evi1-positive cells upregulated Bcl-2 and may, therefore, provide anti-apoptotic signals that collaborate with the NRas-induced proliferative effects. As activation of Evi1 has been shown to coincide with NRAS mutations in human acute myeloid leukemia, our murine model recapitulates crucial events in human leukemogenesis.
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Affiliation(s)
- S Wolf
- Institute of Experimental Hematology, Hannover Medical School, Hannover, Germany
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19
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Fukushima H, Fukushima T, Hiraki A, Suzuki R, Mahmoud SSA, Yoshimi A, Nakao T, Kato K, Kobayashi C, Koike K, Fukasawa M, Morishita Y, Doisaki S, Muramatsu H, Sumazaki R. Central nervous system lesions due to juvenile myelomonocytic leukemia progressed in a boy undergoing first line chemotherapy. Int J Hematol 2012; 95:581-4. [PMID: 22461033 DOI: 10.1007/s12185-012-1046-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 02/27/2012] [Accepted: 02/28/2012] [Indexed: 11/24/2022]
Abstract
Juvenile myelomonocytic leukemia is a rare malignancy that occurs in pediatric patients. Previous reports, have described leukemic cells may infiltrate many organs, such as the lungs, skin, liver, spleen, and intestines, but not the central nervous system, although central nervous system infiltration remains a point of concern in every patient with acute leukemia. Here, we present one case of a boy with juvenile myelomonocytic leukemia who developed multiple lesions in the brain while undergoing chemotherapy with 6-mercaptopurine and cytarabine. We diagnosed the central nervous system involvement by magnetic resonance imaging, cerebrospinal fluid cytology, and the patient's clinical course. He was treated with a high dose of cytarabine and intrathecal chemotherapy, then with unrelated cord blood stem cell transplantation. He has been in a first complete remission for more than 18 months after cord blood stem cell transplantation without any neurological sequelae. In conclusion, we encountered a boy with juvenile myelomonocytic leukemia who developed central nervous system lesions under standard chemotherapy. We subsequently switched treatment to central nervous system-oriented chemotherapy, which resulted in a good clinical condition and successful cord blood stem cell transplantation.
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Affiliation(s)
- Hiroko Fukushima
- Department of Pediatrics, Tsukuba University Hospital, Tsukuba, Japan.
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20
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Matsuda K, Yoshida N, Miura S, Nakazawa Y, Sakashita K, Hyakuna N, Saito M, Kato F, Ogawa A, Watanabe A, Sotomatsu M, Kobayashi C, Ito T, Ishida F, Manabe A, Kojima S, Koike K. Long-term haematological improvement after non-intensive or no chemotherapy in juvenile myelomonocytic leukaemia and poor correlation with adult myelodysplasia spliceosome-related mutations. Br J Haematol 2012; 157:647-50. [PMID: 22348520 DOI: 10.1111/j.1365-2141.2012.09063.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
BACKGROUND Juvenile myelomonocytic leukemia is a rare hematopoietic stem cell disease in children with features of both myelodysplasia and myeloproliferation. Extramedullary involvement has been reported and pulmonary involvement secondary to leukemic infiltration is an initial manifestation, which may result in acute respiratory failure. OBSERVATION We present 3 children with juvenile myelomonocytic leukemia and suspected pulmonary leukemic cell infiltration who all also suffered from respiratory insufficiency. The differential diagnosis included asthma and infections. CONCLUSIONS In each case the patients improved rapidly after initiation of antileukemic treatment including 6-mercaptopurine or cytarabine.
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22
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Genetic analysis of TP53 in childhood myelodysplastic syndrome and juvenile myelomonocytic leukemia. Leuk Res 2011; 35:1578-84. [DOI: 10.1016/j.leukres.2011.06.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 06/16/2011] [Accepted: 06/22/2011] [Indexed: 11/19/2022]
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23
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Park HD, Lee SH, Sung KW, Koo HH, Jung NG, Cho B, Kim HK, Park IA, Lee KO, Ki CS, Kim SH, Yoo KH, Kim HJ. Gene mutations in the Ras pathway and the prognostic implication in Korean patients with juvenile myelomonocytic leukemia. Ann Hematol 2011; 91:511-7. [DOI: 10.1007/s00277-011-1326-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2011] [Accepted: 08/25/2011] [Indexed: 10/17/2022]
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24
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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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25
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Yanagisawa R, Matsuda K, Sakashita K, Nakazawa Y, Tanaka M, Saito S, Yoshikawa K, Kamijo T, Shiohara M, Koike K. Disappearance of minimal residual disease after the early withdrawal of immunosuppressants in a patient with juvenile myelomonocytic leukemia. Pediatr Blood Cancer 2011; 56:501-2. [PMID: 21225940 DOI: 10.1002/pbc.22849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 09/01/2010] [Indexed: 11/09/2022]
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26
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Liontos LM, Dissanayake D, Ohashi PS, Weiss A, Dragone LL, McGlade CJ. The Src-Like Adaptor Protein Regulates GM-CSFR Signaling and Monocytic Dendritic Cell Maturation. THE JOURNAL OF IMMUNOLOGY 2011; 186:1923-33. [DOI: 10.4049/jimmunol.0903292] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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27
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Ando K, Miyazaki Y, Sawayama Y, Tominaga S, Matsuo E, Yamasaki R, Inoue Y, Iwanaga M, Imanishi D, Tsushima H, Fukushima T, Imaizumi Y, Taguchi J, Yoshida S, Hata T, Tomonaga M. High expression of 67-kDa laminin receptor relates to the proliferation of leukemia cells and increases expression of GM-CSF receptor. Exp Hematol 2010; 39:179-186.e4. [PMID: 21056082 DOI: 10.1016/j.exphem.2010.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Revised: 08/09/2010] [Accepted: 11/02/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The 67-kDa laminin receptor (LR) is a nonintegrin receptor for laminin, a major component of the extracellular matrix. To elucidate the role of LR in leukemia cells, we studied the relationship between the phenotype of leukemia cells and LR expression. MATERIALS AND METHODS The relationship between clinical features of acute myeloid leukemia and expression of LR was examined. LR was overexpressed or suppressed by the introduction of complementary DNA or small interfering RNA for LR in a human leukemia cell line to test the effect of LR on the phenotype of leukemia. Expression of granulocyte-macrophage colony-stimulating factor receptors (GM-CSFR) was also tested in leukemia cells, including clinical samples. RESULTS Expression of LR was significantly related to elevation of white blood cell count, lactate dehydrogenase, and survival among acute myeloid leukemia patients. Forced expression of LR enhanced proliferation, cell-cycle progression, and antiapoptosis of leukemia cells associated with phosphorylation of a transcription factor, signal transducer and activator of transcription 5, in the absence of stimulation by laminin. On the other hand, suppression of LR expression had the opposite effects. The number of GM-CSFR increased in leukemia cells overexpressing LR, and there was a significant relationship between the expression of LR and GM-CSFR in acute myeloid leukemia samples. CONCLUSIONS These results suggest that LR expression influenced the characteristics of leukemia cells toward an aggressive phenotype and increased the number of GM-CSFR. These changes might be partly related to enhanced GM-CSF signaling.
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Affiliation(s)
- Koji Ando
- Hematology and Molecular Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, Japan
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28
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Pérez B, Kosmider O, Cassinat B, Renneville A, Lachenaud J, Kaltenbach S, Bertrand Y, Baruchel A, Chomienne C, Fontenay M, Preudhomme C, Cavé H. Genetic typing of CBL, ASXL1, RUNX1, TET2 and JAK2 in juvenile myelomonocytic leukaemia reveals a genetic profile distinct from chronic myelomonocytic leukaemia. Br J Haematol 2010; 151:460-8. [DOI: 10.1111/j.1365-2141.2010.08393.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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29
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Genetic analysis of dasatinib-treated chronic myeloid leukemia rapidly developing into acute myeloid leukemia with monosomy 7 in Philadelphia-negative cells. ACTA ACUST UNITED AC 2010; 199:89-95. [PMID: 20471511 DOI: 10.1016/j.cancergencyto.2010.02.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 01/15/2010] [Accepted: 02/02/2010] [Indexed: 12/20/2022]
Abstract
Despite the recent success of tyrosine kinase inhibitors (TKIs) in the treatment of chronic myeloid leukemia (CML), approximately 2-17% of patients develop clonal cytogenetic changes in the Philadelphia-negative (Ph(-)) cell population. A fraction of these patients, in particular those displaying trisomy 8 or monosomy 7, are at risk of developing a myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML). Consequently, there is a need to characterize the clinical features of such cases and to increase our understanding of the pathogenetic mechanisms underlying the emergence of clonal cytogenetic changes in Ph(-) cells. To date, most cases reported have received treatment with imatinib. Here we describe the case of a patient with CML who developed monosomy 7 in Ph(-) cells during dasatinib therapy. At 20 months after dasatinib initiation, the patient developed MDS, which rapidly progressed into AML. Genome-wide 500K SNP array analysis of the monosomy 7 clone revealed no acquired submicroscopic copy number changes. Given the strong association between monosomy 7 and mutation of genes involved in the RAS pathway in juvenile myelomonocytic leukemia, we also screened for pathogenetic variants in KRAS, NRAS, and PTPN11, but did not detect any changes.
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30
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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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Sugimoto Y, Muramatsu H, Makishima H, Prince C, Jankowska AM, Yoshida N, Xu Y, Nishio N, Hama A, Yagasaki H, Takahashi Y, Kato K, Manabe A, Kojima S, Maciejewski JP. Spectrum of molecular defects in juvenile myelomonocytic leukaemia includes ASXL1 mutations. Br J Haematol 2010; 150:83-7. [PMID: 20408841 DOI: 10.1111/j.1365-2141.2010.08196.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Mutations in NF1, PTPN11, NRAS, KRAS and CBL have been reported to play a pathogenetic role in juvenile myelomonocytic leukaemia (JMML), a rare myelodyplastic/myeloproliferative neoplasm occurring in children. Recently, mutations in ASXL1 were identified in chronic myelomonocytic leukaemia and other myeloid malignancies. We sequenced exon 12 of ASLX1 in 49 JMML patients, and found 2 novel heterozygous (nonsense and frameshift) mutations, one occurring as a sole lesion, the other was in conjunction with a PTPN11 mutation. ASXL1 cooperates with KDM1A in transcriptional repression and thereby ASXL1 mutations may synergize with or mimic other JMML-related mutations.
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Affiliation(s)
- Yuka Sugimoto
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
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Abstract
Zusammenfassung
Die Neurofibromatose Typ 1 (NF1) ist eine autosomal-dominant vererbte Erkrankung. Sie wird durch Mutationen im NF1-Gen auf Chromosom 17q11.2 verursacht. Sie zeigt volle Penetranz, d. h. jeder, der eine Mutation trägt, weist Merkmale der Krankheit auf, jedoch mit z. T. erheblich variabler Expressivität. NF1 ist gekennzeichnet durch die namensgebenden Neurofibrome, bei welchen es sich um gutartige Tumoren der Nervenscheiden handelt. Zu den häufig primär auftretenden Symptomen zählen Pigmentierungsanomalien der Haut, wie Café-au-Lait-Flecken, axilläres bzw. inguinales Freckling, sowie Lisch-Knötchen der Iris. NF1 gehört zur Gruppe der hereditären Tumorerkrankungen. Betroffene weisen ein erhöhtes Risiko auf, an bestimmten NF1-assoziierten Tumoren zu erkranken, die durch eine biallelische Inaktivierung des NF1-Tumorsuppressorgens und aberrante RAS-Signaltransduktion entstehen. In den letzten Jahren sind signifikante Fortschritte bei der Identifizierung und Behandlung der NF1-assoziierten klinischen Symptome sowie in der Entwicklung neuer Therapieansätze zu verzeichnen.
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Affiliation(s)
- H. Kehrer-Sawatzki
- Aff1_191 grid.6582.9 0000000419369748 Institut für Humangenetik Universität Ulm Albert-Einstein-Allee 11 89081 Ulm Deutschland
| | - V.-F. Mautner
- Aff2_191 grid.9026.d 0000000122872617 Bereich Phakomatosen, Klinik für Mund-, Kiefer- und Gesichtschirurgie Universitätsklinikum Hamburg-Eppendorf, Universität Hamburg Hamburg Deutschland
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Abstract
Myelodysplastic/myeloproliferative neoplasms (MDS/MPNs) are rare de novo myeloid neoplasms that exhibit hybrid dysplastic and proliferative features at presentation. This SHP/EAHP Workshop session was uniquely problematic owing to the overlap between MDS/MPNs and both chronic myeloproliferative neoplasms and myelodysplasia. The borderline between MDS/MPNs and overt acute myeloid leukemias was also an issue, mainly related to the accurate and consistent delineation of blast equivalents such as promonocytes. Aside from juvenile myelomonocytic leukemia, genetic features defining specific MDS/MPN subtypes have not been identified. Consequently, there is little change in the 2008 World Health Organization classification of MDS/MPNs compared with the 2001 version.
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Increased c-Jun expression and reduced GATA2 expression promote aberrant monocytic differentiation induced by activating PTPN11 mutants. Mol Cell Biol 2009; 29:4376-93. [PMID: 19528235 DOI: 10.1128/mcb.01330-08] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Juvenile myelomonocytic leukemia (JMML) is characterized by myelomonocytic cell overproduction and commonly bears activating mutations in PTPN11. Murine hematopoietic progenitors expressing activating Shp2 undergo myelomonocytic differentiation, despite being subjected to conditions that normally support only mast cells. Evaluation of hematopoietic-specific transcription factor expression indicates reduced GATA2 and elevated c-Jun in mutant Shp2-expressing progenitors. We hypothesized that mutant Shp2-induced Ras hyperactivation promotes c-Jun phosphorylation and constitutive c-Jun expression, permitting, as a coactivator of PU.1, excessive monocytic differentiation and reduced GATA2. Hematopoietic progenitors expressing activating Shp2 demonstrate enhanced macrophage CFU (CFU-M) compared to that of wild-type Shp2-expressing cells. Treatment with the JNK inhibitor SP600125 or cotransduction with GATA2 normalizes activating Shp2-generated CFU-M. However, cotransduction of DeltaGATA2 (lacking the C-terminal zinc finger, needed to bind PU.1) fails to normalize CFU-M. NIH 3T3 cells expressing Shp2E76K produce higher levels of luciferase expression directed by the macrophage colony-stimulating factor receptor (MCSFR) promoter, which utilizes c-Jun as a coactivator of PU.1. Coimmunoprecipitation demonstrates increased c-Jun-PU.1 complexes in mutant Shp2-expressing hematopoietic progenitors, while chromatin immunoprecipitation demonstrates increased c-Jun binding to the c-Jun promoter and an increased c-Jun-PU.1 complex at the Mcsfr promoter. Furthermore, JMML progenitors express higher levels of c-JUN than healthy controls, substantiating the disease relevance of these mechanistic findings.
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Mizoguchi Y, Fujita N, Taki T, Hayashi Y, Hamamoto K. Juvenile myelomonocytic leukemia with t(7;11)(p15;p15) and NUP98-HOXA11 fusion. Am J Hematol 2009; 84:295-7. [PMID: 19338047 DOI: 10.1002/ajh.21373] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The t(7;11)(p15;p15) translocation has been reported as a rare and recurrent chromosomal abnormality in acute myeloid leukemia (AML) patients. The NUP98-HOXA9 fusion gene with t(7;11)(p15;p15) was identified and revealed to be essential for leukemogenesis and myeloproliferative disease. To date, t(7;11)(p15;p15) with NUP98-HOXA11 fusion has been reported only in one case of ph-negative chronic myeloid leukemia (CML). Here, we report a case of a 3-year-old girl with juvenile myelomonocytic leukemia (JMML) carrying t(7;11)(p15;p15) abnormality with NUP98-HOXA11 fusion. AML chemotherapy followed by bone marrow transplantation (BMT) was found to be effective in treating this disorder, and she remains in complete remission for 3 years after BMT. We suggest the possibility that AML chemotherapy might be effective for treating JMML with t(7;11)(p15;p15) abnormality and NUP98-HOXA11 fusion.
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MESH Headings
- Antineoplastic Agents/therapeutic use
- Bone Marrow Transplantation
- Child, Preschool
- Chromosomes, Human, Pair 11
- Chromosomes, Human, Pair 7
- Combined Modality Therapy
- Female
- Homeodomain Proteins/genetics
- Humans
- Leukemia, Myelomonocytic, Juvenile/genetics
- Leukemia, Myelomonocytic, Juvenile/physiopathology
- Leukemia, Myelomonocytic, Juvenile/therapy
- Nuclear Pore Complex Proteins/genetics
- Oncogene Proteins, Fusion/genetics
- Remission Induction
- Translocation, Genetic
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Affiliation(s)
- Yoko Mizoguchi
- Department of Pediatrics, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, Hiroshima, Japan.
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Chan RJ, Cooper T, Kratz CP, Weiss B, Loh ML. Juvenile myelomonocytic leukemia: a report from the 2nd International JMML Symposium. Leuk Res 2009; 33:355-62. [PMID: 18954903 PMCID: PMC2692866 DOI: 10.1016/j.leukres.2008.08.022] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2008] [Revised: 08/15/2008] [Accepted: 08/19/2008] [Indexed: 02/02/2023]
Abstract
Juvenile myelomonocytic leukemia (JMML) is an aggressive childhood myeloproliferative disorder characterized by the overproduction of myelomonocytic cells. JMML incidence approaches 1.2/million persons in the United States (Cancer Incidence and Survival Among Children and Adolescents: United States SEER Program 1975-1995). Although rare, JMML is innately informative as the molecular genetics of this disease implicates hyperactive Ras as an essential initiating event. Given that Ras is one of the most frequently mutated oncogenes in human cancer, findings from this disease are applicable to more genetically diverse and complex adult leukemias. The JMML Foundation (www.jmmlfoundation.org) was founded by parent advocates dedicated to finding a cure for this disease. They work to bring investigators together in a collaborative manner. This article summarizes key presentations from The Second International JMML Symposium, on 7-8 December 2007 in Atlanta, GA. A list of all participants is in Supplementary Table.
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Affiliation(s)
- Rebecca J. Chan
- Departments of Pediatrics, the Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Todd Cooper
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Christian P. Kratz
- Department of Pediatrics and Adolescent Medicine, University of Freiburg, Freiburg, Germany
| | - Brian Weiss
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Mignon L. Loh
- Department of Pediatrics, University of California, San Francisco, CA, USA
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