1
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Sel FA, Oğuz FS. Can novel methods replace the gold standard chimerism method after allogeneic hematopoietic stem cell transplantation? Ann Hematol 2024; 103:1035-1047. [PMID: 37801085 DOI: 10.1007/s00277-023-05448-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 09/07/2023] [Indexed: 10/07/2023]
Abstract
After hematopoietic stem cell transplantation, chimerism assay is a useful approach to monitor the success of the transplant and to select the appropriate treatment strategy, such as donor leukocyte infusion or immunosuppressive drug dosage. Short tandem repeat PCR is the method that has been accepted as the gold standard for chimerism. However, it has not yet been sufficient to detect mixed chimerism in patients with minimal residual disease. Simultaneously, recent years have been marked by developing sensitive, high-throughput, and accurate molecular genetic assays. These novel methods have subsequently been adapted for the analysis of post-transplant chimerism. In this review, we discuss the technical features of both novel and conventional gold standard chimerism assays. We also discuss their advantages and disadvantages.
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Affiliation(s)
- Figen Abatay Sel
- Department of Biology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
- Institute of Graduate Studies in Health Science, Istanbul University, Istanbul, Turkey.
| | - Fatma Savran Oğuz
- Department of Biology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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2
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Vynck M, Nollet F, Sibbens L, Devos H. Bias reduction improves accuracy and informativity of high-throughput sequencing chimerism assays. Clin Chim Acta 2023:117452. [PMID: 37343694 DOI: 10.1016/j.cca.2023.117452] [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: 01/27/2023] [Revised: 05/22/2023] [Accepted: 06/16/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND AND AIMS Chimerism monitoring by means of high-throughput sequencing of biallelic polymorphisms has shown promising advantages for patient follow-up after hematopoietic stem cell transplantation. Yet, the presence of method bias precludes achievement of an assay's theoretically attainable informativity rate, as method bias necessitates the exclusion of some markers. This method bias arises because of preferential observation of one allele over the other, and for some allelic constellations because of stochasticity. RESULTS This paper suggests how preferential allelic observation may lead to method bias, and when and why such bias necessitates the exclusion of markers. It is shown that also markers that remain informative suffer a reduction in trueness and precision due to method bias. A bias reduction approach in the data analysis phase is introduced and shown to improve trueness and precision under all circumstances, meriting its universal adoption. This bias reduction furthermore allows to achieve an assay's theoretically achievable informativity rate, though at the cost of reduced sensitivity. Several strategies to consider in the assay design phase that may lower biases are proposed. CONCLUSION Improved design and data analysis of chimerism assays increase the accuracy, applicability, and cost-effectiveness of high-throughput sequencing chimerism assays.
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Affiliation(s)
- Matthijs Vynck
- Department of Laboratory Medicine, AZ Sint-Jan Brugge-Oostende AV, Ruddershove 10, Bruges, Belgium; Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Ghent University, Merelbeke, Belgium.
| | - Friedel Nollet
- Department of Laboratory Medicine, AZ Sint-Jan Brugge-Oostende AV, Ruddershove 10, Bruges, Belgium
| | - Lode Sibbens
- Department of Laboratory Medicine, AZ Sint-Jan Brugge-Oostende AV, Ruddershove 10, Bruges, Belgium
| | - Helena Devos
- Department of Laboratory Medicine, AZ Sint-Jan Brugge-Oostende AV, Ruddershove 10, Bruges, Belgium
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3
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Lindahl H, Valentini D, Vonlanthen S, Sundin M, Björklund AT, Mielke S, Hauzenberger D. Early relapse prediction after allogeneic hematopoietic stem cell transplantation for acute lymphoblastic leukemia (ALL) using lineage-specific chimerism analysis. EJHAEM 2022; 3:1277-1286. [PMID: 36467849 PMCID: PMC9713209 DOI: 10.1002/jha2.568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/26/2022] [Accepted: 08/27/2022] [Indexed: 06/17/2023]
Abstract
Relapse is a major cause of treatment failure after hematopoietic stem cell transplantation (HSCT) for acute leukemia. Here, we report a monocentric retrospective study of all HSCTs for B cell acute lymphoblastic leukemia (ALL) performed during the years 2005-2021 (n = 138, including 51 children), aiming to identify the optimal use of lineage-specific recipient-donor chimerism analysis for prediction of relapse. In adults, relapse was associated with increased recipient chimerism in CD3+ bone marrow cells sampled at least 30 days before a relapse. Relapse could be predicted with a sensitivity of 73% and a specificity of 83%. Results were similar for children but with a higher recipient chimerism cutoff. Additionally, adults that had at least one chimerism value <0.12% in CD3+ peripheral blood cells within the first 60 days after HSCT had 89% probability of being relapse-free after 2-years compared to 64%. Results were similar for children but again necessitating a higher chimerism cutoff. These results suggest that high-sensitive lineage-specific chimerism analysis can be used for (1) early ALL relapse prediction by longitudinal chimerism monitoring in CD3+ bone marrow cells and (2) relapse risk stratification by analyzing CD3+ blood cells early post-HSCT.
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Affiliation(s)
- Hannes Lindahl
- Clinical Immunology and Transfusion MedicineKarolinska University HospitalStockholmSweden
- Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
| | - Davide Valentini
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation (CAST)Karolinska University HospitalStockholmSweden
| | - Sofie Vonlanthen
- Clinical Immunology and Transfusion MedicineKarolinska University HospitalStockholmSweden
| | - Mikael Sundin
- Pediatric HematologyImmunology and HCTAstrid Lindgren Children's HospitalKarolinska University HospitalStockholmSweden
- PediatricsCLINTECKarolinska InstitutetStockholmSweden
| | - Andreas T. Björklund
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation (CAST)Karolinska University HospitalStockholmSweden
| | - Stephan Mielke
- Department of Cell Therapy and Allogeneic Stem Cell Transplantation (CAST)Department of Laboratory Medicine (LabMED)Karolinska University Hospital and InstitutetKarolinska Comprehensive Cancer CenterStockholmSweden
| | - Dan Hauzenberger
- Clinical Immunology and Transfusion MedicineKarolinska University HospitalStockholmSweden
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4
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Arnold PY. Review: HLA loss and detection in the setting of relapse from HLA-mismatched hematopoietic cell transplant. Hum Immunol 2022; 83:712-720. [DOI: 10.1016/j.humimm.2022.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/09/2022] [Accepted: 03/02/2022] [Indexed: 01/25/2023]
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5
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Lindahl H, Vonlanthen S, Valentini D, Björklund AT, Sundin M, Mielke S, Hauzenberger D. Lineage-specific early complete donor chimerism and risk of relapse after allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia. Bone Marrow Transplant 2022; 57:753-759. [PMID: 35210563 PMCID: PMC9090632 DOI: 10.1038/s41409-022-01615-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 11/10/2022]
Abstract
Recipient–donor chimerism is routinely analyzed after allogeneic hematopoietic stem cell transplantation (HSCT) to monitor engraftment and graft rejection. For malignancies, chimerism can also be used to screen for disease relapse post-HSCT but methodology and interpretation of results are not standardized and likely depend on underlying diagnosis. We have implemented highly sensitive and accurate methodologies for chimerism analysis for the purpose of improving relapse prediction. Here, we report an exploratory retrospective analysis of clinical routine chimerism results from all 154 HSCTs for acute myeloid leukemia (AML) performed at our center during the years 2015–2020 with the aim of suggesting a clinically useful threshold at which risk of relapse is high. Relapse was not reliably predicted based on single elevated chimerism values obtained before time of overt relapse. However, early complete donor chimerism, here defined as recipient DNA < 0.2% in CD33+ cells in any blood or bone marrow sample taken during the first 60 days after HSCT, correlated inversely with relapse during the observation time (log-rank test P = 0.033). We propose that achievement of complete chimerism determined early after HSCT using sensitive methods can be used for risk-stratification of AML patients.
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Affiliation(s)
- Hannes Lindahl
- Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden. .,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Sofie Vonlanthen
- Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Davide Valentini
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation (CAST), Karolinska University Hospital, Stockholm, Sweden
| | - Andreas T Björklund
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation (CAST), Karolinska University Hospital, Stockholm, Sweden
| | - Mikael Sundin
- Pediatric Hematology, Immunology and HCT, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Pediatrics, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Stephan Mielke
- Department of Cell Therapy and Allogeneic Stem Cell Transplantation (CAST), Department of Laboratory Medicine (LabMED), Karolinska University Hospital and Institutet, Karolinska Comprehensive Cancer Center, Stockholm, Sweden
| | - Dan Hauzenberger
- Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
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6
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Vynck M, Nollet F, Sibbens L, Lievens B, Denys A, Cauwelier B, Devos H. Performance Assessment of the Devyser High-Throughput Sequencing-Based Assay for Chimerism Monitoring in Patients after Allogeneic Hematopoietic Stem Cell Transplantation. J Mol Diagn 2021; 23:1116-1126. [PMID: 34186173 DOI: 10.1016/j.jmoldx.2021.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/07/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022] Open
Abstract
Chimerism analysis is widely used to aid in the clinical management of patients after allogeneic hematopoietic stem cell transplantation. Many laboratories currently use assays based on polymerase chain reaction followed by capillary electrophoresis, with a limit of quantification of 1% to 5%. Assays with a lower limit of quantification could allow for earlier relapse detection, resulting in improved patient care. This study investigated the analytical, clinical, technical, and practical performance of the Devyser NGS chimerism assay, a commercial high-throughput sequencing-based assay for chimerism analysis. Performance of this assay was compared with that of the Promega PowerPlex 16 HS assay, a commercial capillary electrophoresis-based assay. A limit of quantification of 0.1% was achievable with the Devyser assay. The repeatability, reproducibility, trueness, and linearity of the Devyser assay were acceptable. The Devyser assay showed potential for earlier relapse detection compared with the Promega assay. Conclusive analysis was not possible for 3% of donor-recipient pairs with the Devyser assay due to an insufficient number of informative markers; this factor was not an issue for the Promega assay. Further improvements in assay design or data analysis may allow the assay's applicability to be extended to all donor-recipient pairs studied. Technical performance criteria for chimerism analysis by high-throughput sequencing were suggested and evaluated. Both assays were found to be practical for use in a clinical diagnostics laboratory.
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Affiliation(s)
- Matthijs Vynck
- Department of Laboratory Medicine, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium.
| | - Friedel Nollet
- Department of Laboratory Medicine, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium
| | - Lode Sibbens
- Department of Laboratory Medicine, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium
| | - Bernadette Lievens
- Department of Laboratory Medicine, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium
| | - Astrid Denys
- Department of Laboratory Medicine, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium
| | - Barbara Cauwelier
- Department of Laboratory Medicine, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium
| | - Helena Devos
- Department of Laboratory Medicine, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium
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7
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Skou AS, Juul-Dam KL, Ommen HB, Hasle H. Peripheral blood molecular measurable residual disease is sufficient to identify patients with acute myeloid leukaemia with imminent clinical relapse. Br J Haematol 2021; 195:310-327. [PMID: 33851435 DOI: 10.1111/bjh.17449] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 01/03/2023]
Abstract
Longitudinal molecular measurable residual disease (MRD) sampling after completion of therapy serves as a refined tool for identification of imminent relapse of acute myeloid leukaemia (AML) among patients in long-term haematological complete remission. Tracking of increasing quantitative polymerase chain reaction MRD before cytomorphological reappearance of blasts may instigate individual management decisions and has paved the way for development of pre-emptive treatment strategies to substantially delay or perhaps even revert leukaemic regrowth. Traditionally, MRD monitoring is performed using repeated bone marrow aspirations, albeit the current European LeukemiaNet MRD recommendations acknowledge the use of peripheral blood as an alternative source for MRD assessment. Persistent MRD positivity in the bone marrow despite continuous morphological remission is frequent in both core binding factor leukaemias and nucleophosmin 1-mutated AML. In contrast, monthly assessment of MRD in peripheral blood superiorly separates patients with imminent haematological relapse from long-term remitters and may allow pre-emptive therapy of AML relapse.
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Affiliation(s)
- Anne-Sofie Skou
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Hans B Ommen
- Department of Haematology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Hasle
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
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8
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Merli P, Ifversen M, Truong TH, Marquart HV, Buechner J, Wölfl M, Bader P. Minimal Residual Disease Prior to and After Haematopoietic Stem Cell Transplantation in Children and Adolescents With Acute Lymphoblastic Leukaemia: What Level of Negativity Is Relevant? Front Pediatr 2021; 9:777108. [PMID: 34805054 PMCID: PMC8602790 DOI: 10.3389/fped.2021.777108] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/14/2021] [Indexed: 12/18/2022] Open
Abstract
Minimal residual disease (MRD) assessment plays a central role in risk stratification and treatment guidance in paediatric patients with acute lymphoblastic leukaemia (ALL). As such, MRD prior to haematopoietic stem cell transplantation (HSCT) is a major factor that is independently correlated with outcome. High burden of MRD is negatively correlated with post-transplant survival, as both the risk of leukaemia recurrence and non-relapse mortality increase with greater levels of MRD. Despite growing evidence supporting these findings, controversies still exist. In particular, it is still not clear whether multiparameter flow cytometry and real-time quantitative polymerase chain reaction, which is used to recognise immunoglobulin and T-cell receptor gene rearrangements, can be employed interchangeably. Moreover, the higher sensitivity in MRD quantification offered by next-generation sequencing techniques may further refine the ability to stratify transplant-associated risks. While MRD quantification from bone marrow prior to HSCT remains the state of the art, heavily pre-treated patients may benefit from additional staging, such as using 18F-fluorodeoxyglucose positron emission tomography/computed tomography to detect focal residues of disease. Additionally, the timing of MRD detection (i.e., immediately before administration of the conditioning regimen or weeks before) is a matter of debate. Pre-transplant MRD negativity has previously been associated with superior outcomes; however, in the recent For Omitting Radiation Under Majority age (FORUM) study, pre-HSCT MRD positivity was associated with neither relapse risk nor survival. In this review, we discuss the level of MRD that may require pre-transplant therapy intensification, risking time delay and complications (as well as losing the window for HSCT if disease progression occurs), as opposed to an adapted post-transplant strategy to achieve long-term remission. Indeed, MRD monitoring may be a valuable tool to guide individualised treatment decisions, including tapering of immunosuppression, cellular therapies (such as donor lymphocyte infusions) or additional immunotherapy (such as bispecific T-cell engagers or chimeric antigen receptor T-cell therapy).
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Affiliation(s)
- Pietro Merli
- Department of Pediatric Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marianne Ifversen
- Pediatric Stem Cell Transplant and Immune Deficiency, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Tony H Truong
- Division of Pediatric Oncology and Bone Marrow Transplant, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Hanne V Marquart
- Section for Diagnostic Immunology, Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jochen Buechner
- Department of Pediatric Hematology and Oncology, Oslo University Hospital, Oslo, Norway
| | - Matthias Wölfl
- Pediatric Hematology, Oncology and Stem Cell Transplantation, Children's Hospital, Würzburg University Hospital, Würzburg, Germany
| | - Peter Bader
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, Goethe University, University Hospital Frankfurt, Frankfurt, Germany
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9
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Haugaard AK, Kofoed J, Masmas TN, Madsen HO, Marquart HV, Heilmann C, Müller KG, Ifversen M. Is microchimerism a sign of imminent disease recurrence after allogeneic hematopoietic stem cell transplantation? A systematic review of the literature. Blood Rev 2020; 44:100673. [DOI: 10.1016/j.blre.2020.100673] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 02/05/2020] [Accepted: 02/24/2020] [Indexed: 12/12/2022]
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10
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Navarro-Bailón A, Carbonell D, Escudero A, Chicano M, Muñiz P, Suárez-González J, Bailén R, Oarbeascoa G, Kwon M, Díez-Martín JL, Martínez-Laperche C, Buño I. Short Tandem Repeats (STRs) as Biomarkers for the Quantitative Follow-Up of Chimerism after Stem Cell Transplantation: Methodological Considerations and Clinical Application. Genes (Basel) 2020; 11:genes11090993. [PMID: 32854376 PMCID: PMC7565503 DOI: 10.3390/genes11090993] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/19/2020] [Accepted: 08/23/2020] [Indexed: 01/06/2023] Open
Abstract
Chimerism refers to the relative proportion of donor and recipient DNA after hematopoietic stem cell transplantation (HSCT) and its quantitative follow-up is of great clinical utility in this setting. PCR of short tandem repeats (STR-PCR) constitutes the gold standard method for chimerism quantification, although more sensitive PCR techniques (such as qPCR) have recently arisen. We compared the sensitivity and the quantification capacity of both techniques in patient samples and artificial mixtures and demonstrated adequate performance of both methods, with higher sensitivity of qPCR and better quantification skills of STR-PCR. By qPCR, we then prospectively followed up 57 patients that were in complete chimerism (CC) by STR-PCR. Twenty-seven patients (59%) showed 0.1–1% recipient DNA in the bone marrow. Only 4 patients presented 0.1–1% recipient DNA in peripheral blood (PB), and one of them relapsed. Finally, by qPCR, we retrospectively studied the last sample that showed CC by STR-PCR prior to relapse in 8 relapsed patients. At a median of 59 days prior to relapse, six patients presented mixed chimerism by qPCR in PB. Since both approaches have complementary characteristics, we conclude that different techniques should be applied in different clinical settings and therefore propose a methodological algorithm for chimerism follow-up after HSCT.
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Affiliation(s)
- Almudena Navarro-Bailón
- Department of Hematology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (A.N.-B.); (D.C.); (A.E.); (M.C.); (P.M.); (R.B.); (G.O.); (M.K.); (J.L.D.-M.)
| | - Diego Carbonell
- Department of Hematology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (A.N.-B.); (D.C.); (A.E.); (M.C.); (P.M.); (R.B.); (G.O.); (M.K.); (J.L.D.-M.)
- Instituto de Investigación Sanitaria Gregorio Marañón, IiSGM, 28007 Madrid, Spain; (J.S.-G.); (C.M.-L.)
| | - Asunción Escudero
- Department of Hematology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (A.N.-B.); (D.C.); (A.E.); (M.C.); (P.M.); (R.B.); (G.O.); (M.K.); (J.L.D.-M.)
| | - María Chicano
- Department of Hematology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (A.N.-B.); (D.C.); (A.E.); (M.C.); (P.M.); (R.B.); (G.O.); (M.K.); (J.L.D.-M.)
- Instituto de Investigación Sanitaria Gregorio Marañón, IiSGM, 28007 Madrid, Spain; (J.S.-G.); (C.M.-L.)
| | - Paula Muñiz
- Department of Hematology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (A.N.-B.); (D.C.); (A.E.); (M.C.); (P.M.); (R.B.); (G.O.); (M.K.); (J.L.D.-M.)
- Instituto de Investigación Sanitaria Gregorio Marañón, IiSGM, 28007 Madrid, Spain; (J.S.-G.); (C.M.-L.)
| | - Julia Suárez-González
- Instituto de Investigación Sanitaria Gregorio Marañón, IiSGM, 28007 Madrid, Spain; (J.S.-G.); (C.M.-L.)
- Genomics Unit, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Rebeca Bailén
- Department of Hematology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (A.N.-B.); (D.C.); (A.E.); (M.C.); (P.M.); (R.B.); (G.O.); (M.K.); (J.L.D.-M.)
- Instituto de Investigación Sanitaria Gregorio Marañón, IiSGM, 28007 Madrid, Spain; (J.S.-G.); (C.M.-L.)
| | - Gillen Oarbeascoa
- Department of Hematology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (A.N.-B.); (D.C.); (A.E.); (M.C.); (P.M.); (R.B.); (G.O.); (M.K.); (J.L.D.-M.)
- Instituto de Investigación Sanitaria Gregorio Marañón, IiSGM, 28007 Madrid, Spain; (J.S.-G.); (C.M.-L.)
| | - Mi Kwon
- Department of Hematology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (A.N.-B.); (D.C.); (A.E.); (M.C.); (P.M.); (R.B.); (G.O.); (M.K.); (J.L.D.-M.)
- Instituto de Investigación Sanitaria Gregorio Marañón, IiSGM, 28007 Madrid, Spain; (J.S.-G.); (C.M.-L.)
| | - José Luis Díez-Martín
- Department of Hematology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (A.N.-B.); (D.C.); (A.E.); (M.C.); (P.M.); (R.B.); (G.O.); (M.K.); (J.L.D.-M.)
- Instituto de Investigación Sanitaria Gregorio Marañón, IiSGM, 28007 Madrid, Spain; (J.S.-G.); (C.M.-L.)
- Department of Medicine, School of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Carolina Martínez-Laperche
- Instituto de Investigación Sanitaria Gregorio Marañón, IiSGM, 28007 Madrid, Spain; (J.S.-G.); (C.M.-L.)
- Genomics Unit, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Ismael Buño
- Department of Hematology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (A.N.-B.); (D.C.); (A.E.); (M.C.); (P.M.); (R.B.); (G.O.); (M.K.); (J.L.D.-M.)
- Instituto de Investigación Sanitaria Gregorio Marañón, IiSGM, 28007 Madrid, Spain; (J.S.-G.); (C.M.-L.)
- Genomics Unit, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
- Department of Cell Biology, School of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Correspondence: ; Tel.: +91-5868775
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